Growing awareness and understanding of the social determinants of health and health equity do not necessarily translate into sustainable change of our traditional system; which is more grounded in profitability than in feasible efforts to eliminate structural inequities that result in clusters of unmet need and poor health. Nor is it enough to ensure the construction of a culture of health in the U.S. As we struggle through the challenges of creating a system of equitable opportunities for healthy living; existing social norms, institutional policies, and individual habits frequently replicate the very same inequitable practices they claim to be addressing. The healthcare and public health sectors openly appreciate the power of community health workers (CHWs), promotores de salud, and other grassroots agents of change in improving health outcomes in diverse communities. Unfortunately, current initiatives using CHWs and Promotores de Salud as “extensionists” in health improvement efforts often puts these community workers at risk for harms associated with secondary stress, also known as vicarious traumatization. They are tasked with addressing important emerging priorities, such as building social connection and cohesion; but not well prepared to reduce the risks to their own wellbeing in this endeavor. A study of Promotores de Salud in Chile found that only half of the participants had a healthy lifestyle (Cid, Merino & Stiepovich, 2006).
Just as promoting health equity and a culture of health in communities requires the inclusion of strategies that address social determinants of health, the prevention of secondary stress in grassroots community workers relies on more than individual behavior change (The National Child Traumatic Stress Network, 2014); but rather must include a shift in the social norms and institutional policies and practices that enable and promote those healthy behaviors. It should come as no surprise that a multi-country study of CHW productivity and retention found that a work environment that provides supportive supervision, including the facilitation of peer-to-peer support is key to their ability to ability to their ability to do their work (Jaskiewicz & Tulenko, 2012).
Learn more about multi-level self-care policies and practices at Coaction Institute. Strategies included in the model include education, as an empowerment tool; community building among the participants to generate a sense of connectedness, learning, solidarity and mutual support; development of a shared vision of what self-care promoting institutions and communities look like; participatory action planning; and advocacy and action to generate institutional and community systems policy and practice changes to support self-care among agents of change. The 18-month program period includes partnership development, collaborative planning, engagement of participants, self-assessment, implementation, on-going monitoring and evaluation.
Just as promoting health equity and a culture of health in communities requires the inclusion of strategies that address social determinants of health, the prevention of secondary stress in grassroots community workers relies on more than individual behavior change (The National Child Traumatic Stress Network, 2014); but rather must include a shift in the social norms and institutional policies and practices that enable and promote those healthy behaviors. It should come as no surprise that a multi-country study of CHW productivity and retention found that a work environment that provides supportive supervision, including the facilitation of peer-to-peer support is key to their ability to ability to their ability to do their work (Jaskiewicz & Tulenko, 2012).
Learn more about multi-level self-care policies and practices at Coaction Institute. Strategies included in the model include education, as an empowerment tool; community building among the participants to generate a sense of connectedness, learning, solidarity and mutual support; development of a shared vision of what self-care promoting institutions and communities look like; participatory action planning; and advocacy and action to generate institutional and community systems policy and practice changes to support self-care among agents of change. The 18-month program period includes partnership development, collaborative planning, engagement of participants, self-assessment, implementation, on-going monitoring and evaluation.
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