Heal Our Communities!

1. Community Health Workers

The Model:

• Lay Health Workers: From the community, trusted by the community
• Training: 6-month certificate program
• Roles:
  • Health education: Teach diabetes management, nutrition, and prenatal care
  • Navigation: Help patients access services (appointments, insurance, and medications)
  • Outreach: Go to patients' homes (not wait for patients to come to a clinic)
  • Cultural bridge: Between patients and the medical system

Benefits:

• Culturally Appropriate: CHWs speak the language(s), understand the culture(s)
• Trusted: Community members trust neighbors more than outside doctors
• Cost-Effective: Prevent expensive ER visits and hospitalizations

Example: Navajo Community Health Workers (Existing)

• On the Navajo Nation: CHWs visit remote families, provide education, and connect to care
• Improved Outcomes: Diabetes control and prenatal care utilization

Scale-Up:

• 100,000 Community Health Workers: Nationally
• Employment: $50k/year average = $5 billion/year
• Training: $500 million/year

2. Community Health Centers (FQHC Expansion)

Already Covered Above:

• 5,000 FQHCs
• Serve 100 million people
• $30 billion/year funding

Community Governance:

• Patient-Majority Boards: >50% of the board must be patients
• Community Input: What services are needed, clinic hours, and outreach

3. Traditional & Complementary Medicine

Integration (Where Evidence-Based):

• Acupuncture: For pain management (evidence supports)
• Chiropractic: For back pain (covered by M4A)
• Massage Therapy: For chronic pain and stress

Indigenous Healing:

• Respect Tribal Traditional Medicine: On reservations
• Integration: Traditional healers + Western medicine (patient choice)
• Funding: Support traditional healing programs

Note: Complementary medicine = addition to conventional care, not replacement

• If the patient wants acupuncture + medication = fine
• If the patient refuses proven treatment for an unproven alternative = provide counseling but respect their autonomy

4. Mental Health & Substance Use (Community Approaches)

A. Peer Support:

• People with Lived Experience: Support others in recovery
• Peer-Run Organizations: Consumer/survivor-run mental health centers
• Employment: 50,000 peer support specialists (people in recovery helping others)

B. Housing First (Substance Use):

• No Sobriety Requirement: House people first, then offer treatment
• Harm Reduction: Methadone, buprenorphine, and needle exchange (reduce overdoses)

C. Decriminalize:

• Drug Use is a Health Issue: Not a criminal issue (Portugal model)
• Divert from Jail: To treatment (covered elsewhere in criminal justice reform)

5. Social Prescribing

Model (UK):

• Doctor Prescribes: Not just medication, but also community activities
  • Join a walking group (exercise, social connection)
  • Take an art class (mental health)
  • Take a cooking class (nutrition)
  • Volunteering (purpose, community)

Implementation:

• Community Resource Coordinators: At each clinic, connect patients to the community
• Partnership: With libraries, parks departments, and community centers

Benefits:

• Addresses Root Causes: Loneliness, sedentary lifestyle, and stress
• Cost-Effective: Walking group is cheaper than antidepressants