Community health workers

June 1965: The Office of Economic Opportunity approves the first two neighborhood health centers under the Great Society programs: Columbia Point Health Center in South Boston, Massachusetts, and the Tufts-Delta Health Center in Mound Bayou, Mississippi. By December 1965, the Columbia Point center opens in twelve converted apartments inside the Columbia Point housing project, employing physicians, nurses, social workers, and community health aides. The Tufts-Delta center in the Mississippi Delta explicitly trains Black community members as health aides, addressing a rural population where Jim Crow had severed the connection between formal medicine and daily life. These two centers are the prototype for what will become a nationwide network of Federally Qualified Health Centers and the institutional home of the modern CHW role.

Congress establishes the Indian Health Service Community Health Representative (CHR) program, the first congressionally funded community health worker initiative in US history. The CHR program responds to the expressed needs of American Indian and Alaska Native tribal governments for a community outreach component that can meet specific tribal health needs. CHRs provide outreach, education, informal counseling, social support, and referral coordination. The program will grow into one of the most long-standing CHW models in the country, directly inspiring subsequent civilian and Medicaid-funded programs. At its peak the CHR program supports CHWs across every federally recognized tribe in the lower 48 states and in Alaska Native villages.

September 6-12, 1978: The International Conference on Primary Health Care convenes in Alma-Ata (now Almaty, Kazakhstan), bringing together 134 countries and 67 international organizations. The resulting Declaration of Alma-Ata places community health workers at the center of a primary healthcare vision for global health equity, stating that the approach "relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers." The declaration's slogan, "Health for All by the Year 2000," galvanizes CHW programs worldwide. In the United States, the declaration reinforces advocacy for CHW expansion at a time when the federal neighborhood health center program was under budget pressure from the Ford and then Carter administrations. The global frame begins appearing in US academic literature on CHWs through the 1980s.

HRSA's Bureau of Health Professions publishes the first national Community Health Worker Workforce Study, estimating 120,000 CHWs in active practice in the United States as of 2005. The study is the most comprehensive workforce data available before BLS creates a formal SOC code. It documents that CHW programs range from small, grant-funded community initiatives to large Medicaid-funded programs, and that the lack of uniform title or training standards makes the workforce nearly impossible to count from administrative data alone. The study will not be replicated at the same scale, leaving the field reliant on BLS OEWS estimates (which almost certainly undercount CHWs working under adjacent job titles) and periodic state-level surveys.

Two events in 2010 together mark the CHW field's transition from informal practice to formal profession. First, the Bureau of Labor Statistics assigns SOC code 21-1094 to Community Health Workers in the 2010 Standard Occupational Classification, the first time the role has its own distinct category in the national occupational taxonomy. Second, the Patient Protection and Affordable Care Act is signed into law on March 23, 2010; it mentions CHWs fourteen times, designates them as a recognized healthcare profession, and authorizes CDC grants (Section 5313) to fund CHW programs promoting health behaviors in underserved communities. The ACA also enables Medicaid reimbursement for CHW services, accelerating a policy that Minnesota had pioneered in 2007. BLS will publish the first OEWS estimates for 21-1094 in May 2012.

March 28, 2020: The Department of Homeland Security designates community health workers as essential infrastructure workers, weeks into the COVID-19 pandemic, citing their critical role in healthcare system resilience. CHWs pivot rapidly to phone and video outreach, translating pandemic guidance into the languages and communication styles of the communities they serve. The 2021 vaccination campaign against COVID-19 places CHWs at the center of trusted outreach in Black, Latino, and Native communities with historically founded hesitancy toward government health programs. The American Rescue Plan Act, signed March 11, 2021, allocates $225 million for a national CHW training initiative, the largest single federal investment in the field's history, with a stated goal of training at least 13,000 new CHWs.