Who will provide for the providers?

Over the past year, I have had the privilege to follow the work and lives of many of Baltimore's committed community health advocates. These health promoters, organizers, practical nurses, pastors, interns and volunteers are often the trusted leaders of impoverished neighborhoods. The best ones stay even when grant monies run out and short-term projects are deemed complete; they work and volunteer at odd shifts to reverse the plight of underserved communities. They promote stability that benefits us all. Unfortunately, these local heroes often struggle with the same uncertainties that they selflessly work to ease. Some live in outright poverty. They serve others even when they themselves might be in need of assistance.

Are we as a society doing an adequate job to support those who support and empower our communities?

Many recent initiatives and publications, including the Affordable Care Act, National Prevention Strategy (2011) and Healthy Baltimore 2015, emphasize the preventive aspects of health care and the power of healthy communities. Community health promoters provide exactly the types of comprehensive services called for by the current focus on social determinants of health. Yet, very little discussion is dedicated to the challenging realities that shape the lives of those at the front lines of urban health promotion.

Many health care providers struggle to make ends meet. For instance, a full-time home health aide will have to get through a month with just a little over $1,000. Interns and other recent college graduates provide key services as community health promoters but sustain themselves on salaries that may leave them several thousands of dollars below the federal poverty level of individual annual earnings of $11,170. These young people are building their futures and American communities on food stamps.

The group that is at the forefront of Baltimore's hands-on community health promotion seems also to be the one that bears the heaviest burden financially and socially: women of color. The people whose work and lives I follow are often African-American women who provide essential health services to underserved, struggling communities through their professional capacity or volunteering.

In many instances, the socio-economic volunteer profile in the city of Baltimore falls outside the stereotypical philanthropy where a volunteer or a donor shares the fruits of their plenty. The common impression of a volunteer or a donor is of a well-off person sharing the fruits of their plenty, but the socio-economic profile of many Baltimore volunteers and advocates does not fit this stereotype. Many of these women are vulnerable, yet many embrace their roles as health promoters because they are survivors of difficult circumstances. Many turn their experiences of struggle into communal currency, often with little or no financial benefit.

A broad range of studies demonstrates that women — and their children — bear a disproportionate share of poverty. The Great Recession of recent years left t African-American women especially vulnerable. A study by The National Women's Law Center revealed that the black women's unemployment crisis has included a particularly slow employment recovery, even after the recession officially ended in June 2009. We must ask: What can we do to empower those who serve their communities even as they often struggle with unemployment?

Though women shoulder much of Baltimore's health-related volunteering and supply significant labor to the health care industry — one of the largest employment sectors in the city — their own struggle with poverty correlates with a broad range of health challenges. When the Social Science Research Council surveyed female life-expectancy in "Measure of America" (2012), Baltimore landed in the second to last place of 25 metro areas studied. Again, what mechanisms should nonprofit, governmental and educational agencies have in place to ensure that the various positive ways in which women promote health reward them and support their own wellness?

Community health advocates deserve society's solidarity and recognition. Particular attention should be paid to empowering those who often are the most vulnerable, young people and women, so that their involvement in health advocacy serves their professional career advancement. It is hardly possible to imagine a healthy Baltimore if the grass-roots conditions of health promotion work force the workers and volunteers to provide to others that which they, themselves do not have.

Maiju Lehmijoki-Gardner, R.N., Ph.D., teaches theology at Loyola University. She blogs at http://www.healthfaithbaltimore.org.

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