In 1989—the year of our birth—the world appeared to be descending into chaos. The U.S. initiated an invasion of Panama. Thousands were massacred in Tiananmen Square. The Exxon Valdez caused a massive oil spill in Alaskan waters. The Berlin Wall crumbled. It was an turbulent period, characterized by significant unrest, debt crises, economic stagnation, and increasing inequality.
Despite this, even the most conservative global leaders, from to , united behind a singular, critical objective: saving children’s lives. Ceasefires were enacted to allow health campaigns to proceed. Vaccination coverage dramatically increased from 20% to 80%. By 1990, who would otherwise have perished were still alive.
The clear message? Progress stems not from mere luck, but from dedicated focus.
Currently, the world is confronting another era of interconnected challenges: escalating , a growing number of , deepening , and diminishing public confidence in . Yet, for some reason, the most frequent justification offered is a lack of funds.
The fundamental question driving the child survival movement of the 1980s was not, “What are we able to afford?” but rather, “What can we no longer postpone, even amidst a crisis?”
The answer then—and equally so now—begins with those on the frontlines. Community health workers (CHWs) are trained local residents who deliver essential health services directly to households, such as testing children for pneumonia, monitoring blood pressure, distributing medications, offering prenatal guidance, and providing follow-up for patients who might otherwise be overlooked. They serve as the vital link between communities and the formal healthcare system—trusted, readily available, and often the sole health professional many individuals encounter.
Over the past two years, our team at conducted a review of 255 studies encompassing 380 CHW programs. This represents the most thorough cost-effectiveness analysis of CHWs ever undertaken. The findings are unequivocal: when appropriately supported, CHWs prove cost-effective in over 80% of situations, addressing conditions ranging from maternal health to HIV and mental health. They deliver care at a median annual cost of just ,
A mere 59 cents—less than a gallon of fuel and significantly more affordable than the cheapest monthly Netflix subscription. Nevertheless, this amount is sufficient to provide a wide array of services, from malaria treatment to maternal health visits—care that sustains entire communities. And when officially supported and integrated into healthcare systems, CHWs do more than just match clinic-based care. They achieve broader reach, stronger outcomes, and superior value.
This significance extends beyond local areas to a global scale. The pandemic illustrated that viruses do not require passports to spread. When COVID-19 disrupted clinics and supply chains, CHWs frequently remained the and , despite breakdowns elsewhere. Now, as reductions in U.S. aid impact Africa, the repercussions are immediate: X-ray machines for tuberculosis diagnosis because USAID-trained personnel have been compelled to leave their positions.
Presently, we are observing an increase in cases of (TB)—an airborne illness that respects no national boundaries. What starts as a funding shortfall in Kenya can ultimately endanger lives in .
That threat is tangible, but so is the prospect: periods of major disruption have historically presented chances to alter the course of events. Current dangers are as severe as those of the 1980s—with the added dimension that the stakes are now both global and domestic.
This is why the “America First” merits attention. It commits to continued U.S. backing for CHWs in combating critical infectious diseases like HIV, TB, malaria, and polio, while simultaneously urging nations to incorporate salaries into their domestic budgets and ensure these roles are sustained over time. The strategy emphasizes the crucial role of CHWs in disease detection and surveillance— that could reach American shores. This foundational focus should pave the way for expanding CHW responsibilities into maternal, child health, and nutrition, thereby safeguarding families, identifying outbreaks early, and strengthening America’s health security.
The reality is, America requires CHWs with the same urgency as the rest of the world. They are local individuals who visit homes, deliver antibiotics and advice, and persist even when systems falter. In Appalachia, CHWs are connecting community members to opioid treatment and mental health support when the closest clinic is hours away. In Texas and California, promotoras de salud are assisting Latino families in managing diabetes and hypertension, thereby reducing expensive emergency room visits. In New York and Massachusetts, community doulas are providing prenatal and postpartum care that lowers maternal mortality rates, particularly for Black women. These models save money and lives, yet they largely remain small-scale and insufficiently funded. A significant U.S. commitment to CHWs would not only address striking inequities but also bridge the growing gaps caused by rural hospital closures and persistent staffing shortages.
Collectively, these indicators point to a long-overdue realization: CHWs are not merely temporary solutions. They form the essential foundation of resilient health systems. In Liberia, integrated CHW programs of treating neglected tropical diseases by up to tenfold. In the United States, local health worker models have expanded access to chronic disease management and maternal health in underserved communities—delivering improved outcomes at a reduced cost.
The 1980s demonstrated that even amid turmoil, alliances built on courage can steer history towards life. Today’s signals—from Washington to communities globally—suggest a similar potential. At just $6 per person annually, community health workers remain the world’s most effective health investment: proven, trusted, and critically needed.
When we prioritize screen time, isolation, and automation, the result is a world that is sicker and lonelier. When we prioritize connection—through community health workers, through relationships, through trust—we cultivate a healthier world.
The only remaining question is whether we will settle for mere promises or complete the task of establishing frontline care robust enough to ensure the safety of America—and the world. We can choose to view CHWs as dispensable budget items, or as the initial line of defense that prevents pandemics from reaching American borders, that keeps families healthy during crises, and that builds trust where institutions cannot.
History is not shaped by those who surrender to scarcity, but by those who act in spite of it.
