One of the primary motivations for involving lay people in delivering health promotion activities is the potential to engage underserved or marginalised populations who experience poor health. This chapter presents findings from a case study of a Community Health Educators programme, where the lay health workers performed a bridging role within disadvantaged urban neighbourhoods, taking out health messages to local communities and supporting people to participate in healthy activities. The Community Health Educators were recruited from the communities they worked with and the programme focused on their personal development and empowerment. The case study is of interest because the programme pursued an inclusive, flexible approach to recruitment, training and supervision, including using sessional payment to support the Community Health Educators in their work. The chapter highlights some of the tensions arising between empowerment approaches and having to deliver against health targets, as well discussing the thorny issue of payment versus volunteering. The chapter starts by looking at the Community Health Educator model and how it relates to other roles more common in international contexts, such as Lay Health Advisors. It then goes on to look at the Community Health Educators programme as a strategy for tackling inequalities, prior to discussing some of the dilemmas in practice.

Background

The Community Health Educator model first emerged in the UK in the 1990s, with innovative programmes such as Woman-to-Woman: Promoting Cervical Screening to Minority Ethnic Women in Primary Care (1994–97) and Straight Talking: Communicating Breast Screening Messages in Primary Care (2000–02) (Chiu, 2003). Chiu, who played a key role in the development of these programmes, describes the Community Health Educator model as based on the twin principles of empowerment and participation, drawing heavily on the radical ideas of Paulo Freire (1970):

Initially, the model was developed working with minority ethnic women, but was later applied in other communities experiencing disadvantage. Community members typically undertake an in-depth training course that not only educates them about relevant health issues and develops their communication and organisational skills, but also develops their critical awareness and ability to reflect on community health needs (Chiu, 2003).