California is preparing for a major expansion of support and funding for promotores – grass roots health workers who work within their own communities to reach out to rural, remote and otherwise underserved populations.

The federal health reform enacted earlier this year includes $15 billion over the next ten years for preventive health measures, including promotores. State legislation is pending to enable the Department of Public Health to assess existing promotores organizations here to ready California to compete for the federal grants.

The bill, AB 2354 by Assemblyman V. Manuel Perez of Coachella, would also develop a formal definition of what promotores do. Different from community health workers, promotores are based locally and are affiliated with the community more than health institutions.

Originating in Latin American countries, promotores have increasingly surfaced in the United States over the last 30 years.

Typically promotores serve low-income communities that have less access to health resources. Workers are community members, people who speak the same language, understand the culture, and are familiar with the needs of their neighborhoods.

Promotores may hold paid positions or volunteer. They may work independently, with non-profit agencies, local, county or state governments on prevention, educating communities on health resources, or even policy work.

Those living on low-incomes, people who do not speak English, and those who live in rural or remote areas often do not know what health services and resources are available. Promotores actively work to educate these populations and ensure that they do not go without the health care and preventive services they need.

Last year, for example, when fears about H1N1 flu virus were rampant, the state funded promotores to educate people about the virus and help them get vaccinated.

Because of their unique and effective connections to communities, the promotores model has been chosen by state, county, and non-profit organizations to run preventive campaigns and work from within to create healthier communities.

Poder Popular of the Coachella Valley is a locally based group that provides support, training, and employment opportunities for promotores. Originally funded by the California Endowment, Poder Popular of the Coachella Valley now works with various non-profit groups and foundations to tackle specific problems facing the people of Coachella. (Note: The California Endowment also provided initital funding for this web site, calhealthreport.org.)

Currently Poder Popular is working with residents living in mobile home parks, mostly low-income farm workers, throughout the eastern communities of Coachella. Most of these communities get their water from wells that contain unsafe levels of arsenic, above the federal standard of 10 parts per billion.

“Some of these communities are very remote, rural, and don’t have the resources to fix the water issue,” Ana Lisa Vargas, the executive director of Poder Popular, said. “Currently we work with some of those communities to figure out interim solutions or long term solutions” to ensure people have access to safe drinking water.

Vargas estimates that close to 5,000 people living in mobile home parks throughout the area are affected by unsafe well water.

Poder Popular has provided information to residents about the dangers of arsenic, educated residents on their rights to mobilize, and created community action groups to help residents make changes.

Poder Popular is also beginning to work with the National Latino Research Center in San Diego to use promotores to assess the needs of the community and address them appropriately.

“Whether it’s housing, whether it’s access to health, food,” promotores will be trained on the resources available to address those needs and then go out into the community and try to inform people what resources are available to them, Vargas said.

Maria Lemus the executive director of Vision y Compromiso, said promotores provide a “community solution” to health problems in many communities.

Vision y Compromiso, a statewide organization, works to support promotores across California by providing advocacy, training, education, and workforce development, as well as a network of support and resources. With over 4,000 people in their network, Vision y Compromiso is the largest organization of its kind in the nation.

“There is a lot of infrastructure that goes into promotores programs,” Lemus said. “The training is critical.”

As health reform funding expands and creates new promotores programs it will have to keep that infrastructure intact, Lemus said.

Assemblyman Perez’s bill passed the Assembly and is pending in the Senate Appropriations Committee.