Professionalization as a “Double-Edged Sword”: Assessing the Professional Citizenship of Community Health Workers in the Midwest

Community health workers improve health and well-being through, most notably, health education, advocacy, and building individual and community capacity. In spite of these contributions to the health care landscape, these workers are not well integrated within the professional workforce throughout much of the United States. Building on the lens of medical citizenship, I introduce the concept of professional citizenship, which elucidates the belongingness of a group within a professional workforce. Drawing on this framing, I detail the lack of professional belongingness among community health workers in Indiana and the emergent issues that arose via professionalization including: the potential creation of a hierarchy, changes to core roles, and the (in)accessibility of the position due to the requirements for the community health worker certification course. Additionally, I situate these issues within race, ethnicity, gender, and class in examining their effects on the professionalization of these workers. The findings presented in this article can be utilized by policymakers, public health programs, and other employing organizations as community health workers undergo professionalization. Given the poor health outcomes in Indiana, these workers are poised to make significant contributions to the health of their communities—with careful consideration for potential ramifications via professionalization.