An ethnographic study of how nonprofit-based promotoras de salud mobilize community expertise to address health inequities in Santa Ana, CA

This ethnography examines the health equity projects that recruit promotoras de salud, or Spanish-speaking community health workers, to understand how promotoras are discursively positioned to articulate truths about social inequalities. Public health leaders view promotoras as social actors capable of improving health systems and even creating social change in underserved, low-income regions. They are characterized as possessing “community expertise” for being members of the populations they serve. Their knowledge of local context as well as their lived experience of health barriers are considered to provide unique insights on their community’s social needs. Community expertise is constituted as a way of knowing aspects of inequality beyond or inaccessible to academic and professional epistemologies. This research draws from fieldwork conducted between 2014-2018 at a community health nonprofit that mobilizes promotoras to address health inequities in Santa Ana, CA. Through analysis of the work promotoras do and the expected outcomes of their work, I explore how they and other social actors classify and evaluate knowledge-production conducive to social justice. By analyzing the particular conflicts and binds that promotoras encounter in an organizational setting, this study brings out the unspoken ideological mechanisms that give meaning to community expertise and define its role in disclosing the reality of social inequality. This dissertation argues that producing and legitimating the truth-status of community expertise serves as a kind of proxy for regulating knowledge-practices that can overcome social injustice. Narratives over the transformative potential of promotoras and the possibility of eradicating poverty index a symbolic arena seeking veridictional validity over the proper subjects that can say what social justice and health equity is. At stake in this dissertation is the meaning of social change, how one can know or detect it, who has the truth-speaking status to claim when it happens, and, ultimately, the legitimacy of theorizing over how the poor can be saved