Agriculture and Health Sectors Collaborate in Addressing Population Health

Arthur Kaufman; Jon Boren; Sonja Koukel; Francisco Ronquillo; Cindy Davies; Carolina Nkouaga

doi:10.1370/afm.2087

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Author response Re: Cooperative Extension as a Framework for Health Extension
Arthur Kaufman

Published on: 03 October 2017
Cooperative Extension as a Framework for Health Extension
Jeffrey W. Dwyer

Published on: 28 September 2017
Primary Care and Cooperative Extension
James W Mold

Published on: 21 September 2017

Published on: (3 October 2017)
Page navigation anchor for Author response Re: Cooperative Extension as a Framework for Health Extension
Author response Re: Cooperative Extension as a Framework for Health Extension
Arthur Kaufman, Professor of Family and Community Medicine
Dr. Dwyer makes very important points--of fact and of history. He is right to point out that Cooperative Extension has been a major contributor to the health of our nation since its inception. This contribution is not only in its direct, health-affecting programs, but in its impact on rural economic development. In fact, it is Cooperative Extension's major role in addressing social determinants of health which first attrac...
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Dr. Dwyer makes very important points--of fact and of history. He is right to point out that Cooperative Extension has been a major contributor to the health of our nation since its inception. This contribution is not only in its direct, health-affecting programs, but in its impact on rural economic development. In fact, it is Cooperative Extension's major role in addressing social determinants of health which first attracted our interest in New Mexico and motivated our academic health center to create and adapt the agricultural model to our health care environment.
However, a major points of our article is that this valuable contribution and leadership role in health played by Cooperative Extension is virtually unknown to the healthcare system and industry in the U.S. This ignorance diminishes the contribution to community health that could be realized if our two major sectors overcame their isolation from each other. When I present to medical audiences the opportunity available through this collaboration, I usually get blank stares. Perhaps Dr. Dwyer's experience is different.
Our survey was a mix of personal interviews (ex. University of Kentucky and Oregon State), literature reviews (ex. your own Michigan State and Texas A&M) and personal knowledge of other states' efforts by our New Mexico State Cooperative Extension co-authors. Your publication to Academic Medicine and our submission to the Annals of Family Medicine probably overlapped in time so was, unfortunately, unknown to us. So we missed that valuable and highly relevant contribution.
Finally, the New Mexico Cooperative Extension and Health Extension group has benefitted from Dr. Dwyer's presentation at national conferences on the Michigan State University model. His group is a leader in research in this area and his call for broader collaboration is well taken. Different state models should be discussed, shared and valuable aspects adapted to local conditions.
Arthur Kaufman, MD, University of New Mexico
Competing interests: None declared
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Competing Interests: None declared.
Published on: (28 September 2017)
Page navigation anchor for Cooperative Extension as a Framework for Health Extension
Cooperative Extension as a Framework for Health Extension
Jeffrey W. Dwyer, Director, Michigan State University Extension
Other Contributors:
We agree that Cooperative Extension's national infrastructure is an important contributor by collaborating with health care partners to improve population health. It is important to note, however, that Cooperative Extension is not new to the health arena, having been involved with the delivery of educational health programs for 103 years, longer than many community agencies. While the study and advancement of agriculture...
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We agree that Cooperative Extension's national infrastructure is an important contributor by collaborating with health care partners to improve population health. It is important to note, however, that Cooperative Extension is not new to the health arena, having been involved with the delivery of educational health programs for 103 years, longer than many community agencies. While the study and advancement of agriculture is foundational to the Cooperative Extension Service, the organization has addressed health issues since its inception, focusing on the social determinants of health through programs in nutrition, housing, financial management, business entrepreneurship, positive youth development, among others.
As outlined in the Smith Lever Act of 1914, Extension provides outreach through land grant universities, bringing university research and knowledge to people living in communities. Extension is a community- embedded, trusted entity. Primary care needs practical and clearly translated research communicated to patients and that is what Extension does best. In addition, the presence of Cooperative Extension in every state, the long-term history and trust associated with Extension educators living and working in the communities they serve, and the sustainable infrastructure that has remained over time suggests that it can provide an enduring framework and foundation for providing community-based health education and programs in diverse communities across the United States.
We have two additional concerns. First, it is unclear which states were surveyed for the purpose of determining how various approaches to health extension are being piloted nationally. While Michigan State University Extension appreciates being mentioned in the article, we regret not having had the opportunity to be included in the survey of the states providing information on their approaches. We can only assume that the description used was taken from earlier versions of a manuscript that had been in development. Second, this is not, as stated by Kaufman et al., the first published manuscript showing how Cooperative Extension is engaged in the health extension movement. A manuscript titled "Cooperative Extension as a Framework for Health Extension: The Michigan State University Model" was published online ahead of print in Academic Medicine on March 28, 2017. Kaufmann et al., offer a descriptive paper that can continue the conversation, however, we look forward to future publications that have evaluation data associated with different strategies and approaches that will help to improve population health through community-based education and programs that complement typical health care services.
Dwyer JW, Contreras D, Eschbach C, Tiret H, Newkirk C, Carter E, & Cronk L. Cooperative Extension as a Framework for Health Extension: The Michigan State University Model. Acad Med. 2017; 92:1416-1420.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (21 September 2017)
Page navigation anchor for Primary Care and Cooperative Extension
Primary Care and Cooperative Extension
James W Mold, Professor Emeritus
While the Cooperative Extension infrastructure is certainly attractive, and Cooperative Extension is increasingly interested in health education, a more promising infrastructure for primary care extension in some states may be the public health system. In others it may the AHEC system. Every state is different. With regard to the term, "extension," no one can truly lay claim or have ruffled feathers. In Oklahoma, we h...
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While the Cooperative Extension infrastructure is certainly attractive, and Cooperative Extension is increasingly interested in health education, a more promising infrastructure for primary care extension in some states may be the public health system. In others it may the AHEC system. Every state is different. With regard to the term, "extension," no one can truly lay claim or have ruffled feathers. In Oklahoma, we have chosen to create County Health Improvement Organizations (CHIOs; see www.publichealthok.org) in which all parties with a local presence are invited to participate. Cooperative Extension agents are involved in most CHIO counties. Our current emphases at the state level are to increase collaborations with the public health and mental health systems, which have health as their primary missions.
Competing interests: None declared
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Competing Interests: None declared.