Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease

Dr. Green's observation regarding the extraordinary relevance of Health Extension to the NIH and its CTSA and his suggestion that we circulate the paper at NIH set off light bulbs here at the University of New Mexico. Following his advice, we have just mobilized the leadership of our CTSA, including its Community Engagement team to do as he says.

Arthur Kaufman

Competing interests:   None declared

This report is destined, in my view, to be a benchmark paper long- cited by many people in many countries. It at once provides synthesis and theory with practical strategy that is replicable in many places. It exposes the failure of the modern academic health center in the US to be seen as a source of the help communities need, without whining or complaining. Rather, it shows a way forward. I suggest that the authors send it directly to the Director of the NIH CTSA program, suggesting further distribution within NIH and to all community engagment components of awarded CTSA institutions, with this query: "Are you doing something like this? If so, how? If not, why not?"

Competing interests:   None declared

The article by Kaufman, et. al., is, as Dr. Mold suggests, a good model for using the previous success of the agricultural extension model to apply to health. Among the important additions that HEROs makes to the previously published models is the emphasis on educational pipeline development -- encouraging and supporting rural youth to enter health careers. Such extensions can work at (at least)3 levels, with parallels to the agricultural model. 1. Practice enhancement, the improvement of rural primary care practices with "modern" (e.g., HIT) methods; this is parallel to the teaching of "scientfic farming" methods to farmers, and is the aspect most likely to be supported in the health reform bill, and is addressed by Grumbach and Mold (JAMA, 2009, http://jama.ama-assn.org/cgi/content/full/301/24/2589) 2. Community health improvement, also addressed by Grumbach and Mold, and a big part of the health extension work in Kentucky. With a more community and public health orientation, this can look at wider-scale prevention, screening and health behavior issues in a community, as well as questions of "built environment". This is a parallel to the extension services' efforts in overall enhancement of rural communities, including business and services for farmers. 3. Health education and pipeline development. Modeled on 4-H, this can identify children/youth with interest in health careers and nurture, tutor, and support them to achieve these goals. Also, in common with 4-H, it can emphasize teaching healthy (and healthful) behaviors to young people whether or not they intend to enter health careers, thus helping to achieve #2 above.

Competing interests:   None declared