Improving health for all in New Mexico:
Communities Lead in Addressing Social Determinants of Health
Most healthcare dollars in the United States and New Mexico are spent on care provided within the walls of hospitals and clinics addressing acute issues stemming from chronic illness through episodic care. The work of doctors and hospitals has been compared to that of a lifeguard who stands by the side of the river and pulls out drowning people as they drift by, rather than asking why so many are falling into the river in the first place (causal factors often referred to as social determinants of health, which are too infrequently addressed in traditional medical care).
Finding ways to help communities and individuals avoid chronic illness and live longer and healthier lives is a much more effective approach with better health outcomes and steep cost-savings for the healthcare system. Our proposal to achieve these goals is Community Health New Mexico, an evidence-based model created by some of the state’s leading healthcare and public health experts. The program is based on components which have been implemented and validated in many countries, states, and local communities in New Mexico with great success.
Annual healthcare expenditure in New Mexico is approximately $26 billion. This amounts to nearly three times the state’s total budget. Paradoxically, the health outcomes of the people of New Mexico significantly trail national trends. When comparing New Mexico to the national average, life expectancy is shorter (ranked 37th in the country and dropping) and chronic medical disease conditions and drug and alcohol addiction higher.
Despite these challenges, New Mexico is rich in cultural heritage and the spirit of local innovation. Our policymakers strive to leverage these strengths and attain equity in access to resources for everyone in the state. This finds expression in such landmark decisions including expansion of Medicaid, promotion of enrollment in the Affordable Care Act, increased opportunity for education and training of healthcare workers, and implementation of free college tuition. Momentum is gathering to positively impact health and well-being for all in New Mexico.
We propose to test a model that is far less expensive than traditional healthcare but offers much promise for significantly improved health outcome. In New Mexico, we believe answers often lie in unique circumstances to each community. Our model leverages existing processes and programs, augments the strengths of each community, and builds upon existing resources. The cornerstone of the model’s success is integrating direct health interventions to mitigate the social determinants of poor health and simultaneously addressing barriers to health through a proactive, preventative approach to care. CHNM will offer a unified framework of care linking community innovators and their approaches to each other and to health systems and counties across the state, tailoring the model to each community’s priority health and social needs.
Four areas of the state with already existing programs based on similar premises as outlined in the model have been selected. CHNM will work with these pilot counties to solidify and grow already developing infrastructure and codify the growing relationships bridging our disjointed healthcare system. These pilot programs will provide the information and evidence needed to scale the program statewide most cost-effectively.
Despite increases in healthcare expenditures, health measures are worsening for too many New Mexicans. Our hospitals are at or near capacity, clinics are booked-out for months, and access to care is almost non-existent in many rural areas. Healthcare outcomes are declining as a result.
We have a unique opportunity now to turn our recent bounty of budget surpluses into lasting gains and a permanent shift in the health and wellbeing of our communities, while also reducing the burden on our over-stressed hospitals, clinics and emergency rooms. Now is our time to galvanize our ingenuity and shift our paradigm by building local capacity to create and sustain health-promoting models. Community Health New Mexico provides the roadmap to put New Mexico on the path for better health for all its citizens for decades to come.