CHNM Outreach: “Bottom up” rather than “Top down”

Most healthcare in New Mexico and the U.S. is focused on late-stage illness and chronic disease. Medical providers usually intervene only when a chronic condition becomes known. By then, irreparable damage may have been done. Patients visit the ER when they have a heart attack, a stroke or a severe asthma exacerbation, the outcome of uncontrolled chronic illness. Investment in preventive approaches is better for community health and more cost-effective.

Evidence-based, successful community health programs work on grassroots, “bottom-up” methods, focusing on reducing health and social risks at their origin before they can result in chronic illness. They assess health levels in each household, worksite, community and suggest appropriate methods to deal with discovered risks early, before people become so sick that they must visit the emergency room.

Two examples that fit into this way of delivering a different kind of healthcare are Community Health Workers (CHWs) and Health Extension Regional agents (HEROs). Both live in the communities they serve and can draw upon personal and institutional resources from their communities, agencies or institutions. CHWs regularly contact the households in their district, either with personal visits or telephone calls. The CHW understands the life histories and make-up of “their” district. They anticipate healthcare needs. CHWs can identify early risk factors of disease and help families make lifestyle changes, they can help address social determinants of health, and they can provide basic health coaching and preventive advice for those who are pregnant or may have some chronic diseases or other conditions.

Health Extension Resource Officers (HEROs) also live and work in the communities they serve and are selected by those communities. They provide local technical assistance in the health and social sphere, support capacity development of community organizations, strengthen pipeline development of youth into health careers, link community organization priority health needs to UNM resources and offer a set of special skills such as grant-writing and program evaluation to community-based organizations.

Both Community Health Workers and HERO programs have been implemented in New Mexico with great success, but this  has been through sporadic grant-funded programs that aren’t fully integrated with the healthcare system or with many social service and community organizations.


Asuccessful model of a community addressing social determinants of health comes from Santa Fe and the Connect program. Santa Fe County and the City of Santa Fe collaborated to create the program which set up a network of social support throughout the county that links almost every social service agency and healthcare institution in a mesh that can address most social and healthcare needs of community members. The concept is called “no wrong door.” This means that wherever a person might come seeking assistance, they can be referred to an agency that will help. Each agency trains “navigators” to help get community members to the right services. Organizations that receive referrals actively reach out to community members rather than passively waiting for them to access services.


Our model combines elements of these successful and innovative programs and also leverages local strengths so that each community can tailor the initiative to their particular situation, needs and resources. Critically, we also propose sustainable funding for our model so each community can have the time to build a program that works and show its effectiveness, both in terms of improved community health and cost-savings. Further discussion of New Mexico programs that inspired our model can be found in Appendix A. A list of references and studies that show the possibilities and evidence base for our model is in Appendix B.