What works? The Evidence for Community Health New Mexico

The term “healthcare” evokes visions of hospitals and clinics, doctors in long white coats, nurses, and other medical professionals responding to acute illnesses and needs. However, health and well-being are much more determined by our environment, relationships and behaviors and the quality of our lives in our homes and communities. Traditional institutional medical care impacts only a minority of health outcomes, potentially contributing about 15% to preventing mortality[1]. Health and wellbeing are much more significantly affected by what are known as social determinants of health[2].

Social determinants of health include educational attainment, economic stability, healthcare access, housing and quality, safe and healthy neighborhoods, and social and community supports.

Chronic and preventable medical disease conditions are prevalent. This is due to the various challenges residents of New Mexico face, including low levels of education, poverty, and health inequities. Without programs to address preventive care and the social determinates of health, our healthcare system is left with the impossible task of mitigating late state chronic disease in a reactive, costly and mostly ineffective manner.

We can broaden our concept of “healthcare” to include programs that are proven to address the behaviors, environment and structures that affect health and wellbeing before they lead to uncurable chronic disease. These programs must start at home and in the community.

Many chronic diseases can be mitigated through early interventions. For example, pre-diabetes is present in nearly one in four New Mexicans, and among those who have diabetes, one in five people are unaware. If diabetes is identified in its early stages through routine screening, appropriate interventions and lifestyle changes can be employed in a proactive or “up-stream” approach preventing complications and preserving health and wellbeing.

Community-based health care programs using networks of care, community health workers, peer support workers, and community organizers and advocates have shown success in many countries, states and local communities that have implemented aspects of this model. We propose to combine these evidence-based approaches into one powerful and cost-effective new program which leverages already-existing strengths in each community. These programs tend to be the most effective when direct health interventions are combined with efforts to address social determinants and barriers to health.

Countries throughout the world with healthcare delivery models prioritizing community health show significantly greater improvement in health and well-being of their populations and individuals as well as significant cost savings. Similarly, there are smaller scale successful community health programs within the United States and in New Mexico that can serve as examples. We propose to combine these evidence-based approaches into one powerful and cost-effective new program which leverages and disseminates already existing strengths in each community. (See appendix B for a bibliography of evidence for these approaches.)