Academic health centers (AHCs) often have complicated relationships with communities who, in turn, often feel ambivalent about the role of AHCs vis-a-vis their communities. At times there is considerable distrust. Many times communities see the AHC come when there is a grant, and leave when the grant goes away. There seems no long term commitment or investment in local needs. In fact, many communities feel resentment that their priorities, their wisdom and expertise are not elicited when the AHC proposes a project or research opportunity.

The following quotes illustrate the difficulties faced by universities attempting community engagement:

“Most university-community partnerships are one-sided altruism. The university gives things to a needy community, compensated by warm feelings and a grant until it ends.” Howell Baum

“Shifting institutional leadership and grant-based funding often relegates community partnerships to boutique initiatives, paraded out when the university needs to demonstrate its engagement bona fides… Many community engagement offices are tucked away in outreach centers or isolated in a single school or college, outside the mainstream of the university’s priorities.” Mary Jane Burkardt

Health Extension, community-based and offering a long-term commitment to link community priorities with AHC resources offers a bridge toward greater university-community trust. Below are a set of AHC resources that have been successfully mobilized to address community priorities.

The Social Mission of the Academic Health Centers

The UNM HSC Vision 2020 – “University of New Mexico Health Sciences Center will work with community partners to help New Mexico make more progress in health and health equity than any other state by 2020” came from the leadership of the HSC as a way to support the improved health of New Mexico communities.

We will do this by focusing on evidence-based interventions and evidence-informed policy, by disseminating and building on successful programs and pilots, and by linking and aligning existing resources to address community priorities for improving health and health equity.

This is part of a national movement for Academic Health Centers to measure their success by the health of the communities they serve. An institutional commitment through the adoption of the vision has been an essential piece of this goal, as well as the integration of this vision into the work of all the colleges, departments, and offices.

As a concrete example of how an AHC responded to an identified community need experienced in New Mexico, many elderly do not have transportation to drop off/pick-up and consult with a pharmacist about their medications, including prescriptions, over-the-counter, herbal, etc. A HERO agent coordinated a brown-bag session at a local community center for pharmacy faculty and students to provide a 1-on-1 session for seniors to address polypharmacy issues and concerns, with coordinated scheduled individualized appointments on-site at the senior center. This response to a community need prevented possible polypharmacy issues by informing and advising seniors about their medications.

Tapping the Resources of the Academic Health Center

Academic health centers resources are siloed into colleges, departments, and administrative offices or they are siloed between different mission areas—education, service or research. But the health needs of communities, hospitals and primary care practices are broad, often spanning all of these silos. It is thus the role of Health Extension to serve their communities by tapping into all the relevant “silos” and to monitor their effectiveness, giving feedback to the academic health center.

To shift locus of control of programs from AHC to community and to facilitate the effectiveness of Health Extension in bridging the silos, UNM HSC has come up with several strategies. One is a single, unifying vision for all components of the HSC called “Vision 2020: Working with community partners, UNM HSC will help New Mexico make more progress in health and health equity than any other state by 2020.” Vision 2020 is bolstered by performance plans incorporating outcomes of the Vision and by a set of metrics (such measures as prevalence of chronic disease, access to care, educational attainment) in all the “silo” areas comparing NM to other states at the state and county level. Achieving improvement in those metrics requires collaboration not only with community partners but collaboration across the HSC. Click below to watch a short video about Vision 2020:

Research for Discovery & Problem-Solving

In New Mexico, each of the 33 counties had a comprehensive health planning council representing different stakeholders in the community. Each would come up with a list of health-related priorities for their county. We matched these priorities with the research priorities or “signature programs” of UNM HSC and here were the results:

The HEROs health extension program sought ways of bridging this gap between community health and university research priorities. Approximately half of the academic health centers in the U.S. received substantial awards to establish Clinical Translational Science Centers (CTSCs). An important aspect of the CTSC is to hasten the translation of scientific discoveries to their practical application in patient care. In addition, the priority health needs of patients and communities should help drive the research enterprise of academic health centers. To receive such an award, therefore, each applicant submitted a component related to “community engaged research.” The University of New Mexico received such an award and in its community engaged research component, it described the HERO program and its bi-directional role in connecting communities with researchers. The CTSC then decided to fund one HERO FTE to support 10% of 10 different HEROs around the state. The MOU establishing this relationship between HEROs and the CTSC contains the following language:

PURPOSE: The purpose of this agreement is to define the responsibilities of the HEROs Agents and the CTSC related to the Agent’s expanded roles in bidirectional research communication between investigators and communities joined in sustainable clinical and translational research.

A. The CTSC will: provide salary support, provide a menu of active research studies, provide training of HEROs in a set of research skills relevant to their field work
B. The HEROs will: provide orientation of researchers to their communities, be responsible for informing the CTSC on HEROs capacity to facilitate research, ensure research outcomes are presented to their communities and translated into action

* Southwest NM: Community Safety (injury prevention, domestic violence, sexual assault); Family resilience (including food insecurity); Fitness and nutrition; Economic development
* Southeast NM: Housing; Teen pregnancy; Emergency response; teen pregnancy; Asthma
* Native American communities: Suicide prevention; Obesity prevention; Motor vehicle deaths
* African American communities: HIV; Diabetes; Teen dating violence; Pipeline programs
* US/Mexican Border Counties: Impact of violence in Mexico on Hispanic families in NM

Educating the Health Workforce

Health Extension plays many roles in educating the health workforce. One is to train added participants to the health team like community health workers. Another is to build the workforce appropriate to the ethnic and geographic needs of the community through pipeline programs or “grow your own” strategies. And another is to offer new skills to different levels of the existing workforce including skills in improving health literacy of patients in a primary care practice or in the community at large. One example of this is the “Salida” developed by Health Extension and community health workers at the One Hope Clinic in Albuquerque’s International District. The clinic serves a predominantly Mexican immigrant population where health literacy is low and linguistic and cultural barriers to care are high. After each patient is seen, a bilingual community health worker from the community interviews the patient with the chart and assesses how much the patient understood of the encounter, the recommendations, the prescriptions and tests. Also, an assessment is made of the ability of the patient to pay for what was ordered. In about half the cases, the community health worker returns to the doctor for clarification or suggestions re: cheaper tests or prescriptions. In some cases, the doctor is informed that the specialty clinic referred to is inhospitable to immigrants or has no bilingual staff.

Another key element of educating the health workforce is offering ample opportunities to serve in the community. The following video describes an initiative developed with the assistance of health extension, in which health sciences students arose to serve the community, assisting with the school immunization project.

Clinical Service: Serving People & Communities

An extraordinary, collaborative effort is being mounted nationally to transform primary care practices to increase access,efficiency and quality of patient care. From on-line tools to regional IT consultants to face-t0-face practice facilitators and academic detailers, an array of resources are being mobilized to facilitate the practice transformation toward patient centered medical homes. As part of this process, adoption of electronic medical records with their meaningful use can be rewarded by NCQA recognition and Medicaid or Medicare funding for adopting the technology in practice.

Health Extension can help practices go beyond the PCMH by applying some of the same practice facilitation approaches to amplifying that transformation to an impact on the helath of the community served by that practice. This can take many forms and a practice can seek outside help in the process, tapping into shared resources serving the region. The importance of this broader approach is clarified by a recognition that for every patient seen in practice with a chronic condition, there may be 5-10 people in the community with the same condition not being seen or treated. Health Extension can reach out to community members through distribution of refrigerator magnets with the telephone number of the 24/7 statewide nurse advice line. When called, the line can offer those without a medical home appointments in primary care sites near the caller’s home. Another intervention is to link primary care clinics to local public health clinics where public health nurses can offer parents who bring children for free immunizations can be linked with medical homes. And finally, the Health Extension agent can work to improve the health literacy of the community through articles in local papers, interviews on local radio or TV and sharing clear, simple messages critical to the health of their community with individuals with high population contact such as ministers or hair dressers.

Related Literature & Tools

Click on the thumbnail images below to access key literature related to academic health centers as engaged institutions:

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

“A Healthcare Cooperative Extension Service”

“Global Consensus for the Social Accountability of Medical Schools”

“The Role of Academic Health Centers in Addressing the Social Determinants of Disease”

“Academic Health Centers: The Compelling Need for Recalibration”



Metrics and Evaluation Financing Message Mapping Building a Movement Chp6 Sustainability Diverse Populations Critical Health Literacy CHWs Chp5 Population Health Beyond PCMH Shared Resources Community Health Systems Small Practices PCEP Chp4 Primary Care Health Outcomes Core HERO Functions Engagement Perspective HERO Model Chp3 Health Extension Model Public Health Cooperative Extension Academic Health Centers Primer for Engagement Chp2 Engagement What is a Hero General Overview Using the Toolkit Chp1 Getting Started