Health Extension is a community engagement strategy that has emerged at academic health centers around the country, in collaboration with the cooperative extension services and public health departments. The term “Health Extension” has come to refer to several different things– from the place where a health extension office is located, to the person who carries out the work of health extension, to the model for community engagement, to the strategy for community health improvement.

In essence, “Health Extension” is:

  • a PERSON– agents, coordinators and champions who live in rural and underserved communities, posses community health empowerment skills, and build bridges between communities and the university;
  • a PLACE- a regional hub connecting health systems, higher education, and community organizations;
  • a MODEL– based on agricultural cooperative extension of academic health center engagement in rural communities; and
  • a STRATEGY– community health improvement through addressing the social determinants of health, priority health conditions, and health workforce.


Health Extension agents are, in essence, community health practitioners, with deep roots in their local communities. They are active in community organizations, and work to link higher education, health systems, philanthropy, and community partners to address priority health issues.

Health Extension agents:

  • LIVE in community
  • LINK local health needs with academic health center resources
  • IMPROVE local health services and systems
  • ENCOURAGE youth to finish school and enter health careers
  • RECRUIT & RETAIN a local health workforce
  • IMPROVE local health services and systems
  • BRING latest research and health care practices to community
  • LISTEN for needs and opportunities
  • STRENGTHEN community capacity to address local health problems
  • DEVELOP relationships between community partners and academic health center programs
  • MAINTAIN CURRENT about the range of academic health center resources that are available

Health extension skills include training, technical assistance, community organizing, resource development, health content area expertise, meeting facilitation and collaboration development.

A sample job description is included in the “Related Literature & Tools” section, below. Health Extension agents are frequently Masters-level professionals, with backgrounds in health education, public health, healthcare, social work, or social sciences, with at least 5-10 years of community health experience. Salary depends on regional and organizational standards, but as a guideline, health extension agent salaries should match job titles such as senior program manager or program officer.

So, what does a day in the life of a Health Extension agent look like?


Health Extension offices are outposts around the state, in rural and underserved communities, linked to the “mothership” of the university. Agents are stationed in their own communities, and through partnership agreements with local organizations, and/or an academic community health “hub”.

A sample of a partnership agreement is included in the “Related Literature & Tools” section, below. A visual representation of these “hubs”, as carried out in New Mexico, is shown here:

In other states, such as North Carolina, health extension occurs and is leveraged by regional centers from complimentary programs:

HEALTH EXTENSION: A Model for Engagement

The health extension model can be viewed through the lens of the engaged institution, whether that be an academic health center, a health system, cooperative extension, or public health. Though this lens, health extension activities can be leveraged to bring about key community health outcomes– building a health professions workforce, addressing determinants of health, and developing health system infrastructure.

Click on the image below to get more information on the NM health extension model:

HEALTH EXTENSION: A Strategy for Health Improvement

Health extension has the strategic vision of working with community partners to improve health and health equity. It acts as a bridge between academic and community knowledge & expertise, extends university resources and programs into remote and underserved areas, and links community needs to research and service priorities of the health center.

Additionally, the fundamental strategy to address the challenges to primary care infrastructure and practice is the concept of Health Extension as a community-based, state-wide, but university-linked network of agents that can assist primary care practices with the best evidence-based practices to support the provision of quality care and practice transformation. These resources are important for the transformation process since many practices do not have the capacity nor could they afford to develop and support these developmental milestones on their own.

The model of how HEROs functions as a “Primary Care Extension Program” is demonstrated below:

Related Literature & Tools

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

HERO Job Description

MOU for a Shared HERO



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