Working with diverse populations is an essential function of health extension. Characteristics of diverse populations generally cross-cut a multitude of factors including but not limited to: age, race, ethnicity, socioeconomic status, gender, sexual orientation, religious affiliation, status as a veteran, rural/urban place of residence, disability, etc. As a liaison across cultures, health extension agents engage populations through the lens of social justice, often negotiating and advocating between cultural environments that pose structural barriers to community groups and members. Importantly, deeply entrenched institutional systems are often shaped by “isms,” such as racism, sexism, classism to name a few, that are responsible for on-going inequity.

The ultimate goal of this area of work is to support, compliment and/or be a catalyst for systemic change that diminishes health disparities and promotes health equity. The unique nature of health extension allows for long-term engagement with marginalized groups in order to help facilitate the expansion of political and social capital. Sometimes the health extension agent can be a messenger to government or institutional leadership about how policies and procedures are affecting people “on the ground.” Or, they can get behind existing movements pushing for change, often at the invitation of community leaders requesting technical capacity assistance.

Determining Priorities: Listen Locally

Listening to community knowledge is crucial to the work of health extension. Change can only occur with support from the community and a focus on working on the issues it deems as priority and will be active in working to change.

Expanding the traditional extension model of unidirectional flow of expertise from the University to communities, health extension enables 360 degree learning and exchange from practices back to the University and from community partners to the practice and back, to further inform and refine the model. In addition to strengthening the model, this enables greater effectiveness. A one-size-fits-all approach to practice transformation is ineffective for many states, where the mission and goals of a federally-funded clinic on an Indian reservation are different from those of an urban, private practice. Health extension engagement in practices is responsive to the unique aims and needs of each practice, and also linked to priority health needs and conditions of the locality and region. Further, health extension is embedded in communities –versus being “dispatched out” from the academic center for time limited interventions – enabling health extension to play a “conduit” role that serves a connecting and convening function to bridge external bodies, including universities and the state Department of Health, into a more coordinated community health effort that is linked to local primary care.

Community Competencies: Working Effectively Within Contexts

Crucial is determining what is meant by “community” when wishing to work within diverse populations. Different from a geographic location, you cannot establish the issues by looking at quantitative data or speaking only to the leader of an organization. A race/ethnic population represents multiple and complex communities. You may be seeing in just one defined group multiple languages, cultures, socioeconomic classes and experiences of racism.

The different experiences of racism have a lasting impact on how the groups interact with health institutions: seeking services, collaborating with or participating in initiatives, or understanding and accepting institutional strategies. Not to mention the various historical experiences that contributes to distrust of institutions.

For so long diverse populations have had to utilize alternative methods of change and action. This has developed into significant strengths in meeting the needs of the community. Institutions and those working in institutions have difficulty working within these methods or fail to see them as strengths. Health extension can help institutions to see the strengths in methods diverse groups have developed. Additionally they can call attention to the structural barriers placed against these groups.

Experiences from New Mexico as a Diverse State

New Mexico is a minority-majority state, with half its population being Hispanic/Latino and about 10% Native American, along with sizeable numbers in the African American and immigrant populations. HEROs work with local communities to identify health priorities for each of these populations, as well as deciphering methods for like-minded organizations to collaborate and share resources. They assist in cultural competency issues, provide trainings and presentations around the health needs of the populations they serve. HEROs also help communities access services, by linking them to shared resources. Below is an example of manual which started within the Office for Community Health at the University of New Mexico, and was later converted into a community-run consortium.

Salud Manual: Community Health Resources

Addressing the health of diverse populations for New Mexico is imperative given the fact that approximately 57% are racial/ethnic minorities, according to the 2010 Census. The largest ethnic group is Latinos followed by Native Americans, African Americans, Asians and other minority groups.  New Mexico’s racial/ethnic communities disproportionately suffer from chronic conditions such as diabetes, obesity, cancer, mental illness or drug abuse.  These health differences are closely linked with social or economic disadvantages.  These disadvantages are primarily due to structural inequities including institutional racism that still prevails and manifests itself in various overt and covert actions. It is critical that governmental and private entities begin addressing these racial/ethnic health inequities by investing in and developing minority leaders, using data for strategic planning and resource allocation to improve health and making systems and policy change.

HEROs, in addition to being “generalist” community health practitioners, also have unique speciality expertise about the health issues of their community. Click on any of the topic areas below to learn more about New Mexico’s experience:

Related Literature & Tools

New Mexico Racial & Ethnic Health Disparities Report Card- 2010

The Challenge of Serving and Working with Diverse Populations in American Hospitals

One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations

Patient-Centered Care for Underserved Populations: Definitions & Best Practices

Other Useful Websites



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