HERO has origins in addressing the health challenges of rural New Mexico. Like much of rural America, health systems and access to care and services in rural/frontier New Mexico is fragile and disparities are pronounced – underscored by an array of health determinates where poverty, race, access, health professional shortages, and rurality compound the burden. Rural New Mexicans have lower incomes, lower educational attainment, and higher rates of being un- and underinsured. While rural New Mexicans have higher rates of injury and disproportionate burdens of disease, they are less likely to receive screening and care than their urban counterparts – as well as having the second highest rate of rural suicides in the nation. Added to the equation are new patterns of risky health behaviors that are correlated with an emerging “rural culture” health determinate. At the same time, rural New Mexico is resilient: we have strong connections to family, the land, culture, and community, as well as a tremendous capacity for hard work and perseverance. Together, these complexities present challenges that change both the way we define primary care, as well as how we design the delivery of care and services.
Place-based rural HERO agents are a vital link between New Mexico’s rural communities and the state’s academic health center to address the challenges of rural heath needs and disparities. Indigenous to locality/region, rural HEROs ensure that health extension is bi-directional, and are positioned to stimulate small local changes that can impact larger systems. Large systems can also benefit from the expertise, resources, and best practices emanating from rural communities, as well as the lateral ‘spread’ or cross-pollination of promising practices and practice-based evidence from locality to locality, facilitated by HEROs. As health extension becomes more iterative, the more we are able to build effective relationships between communities and large systems – which creates the conditions necessary to improve health – particularly in rural & tribal communities.
Rural HEROS also bring community-based fluency, currency, knowledge, and competence to the table as members of teams within large, centralized institutions. To internal university partners, HEROs are conduits to communities that possess experience and knowledge that can support, inform, and enhance large systems. All of this lends itself to process outcomes that are contributing factors to community health improvement. Recruiting HEROs who are indigenous to rural communities ensures they bring with them relationships, knowledge, and experience that can be leveraged to the work of health extension.