Community-based health focus offers hope
Are our precious children, the most important resource necessary to support our state’s economic success in the next 20 years, healthy? During this year’s 30-day legislative session, will the actions of our political leaders be prepared to help those children achieve the health necessary as those children take charge of New Mexico’s economic and social leadership in 2040?
My view, my answer is that, based on rigorous and widely respected data generated by the Kids Count states’ rankings for the past 30 years is a hopeful maybe. Our state’s rankings are not improving; we were 50th in the most recent Annie E. Casey Kids Count report.
Our policies seem stuck with a perspective that remains at least 50 years behind the health and wellness policies of many, if not most of our sister states. That perspective supports the funding of medical care visits, services, testing and procedures, but ignoring the now widely accepted model, in place and evolving since the 1990s in Wisconsin, that recognizes only 15% to 20% of any individual’s health and wellness is from organ-specific biological causes, with “rescue and repair” actions for chronic diseases of aging — heart disease, arthritis and diabetes. The other 80% of ill health, whether children or seniors, is caused by environmental, social and economic determinants that a doctor cannot correct with her prescription, test or procedure.
Good health is the clean, toxin-free air our children breath as they bicycle past industrial pollution on their way to school. Good health is the parks and green spaces, safe and well-maintained, that those kids, their friends and families can access for exercise and pleasure. Good health is the safety from family, neighborhood and community violence that puts their lives at risk.
In 2024, the majority of U.S. state health agencies have explored and are gradually implementing a community health framework. These states are finding medical outcomes, whether childhood diabetes, maternal deaths or coronary heart disease are improved, the shared social determinants that are not named diseases, but result in poor health for communities are identified, and local actions taken to address each prioritized determinant.
That population/community health framework holds a primary tenet of local control and a focus on health equity across a community’s subpopulation. A process, MATCH— mobilizing for action through community health, uses evidence-based, locally supported programs to address critical social determinants such as child abuse and education/reading underperformance — not medical diseases — but have enormous impact on the healthiness of all children.
To that end, I am heartened and hopeful in The New Mexican‘s Page A-1 story (“A Rural Lifeline,” Feb. 7) describing the 2019 legislation that codified the roles and responsibilities of the Department of Health and county and tribal health councils. That law envisioned a health/wellness and community health structure, a central element of the community health model. These local councils were launched in 1992 were often inactive, if not dormant, over the past 15 years in many counties. They were never funded with our state tax revenues adequately.
In the current session, House Bill 67 recognized adequate funding is necessary to develop, over the decade, the communication connections between each county, tribal local health and wellness council and the Department of Health and the Children’s Cabinet.
As noted in the article, the health council is not meant to be a medical care service provider but a gathering of local providers and nonprofits to collaborate and coordinate. The legislation specifies each community council will convene its diverse communities, focusing on local health equity and disparities, collect local data to allow for prioritization of those determinants of local ill health, coordinate community-driven planning of solutions, lead in monitoring of local projects and collect local data to determine whether predetermined targets are achieved.
The focus by the governor on reorganization of the Department of Health, lead by Secretary Patrick Allen, may demonstrate the necessary health leadership lacking in our state — one that really has had no “system” in its medical system. Allen’s previous leadership role at the Oregon health authority demonstrated knowledge and expertise in this shift toward a model of community health. Note that Oregon’s children’s health rankings improved from 32nd to 26th over the past decade.
Local, community-driven action will allow for the slow and steady changes, embraced by the new community/population health model and lead by Allen and his team.
Dr. Norman Marks is a retired physician who divided his 45-year medical career between community practice of surgery and two decades of public health work in medical product safety at the Food and Drug Administration. He resides in Santa Fe.