Fellow's Research Tackles Tough Health Issues on the American Frontier

Using established methods for addressing chronic disease, a University of New Mexico Fellow takes on the challenge of protecting health in some of the most rural, poor and underserved areas of the nation.

    • December 20, 2011
This story is part of a series highlighting the research accomplishments of Robert Wood Johnson Foundation (RWJF) grantees from the Human Capital portfolio and the mentors that guide them.

In 1953, a daring team of filmmakers attempted to tell the true story of Latino miners protesting inhumane working and living conditions in Silver City, a New Mexico border town. The film, Salt of the Earth, addressed racism, sexism and the impact of poverty so boldly that then-Sen. Joseph McCarthy banned it in the United States.

Fast forward to 2011, and Latino Silver City area residents are still struggling with the health legacy created by generations of low wages, severely limited health and other resources and now, high unemployment. “That’s why we chose this area—New Mexico’s Hidalgo and Grant Counties—to test a community-based, primary care intervention designed to identify how upstream health policies and specific social determinants of health contribute to chronic diseases in this frontier, border region,” says Lisa Cacari Stone, PhD, a senior fellow at the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at the University of New Mexico (UNM).

By making this uniquely underserved area the focus of a two-pronged, Community-Based Participatory-Research (CBPR) project, Cacari Stone and her colleagues are breaking new ground in discovering how to prevent illness and deliver better health services. “The number of Latino residents living in the counties bordering Mexico is four times the U.S. average. They are 64 percent of the population compared to 16 percent nationwide and the rate is even higher for Bayard and Grant counties at 83 percent,” Cacari Stone explains. “Their ability to protect their health is constrained by many factors. Many are a two-hour drive from healthy, affordable food and some live without electricity or hot water. This is also one of the worst health professional shortage areas in the country. Few are able to obtain medical insurance or stable jobs.” As a result, preventable diseases such as hypertension have been diagnosed in 21 percent of the adults in one county and hypertension is the third leading cause of death in another.

Most research, Cacari Stone notes, has addressed hypertension rates and mortality in urban Latino communities but, “the New Mexico border area [60 miles north and south of the border, as defined by the federal government] is very rural. It’s what we think of as the old West. It’s the frontier.”

Helping People Get Healthy

To help community members take charge of their hypertension risk and care, Cacari Stone, who is also a professor in the department of Family and Community Medicine at UNM, and her team, partnered with Hidalgo Medical Services (HMS), a community health center that has been the key health care provider in the area for 40 years. HMS has three sites that offer primary care, dental and other services. Together, they adapted a nine-week, science-based intervention— Su Corazón, Su Vida (Your Heart, Your Life)—that is being administered by promotoras de salud (Spanish speaking community health workers) from the area.

“Study participants are taught to exercise, cook and shop for a healthier diet. They are also taught health literacy and how to manage their prescriptions and care. To motivate them and support the healthy changes they are making, the promotoras de salud make home visits, help participants navigate the health system and accompany them to exercise classes and grocery shopping,” Cacari Stone says.

“We began the intervention in January 2011 and 90 percent of the participants (ages 26 to 84) who start the program completed the nine-week course. In our focus groups, we sit down and talk to folks and they tell us about what they’ve learned. They explain, for example, how they think they got the disease and their struggles with living with high blood pressure and their stories are so compelling,” Cacari Stone says. “They say, ‘we don’t have healthy food here. Or, I can get canned vegetables from the food program, but I don’t have electricity to cook regularly. We learned that these people do not choose to be unhealthy. It’s the circumstances. But I also see positive change not only in the people in the study, but in their families.”

Building a Healthier Environment

For the second stage of the intervention, Cacari Stone and her team are looking at the upstream factors that contribute to high rates of hypertension in the community. They are also road-testing THRIVE (Tool for Health and Resilience in Vulnerable Environments), a system designed to teach community members how to address health issues in their community, to see how effective the tool is for assessing rural communities.

“With the leadership of Hidalgo Medical Services, we brought together members of the local health consortium [more than 35 providers, services agencies, law enforcement, schools, religious leaders and local residents] to assess and prioritize needs in housing, education, safe parks, jobs and other factors that might contribute to hypertension and poor health,” Cacari Stone says.

Like the lessons learned from the Your Heart, Your Life intervention, THRIVE results will be used by the HMS health center, community leaders and partners to create strategic plans and policies that will address the social determinants of health in the region.
UNM Policy Center Support

In addition to being “a broker for resources for someone like me, a junior minority faculty member,” Cacari Stone says, staff at “the UNM Policy Center have served in a mentoring role and provided research space, administrative support and some funding for the project.”

The bonus, Cacari Stone notes, “is that I also get to work with wonderful UNM Policy Center doctoral fellows. This interdisciplinary team—an economist, anthropologist and sociologist—along with our community partners, is bringing their skills together on this project. It’s very exciting.”

Cacari Stone and her community/academic team hope to publish the final results from the study in coming months. “With the vision and leadership of our community partners, we are eager to test this chronic disease prevention model on a broader range of health issues for border area residents.”

The RWJF Center for Health Policy at the University of New Mexico is a collaborative project between the Robert Wood Johnson Foundation and the University of New Mexico. The purpose of the Center is to increase the diversity of those with formal training in social sciences who engage in health services and health policy research. In particular, the Center seeks to become a nationally recognized locus for health policy research that will support work to inform health policy debates at multiple levels.

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