Scenic view of a southwest rock formation.

San Juan County, New Mexico

Tucked into the northwest corner of New Mexico, San Juan County sits atop the Colorado Plateau, a high-desert region known for its rugged beauty and complicated social history.

San Juan County encompasses several governing bodies: the semi-autonomous Navajo Nation Reservation; the county; and the municipal governments of its largest cities—Farmington, Bloomfield, and the county seat of Aztec. Farmington, the county’s largest metropolitan area, is a majority white community that borders Navajo Nation and is the commercial hub for tourism in the Four Corners area (where the borders of New Mexico, Arizona, Utah, and Colorado meet).

Although the separation of governance is vital for Navajo Nation’s preservation and protection of its tribal heritage, a lack of communication and understanding between the reservation and non-reservation communities has led to racial tensions and contributed to stark disparities. A 2010 report by Navajo Nation Human Rights Commission found that, despite decreasing tensions, the Navajo continue to experience severe economic and health disparities; unequal access to services, benefits, and opportunities; and other examples of institutional racism. Agencies and individuals, located on- and off-reservation, are responding to selected health and social concerns, however many initiatives focus largely within one governing unit or the other and typically do not encompass the population as a whole.

Overview

Population and Demographics

Population: 127,358

SOURCES:
U.S. Census Bureau

Context and Actions

Community Context and Challenges

An estimated $0.70 of every $1 in personal income is spent off-reservation in border towns, further complicating efforts by Navajo Nation to maximize local sources of revenue, such imbalanced spending results in a decreased tax base.
Transportation and infrastructure are key barriers in connecting Navajo Nation residents with services, resources, and opportunities.
San Juan County’s uninsurance rate is 26%, which is significantly higher than state (18%) and national (14%) averages.
The county’s per capita rate for violent crimes (644 per 100,000 residents) is significantly higher than the national rate (366 per 100,000 residents).
American Indian residents have almost half the household income and a lower level of educational attainment than their white counterparts, and much higher rates of unemployment and poverty; they’re also twice as likely as white residents to be uninsured and twice as likely to have used the emergency room in the past year.

SOURCES:
U.S. Census Bureau. (2014). 2010–2014 American Community Survey 5-Year Estimates.

Professional Research Consultants, Inc. (2014). 2014 PRC Community Health Needs Assessment Report, San Juan County, New Mexico. Sponsored by San Juan Regional Medical Center & San Juan Regional Rehabilitation Hospital.

Taking Action

Collaborative partnerships between on- and off-reservation agencies are working to address disparities and stimulate progress.

Organizations across San Juan County are working to create a blueprint for addressing the ethnic disparities in income, employment, educational attainment, access to care, and exposure to environmental toxins. With increased focus and support, such partnerships may lead the way toward improved community health.

NOTE:
These baseline reports, created in 2016, reflect our initial observations on select community programs and initiatives to gauge ongoing, as well as newer, efforts to improve community health. Future reports will provide more in-depth insights and analysis into this community's activities.

New Mexico Health Equity Partners

The reach and focus of the New Mexico Health Equity Partnership offers a promising case for identifying and addressing disparities through cross-sector collaboration and community engagement. Through its local chapter, the San Juan Community Alliance (SJCA, formerly known as the Place Matters initiative), the partnership brings together individuals, organizations and resources with an emphasis on promoting cultural diversity and reflecting community voice and input.

Improving Built Environments

The San Juan Community Alliances Safe Passage Initiative Council, alongside Shiprock Health Promotion, Strides for Shiprock, Total Behavioral Health Authority, the Farmington Police Department and Planning Office, and other community partners, recommended and oversaw improvements to the built environment in its high traffic corridor based on their findings.

Safe Routes to School

Since 2009, the Safe Routes to School program has been developing action plans and allocating funding for non-infrastructure and infrastructure projects in Farmington to create safer, walkable routes to school, as well as continually tracking student arrival counts at participating elementary schools.

Indian Health Services’ Community Health Representatives Program

The Indian Health Services’ Community Health Representatives Program (CHRP) coordinates and trains individuals to serve local communities by providing health care, health promotion and disease prevention services. A community-based outreach program, CHRP provides training and funding to members of the American Indian community who are then tasked with reaching out to residents individually to address their most pressing health needs.

Going Forward

In the face of historic marginalization of the American Indian population and its resulting disparities in health outcomes, San Juan County is taking initial steps to address inequities through focused attention on root causes and cross-sector collaborations that respect Native traditions. Additional surveillance; data and information gathering; analysis; and reporting will determine the extent to which these initiatives address the needs of the community. The resulting data should help identify the most effective methods and partnerships and also help guide the community’s efforts and resource allocations.

Answers to the following questions could provide insights into the degree to which meaningful change is taking place and can be sustained:

What type of health outcomes may result from more health equity-focused partnerships?
How will these partnerships involve those directly affected by health inequities in addressing the structural causes of those inequities?
In what ways can partnerships between San Juan County, local municipalities, and Navajo Nation more effectively coordinate efforts to achieve positive outcomes both on- and off-reservation?
How can existing and future partnerships and initiatives better assess, address, and include the Hispanic population?