Community Context

San Juan County, with Farmington as the county seat, includes many rural areas and natural infrastructure including the confluence of three rivers, volcanic structures, buttes, and mesas. The self-governing Navajo Nation occupies approximately 60 percent of the land in San Juan County. The largest local industries include mining and natural gas extraction, as well as retail and healthcare. The extraction industry has been declining over a decade and has resulted in legacy issues of severe environmental contamination, particularly on parts of the Navajo Nation. The industry’s decline has left many residents unemployed and living in poverty. Stakeholders in the county are attempting to rebrand the county’s economy to include advanced manufacturing and outdoor recreation-based tourism. Economic development has been the top priority for local politicians, which have been politically mixed at the municipal and county levels in a state that has trended Democratic in recent years. There have been clashes within the county and with state officials over a planned transition to more renewable energy and COVID-19 mitigation efforts, among other issues.

Major health concerns in the community include diabetes, obesity, alcohol-related and mental health concerns, particularly among Diné and Latino residents. Lack of transportation, high rates of health uninsurance, and severe healthcare provider shortages contribute to the disparate burden of disease and poor health outcomes among these groups. COVID-19 also disproportionately impacted people within the Navajo Nation, accounting for many of the cases in San Juan County and the state of New Mexico over the course of the pandemic.

San Juan County’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, leadership for health and well-being has been distributed across the local health system and some larger local nonprofits, in addition to some economic development organizations.

Stakeholders in San Juan County were working on several initiatives to support well-being of community residents in 2017, focused on positive health behaviors, mental health, and environmental justice, many of which have continued over the past five years. New efforts have been initiated with a focus on addressing issues across sectors such as educational attainment and economic transition. Regarding the health narrative in San Juan County over the past five years, mental health has been solidified as part of a more holistic conceptualization of health, while attempts to reimagine the local economy have also become more connected to health and well-being. Attempts to address health equity in San Juan County have continued to be challenged by ingrained racial and political tensions, though the past five years have seen the issue being addressed by a broader set of partners.

Lessons Learned: Where is San Juan County Five Years Later?

San Juan County’s journey to promote health, well-being, and equity is one that illustrates the challenge that a lack of resources and cross-sector collaboration can present. Cultural and political divisions have also inhibited the development of shared values around health, well-being, and equity, suppressing civic engagement, and open dialogue. However, a shared commitment to improving access to mental health and the ability of the community to capitalize on its natural assets have been bright spots. Other communities can learn from San Juan County’s approaches to make these changes, as well as the challenges they encountered, to inform their own journeys. And as COVID-19 recovery continues—with historic funding flowing to local communities—future research could consider the ways momentum around health, equity, and well-being influences community health narratives and decisions moving forward.

San Juan County has leveraged its informal networks and connections to culture and environmental assets to begin to establish a new vision for health and well-being in the community. However, its rurality, limited financial resources, and cultural and political tensions continue to stymie efforts.


  • Federal funding for health and wellness

  • Informal partnerships and personal connections

  • Cultural connection to the land

  • Economic transitions presenting opportunities for a new community vision


  • Geographic diversity and expansiveness

  • Cultural and political differences presenting barriers to shared dialogue 

  • Limited philanthropic support

  • Lack of formal cross-sector collaboratives for health

  • Economic decline and population loss