[Calming folk music] >> Daitz: New Mexico is the fifth largest state in our country, and it is overwhelmingly rural.

From the desert rock spires of the Navajo Nation to picturesque, isolated mountain villages to the rolling eastern plains and the arid oil fields of the southeast.

New Mexico has 33 counties, and 32 of them are classified as health underserved.

There is much poverty here.

There are not enough health practitioners.

And there are long waits for care.

Rural clinics and hospitals are threatened with closing.

There are federal cutbacks to Medicaid funding.

The so-called Land of Enchantment is in the middle of a health care crisis.

>> Richards: We certainly are very stressed with the ability to deliver health care in our state.

We don't have enough health care infrastructure or providers to be able to deliver services.

We don't have enough providers in rural areas.

There's not the same amount of support services for those health care providers.

But another really big problem in rural areas is that there's not an infrastructure.

So doctors, nurses, health care professionals of all types need health care infrastructure to work in.

So if there's no clinics or no functioning hospitals, then there's no place to recruit people into.

>> Daitz: Unfortunately, there are no quick fixes, but there is a solid framework to build on.

The everyday life conditions that affect health.

They are called the social determinants of health.

>> Kaufman: Social determinants are those factors in our community and our society which affect health.

But they're not medical care.

For example, transportation and housing, food, water, utilities, social inclusion.

And why is that important?

Because when you look at what actually affects health, about 60 or 70% of health are those social determinants.

And only like 10 or 20% are actually the medical health system.

>> Daitz: Many communities don't have the resources to address these social determinants of health.

But Doctor Kaufman had an idea, an idea borrowed from agriculture.

Agricultural extension agents in state land grant universities have traditionally brought university resources to help farmers and everyday gardeners.

Doctor Kaufman thought of using that same concept for health.

Why not have health extension agents?

They're called heroes.

Working with community partners to address social determinants issues.

Over the last decade, the Heroes program has grown to include a full time community representative in every region of the state.

The heroes' job is to link rural, urban and tribal communities, health and social needs back to the university.

But they also identify where resources are lacking and they work with local stakeholders to build those capacities.

Here are some of their stories.

[Up beat country music] The City of Raton has a little over 6000 people.

It's named after Raton Pass, where the old Santa Fe Trail brought early settlers to New Mexico.

It was a coal mining town, but the mines are closed, jobs are scarce and income is below the state's average.

There are few resources for young people, particularly if they're doing poorly in school.

If they were bullied, if they were in trouble.

The hero in Raton, Danielle Archuleta, introduced kids to horses.

>> Sanchez: She's an.

Alcoholic.

My mom kicks me out constantly.

I have nowhere to go.

So then I have to either hope someone will let me crash on their couch or find a hotel room.

>> Smith: I got on probation and I got into a little bit of trouble.

I was just not wanting to listen at all.

And I was getting into some fights at school.

They sent me to therapy, like with an actual therapist for a while, but that really wasn't something I needed.

>> Daitz: Danielle developed a model program in community justice, bringing Raton schools and community together to address the problem.

Danielle is the linchpin.

She connects the community.

So the juveniles range in a variety of different problems.

More things that we're seeing is fighting.

Sometimes there is assault or battery charges.

And part of our program is to provide case managers to them and to provide support to help them to make more positive decision making.

We are headed to Blue Sky Ranch today.

I'm so excited.

Blue Sky Ranch does great things for our youth, and today they are teaching kids life skills on the horses and they will also be teaching them how to support and take care of the horse and a lot of different skills throughout this horse camp.

>> White: The horses are a mirror to your soul, so they're working on empowering themselves, gaining confidence, learning about speak a new language.

Horses obviously don't speak our language, so they're learning an entire new being, which is amazing.

>> Hall: Their confidence goes through the roof.

We've seen kids who come in who don't want to even talk to us.

By the end, they're laughing and giggling with the camp mates they've made.

Our horses are our biggest teacher.

>> Conder: Danielle initially recognized her skills in the community.

We recognized that she could run programs and she proposed to us the JCC, Juvenile.

Community Corrections Program.

And then she became involved with UNM Hero.

>> Kaufman: I think this is incredible because your program we just saw is dealing with stress, in youths and anger, transportation, housing, community development.

And this is really where we should be going, should we want to learn from you?

>> Sanchez: Danielle is the one who introduced me to the program, and now I am working here.

Because of Danielle and Miss Donna allowing me to work here, get some money to live, and have a safe place where I can rely on and not have to worry about getting kicked out of every other day.

Or yeah.

>> Smith: Whenever I first started here, I really wasn't willing to like, do a lot of things.

And then I kept going and going and the horses have saved me a lot.

And now I'm here and I'm starting rodeo Queen and starting to be in the rodeos.

And this place has really, really, really helped me >> Danielle: With the University of New Mexico Hero project.

We're currently waiting contracts for the new fiscal year.

We are excited to continue and offer support to the community to advocate for the community.

We have received a really great contract in financial literacy.

Where the interns did a really great job today in their financial literacy workshop.

>> Kaufman: Danielle the hero, she knows the policymakers, the local county commission, and she works with all of them to develop the programs there.

And that's the other characteristic of a hero.

They have to not only be from communities and live in communities, they have to be folks who those like working with and can affect change because unless people are well known and respected locally, they can't bring people together locally to address the critical needs they have in these areas of social determinants.

[Light piano music] >> Daitz: Evelyn rising is a hero in Hobbs.

She's active in her church in organizing health care opportunities, and she works with the immigrant and the Afro-American community on housing and social justice issues.

Her latest project is developing a safe space where people can access a variety of helping resources.

>> Rising: This is called your safe space.

We created a building in the community.

And at one time it was called the Pink Hall.

And, it was where all the young people hung out and danced.

And this building was set abandoned for almost 40 years.

[Cheering] We still have crime.

We still have hunger.

We still have those who don't have needs fulfilled by the social services department.

Sometimes they don't know how to fill out the form or they fall right in their little category.

Or maybe they are dollar short, or they are a dollar over.

How do you work within those guidelines?

[Calm country music] You know, you have to ask questions.

You have to make phone calls.

You have to work with, all the other agencies to try to work together.

About ten minutes.

I'd be at your house in about 15.

Okay.

>> We're part of this state.

We've been contributing in this state for centuries.

So, you know, we have to ensure that we're pushing back on that tri-cultural myth, you know, that there's only the Anglo, Hispanic and native communities here.

We're part of the community as well.

[Uplifting piano music] >> Rising: We want the best for our state.

We live here.

We want the best for our state.

We're tired of the numbers being low when ypu reflect New Mexico.

We want them to rise.

We know that we're making a difference in, childhood education.

We want to make a difference in all the land.

It's important to house because if you remember, we are, I know people look down the nose at the oil fields.

But the oil field gardeners, 90 over 90% of the money for the state funded.

We want to just make sure a portion of that money comes back into the county, and that we can use it for our people.

[Uplifting piano music] [Rising exclaiming] >> Hi there, how are you?

[Upbeat piano music] >> Cargas: We are on our way to Northern New Mexico College because the deputy secretary of the Higher Education Department and I are traveling to all the institutions in the state to talk about the problem of food and housing insecurity that we have uncovered among our students and faculty and staff.

>> Sanchez: There's this perception that the hungry college student is normal, and it shouldn't be normal.

We shouldn't accept that skipping meals is just part of the college experience, because it's taking a toll on the students lives.

>> Gonzales: With my food allergy it's usually rice and beans that I'm making in my dorm.

>> Trujillo: It's a really ubiquitous program across, most campuses.

And the reality for the state of New Mexico is that our data that we just collected is pretty bleak.

It shows that about 1 in 3 students in the state of New Mexico suffer from food insecurity.

About 1 in 3 suffer from housing insecurity.

And in the year that the study was done, about 14% of college students in the state of New Mexico, had experienced homelessness.

>> Sanchez: I've lived in four different homes since starting college.

I've lived in the dorms.

I've lived with my uncle.

I've lived with my parents.

And that is as much housing insecurity as being homeless.

I am food insecure because I regularly skip breakfast.

I am food insecure because I don't have time to cook healthy meals.

So I just get fast food.

>> Rodriquez: I would just eat once a day so I could save money on that.

I could get as many calories as I could during that meal so I could get like my calories for the day.

>> Kaufman: What they found is there is a correlation between those who have insecurity with food and housing have very high rates of dropping out, not finishing school.

The majority of people who drop out of college is not because of academic failure.

It's because of lack of resources to pay for these basic social determinant needs.

>> The government has really cut back in its funding of higher education.

So it is really harder for today's students.

Many are below the poverty line.

60% of our students work.

>> Kaufman: So what do we do?

>> Today we're asset mapping.

We're talking about what institutions have already been able to do.

HRD has been able to provide, through funding provided by the Governor's Food Initiative, over $2 million in food security grants to over 20 higher ed institutions.

We've been able to give over $2 million in mental and behavioral health grants to over 20 institutions.

>> Cargas: We want to encourage leadership to take a new approach to taking care of people in our communities.

It's of crisis proportions.

>> Daitz: Francisco Ronquillo is a hero working on many projects in central New Mexico, including a peer support program where a group of UNM students are being trained to help fellow students who are experiencing food and housing insecurity.

>> Ronquillo: The idea is to have this conversation, an informal conversation with the students to present the findings from this basic needs survey that was done with these 27 institutions across the state.

Our solution, or idea of responding to this need is to train university students as community health workers.

Have them become certified community health workers through the state, and be able to help their peers navigate social issues and be able to connect them to the community resources.

If it's food insecurity an issue, if it's housing or if it's transportation, so that they can have the information and be able to share it with their peers and connect them to the needed services.

>> Perkle: I think it definitely helps with individuals who are within the community, like peers, just talking to one another.

>> Dixon: I do think for something like this to work there would have to be some sort of pay element for the students, because I think a really big struggle, one of the reasons why I had to leave school was because I had an opportunity to be able to afford my rent.

>> Wells: I think that there's a lot of students here on campus who want to, like, be in their community.

They have this calling for helping their peers, and I think that that would be an excellent way for them to get into their community and show their support and again, help their peers.

>> Daitz: Professor Cargas and Secretary Trujillo have spread the word in New Mexico and nationally about food and housing insecurity.

At Northern New Mexico College, there is now a farm in the middle of the campus, providing fresh produce for students and staff.

>> Muniz: Our vision, our idea is that a social determinant of health for this region is acequias flowing corn growing and chili producing, and then all of this produce is gathered and harvested primarily by our student body volunteers, by our food pantry staff.

And then they process it and distribute it out through the student staff and faculty body at northern.

>> We need to educate students that they're not alone, because we know there's a huge amount of stigma and they suffer in silence.

So education is fundamental to what we do, and then to build resources and also to convince higher ed that dealing with food and housing insecurity is something we should pay attention to.

We can do something about it in higher ed for our community.

[Uplifting country music] >> Daitz: Like so many small towns along the interstate highways, gas, food and lodging are Santa Rosa, New Mexico's calling cards.

Chantel Lovato was born and raised here.

And she's Santa Rosa's hero.

And she knows her community, its people, and its problems.

She's working on economic issues like revitalizing downtown, affordable housing, and helping an enterprising citizen to open a great restaurant.

>> Lovato: It was a place like for business incubation.

You know, where we could bring in a business, and help them get started.

Let them test out the financial feasibility of it.

And so I think we also see it as a place of community gathering.

We're doing some work right now with New Mexico Main Street so that we can kind of help our community grow in the downtown area.

You know, you can have a community gathering space, but then you can also walk across to the small business.

It feels like a walkable, safe area.

So we're looking at doing some crosswalks in this middle area here.

>> Campos: The Community Development Corporation, which she has also is the Main Street organization for our community.

So there's a lot of -- business support.

There's grants and such that she administers for facade improvements of businesses, events planning, local development for the local businesses.

So that's really where she's able to bridge together her heroes work with her community development work and her school board work, and it's all like symbiotic.

>> Lovato: So now we're at Chico's.

This was one of the first projects that I actually worked on when I was hired.

All things are related to health, so including economic development.

And so we had identified that this family had moved to town and had been in the restaurant business, and we had this vacant building, you know, that was set up as a restaurant.

And so one of the first things that we did was we brought this family in and we were able to put them in this building kind of as a business incubator.

We did a reduced rent price for them.

They were able to bring the building back to life.

also creating financial support for this family to stay in our community and be a part of it and create a healthy lifestyle for them.

So with that comes housing and all of the obstacles that small communities face.

And so, you know, I'm really proud that this family has been in this building for as many years as they have.

It's bigger than just saying, oh, I help people with social determinants of health.

You know, heroes are people who live in those communities, who love those communities, who know their neighbors.

I think heroes are essential.

An example of how our office and our heroes, along with our other programs, identify a deficit and try to build a resource in those communities that don't exist, is earned income tax credits.

What is that?

That is the largest poverty reduction program in the United States that many people don't know about.

>> Hardy: So this is another one of our volunteers.

>> Daitz: Monique Hardy is a community health worker.

She lives and works in Albuquerque's International District, a community where recent immigrants and poverty coexist.

>> Hardy: You're here at our Whittier food hub.

We have three sections right now.

We're in our cafe, so we utilize some of our fresh fruits and vegetables, especially when it's harvest time.

And miss Eliana here will make these awesome meals for our families to come in and eat.

We also have a section where you can get free clothing and household items, hygiene stuff.

And then we also offer non-perishables, fresh fruits and vegetables.

>> Daitz: Jharlyn Angle-Mejia here is and she is also a partner hero working on financial literacy education in both rural and urban communities.

>> Angel-Mejia: So Monique is doing many things to help boost community's health.

She's also dealing with some family things.

She has six kids.

Her and her husband were married for 25 years.

Her husband passed away January of this year.

They raised six beautiful children.

Two of our children just went off to college.

>> Hardy: So that's my son, Diego.

>> Angel-Mejia: She has one child who has a disability.

She is the primary caretaker for that child.

She's been navigating single parenthood.

I think she's doing it very graciously, doing it very well.

>> White: New Mexico is one of the greatest states in the country for financial need.

For example, we have the fourth highest rate of citizens who are unbanked, meaning that these are people for one reason or another, that don't feel comfortable engaging the banking system, engaging the financial system, engaging the credit system.

And here in New Mexico, things like the earned income tax credit are important.

And this allows families, particularly low and middle income families, to receive a substantial tax credit that varies depending on the number of children that they have.

They spend that money on improving the welfare of their children.

And so this is a multi-generational improvement.

>> Daitz: So Danielle and Jharlyn are bringing a symposium on financial literacy and the earned income tax credit to Raton and other rural communities around the state.

>> Angel-Mejia: The earned income Tax Credit is a credit for families who are working, but are living below the federal poverty level.

Basically, any individual who's worked, even if they only earned a dollar, is entitled to a refund through this credit.

The essential part of this is by doing this work, we get people this money back that can then be used back into their communities, boosting their local economy.

One of the innovators that's a hero is a couple, Zach and Mary.

Ben, there on the Navajo reservation, and he became very interested in farming.

What they noticed is that there's real problems in accessing natural foods.

You know, many people get their foods by commodities which are not very healthy.

And the idea of grow your own food, not just naturally, but also using traditional foods that were grown by the Navajo to make it into an economic development site.

So they formed, company Bidii Baby Foods, and they use traditional grains and they make baby food out of it.

>> Ben: The average person on Navajo Nation drives about 50 to 70 miles one direction to access food.

And then once you get to an access point, most of the time the food is not very nutritious.

It's a lot of, you know, processed foods, and they often don't keep very well, too.

So if you were to go to Bashas' on your way out here in Shiprock, this Bashas' in Shiprock is the last stop on the delivery route.

So if you go to get strawberries and blueberries and things like that, they're going to be spoiled at the point of sale.

Where are we going, Zach?

>> Ben: Hey, we're heading on over to the Bidii Baby food farms.

We're going to go and teach the community how to collect corn pollen.

Why we do that?

The cultural significance of that out of there for the culture.

We use corn pollen as a connection to our deities.

>> Bex: We have seven different recipes we're going to be doing today.

And each table is going to.

Be like a, quote unquote, cooking station.

So this is where the Navajo breakfast scramble is going to be.

About 75% report some level of food insecurity.

And so it's important for me to encourage my community healthier, but also to address food insecurity.

This event is kind of a way to address that in a fun and interactive way to help families get to know what all this is about, and how easy it is to kind of incorporate healthier foods without making it too complicated with making it a little bit more approachable.

The best way to learn how to cook healthier is to do hands on.

>> Ben: A lot of, sharing of, you know, ancestral knowledge, current knowledge, of course, talking about our initiative as Bidii Baby foods and sharing all of these conversations, sharing all of this wisdom over some, traditional foods.

>> Daitz: Wendell Berry, the poet and philosopher, wrote “The community in its fullest sense, a place and all its creatures is the smallest unit of health” For the heroes program at the University of New Mexico, the community is also the most important unit of health.

Our communities support the everyday life conditions that affect our well-being.

Those vital social determinants are income and employment, education, a healthy environment, and good nutrition.

The availability of medical care and social connections.

Our health care system needs help and heroes.

Starting with the social determinants of health are connecting the resource office of the University of New Mexico to communities in every corner of the state.

[Heartfelt western music] >> Daitz: Hello and welcome.

My name is Ben Daitz, and my colleague Bob Behlendoff and I produced, Heroes for Health, the documentary film that you guys just saw.

We hope that you'll be interested in this follow up discussion about the issues that the film raised about health and health care in New Mexico.

I'm fortunate to be joined by a very knowledgeable group of folks to talk about these issues.

And so, without further ado, let me introduce them.

On my left, My old friend, Doctor Arthur Kaufman.

Art is the distinguished professor of family and community medicine at the University in New Mexico.

He's the founder of the heroes program.

And, he's now the vice president for community health at the University.

Doctor Julianna Reece is from the Navajo Nation.

She's been a family practitioner for many years in rural practice.

She was the chief of the Albuquerque office of the Indian Health Service.

And she was the director of the Healthy Tribes program for the centers for Disease Control.

She's now, the director of community engagement in the Office of Community Health at the University of New Mexico.

And Fred Nathan is an attorney and the, founder and director of Think New Mexico, which is a think tank, that produced a very valuable document last year about the shortage of health workers in New Mexico.

Christina Campos welcome.

We've known each other for a long time.

You were a community organizer, a community health organizer in Santa Rosa, and you stayed with the job and ultimately became, the, CEO of the Guadalupe County Hospital in Santa Rosa.

And last year, you were appointed a regent, for the University of New Mexico.

Welcome, Christina.

And Art I'd like you to tell us a little bit more about how the heroes program came to be and why you concentrated on the social determinants of health.

That were discussed in the film.

>> Kaufman: Thank you Ben.

You know, it really did begin with an understanding of social determinants.

And what social determinants are, are the non-medical factors that affect health like housing, transportation, food, education, income, social inclusion, all of those factors that have such a profound effect on health.

And, you know, it was interesting, when you look at New Mexico as a state, you realize, oh, we have the fewest resources of any of the 50 states to address those social determinants.

We're unique.

And, several years ago, the University Hospital and First Choice Community Health Centers wanted to know what is the magnitude of these social determinant problems among our patient population?

And we actually screened about 50,000 patients, over a year.

And we found that half had at least one adverse social determinant.

Half of those had more than one.

Some had 5 or 6.

And what was remarkable is these very important influences on health were mostly unknown to the doctors and nurses and clinics.

Why?

We don't ask those questions.

So it was very important that we disseminate this information.

And in fact, state Medicaid University hospital has built up a resource around community health workers in the clinics, in the hospital, not just to screen, but to actually intervene.

And help navigate patients to the resources they need to address social determinants.

The problem is that when you look around the state, you don't have all of those resources, especially in rural areas or urban underserved areas.

If you look, for transportation, there is no public transportation in most rural areas.

There's no Uber.

When you look at food deserts, health service deserts, you are filled with gaps in the ability to address these very, very important, impacts on health.

How big an impact?

As it turns out, the, if you look at all the money we put into health and social services as a nation, about 90% of that dollar goes to the medical system, the medical care system.

The medical care system affects 20% of health.

It's important, but it's 20% of health.

When you look at the amount of dollars in that same health and social dollar total in the United States, that goes into social determinants, prevention, social services, 3%.

3% affects 60% of health.

So our feeling was, wait a minute, how do we develop some kind of system that would help our health care system by addressing social determinants.

And that's where the idea of health extension came.

Because who are these health extension agents?

They live in the communities served.

They, are usually popular.

They are trusted.

And they work with other community members to help set up the resources that don't exist in any of those social determinant areas at the, leadership of the local community.

And, the university gives resources to help them, do this work, but they can tap into the university's resources as well.

And finally, these health extension agents give voice to the community's needs, and they make them very popular for funders like the universities, like, state agencies and others.

And through this role, most communities know what their priority health needs are and social needs.

Most communities have leadership that could develop this.

Most communities have a very good set of assets that could be built upon, but they may not have resources.

They may not have the technical assistance they need.

And that's what the heroes do.

That is the role of heroes.

So I think that this program touches on that very needed area in this state that complements the health care delivery system, and it makes it more robust.

Christina, Santa Rosa has had a hero in, Chantel Lovato.

She worked on housing.

She worked on economic development.

Tell us a little bit about how that's affected your community.

And in your role as the CEO, the former CEO of the Guadalupe County Hospital.

How did that affect health care in your community?

Well, you know, it's hard to overestimate or to exaggerate what an impact she's had on our community.

I'll take you back farther.

I'll take you back.

30 years ago, for my experience at, getting involved as a volunteer within the community, trying to keep my hospital open, partnering early on with the University of New Mexico and, University medical School, especially, and University Hospital, just to keep my hospital open because of the importance to our economic survival.

Just having a hospital there.

That started off in 1993, and I did, get to serve on the hospital board at University Hospital for a period of time and then went back to my community and became the CEO of the hospital in 2004.

So I was really, you know, like, focused, primarily on my hospital and the survival of my hospital.

And yet there was so much more work to do outside the hospital.

I didn't have the capacity to do that.

I couldn't be cloned.

Everybody else was busy working.

And in rural areas, it's really difficult to identify people who are capable of fulfilling the role of a hero.

I was fortunate that the university established a program and brought funding to that program and was able to identify Chantel Lovato, who actually a high school, classmate of my oldest daughter, and she is in many ways my protege.

She's almost like, like a daughter to me anymore.

And has taken it so much farther than I could have taken it myself.

Whereas I focus primarily on health care and partnering with the local primary care clinic to keep that 20% or small percent of health care available in my community.

She has expanded it into other areas.

Economic development, you know, community safety programs with better lighting and streetscapes.

She's worked with small businesses.

To do, employee development.

Chantel has just been, remarkable.

So it's so much bigger than what I started off with.

Back in 1993.

>> Daitz: Juliana, We saw, a segment about Zach and Mary Ben, who had started a program to try to address nutritional, you know, problems on the Navajo.

Talk to us a little bit about about what the problems are, how folks are trying to solve them.

Your experience as a family doctor?

>> Reece: Yes.

Thank you.

Let me back up first and just do a quick, traditional introduction in Navajo [Diné language] Juliana Reece, yinishyé Tábaahá nish'i'' Tsé Nahabi'nii bashishchiin Kinyaa'áanii a dashicheii dóó Ásh''hi a dashinali' Tséhootsooí naashá Ákót'éego asdzáán nishli I say that because I know I have a number of folks that in the community that will be watching this, and it's very important to be able to identify where you're from and, how you connect to the community.

And that ties into for a lot of the reasons why I went into medicine and why I'm sitting in this chair today.

There's a lot of discussion about the staggering statistics in Indian country across the nation, but there's not a lot of discussion about the resilience, the strengths the indigenous determinants of health that have really been at the root of, having our communities not only survive, but thrive.

When you talk about Zach and Mary Ben, they're doing incredible work, in this sort of food insecurity.

lane.

And you always hear this, concept of a food desert and yes, there are, definitions of a food desert, and we can't identify many food deserts in areas in New Mexico.

But when you look at it from a flip side, we are full of nourishing foods and traditional foods and indigenous ways of living that have been erased and have been eliminated.

And so reclaiming those types of practices are really important.

And that's what Mary and Zach Ben are doing.

>> Daitz: Thank you, Juliana.

Fred, one of the social determinants, is access to care, good access to health care.

And think New Mexico did, I think, a very comprehensive report on why we're losing health care workers around the state?

Can you can you tell us about what that report says and what your recommendations are?

>> Nathan: Sure.

So, there's a lot of good data out there.

And so first we just kind of looked comprehensively at the problem.

And, you know, the film did a very good job of pointing out, for example, that statistic about 32 out of 33 counties in New Mexico, are experiencing severe health care shortages.

Which illustrates this is not just a, rural problem.

It's a statewide problem.

Other studies that we came across, for example, New Mexico is the only state that's lost doctors in the last five years, 248 meanwhile, nationally, the number of doctors has gone up by about 44,000.

So while we've lost 8% of our physician workforce, the number of doctors nationally has gone up 7%.

So which isn't to say there aren't shortages in other states, but it's the most severe in New Mexico.

And then we have the statistic that 39% of our physician workforce are 60 or older.

We have the oldest physician workforce, in the country.

And this just underscores how urgent it is that our elected officials need to address this healthcare worker shortage.

In terms of recommendations, we came up with a report in September of last year.

That made ten major recommendations.

Of those, five have a legislative component.

They've all been introduced this session and will be considered three have to do with the doctor shortage, the other to address.

We have shortages in every health care category.

So it's not just doctors, it's nurses, physician assistants, psychologists and so forth.

So in terms of the doctors, the number one issue, when you talk to doctors as to why they're leaving the state or retiring early, it's about medical malpractice and the cost of our premiums, which are about double, what most states are paying.

And this is because we're number one in the number of cases filed per capita, and we're for the last 12 years, consistently above the national average for these larger cases that are $500,000 and above.

So, not surprisingly, our medical malpractice premiums are also quite high.

For example, OB GYNs and we have a shortage of those all across the state.

Those premiums are about double of our neighbors.

Andy Metzger, a local neurosurgeon, left the state, and he testified on our med mount bill last year that when he moved to Arizona, his medical malpractice premium was one fifth of what it used to be in New Mexico.

So to address this, we we've really zeroed in on punitive damages.

We have the lowest standard for proving punitive damages in the country and no cap on punitive damages.

So our bill would raise the standard of proof, from a preponderance of the evidence, which is a very low standard to clear and convincing, which is what 32 other states do.

We'd also cap punitive damages.

We'd also there are a lot of things that need to be done to balance out our medical malpractice law.

Another example is attorneys fees.

We don't cap attorneys fees, but when we look at other progressive states, they all cap attorneys fees.

Why?

Because it's a it's a zero sum game.

The more that goes to the attorney, the less that's left to the patient.

And at a fundamental level, with any medical malpractice system, we're trying to make those patients whole.

And that's hard to do when the lawyer's getting 40% or 35%.

So that's that's one issue to help to attract and retain more doctors.

A second issue is to repeal the the tax on medical services.

New Mexico's the only state that taxes medical services.

And then the third issue that we hear about over and over again from doctors as to why they leave the state or retire early, is our low Medicaid reimbursement rates, despite the fact that, I have to say, our legislature has moved to heaven and earth to try to bring those rates up.

But still, doctors say in many instances, they're losing money on every Medicaid procedure that they perform.

Now, with other health care providers where we also have shortages, the single most important thing our elected officials can do is to join all ten of the major health care compacts.

It's like the driver's license compact, where you get licensed in one state, and the other states recognize that most states are in most compacts.

But New Mexico, unfortunately, is in just one of those ten compacts.

And then the final issue is, loan repayments for health care providers.

36 states now do something to address this crushing debt, for example, doctors, I think the average debt load is like $235,000.

So, the legislature has a bill that we support to increase from 14 million to $25 million to help some of these providers, not just doctors and nurses and others are included, but that only helps us to attract these health care providers.

It doesn't help us to retain them.

And that's why, for example, the medical malpractice reform bill is so important because that will help us create a different environment, a more welcoming environment for our health care providers.

>> Daitz: You know.

New Mexico is a rural state, and one of the, great points about the heroes program is that the heroes are mostly in rural areas.

Art, tell us about what the problems are in rural New Mexico.

How can we how can we get more providers there, health care providers of all stripes?

I think if there hadn't been physician assistants and nurse practitioners, in this state during the Covid epidemic, the whole system would have crashed.

How can we remedy that?

You know, those those particular problems.

>> Kaufman: If you look at the data, what it shows is, remarkable, difference between who comes into, let's say, medicine.

It's similar for nursing and pharmacy.

If you come from a rural community in New Mexico and you go to high school in a rural community, and then you go to college in rural, any state school in New Mexico, and if you go to the University of New Mexico and you stay for residency here, your likelihood of staying in the state and going to a rural area to practice is like 3 to 4 times as high as if you come from another state.

Wait a minute.

So that means if we invest in getting kids excited about health careers, which is the number one employer nationally now, it's good careers to stay in school that provides benefits and then goes to any health career in any of our colleges.

Profound effect on us.

The data shows that why aren't kids going through college?

You know, some of the colleges graduate as low as 13% of their entering students go through the highest one like university of New Mexico, New Mexico state, New Mexico Tech, 53% graduate in six years.

Oh, wait a minute.

That loss is massive.

And as it turns out, it's not because of academic failure.

It's because of lack of social support.

So and you see a bit of that in the documentary.

So we can invest in keeping kids in high school, keeping kids in college, not just focusing on, academic success, which is important, but giving them the support they need to get through, because we know that is the secret sauce of making sure if, Fred Nathans work with the legislature is effective.

You also need to have the right people going into health careers.

So that's absolutely critical.

The other part of this is that we are it's like leaving on the table the role of higher education.

When you talk about social determinants, It's not just health.

Parts of our colleges and universities.

Every single college, in every single department and every college has a role to play.

And something that, was in that film and that you pointed out, Christina, is so important that if you look at law school, if you look at architecture, transportation comes out of the experts there in engineering and, arts and sciences.

They were actually all or parts of them were all in that documentary.

We have to mobilize higher education to be a partner with us if we're serious about health.

So it's who we bring in, but who trains them and who helps us in the broader aspect of health, not just importantly, but not just the number of health providers, in each category.

>> Daitz: Julianna, in in Indian country, what are the problems in terms of recruiting health practitioners, to serve on the Navajo and in pueblos?

>> Reece: I think it's similar in tribal communities across rural New Mexico.

You have, rural populations that just don't have access to the same types of resources that, folks do in the urban areas.

You can't just go and cherry pick a few promising students from a class.

You really have to be present in the community.

You have to mentor kids from a young age, and you have to instill ideas for, what could be, careers for them in the future and instill the idea of them actually coming back in and supporting that whole network.

One of the things that one of the stories in the film was about, and I think a fairly dramatic one, was about the fact that 60% of students at UNM are housing insufficient or food insufficient, and that relates, to, financial literacy as well.

That whole concept.

Fred, you were talking about the fact that your organization is trying to do something about financial literacy, introducing it in high schools.

Can you tell us fairly quickly about that?

Sure.

>> Nathan Jr: So the legislatur two years ago that allowed every school district, the 89 school districts in New Mexico, to have two local credits.

And we think that financial literacy is probably one of the most effective anti-poverty strategies.

And so it's just critical to get students information about budgeting savings, how banks work, how credit works, investing.

And so we went to all 89 school districts, talk to superintendents, talked to school board members, and persuaded 49 districts have now made financial literacy a high school graduation requirement, for all their students.

>> Daitz: Art, the social, the heroes Art, the social, the the heroes program, the social determinants of health that are being emphasized was developed here.

It's really, I think, a model program.

What do you see as the future of that program, not only here in New Mexico but nationally?

>> Kaufman: Now, we've always been kind of the primary, lead in this, along with several states.

Now there's 17 to 20 states that are using this.

And it's not just the pleasure of having a model disseminated.

We're learning from each other.

And I think when you create a national movement, and especially with health extension, because the major models at this time are not coming out of Washington, they're coming out of the states and states are learning from each other.

And I think if we continue to build this model and we can link with, 100% community, we can link with our Department of Health, health promotion specialists.

We have lots of partners.

We could work with and develop this not just as a state, but as a state leading a national movement and learning from our partners in other states.

>> Daitz: Fred, why don't you.

Why don't you tell us how how.

Folks.

Can get involved?

I mean, this this all comes down, I think, not just to legislators, but to citizens, in their communities trying to make a difference, trying to improve the health and health care for all New Mexico.

>> Nathan Jr.

: You're absolutely right.

Its critical for the public to engage with their elected officials.

And if they want, they can go to our website www dot think New Mexico think New Mexico written out is one word.org.

And on the home site press on, take action.

And you don't even need to know who your legislator is.

If you just type in your address, the computer figures it out for you and you don't even need a stamp.

And we have pre-scripted letters on all five of those issues that I outline.

I always encourage people we have no pride of authorship.

They should delete that and put in their lived experience how difficult it is in their community.

Perhaps to find a doctor, or if they have a doctor, how long it takes to get in to see that doctor.

That's what legislators need to hear about.

You know, the film and the documentary that you saw ended with a quote from Wendell Berry, who is, a farmer philosopher, a very, very wise man who said that communities are the smallest unit of health.

And that's really true.

I think communities and the citizens within those communities have to advocate for better health and for better health care in New Mexico.

So we hope that all of you who are watching this program, take that to heart and and be your own heroes in your own communities.

Goodnight.