Honoring local knowledge, growing health, and improving equity

A group of kids hold up the peppers they helped grow.

Honoring local knowledge, growing health, and improving equity

Presbyterian Hospital - New Mexico
This metropolitan health system supports local agriculture, food access, equity, and economic development through community supported agriculture, a mobile market, and a wellness referral center.
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  • New Mexico is ranked 37th in the country for overall health and often has some of the worst rankings for social indicators of health, including rates higher than the national average for poverty, low food access, and food insecurity.
  • Presbyterian Hospital is involved with three innovative projects focused on improving food access and health equity, made possible by their community benefit investments and cross-sector partnerships:
    • La Cosecha Community Supported Agriculture 
    • Healthy Here Mobile Farmers Market
    • Healthy Here Wellness Referral Center
  • Presbyterian’s food-related work is part of a system-wide effort coordinated by their Center for Community Health. The center has grown from one staff person to fifteen within the last five years, demonstrating the health system’s strong commitment. 
  • The Center for Community Health has leveraged over $12.5 million in funding to help sustain their community health improvement work. 
  • Hospital Name: Presbyterian Hospital 
  • Hospital Type: Private, nonprofit; critical access 
  • Hospital Size: Large (453 beds)
  • Geographic area: Metropolitan
  • System/Network: Presbyterian Healthcare Services (PHS)
  • Network coverage: New Mexico 
  • Black: 2.8%
  • American Indian & Alaska Native: 4.42% (as compared to 0.82% of U.S. population)
  • Asian: 2.35%           
  • White: 71.74%1
  • Community health needs assessment region: Central New Mexico (5-county region that includes Bernalillo County where Presbyterian Hospital is located)       
  • Population (Bernalillo County): 671,429
Health indicators
  • Obesity: 20.3% are obese
  • Diabetes: 6.2% have diabetes2
  • Food insecurity: 15.4% experience food insecurity3
  • Low food access: 22.86%  experience trouble accessing food4  
  • Poverty: 18.59% experience financial instability5
  • Unemployment: 5% experience job insecurity6

Albuquerque sits in the high desert straddling the Rio Grande River. It is the largest city in New Mexico, but despite the predominantly urban setting, there are still many areas with limited access to grocery stores and a lack of affordable produce. These factors contribute to the low rates of healthy food access and food security and the resulting high rates of chronic diseases like diabetes and heart disease. 

However, the burden of these community health problems is not equitably shared. The South Valley and the International District of Albuquerque are two areas of the city with the highest rates of poverty and health disparities. Presbyterian Center for Community Health is working strategically in these areas to develop innovative approaches to addressing the most pressing health needs in the community. 

Presbyterian Healthcare Services (PHS) is the largest health system in New Mexico and has eight hospitals and thirteen primary care clinics throughout the state. Based in Albuquerque is Presbyterian Hospital (Presbyterian), the system’s flagship hospital and the largest acute care hospital in New Mexico.

Part of what makes Presbyterian’s efforts successful is identifying and leveraging existing community strengths. The International District is the state’s most diverse legislative district and is known not only for its diversity but also for its great food. The South Valley region has a long history of farming culture and this case study highlights the partnerships between farmers and health professionals that are improving food access for the community.

New Mexico food access and security stats
These charts illustrate food insecurity, income, and other social determinants of health based on a Community Health Needs Assessment conducted for the area.



Community health needs assessment: Priorities and process

  • Food and diet-related disease priorities
    • 2013 CHNA - healthy eating
    • 2016 CHNA - healthy eating
  • Participation from food-based organizations in CHNA process
    • Kids Cook!, ICAN Program (Ideas for Cooking and Nutrition) at the New Mexico State University Cooperative Extension Service 
  • How/why did food issues emerge as a priority?
    • In the 2013 CHNA, healthy eating was prioritized as a root cause of health. It continues to have a significant impact on the health of communities throughout New Mexico and was prioritized again in the 2016 CHNA.
    • Food insecurity is the primary barrier to making progress on this healthy eating strategy. Therefore, specific focus areas within the overall strategy include: improving food access, supporting growers markets, and changing policy.
  • Key community indicators
    • Nearly one in four people living in Bernalillo County have trouble accessing food. 
    • New Mexico has a higher-than-average rate of food insecurity, especially among children: One in three children is food insecure.

Full assessment: Presbyterian’s 2016 Community Health Needs Assessment for Central New Mexico

Assessing health needs — and how to meet them

Community health needs assessment process

Presbyterian has been working actively to address community health needs that fall outside the scope of traditional medical care since 2013. One example is the health system’s implementation of New Mexico’s Child and Adult At-Risk Feeding Program and the Summer Feeding Program. As part of these programs, Presbyterian Hospital is one of five hospitals in the state where community members can walk-in and receive a free meal in the cafeteria. The program at Presbyterian Hospital served 2,000 children last year, demonstrating the immense need within the Albuquerque community that Presbyterian is stepping up to fill.

In 2016, the health system formalized this focus on community health improvement by establishing the Center for Community Health. The center is based at Presbyterian Hospital in Albuquerque and organizes the entire health system’s efforts to address the health needs of underserved populations through funding, programmatic support, and cross-sector collaborations. Leigh Caswell is the Director of Presbyterian’s Center for Community Health and oversees a staff of fifteen. The growth of the center from one staff person to fifteen demonstrates the health system’s strong commitment to addressing the social determinants of health. 

"In New Mexico, many families experience food insecurity. At Presbyterian, it is our purpose to improve the health of the patients, members, and communities we serve. Part of this mission is to help members of our community who face barriers in accessing basic supports needed for good health.”

- Leigh Caswell, Director of Presbyterian’s Center for Community Health

One specific function of the center is to coordinate the community health needs assessments (CHNA) and implementation plans for the counties where their hospitals are located. In 2016, the center coordinated six CHNAs which involved covering health assessment for much of New Mexico. To meet this challenge, they used the state’s non-traditional health department structure to work in their favor and succeeded in creating a streamlined process that draws more directly on the communities experiences.


Joseph Alaro from Valle Encantado Farms. (Healthy Here PR at CWA Communications)
Joseph Alaro from Valle Encantado Farms. (Healthy Here PR at CWA Communications)



New Mexico is unique in that it does not have county divisions under their state health department. Instead, there are 38 county and tribal health councils whose primary role is health assessment and planning — including informing the individual counties’ community health needs assessments. Working with the councils on the CHNA process not only honors local expertise but also it allows for community input to be gathered more thoroughly at the county level.

In Bernalillo County, where Presbyterian Hospital is located, the assessment process was part of a larger “Central New Mexico Community Health Needs Assessment.” To inform the development of the Central New Mexico CHNA, the center contracted with nine county health councils. They compensated each council $5,000 to identify significant health needs in their respective counties. The methods used by the health councils varied. For example, the Bernalillo County Community Health Council conducted meetings and sent out surveys to solicit input from community members and public health experts. 

The Center for Community Health then consolidated and prioritized the identified health needs by considering which contribute most significantly to chronic disease, injury and mortality, poor health and quality of life, and high health care costs. 
The resulting priorities from the 2016 Central New Mexico CHNA included: 

  • healthy eating
  • active living
  • and prevention of unhealthy substance use 

While all nine health councils identified food and nutrition in some form, the Bernalillo County Community Health Council specifically called out “access to affordable healthy food” as a priority. This focus on access, as opposed to behavior also plays a part in the implementation strategy, as well as in the projects highlighted in this case study.

Five generations of the Baca family have farmed in the South Valley of New Mexico. (Healthy Here PR at CWA Communications)
Five generations of the Baca family have farmed in the South Valley of New Mexico. (Healthy Here PR at CWA Communications)


Investing in solutions

Implementation strategy

The Center for Community Health also relies on the health councils during the process to develop implementation strategies (comprehensive plans that accompany each CHNA to take action on the prioritized health needs). At this stage, the health councils identify gaps in community resources as well as community strengths to determine the specific activities and interventions that will be written into the implementation strategies.

This year, the center tried a new process and granted each health council $20,000 to build staff capacity and carry out parts of their county’s implementation strategy. The center also strategically funds more than 60 community-based organizations across ten counties to help with specific interventions.

Bernalillo County Community Health Council has partnered closely with Presbyterian Hospital over the years to form the Healthy Here Initiative. In 2014, the Healthy Here Initiative was awarded a Racial and Ethnic Approaches to Community Health (REACH) Cooperative Agreement from the Centers for Disease Control and Prevention (CDC), and Presbyterian was designated to manage the award.

As part of the cooperative agreement, the Healthy Here Initiative links several sectors of the local food system to improve health in priority communities. Therefore, the implementation strategy for Bernalillo County has a strong focus on increasing access to healthy food in communities with high rates of poverty, low educational attainment, and high percentages of Native American and Hispanic residents. In Bernalillo County, 4.42 percent of the population is Native American (as compared to 0.82 percent of the U.S. population) and 49.7 percent of the population is Hispanic or Latino.

The interventions highlighted in this case study are a result of the perfect storm in Bernalillo County that brought together a hospital committed to addressing high rates food insecurity in their patient population, a diverse set of stakeholders committed to creating a more equitable food system, and an infusion of funding. These projects include: a community supported agriculture program, a mobile farmers market, and a wellness referral center.

Project spotlights

Keys to success 

  • Cross-sector engagement - The REACH Cooperative Agreement and Healthy Here Initiative has brought together clinical, research, academic, government, community, and social service partners. This has not only helped to increase the scope of the work but it will also help to ensure the sustainability of the projects. 
  • Partners that share equally in the work - Presbyterian houses the van that is used for the mobile market though it is branded with ‘Healthy Here’ signage. Associating the program with the community health work more broadly, as opposed to the hospital specifically, has been helpful in engaging participants. 
  • A unifying force - The three projects highlighted in this case study are very collaborative and involve multiple community partners. Having a unifying force has been an important factor in work that involves a variety of stakeholders. In the case of these three projects, it has been the REACH Cooperative Agreement providing funding, along with the Bernalillo County Community Health Council bringing partners together and Presbyterian managing the funds and providing program support.
“Presbyterian has been there at the table as we determine how to best to serve the community’s needs,”

– Helga Garcia-Garza, Co-Director of the Agri-Cultura Network
The Healthy Here Mobile Farmers Market
The Healthy Here Mobile Farmers Market is a market on wheels that sells produce from Agri-Cultura in Albuquerque’s areas of highest need (Presbyterian Healthcare Services)


Integrating healthy food into the health care system

Not only has Presbyterian identified healthy eating as a community health priority, but they are also committed to addressing food issues within their hospital walls. In fall 2015, they committed to Health Care Without Harm’s Healthy Food in Health Care Pledge and made purchasing changes to include meat and poultry raised without routine antibiotics, rBGH-free milk, and organic fair trade coffee. Presbyterian Hospital has made environmental changes that support healthy eating by hosting an on-site farmers market, maintaining a garden on the hospital grounds, and revamping the vending machines to include a healthier product mix. 

With 11,000 employees system-wide, Presbyterian has a robust employee wellness program that includes complimentary fruit delivery, the “Pres Chopped” local food cooking challenge, and Salad Bar Bucks that incentivize fruit and vegetable purchases in the cafeteria. 

The future of food at Presbyterian focuses on increasing local procurement, developing a comprehensive food policy, and continuing to invest in community-driven strategies that address healthy eating.


Elijah Alfaro admires freshly picked carrots at Valle Encantado Farm. (Healthy Here PR at CWA Communications)
Elijah Alfaro admires freshly picked carrots at Valle Encantado Farm. (Healthy Here PR at CWA Communications)
End Notes
  1. In Bernalillo County, 49.7 percent of the population is Hispanic or Latino. Data source: U.S. Census Bureau, 2016.
  2. Data Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 2012. 
  3. Food insecurity refers to the lack of access, at times, to enough food for an active healthy life for all household members and limited or uncertain availability of nutritionally adequate foods. 
  4. Areas of low food access are defined in this CHNA as food deserts. A food desert is a low-income census tract where a substantial number or share of residents have low access to a supermarket or large grocery store. This indicator is relevant because it highlights populations and geographies facing food insecurity. Data Source: U.S. Department of Agriculture, Economic Research Service, USDA - Food Access Research Atlas. 2010.
  5. Poverty is defined in this CHNA as individuals living in households with income below the Federal Poverty Level. Data Source: US Census Bureau, American Community Survey. 2010-14. 
  6. Data Source: US Department of Labor, Bureau of Labor Statistics. April 2016. 

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