New York State has a large rural and socially vulnerable population. Age-adjusted mortality rates are 20% higher for rural Americans, influenced by the social and structural determinants of health: lower education rates, higher poverty rates; limited access to health insurance, health care, and public health services; food deserts; and transportation barriers. To achieve health equity, rural communities need improved use of resources to prevent disease and reduce harm. This can be achieved when community capacities are leveraged for shared impact, facilitated by community-based public health workers via embedded, sustainable, culturally relevant programming. We propose a sustainable solution with cooperative extension offices at the core.

In rural New York communities, cooperative extension office staff are trusted leaders who provide services, support education, and facilitate rural development. Many extension offices work to support the determinants of health, but staff are not fully equipped to engage in “public health” initiatives. We aim to change that.

We will use active distance-learning to achieve four project objectives. Using the Public Health Essentials Training we will (1) build public health competence (health literacy) among inter-professional cooperative extension teams, helping develop their ‘public health identities’; (2) facilitate development of coordinated public health improvement plans linked to existing county priorities; and (3) support planning to augment extension programming to reach underserved communities using seed-grants. Using developmental evaluation and outcomes evaluation, we will (4) monitor and improve processes to achieve program impacts: increased use of health promotion programs that support community health, wellbeing, and quality of life.