show how the daily lives of individuals are nested within and influenced by interpersonal relationships, families, schools, workplaces, communities, and societal norms and values. Factors outside of the individual that have an influence on an individual’s health are known as the social determinants of health (SDoH). Contemporary population health frameworks draw from a growing, and well documented body of literature illustrating the multiple determinants of health extending beyond individual behaviors and health care. There are also numerous models for grouping the many determinants of health into distinct categories. For example, The National Academies (2017) identify education, employment, transportation, social environment, public safety, physical environment, housing, wealth, and health systems as nine areas upon which systems change can focus. Healthy People 2030 groups determinants into health care access and quality, education access and quality, neighborhood and built environment, social and community context, and economic stability. Community Commons (2020) suggests that meaningful work and wealth, basic needs for health and safety, belonging and civic muscle, lifelong learning, humane housing, reliable transportation, and a thriving natural world are the vital conditions necessary for intergenerational well-being. The County Health Rankings Model emphasizes the factors that determine how long and how well people live. As mentioned earlier, the 2014 Framework recognized the powerful influence of the social determinants of health but stopped short of advocating that Extension engage in efforts to address them and instead identified six broad areas of educational programming that should be emphasized. The updated framework supports the positions of authors who suggest that work to promote the adoption of healthy behaviors across the general population must continue (Koukel et al, 2018) but also suggests that Extension must continually strengthen its capacity to support PSE changes for individuals and communities experiencing health inequities. Utilization of this “twin approach” (CDC, 2015) supports improved health for the larger population while also using precision interventions to address barriers and challenges implemented through oppressive and discriminatory policies, systems, and environments. It is important to note that some individuals may view efforts to address barriers to health as being outside of Cooperative Extension’s core work and mission. Others may see efforts to drive resources toward groups that have been historically underserved as taking resources away from those who currently benefit from the work of Cooperative Extension. Not only are these beliefs historically inaccurate, as evidenced by the work by the chronically under-resourced 1890 and 1994 land grant universities, they also jeopardize the future of Cooperative Extension. Accordingly, a central theme of the updated framework focuses on how Cooperative Extension can address the social determinants of health and well-being that are preventing some communities and groups from experiencing optimal health. Coalitions and Community Health Assets as a Core Theme Extension has a long and rich history of engaging in partnerships with schools, government agencies, and various community-based organizations to support the delivery of programs. The 2014 framework identified partnership development as a key component in advancing Cooperative Extension’s health-related work and suggested a number of potential partners with whom Cooperative Extension might engage. However, it stopped short of defining Extension’s 11
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