Editor’s note: This post is part of an ongoing series written for Health Affairs Blog by local leaders from communities honored with the annual Robert Wood Johnson Foundation Culture of Health Prize. In 2014, six winning communities were selected by RWJF from more than 250 applicants and celebrated for placing a priority on health and creating powerful partnerships to drive change. Interested communities are encouraged to apply for the 2015 RWJF Culture of Health Prize. Applications are due September 17, 2014.
Durham, North Carolina is so richly endowed with health care resources that it is known as “the City of Medicine;” it is home to 95 percent of the companies that comprise the Research Triangle. Yet, while many of the county’s 288,133 residents are thriving, others are not nearly as healthy.
A 2004 community health assessment revealed that in Durham’s very diverse population — currently, 38.7 percent black, 42.1 percent white, and 13.5 percent Hispanic — there were high rates of cardiovascular disease and other chronic conditions, HIV and other sexually transmitted diseases, and infant mortality.
A 2007 evaluation also showed that 29 percent of the county’s adults were obese. The rate was 42 percent among African Americans. In the same report, 49 percent of adults said their health prevented them from participating in even moderate physical activities. Among children entering kindergarten in 2009, 18 percent were overweight or obese.
Job losses in 2008 and 2009 contributed to a 2009 poverty rate of 17 percent for individuals. To address these issues, the Durham County Department of Public Health (DCoDPH) invited organizations from many sectors to work together to transform the county’s health, education, and employment resources.
Gayle Harris, Durham County’s public health director, noted that the community came together to “not only deal with access to health care … but to look at those other issues that impact health … unemployment, education, and poverty.”
Drawing on History and New Resources
Building on a tradition of activism that dates back to the civil rights movement, DCoDPH turned the Partnership for a Healthy Durham into an alliance of more than 150 nonprofits, hospitals, faith-based organizations, and businesses working to improve health. DCoDPH provides a full-time staff person for the group and helps to fund health priorities determined by the partnership.
The group’s work — including the collection and distribution of county health data and regular networking around health priorities — has led to a broad spectrum of achievements.
Replacing an Eyesore with an Economic Anchor
Once an empty, run-down junior high school, Holton Career & Resource Center is now home to programs that offer mentoring, internships, and hands-on career training to high school students. Durham’s high school graduation rate rose from 70 percent in 2008 to 83 percent in 2013.
To further increase opportunities for children facing economic and academic barriers to success, Durham created the East Durham Children’s Initiative (EDCI). Modeled after the Harlem’s Children’s Zone, EDCI works to improve academic outcomes for children living within a 120-block area of East Durham. The program is currently being evaluated by Duke University, but a 2011 report has shown improvements in a range of test scores among students at Y. E. Smith Elementary Museum School, one of the lowest performing schools in the district.
Supporting Healthy Living
Community assessments found that the city had an inadequate number of pedestrian walkways and cycle paths. Not surprisingly, in 2005, only 36 percent of residents met national guidelines for recommended physical activity. In lower income neighborhoods, such as Northeast Central Durham, a 2008 survey showed that there were 31 supermarkets, but 34 fast food chains and 84 convenience stores.
The partnership’s Obesity and Chronic Illness Committee targeted these problems. Collaborative work with many organizations has resulted in 5 new bike lanes, 58 new bike racks, 8 new sidewalks, and the extension of the American Tobacco Trail. Residents say they prefer to exercise within their neighborhoods, so the committee is creating “Healthy Mile Trail” markers on neighborhood sidewalks. Corner food stores have also agreed to increase the number of healthy food options in displays near registers.
Bringing Specialty Care to Vulnerable Populations
When health assessments revealed that the city’s uninsured (23 percent of people under 65) had great difficulty seeing specialists, the partnership joined Durham Congregations, Associations & Neighborhoods (CAN), the Latino Community Credit Union, and Duke Medicine to find a solution. Working with a model created in Buncombe County, NC, they created Project Access of Durham County which now coordinates more than 700 cardiologists, orthopedists, dentists, and other clinicians who donate the specialty medical care.
Project Access has produced a $17.55 return on investment for each county dollar spent, with donated care valued at $13 million (2012 Medicaid rates). Perhaps most important, 95 percent of patients reported they were satisfied with their care. The county also saw a statistically significant decrease in non-urgent emergency department visits among patients who had three or more visits in the prior year.
In a dramatic shift for a city that once had a tobacco-based economy, the partnership also convinced the county’s Board of Health to pass a regulation prohibiting smoking in select outdoor areas — building on the state’s indoor smoking ban passed in 2010.
During debate on the regulation, the community held public forums, published letters in local media, and engaged local leaders to build support. In 2012, a rule prohibiting smoking at bus stops, on abutting sidewalks, and on city and county property was passed.
Learning How to Change
Durham’s progression toward a culture of health for every resident is built on the following foundation:
- A formal structure. DCoDPH created, implemented, and continues to use a plan for achieving better health for residents of the community.
- Putting data to work. The partnership gathers information from experts and residents and measures project outcomes. Data sharing is built into the rules and structure of the Partnership so that discussing it is considered routine.
- Supporting consistent community involvement. People know they can come to a partnership meeting if they want to address a health problem. The partnership’s leaders reach out, talk to residents and community organizations, and listen.
By bringing hundreds of people together for dynamic conversations, the county continues to transform itself. Partnership committees are currently working with corner stores to increase healthy food choices, implement the smoking rule, and set new goals for 2014. By working together, Durham will succeed.