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.
Located in the Blue Ridge Mountains, at the junction of the Swannanoa and French Broad Rivers, Asheville, N.C. is graced with natural beauty and an abundance of health and economic resources. But in 2012, many residents of Asheville and the surrounding Buncombe County area were struggling with poverty and chronic illness. So the community responded as advocates, public health experts, community leaders, and business leaders came together to establish a culture of health.
As County Health Director Gibbie Harris explained, “the thing that is really driving us forward is an interest in being the healthiest community in the country… We have people who are interested in social justice, and a desire to improve the lives of our friends and neighbors.”
A Data-Driven Movement
Since 2000, Buncombe County has used Community Health Assessments (CHAs) to guide health policy. In 2012 the Buncombe County Department of Health & Human Services (HHS) partnered with Mission Hospital, Park Ridge Health and Care Partners on the assessment and found some alarming trends: Nearly 30 percent of Buncombe adults were obese; an additional 33 percent were overweight; more than 37 percent of adults had hypertension; and diabetes prevalence was at 7.9 percent.
The poverty rate in Buncombe was 14.7 percent among adults and 20.6 percent for children. Buncombe’s poorer families were also enduring extended waiting periods for badly needed child care subsidies, leading to a 30 percent drop in enrollment in early childhood education programs.
Fortunately, the survey also found that 9 out of 10 Buncombe residents wanted to work to create a healthier community. Based on these results, the Buncombe County HHS identified six priorities:
- Improve women’s health during childbearing years.
- Address obesity rates and promote healthy living.
- Improve children’s health outcomes.
- Increase school readiness.
- Increase access to primary care homes.
- Increase access to mental health care homes.
Empowering a Community to Eliminate Disparities
In addition to prior initiatives in place, community organizations also worked with the Buncombe County HHS to eliminate disparities and improve health for their residents. Guided by the motto “Building on the legacy, embracing the future,” for example, Shiloh, Asheville’s oldest historically African-American community, established in the 1800s, decided to tackle the disproportionately high health risks and rates of chronic disease in their neighborhood. Residents created the Shiloh Community Association and asked to be included in a Buncombe County HHS Minority Health Equity Project focusing on the self-management of chronic diseases.
The association worked with the Buncombe County HHS to help residents gain access to social service programs, including Mission Hospital’s smoking cessation program; a diabetes prevention program; health screenings, counseling to help them establish primary care health homes, and a chronic disease self-management program. Nutrition has also been improved at neighborhood after school programs. Working in partnership with a local restaurant, Tupelo Honey, a bountiful community garden provides healthy food and a place for social gatherings.
In another predominantly African-American neighborhood, a Community Navigator Program was created in the Pisgah View public housing complex after a child died from abuse. Navigators connect residents with services such as medical care and food assistance, but more importantly navigators are neighbors who have garnered the trust of residents.
Protecting Children from Poverty
Success Equation, a project of the local non-profit Children First/Communities in Schools, uses education and advocacy to support low-income families and children. The group worked with legislators to pass an amendment to the state’s budget that protected $1 million in child care subsidies in 2013.
To respond to pressing family needs, the organization offers direct support through their Family Resource Center at Emma Elementary School. Located in a Latino community, the school has the highest number of children in a subsidized lunch program in the area. The center offers emergency financial assistance, a food pantry and parenting classes, as well as counseling in accessing social services and other resources.
Another project that seeks to help families is the Innovative Approaches Project, a four-county effort, supported by the North Carolina Department of Health and Human Services that brings pediatricians, child care agencies, and parents together. The project works to improve the quality and continuity of care by creating customized electronic medical records for children and care handbooks for parents.
Buncombe’s pre-K children also take part in Rainbow in My Tummy® at 14 child-care centers. As the name implies, the program introduces Buncombe’s youngest residents, and their caregivers, to a colorful selection of fresh fruit and vegetables, while teaching them about nutrition.
Encouraging a Healthy Lifestyle
The Buncombe County Greenway & Trails Commission focuses on creating more safe spaces for physical activity. To make it easier for people to walk, the organization created a system of greenways and sidewalks linking neighborhoods. The plan includes a Safe Routes to School component for children, a true collaboration of many partners including the state, City of Asheville, and Emma Elementary School.
Learning to Optimize Local Resources
Buncombe’s success is built on collaboration. Organizations that have been in operation for more than a decade, as well as new projects, local government, and health leaders, among many others, all have a role to play.
Two essential parts of engaging these stakeholders are:
- Making use of data. Every PHAC/Community Health Improvement Project program is outcome-based and data driven. When organizing a project or deciding how to invest resources, people are asked to look at the county health assessment information and use it to shape their work and keep careful track of results.
- Measuring progress. To assess the effectiveness of the Buncombe initiatives, the county HHS is working with Western North Carolina Healthy Impact, local hospitals, and community partners to monitor data collection and sharing based on the Agency for Healthcare Research and Quality’s Prevention Quality Indicators.
There are so many needs to be met in Buncombe that there is a constant effort to make sure no group is missing from the table. Community members remain united to close the county’s health equity gap and inspire other communities to do the same.