This issue of the NCMJ discusses factors that influence the well-being of residents in rural communities in North Carolina. These include factors related to health care, such as physician recruitment and retention, the effects of hospital closures, and the need for behavioral health services, and factors beyond the health care sphere, such as child care, health behaviors, economic development, and access to health services.
Healthy Places NC
Almost 2.2 million North Carolinians live in a rural county , and many of these individuals face challenges to health. Research indicates that rural residents are less likely to have access to health services, are more likely to engage in risky health behaviors, and have a higher mortality rate compared to those living in nonrural areas . However, rural communities also have unique assets that make them quite resilient to these challenges. There is a strong sense of place and an understanding of community strengths in rural areas. There is also a sense of commitment to the community and to each other, which enables rural communities to accomplish much with limited resources .
During its 68 years of service, the Kate B. Reynolds Charitable Trust has been capitalizing on the impressive work already being done in rural counties. Over the past 5 years, especially, the Trust has shifted its focus and now primarily supports rural health improvement. This work involved partnering with the North Carolina Institute of Medicine in 2013 to convene a task force on rural health; this task force recently developed a Rural Health Action Plan that provides policy makers, funders, and stakeholder organizations with a common vision and action steps to improve rural health. As part of the planning effort for this report, the task force conducted 8 community meetings in 8 rural North Carolina counties.
The Kate B. Reynolds Charitable Trust also launched the Healthy Places NC initiative in 2012, which is working with economically distressed rural counties in order to make a lasting impact on major health challenges. The projects are being driven by a $100 million investment over the next 10 years; the Trust is currently working in 5 counties and plans to expand to 4 or 5 more rural communities in 2015. As the following examples show, these locally led projects are part of a lasting investment.
Healthy Places NC is partnering with Beaufort County to support a myriad of projects, one being the construction of an interactive walking trail at Beaufort County Community College. The mile-long walking trail will include fitness stations as well as places to rest, and it will be open to the public. Multiple community organizations—including the Mid-East Commission Area Agency on Aging, the Beaufort County Developmental Center, and Life Quest, Inc.—are working to make the trail a reality, and these partners plan to promote its use by residents of all ages and abilities. Other projects in Beaufort County include the expansion of healthy food opportunities, more integrated mental health and medical care, and a new regional website that highlights local health opportunities.
In partnership with Rural Health Group and Access East, Healthy Places NC has launched the Community Health Center in Halifax County, the state’s first co-located federally funded clinic at a hospital. It is projected that 3,000 new patients will visit a primary care doctor at the center during its first 3 years, and Halifax Regional Medical Center will hopefully see inappropriate emergency department visits drop by at least 6,000 patient visits.
The Kate B. Reynolds Charitable Trust continues to build on the momentum around health care in Rockingham County. In 2014, Healthy Places NC helped to launch the Rockingham County Nurse-Family Partnership, an evidence-based community health program that supports low-income, first-time mothers and their babies through home visits from registered nurses. Forty families are currently being served by the partnership. Nationally, the Nurse-Family Partnership has provided thousands of participating families with the resources they need to have a healthy pregnancy, to provide appropriate care for their children, and to become more economically self-sufficient in both the short- and long-term.
The YMCA of Western North Carolina has received investments from Healthy Places NC to support its diabetes prevention program, which is a national initiative based on an evidence-based model from the Centers for Disease Control and Prevention. The program has served 196 adults to date and has shown impressive results, including an average weight loss of 10.9% and a 90% retention rate. Support from Healthy Places NC will help the program serve an additional 360 adults who are at risk of diabetes, including those currently on a waiting list.
The Kate B. Reynolds Charitable Trust is investing $4.2 million to build and/or improve 75 play areas and recreational facilities in Beaufort, Halifax, Rockingham, and McDowell counties. Of those facilities, 47 are located at elementary and middle schools in areas with high poverty rates. Other facilities are located at county parks, community colleges, social service agencies, and child care centers. The Trust also partnered with the national nonprofit KaBOOM! to build 8 new playgrounds, 2 in each of these rural counties. Prior to investments by Healthy Places NC, children in these communities had limited opportunities to play and exercise safely.
The overarching theme that drives the work of Healthy Places NC is community engagement. In each county, efforts are based on the ideas and input of local residents, and everyone is encouraged to participate—especially people and groups who do not normally think of themselves as leaders or decision makers. During community health forums and one-on-one conversations, community members identify what is already being done in their county to support health and suggest ideas for improvement. In this way, Healthy Places NC is able to respond to the specific needs of each community in order to improve health and overall quality of life over the long term.
1. US Department of Commerce, US Census Bureau. State and County QuickFacts North Carolina. US Census Bureau website. http://quickfacts.census.gov/qfd/states/37000.html. Accessed February 24, 2014.
2. Robert Wood Johnson Foundation. County Health Rankings & Roadmaps. A Healthier Nation, County by County. University of Wisconsin Population Health Institute website. http://www.countyhealthrankings.org/app/north-carolina/2013/rankings/outcomes/overall/by-rank. Accessed July 18, 2013.
3. Averill J. Keys to the puzzle: recognizing strengths in a rural community. Public Health Nurs. 2003;20(6):449-455.
Address correspondence to Ms. Kiah Gaskin, North Carolina Institute of Medicine, 630 Davis Dr, Ste 100, Morrisville, NC 27560 (firstname.lastname@example.org).