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Return on a Health Care Investment in a Rural NC County


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Healthy Places NC, a Kate B. Reynolds Charitable Trust initiative, helps the people of Halifax County coordinate efforts to address childhood obesity.

By Taylor Sisk

Karen Daniels’ husband used to fly airplanes and would sometimes remind her that velocity is irrelevant without direction.

Daniels, vice president of nursing services at Halifax Regional Medical Center in Roanoke Rapids, references this principle in describing her community’s past efforts at improving the health and well-being of its residents.

HalifaxCounty_RuralMap

Rural Rx: N.C. Health News coverage of rural health issues. This week: Halifax County

It distresses the people of Halifax County to be ranked 99th in the state for health outcomes (ahead of only Columbus County) in the Robert Wood Johnson Foundation’s 2014 County Ranking’s & Roadmaps. People were doing good things. Halifaxians have always been eager to help one another out, Daniels said, and a number of organizations and clusters of citizens were taking their own measures toward improved community health.

What was missing was a coordination of efforts.

Enter the Kate B. Reynolds Charitable Trust’s Healthy Places NC program, a “place-based” initiative aimed at improving the health and overall quality of life in rural North Carolina counties.

In May of last year, the trust announced an investment of more than a million dollars in grant money to Halifax County.

The money is financing two initiatives. One is a school-based program that promotes health-focused classroom activities, more nutritious lunches and more effective physical activities. The other is a community-based project to advance education about healthy living and nutrition and fund recreational facilities.

The primary objective is to address childhood obesity.

But the activist-minded folks of Halifax will tell you that the Healthy Places NC program has offered a solid foundation for communication that’s just as valuable as the grant.

“When you’re in a rural community, with as poor a population as we have, we don’t have the luxury of wasting time or resources,” said Will Mahone, Halifax Regional’s chief executive officer. “There’s a phrase in economic development that ‘working together works.’”

Coordinating resources “in an organized fashion with the help of some people who know how to organize has been absolutely invaluable,” Daniels said of the assistance they’ve received from the trust.

Being ranked 99th of 100 in health outcomes offered a “great opportunity to improve,” said Mahone, unquestionably a glass-half-full kind of guy. With the help of Kate B. Reynolds, the county has embraced that opportunity with a countywide, inter-agency, grassroots campaign.

Rising to the need

In the past few years, the Kate B. Reynolds Charitable Trust has shifted from what the trust’s president, Karen McNeil-Miller, has referred to as a “let a thousand flowers bloom” approach to one with a tighter focus.

The plan for Healthy Places NC is to invest $100 million in 10 to 15 financially disadvantaged, rural North Carolina counties over the next decade, promoting efforts that are based on the ideas, input and energy of the people who live there.

The N.C. Department of Commerce annually ranks the state’s 100 counties based on economic well-being and assigns each a Tier designation. The 40 most distressed counties are designated as Tier 1, the next 40 as Tier 2 and the 20 least distressed as Tier 3.

The N.C. Department of Commerce annually ranks the state’s 100 counties based on economic well-being and assigns each a tier designation. The 40 most distressed counties are designated as Tier 1 (blue), the next 40 as Tier 2 (green) and the 20 least distressed as Tier 3 (yellow). Image courtesy N.C. Dept. of Commerce

Funded initiatives are underway in Beaufort, Edgecombe and Halifax counties in the east; Rockingham County in the Piedmont; and Burke and McDowell counties in the west. The plan is to remain invested in these communities for up to 10 years, offering money, technical assistance and capacity-building and grant-writing skills. It’s up to each community to determine its own initiatives.

In selecting those initial counties, a trust team reviewed the state’s 40 most distressed, or Tier 1, counties, as ranked by the N.C. Department of Commerce. Those were whittled down to 15. They then examined the capacity within those counties to meet the program’s objective of helping build something sustainable.

Jehan Benton-Clark, the Kate B. Reynolds senior program officer who oversees the trust’s Healthy Places NC efforts in the eastern region, found a groundswell of interest in Halifax, people “wanting to figure out this health thing, some knowing where to go, others just wanting to be involved.”

She saw a commitment in Halifax County to rise to the need.

Meet and greet

The next step for Benton-Clark and her colleagues at the trust was to get to know the community.

“So for us, that meant, yes, going to visit with the usual suspects,” she said, “like the health department, hospitals, any kind of health entity. But what was different was that we started to expand our reach.”

Victoria Chetty, a community transformation catalyst coordinator with the N.C. Public Health Foundation, stands in front of a Healthy Places NC-funded playground project.

Victoria Chetty, a community transformation catalyst coordinator with the N.C. Public Health Foundation, stands in front of a Healthy Places NC-funded playground project. Photo credit: Taylor Sisk

They met with the chamber of commerce, school administrators and church leaders, and reached out to the local NAACP, sororities and fraternities and local businesses, to get a sense of what was happening in the community.

“And then you ask those folks, ‘Who else should I talk to?’ Benton-Clark said. “And that’s how we really get to some of those folks who wouldn’t have necessarily known about it.”
Bonds were being forged.

“What’s most beautiful to me is that Healthy Places came in initially to do all this really intensive listening and reflection about ‘how can we support this,’” said Victoria Chetty, a community transformation catalyst coordinator with the N.C. Public Health Foundation and a Halifax County native.

“Jehan was hanging around, out at meetings, brainstorming,” said Mahone, “and that’s where I think that Kate B. became the catalyst that they’ve become.”

Meetings were held with local elected officials, county staff, laws enforcement and others.

“We talked about, ‘Hey, we’re here. We want to hear from you, want to support you, want you to tell us what you want to do,’” Benton-Clark recalled.

Next was a community forum and then a meeting for providers, “not just medical providers, she said, “but anyone who works in the health care field,” including, for example, parks & rec staff, phys-ed instructors and the county cooperative extension office.

They looked together at data, what was working, what was not, what assets were available, examining projects already underway and exploring new ideas.

‘Get Fit, Stay Fit’

The outcome was a collection of initiatives focused on nutrition and physical activity, with that primary goal of reducing childhood obesity. (North Carolina is among the states with the highest rate of childhood obesity, and Halifax County ranks among the worst counties in the state.)

Kate B. Reynolds provided a $664,509 grant to the Halifax County Public Health System in partnership with the county’s three school districts to introduce a Coordinated Approach to Child Health program in 15 elementary schools that serve low-income children.

Jehan Benton-Clark, a Kate B. Reynolds senior program officer, oversees the eastern region of the Healthy Places NC program.

Jehan Benton-Clark, a Kate B. Reynolds senior program officer, oversees the eastern region of the Healthy Places NC program. Photo courtesy Kate B. Reynolds

A trust grant of $622,250 went to Halifax Regional, on behalf of the Roanoke Valley Community Health Initiative, to implement a “Get Fit, Stay Fit Roanoke Valley” campaign, a five-year initiative that includes education, enhancements to local parks, easier access to healthy foods and workplace-wellness activities.

Community buy-in

Healthy Places NC helped build the bridges to better health, relationships that must span from Littleton (pop.: 663) in the northwest to Hobgood (pop.: 342) in the southeast across a county that’s 14th largest in the state in square mileage and has the second-highest poverty rate. The people of Halifax County are committed to reinforcing those bridges.

“I think there’s more buy-in from the community when it’s something we’ve actually been invested in creating,” Chetty said. “And I think the litmus test of any kind of funding opportunity is what’s left after the grant runs out.”

“I think, and I hope,” she said, “that one of the long-lasting impacts of Healthy Places North Carolina will be connections that outlast [Kate B. Reynolds’] financial investment here in Halifax County.”

“I hope that we’ve provided them the return on investment they looked for,” said Mahone.

“There’s no doubt,” he said, “that we’re moving from sick care to health care.”

Coming soon: A closer look at Halifax County’s community-based health initiatives.
This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina.

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