By Taylor Sisk
For the weary traveler, I-95’s Roanoke Rapids exit, just south of the Virginia border, is a welcome oasis. The town offers a spate of motels, a smorgasbord of fast food options and a Starbucks.
The tourist dollars are much appreciated by the people of Halifax County, a county where 31.6 percent of residents live below the poverty line (now calculated at $23,850 for a family of four), second highest in the state. More than 40 percent of children between the ages of 5 and 17 live in impoverished families, tied with Edgecombe County for worst in North Carolina.
But none of that begins to define what this county is about. What lies beyond is a community making a concerted effort to improve the health and well-being of its people.
In May 2014, Halifax County received a $1.2 million Healthy Places NC grant from the Kate B. Reynolds Foundation to fund a school-based program that promotes healthy habits. The money also went to a community-based project to advance education about healthy living and nutrition and fund recreational facilities.
Spanning this 724-square-mile landscape is a community mobilized, committed to improving the health of its residents and enhance the general quality of life in a setting rich in natural resources and historical heritage.
“We’re making a cultural and environmental change in Halifax County,” said Cardra Burns, the county’s health director, “and it’s wonderful.”
Targeting childhood obesity
In 2014, the Robert Wood Johnson Foundation ranked Halifax County 99th of the state’s 100 counties for health outcomes. Two years prior, the foundation’s rankings found that in the entire U.S., Halifax had the fifth-highest rate of low birth-weight babies and an obesity rate of 39 percent, one of the highest in the country.
While conducting its 2012 community health needs assessment, the staff at Halifax Regional Medical Center in Roanoke Rapids, working in collaboration with the county health department, identified six primary concerns. They found obesity was a contributing factor to each.
The assessment revealed that childhood obesity had risen in Halifax County from 19.1 percent in 2007 to 21.7 percent in 2009. The team determined to turn this trend around.
“In trying to establish an action plan, we decided that to affect community obesity the best way to get a parent to do something is to have their child go about it first,” said Karen Daniels, vice president of nursing services at Halifax Regional.
They anticipated a ripple effect, within families and then throughout the county.
The Roanoke Valley Community Health Initiative launched a “Get Fit, Stay Fit Roanoke Valley” campaign, a five-year effort to engage residents through education, physical activity and recreation at local parks and to improve access to healthy foods and workplace-wellness activities.
Halifax and Northampton counties received $622,250 in Healthy Places NC funding for that project. And the Halifax County Public Health System, in partnership with the county’s three school districts, received $664,509 from Healthy Places to introduce a Coordinated Approach to Child Health program in 15 elementary schools that have high enrollments of low-income students.
(More than 80 percent of students at all 11 elementary schools in the Halifax County School District receive free or reduced-price lunches, with eight of those schools at more than 90 percent.)
CATCH is an evidence-based program that promotes health-focused classroom activities, more nutritious lunches and results-oriented physical activities.
Place it where they’re going
At the same time, hospital staff was examining what was perceived as misuse of its emergency department: people showing up with non-emergency needs.
“But for me, it’s not misuse,” Daniels said. “It’s that [people] don’t know what else to do.”
So hospital administrators engaged Rural Health Group CEO Brian Harris in exploring a solution.
Founded in 1974 as an initiative of Lyndon Johnson’s War on Poverty, RHG is a nonprofit federally qualified health center headquartered in Roanoke Rapids with 15 sites in five counties. It offers primary care, behavioral health, dental and other health-related services to the region’s underserved on a sliding-fee scale.
RHG’s clinic in Roanoke Rapids offered late hours to its patients, but anecdotal evidence indicated people preferred the hospital emergency department’s well-lit parking lot; many felt safer there. So that’s where they went, even if they didn’t need immediate attention.
Thus came the eureka moment: Rather than trying to change behavior patterns, Harris said, “put a clinic where they’re showing up.”
With help from Kate B. Reynolds, the community now has the state’s first federally funded clinic co-located at a hospital, right off the emergency department lobby. Some 3,000 patients are expected to visit a primary care doctor at the clinic in the first three years, with Halifax Regional anticipating a decrease of at least 6,000 unnecessary ED visits.
The clinic takes an integrated approach to care, serving, Harris said, as an “orchestra conductor” for all the patient’s health needs.
“It’s a clinic that’s trying to establish a primary care relationship with the patient so that there’s continuous health care for that patient rather than just episodic care,” Daniels said. “And we’re very pleased that they’ve taken that stance … because that’s what’s needed.”
“What we’re telling people is that this is your medical home,” Harris said. “This is where you need to go; this is your provider.”
He said the quality of the provider-patient relationship affects the quality of care and outcomes. “If the relationship isn’t there with the provider, you’re just getting medication thrown at you. The quality of the relationship to us is paramount.”
Improving health outcomes in Halifax County is a community-wide team effort.
The county health department collaborated closely with the hospital to assess the county’s needs and in turn has partnered with the schools to introduce the CATCH program. Underpinning the program is a philosophy that everything happening in the classroom should have a healthy-living component.
Burns calls CATCH “the seed.”
“How can we grow this seed and impact our children further?” she asked. “This is just our initial phase.”
Ideas Burns has include addressing the teenage pregnancy rate, which is the 13th highest in the state.
Meanwhile, all three of the county’s school districts have new outdoor or indoor recreational equipment and they’ve opened their facilities after school and on weekends to the community.
And there’s an initiative underway with the Weldon school system to provide safer routes for kids to walk or bike to school.
‘Make something happen’
Community members have also drafted a countywide master recreation plan. It includes, for example, tips on how to eat more healthily even if a convenience store is the only easily accessible option for groceries, as is the case for many rural Halifax residents.
The plan was recently presented to and approved by the board of county commissioners at a standing room-only meeting.
“The biggest thing is that folks came out and came out and came out to talk about what they needed,” said Chris Wicker, former longtime director of the Roanoke Rapids Parks and Recreation Department and co-chair of the committee advancing the plan.
He attributes this turnout to the need, “And folks are seeing that there may be an opportunity to maybe make something happen.”
Wicker attended Kate B. Reynolds’ Center for Creative Leadership training program where he met people who’ve been living in the county as long as he has but previously were all doing their own things.
“Now we can call upon each other,” he said. ”It seems to me that folks are owning improving their county.”
Wicker has a vision for his community: “I would love for Halifax County to do so well in improving its health, and its excitement about being healthy, that we can be a model of a poor rural, unhealthy county becoming a vibrant, healthy place that attracts attention. Where folks say, ‘I want to live there because they’ve got a real focus on quality of life and health.’”
“I definitely think the potential is here,” Burns said. “I’m seeing here in communities their want and willingness to change.”
“The communication and respect that’s coming from this has made all the difference,” Harris said of the community-wide approach. “We recognize that health is not what happens in the exam room.
“Health happens at home. Health is where you live.”
Coming soon: A young, activist-minded native of Halifax County returns home to help.
This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina.