By Thomas Goldsmith
When pediatrician Laura Gerald returned to her hometown of Lumberton as head of the Kate B. Reynolds Charitable Trust, she told the welcoming crowd that she had plenty to discuss with them.
“Normally, I’d only be up here for about 10 minutes, but I’m home, so you might as well settle in,” a smiling Gerald told a gathering at Southeastern Regional Medical Center in September.
But the Harvard- and Johns Hopkins-educated physician left no doubt that she was well acquainted with the health challenges faced by residents in Robeson County in Southeastern North Carolina.
A person born in Robeson County has a life expectancy of about 73 years. About a hundred miles away in Wake County the comparable life expectancy is 81 years, she told the crowd, in numbers referenced in a Robert Wood Johnson Foundation report.
“Why should something as simple as the Zip code you were born in give you seven more years of life?” Gerald asked.
One in three
Robeson County, with a population of more than 133,000, lies in the state’s scenic Sandhills region. Multiple factory closings in recent decades has lead to an unemployment rate that’s stuck at nearly 7 percent, down from years of recession-driven double digit rates.
And one in three Robeson County residents lives in poverty.
“A lot of rural North Carolina issues relate to poverty, like obesity and this recent opioid epidemic,” said Dr. Pearly Graham-Hoskins, a friend of Gerald’s and hospitalist and medical director at Cape Fear Valley – Bladen County Hospital. “The thing people forget is that it’s an economic issue. People are selling drugs and they’re trying the drugs.”
Graham-Hoskins was in Lumberton, the county seat, to attend Gerald’s first hometown appearance since she was installed as president of the Kate B. Reynolds Charitable Trust. The Winston-Salem-based foundation is among the nonprofit, academic, public and private entities working to address health problems in the county.
(The Kate B. Reynolds Trust has also granted NC Health News with funds to focus on rural health issues through a donor-advised fund at the Winston-Salem Foundation.)
Public health officials say the county’s troubling health statistics arise from a number of factors, some of the most persistent linked to ingrained cultural issues as well as the county’s lack of economic dynamism. Young people in Robeson experience a death rate 60 percent higher than the state average. And the overall homicide rate is more than triple the state average.
‘There are historical divisions’
One key to the rate of violent crime could be a statistic that also makes Robeson distinctive: A diverse population that’s 39.9 percent Native American, 32.2 percent white, 24.4 percent African-American and 8.3 percent Hispanic, according to 2015 census numbers.
“There are historical divisions and tensions between different groups on the ethnic side,” Gerald said.
Dr. Joseph Bell is a Lumbee Indian and Robeson County native who earned first a pharmacy degree, then a medical degree from the University of North Carolina at Chapel Hill before founding Pembroke Pediatrics in Pembroke. He agreed with Gerald’s assessment of tensions that can lead to stress and violence between ethnic groups.
“The old historic tension and racial prejudice — anyone would be naive to think that that had totally gone away,” Bell said.
A mix of resources
Lumberton is home to the 452-bed Southeastern Regional Medical Center, a nonprofit facility which treats 16,000 inpatients and 68,000 emergency patients from across the region annually. The hospital and its parent organization, Southeastern Health, held the homecoming for Gerald.
“We have great hospitals and great doctors,” state Sen. Jane Smith, who represents Robeson and Columbus counties in the General Assembly, said at the event. “The outcomes are mostly attributable to the poverty rate.”
Many Robeson County residents wind up in a hospital emergency department for care because they can’t afford regular medical care, Smith said. She also expressed frustration that the Republican legislature refused to expand Medicaid, as is allowed for under the Affordable Care Act.
Robeson by the numbers
Robeson residents compared to state average
Uninsured: 25 percent vs. state average 18 percent
Children in poverty: 47 percent vs. state average 24 percent
Adult smoking: 29 percent vs. state average 19 percent
High school graduation: 85 percent vs. state average 83 percent
Excessive drinking: 13 percent vs. state average 15 percent
Smith, a Democrat, ran for reelection this month, stressing the need for a strengthened education system, job creation through economic development organizations, promoting business and agriculture, and ensuring that rural areas get their fair share of resources.
She lost to Republican lawyer and military veteran Danny Britt, who said Smith had been ineffective in Raleigh.
“We have the opportunity to market our positives, our location and resources, to bring jobs and wealth back to Robeson and Columbus Counties,” Britt told the Robesonian.
Obesity, asthma, vehicle crashes plague county
One of Robeson County’s problems, both economic and health-related, is the presence of food deserts, regions where fresh produce and other items are absent from stores or difficult to obtain.
“One of the biggest problems is the access to healthy food,” said Tim Bell, CEO of Children’s Health of Carolina. “We have obesity in both children and adults.”
Other conditions, such as a rate of inpatient hospitalization for asthma among children 14 and younger that’s twice the state average, could be linked to longstanding unhealthy habits.
“There’s a high percentage of asthmatics,” Bell said. “We know there’s a fair amount of smokers.”
Solutions to some problems come from concentrated efforts such as the Robeson-Columbus counties Nurse-Family Partnership. The partnership’s registered nurses work with first-time mothers until their children are two years old, boosting positive outcomes and improved statistics in key areas such as immunization and breastfeeding rates.
Five-year effort brings results
Some problems are so intractable as to require even broader interdisciplinary efforts, such as the North Carolina Academic Center for Excellence in Youth Violence Prevention, known as NC-ACE. The initiative won nearly $6.5 million in federal funding to allow UNC researchers, led by School of Social Work professor Paul Smokowski, to work toward community support and solutions for preventing and reducing youth violence in Robeson County.
The UNC effort is nearing an end in December, when a full report of its work will be released. But results already in show impressive outcomes from its Teen Court, Positive Option and Parenting Wisely programs, Smokowski said in a phone interview Friday from his new post at the University of Kansas.
“Very briefly, the difference with Teen Court is that it reconnects them largely to community service,” he said. “Instead of a sentence we call it a sanction. They have to do community service, they have to make reparations from whatever the damage is.”
Youth who have gone through Teen Court in Robeson have a recidivism rate of less than half that of those who are handled by the juvenile justice system, he said. Positive Option works with middle-school students to create a more positive school climate by decreasing behaviors like bullying and disrespect. Parenting Wisely helps mothers and fathers manage conflict with their teenage children.
“Parent-child conflict is a risk factor for delinquent behavior, for substance abuse, for violence and aggression, and for teenage promiscuity,” Smokowski said. “When you can decrease that conflict between parents and children, it keeps the adolescents closer to the family. There’s less aggressive behavior and less violence.”
Gerald said no one person or organization can solve Robeson County’s problems alone.
“It’s going to take public health, colleges, community colleges, the faith community and the business community. It takes all of those sectors working together,” she said. “We want to secure a future of hope and opportunity for our children.”