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The Lumberton native says she’s determined to bring focus to places like her home town, from her new position at the head of the Kate B. Reynolds Trust.

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By Thomas Goldsmith

When pediatrician Laura Gerald conducted a checkup with an older teenager in Robeson County she was taken aback by the youth’s plans for life after high school graduation.

Dr. Laura Gerald, center, president of the Kate B. Reynolds Charitable Trust, greets guests at an event in Winston-Salem this fall. Photo credit: Thomas Goldsmith

Gerald, a physician who’s also the high-profile president of the Kate B. Reynolds Charitable Trust, maintains a clinical home in the city where she grew up. Concluding the recent 10-minute exam, she had asked the young man what he saw in his future.

“With this young man, his mother answered, ‘Oh, he’s going to go on disability,’” Gerald recounted during a homecoming celebration earlier this year at Southeastern Regional Medical Center.

“We have come to a place where poor health is a more viable economic opportunity than having a job,” Gerald concluded. “We have real problems.”

Gerald has traveled far and wide since leaving her hometown of Lumberton and has a high-level resume: An undergraduate degree from Harvard University, an M.D. from Johns Hopkins School of Medicine, and a master’s in public health from Harvard. She served as state health director and director of the Division of Public Health for the North Carolina Department of Health and Human Services in 2012-2013 and is the market medical director at the for-profit Evolent Health company.

“It’s been quite the journey,” Gerald said at her Kate B. Reynolds Trust office in Winston-Salem’s Reynolda Village. “It’s been fascinating and rewarding.”

Before her term as state health director, Gerald served as executive director of the North Carolina Health and Wellness Trust Fund and chaired the N.C. Eugenics Task Force. Her first job after completing medical training was taking care of children in Lumberton, where she saw the positive aspects and the deep health challenges that faced residents.

Robeson County placed last in the state in health rankings compiled by the Robert Wood Johnson Foundation.

Gaps seen in resources, opportunities

“As someone who is from Robeson County, what I can say in growing up there, and in some ways continuing to be a member of a rural community, there is no gap in community strength, in desire for health for ourselves and our children. There is no gap in worthiness to have good health outcomes,” Gerald said.

Dr. Laura Gerald greets long-time friend Dr. Pearly Graham-Hoskins at a homecoming event for Gerald at Southeastern Regional Medical Center in Lumberton. Photo credit Thomas Goldsmith

“We have a gap in resources and we have an opportunity gap,” she argued. “Generally, there are community assets you could have that would result in better health. When we think about what some of those are, rural communities often find themselves on the short end of the stick as far as investments that would turn those indicators around.”

Gerald must consider the entire state in her new role at the Kate B. Reynolds Trust, from which much of the $30 million in annual grants goes to rural health concerns. The nonprofit foundation helps to fund projects in Robeson County including the Nurse-Family Partnership, several programs at Southeastern Regional Medical Center and an effort to send paramedics to visit patients recently discharged from hospitals.

“One thing that we know is that most of the issues we are facing in health and well-being are multifactorial and require the kinds of collaborations that can address those issues,” Gerald said. “Of course it is true that we need to have individuals engaging in healthier behaviors, exercising, eating right, not smoking.

“But again, we also recognize that those negative health behaviors are more likely to occur in communities that aren’t supportive. You need opportunities for walking and exercise and access to healthy food in your neighborhood.”

In short, she said, a healthier Robeson County will require neighborhoods that support healthy behavior.

“Whether it’s philanthropy or government, we need to make investments in neighborhood and community – housing, food, putting away money for their child’s education,” Gerald said.

“To give people the bandwidth to focus on health, they need to have their needs met.”

Among additional policy changes that would support community health, Gerald cited raising the minimum wage and increasing access to health insurance.

“A very positive experience”

Gerald has positive memories of her childhood in Lumberton, where family, church and community provided opportunities for advancement such as summer programs and community plays. But she was also aware of the negative aspects of a Southern upbringing for an African-American child.

“I grew up in a segregated community, right on MLK [Drive], where many African-Americans live in the city,” she said. “We were aware of historical divides and issues; that is not lost on you as a child. I was probably in ninth or 10th grade before I saw a swimming pool.”

Gerald attended the N.C. School of Science and Mathematics, the statewide public high school in Durham, for her junior and senior years.

“I had PhDs as teachers and was taking courses with people as teachers who were really quite exceptional,” Gerald said. “When I went to Harvard from the North Carolina School of Science and Mathematics, I did not necessarily feel educationally deficient.

“It wasn’t really until I was an adult that I began to recognize how disadvantaged my background had really been.”

When she saw her home community on a national list of underserved communities, Gerald went from medical school at Johns Hopkins back to Lumberton, where she worked for three years in primary care.

“We had inpatient care, outpatient care, public-health patients,” she said. “We would literally leave the office and go over and deliver babies at the hospital.”

These days, Gerald is concerned that the stresses of life in Robeson are causing residents to undergo epigenetic changes, or effects on their genes that are caused, even before birth, by stressful life experiences.

“There are connections between stress and the production of stress hormones that can result in heart disease or diabetes — that’s true for an adult and it’s true for children,” she said.

“If a child is growing up in poverty, that results in certain stresses and trauma that result in physiological changes that result in chronic disease.

“That can have manifestations in future generations. The cycle of poverty will have to be broken if we are going to see differences in chronic disease.”

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...