Improving Community Health through Healthy People, Healthy Carolinas

The Duke Endowment launched its Healthy People, Healthy Carolinas Initiative in 2015 to help communities in North Carolina and South Carolina address chronic health issues such as obesity, diabetes and heart disease.

Healthy People, Healthy Carolinas began with coalitions in five N.C. regions receiving $450,000 each over three years. With additional communities joining in both North and South Carolina, the Endowment expects to spend more than $9.4 million over the next few years as it expands to 20 local health coalitions. The local coalitions will engage leaders from a wide spectrum of area organizations in aligning existing programs and developing ways to help residents get involved in improving their health.


Rates of diabetes, heart disease and unhealthy weight are high throughout the Carolinas – and in many communities, those rates are higher than national averages. Research shows that about one in three people in North Carolina are considered obese, with similar rates of obesity found in South Carolina.

America’s Health Rankings, published by the United Health Foundation, reports that North Carolina ranked 32nd overall in 2016; South Carolina ranked 42nd.

Healthy People, Healthy Carolinas recognizes that health and well-being are created and sustained not through individual and clinical efforts alone, but through the cooperation and support of the extended local community.

“In order to improve health, we must recognize that where we work or go to school, how we spend our free time – even our ability to access fresh food and exercise in a safe environment – all contribute to our health and well-being,” says Rhett Mabry, president of The Duke Endowment. “To improve health within a community, we have to expand how we think about what affects it locally. We need to address health improvement on the ground, at a very local level.”


The Duke Endowment has been a longtime supporter of statewide health improvement efforts.

In 2008, for example, the Endowment helped support a task force to research and study ways to improve public health by focusing on prevention. Led by the North Carolina Institute of Medicine, the task force examined underlying causes of death and morbidity, looked at systemic health disparities in the state, and recommended dozens of prevention strategies to address root causes of poor health.

Based on the findings, the North Carolina Division of Public Health produced Healthy North Carolina 2020, a list of 13 key prevention focus areas for the state. They include promotion of healthy eating, physical activity, prevention of obesity and education about chronic diseases.

In South Carolina, the Endowment has supported Alliance for a Healthier SC, a coalition of more than 50 executive leaders from diverse organizations working together to ensure that all people in the state have the opportunity to have healthier bodies, minds and communities.

Healthy People, Healthy Carolinas builds on those successful efforts by targeting resources to communities that have considerable health needs, but also the proven ability to take on local challenges. The model will help those communities tackle deeply entrenched and complex social problems to stimulate sustained improvement in population health.

The program is designed to support coalitions through collective impact and to enhance community capacity to implement evidence-based and informed interventions. Performance metrics will be monitored throughout to help the coalitions improve and learn.

Program goals include:

  • Increase the number of highly effective community coalitions
  • Increase the number of health promoting programs adopted in community settings
  • Increase the adoption of policies that promote health
  • Increase the community infrastructure necessary to engage in healthy behaviors.
  • Increase the number of community residents engaged in health promoting activities
  • Document the impact of health improvement efforts

First Coalitions

In November 2015, the Trustees of The Duke Endowment approved funding for five initial North Carolina communities to participate in the Healthy People, Healthy Carolinas program. Selected coalitions are serving Catawba, Chatham, Granville, Montgomery/Richmond and Wilkes counties. In November 2016, the Trustees approved funding for five additional communities: Henderson, Pitt, Rowan, Robeson and Brunswick counties.

Representatives from those coalitions are sharing information as they develop best practices for organizing, planning and implementing evidence-based and informed interventions known to improve health.

North Carolina Healthcare Association together with Population Health Improvement Partners, , is providing technical assistance, helping the groups map assets in their communities and better understand the landscape. The trustees in May 2017 approved funding to expand to five regions in South Carolina: Greenville, Kershaw, Fairfield, Chesterfield and Orangeburg counties. In 2018, they approved funding to expand to five more S.C. regions: York, Barnwell, Georgetown, Spartanburg and the Charleston-Berkeley-Dorchester area. The South Carolina Hospital Association has assembled a team to help the coalitions in that state.

The coalitions selected by the Endowment are intentionally diverse and unique. While there will be many opportunities for exchanging ideas, each community will receive support to pave its own path forward. The hope is that the lessons of the earlier coalitions can inform the work of others throughout the Carolinas.

Endowment Trustees also approved nearly $2 million in additional funding to support the technical assistance components of the program for two years. 

Participating Sites


Area of Work

  • Prevention

Program Area

  • Health Care

Grantmaking Status

Areas of Work

  • Prevention and early intervention for at-risk children

    To equip children and families with skills to ensure that children reach developmental milestones to lead successful lives.

  • Out-of-home care for youth

    To drive child welfare systems toward greater accountability for child well-being.

  • Quality and safety of health care

    Improving the quality and safety of health care delivery

  • Access to health care

    Improving health by increasing access to comprehensive care

  • Prevention

    Expanding programs to promote health and prevent disease

  • Academic excellence

    Enhancing academic excellence through program and campus development

  • Educational access and success

    Increasing educational access and supporting a learning environment that promotes achievement

  • Campus and community engagement

    Promoting a culture of service, collaboration and engagement among schools and communities

  • Rural church development

    Building the infrastructure and capacity of United Methodist churches to enhance ministry and mission

  • Clergy leadership

    Strengthening United Methodist churches by improving the quality and effectiveness of church leadership

  • Congregational outreach

    Engaging United Methodist congregations in programs that serve their communities