Promoting Healthy Hospital Campuses

Hospitals make up one of the largest industries in North Carolina and South Carolina, with more than 272,000 employees. They are cornerstones of healthy communities, and healthy living practices promoted by hospitals can have a significant impact on the population in their area. Therefore, hospitals are ideal locations to introduce and support behaviors such as smoking cessation, healthy eating and exercise. To help North Carolina and South Carolina hospitals create environments that will support the healthy choices of employees, patients and visitors, The Duke Endowment has awarded nearly $3.4 million in grants targeted toward reducing tobacco use, improving nutrition standards and practices, and increasing levels of physical activity.


While hospitals are designed for medical treatment and healing, before 2006 many hospital campuses in North Carolina and South Carolina permitted the use of tobacco, maintained varying standards of nutrition and food options, and had no plans in place to encourage physical activity among staff. 


Since 2006, The Duke Endowment has supported a growing movement to promote healthy hospital campuses in North and South Carolina. 

In North Carolina, The Duke Endowment supported hospitals through the North Carolina Hospital Association and NC Prevention Partners for the Healthy NC Hospitals Initiative.

In November 2010, the Endowment awarded a multi-year grant to the South Carolina Hospital Association to launch the Working Well Initiative. With technical assistance from NC Prevention Partners, hospitals in South Carolina developed and are implementing wellness policies and work environments that support better health.

During the course of this work, NC Prevention Partners developed a “four pillars” approach to creating healthier workplaces now used by participating hospitals. The pillars are: tobacco-free campuses, healthy food options, tobacco cessation among employees and patients, and physical activity. 

Increasing the Number of Tobacco-Free Hospitals

In 2006, The Duke Endowment awarded a $600,000 grant to increase the number of North Carolina acute care hospitals with 100 percent tobacco-free, campus-wide policies. Tobacco-free hospitals see a significant interest in tobacco cessation programs by employees; studies show that worksite tobacco bans significantly increase cessation rates and protect workers from secondhand smoke. As of 2013, all of the state’s 129 campuses are tobacco free. 

Improving Nutrition on Hospital Campuses

In 2007, the North Carolina Hospital Association was awarded a three-year, $1.1 million grant from The Duke Endowment to work with NC Prevention Partners to revolutionize nutrition standards in hospital cafeterias, vending machines and at all hospital-related events. Because hospitals are in a prime position to help combat the obesity epidemic in North Carolina, NC Prevention Partners is working with them to enhance healthy food environments. NC Prevention Partners provides information about healthy options and pricing and marketing to help move the healthier options. It also advises hospitals about creating new employee wellness benefits to encourage healthier behavior.

As part of this effort, NC Prevention Partners created the “Red Apple Project” to encourage hospitals to create and promote healthy food options. The Red Apple Project received one of eight Healthy Living Innovation Awards from the United States Department of Health and Human Services in 2011.

In 2010, chefs and other food service representatives from seven hospitals across North Carolina gathered for the state’s first-ever “Cut to the Core Culinary Challenge” to showcase their abilities to create healthy and delicious food options. 

Helping Employees and Patients Quit Tobacco Use

In 2009, The Duke Endowment awarded a $250,000 grant to the North Carolina Hospital Association to develop a comprehensive tobacco-cessation system in North Carolina hospitals. The Endowment continued the “Quit Tobacco” initiative in 2010 with a two-year, $500,000 grant. NC Prevention Partners is guiding the new effort. 

Expanding Into South Carolina

From 2010 to 2012, The Duke Endowment awarded $1.2 million to the South Carolina Hospital Association to bring healthy hospital programs to hospital campuses throughout South Carolina. Called the Working Well project, the South Carolina effort is modeled after the Healthy North Carolina Hospital Initiative and receives technical assistance from North Carolina Prevention Partners. Participating hospitals use the WorkHealthy America assessment tool to set goals and monitor their progress in the areas of tobacco, nutrition and physical activity. Eight South Carolina hospitals have emerged as Centers of Excellence, improving their knowledge of other employee wellness initiatives around the state. By using learnings from North Carolina, the South Carolina project is implementing new practices with improved efficiency and lower costs.

Measuring and Sustaining Success

In 2012 and 2013, The Duke Endowment awarded a $420,000 grant to the North Carolina Hospital Association to support evaluation and sustainability for the Healthy North Carolina Hospital Initiative. These funds are being used to evaluate financial outcomes of the initiative, sustain excellence in wellness among the 129 participating acute care hospitals, and ensure the use of comprehensive wellness approaches. Ultimately, these hospitals can serve as role models for other sectors across the state and play a significant role in improving the health of North Carolina’s population.

Participating Sites


Area of Work

  • Prevention

Program Area

  • Health Care

Grantmaking Status

The Endowment is continuing to work through current grantees and is not accepting new applications.

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