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.

Challenge

According to the Centers for Disease Control and Prevention, the environments of many American communities inadequately support healthy diets and regular physical activity. Healthy diets and physical activity can lower the risk for heart disease, Type 2 diabetes and some cancers. In addition, excess calorie intake and physical inactivity contribute to obesity, which is associated with some of the leading preventable chronic diseases, including heart disease, stroke, Type 2 diabetes and some cancers. In North Carolina and South Carolina, the rates of obesity and related conditions impact a large percentage of Carolinians, placing them at higher risk for adverse events and reduced life expectancy.

North Carolina

13.5%

of children age 10 – 17 are obese, 2017 – 18

34%

of adults are obese, 2019

35.1%

of adults have hypertension, 2019

11.8%

of adults have diabetes, 2019

South Carolina

17.9%

of children age 10 – 17 are obese, 2017 – 18

35.4%

of adults are obese, 2019

38.8%

of adults have hypertension, 2019

13.4%

of adults have diabetes, 2019

There is increased recognition that demographic disparities have a profound impact on health and highlights the importance of authentically engaging marginalized communities and organizations.

  • Black and Hispanic individuals are over-represented among the population living in poverty
  • Obesity is linked to lower education and income, as is place of residency
  • Food insecurity and lack of access to healthy foods are linked to economic conditions
  • Minority adults have higher rates of obesity than white adults
  • Minorities are up to two times more likely than white individuals to have major long-term medical conditions

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.”

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.”

— Rhett Mabry, President, The Duke Endowment

Response

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 promoting healthy eating, physical activity, prevention of obesity and education about chronic diseases. This effort continues today with the funding of Healthy North Carolina 2030, which reinforces the importance of healthy behaviors.

In South Carolina, the Endowment has supported Alliance for a Healthier South Carolina, 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. Live Healthy South Carolina, the current State Health Improvement Plan, highlights the importance of addressing chronic disease.

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

The Endowment 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. Shaped by the Division of Public Health’s 2020 objectives to reduce obesity and chronic disease, the initiative brings together diverse leaders to implement programs and policies that promote healthy behaviors through a collective impact model. Through this mutual work, opportunities to engage in physical activity and healthy nutrition become more prevalent in the places where people spend time, such as child care, school, work, church and recreation.

Healthy People, Healthy Carolinas began with coalitions in five North Carolina regions that have currently received seven years of funding. There are 24 coalitions in North Carolina and South Carolina. As the first cohort of coalitions becomes self-sustaining, the Endowment plans to add additional coalitions across the Carolinas. The Endowment has, to date, invested $18.6 million in the coalitions. The local coalitions 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. 

Healthy People, Healthy Carolinas builds on those successful efforts by targeting resources to communities with considerable health needs and the proven ability to take on local challenges. The model will help those communities tackle 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 communities
  • Increase the adoption of policies by government and non-government agencies that promote health
  • Increase the community infrastructure necessary to engage in healthy behaviors
  • Increase the number of organizational changes that make the healthy choice the easy choice
  • Increase the number of community residents engaged in health-promoting activities
  • Document the impact of health improvement efforts

Data about the HPHC coalitions, their interventions and outcomes are publicly available and can be found at the Duke Endowment HPHC online dashboard.

Halthy People Healthy Carolinas 02

Healthy People, Healthy Carolinas 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 serve Catawba, Chatham, Granville/​Vance, Montgomery/​Richmond, and Wilkes counties. 

In November 2016, the Trustees approved five additional communities: Henderson, Pitt, Rowan, Robeson, and Brunswick counties. In May 2017 the Trustees approved funding to expand to five regions in South Carolina: Greenville, Kershaw, Fairfield, Chesterfield/​Dillion/​Marlboro, and Orangeburg/​Calhoun/​Bamburg counties. 

In 2018, they expanded to five more South Carolina regions: York, Barnwell, Georgetown, Spartanburg, and the Charleston/​Berkeley/​Dorchester area. In 2021, based on prior learnings, a new readiness phase was added that allows for potential expansion in Durham, Forsyth, and eight western counties (Cherokee/​Graham/​Clay/​Macon/​Swain/​Jackson/​Haywood/​Transylvania).

The North Carolina Healthcare Association, together with Population Health Improvement Partners, is providing technical assistance to North Carolina Cohorts. The South Carolina Hospital Association has assembled a team to provide technical assistance to South Carolina Cohorts. 

Technical assistance teams support the coalitions in:

  • Mapping assets in their communities
  • Better understanding the landscape
  • Adopting the tools necessary for an effective coalition
  • Bringing diverse voices and stakeholders to the table
  • Selecting interventions to move upstream to policy, systems and environmental changes
  • Creating learning opportunities across coalitions

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. 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.

The Endowment Trustees also approved $4.7 million in additional funding to support the technical assistance components of the program. 

Participating Sites

Health care map S
  • Brunswick Wellness Coalition 
  • Chatham Health Alliance
  • Healthy Robeson
  • Healthy Rowan
  • Healthy Wilkes Action Team
  • Henderson County Partnership For Health
  • LiveWell Catawba
  • Montgomery & Richmond Coalitions
  • Pitt Partners for Health
  • Working on Wellness (WOW)
  • Eat Smart Move More Barnwell County
  • Eat Smart Move More Spartanburg County
  • Fairfield Community Coordinating Council
  • Healthy Tri-County
  • Impact York County
  • LiveWell Greenville
  • LiveWell Kershaw
  • Northeastern Rural Health Network
  • Tidelands Community Care Network
  • Tri-County Health Network

Lessons Learned

Insights

Healthy People, Healthy Carolinas has identified the following insights over the past several years:

  • Community health challenges are longstanding and complex and cannot be effectively or efficiently addressed by organizations acting alone.
  • Community-based work takes time and trust, and it is important to establish clear guidance such as bylaws. As observed during COVID-19, this social capital can be leveraged to mobilize the community.
  • Aligning coalitions’ efforts with existing work such as Community Health Improvement Plans will reduce siloed community efforts that can compete for scarce resources.
  • Community engagement in health decision-making is critical to improving community participation in health promotion and disease prevention efforts.
  • Community organizations can maintain a new intervention or policy, but having dedicated backbone staff is critically important to support the partner organizations in the heavy lift of implementing new evidence-based and ‑informed interventions. 
  • Technical assistance is critical to support communities in using formal quality improvement methods, adopting policy changes, applying evidence-based and ‑informed interventions, standardizing data collection and addressing health disparities.
  • Recognition that increasing the voice of minority populations and individuals with lived experience will strengthen the coalition’s ability to implement effective interventions in marginalized communities.

Resources

zip – June 1, 2017

Key Messages - Healthy People, Healthy Carolinas

Healthy People, Healthy Carolinas key messages that can be customized with your location and/or county in Microsoft Word.

pdf – June 1, 2017

Social Media Guidelines - Healthy People, Healthy Carolinas

Use these social media protocols, tips and best practices to help ensure consistency and a collective voice across all the coalitions.

zip – June 1, 2017

Elevator Speech - Healthy People, Healthy Carolinas

Sample Healthy People, Healthy Carolinas elevator speech that can be customized in Microsoft Word with your organization's contact information and messaging.

zip – June 1, 2017

Brochure Template - Healthy People, Healthy Carolinas

Bi-fold, two-sided, Healthy People, Healthy Carolinas brochure template that can be customized in Microsoft PowerPoint with your organization's messaging, contact information, logo and other content.

zip – June 1, 2017

Flyer Template - Healthy People, Healthy Carolinas

Two options for an 8.5" x 11", single-sided, Healthy People, Healthy Carolinas flyer template that can be customized in Microsoft PowerPoint with your organization's messaging, contact information, logo and other content.

zip – June 1, 2017

Poster Template - Healthy People, Healthy Carolinas

Two tabloid-sized poster template options that can be customized in Microsoft PowerPoint with custom content and logos.

zip – June 1, 2017

Newsletter Template - Healthy People, Healthy Carolinas

A newsletter template that can be modified in Microsoft PowerPoint with custom content, graphics, images and logos. Easily save the file as a PDF to share electronically.

doc – June 1, 2017

General Letter Template - Healthy People, Healthy Carolinas

General letterhead template with the Healthy People, Healthy Carolinas logo that can be customized in Microsoft Word with your organization's content and contact information.

zip – June 1, 2017

Business Card Template - Healthy People, Healthy Carolinas

2" x 3.5" Healthy People, Healthy Carolinas business card templates that can be customized in Microsoft PowerPoint with your organization's contact information and website.

zip – June 1, 2017

PowerPoint Presentation Template - Healthy People Healthy, Carolinas

PowerPoint presentation template in all Healthy People, Healthy Carolinas brand colors with multiple slide layout options.

pdf – June 1, 2017

Brand Usage Guidelines - Healthy People, Healthy Carolinas

The Healthy People, Healthy Carolinas logo and brand guidelines serve as a common visual thread to connect all community efforts. Because coalitions are as diverse as the communities they aim to serve, numerous branding options are available.

zip – June 1, 2017

Table Tent Template - Healthy People, Healthy Carolinas

Two table tent template options that can be customized in Microsoft PowerPoint and printed on 11" x 17" tabloid paper (fits two table tents per sheet). The finished size of each when cut is 4.5” x 17”.

zip – June 1, 2017

E-mail Signature Guidelines - Healthy People, Healthy Carolinas

Suggested guidelines and format for a Healthy People, Healthy Carolinas e-mail signature.

zip – June 1, 2017

News Release (North Carolina) - Healthy People Healthy Carolinas

A Healthy People, Healthy Carolinas news release template for the coalitions of North Carolina that can be customized in Microsoft Word with your organization's location, contact information and messaging.

zip – June 1, 2017

News Release (South Carolina) - Healthy People Healthy Carolinas

A Healthy People, Healthy Carolinas news release template for the coalitions of South Carolina that can be customized in Microsoft Word with your organization's location, contact information and messaging.

zip – June 1, 2017

Logo (JPG Version) - Healthy People, Healthy Carolinas

All Healthy People, Healthy Carolina logos saved as PNG files. PNGs are pixel-based and best used on websites, social media or within presentations. PNGs support image transparency — meaning logos will blend seamlessly into existing background colors or images. PNGs cannot be enlarged from their original size without image pixilation and should only be used at 100% size or less.

zip – June 1, 2017

Logo (Adobe Illustrator) - Healthy People, Healthy Carolinas

All Healthy People, Healthy Carolina logos saved as Adobe Illustrator files (.ai file extension). AI files are vector-based and best used on printed pieces. AI files contain the same information as EPS or PDF files but require at least the same version of Adobe Illustrator to open as it was created it. Since AI files can be enlarged from their original size without image pixilation, they can be made larger or smaller than the original size.

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