We are excited to share the online "Community Health Improvement Scorecard." It's an easy way to learn about Buncombe County’s current health priorities and what our community leaders, partners and residents are working on together to improve the health of our community.



This Scorecard is a living document that will change as the community priorites, progress and landscape changes. This tool makes it easy to see and get up-to-date information about:

  • Results we hope to see as our health improves
  • Data that concerns us and the story behind the data that helps us understand why things are getting better or worse
  • Partners and programs working together to make things better
  • Ways we are measuring success and describing how we are making a difference

Click anywhere on the scorecard to learn more about the programs and partners who are working together to improve health in Buncombe County. Use the + icons to expand items and the note icon to read more. For a detailed tutorial on navigating the scorecard please view video to the right:


All children have safe, stable, nurturing environments so they can reach their full potential
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When we achieve this result:

  • All babies in Buncombe County are born healthy.
  • In their first year, babies are breastfed, safe, thriving, and nurtured in a healthy environment.
  • All women have access to the full spectrum of reproductive care, including preconception care and family planning services, ensuring that women are healthy before they get pregnant and during their pregnancy.
  • Thriving families are supported by living wages and resilient communities. Racial equity eliminates disparities in maternal and child health outcomes.
Why Is This Important?

In Buncombe County in 2015, 12 babies died before their first birthday. At 4.6 infant deaths per 1,000 live births, Buncombe County's infant mortality rate is lower than the rate of North Carolina (7.3 infant deaths per 1,000 live births) and the United States as a whole (6.0 infant deaths per 1,000 live births). While this is a decrease from the peak of 27 deaths in 2013, it is higher than the infant mortality rates for the six years prior. Because of this and the racial disparities in infant mortality, it is an area of great concern in Buncombe County. It indicates that not only are our infants becoming less healthy, but our women are becoming less healthy, too. Additionally, improving maternal and infant health as well as reducing unintended pregnancies are state objectives under Healthy North Carolina 2020.

According to the CDC, one of the main causes of infant mortality is most often caused by babies born preterm and/or at a low birth weight. Most often babies born early have a low birth weight simply because they have not had adequate time to develop. The March of Dimes reports that the primary risk factors that cause or influence prematurity and birth weight relate to the health of the pregnant mother including chronic health conditions, infections, placenta problems, weight, and smoking, alcohol and substance abuse.

An increased risk of low birth weights and prematurity means an increased risk of infant mortality. Note, these risk factors are primarily focused on the mother's health before and during pregnancy. Access to the full spectrum of reproductive care including preconception care, family planning services, and prenatal care can lead to healthy women with healthy pregnancies. 43% of pregnancies ending in a live birth in North Carolina are unintended. Planned pregnancies can help to decrease risk behaviors and screening for chronic conditions, while increasing women’s engagement in their health and positive behaviors such as taking folic acid and being up to date on protective vaccinations. Unintended pregnancies refers to mistimed or unplanned pregnancies and unintended pregnancies are associated with poorer birth outcomes and have been associated with late entry into prenatal care, low birth weight, and child abuse and neglect. Women under 17 and over 35 years old are at increased risk of complications.

However, social determinants have an impact on infant mortality. Social determinants are social and economic conditions that are not directly related to health, but have a great impact on an individual's or population's ability to be healthy. Poverty, unemployment, and low education levels of mothers and parents increase the risk of infant mortality. In addition, risks are further impacted by race and ethnicity as well as age. African Americans have 8.4 times the risk of infant mortality when compared to the white population in Buncombe County in 2014. While this yearly figure can be significantly influenced by one death due to small numbers, the five year aggregate still shows African American babies have 2.6 times the risk of infant mortality compared to white infants.

Infancy is a critical window of time that sets the stage for a child’s development and a person’s lifelong health. Because so much biological and psychological development occurs during this time, infants are particularly vulnerable the negative impacts of malnutrition, stress, poverty, and other risk factors.

For more information available at the follow sites:,

Healthy North Carolina 2020: A Better State of Health
March of Dimes, Your Premature Baby
Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality and here
North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) Results.

Data Holes

Identifying the root causes of infant death will direct community health improvement practices by indicating the areas of concern and the areas where improvement efforts need to be targeted. Quantitative data will illuminate what health issues and disparities are occurring. Qualitative data, from focus groups and interviews in the community, will bring information on what the community thinks are the the most important issues and barriers to health. Finally, mapping the data can highlight populations and geographic areas where new health improvement efforts need to be focused.

Community Partners have identified the following holes in data:

  • root causes of infant mortality
  • access to mental health services
  • access to community resources
  • ways to measure how programs help customers
  • customer experience of services, including if the customer feels respected and gets the help they need
  • community trust of service providers
  • community identity and pride
  • parent engagement

For data on additional indicators that impact infant mortality that are being monitored, click here.

Partners

Asheville Buncombe Institute of Parity Achievement (ABIPA): providing education, health services and advocacy from a unique understanding of the African American experience and a demonstrated ability to increase collaboration, connection, awareness and trust across diverse segments of the community.

Child Protection/Fatality Prevention Team: Reviews the infant mortality cases to understand the cause of death and identifies gaps in services related to all child deaths

Buncombe County Health and Human Services:

Family Planning and STD Clinics: Women's wellness visits, family planning services and STD screening, education, treatment and follow-up

Nurse Family Partnership: NFP is an evidence-based community health program that helps transform the lives of vulnerable mothers pregnant with their first child. Each mother served by NFP is partnered with a registered nurse early in her pregnancy and receives ongoing nurse home visits that continue through her child’s second birthday.

Minority Health Equity Project: This project brings together five different community partners and the Buncombe County Department of Health to combine our resources to promote health equity.

HHS Community Service Navigators: The CSN initiative was created to connect people with Buncombe County Health and Human Services, strengthen the communities capacity to help meet citizen needs, empower citizens and communities as change agents to promote positive outcomes, build and enhance collaborative partnerships, and reduce over utilization of more costly services.

Children First/Communities in Schools: A not-for-profit organization that offers direct services to economically disadvantaged children, youth and their families. These services include: Family Resource Center at Emma, Learning Centers, Project POWER/AmeriCorps program, Student Support Specialist , The Success Equation

Community Care of Western North Carolina (CCWNC): OB Case Management through Pregnancy Medical Home working to reduce infant mortality in North Carolina.

Guardian Ad Litem: Guardian ad Litem volunteer is the eyes and ears for a judge and the person who tells the child's story to the court in maltreatment cases resulting in court intervention.

Mission Health: not-for-profit, independent community hospital system governed and managed exclusively in western North Carolina

Mountain Area Health Education Center (MAHEC): Family Health, Obstetrics & Gynecology, School Health Nursing Program, Buncombe County Prenatal Safety Net

Mt. Zion Community Development, Inc.: Project NAF (Nurturing Asheville & Area Families) is Buncombe County's Minority Infant Mortality Program that provides advocacy and support services to African American pregnant and post-partum women and their babies; Project EMPOWER (Education Means Power), one of Buncombe County's Teen Pregnancy Prevention Initiatives, which works in collaboration with the Asheville City Schools System and Foundation.

Pisgah Legal Services: provides free civil legal aid in WNC to disadvantaged children, seniors, at risk families & domestic violence victims

Planned Parenthood: women's health, reproductive health, and family planning services

Western North Carolina AIDS Project: offering supportive services for those who are living with HIV or AIDS

Western North Carolina Community Health Services (WNCCHS): Federally Qualified Health Center providing primary healthcare, dental, behavioral health, and support services

WIC: Women, Infants and Children (WIC) Supplemental Nutrition Program is designed to improve the health and well-being of low-income pregnant, breastfeeding and postpartum women, infants and children up to age five who are at nutritional risk by providing nutrition education, breastfeeding education and support, referrals for health care, and free language assistance.

YWCA MotherLove: MotherLove is a comprehensive program for pregnant and parenting teens. The goals of the MotherLove Program are that pregnant and parenting teens stay in school, access higher education and vocational training, develop the skills and knowledge needed to become strong parents and delay another teen pregnancy.

SubstanceAbuse
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Substance Use Disorders in Pregnancy-Community Team Initiative and the Family-centered Integrated Treatment of Substance Use (FITS U) Buncombe County workgroup is working with CHIP staff to identify results and indicators to facilitate collective efforts to reduce substance use in Buncombe County.

When we achieve this result:

  • All families in Buncombe County are healthy and productive.
  • All women and families have access to behavioral healthcare and substance abuse treatment.
  • Babies are born healthy and thriving families are supported by living wages, resilient communities, and have access to safe housing.
Data Holes

Data development currently underway.

For related indicators that are being monitored, click here.

Partners

Buncombe County Health and Human Services:

Family Planning and STD Clinics: Women's wellness visits, family planning services and STD screening, education, treatment and follow-up

Nurse Family Partnership: NFP is an evidence-based community health program that helps transform the lives of vulnerable mothers pregnant with their first child. Each mother served by NFP is partnered with a registered nurse early in her pregnancy and receives ongoing nurse home visits that continue through her child’s second birthday.

Community Care of Western North Carolina (CCWNC):

HHS Community Service Navigators: The CSN initiative was created to connect people with Buncombe County Health and Human Services, strengthen the communities capacity to help meet citizen needs, empower citizens and communities as change agents to promote positive outcomes, build and enhance collaborative partnerships, and reduce over utilization of more costly services.

Julian F. Keith Alcohol and Drug Abuse Treatment Center (ADATC): ADATC provides detox services and residential treatment as well as collaboration onsite with MAHEC OB high risk clinic, ADATC can administer MAT

MAHEC High Risk OB: Clinic provides prenatal care and Substance Use Disorders assessment and linkage to services.

Medication Assisted Treatment Programs:

BHG Asheville: provide opioid replacement and basic SUD therapy

Crossroads Treatment Center: provide opioid replacement and basic SUD therapy

Mission NAS Project: Duke Endowment awarded Mission Health a grant to support the Neonatal Abstinence Syndrome program, which was developed to wean babies who were exposed to drugs while in utero. The program was developed here at Mission Hospital in Asheville, and has since become a worldwide protocol. This program will aid in solidifying and educating eligible families.

Mt. Zion Community Development, Inc.: Project NAF (Nurturing Asheville & Area Families) is Buncombe County's Minority Infant Mortality Program that provides advocacy and support services to African American pregnant and post-partum women and their babies; Project EMPOWER (Education Means Power), one of Buncombe County's Teen Pregnancy Prevention Initiatives, which works in collaboration with the Asheville City Schools System and Foundation.

October Road: SAIOP for pregnant/non-pregnant women

RHA Behavioral Health Services:

Neil Dobbins Center: detoxification first trimester case by case

Mary Benson House: provides residential option for women with young children and coordinates with WRC for SACOT

Smoky Mountain LME/MCO: Smoky Mountain LME/MCO is a public managed care organization that oversees Medicaid, state and local funding and offers a comprehensive health plan for individuals and families in need of mental health, substance use or intellectual /developmental disability services.

Women’s Recovery Center (WRC): WRC provides engagement and support as well as SACOT for Mary Benson House clients and others. Also collaboration onsite with MAHEC OB high risk clinic

Western North Carolina Community Health Services (WNCCHS): Federally Qualified Health Center provides prenatal care, case management, SUD assessment and therapy, and linkage to other services. Does not provide transportation or childcare

YWCA MotherLove: MotherLove is a comprehensive program for pregnant and parenting teens. The goals of the MotherLove Program are that pregnant and parenting teens stay in school, access higher education and vocational training, develop the skills and knowledge needed to become strong parents and delay another teen pregnancy.

Why Is This Important?

Substance Use Disorders in Pregnancy-Community Team Initiative and the Family-centered Integrated Treatment of Substance Use (FITS U) Buncombe County workgroup is working with CHIP staff to identify results and indicators to facilitate collective efforts to reduce substance use in Buncombe County.

According to the CDC, drugs overdose deaths in the United States hit record numbers in 2014. The majority of those involved opioids including prescription pain relievers and heroin, and 78 Americans die every day from an opioid overdose. Since 1999, the amount of prescription opioids sold in the US has nearly quadrupled. Substance abuse is a priority for Healthy NC 2020 because addiction to drugs or alcohol is a chronic health problem, and people who suffer from abuse or dependence are at risk for premature death, comorbid health conditions, injuries, and disability. Therefore, prevention of misuse and abuse of substances is critical. Furthermore, substance abuse has adverse consequences for families, communities, and society, contributing to family upheaval, the state’s crime rate, and motor vehicle fatalities.

Substance use disorders in pregnancy are an emerging concern in Buncombe county and the Western North Carolina region. About 400 babies were delivered with positive toxicology from mothers at Mission Hospital in 2015. Additionally, 85% of children in foster care were placed there related to substance abuse issues and many of those children were under the age of 2. Substance use disorders have significant impact on individuals and families. Families who live with addiction may become traumatized to varying degree because of the emotional, psychological and behavioral instability that comes along with substance use disorders. During early childhood, this environment can negatively impact development and attachment which can have lifelong impacts on children involved.


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Why Is This Important?

(From the Buncombe County Sheriff's Office website):

  • Domestic violence is the leading cause of injury and 7th leading cause of death for women in the United States.
  • It is the number one reason women and children become homeless in the U.S.
  • 1 in 4 women will report violence at the hands of an intimate partner at some point in their lifetime.
  • 54% of employees living with domestic violence miss at least three full days of work per month.
  • A child's exposure to their father abusing their mother is the strongest risk factor for transmitting violent behavior from one generation to the next.
  • Domestic violence costs our community over $6.7 million each year.

Research shows that 65% of domestic violence homicide victims had contact with the criminal justice system or a health care professional before they were murdered, and 58% of perpetrators had been arrested before they killed their partners and 22% had seen a mental health professional... there are opportunities to intervene, and the coordinated community response will provide the tools. The success of this initiative can make the community safer for everyone.

Injury and Violence is a priority for Healthy NC 2020 because injury is the leading cause of death among people aged 1 to 49 years, and homicide in particular is the second leading cause of death for people aged 15 to 24 years.


(from Our VOICE website):

Of reported rapes in 2008 in North Carolina: State Bureau of Investigation. 2009. Rape Victims by Age and Race, 2008.

  • 21.5% of the victims of sexual assault were under age 14.
  • 61.7% were under the age of 30.
  • 64.6 % of victims were white.
  • 32.6% of victims were black.

1 out of every 6 American women has been the victim of an attempted or completed rape in her lifetime (14.8% completed rape; 2.8% attempted rape). National Institute of Justice & Centers for Disease Control & Prevention. Prevalence, Incidence and Consequences of Violence Against Women Survey. 1998.

1 in 4 girls and 1 in 6 boys will be sexually abused before age 18. www.pcar.org

One study estimates that more than 90% of people with developmental disabilities will experience sexual abuse at some point in their lives. Valenti-Hein, D., Shwartz, L. 1995. Sexual Abuse Interview for those with Developmental Disabilities.

Victims of sexual assault are:

  • 3 times more likely to suffer from depression
  • 4 times more likely to contemplate suicide
  • 6 times more likely to suffer from Post Traumatic Stress Disorder
  • 13 times more likely to abuse alcohol
  • 26 times more likely to abuse drugsWorld Health Organization. 2002

In the US, rape is the most costly crime to its victims totaling $127 billion a year considering factors such as medical costs, lost earnings, pain, suffering and lost quality of life. www.nccasa.org.

The Experience

When we achieve this result:

  • There will be zero lives lost to domestic, sexual or child violence, and no re-offenders of those crimes.
  • Discussion of crimes will be focused on the perpetrator--why/how did the perpetrator commit the violence, NOT on the victim's age, situation, clothing, choices to stay/leave, etc.
  • More community service dollars will be devoted to prevention rather than treatment (Helpmate & Our Voice will provide prevention education, not crisis services)
  • Bystanders will actively redirect and/or report potential violence.
  • Social norms in Asheville move toward more use of conflict resolution skills, including court-based and peer-led conflict resolution.
  • We will overhear effective parenting everywhere--parents setting clear and firm boundaries, praising good behavior, etc.
  • Ample, quality childcare will be available, including short-term/drop-in care and second-shift care.
  • Schools at all grades will incorporate more social/emotional learning and expression, and everyone in the community will know concrete ways to manage their stress.
  • People will feel safe in their homes and communities and miss fewer days of work.
  • Buncombe residents will have healthy gender norms based on equality, and those healthier norms will be visible in local media as well.
  • People will be able to comfortably talk about sex (including non-hetero-normative) and everyone will have a strong understanding of consent.
  • People will understand that domestic and sexual violence is about POWER (vs. relationship).
Data Holes
  • A measure/scale of COMMUNITY ATTITUDES TOWARD VIOLENCE (Our VOICE conducted a large survey using the Illinois Rape Myth Acceptance Scale in 2008 and a smaller survey in 2015, so there is a bit of baseline...)
  • ED admissions for child maltreatment
  • Prosecution/Conviction data for domestic violence, sexual assault and child maltreatment (These are more performance measures...)
Partners

Asheville Police Department: The City of Asheville Police Department is dedicated to providing public safety and maintaining order and enforcing the laws of NC, upholding the US Constitution and enhancing National Security. The City of Asheville is committed to supporting a safe city with safe neighborhoods. Guiding Principles: Integrity, Fairness, Respect & Professionalism.

Buncombe County District Attorney’s Office: The mission of the District Attorney's Office is to seek justice by ensuring that victims' rights and the public's safety are our number one priority through the fair, equal, vigorous and efficient enforcement of the criminal laws.

Buncombe County Health and Human Services: HHS is creating a streamlined group of services that address the health, safety, and well-being of residents in our community.

Family Justice Center: The Family Justice Center co-locates and integrates victim service providers to create a comprehensive, one-stop model to meet victim needs and increase safety.

Buncombe County Sheriff’s Department: The Buncombe County Sheriff’s Office is a professional, service oriented law enforcement agency. We are dedicated to improving the quality of life of everyone in Buncombe County by utilizing the highest degree of integrity and professionalism at every level, making certain that we lead by example, treat all persons with dignity, and hold ourselves accountable to the highest possible standards.

Helpmate: Provides services for victims of domestic abuse including emergency shelter for women and children, 24-hour hotline, individual and group counseling, case management, court advocacy, and preventive education and training.

Mission Health: Mission Health is a not-for-profit, independent community hospital system governed and managed exclusively in western North Carolina.

Mountain Area Health Education Center (MAHEC): MAHEC is passionate about excellence in healthcare. For 42 years they have provided high quality, compassionate healthcare as a foundation for training top physicians and health professionals.

Our VOICE: Provides services for victims of rape and sexual assault. Direct services including 24-hour crisis line, case management, individual and group counseling, accompaniment to medical services, law enforcement interviews and court proceedings information and referrals. Additionally they provide prevention, education and outreach services.

Pisgah Legal Services: Pisgah Legal Services provides free civil legal aid in WNC to disadvantaged children, seniors, at-risk families & domestic violence victims.

SPARC Network and SPARC Foundation: Working to keep people out of institutional care.

Mountain Child Advocacy Center: Provides education, prevention, advocacy and intervention services for abused children in Buncombe County. Today, the Mountain Child Advocacy Center (MCAC) functions as the hub for services provided to children and families experiencing abuse and neglect.

United Way: United Way of Asheville and Buncombe County is about local giving with local impact. Runs the NC 2-1-1 Asheville Call Center.

YWCA of Asheville: The YWCA is on a mission to eliminate racism, empower women, stand up for social justice, help families and strengthen our community.

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Why Is This Important?
All are able to eat healthy, be active and better manage disease
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When we achieve this result:

  • All in our community, regardless of age, race, gender or income will eat healthy.
  • Individuals will have security in their ability to access needed food for themselves and their families.
  • This includes being inspired to make healthy choices and utilizing skills to make it happen such as cooking, growing, or shopping for their own food
Partners

ASAP: The Appalachian Sustainable Agriculture Project's mission is to help local farms thrive, link farmers to markets and supporters, and build healthy communities through connections to local food.

Asheville Buncombe Institute of Parity Achievement (ABIPA): providing education, health services and advocacy from a unique understanding of the African American experience and a demonstrated ability to increase collaboration, connection, awareness and trust across diverse segments of the community.

Asheville Housing Authority: Striving to serve its residents by providing an affordable home and avenues to self-sufficiency.

Asheville Buncombe Food Policy Council: A community-based coalition in the City of Asheville and Buncombe County, North Carolina working to achieve policy improvements that create healthier food environments and improve healthy food access for all Asheville and Buncombe County residents.

Bountiful Cities: Working with communities teaching urban agricultural skills from seed to seed, and advocating for healthy food systems that are accessible to all.

Bounty & Soul: Bounty & Soul is a grassroots, volunteer-run non-profit dedicated to creating a health and wellness movement in underserved communities in Buncombe County. Their fresh, free food markets are providing healthy food along with nutrition awareness and health and wellness resources for children, families, individuals, and seniors who may not have access to these resources.

Buncombe County Health and Human Services:

HHS Community Service Navigators: The CSN initiative was created to connect people with Buncombe County Health and Human Services, strengthen the communities capacity to help meet citizen needs, empower citizens and communities as change agents to promote positive outcomes, build and enhance collaborative partnerships, and reduce over utilization of more costly services.

Minority Health Equity Project: This project bring together five different community partners and the Buncombe County Department of Health to combine our resources to promote health equity

School Health and Migrant Education Program:

Children First/Communities in Schools: A non-profit committed to advocating and empowering children and families living in poverty. This is achieved through education and direct services such as the Family Resource Center at Emma, our after-school Learning Centers, Latino Outreach, Project POWER/AmeriCorps, and Success Coordinators in Emma & Johnston Elementary School.

Cooperative Extension: provides food, nutrition and agricultural education and resources

FEAST Asheville: empower youth and families to grow, prepare and enjoy fruits and vegetables through hands on cooking and garden educationempower youth and families to grow, prepare and enjoy fruits and vegetables through hands on cooking and garden education

Gardens That Give WNC: A network of volunteers, garden managers and other participants representing diverse models of community gardens in WNC and their partners that grow food for donation

MANNA Foodbank: Mountain Area Nutritional Needs Alliance. We are a member of Feeding America, the nation’s largest domestic hunger relief organization. MANNA distributed 15.7 million pounds of food through some 229 community-based food assistance agencies in 16 Western North Carolina counties

Mission Health:

Disease Management Programs: Diabetes education and support can mean the difference between a healthy life and one diminished or cut short by the many serious problems faced by people with diabetes. Mission Hospital’s Diabetes Management program provides the educational foundation and tools you need to take charge of the condition.

UNC Asheville-NC Center for Health and Wellness: collecting data and evaluating the program for the Minority Health Equity Project

WIC: Women, Infants and Children (WIC) Supplemental Nutrition Program is designed to improve the health and well-being of low-income pregnant, breastfeeding and postpartum women, infants and children up to age five who are at nutritional risk by providing nutrition education, breastfeeding education and support, referrals for health care, and free language assistance.

YES!: YES!’s Real Food, Active Living team is working to engage and empower young people in community change efforts to increase access to healthy food and active living, and decrease the childhood obesity epidemic.

YMCA:

Federal Nutrition Programs: Summer Food Service serves summer camps and community sites to ensure low-income children get nutritious meals when school is not in session. The Child and Adult Care Food Program that provides nutritious meals and qualifying facilities.

Outreach Programs: Healthy Living Pantry provides nutritious food the families that need temporary food assistance and has cooking demonstrations. The Healthy Living Mobile market distributes mostly produce around the community. Healthy Living Mobile Kitchen is a remodeled bus that functions as a nutrition education and food assistance outreach hub. Share Our Strength's Cook Matters provides nutrition demonstrations.

diabetes prevention program and Taking Control of Type 2

YWCA:

Diabetes Wellness and Prevention Program: Empower individuals with diabetes or those at risk of diabetes to develop the habit of exercise, reduce the incidence of diabetes, through exercise and education that supports healthy eating, promote healthy lifestyle changes for the entire family.

Data Holes

The Community Health Improvement Process team at the Mountain Area Health Education Center is working to illuminate the root causes of food insecurity specific to Buncombe County. Poverty and access to healthy food sources are of particular interest. Quantitative data will illuminate what issues and disparities are occurring. Qualitative data, from focus groups and interviews in the community, will bring information on what the community thinks are the the most important issues and barriers to health. Finally, mapping the data can highlight populations and geographic areas where new health improvement efforts need to be focused.

Community Partners have identified the following holes in data:

  • Measures that appropriately represent economic access. Does "meal gap" data reflect economic access?
  • How do we measure knowledge and skills?
  • What kinds of fruits and vegetables are people eating? (e.g. fresh, frozen or canned)

For additional indicators being monitored, click here.

Why Is This Important?

In Buncombe County 14.3% of households experience food insecurity compared to 15.4 % nationally and 17.7% in North Carolina. While we are ahead of these trends, we want to see this number at zero.

Food security means access by all people at all times to enough food for an active, healthy life. Food security and health are significantly associated. People who are food insecure are disproportionately affected by diet-sensitive chronic diseases such as diabetes and high blood pressure, and according to research, food insecurity is also linked to many adverse effects to overall health.

  • Food insecurity has particularly harmful impacts on children including negative impacts on a child’s physical and mental health, academic achievement and future economic prosperity. Pregnant women who experience food insecurity are more likely to experience birth complications.
  • Seniors face a number of unique medical and mobility challenges that put them at a greater risk of hunger. Many seniors live on fixed incomes and have increased healthcare expenses.
  • African Americans are more likely to suffer from food insecurity as their white, non-Hispanic counterparts. African Americans households are also more likely to experience poverty.
  • Latino adults and children are at greater risk of obesity and diabetes than their African American and White, non-Hispanic peers. Latinos have a higher risk for diabetes and other chronic health conditions that can further complicate the issue of food insecurity. Latino households are also more likely to experience poverty.
  • Rates of food insecurity among rural households are generally higher than urban households. Rural communities face different challenges including concentration of employment in low-wage industries, higher unemployment and underemployment, lower education levels, lower access to work support services, and poor communication and transportation networks.

Food security and food insecurity are two related but different issues. Two resources that provide a more in-depth look at these include Feeding America which focuses primarily on food insecurity and the Appalachian Foodshed Project with their discussion of community food security in Western North Carolina and Buncombe County and some of the root causes and challenges related to creating a food secure

One indicator of improved health behavior and increased security is the number of servings of vegetables that adults consume weekly. In Buncombe County, adults on average consume 9.3 servings of vegetables a week. Because those with food insecurity often consume low-cost food that are less healthy, foods insecurity is closely tied to diabetes prevention and management. In Buncombe County, 7.3% of individuals have diabetes compared to 9.3% nationally and 10.9% in North Carolina, and we would like to see a continued trend downward. Both diabetes and fruit and vegetable consumption is also being monitored by the state through Healthy NC 2020.



Partners identified that diabetes is an important indicator to monitor in regards to food security and vegetable consumption. You can view the Diabetes Work Group result here.

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Decreased physical activity has been related to several disease conditions such as type 2 diabetes, cancer, stroke, hypertension, cardiovascular disease, and premature mortality, independent of obesity. Inactivity causes 11% of premature mortality in the United States, and more than 5.3 million of the 57 million deaths that occurred worldwide in 2008.1 In addition, physical inactivity at the county level is related to health care expenditures for circulatory system diseases.2 Physical activity is also being monitored through Healthy NC 2020.

The role of the built environment is important for encouraging physical activity. Individuals who live closer to sidewalks, parks, and gyms are more likely to exercise.1-3

When we look at the rise of obesity over the past several decades in the context of what has changed in our communities, we see a significant decrease in walking or biking as a form of transportation with much more time spent in cars. Car-centric community design makes it challenging in many parts of our community to walk, to bicycle, or to use public transportation (which generally requires walking and biking to round out a trip) to get around. There is a growing body of evidence that suggests that adults and children who live in communities where active transportation is realistic, affordable and convenient are more physically active. In fact, when active transportation is part of an everyday commute it may be as beneficially as structured exercise work out. A 2012 study in the American Journal of Preventive Medicine found that the farther people commute by vehicle, the higher their blood pressure and body mass index. Also, the farther they commute, the less physical activity the individual participated in.1 In Buncombe County, 20% of the population spends more than 30 minutes driving alone to work every day.

Making active transportation a realistic, affordable and convenient option for all transportation users would help reduce health impacts and also promote physical activity, recreation and environmental preservation. Well connected streets with safe pedestrian and bicyclist paths and infrastructure can promote a healthy and active lifestyle for everyone.

Consider the following alarming statistics:

  • Three-quarters of American adults will be overweight or obese by 2015 (1) , while childhood obesity has more than tripled in the past 30 years2
  • Physical inactivity can lead to chronic diseases, such as high blood pressure, heart disease, osteoarthritis, cancer, stroke, and diabetes3
  • Obesity costs account for approximately nine percent of all health care spending in the U.S., and part of these costs are attributable to auto-oriented transportation that inadvertently limits opportunities for physical activity 4
  • According to the Centers for Disease Control (CDC), roughly 23 percent of U.S. children do not participate in at least 60 minutes of weekly physical activity and 44 percent do not attend physical education classes in an average school week 5

The anticipated re-authorization of the federal surface transportation bill presents the nation with an opportunity to reinvent its transportation system to promote health across urban, suburban, and rural communities.

Consider these opportunities for health from an enhanced transportation network:

  • Women who walk or bike 30 minutes a day have a lower risk of breast cancer6
  • Active commuting that incorporates cycling and walking is associated with an 11 percent reduction in cardiovascular risk7
  • Active transportation as part of everyday travel is as effective as structured workouts for improving health8
  • Teenagers who bike or walk to school watch less TV and are less likely to smoke than their peers who are driven to school, in addition to getting more overall physical activity daily9
  • Public Transit users take 30 percent more steps and spend roughly eight more minutes walking each day than drivers10
  • A 30-minute round-trip bicycle commute is associated with better mental health in men11
  • New Yorkers save $19 billion per year because they rely less on cars than residents of other major U.S. cities12

References

Visit www.apha.org to learn more.

Partners

City of Asheville Transportation Department, French Broad MPO, Asheville Bike and Pedestrian Taskforce, Active Routes to Schools, Connect Buncombe,

Blue Ridge Bicycle Club: The mission of the Blue Ridge Bicycle Club is to promote healthy and fun lifestyles through cycling in Western North Carolina.

Buncombe County Schools: The mission of Buncombe County Schools is to collaborate with stakeholders to provide a safe, caring, rigorous and engaging learning environment that prepares all students to be Career and College Ready

Buncombe County Parks Greenways and Recreation:The mission of Buncombe County Recreation Services is to improve the quality of life within our community by providing high quality recreational facilities, opportunities for social interaction, and programming which encourages health and wellness through active lifestyles.

WNC Health Network: WNC Health Network exists to convene stakeholders and provide support for our members and partners to improve health and healthcare across our region.

Youth Empowered Solutions: Youth Empowered Solutions (YES!) is a nonprofit organization that empowers youth, in partnership with adults, to create community change. We equip high school youth and their adult allies with the tools necessary to take a stand in their communities and create change that will positively impact adolescent health.

Data Holes

Community Partners have identified the following holes in data:

  • DSS bus vouchers
  • Walking distance to greenways and bus stops
  • Looking at demographics at census block level
  • Goat trails (where people walk where there are no sidewalks)
  • Crossings, number of signals with pedestrian crossing/total signals (a safety measure)
  • People counts on greenways (group believes Black mountain and Asheville City have this data)
  • Percent of people that support greenways
  • Economic return of greenways (analysis will be done within 6-12 month)
  • Connectivity of transportation, sidewalk and greenways - would like a dataset

For additional indicators being monitored, click here.

The Experience

When we achieve this result:

  • Buncombe county will have a connected community that welcomes pedestrians and cyclists.
  • People will have access to multiple modes of transportation and people will walk, bike, and take the bus to school, work and other activities.
  • People will be more connected to neighbors and their neighborhoods.
  • All ages and types of people will have access and utilize diverse modes of transportation.
CI
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When we achieve this result:

  • Everyone in Buncombe County is able to either prevent developing Type 2 diabetes or to successfully manage an existing condition.
  • Buncombe will be a safe environment where people are inspired (not just able) to lead an active lifestyle and eat readily available, nutritious, healthful food.
  • Nutrition and exercise are regular parts of school curriculum.
  • Clinics are accessible within communities so individuals do not have to travel to receive healthcare.
  • People who are at risk of diabetes or who have diabetes receive culturally and linguistically appropriate education about behaviors they can engage in to prevent or manage their disease.
Data Holes

The Community Health Improvement Process team at the Mountain Area Health Education Center is working to identify strategies to reduce diabetes prevalence and mortality in Buncombe County. Poverty and access to healthy food sources are of particular interest.

Community Partners have identified the following holes in data:

  • Access to fresh fruits and vegetables or exercise opportunities
  • Data from Harvard (about results of Community Health Worker model???)
  • Measuring the proportion that have diabetes appropiately managed with normal or improved HbA1c
  • Self-reported or provider identified positive health behavior changes
  • Percent of population 18 and older have been screened in past year for diabetes

For more additional indicators that are being monitored, click here.

Partners

Asheville Buncombe Institute of Parity Achievement (ABIPA): providing education, health services and advocacy from a unique understanding of the African-American experience and a demonstrated ability to increase collaboration, connection, awareness and trust across diverse segments of the community

Buncombe County Health and Human Services:

HHS Community Service Navigators: connecting residents with Buncombe County Health and Human Services, strengthening communities' capacity to help meet citizen needs, empowering citizens and communities as change agents to promote positive outcomes, building and enhancing collaborative partnerships, and reducing over-utilization of costly services

Minority Health Equity Project: bringing together five different community partners and Buncombe County Health and Human Services to pool resources to promote health equity.

Cooperative Extension: providing food, nutrition, and agricultural education and resources

Council on Aging: Providing education, innovative programming, and coordination of resources for aging

Eschelmen School of Pharmacy (UNC): training doctor of pharmacy students, with the option of a Rural Pharmacy Health Certificate

Family Resource Center at Emma: providing emergency assistance through a food pantry, a clothing closet, emergency financial assistance for rent and utilities, parenting classes and holiday assistance

Land of Sky Regional Council: coordinating Living Healthy classes and training leaders for the Living Health classes. For more information, visit Living Healthy WNC.

Mountain Area Health Education Center (MAHEC): providing high quality, compassionate healthcare as a foundation for training top physicians and health professionals

School Nursing Program: School Health is available to reach over 30,000 students in Buncombe County and Asheville City schools. They do health assessments, train school staff on health -related issues, advise staff and families about contagious diseases, participate on school wellness teams, and much more.

Mountain Area Nutritional Needs Alliance (MANNA) Foodbank: a member of Feeding America, the nation’s largest domestic hunger relief organization, MANNA distributes food through 229 community-based food assistance agencies in 16 Western North Carolina counties

Mission Health Disease Management Programs: providing the educational foundation and tools people need to take charge of chronic diseases.

Mission Health Partners (Accountable Care Organization): a network of hospitals, physicians, and other healthcare providers working together to improve healthcare quality, performance, efficiency and value for the patients of western North Carolina.

NC Center for Health & Wellness (UNCA): working to impact policy, build capacity and ignite community initiatives by working through a web of cross sector relationships organized around building healthier places throughout the state; providing data collection and evaluation for the Minority Health Equity Project and other CHIP efforts

Western North Carolina Community Health Services (WNCCHS): Federally Qualified Health Center providing primary healthcare, dental, behavioral health, and support services

YMCA: providing programs youth development, healthy living, and social responsibility; offering affordable opportunities for exercise and wellness education

YWCA: working to eliminate racism, empower women, stand up for social justice, help families and strengthen our community; providing affordable opportunities for exercise and wellness education.

Partners the group hopes to engage in the future:

  • Schools - Migrant Health, Norma Brown, Nancy Moore, Rosario Villarreal (contacted June 2016)
  • Council on Aging
  • Primary Care / OB Providers
  • FQHC - Dale Fell Center is going to have clinics in housing communities (contacted June 2016)
  • WCU Nursing students
  • AB Tech Nursing program
  • VA Hospital
  • WNC Dietetic Association
  • Asheville City Neighborhood Advisory - Marsha Stickford
  • PACE
  • Faith-based organizations
  • Planning (built environments)
Why Is This Important?

Type 2 diabetes is associated with obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, older age, and race/ethnicity. In Buncombe County, the disparity in diabetes mortality between the White non-Hispanic population and the Black non-Hispanic population is startling. In 2014, the age-adjusted mortality rate for White non-Hispanics was 14.2/100,000 while the Black non-Hispanic rate was 2.8 times that, at 40.0/100,000.

Reducing the prevalence of diabetes is an objective of Healthy NC 2020. Chronic diseases such as heart disease, cancer, and diabetes are major causes of death and disability in North Carolina. Although genetics and other factors contribute to the development of these chronic health conditions, individual behaviors play a major role. As much as 50% of individual health can be attributed to behavior alone. Physical inactivity, unhealthy eating, smoking, and excessive alcohol consumption are four behavioral risk factors underlying much of the burden caused by chronic disease. According to the CDC, diabetes is a leading cause of death, lower-limb amputation not related to trauma, new cases of blindness, and kidney failure in the United States. It also is a major contributor to cardiovascular disease, the number one cause of death in this country. In addition, diabetes cost the nation an estimated $245 billion in direct and indirect costs. To read more about diabetes go here.

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Diabetes Prevention and Management Program Providers:

  • Asheville Buncombe Institute for Parity Achievement (ABIPA)
  • Land of Sky Regional Council-Area Agency on Aging
  • Mission Diabetes Center
  • YMCA of WNC
  • YWCA of Asheville

Clinical/Primary Care Providers (or other referral sources)

  • Asheville Family Medicine*
  • Asheville Internal Medicine*
  • Family Health Centers*
  • MAHEC Family Health
  • Mission Health Partners
  • Mission My Care Plus*
  • Trillium Family Medicine*
  • WNCCHS (Minnie Jones Clinic)

* Partners in the original pilot 2014-2015

Evidence Base

From the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)'s Community Partnerships Page (written for a clinical audience):

Patients live, work, and play in social and physical environments outside the health care system. Therefore, clinic-community partnerships are key to building community support for diabetes self-management.1,2 Increasing patient access to effective community resources through linkages with relevant agencies and organizations is a cost-effective way to obtain important services such as nutrition counseling or peer-support groups.3,4 Furthermore, clinic-community partnerships have demonstrated benefits at the individual, organizational, and community levels.5 For example, clinic-community partnerships result in better clinical outcomes; increased capacity for outreach; improved access to community resources; enhanced community engagement in diabetes support; and, ultimately, reductions in morbidity and mortality and improvements in quality of life related to diabetes.6,7

References

1. Glasgow RE, Davis CL, Funnell MM, Beck A. Implementing practical interventions to support chronic illness self-management. Jt Comm J Qual Saf. 2003;29(11):563-74.
2. Fisher EB, Brownson CA, O’Toole ML, Anwuri VV, Shetty G. Perspectives on self-management from the Diabetes Initiative of the Robert Wood Johnson Foundation. Diabetes Educ. 2007;33 Suppl 6:216S-224S.
3. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: Translating evidence into action. Health Aff (Millwood). 2001;20(6):64-78.
4. Johnson P, Thorman Hartig M, Frazier R, et al. Engaging faith-based resources to initiate and support diabetes self-management among African Americans: A collaboration of informal and formal systems of care. Health Promot Pract. 2014;15(2 Suppl):71S-82S.
5. Cashman SB, Flanagan P, Silva MA, Candib LM. Partnering for health: Collaborative leadership between a community health center and the YWCA central Massachusetts. J Public Health Manag Pract. 2012;18(3):279-87.
6. Klug C, Toobert DJ, Fogerty M. Healthy Changes for living with diabetes: An evidence-based community diabetes self-management program.Diabetes Educ. 2008;34(6):1053-61.

7. Boyd ST, Scott DM, Augustine SC. Exercise for low-income patients with diabetes: A continuous quality improvement project. Diabetes Educ. 2006;32(3):385-93.

Additional Resources

Clinical Referral Tool 2016-9-1

Actions and Accomplishments


Actions & AccomplishmentsBy WhenStatus
Update Clinical Referral Tool Aug '16completed
Share Clinical Referral Tool at MAHEC's Managing Diabetes Throughout the Lifespan programAug '16completed
Share Clinical Referral Tool with all residents and providers at MAHEC Family HealthAug '16completed
Meet with WNCHHS referral specialists/staff to discuss integrating community referrals into workflowOct '16completed
Meet with MAHEC referral specialists/staff to discuss integrating community referrals into workflowOct '16completed
Meet with 211 to learn about potential for clinician referrals directly to 211Nov '16completed
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Additional Resources

These are two tools the work group has developed as a first step to accomplishing this strategy:

Buncombe Diabetes Services Map (PDF)- Updated September 2016 This is a big-picture view of what Buncombe County offers - from universal diabetes prevention (like healthy cooking classes) to management and treatment.

Working Google Drive Document Cataloging Diabetes-Related Services in County - Clicking on this link will take you to the working document where YOU CAN EDIT the information for your own programs.

Excel Document Cataloging Diabetes-Related Services in the County - Clicking on this will download the document, but if you want to edit it, you must email the edits to deanna.lamotte@mahec.net.

Actions and Accomplishments
ActionBy WhenStatus
Connect with referral specialists at WNCCHS and MAHEC to identify what information they need and what processes will best integrate into clinic workflow.Nov '16Beginning Oct '16
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