While diabetes prevalence in Buncombe County is slowly decreasing, the 5-year aggregate age-adjusted mortality rate has increased from 11.3/100,000 in 2011 to 15.3/100,000 in 2014. Though there are many factors contributing to this increase, this may suggest that people with diabetes are struggling to manage this chronic disease. The large racial disparity also suggests that managing diabetes is even more difficult for African-Americans than for Whites in our community. Research suggests many possible barriers to diabetes self-management, including limited health literacy and/or access to self-management information, the cost of medication, the limited availability and high cost of fresh foods vs. processed foods, and a historical mistrust of physicians in certain minority communities.
There are several initiatives working directly to overcome these barriers in the county. MANNA Foodbank and the Community Service Navigators organize "pop-up markets" regularly in housing communities, where residents cannot only get free healthy, fresh food, but they can also participate in health screenings and education and get connected to community-based disease management programs like those at the YMCA, YWCA, and Land of Sky. The Minority Health Equity Project, funded by the state CFEHDI grant, helps organizations that focus specifically on African-American and Latino health to collaborate and pool resources for greater impact. Clinical and community partners have also worked to increase physician referrals to community-based diabetes education and management programs to increase participation, and the number of primary care practices now certified as Patient Centered Medical Homes means that more disease management support will come from those practices.
Though Buncombe County has quality health care providers, many community resources and promising initiatives, there is more to be done. There is a deep distrust of the medical community in some parts of the county, and a perception in some areas that diabetes is "normal." Many people with diabetes are either confused by the information they receive or do not have the information they need to successfully manage the disease. In addition, the large group of uninsured or under-insured residents, due to North Carolina's decision not to expand Medicaid, means access to physicians and medication is a challenge, and limited public transportation presents more access problems. Even though there are many organizations that offer instruction in food-growing and cooking, there isn't yet a system for referring patients with diabetes to these kinds of supports.