Reynolds Trust targets health in poorest counties

By Todd Cohen

WINSTON-SALEM, N.C. — The Kate B. Reynolds Charitable Trust in Winston-Salem is investing $100 million over 10 years to improve health in 10 to 15 of North Carolina’s most economically distressed counties.

Starting with Beaufort, Halifax and McDowell counties, the Trust plans to work in each county with local leaders and residents, not only nonprofits and not only in the health-care field, to develop a range of “mutually reinforcing” strategies to promote good health.

Those strategies, to be developed differently by each county based on local factors, will focus on issues such as access to primary care; community-centered prevention; diabetes; and mental health and substance abuse.

Addressing those issues could involve approaches such as fostering opportunities for people of all ages to engage in physical activity and get access to healthy foods; and offering affordable, accessible and preventive health care.

“We’re really recognizing that there are so many other factors outside the health-care system that go into either supporting or defeating a community’s attempt to get healthier,” says Allen J. Smart, director of the Trust’s Health Care Division.

While funding from the Trust will support and stimulate the development of these strategies, it wants to do that in partnership with other groups and funders

And while the Trust within five years expects to be investing in the new initiative half the roughly $15 million it distributes each year through its Health Care Division, which accounts for three-fourths of its total grants, it will not be “leading with money” or trying to shape the health-care solutions for the counties it supports, Smart says.

“This is not a prescriptive model,” he says. “It’s really meant for people to come together around common interests in utilizing some of the assets they have in place, and do some serious attempts at problem-solving – not just grants and putting people in competition for grant dollars, but trying to break both our own model and how communities often respond to funders.”

The Trust is among fewer than 10 funders throughout the U.S. that are “attempting to embrace a larger community ownership of health issues in the community, and doing it with long-term commitment,” Smart says.

While it might identify “assets” it has in the area of children’s health, such as good pediatricians and a good health department, for example, a community might find it has gaps in care, with children not being as healthy as they might be, he says.

So community leaders might work together to identify and advocate for strategies to improve health outcomes for children, with the Trust investing in better access to health care, for example, other funders investing in increasing the availability of child care, and private employers working to improve the health of parents.

The focus, Smart says, is “longer-term, from when you get up in the morning to when you go to bed at night, and everything that affects your health.”

The Trust selected the first three counties based on an analysis of their populations’ health needs, and existing “capacity” in the public and private sectors, as well as the state’s geographic and cultural diversity.

If the strategies work in the counties the Trust is targeting, it will try to expand into adjacent counties, with the pilot counties serving as “hubs,” Smart says.

The initiative, he says, is “an attempt to create discussion and ownership of community health issues by people and institutions well outside the health-care delivery system.”

The focus will include not only the health status of children entering school, opportunities for people of all ages to engage in physical activity, or access to healthy foods, for example, but also affordable, accessible ad preventive health care; and developing better access to transportation, child care and employment.

“We’re really recognizing that there are so many other factors outside the health-care system,” Smart says, “that go into either supporting or defeating a community’s attempt to get healthier.”

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