Community colleges aim to spur better health

By Todd Cohen

[Note: This was written for the Kate B. Reynolds Charitable Trust.]

On a cold Friday afternoon in February, a group of students, faculty and staff members gathered in a warm teaching dining room on the campus of Nash Community College in Rocky Mount to break bread together — and learn how to bake it.

As part of the school’s effort to stimulate healthier living in the rural community, a culinary teaching chef showed the group how a few simple substitutions in ingredients could turn an ordinary loaf into something much healthier and tastier.

“People couldn’t believe all the nutritious goodness that was packed in,” says Trent Mohrbutter, vice president of instruction and chief academic officer at the school.

Sometimes, he says, it takes small steps — especially when shared by a group or community — for individuals to make big changes.

Inspiring people in rural communities to live healthier lives by providing them with better access to information about health and wellness, and to opportunities to visit a doctor, exercise and eat more nutritious food, is the focus of a 10-year, $100 million investment by the Kate B. Reynolds Charitable Trust.

Launched by the Trust in 2012, Healthy Places NC is investing up to $100 million to improve the health of residents in 10 to 12 of the state’s most rural and financially disadvantaged counties.

As part of that initiative, the Trust is providing support designed to help seven community colleges become resources and catalysts for healthier living on their campuses and in the counties they serve.

Working with MDC, a research and consulting nonprofit in Durham, the schools are undertaking a broad range of projects. For example, Beaufort County Community College is hosting health summits. Edgecombe Community College is creating a natural playscape on campus. Halifax Community College is establishing a clinic on campus. McDowell Technical Community College is serving the campus and community through telemedicine.  Rockingham Community College is creating an “edible” greenhouse. And Western Piedmont Community College is developing a campus-wide healthy lifestyle initiative.

“The goal of our initiative is institutionalizing the idea of influencing healthy behavior and improving health outcomes into the colleges,” says Dan Broun, senior program director at MDC. “If they’re successful, even when the funding ends, that will be part of the way business is done at the campus.”

Change agents

Community colleges in rural counties are naturally positioned to stimulate healthier living in their communities. The schools often rank among their counties’ larger employers, and their classes and cultural events during the day and in the evening attract a steady flow of students and visitors.

The schools train workers who can join the local health-sciences workforce. They offer programs and facilities such as physical education classes, gyms and walking trails that give students and employees opportunities for physical activity. Some offer direct health services for the community.

“Community colleges serve some of the most vulnerable populations in a community,” Broun says. “There’s a lot of opportunity to make lasting change in terms of the goals of the initiative, which is to dramatically improve health outcomes in these distressed counties.”

Providing access

Living in counties that rank among the lowest in the state on indicators that measure socio-economic status, residents of Eastern North Carolina typically have less access than people in more affluent counties to “healthier food options, and to some extent to health and wellness opportunities,” says Mohrbutter at Nash Community College.

Another hurdle to healthier living in the region is a limited local “knowledge base” about health and wellness. “Everybody knows donuts are not good for you,” he says, “but just saying that doesn’t necessarily provide knowledge to people.”

Thanks in part to its support from the Trust, the school is working to make it easier for local residents — including its students, faculty and staff — to find out how to eat better, stay fit and be healthy. And it is providing them with tools to practice what they learn.

A February seminar on baking healthy bread, for example, was held in an interactive classroom across the hall from a culinary teaching kitchen equipped for Nash Community College’s programs on restaurant management, and culinary and hospitality management.

Instead of flour and sugar, the culinary teaching chef leading the seminar used honey and “spent” grains, including those high in protein but low in carbohydrates — ingredients that produced a lower calorie count. Seminar participants watched him prepare and bake the bread, then sampled it. And they left with the recipe.

The seminar was one of six scheduled for the spring semester. The school also received a grant from the Trust to equip its weight room and cardiovascular room. With the new equipment, more employees and students are using the fitness rooms.

“Once you start doing something that has value,” Mohrbutter says, “the students and employees not only come to value it themselves, but they also come to expect it.”

To get the word out about its healthy-living efforts, the school launched a communications campaign that uses social media and features articles in an e-newsletter it distributes every Friday throughout the county.

“As we expose students and employees to the opportunities — anyone who comes into contact with the college — we will expand their knowledge and experiential base,” he says. “Then it becomes part of what they do, and that’s behavior change. Whether students, employees or community partners, they come, they learn about something, they try it, they experience it on their own, they come back again, and before you know it, their lifestyles have changed, hopefully for the positive.”

Learning together

Heathy Places NC has created a “learning network” among the schools. A newsletter keeps all participants up to date on projects at each campus, and on best practices.

Critical to securing future funding for campus health and wellness projects, says Broun of MDC, will be the ability to show the difference they make on indicators that reflect students’ health and are tied to public funding.

“What ultimately could be most valuable” in addition to healthier living, he says, “is if people see that investing in these initiatives has an impact on increasing measurable things like student retention and completion.”

[The Trust’s Healthy Places NC initiative is currently working to improve health in the rural counties of Beaufort, Burke, Edgecombe, Halifax, McDowell, Nash and Rockingham.]

Rural gap found in subsidized health coverage

A smaller share of people in North Carolina’s 80 rural counties who are eligible for subsidized health insurance under the federal Affordable Care Act have enrolled to get that coverage than the share that have enrolled in the state’s six urban counties or 14 suburban counties, a new study says.

Throughout the state, 51 percent of people estimated to be eligible to buy subsidized coverage through a “marketplace exchange” during the first two open-enrollment periods had enrolled by the end of the 2014 open-enrollment period, says the report, “Enrollment Deficits under the Affordable Care Act.”

In rural counties, which are home to over four million people, or 42 percent of the state’s population, the “enrollment deficit” totaled 210,855 people, or 39 percent of the rural population eligible for coverage, says the study, which was prepared by the School at Law at Wake Forest University and supported by the Kate B. Reynolds Charitable Trust in Winston-Salem.

The enrollment gap in urban counties, which are home to over 3.1 million people, or 33 percent of the state’s population, totaled 184,880, or 35 percent of those eligible, while the gap in suburban counties, which are home to over 2.4 million, or 25 percent of the state’s population, totaled nearly 137,951 people, or 26 percent of those eligible.

In rural counties, the study says, income and eduction levels are noticeably lower than in urban or suburban counties and might affect enrollment efforts.

“Enrolling in the marketplace is not a simple process to understand or accomplish,” the study says. “Those with lower education may find it more difficult to complete this process.”

Individuals with lower income also “may face more transportation difficulty in meeting with an insurance agent or enrollment assister, especially those living in areas that lack public transportation.”

Language or cultural barriers among foreign-born residents also may pose an enrollment hurdle, the study says.

“Many foreign-born residents are citizens and so are potentially eligible, but so too are noncitizen legal immigrants,” the study says.

On the whole, it says, foreign-born residents account for 4.2 percent of the population of rural counties, 6.7 percent of suburban counties, and 10.8 percent of urban counties.

That overall concentration of foreign-born residents in rural counties ranges from less than one percent in individual rural counties to over 10 percent.

A low concentration of foreign-born residents can present special difficulties where it indicates “the absence of an identified immigrant community with developed resources and institutions that can provide the more specialized enrollment assistance required,” the report says.

While average rural enrollment is within one percentage point of the statewide average, the study says, the enrollment gap ranges from nearly two-thirds of those eligible for marketplace subsidies in some rural counties, to less than one-third in other rural counties.

The report was written by Edwin Shoaf, a research associate, and Mark A. Hall, a professor of law and public health, both at Wake Forest University School of Law.

Todd Cohen

McNeil-Miller to head Colorado Health Foundation

By Todd Cohen

WINSTON-SALEM, N.C. — Karen McNeil-Miller, president of the Kate B. Reynolds Charitable Trust in Winston-Salem, has been named president and CEO of the Colorado Health Foundation in Denver, effective September 1.

Allen Smart, vice president of programs at the Reynolds Trust, will serve as interim president, starting September 1, while Wells Fargo, the Trust’s sole trustee, leads the search for a new president.

With $585 million in assets, the Reynolds Trust is one of North Carolina’s largest foundations.

Formed in 1947 through the will of Kate B. Reynolds, the widow of a chairman of R.J. Reynolds Tobacco Co., the foundation focuses one-fourth of its assets on the poor and needy in Forsyth County, and three-fourths on health programs and services throughout North Carolina.

Its poor-and-needy grants total roughly $6 million a year, and its health grants total roughly $20 million a year.

The Colorado Health Foundation, with $2.3 billion in assets, awarded over $112 million in grants and contributions in 2014 to improve health and health care in Colorado.

Former teacher

McNeil-Miller joined the Reynolds Trust as president in January 2005 after working for 16 years at the Center for Creative Leadership in Greensboro, where she served as vice president for corporate resources and, for six years in the 1990s, headed its office in Colorado Springs.

She was raised in Spindale in Rutherford County, the daughter of a carpenter and a weaver in local mills. A former special education teacher and head of The Piedmont School, an independent school in High Point for children with learning differences, McNeill-Miller is the first non-banker, woman and African American to have headed the Reynolds Trust.

Making an impact

During her tenure, she says, the Trust has shifted from “a charity model and investing in activities to a change model and investing in impact.”

While it previously might have funded efforts to increase the number of people enrolled in programs to train them to manage their diabetes, or to treat people who already had a disease, for example, its investments now focus on how many people enrolled in diabetes-management programs actually lower their blood-sugar rating, or on preventing disease rather than treating it.

A key focus of its health investments is “helping people understand how to eat better, the value of exercise, movement, diet, the built environment, walking trails, as opposed to making sure people can get to dialysis treatment or could get their medicine after they already have chronic illness,” she says.

Systemic change

The Trust, which has 14 staff members, nearly double the total when McNeill-Miller joined the foundation, also has undertaken two big initiatives to give people with little or no income greater opportunities, respectively, to improve their health and their learning.

Both efforts aim to produce systemic change through community-based strategies that are designed for individual communities and count on state and national partners and “best practices” from multiple disciplines and sectors, in addition to local partners and those in health and education.

The Trust’s Health Care Division is investing $100 million to $150 million, or roughly $10 million a year, to improve health in 10 to 15 of the state’s most economically-distressed and health-distressed counties.

And its Poor and Needy Division is investing $30 million to $45 million, or roughly $3 million a year, to make sure every child in a family with financial need is ready for kindergarten and school, and meets every developmental milestone by the end of kindergarten.

That spending, which will grow over time as the Trust’s assets grow through income on investments, McNeil-Miller says, represents roughly half the funds each of the two divisions makes in grants each year.

The big challenges for the Trust, she says, will be “to sustain those efforts, learn as we go, and make appropriate mid-course corrections, and really be able to evaluate our results and tell that story, not only for our own organization, but also for the benefit of communities, legislators and other funders.”

Community focus

During McNeil-Miller’s tenure, the Trust also:

* Expanded Federally Qualified Health Clinics throughout the state to ensure financially disadvantaged residents, especially in rural areas, had access to quality health care.

* Enlisted local funders after computer problems blocked access to food assistance for hundreds of local families, an effort that led to a new coalition of local food funders to look at more effective ways to provide food to families in need.

* Established an effort during the economic downturn to provide basic operating funds to community organizations with small budgets in Forsyth County.

* Invested in major capital improvements in Forsyth County at Family Services, Samaritan Industries and Winston-Salem State University, and across the state at rural playgrounds, schools and community centers.

‘Vision and leadership’

“Karen’s outstanding vision and leadership are shaping how, why and where the Trust  invests for years to come,” Sandra Shell, senior vice president and chief operating officer for philanthropic services at Wells Fargo, says in a statement.

“Karen joined the Trust at a time that its work needed focus and creative thinking, and Karen delivered,” Shell says. “Thanks to her leadership, the Trust is making smarter, more thoughtful investments in communities with an eye on long-term impact.”

N.C. diabetes ‘epidemic’ costs billions, Harvard finds; broad-based solutions urged

By Todd Cohen

RALEIGH, N.C. — Diabetes rates in North Carolina have nearly doubled in 20 years, reflecting a rapidly growing “epidemic” that costs billions of dollars in medical spending and a less efficient workforce, a new report from Harvard University says.

Diabetes is now the seventh-leading cause of death in the state, where the disease is far more prevalent than in the U.S. overall, the report says. And among African Americans and American Indians in the state, it is the fourth-leading and third-leading cause of death, respectively.

Economic impact

“This growing threat to the health of North Carolinians is also a threat to the state’s economy,” the report says.

At its current pace, it says, diabetes is on track to cost the state’s public and private sectors over $17 billion a year in medical expenses and lost productivity by 2025.

“With such high stakes, the state must take significant steps to address the disease from every angle,” the report says, including collaborative, coordinated efforts to attack known risk factors for diabetes for the population overall, and to improve the quality of care and access to it for all individuals living with the disease.

The report calls for “multipronged changes to the state’s healthcare, nutrition and physical activity landscapes,” including better access to healthy food and education programs; better access to medical and lifestyle interventions; improvements in the built environment; and new legislation and diabetes-related task forces.

1 in 10 Americans

In the U.S., diabetes affects nearly 26 million children and adults, or 1 in 10 Americans, and is the main cause of death for over 71,000 Americans a year, according to the American Diabetes Association. By 2050, if current trends continue, as many as one in three Americans will have diabetes, which now generates $245 billion a year in costs.

Type 2 diabetes, which accounts for nine in 10 diabetes cases, is a disorder of the body’s metabolic system that is characterized by high blood sugar, with obesity believed to be the main cause of the disease in people genetically predisposed to it. People who develop type 2 diabetes can lose up to 15 years of life, the report says.

Broad-based change

Funded through a grant from the Bristol-Myers Squibb Foundation and released last night in Raleigh, the report from the Center for Health Law and Policy Innovation at Harvard Law School is the result of research and over 90 interviews with policymakers, government agencies and nonprofits involved in North Carolina’s response to diabetes.

The report, “2014 New Carolina State Report: Providing Access to Healthy Solutions (PATHS) – The Diabetes Epidemic in North Carolina: Policies for Moving Forward” calls for a broad range of approaches to tackle diabetes. Among those recommendations:

* Promote “team-based, whole-person models” to deliver and finance diabetes care.

* Increase access to diabetes prevention and self-management programs.

* Expand telemedicine programs and access to durable medical equipment and insulin.

* Improve behavioral health services for people with diabetes.

* Increase economic and geographic access to healthy food.

* Increase opportunities for physical activities, and nutrition and cooking education.

* Expand programs for early childhood, school food, nutrition and wellness.

Focus on prevention

Allen Smart, vice president for programs at the Kate B. Reynolds Charitable Trust in Winston-Salem, says investment in efforts to reduce diabetes has focused on treatment of the disease, and on prevention of its complications, not on prevention of the disease itself.

The big challenge in fighting the disease, he says, will be to find ways to “engage communities, not just people in the health world, around some of the fundamental causes of diabetes that are really fueling this escalation.”

The Reynolds Trust, the state’s biggest private funder of diabetes programs, has invested roughly $10 million over the past five or six years to address the disease.

Just this week, the Reynolds Trust announced it is giving nearly $200,000 to the YMCA of  Western North Carolina to expand a diabetes program for McDowell County that has served 196 adults, helping them reduce their weight by 10.9 percent, on average.

Still, Smart says, “if I had $10 million to invest today in effective diabetes prevention programs in North Carolina, I wouldn’t have a place to put that money. There’s not enough evidence-based prevention work that’s been accepted that we feel confident works.”

Brad Wilson, president and CEO of Blue Cross and Blue Shield of North Carolina, the biggest health insurer in the state, says diabetes “is taking an increasingly heavy toll in our state on patients and families, citizens and taxpayers, and hospitals and other healthcare providers, and this has a direct impact on both the health of our customers and the cost of health insurance.”

The good news, he says, is that “common-sense, collaborative strategies can significantly reduce the impact of diabetes on the health and pocketbooks of North Carolinians, and on the costs to organizations that serve them.”

[Note: This article is a joint project of Philanthropy North Carolina and, with financial support from Blue Cross Blue Shield North Carolina.]

Reynolds Trust counts on partners to boost health, learning

By Todd Cohen

WINSTON-SALEM, N.C. — The Kate B. Reynolds Charitable Trust in Winston-Salem has joined a small but growing number of foundations that are turning to partners from a broad range of disciplines and sectors to give people with little or no income greater opportunities to improve their health and learning.

Nearly two years ago, the Reynolds Trust launched a $100 million, 10-year effort to improve health in 10 to 15 rural North Carolina counties, including some of the poorest in the state.

Known as “Healthy Places NC,” the effort is rooted in the idea that state and national partners and “best practices,” as well as local partners in addition to those in the health field, are critical to creating community-based strategies that are geared to individual communities and more likely to succeed.

“It requires a constellation of partners and evaluation, in state and out of state, to transform community health,” says Allen Smart, director of the Trust’s Health Care Division.

In January, Smart was given the additional job of vice president of programs, overseeing both the Health Care Division, which has a statewide focus, and the Trust’s Poor and Needy Division, which focuses on Forsyth County.

The Health Care Division is responsible for 75 percent of the Trust’s $22 million in annual grantmaking, and the Poor and Needy Division, directed by Joe Crocker, is responsible for the remaining 25 percent.

With $550 million in assets, the Trust is one of the largest philanthropies in the state.

The organizational restructuring is designed to take the strategic approach and lessons from Healthy Places NC and integrate them into the work of the Poor and Needy Division, particularly a new initiative that will focus on preparing children from birth to   age five to enter kindergarten.

Known as “Great Expectations,” the effort aims to enlist partners not just in the field of education but also from throughout the community, including parents, community leaders and those in fields such as health care, social services and child care.

What is needed, Smart says, is “everything that makes a more supportive environment that allows kids to be thriving by the time they go to kindergarten.”

The level of funding both for Healthy Places NC and for Great Expectations will grow for each of the first five years, and then will level off at 50 percent of the annual grantmaking, respectively, for the Health Care and Poor and Needy divisions.

To help integrate into the Poor and Needy Division the strategy of “multi-sectoral stakeholders” that the Health Care Division has developed, the Trust now is looking for a program coordinator to handle a range of key administrative functions for both divisions.

To fill the new position, which replaces a two-year post-graduate fellowship, the Trust is looking for someone with at least 10 years experience.

Critical issues such as health and learning represent complex challenges and require integrated solutions and a broad range of perspectives, Smart says.

For Healthy Places NC, for example, “state and national partners are bringing best-practice work to these communities that either weren’t aware of them or couldn’t afford them,” he says.

The initiative also is “bringing new people into the mix in these partnerships,” he says.

“In health care, we’ve really determined that to improve the health status of a community, institutional stakeholders have to be involved who are not in health care,” he says.

“To improve health care, you can’t just talk about doctors and nurses and the health department and the hospital,” he says. “You also have to talk to the school board and the planning commission, who have a hand in the health of the county.”

Partners from multiple sectors also are important because “your issue is not just owned by the people who work at it every day,” he says. “We’re trying to create community ownership over the larger program.”

Just as many adults are not as healthy as they should be, many children, particularly those who are financially disadvantaged, are not as prepared as they should be to enter kindergarten, Smart says.

The solution is “not just engaging child care, but all sorts of people, such as the housing authority, for example, or the communities those kids are in,” he says. “Multi-sector thinking will definitely be embedded in the Poor and Needy Division as it is in our health care work.”

Nurses partner with first-time mothers

By Todd Cohen

WINSTON-SALEM, N.C. — Fifty of every 1,000 pregnancies in Forsyth County involves a teen mother, compared to 43 of every 1,000 pregnancies throughout the state, and nearly eight births for every 1,000 in the county result in the death of an infant, with 10.3 percent of all babies born in the region considered low birth-weight, or 5.5 pounds.

To help address those and related problems, Forsyth is joining 16 other counties in the state that are part of a national, evidence-based program that pairs nurses with low-income, first-time mothers, thanks to a five-year, $2.5 million grant from the Kate B. Reynolds Charitable Trust in Winston-Salem.

The Foundation has selected the Forsyth County Department of Public Health to lead the initiative, which is known as the Nurse-Family Partnership.

The initiative features regular in-home consultations, with registered nurses working with first-time mothers to improve maternal health, promote healthy child development, and help mothers continue school or find work.

The grant supports a masters-prepared nurse supervisor, four registered nurses and an administrative assistant, with each nurse dedicated to a caseload of 25 mothers at a time.

Home visits for the program, which is free and voluntary for eligible mothers, begin early in pregnancy and continue until a child’s second birthday.

Registered nurses encourage participation from fathers and other family members.

“Nurse-Family Partnership is such an essential resource for vulnerable families, providing knowledge and support at an absolutely critical time,” says Marlon Hunter, Forsyth County health director.

“Decisions made during pregnancy and in the first years after a child’s birth can greatly impact the health of the child and the future of the family,” Hunter says. “Nurse-Family Partnership ensures that our most fragile families have the care they need to get on the right path.”

Randomized, controlled trials conducted over 30 years have found Nurse-Family Partnership resulted in a 79 percent reduction in pre-term delivery for women who smoke; 50 percent reduction in language delays of the child at age 21 months; 48 percent reduction in child abuse and neglect; 46 percent increase in the father’s presence in the household; 32 percent fewer unintended subsequent deliveries; and 20 percent reduction in months on welfare.

Nurse-Family Partnership operates in 16 other North Carolina counties through a public-private partnership that includes the Kate B. Reynolds Charitable Trust; The Duke Endowment; Division of Public Health in the state Department of Health and Human Services; Blue Cross and Blue Shield of North Carolina Foundation; The North Carolina Partnership for Children; and Prevent Child Abuse North Carolina.

Other counties served by Nurse-Family Partnership are Buncombe, Cleveland, Columbus, Edgecombe, Halifax, Hertford, Gaston, Guilford, McDowell, Mecklenburg, Northampton, Pitt, Polk, Robeson, Rutherford and Wake.