reframing health

As much as 80 percent of health outcomes can be attributed to the interplay and influence of social, physical, and economic environments. Therefore, in order to significantly improve the health and well-being of North Carolinians, it is critical that we acknowledge and address the many factors that impact health.

A new approach

Over the past year, as the Foundation continued to support organizations and communities throughout North Carolina, we’ve also been conducting a strategic review. It’s been a process of figuring out the best way to fulfill our vision of achieving health equity in North Carolina.

This work was rooted in the premise that health is so much more than what happens within the confines of the health care system.

Now, by itself that’s not really a novel concept. We all understand the benefits of things like healthy eating and staying in good physical shape, tenets of our grantmaking for many years.

Where this can have profound implications is when we look further, at the impacts of housing, early child development, and transportation, as examples. And, as we broaden the scope from a single person to entire communities, we can see all of the factors that are beyond individual control.

As a society we’re learning more and more about the impact of social, physical, and economic factors on health. And as a funder, we've gained a greater understanding of these issues through the work being done by our grantees.

As we expand our perspective, we are also elevating equity. Equity is one of our core values, along with Authenticity, Collaboration, Curiosity, Health, and Leadership. We believe that acknowledging and addressing inequities is key to unlocking good health.

What does this mean for our work?

It means supporting individuals, organizations, and communities to recognize and act on the root causes of poor health and health inequities, especially for those at high risk.

It means increasing our commitment to systemic and policy innovations that can impact large numbers of people and create lasting change.

It means shifting from a siloed grantmaking structure — which, in the past, separated Health Care, Healthy Living, and Nonprofit Leadership — to a more expansive, integrated approach built around the many drivers of health.

And it means a focus on:
transforming the health care system (including oral health)
expanding access to healthy food
supporting a healthy start for children
improving the places where people live
strengthening the ability of communities to improve their own health

An evolution in action.

Parts of our work will go forward as they have, with increased emphasis.

We will continue to embed leadership development into all of our work, based on our belief that strong leaders are key to accelerating meaningful and innovative change.

And we will continue to engage directly with stakeholders at all levels — from decision-makers and influencers to community members and those most affected by inequities. We do this not only because we value collaboration, but because we know from experience that this is the best way to both identify the factors influencing health and to implement the actions needed to improve them.

We’ve already begun adopting this new strategy in our work. It’s an ongoing process; additional refinements will continue in the months ahead as we learn more, and as we seek out new grant and program opportunities.

Clearly, we have a lot of work ahead of us. Important work, demanding work, the kind of work that can contribute to positive transformation throughout our state. We’re excited about our new strategy and can’t wait to pursue opportunities that can lead to a healthier North Carolina in the years ahead.

Ada Jenkins Families and Career Development Center
Albemarle Regional Health Services
Alexander County Health Department
Alliance Medical Ministry, Inc.
Ashe Memorial Hospital, Inc.
Benson Area Medical Center, Inc.
Better Health of Cumberland County, Inc.
Black River Health Services, Inc.
Blue Ridge Community Health Services, Inc.
Blue Ridge Mountains Health Project, Inc.
Blue Ridge Parkway Foundation, Inc.
Bridge II Sports
Cabarrus Rowan Community Health Centers, Inc.
The Center for Rural Health Innovation
Charlotte Community Health Clinic, Inc.
Community Care Center for Forsyth County
Community Care of Western North Carolina
The Community Foundation of Western North Carolina, Inc.
CORRAL Riding Academy
County of Orange
Davidson Medical Ministries Clinic, Inc.
Down East Partnership for Children
FaithAction International House
Family Promise of Wake County, Inc.
Farmer Foodshare, Inc.
FIRST North Carolina
Foundation for Health Leadership and Innovation
Gaston Family Health Services*
Girl Scouts Carolinas Peaks to Piedmont, Inc.
Graham County Health Department
Greater Hickory Cooperative Christian Ministry
Guilford Adult Health, Inc.
HandsOn Northwest North Carolina
HealthReach Community Clinic, Inc.

High Country Community Health
Hispanic League
The James Beard Foundation, Inc.
Lincoln Community Health Center, Inc.*
National Association of State Park Directors (America's State Parks)
NC State Natural Resources Foundation, Inc.
NeighborHealth Center, Inc.
Neighbors for Better Neighborhoods
The North Carolina Albert Schweitzer Fellowship, Inc.
North Carolina Alliance for Health
North Carolina Baptist Men, Inc.
North Carolina Center for Nonprofit Organizations, Inc.*
North Carolina Congress of Parents and Teachers
North Carolina Department of Public Instruction School Nutrition Section
North Carolina Farmworkers Project, Inc.
North Carolina Institute of Medicine*
North Carolina State University*
North Carolina Therapeutic Riding Center, Inc.
Onslow Community Ministries, Inc.
Organic Growers School
The Parenting PATH
Piedmont Health Services, Inc.
Randolph County Health Department
Reinvestment Partners
Rockefeller Philanthropy Advisors, Inc.
Southside United Health Center
Student Action with Farmworkers
Two Rivers Community School
University of North Carolina at Chapel Hill*
University of North Carolina Wilmington
Urban Ministries of Wake County*
Wake Health Services
Wayne Health Foundation, Inc.
West Caldwell Health Council, Inc.
Western Piedmont Council of Governments

*Received multiple grants

Mothering Asheville

better births with
expert guidance

Photo courtesy of Mountain Area Health Education Center

Asheville is known for its beautiful mountain landscape and focus on healthy living. But not everyone has the benefit of a healthy start to life. Currently, African-American babies in the area die at three times the rate of white babies. Mothering Asheville, a community collaboration in partnership with the Mountain Area Health Education Center, is working to address racial disparities in infant mortality by training local women to become doulas so they can help pregnant women in their community experience a healthy birth.

Watch the video to learn more.


expanding the
primary care pipeline

Photo courtesy of MedServe

“Two years ago, my life had a much different trajectory. Now, I'm going to be a rural primary care physician, trained at my dream school, with connections and support from professionals all across the state. MedServe’s role in that process and transformation cannot be understated.”

Misty Cox
MedServe Fellow

In 2015, MD/MBA students Anne Steptoe and Patrick O’Shea created a program that combined their interest in medicine with their desire to help the world. MedServe was a leap of faith, powered almost solely by their own determination, that they could increase the pipeline of primary care practitioners in North Carolina — and do it by focusing on students who demonstrate grit and a commitment to service.

Three years on, the program they founded is known as the “Teach for America of health care.” It provides practical experience (and medical school application fodder) for college graduates who are committed to providing primary care in safety-net settings. And it’s definitely expanding the pipeline. More than 70 percent of participants come from backgrounds that are historically underrepresented in health professions schools, and a quarter are first-generation college graduates.

When they hatched the idea, Steptoe and O’Shea were responding to the fact that only 12 percent of their medical school colleagues were choosing primary care as a career. Rural and underserved communities in particular experience a gap in young medical professionals: 70 of North Carolina’s 80 rural counties are classified as medical deserts due to their lack of primary care providers.

Steptoe and O’Shea believed that enabling early, significant experiences in primary care could be transformational, both in inspiring students’ careers and meeting the needs of communities across the state.

“This is the program I would — and should — have done after college,” said Steptoe. “I've been more inspired about the future of primary care living vicariously through our Fellows than I ever have been. I believe this experience can be career-affirming for other young people because it’s been that for me, watching from the sidelines."

MedServe recently graduated its first cohort of Fellows. Eleven of the 12 were accepted into medical school, and 25 percent of them received full or significant scholarships. Half of the graduates are also current finalists for National Health Service Corps — an early indication of their commitment to primary care in high-need communities.

The Blue Cross NC Foundation was one of the program’s earliest supporters, beginning with an initial grant of $52,500 that included $12,500 for capacity building, and continuing with an additional grant of $80,000 in 2017. A third grant of $300,000 was approved this past November that will enable MedServe to strengthen its organizational infrastructure and provide additional support to its Fellows.

This year, the program received funding from AmeriCorps and increased its cohort size to 25 Fellows, with more growth to come. But early on, given its entrepreneurial nature, MedServe was seen as a high-risk investment of sorts. In fact, a significant portion of early funding came from startup contests.

“The degree to which MedServe has grown in such a short time, from essentially a sketch on a napkin to a federally-funded program, is proof that success can come from a combination of great ideas and visionary leadership,” according to Katie Eyes, Blue Cross NC Foundation Senior Program Officer. “It also shows that those closest to a problem can often see the clearest path through.”

Eyes added, “What they’ve built is a testament to their own ingenuity and grit. And we’re confident it will support North Carolina’s primary care pipeline for years to come.”

Bull City Bucks

a fresh approach
to healthier eating

“We're trying to move food assistance to a sustainable model that saves health care costs and therefore warrants the investment in better nutrition. It may sound jargony, but basically it’s not enough to simply want to do good. Our ideas have to be competitive in the marketplace to really have an impact. And the results are showing that.”

Peter Skillern
Executive Director
Reinvestment Partners

Recognizing the critical role that non-medical drivers — commonly referred to as social determinants — play in a person’s health is important. The equally essential next step is creating effective ways to address them. And that’s where a program like Bull City Bucks comes in.

It started with a USDA grant to Durham-based Reinvestment Partners, to implement a healthy food incentive program for medically and food insecure clients in Durham.

“As part of our work to foster healthy communities, we were already looking at how social determinants, such as housing and food, affect health outcomes,” said Skillern. “And at the same time, health care in North Carolina is moving toward an emphasis on outcomes, not just treatment. It’s clear there’s a role for communities and health care providers to work together; so once we got this grant, we approached Lincoln Community Health Center as a partner.”

Lincoln is not new to innovations in patient care. They are currently intensifying their efforts to assess and address the non-medical needs of their patients, by implementing social determinants screening tools in their workflows as part of their standard of care.

So Howard Eisenson, MD, Chief Medical Officer at Lincoln, was eager to integrate this new offering into their practice. Bull City Bucks addressed a common issue faced by Lincoln’s patients. “We’ve always offered integrative health care — thinking beyond medical care, providing support for jobs, shelter, psychosocial needs, all under one roof. Now we’re able to add another vital component. When we hear people say, ‘I know I should eat better, but I can’t afford to eat that way,’ we have a good answer for them.”

The answer is a program that gives people who receive SNAP benefits — the federal Supplemental Nutrition Assistance Program, commonly known as food stamps — an additional $40 each month to spend on fruits and vegetables. Skillern said that “one of our goals was to make it easy on the clinicians who are enrolling the clients and on those clients as they redeem the credits.” And that’s where another key partner came in.

“Food Lion has really been willing to work with us to make this happen,” Eisenson explained. “They handled all the back-end systems. Our patients can use their existing SNAP card and their MVP Rewards card at Food Lion stores all over Durham County, so it’s easy and it’s accessible.”

Another important piece of the puzzle is evaluating their efforts. “We’re working with the Duke Center for Research on Personalized Health Care,” said D’Nicole Tangen, Social Worker and Case Manager at Lincoln. “They’re talking to our patients: Is this program helpful? What barriers did you encounter?” Also novel is the ability to access point-of-sale data, which the evaluators can use to track long-term purchasing behavior and see how the program influences the type of food purchased over time. “That’s a big focus of the grant we received from the Foundation,” Tangen added. “It makes it possible for us to evaluate, fine-tune, really understand what’s working.”

“Nonprofits are social innovators,” Skillern said. “We’re combining everyone’s expertise and coming up with a new way to try to improve health and impact people’s lives. We’re not approaching this as charity. We see this as a social entrepreneurial venture to deliver better outcomes for clients, profits for Food Lion, savings for the health care industry — and that makes it more likely to be sustainable and scalable.”

Within the first six months, Bull City Bucks enrolled more than 400 participants who redeemed $16,000 worth of healthy food. Based on the initial results, Reinvestment Partners has already received additional USDA funding to expand the program. “We’re going to be in 30 more counties in North Carolina, beginning in 2019.”

According to Merry Davis, Blue Cross NC Foundation Senior Program Officer, “the hope is that this work provides evidence for Medicaid and others to consider supporting the purchase of healthy foods as a preventive health and wellness measure.” The Foundation has committed to investments totaling almost $1.7 million through 2021 to provide the matching funds required by USDA for Bull City Bucks and its expansion, and for Lincoln Community Health Center to develop its capacity to assess and respond to the non-medical health needs of their patients. “We’re excited to support these efforts to try something new and different to improve health.”