- Developing Community Capacity

The 2005 collection of "Healthy Carolinians: Stories and Ideas from the Community" illustrates innovation, energy, and success that can happen when partnerships work collaboratively on community health improvement. These stories honor the diversity of their communities and focus on shared values of community members. Most importantly, these stories and ideas demonstrate the variety of solutions and resources that can be mobilized to address problems when communities commit to improving the quality of life for all. In every community there is work to be done. In every heart there is the power to do it. These stories capture the spirit and soul of Healthy Carolinians communities.

Thank you to the communities that inspired these stories and to the authors who paused long enough to record them. Additional thanks for editing, writing and preparing the 2005 collection of Healthy Carolinians: Stories and Ideas from the Community go to:

Sarah Thack
Laurie Bazemore
Mary Bobbit-Cooke
Christopher Cooke
Jane Gauntz

** Bazemore NC county case studies excerpted from 2005 Healthy Carolinians report **

To combat rising obesity rates, Ashe County is creating accessible places for its residents to walk and be physically active. Recognizing Ashe County's lack of sidewalks and the need for a centralized, safe walking space, the Ashe County Health Council used Be Active NC funding to develop a public park in downtown Jefferson, the county seat. Once a weed-covered field, the park is a source of pride to multiple community members who have contributed labor & plants (individual residents), benches (the Rotary Club), and lightbulbs and extra light poles (the utility company). The Town of Jefferson has committed to ongoing upkeep of the park, and the town's maintenance department keeps it in prime condition throughout the year.

During a peak summer day, an estimated 80 community members were observed using the park's walking paths. The partnership has used the park for various programs, such as the 'Volunteers Make a Difference Day,' when twelve volunteers came to the park and planted flowers, and the eight-week 'Hearts in the Park Program,' in which twenty people participated in nutrition education and physical activity.

West Jefferson is considered Ashe County's most accessible city to all county residents. Downtown West Jefferson's sidewalks have been joined together to form a centralized, handicapped-accessible walking trail with help from a North Carolina Department of Transportation enhancement grant. Through the community's 'Locomotion Fitness Trail' program, started in July 2005, community walkers are encouraged to increase and sustain their monthly walking mileage. Local merchants along the trail donate prizes to the resident with the greatest monthly mileage. The Ashe County Health Council is exploring funding to install bronze plaques into the sidewalks as markers and also plans to install signs along the trail to motivate trail walkers.

Bladen: "Health Watchers at School" Walking Program
Bladen HealthWatch

Geographically, Bladen County is the 3rd largest county in North Carolina, but it is sparsely populated with only 30,000+ residents. Because funding for developing and maintaining safe pedestrian areas such as walking trails and bike lanes has not been a county priority, Bladen HealthWatch (BHW) partners promote physical activity using centralized locations such as schools and downtown neighborhoods. With a grant from the Kate B. Reynolds Charitable Trust, BHW has created the "HealthWatchers At School" walking program.

Since 2001, BHW has conducted an annual, eight-week walking campaign every October-December among Bladen County's 14 public school campuses. BHW partners create a new campaign theme annually. During the 2001 campaign, HealthWatchers at School enrolled 2,182 participating students in the campaign. Five hundred students walked at least 25 miles and five schools walked over 2001 miles. One school walked over 10,000 miles, and another had a 98.7% student participation rate.

Between 2002 and 2003, the overall number of student walkers increased 16% from 2,373 to 2,763. Other indicators of the campaign's success include 31% increased staff participation (from 108 to 142); 13% increase in classroom participation (from 120 to 136); 26% increase in mileage walked (from 60,000 to 75,700); 12% more students walking over 25 miles (from 631 to 705); and 63% more classrooms walking over 500 miles collectively (from 30 to 49). During the 2003 campaign, three schools achieved 100% student participation. During its first two years, HealthWatchers at School documented approximately 90,000 miles walked by Bladen County Schools students and staff. At the Bladen HealthWatch 10th anniversary celebration in April 2003, seventh-grader Dezveau Troy was honored as a Distinguished HealthWatcher for motivating her homeroom classmates to walk over 2000 miles during the 2002 campaign.

This increased walking seems to result in better educational and health outcomes. Preliminary results released on July 18, 2005 indicate that five of the top performing "HealthWatchers At School" schools are the five schools in Bladen County that have met the Adequate Yearly Progress (AYP) objectives of the federal "No Child Left Behind" legislation for the 2004-2005 school year. And preliminary analysis of 4593 questionnaires conducted over the past four years indicate student exercise has increased an average of 0.3 days/week. Since its initiation, the walking campaign has cost Bladen County Schools an average of $3.77 per student and $7.52 per campaign participant. In the coming year, BHW partners will begin discussing how to sustain "HealthWatchers At School" beyond the life of the grant. Prospectively, program costs will be streamlined and shared through local civic groups, business/industry partners, and other partnering agencies.



In September 2003, Healthy Carolinians of Macon County partners culminated a five-year collaborative effort to hire a full-time public health dentist and construct a mobile dental unit. Nicknamed the "Molar Roller," the unit travels with a core staff to pre-schools, elementary and middle schools to provide dental health services to uninsured and under-insured Macon County students. Macon County residents ages 2-20 covered by Medicaid and NC Health Choice can receive Molar Roller services by filling out an application at the Macon County Health Department. Parents of those without insurance show proof of income and are billed on a sliding scale.

During its first year of service, 11,534 visits were provided to children enrolled in Medicaid. The unit occasionally also provides dental services to pregnant women in the second and third trimester and to other adults in emergency situations. In 2005, the Molar Roller's dental staff began contacting area nursing homes and assisted living facilities to increase awareness of the Molar Roller's provision of ambulatory services on an emergency basis.

Collaborators of this project included Macon County Commissioners, the Macon County Board of Health, the Macon County Board of Education, and the Macon County School Administration. The Kate B. Reynolds Charitable Trust awarded the Macon County Public Health Center $300,000 to construct the unit, and the Highland-Cashiers Hospital made in-kind contributions of dental and computer equipment. Dental staff salaries were initially county-funded, but staff salaries are now sustained by Medicaid and other billing reimbursements, as well as by in-kind contributions from the Macon County Health Department and the community.


In 2002-2003, UNC-Chapel Hill School of Public Health students conducted a year-long community needs assessment to identify needs of the Latino population in southern Orange County. Through both a community forum and one-on-one interviews, Latino community members identified the need for Spanish-translated materials to help them understand and access the health care system. The needs assessment findings were adopted as a focus for future work by the Comitй de Asuntos Latinos de Orange (CALDO, "Orange County Latino Issues Committee"), which includes representatives from 24 community agencies that serve the Hispanic community of Orange County, such as Orange-Person-Chatham Mental Health, Orange County Health Department, and El Centro Latino.

In 2004, CALDO and Healthy Carolinians of Orange County members collaboratively produced and distributed a pocket-sized resource card for the Orange County Latino community that lists contact information for key community agencies and service providers. The resource card also has space for individuals to list their own contacts. While no formal evaluation has been conducted to measure the resource card's direct benefit to the Latino community, its development and distribution meet a clearly identified need for additional healthcare knowledge within Orange County's Latino population.

In November 2004, Healthy Carolinians of Orange County, CALDO, Chapel Hill-Carrboro and Hillsborough Chambers of Commerce and El Centro Latino sponsored a community-oriented 25 workshop instructing countywide employers on how to hire bilingual and bicultural workers. Eleven presenters facilitated workshop discussions, which included the visa process, recruit sponsorship, and advocacy opportunities for increasing international employees in a given work sector. Twenty-four participants attended the workshop which was organized by UNC Hospitals, Piedmont Health Services and Durham Technical Community College. Participants rated the workshop a 4.4 on a scale of 1 to 5 (1=pretty bad; 5=excellent). Many participants provided positive open-ended feedback such as, "The legal part helped debunk fears/myths that I think are out there" and "This training really inspired me to focus effort more on Latino/a individuals who are native Spanish-speakers."

In 2004-2005, Latinos living in the northern part of Orange County were the focus of another community needs assessment conducted by UNC-Chapel Hill public health students. Needs identified by the assessment included: additional methods of county transportation and Spanish-translated route materials; a central information center in Hillsborough for Spanish-speakers; additional low-cost, children's dental care; additional ESL classes; and more culturally competent and Spanish-speaking providers.

The assessment resulted in the newly formed Nuestro Condado ("Our County") group, which includes many Latino community members from the Hillsborough area. Nuestro Condado is partnering with the North Carolina Department of Transportation, Orange County Literacy Council, Durham Technical Community College and Orange County Health Department to facilitate issue-specific projects, including: children's dental screenings in September 2005; Spanish-translated materials for new transportation routes starting in January 2006; and additional ESL classes. Awareness and information dissemination for these projects will be supported by Orange County churches, schools and a lay health promoter network. The new programs are currently entirely volunteer-supported. Use of the new services (e.g., increased use of transportation services) will be conducted by administering surveys and tracking participation in a Latino Health Fair to be hosted by the Orange County Health Department in September 2005. Sustained funding for these new projects will be sought based on evaluation results.

The formation of Nuestro Condado provides an outlet for Northern Orange County Latinos to voice their needs and helps agencies collaborate to initiate projects that enrich this population.