2014 RWJF Culture of Health Prize Winner: Durham County, NC

Once the center of the state’s tobacco industry, people have come together in Durham County, North Carolina to tackle the county’s health problems from every angle. For decades, the county has struggled to overcome both racial and socioeconomic inequities and the community continues to face high rates of chronic diseases, poverty, unemployment, and low high school graduation rates. Today, community leaders, health care partners, and residents are responding as one and forging a new approach known as “The Durham Way.”

“I’m really excited about how we’ve come together as partners to not only deal with access to health and the healthcare system itself, but looking at those other issues that impact health—those social economic issues,” said Gayle Harris, director of the Durham County Department of Public Health.

To address this host of concerns the County convened the Partnership for a Healthy Durham, a multi-sector collaboration of over 500 members, which is responsible for mobilizing stakeholders and prioritizing health in Durham.

Through a program called Project Access of Durham County, local clinicians and hospitals donate specialty medical care to the uninsured, ensuring the community benefits from Durham’s world-class health resources. In six years, over 700 clinicians have provided services valued at approximately $24 million and improvements in patient health and appropriate health system use have been achieved. “Project Access was one of the coolest things that we have had happen in Durham,” says Harris. For each dollar spent on the program, the return on investment to the county is estimated at $15 million.

Additionally, a longtime partner, Duke University Health System, initially launched and operated school based wellness centers in three elementary schools within Durham Public Schools. These wellness clinics will soon be replaced with enhanced role nurses from the Durham County Department of Public Health, providing a well child health assessment and prevention model of care including immunizations in five elementary schools.  The model complements the Department of Public Health’s existing “Tooth Ferry” mobile dental clinic, which travels from school to school in underserved communities throughout Durham County.

Durham County’s emphasis on healthy environmental and policy changes led to smoke-free policies in virtually all public places. For a county once entrenched in tobacco production, the Board of Health’s 2012 rule prohibiting outdoor smoking in public areas demonstrates their commitment to creating sustainable environmental changes. Community efforts have helped to create 32 miles of bike lanes in Durham and the development of two marked “Healthy Mile Trails” offer exercise opportunity to individuals living in underserved communities. The County’s Comprehensive Bicycle Transportation and Pedestrian Plan is changing the community landscape and the County government has enacted an extensive worksite wellness program  encouraging employees to exercise 30 minutes daily by providing paid release time for physical activity. The smoke-free public places, workplace wellness programs and bicycle and pedestrian plan work together to offer residents more choices and healthier options. 

Through its numerous education and career preparation efforts, Durham County is laying the groundwork for long-lasting change for future generations.  The East Durham Children’s Initiative offers home-based support programs for parents, afterschool and summer enrichment for students, literacy and arts programs, and health and nutrition services.  “They’ve improved the test scores in the elementary schools getting them on the road to success for graduation and future careers,” said Harris. The Holton Career and Resource Center also provides an assortment of education, health, and recreation benefits to Durham residents.  Accessible to even the youngest residents, the facility includes an auditorium, dance and music studios, art room, computer room, learning center, and athletic fields. Harris emphasizes Holton’s importance, “that center has now become the pulse of that community.” 

Through collaboration Durham County is building a Culture of Health. “We’re all in this together,” said Harris. “That’s what I like about Durham. If there’s a problem, people come together, voice their opinions and work toward a solution.”

Learn more about Durham's efforts to improve health at RWJF.org.