*Current & Former: CHIP Leadership and Data Team

Buncombe County ranks 19th out of 100 counties in NC based on more than 30 measures of how healthy residents are and what will impact their future health (County Health Rankings, 2022).

Primary and secondary data show that health focus areas, especially heart disease and diabetes, birth outcomes, and mental health and substance use disorder, adversely impact the community as a whole and disproportionately and significantly impact community members who are historically marginalized. Black/African American, Hispanic/Latin/Latinx, Indigenous/First Nation and those with low incomes are more likely to have poorer health outcomes, lower high school graduation rates, higher food and housing insecurity, increased hazardous environmental risks, and more limited access to economic and social development opportunities (NCOMHHD, 2018).

In 2020, Buncombe County (BC) Commissioners declared, “Racism a Public Health and Safety Crisis (BCG, 020)” to acknowledge and address the impacts that persistent structural racism in public policy, institutional practices and cultural norms have on the root causes of health and social-economic disparities for populations of color (NCIOM, 2020). The declaration links the social determinants of health (SDoH), to how historical and continued systemic racism shape the structure of communities, social and economic opportunities, and access to resources, wealth, and power. The SDoH, those conditions in the community where people live, learn, age, work, play, worship are structurally designed by public policy, drive 80% of health outcomes and highly correlate with race, age, gender, and income (CDC, 2021; NCIOM, 2020). By focusing attention on the root causes of health and life course disparities, the 2021 CHA aligns strongly with and supports the BC Commissioner’s Declaration of Racism as a Public Health and Safety Crisis, the BC Strategic Plan 2020-2025 and the BC Racial Equity Action Plan.

The 2021 Buncombe County CHA health priorities/health focus areas were identified due to common underlying or root causes for health inequities related to systemic racism, oppression, and trauma.

• Birth Outcomes & Infant Mortality - significant disparties are present in birth outcomes, infant mortality, and preconception health for Black/African American and Hispanic/Latin/Latinx residents of Buncombe County
• Mental Health & Substance Misuse - trending increase of reported mental health symptoms (depression and suicidal ideation/thoughts), and continued increase in drug overdose related deaths
• Chronic Disease: Diabetes & Heart Disease - significant disparities are present in mortality and morbidity rates for Black/African American and Hispanic/Latin/Latinx Buncombe County residents

The Buncombe County CHIP Data Team and CHIP Advisory Council utilize an overarching public health framework centered on Social Determinants of Health (SDoH), anti-racism, and the application of a life course perspective to identify underlying or root causes for health disparities within Buncombe County. The most prominent and influential root causes identified during data analysis were systemic racism, oppression, and the pair of Adverse Childhood Experiences (ACEs) and Adverse Community Experiences. More specifically, the impact of trauma exposure epigenetically (generationally and historically), in utero, early life, and throughout the life course, has a weathering effect resulting in poorer health outcomes and premature deaths for Black, Indigenous, and People of Color (BIPOC), persons with marginalized identities and low income.