Chronic Disease (Heart Disease & Diabetes) and our related result are aligned with the following Healthy NC 2030 indicator:

• Life expectancy ratio

How would we experience this result in our community if we are successful?

• Eliminate the achievement gap
• All kids/all people have access to safe green spaces
• Quality health outcomes
• Seen, heard, and taken care of by healthcare providers
• Access to healthy/fresh food
• Access/attain safe and affordable homes
• Knowledge of and access to services/resources
• Free transportation
• Accountability and commitment
• Dismantle hierarchical systems
• Less gatekeeping services
• Systems that empower
• Self-advocacy to meet needs
• Equitable opportunities

What information led to the selection of Chronic Disease: Heart Disease & Diabetes and this related result?
Heart Disease and Diabetes were one of 5 health conditions based on the size and severity of the issue in our community. Both primary and secondary data sources were compiled to support with size, severity, and feasibility. The Buncombe County CHIP Advisory Council, with representation from 40+ community organizations, were actively engaged in multiple monthly work sessions to identify which community health conditions to prioritize based on relevance, impact and feasibility.
 

Key findings related to Chronic Disease included:

• 6% of respondents consume five or more servings of fruit and vegetables per day compared to 11% from the 2015 Buncombe CHA 
• 23% of survey respondents meet the recommended amount of physical activity compared to the Healthy People 2030 target of 28% or higher 
• 65% of survey respondents have a Body Mass Index (BMI) of 25.0 or higher compared to 59% from 2015 Buncombe CHA 

Chronic Disease – Heart Disease and Diabetes

• Buncombe County’s 2015 – 2019 disaggregated diabetes mortality rates for Black/African American men are nearly 7 times higher than rates for all Whites combined 
• 7% of all Buncombe County survey respondents have been diagnosed with heart disease compared to 5% from the 2018 Buncombe CHA 
• 12% of Black/African Americans Buncombe County survey respondents have experienced a heart attack or have been diagnosed with heart disease compared to 7% of White survey respondents 

Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both (CDC, 2022). SDoH, or root causes, have been found to “serve as a direct cause for a number of diseases” (Cockerham, et al., 2017). According to the National Academy of Medicine, the most significant underlying determinants of health are “income, accumulated wealth, education, occupational characteristics, and social inequality based on race and ethnic group membership” (2017). The Adverse Childhood Experience Study (ACES) and subsequent research expanding the original ACES and Community ACES, known as the Pair of ACEs, connect how stress and trauma increase the risk of chronic illness and premature deaths (CDC, n.d.a.; Social Policy Institute, n.d.)

In utilizing a social-ecological framework and life course approach, Black, Indigenous, and People of Color (BIPOC) groups are often most negatively impacted by chronic disease due to systemic oppression, influences of intergenerational trauma, and individual and community adverse childhood experiences (ACEs and Community ACEs) - meaning that BIPOC individuals experience increased risks for developing chronic diseases such as diabetes and heart disease. There is also a connection between food security, poverty, and chronic disease, as barriers to accessing prevention services, as well as timely health and wellness resources often creates further health inequity (Jayathilaka, 2020). When these circumstances are paired with existing issues related to high cost of living, lack of living wages, and chronic housing insecurity in Buncombe County, the negative impact on health outcomes is amplified.

Centers for Disease Control and Prevention. (2022, May 3). About chronic disease. Available from https://www.cdc.gov/chronicdisease/about/index.htm

Center for Disease Control. (n.d.a.). Adverse Childhood Experiences. Available from: https://www.cdc.gov/violenceprevention/aces/

Cockerham, W. C., Hamby, B. W., & Oates, G. R. (2017). The social determinants of chronic disease. American journal of preventive medicine, 52(1S1), S5–S12. https://doi.org/10.1016/j.amepre.2016.09.010 

Jayathilaka, R., Joachim, S., Mallikarachchi, V., Perera, N., & Ranawaka, D. (2020). Do chronic illnesses and poverty go hand in hand? PloS one, 15(10), e0241232. https://doi.org/10.1371/journal.pone.0241232

Magnan, S. (2017). Social Determinants of Health 101 for Health Care: Five Plus Five. National Academy of Medicine. https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/

Social Policy Institute. (n.d.). The pair of ACES: Knowledge to action brief. San Diego State University School of Social Work. Available from https://cblcc.acf.hhs.gov/wp-content/uploads/The-Pair-of-ACEs-K2A_4.2.2021.pdf#:~:text=Children%20and%20adults%20who%20have%20had%20adverse%20childhood,the%20Pair%20of%20Aces%20%28Ellis%20%26%20Dietz%2C%202017%29.