The data for this Performance Measure will be collected in partnership with community organizations awarded contracts for implementing chronic disease prevention and early intervention programs in Buncombe County.

https://ymcawnc.org/minority-diabetes-prevention-program-mdpp

**NOTE: The data included in this Performance Measure will not include all BIPOC Bucombe County residents accessing pre-diabetes services, as there is no formal collection system or database to provide that level of population health outcomes.  

The “story behind the measure” is a compilation of narrative from lived experiences shared during community listening sessions on the 2021 CHA health focus areas and cross-cutting results related to dismantling white supremacy culture and creating trauma-informed systems for a resilient community. The included “story” narrative below focuses more broadly on the systemic factors in the community environment in which programs operate and function. As programs and performance measures begin and/or strengthen, there will be organic opportunities for direct narrative collection to occur from program staff providing implementation and from community members engaged in the program’s services.

The "Story Behind the Curve" helps us understand the causes and forces at that work that explain the data behind chronic disease and pre-diabetes programming.

What's Helping What We Do?

These are the positive forces at work in our strategy/ program that influence how much we do or how well we do it.

• Expanded access to food banks and pantries - especially following the COVID-19 pandemic 

• Free walking trails and parks for exercise

• Support from multiple organizations during COVID-19 pandemic navigating healthcare, food resources, etc. 

What's Hurting What We Do?

These are the negative forces at work in our strategy/program that influence how much we do or how well we do it.

• Language access - interpretation services need to be expanded, particularly in healthcare settings and hospitals

• Financial instability and housing instability

• Cost of diabetes medications are too high - creates barriers for access

The following actions have been identified as ideas for what can work for this performance measure to make a difference on chronic disease.

(A) Actions and Approaches Identified 

These are actions and approaches that we think can make a difference for this performance measure.

• Increase access to healthy foods in schools

• Paid time off from work to attend medical/health-related appointments

• Access to affordable and efficient health and dental services

• Bringing health and chronic-disease related programming and services to the community - going into rural areas regularly to improve access and engagement

(B) No-cost and Low-cost Ideas

These are no-cost and low-cost actions and approaches that we think can make a difference for this performance measure.

• Expand elderly transportation supports (with language access) to access medical care and other necessary services

• Partnering with other community health and outreach services to bring healthcare and resources to the communities in need

• Increased public awareness and education on chronic disease and root causes that are culturally humble

• Expanding community health worker model to provide prevention education and advocacy

(C) What BIPOC Buncombe County residents say

These are actions and approaches that our customers think can make a difference for this performance measure.

• Improved collaboration and referral system for accessing resources between organizations

• A central place in each community where service providers return each month to support with navigating the resources available for chronic health conditions

• Access to free or low-cost health and dental services

• One-stop location for healthcare resources and services focused on whole person health

• Addressing systemic racism, bias, and language access issues within medical/healthcare services

(D) List of Questions/Research Agenda

These are questions to follow-up on for this performance measure. 

• What does final data analysis reflect from the 'one question' campaign?

• What policy-level interventions would support movement on this performance measure?