The "Story Behind the Curve" helps us understand why the data on the adult pre-diabetes rate is the way that it is in our community. When we understand the root causes of our community problems, we have a better chance of finding the right solutions, together.

What's Helping? These are the positive forces at work in our community and beyond that influence this issue in our community.

• Health care providers refer individuals to nutrition counseling and Diabetes Prevention Program (DPP) classes.
  • Nutrition services are available at Blue Ridge Health and Haywood Regional Medical Center.  
• Grant funding to Haywood County HHSA administered by NC State University provides free DPP classes.
• Physical activity is supported by free use of school tracks and playgrounds when activities are not scheduled.  

What's Hurting? These are the negative forces at work in our community and beyond that influence this issue in our community.

• Fewer than four percent of adults consume at least five servings of fruits or vegetables per day (WNC Health Network-WNCHN,2018).  
• Transportation is a barrier for many residents.  While public transportation exists and is making great strides, it is only available during the day and not on weekends.  
• Fewer than 1/5 of adults meet the recommendations for daily physical activity (WNC Health Network-WNCHN, 2018).  
• Only 34% of adults report having a healthy weight (WNC Health Network-WNCHN, 2018).  

The partners for the National Diabetes Prevention Program include:

The following actions have been identified by our Wellness Action Group and community members as ideas for what can work for our community to make a difference on pre-diabetes.

Actions and Approaches Identified by Our Partners These are actions and approaches that our partners think can make a difference on pre-diabetes.

• Expansion of the Diabetes Prevention Program (DPP) through grant funding 
• Additional referrals to the DPP from health care providers
• Community gardens 

What is Currently Working in Our Community These are actions and approaches that are currently in place in our community to make a difference on pre-diabetes.

• Referrals from health care providers to the DPP
• Double Up Food Bucks, a bonus dollars program for Supplemental Nutrition Assistance Program (SNAP) recipients.  
• A greenway system that spans nearly five miles 
• A healthcare foundation that funds initiatives to address unmet health needs in the county.  

Evidence-Based Strategies These are actions and approaches that have been shown to make a difference on pre-diabetes.

What Community Members Most Affected by pre-diabetes Say These are the actions and approaches recommended by members of our community who are most affected by pre-diabetes

• More free and low-cost fitness opportunities 
• Support and promote food security initiatives 
• Support Medicaid expansion 

The following actions have been identified by our Haywood County Health and Human Services Agency (HHSA) as ideas for what can work for this performance measure to make a difference on the percentage of adults with pre-diabetes.

Actions and Approaches Identified by the HHSA These are actions and approaches that we think can make a difference for this performance measure.

• Expansion of the DPP through grant funding 
• Becoming a Medicare DPP supplier.  
• Health care provider referrals 
• Community gardens 

No-cost and Low-cost Ideas Identified by the HHSA These are no-cost and low-cost actions and approaches that we think can make a difference for this performance measure.

• Health care provider referrals to the DPP
• Improved promotion of existing resources and opportunities 
• Promote active transportation through policy change and by providing resources through the Healthy Communities program  

What communities served/customers think would work to do better These are actions and approaches that our communities served/customers think can make a difference for this performance measure.

• Expanded public transportation 
• Improved delivery and accessibility for food resources- assistance available during evenings and weekends 
• Improved education about nutrition and other healthy habits using formats like social media

Process for Selecting Priority Strategies

The Wellness Action Group (WAG) discussed the data indicators they felt could be impacted within the three-year Community Health Assessment cycle.  From this, the group discussed programs to address the data indicators of greatest concern.  Programs were reviewed and chosen based on resource availability, community acknowledgement of needs and programs' merits to positively influence indicator outcomes.  Programs were selected that could be realistically implemented within a three-year period.  The programs align with the mission statement for the WAG and support the third health priority identified by the CHA.  Specific actions were determined that could be achieved for each data indicator.  Specific programs were identified that will be implemented to reduce negative outcomes for each data indicator.  Each program addresses some of the more well-known and researched root causes of Type 2 Diabetes.  For instance, the 5-7% weight loss encouraged by the DPP is enough to prevent or delay Type 2 Diabetes.  A community fitness challenge will assist residents in reaching 150 minutes of moderate activity weekly, the current federal guideline.