HNC 2030 Scorecard: Durham 2020-2023
The Durham Community Health Assesment is a collaborative effort done by the Partnership for a Health Durham, Durham County Department of Public Helath and Duke Health every three years. The top health priorities are identified by community members' responses to the Community Health Assessment Survey. These priorities reflect the priorities set in 2017 and are carried over to 2020.
The 2020 Community Health Assessment priorities are:
- Affordable Housing
- Access to Healthcare and Insurance
- Poverty
- Mental Health
- Obesity, Diabetes, and Food Access
The Partnership for a Healthy Durham is a coalition of local organizations and community members with the goal of collaboratively improving the physical, mental, and social health and well-being of Durham’s residents. The Partnership has five committees that focus on Durham County health priorites and communications, which are led by our Steering Committee. There are currently hundreds of active members in the Partnership.
Executive Summary
Priorities
The current health priorities for Durham County are affodable housing, access to healthcare and health insurance, potverty, mental health, and obesity, diabetes, and food access.
Why Is This Important?
Seventy-one percent of Durham residents who were surveyed during the 2017 Community Health Assessment identified affordable housing as a top issue, making it the number one cited priority area. Affordable housing affects homeowners and renters in Durham due to the increasing housing prices.
Since 2010, the median listing price for homes sold in Durham has increased by more than 40%. However, renters are being hit the hardest with increasing prices. The United States Department of Housing and Urban Development (HUD) defines affordable housing as spending 30% or less of your income on housing costs. In 2017, an estimated 23% of homeowners in Durham were spending a third or more of their income on housing costs compared to 48% of renters.
Why are there inequities?
In 1934 the Federal Housing Administration began a practice known as redlining, which assigned risk categories to neighborhoods based on racial demographics. Neighborhoods with a majority of people of color were deemed risky, which resulted in lower levels of access to mortgages for people of color compared to whites. Redlining was outlawed in 1968, but the effects can still be seen. Research shows that the history of redlining contributes to as much as 30% of the homeownership gap between people of color and whites in recent years. Given that renters are most impacted by rising housing prices in Durham, there is a clear link between home ownership and lack of affordable housing.
What We Do
Who We Serve
How We Impact
What We Do
Who We Serve
How We Impact
Why Is This Important?
Access to care was identified as the number two health priority among Durham residents in the 2017 Community Health Assessment, with 70% of residents surveyed identifying it as a top issue in Durham.10,13 Although the proportion of uninsured residents has decreased from 15% in 2015 to 13% in 2017, a large number of residents continue to be affected. An estimated 38,816 Durham residents were uninsured in 2017. Of those, 4,743 were children and adolescents under 19 years old.6 Residents who were surveyed as part of the most recent Community Health Assessment identified cost as the number one barrier in getting health insurance. That was followed by lack of employer based plans, immigration status, and unemployment.13
The percent of Durham residents without insurance varies significantly by race and ethnicity. Data are disaggregated in the chart below.
What We Do
Community Health Workers are frontline healthcare workers who are a part of, or have trust and understanding, of the populations they serve. CHW's are important in providing equitable, culturally competent health care services to members of the community. Durham has a Community Health Worker Roundtable designed as a place for CHW's to share resources and develop strategies to improve workforce development. Additionally, Durham has a Community Health Worker workgroup that strategizes funding sources to improve stability and fair wages for CHWs while proposing improvements to the healthcare system utilizing CHWs.
Who We Serve
The program directly serves Community Health Workers in Durham County and organizations employing Community Health Workers in Durham County.
How We Impact
This initiative improves the healthcare system and services provided by supporting Community Health Workers.
What We Do
Who We Serve
How We Impact
What We Do
Who We Serve
How We Impact
What We Do
Who We Serve
How We Impact
Why Is This Important?
Fifty-five percent of Durham residents surveyed as part of the Community Health Assessment
identified mental health as a top community priority.10,13 This report focuses on adolescent mental health due to a lack of county level data for adults. The Youth Risk Behavior Survey (YRBS), which is administered to Durham Public School (DPS) students, shows increasing levels of depression among adolescents. The percent of middle school students who reported being depressed increased slightly from 24% in 2013 to 26% in 2017. A similar increase was seen among high school students during the same time period (24% to 30%). Females reported the highest levels of depression among middle and high school students.15
High school students were asked about suicide ideation in the 12 months leading up to the survey. Among high school students, 16% considered committing suicide. There was not a significant change from 2015 to 2017. However, differences by race, ethnicity, and sex were significant during the 2017 school year.15
Why are there inequities?
The percent of white students reporting suicide ideation was the highest of any race; the percent of white students who attempted suicide was the lowest. While the percentage of Latinx students who considered suicide was lower than white students, most Latinx students who considered suicide attempted suicide.15 Differences in access to mental health services may contribute to inequities in attempted suicide by race.8
What We Do
Who We Serve
How We Impact
What We Do
Who We Serve
How We Impact
What We Do
Who We Serve
How We Impact
Action Plan
In reviewing input from the community, the committee’s 2018-2021 strategies will focus on:
· Working with Durham Public Schools to shift the culture around school meals to be more positive to increase the amount of sales and quality of food
· Shifting the culture and narrative to support an understanding of unhealthy foods and the companies that sell them
· Increasing use and support of existing infrastructure around physical activity and nutrition
· Increasing access to fruits and vegetables through existing programs (e.g., Double Bucks, SNAP)
What We Do
Between 2015 and 2018, the Obesity, Diabetes, and Food Access committee supported and promoted the Double Bucks program, created two Healthy Mile Trails and educated policymakers about the need for Complete Streets in Durham.
Why Is This Important?
Partnership for a Healthy Durham Physical Activity, Nutrition, and Food Access committee members came together to create this results statement for Durham County residents. Members of the committee represent community members, community-based organizations, local and state-wide non-profit and not-for-profit organizations, local government, and educational institutions.
Nearly half (46%) of Durham residents who participated in the community health assessment survey said obesity, diabetes, and food access were top issues affecting their communities.10,13 In 2017, 66% of adults in Regions 3 and 5 were overweight or obese. The percent of people who were overweight or obese in North Carolina was slightly higher (67%).22 In contrast, the majority of Durham Public School (DPS) high school students (63%) surveyed in 2017 during through the Youth Risk Behavior Survey were neither overweight nor obese. Height and weight measurements for adults and high school students were self-reported.15
Obesity is one of the biggest predictors for type 2 diabetes.23 The estimated percentage of the Durham population with diabetes (13%) was higher than the national average (9%).17,7 Durham estimates are based off of prevalence data among Duke and Lincoln Community Health Center patients. Type 2 diabetes varied by race in Durham and is displayed below.
Why are there inequities?
Fast food companies target people of color with ads for unhealthy food and open up more fast food chains in neighborhoods where most residents are people of color compared to
predominantly white neighborhoods.25
This is compounded by the fact that people of color are also more likely to live in areas without access to a nearby grocery store, which leads to lower levels of access to fresh fruits and vegetables.1 The overabundance of fast food and limited access to healthy food in neighborhoods where most residents are people of color contributes to an increase in obesity and diabetes among people of color.1,25
Strategy
What We Do
Who We Serve
How We Impact
What We Do
Healthy Mile Trails are one-mile loops marked by the image of a walker in permanent yellow paint on neighborhood sidewalks. Some trails may have permanent green paint as we update the Healthy Mile Trail logo colors.
The Partnership for a Healthy Durham first created these walking trails because residents identified their neighborhoods as the top places where they exercise in the 2014 and 2017 Community Health Assessments.
The first Healthy Mile Trail was created in 2012 in partnership with the Historic Stokesdale community near the Lincoln Community Health Center. Since 2012, five other Healthy Mile Trails have been established near the Holton Career and Resource Center, McDougald Terrace, Old North Durham Park, Ridgefield neighborhood and Hillside Park.
Current Healthy Mile Trail partners include the American Heart Association, Bull City United, City of Durham, Durham County Department of Public Health, Durham Housing Authority, Durham Parks and Recreation, DCI, Historic Stokesdale Community, Keep Durham Beautiful, Lincoln Community Health Center and North Carolina Central University.
Who We Serve
How We Impact
What We Do
Who We Serve
How We Impact
What We Do
Grocers on Wheels was awarded $5000 to increase access to healthy foods in Durham communities. The Double Bucks program provides Supplemental Nutrition Assistance Program (SNAP) recipients with a dollar-for-dollar match up to $10 for healthy foods.
From Grocers on Wheels Staff:
“We found a common ground where seniors can meet and shop. Many of our customers could not figure out how to buy fresh produce in bulk and use it all before it perished. The Durham County Department of Public Health Nutrition staff and volunteers helped teach participants how to use the items we sold. That allowed them to use produce in various ways before it went to waste.”
- Community member making a purchase
- Community member looks over produce
- Nutrition staff shares smoothie recipe with happy customer
Who We Serve
How We Impact
What We Do
The Physical Activity, Nutrition, and Food Access committee has a School Nutrition workgroup that focuses on supporting Durham Public Schools Nutrition. The workgroup does this by developing content around nutritional facts of school meals, availability of free and reduced price meals, and sites where meals are available. The group has also led the Partnership to purchase items for Durham Public Schools nutrition like cooler bags and meal pick-up site signs in English and Spanish. This workgroup is also working on advocacy strategies to expand free meals for school children.
Who We Serve
The workgroup serves students, and parents of students, who attend Durham Public Schools. The workgroup has also showed apprection and support for Durham Public Schools Nutritioni staff.
How We Impact
The impact of this work is increased use of school meals that leads to an improved school nutrition system. The coolers donated allowed school nutrition to deliver meals at safe temperatures throughout COVID to satelite locations and classrooms. The documents produced by the workgroup are distributed throughout Durham to ensure that families are aware of changes in nutrition and how to access assistance.
Progress on CHIPs
Access to Care
- Number of community health workers employed in Durham County
- Baseline will be set summer of 2022
- Percent of uninsured and underinsured residents who have a usual primary care provider
- 82.9% of black residents, 82.9% of white residents and 50.8% of Hispanic/Latin residents
Mental Health
- Percent of Durham County residents who report getting the social and emotional support they need always or usually
- County-wide– 76.9%; Hispanic/Latin– 52.2%; updated data available spring 2023
- Number of days of the past 30 were not good mental health days
- County-wide– 0 days 51.6%; 1-2 days 13.8%; 17.8% 8 or more days out of the last 30.
- Hispanic or Latin- 0 days 56.4%; 1-2 days 12.3% ;11.1% 8 or more days out of the last 30.
Housing
- Number of housing resources available in NCCARE360
- 12 organizations
- Number of Durham County residents referred and linked to housing resources through NCCARE360
- 766 referrals made, 302 accepted by the receiving organizations January-December 2021
- Confirmations among lead tested ages birth to 6 years
- 5,104 tested; 10 with 5-9 mcg/dl and 3 confirmed with 10-19 mcg/dl (2019)
- Residents who understand the effect of housing on health
- 55% County-wide; 40% Hispanic/Latin
Obesity, Diabetes, and Food Access
- Number of new Healthy Mile Trails created by December 31, 2021
- 8 existing Healthy Mile Trails; 2 new
- Produce redeemed by Bull City Bucks participants
- Distributed $53,334 January 1, 2022 through August 31, 2021 when program ended
Morbidity and Mortality Changes Since Last CHA
Cancer remains the leading cause of death among Durham residents, followed by heart disease. Cerebrovascular disease moved to the fourth leading cause of death from the third in 2018. Other Ischemic heart diseases is now the third leading cause of death, previously not included in the leading causes. Ischemic heart disease occurs when there is insufficient oxygen in the heart’s muscles. Trachea, bronchus and lung diseases are also a new leading cause of death. Detailed tables of leading causes of death by race and sex are below. Rates for races other than Black and white are excluded due to small numbers of events, resulting in unstable rates. There was a total of 296 deaths related to COVID-19 in Durham County from March 12, 2020 through February 28, 2022.
Emerging Issues Since Last CHA
Durham County confirmed 25,894 COVID-19 cases throughout 2021. The data revealed racial disparities in COVID-19 cases, similar to other health issues. Black or African Americans are over-represented in COVID-19 cases, making up 36% of Durham’s population but representing nearly 44% of total cases. While 54% of Durham’s population is white 31% of COVID-19 cases are represented by this demographic. Hispanic or Latin residents are proportionately represented in COVID-19 cases, making up approximately 14% of the population and 17% of total cases.
Durham County confirmed its first case of Omicron variant on December 20, 2021. During the first 11 days of January, Durham saw 6,475 cases, equating to 25% of the total cases confirmed in 2021 due to the highly contagious Omicron variant. This led to a total of 70,757 COVID-19 cases confirmed through February 28, 2022. This surge in COVID-19 cases illuminated a need for additional testing sites, especially in marginalized communities at trusted locations, at-home testing kits available with minimal barriers, and the proper masks recommended by the Centers for Disease Control and Prevention. In response, COVID-19 testing locations were added in Durham to include Wheels Fun Park, El Centro Hispano, Durham County Memorial Stadium, and the parking lot of the Durham County Health and Human Services Building. Community Health Workers were trained to disseminate information on how to retrieve free at-home test kits regardless of internet accessibility. N95 masks were distributed from public libraries.
Several groups emerged in response to the need for testing and vaccine equity. Partnership for Healthy Seniors and More, LATIN-19 and African American Covid Taskforce+ (AACT+) created regular convening spaces to strategize methods for closing the gaps for health inequities related to COVID-19. Several existing community-based organizations hosted vaccination events, developed health literacy tools, and provided question and answer sessions with trusted health care providers. In line with health equity principles, testing and vaccinations were provided in community spaces such as schools, churches, and resource fairs.
New/Paused/Discontinued Initiatives Since Last CHA
Diversity and Equity in Research- Duke School of Medicine opened a new clinical research center in Durham after receiving a $2.65 million grant from The Duke Endowment to increase diversity and equity. Duke Clinical and Translational Science Institute, Duke University School of Medicine, and Duke University Health System started the “Changing the Face of Clinical Research at Duke Through Community Outreach and Engagement” initiative to achieve equitable representation in clinical research. The focuses of this project include building community trust, reducing health inequities and supporting community engagement strategies that address research participation barriers. This effort will also include a Community Advisory Council comprised of partners from the African American COVID Taskforce Plus (AACT+), faith leadership networks, LATIN-19 and North Carolina Central University among other valuable partners.
New Community Health Improvement Plans- The Partnership for a Healthy Durham completed Community Health Improvement Plans. Plans are developed for affordable housing, access to healthcare and insurance, communications, mental health, and obesity, diabetes and food access, Durham’s top health priorities identified in the 2017 Community Health Assessment. Committee members, community members and partners collaboratively developed the strategies and interventions for 2022-2024. These plans focus on building equity, strengthening and elevating existing efforts throughout Durham, and building sustainability by advocating for policy changes.
Award Winning Coronavirus Data Hub- In April 2020, Durham County Department of Public Health, Durham County Emergency Medical Services, Duke Health, and DataWorks developed a Durham County Coronavirus Data Hub including information on confirmed COVID-19 cases. Vaccine data was added to the dashboard in 2021, showing that 505,777 doses of COVID vaccines were administered January to December of that year. This number includes first, second and third doses. Vaccine data is presented in categories such as age groups, vaccine sites, dates and includes data aggregated by zip codes and census tracts, including demographic data. In 2021, Durham County Department of Public Health received the National Association of Counties (NACo) Achievement Award in the Health Category for the dashboard that recently hit 1,000,000 total views.
Duke Health and Durham County Department of Public Health staff at community event.
Progress on CHIPs
Affordable Housing
The Health and Housing committee is meeting monthly and engaging with organizations leading initiatives that address health and housing issues. Organizations such as PEACH that works on lead abatement, Lincoln Homeless Health Clinic, and NC Healthy Homes have shared initiatives and are working on plans for collaboration. The committee is seeking the most efficient platform to host a health and housing symposium that incorporates small and large organizations without burdening those with the least resources.
Health and Housing Advocacy
The Health and Housing committee has identified seven Durham-based organizations that provide the data or infrastructure for healthy housing advocacy. Based on these resources, the committee is developing tools to advocate for healthier home conditions.
Health and Housing Collaboration
The Health and Housing committee has identified seven Durham-based organizations that provide the data or infrastructure for healthy housing advocacy. Based on these resources, the committee is developing tools to advocate for healthier home conditions.
Access to Healthcare and Health Insurance
Faith-based Access to Care Program
The Partnership Access to Care program has held two meetings focused on discussing the intersection of faith communities and accessing healthcare and health insurance. While faith centers continue to support the community the best they can, staff need more training and knowledge of the resources available. The Access to Care committee plans to administer a survey to a larger pool of faith leaders to identify the specific needs of faith communities as it relates to accessing care. After the assessment is complete, the committee will develop an action plan along with the leaders.
Digital Health Literacy Program
The Partnership Access to Care committee has hosted two informational sessions on health literacy resources in Durham. The committee continues discussing how to equitably share these resources to Durham residents with the greatest barriers to access.
Mental Health
Mental Health Resource Awareness
The mental health committee has distributed over 300 physical mental health resource brochures in English and Spanish to healthcare facilities, educational institutions, community events, and partnering organizations in 2022. The resource is also available online in English and Spanish.
Community Resiliency Model Training
The Mental Health Committee hosted a Community Resiliency Model training in Spring of 2022 for committee members. The committee selected this modality to increase access to non-traditional mental health tools. Mental Health committee and Durham Adverse Childhood Experiences and Resilience Taskforce created a joint Community Resiliency Model Teacher Collaborative. The goal of this project is for the Durham community to report having increased skills to support their social, emotional, and mental health. The purpose is to disseminate mental health and wellness information and skills within the Durham community in partnership with community health advocates. Recruitment of community health advocates to become certified CRM teachers is scheduled to begin spring of 2023.
Obesity, Diabetes, and Food Access
Double Bucks Program
Durham Double Bucks is now offered at four local farmers’ markets and doubles SNAP benefits, Farmers’ Market Nutrition Program (FMNP) vouchers, and cash for people receiving SNAP, WIC and Section 8 housing vouchers. Double Bucks has been offered at the Durham, South Durham and East Durham farmers’ markets for a number of years, funded by a grant from Blue Cross Blue Shield of North Carolina. In FFY22, DINE facilitated expansion of the program to the Black Farmers’ Market. The market began accepting FMNP (it already accepted SNAP) and secured funds from the American Heart Association and United Way of the Greater Triangle to double SNAP and FMNP benefits. In FFY22, this market reached 70 unique Double Bucks customers.
The three other markets reached 452 unique customers. Customers shopping with Double Bucks spent $93,310 on local foods in 1,595 transactions.
Eighty-two percent of participants felt like their household had been eating healthier since using Double Bucks. Eighty-five percent of participants stated that since shopping with Double Bucks, their household has been able to buy more food. 15% reported buying the same amount of food, and 0% reported being able to buy less food.
Healthy Mile Trails
The Healthy Mile Trails were cleaned and repainted in 2022. The committee exploring avenues to include signage in Spanish and expand to green spaces.
School Nutrition Program
As of October 31, 2022, 18,661 free lunches were distributed, 803 reduced price lunches were distributed, 12,203 lunches were paid for in full. A total of 31,667 meals were served by Durham Public Schools, covering 61.46% of the students.
Food Access Program
Blue Cross Blue Shield Endowment funding for the Double Bucks program ended, but the program has been partially funded through support from Duke Office of Community Health and will continue operating. Program administrators continue seeking additional funding to operate the program at its full capacity. The program is expanding to the Black Farmers’ Market in Durham and Raleigh. Durham Public School Nutrition program began conversations with students and parents to include more culturally appropriate meal options on the menu. PANFA members created materials to notify families about changes with free and reduced lunch applications and eligibility.
Morbidity and Mortality Changes Since Last CHA
Cancer remains t he leading cause of deat
Why are there inequities?
Mortality rates are higher for Black or African Americans than other races or ethnicities for all leading causes of death in Durham County, with the greatest disparities in cancer and heart disease. Mortality rates are higher for men than women each of the leading causes of death. Structural racism is a root cause of these inequities.
Life expectancy rates are similar to previous years, still showing lower life expectancy for Black residents than white residents. Average life expectancy overall is 80.0 2018 to 2020.
Emerging Issues Since Last CHA
Emerging Issues
Durham County has one of the highest COVID-19 vaccination rates in North Carolina- As of February 21, 2023, Durham County has administered 648,775 doses of COVID-19 vaccines. According to the CDC, approximately 95% of the population ages five and older is partially vaccinated and 85.4% of the population is fully vaccinated, meaning Durham County has the third highest vaccination rate in the state. Organizations such as the Durham County Department of Public Health, Duke Health, healthcare providers, Bull City Strong, LATIN-19, AACT+, Together for Resilient Youth (TRY), El Centro Hispano, and Triangle Empowerment Center continued providing vaccines in communities throughout the pandemic.
Durham County confirmed its first case of MPox- MPox, formerly known as Monkeypox, is a rare disease caused by the Mpox virus first discovered in 1958. Durham County confirmed its first case of mpox on July 11, 2022. Cases rose exponentially by the first week of August and doubled each week. Case numbers began to flatten in mid-September 2022, corresponding to the administration of Mpox vaccines. Durham County identified 46 cases of Mpox as of January 9, 2023. The last positive Mpox test reported in Durham County was November 30, 2022.
Gun violence is decreasing in Durham- Durham had 770 shootings January 1, 2022 through December 31, 2022, a decrease from 971 shootings in 2020 and 793 in 2021. Two-hundred and forty-seven people were shot in 2022, a decrease from 318 in 2020 and 278 in 2022. Durham County Public Health has a Gun Safety Team, Bull City United, and Project Build are programs designed to decrease violence in Durham.
New/Paused/Discontinued Initiatives Since Last CHA
New Initiatives
Aging Well Durham (AWD) is the result of merging two coalitions: the Durham Partnership for Seniors and the Durham Partnership for Seniors and More – COVID response. AWD’s purpose is to center lived experiences of aging adults in its work and foster awareness of the implications of Durham's growing aging adult population. The backbone agency promotes and facilitates partnerships while advocating with aging adults on priorities they have identified. During its first year, AWD’s focus will be implementation of Durham’s Master Aging Plan. The plan focuses on civic participation/employment,outdoor spaces/transportation, housing, community support and health services/older adult hunger and nutrition, social inclusion/social participation/elder abuse, neglect, and exploitation.
GoDurham Connect offers free Lyft rides in North Durham- GoDurham Connect is a pilot program with the rideshare company, Lyft, allowing free rides up to $25. This option provides transportation from residents’ homes to schools, libraries, GoDurham bus stops, and shopping centers. This project is funded by the City of Durham and has support from the Durham County Transit Plan. Those interested in using GoDurham Connect can use code GDCONNECT2 for a free ride in eastern Durham or GDCONNECT3 for a free ride from northern Durham. Riders without smartphones or those who need transportation with wheelchair accessibility can schedule a ride by calling 919-485-7433.
Clear Impact Suite is an easy-to-use, web-based software platform that helps your staff collaborate with external stakeholders and community partners by utilizing the combination of data collection, performance reporting, and program planning.