Between the Blue Ridge and Appalachian mountain ranges sits the bountiful farmland of Buncombe County, N.C.
Between the Blue Ridge and Appalachian mountain ranges sits the bountiful farmland of Buncombe County, N.C. Between the Blue Ridge and Appalachian mountain ranges sits the bountiful farmland of Buncombe County, N.C.

2014 RWJF Culture of Health Prize Winner

A Culture of Health Is Taking Root

Nestled in the Blue Ridge mountain range is a valley with a blend of urban and rural areas that make up Buncombe County, N.C., and the eclectic county seat of Asheville. Across this picturesque landscape a new Culture of Health is taking root. With the support of more than 70 organizations and thousands of individuals, the community is coming together to improve health outcomes—now and for generations to come.

“The thing that is really driving us forward is an interest in being the healthiest community in the country,” said Buncombe County Health Director Gibbie Harris. “We have people who are interested in social justice, and a desire to improve the lives of our friends and neighbors. That is more of an incentive for us than anything else.”

Coordinated Change

Buncombe County exemplifies the concept that improved collaboration among groups can lead to better health for residents.

In 2013, Buncombe County Health and Human Services convened the Public Health Advisory Council. The leadership council includes an array of community stakeholders, including the YMCA of Western North Carolina, the Asheville Area Chamber of Commerce, health care professionals, transportation experts and environmental organizations, among others. This broad-based group is looking at all aspects of life in the county in order to address the multitude of forces that impact health. The mission of the council is to bring together individuals, families, and local leaders to make Buncombe County a community where healthy choices are easy to make and are supported by the environment. The council serves as a catalyst for providing leadership, support, and coordination to assist the community in reaching its health goals—spreading Buncombe County’s success and causing a ripple effect into all of Western North Carolina.

The Council has led and supported a number of initiatives, including the Innovative Approaches project, which is focused on bringing pediatricians, parents, and support agencies together to improve quality of care for children with special health care needs. Through this program, electronic health records have been customized to ensure that special needs children receive customized services during doctor’s visits, and handbooks have been created for parents so they can keep all the information about their child in one place.

Harris cited some of the specific community health wins supported by the Council, including a concerted approach for the community’s physicians in addressing both obesity and asthma; reducing secondhand smoke through collaborative efforts to make multi-unit housing complexes smoke-free; and working with area “tailgate markets” and larger farmer’s markets to accept EBT food assistance in exchange for healthy foods.

“Community partners are excited about working together,” said Harris. “The focus of organizations has shifted to achieving outcomes for our community as a whole. We’re early in this process, but we are already starting to see some benefits of this work.”

By creating a broad collaboration of community partners, Buncombe County, N.C., is on a path to long-term and sustainable change.

Access, Healthy Eating and Prevention

Buncombe County, North Carolina, has engaged all sectors of its community to strive for better health for its residents.

Reducing Childhood Poverty

In many ways, a healthier Buncombe County starts with a reduction in childhood poverty. Led by the local nonprofit Children First/Communities in Schools, community leaders are attacking the issue of poverty at both the individual level and the policy level. All of their work has been driven by having community members, facing the daily challenges of living in poverty, at the table to help identify and implement solutions to the most pressing issues facing their families.

Through their advocacy initiative called the Success Equation, community leaders have addressed the long-term issues that affect childhood poverty and measured their impact in moving families out of poverty. Advocacy efforts with state legislators spared $1 million in cuts to Buncombe County’s child care subsidy resources. They have studied potential negative impacts that may arise as families lose public assistance due to increasing incomes, and also, raise awareness among community members of resources—such as SNAP, affordable housing and Medicaid—that are available to families in need.

Another critical approach to preventing child poverty is ensuring parents can access the income they need to support their families. Asheville’s living wage ordinance, passed in May 2007, ensured that city employees were paid a living wage (currently $11.85). Though state law has stymied some expansion of the living wage law, a voluntary certification program identifies and promotes local employers that pay a living wage. So far, more than 300 local businesses have been certified through this program, which has extended beyond Buncombe to several other Western North Carolina counties.

While long-term advocacy efforts are important, community leaders and members also recognize that low-income children and families need support today. A key part of their strategy has been to establish Family Resource Centers, such as the one at Emma Elementary School, where folks are working together to improve the financial stability of families in poverty. This comprehensive program of Children First/Communities in Schools provides a myriad of direct resources to families, including a food pantry; parenting classes; emergency financial assistance for rent, utilities and medical expenses; and eyeglasses for children.

Harris explained, “The Family Resource Center has become a hub and safe place for families in need. The focus is not on just dealing with a crisis, but also helping families secure jobs and housing. Already, we’re seeing families become more stable, and as they do, many have come back to volunteer at the center and help other parents.”

Making Healthy Eating Accessible—and Fun

A food-lover’s dream, Asheville is home to countless restaurants, and has earned a reputation as “Foodtopia.” In this diner’s paradise, community leaders are working hard to ensure that children have access to and knowledge about nutritious local food.

Perhaps no program better illustrates this effort than Rainbow In My Tummy®. Originally created at Asheville’s Verner Center for Early Learning as a way to improve the quality of food served to children in child care, the Rainbow In My Tummy program has grown to become a county-wide effort to improve childhood nutrition—and a national model.

As the program name implies, Rainbow In My Tummy is designed to make healthy eating a colorful and fun experience for children. Now implemented in 14 child-care centers throughout the county, children eat of fresh, whole and nutritious foods cooked from scratch, and a curriculum has been developed to educate parents and other caregivers on how to create a healthy food culture for their young children.

“Thanks to Rainbow In My Tummy, we have 1-year-olds eating lima beans and squash casserole and eggplant,” said Harris. “It’s a whole curriculum that engages the entire school as well as the community, and makes healthy eating fun.”


It’s become very clear, and critical to the health of our community, that we must work together to build healthier communities. Through a systems approach, we have broken down the silos that traditionally exist in social change initiatives, and together we are strengthening our community.

 Paul Vest, CEO of the YMCA of Western North Carolina

Empowering Underserved Communities

A central component to building a Culture of Health is the empowerment of key voices from within underserved communities.

At Pisgah View Apartments, a Community Service Navigator program has supported community efforts, such as afterschool care, exercise classes, boys’ self-esteem groups, and a community garden entrepreneurship. The Navigator program emerged from conversations held between a Department of Social Services Social Worker and community members after unreported child abuse led to an infant death. Critical to the success of this program is the trust that has been established with local agencies, in partnership with “navigators” who come from the neighborhood in which they serve. Navigators are seen by community members as trustworthy neighbors who can provide expert advice and facilitate access to services such as food assistance and medical care.

In Asheville’s oldest historically African-American community of Shiloh, community members have also been engaged to shape a healthier future for residents. In recent years, the Shiloh Community Association has partnered with several community organizations, such as the YMCA of Western North Carolina, the faith community, city government and local businesses, to establish a community center where residents have learned how to make healthier choices. The association created a garden with the help of local colleges and non-profits, and is working with a local restaurant to build a community amphitheater. They have also worked with community groups to establish a variety of health promotion programs, such as tobacco cessation, health screenings, diabetes prevention, and chronic disease management. They have also worked to strengthen relationships with local law enforcement.

“It’s become very clear, and critical to the health of our community, that we must work together to build healthier communities,” said Paul Vest, President and CEO of the YMCA of Western North Carolina, “Through a systems approach, we have broken down the silos that traditionally exist in social change initiatives, and together we are strengthening our community.”

The Culture of Health Prize

The Prize honors and elevates U.S. communities working at the forefront of advancing health, opportunity, and equity for all.