A new State of the County Health Report is out and the message is clear. Durham is making progress on some major health priorities. But more work is needed.
Racial and ethnic disparities remain a systemic problem, this year’s Partnership for a Healthy Durham report stresses. “Racism is a public health crisis,” it reads, echoing recent statements by local elected officials.
For one, Black babies here are more likely to die during their first year of life than white babies. From 2014 to 2018, Black infants died at three and a half times the rate that white infants died in Durham County. In addition, life expectancy among Black county residents was 5.3 years shorter than among white residents during 2016 to 2018, according to the report.
While the 2019-focused report doesn’t address the new coronavirus, recent data makes clear that Black and Latinx people living in Durham County are hardest hit by the pandemic. Where people work, construction projects, nursing homes and jails included, explains some of the risk.
“Racial equity is being embedded in all the activities that we’re involved with,” said Angel Romero Ruiz, coordinator for a local community health program and co-chair of the Partnership for a Healthy Durham.
Three years ago, residents of Durham County ranked their top five health-related priorities, including affordable housing, access to healthcare and health insurance; poverty, mental health, and links between obesity, diabetes and food access.
The partnership, a group of 200 active members and dozens of organizations, this year predominantly addresses three of those priorities. Here’s a summary of the latest major findings:
Expand affordable housing
Between 2010 and 2019, the median sale price for homes in Durham rose by more than 50%, the report notes. Median gross rent rose 27% from 2010 to 2018, from $798 to $1013.
“Durham is gentrifying, so housing that used to be affordable is starting to be unaffordable,” said Romero Ruiz.
A large proportion of Black and Latinx residents are renters. Only 29% of Black residents and 33% of Latinx residents own their homes, compared to 64% of white, 49% of Native American and 44% of Asian households, according to the report.
This disparity leaves Black and Latinx renters especially vulnerable to rising house prices. Consequently, Black and Latinx households have less to spend less on food, healthcare and other necessities.
“Housing and health is totally related. You know, depending on what neighborhood you live in, you’re probably more likely to have better or worse outcomes,” said Romero Ruiz.
Progress in 2019
Durham County voters approved a $95 million housing bond last fall. Paired with $65 million in federal and local funding, the bond money will help redevelop public housing properties in downtown Durham over the next five years. The money will also help finance permanent housing for people who are homeless, fund down payments for first-time home buyers with low incomes and assist people in danger of being evicted.
Durham City Council approved Expanded Housing Choices, an ordinance that permits higher density building in neighborhoods near downtown.
Durham County created a coordinated entry program for people who are homeless in October 2019. Anyone who needs shelter must first report to Durham County Department of Social Services for a coordinated entry and diversion intake. This creates one point of entry for shelter and housing resources.
Challenges
Durham was reminded that health and housing are connected in a big way this year. Nearly 900 people living in McDougald Terrace were evacuated from their homes after carbon monoxide leaks were detected in some apartments. Inspectors found stoves, furnaces and water heaters leaking hazardous gas at the public housing complex.
Conditions at McDougald are also a reminder of the long-lasting impact of racial segregation and economic discrimination. McDougald was built in 1954 for Black tenants in what has traditionally been a Black neighborhood at a time when Durham was still racially segregated.
Local officials have big plans to upgrade many public housing properties here, but not McDougald. That’s because it’s located outside the city’s growing downtown, officials say, where investors are less likely to risk their money.
There are multiple ways that long-ago racial discrimination affects the health of Durham residents today, said Jannah Bierens, a health equity consultant and co-chair of the Partnership for a Healthy Durham.
“Just because laws change, that doesn’t mean that people change or that the practices change. So it takes an internalized transformation as well,” she said.
Increase access to care
The proportion of uninsured residents in Durham has decreased from 15% in 2015 to 12.2% in 2018. But among that 12.2%, who remains without coverage? Most are Latinx residents, who cite immigration status as the most common barrier to receiving health insurance.
In 2018, 40% of Latinx residents were uninsured along with 11% of Black residents, according to the report. Durham has a small Native American population, totalling 726 at the last count; 19% of these residents are uninsured. In comparison, the percentage of white and Asian residents uninsured was 6% and 7% respectively.
To increase access to care and address racial and ethnic disparities, Partnership for a Healthy Durham has outlined two main goals for 2018-2021: increase knowledge about healthcare resources, such as Lincoln Community Health Center, and increase access to culturally appropriate care. That includes patient care teams trained in racial equity.
Progress in 2019
The partnership recently received a grant from Duke University to place more bilingual community health workers with organizations such as Project Access of Durham County and El Centro Hispano, according to Romero Ruiz. These health workers help both insured and uninsured members of the Latinx community navigate the resources available to them, said Romero Ruiz.
For the first time since 2015, the partnership updated its Medical Care Options in Durham brochure, which provides uninsured or underinsured residents a long list of resources, including the Lincoln Community Health Center’s new satellite clinics. The new brochure also includes updated information on how to apply for Medicaid.
Alliance Health, a behavioral health organization, continued to focus on evidence-based care in 2019 for Durham County residents who are uninsured or insured by Medicaid, according to the report. Its staff has expanded efforts to respond to severe mental illness, substance use disorders and long-term needs, according to the report.
Challenges
Employment and access to care through insurance coverage go hand-in-hand. According to the report, residents ranked lack of employer based plans and unemployment as their second and third barriers to health insurance. The report partially blames workforce discrimination for inequities in access to care.
Linking obesity, diabetes and food access
In 2018, 70.4% of adults in Durham and several nearby countries were overweight or obese, according to the report. Additionally, one in 10 people skipped a meal or cut the size of a meal because they didn’t have enough money to buy food.
Limited access to healthy food, contributes to obesity, among other health problems like heart disease, diabetes and chronic kidney disease. Additionally, income, employment, race, ethnicity and disability may be factors in residents’ ability to get healthy food options, according to the report.
Black and Latinx residents are disproportionately affected here too. According to the report, 14.9% of Black residents skipped or cut a meal sometimes or frequently in the past year, compared to 12.6% of Latinx residents and 6.6% of white residents.
Bierens said that Black and Latinx residents don’t always have access to healthy food.
“Black and brown neighborhoods are heavily saturated with fast food restaurants and alcohol and tobacco. Those things are also coping mechanisms, so there’s so many interrelated layers,” she said.
Progress in 2019
The City of Durham, Sustainable Duke, Feed My Sheep of Durham, TROSA, Duke Pratt School of Engineering, Sarah Duke Gardens, Duke Farm, Inter-faith Food Shuttle and Healthy Duke created the Bull City Community Garden, a new addition to the local food scene.
The partnership also collaborated with Durham Public Schools to expand more nutritional choices in school meals. It created a document discussing health and nutrition for parents. And it improved Durham’s Healthy Mile Trails,
Challenges
The link between obesity, diabetes and food access is not as simple as many think, according to Bierens. Stress and lack of sleep are commonly overlooked factors that induce higher cortisol levels and a rise in body fat, said Bierens.
Teaching people to eat healthy diets without discussing effects from stress and lack of sleep is not enough, Bierens said.
It’s vital to understand the racial dimension of these community health problems, she said. For that reason, the partnership has a Racial Equity Task Force, whose members will include Durham residents grappling with these problems.
Looking forward
One priority from the 2017 survey was reducing poverty. According to the 2019 report, poverty is decreasing in Durham. But this positive news comes with a caveat.
While the percentage of Durham residents living in poverty decreased from 20% in 2010 to 15.8% in 2018, the actual number of people in this category has increased by 64% since 2000. In 2018, 46,805 people had incomes below the poverty level compared to 28,557 in 2000, according to the report.
The decrease in the percentage of people living in poverty is likely explained by an increase in the the number of higher-income households moving to Durham.
The partnership, like so many institutions locally and nationally, will focus more than ever on the racial and ethnic dimensions to health disparities in Durham. “We just started adding the ‘why’ and talking about inequities,” Bierens said.
At top: People angry over dangerous conditions at McDougald Terrace public housing protested outside City Council chambers last winter. Access to affordable housing is one of five issues that Durham residents have rated as priority needs. Photo by Bella Hutchins
Correction: This article was modified to correct Jannah Bierens’s work title.