Wrong side of the river: Overcoming health disparities in rural North Carolina

Background/Purpose: Underlying the disproportionately high rates of chronic disease, other health conditions, and associated poor health outcomes among African Americans is limited access to healthcare, fueled by an array of environmental and social factors. This paper presents the results of a community diagnosis performed in the African American communities of two towns in eastern North Carolina, focusing on the ways these communities have overcome a history of racism and poor geography to begin resolving existing disparities through improved access to healthcare services. Methods: An Action-Oriented Community Diagnosis (AOCD) was conducted with these African American communities over a seven-month period. Three qualitative data collection methods were used to assess the strengths and challenges facing these communities. These methods were participant observation field notes; semi-structured individual interviews with 40 community residents and service providers; and secondary data sources such as historical archives and technical documents. Data were analyzed using a transcript-based analysis approach to determine patterns of meaning related to community and identity. Results/Implications: Preliminary findings indicate striking differences in both health outcomes and access to healthcare, based on race and residential location. In an effort to reconcile existing health disparities within the communities, public health practitioners must continue collaborative efforts with government and community leaders to advocate for structural changes that will improve the population's health. Advocating for a public transportation infrastructure, particularly to medical facilities, will be an important first step in promoting equal access to care and developing policy-level interventions to eradicate health disparities in this population.