CHAPTER 6: HEALTH ISSUES

With regards to other health concerns, as mentioned in the previous chapter, most residents and service providers spoke of improved access to health care as most central to addressing the health of Durham residents. Of the specific health issues plaguing Durham residents, asthma, chronic disease (cardiovascular disease, diabetes, etc.), and cancer were most frequently cited.

The dramatic increase in asthma was mentioned by both residents and service providers as a concern that affects residents across all age ranges. More specifically, however, the increase in asthma among youth was mentioned as a particular area of concern. One service provider stated that "In elementary schools, 10% of students have asthma." The medical care needed in the school systems to address the "increasing proportion of students with medication, chronic illness, and more complex medical needs" was noted as an issue that has impacted the current allocation of health resources in the county school system. One example is the Asthma Management Project that has started to address this growing problem. According to one service provider, school nurses and the health department are working together to try "teach students skills to increase their quality of life." The effort put into encouraging active participation of Durham youth in their disease prevention and health maintenance is one step in making a profound impact on the health of the next generation in Durham County. Moreover, it is likely to act as a window on the health issues that Durham will face in the coming decades.

Respondents in interviews and focus groups also mentioned the impact of chronic disease and cancer on the health of Durham County residents. When asked what specific health issues family and close community members are dealing with, one respondent said, "people are growing older." He subsequently listed heart disease, cancer, Alzheimer's, arthritis, and other "crippling diseases" as some of the more common health conditions impacting the quality of life of Durham residents.

Since the 1960s, the elderly proportion of the Durham County population has increased (Durham County, 1998). Efforts to address both the health needs and barriers to service utilization of the older residents in Durham who suffer from asthma, diabetes, and hypertension include the Promising Practices and the neighborhood nursing programs. These outreach programs involve nurses going into regions of the county that have been identified as having elevated rates of chronic illness and limited access to services according to zip code classification. Nurses will target these regions to do health promotion and health education work to address the health disparities and barriers to service utilization. Community members remarked on the helpfulness and responsiveness of the programs, considering them as innovative steps in addressing the needs of community health. For example, one service provider viewed Promising Practices as "an interesting concept" that includes community members and service providers in the development and implementation of their own health initiatives. Programs such as these show promising changes in the health of the community because they intend to equip residents with the skills and knowledge to be more successful in creating healthy lives.

Finally, as the "City of Medicine," Durham is a place with a multitude of resources as well as "groups and coalitions [who try] to get people to do more preventive stuff and take advantage of the facilities that are here." However, as one community member stated, "There are lots of health problems here, and for a long time to come, they're going to be here."

Improvement on those issues is expected to result from continued and increased collaboration between community members and service providers who recognize not only their assets and needs, but who are willing to work towards improved health in a more unified manner. Using the example of asthma, this effort will also need to incorporate other agencies to look at contributing factors like "environment - poor plumbing and dampness in houses," reflecting one service provider's suggestion for the need to look "deeper than a medical diagnosis in addressing the problem."

Chapter 5: Behavioral Health

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Chapter 7: Cultural Diversity/Hispanic Issues