Major social, economic, education and health disparities plague Buncombe County and particularly the City of Asheville. For example, Asheville's Census Tract 9 is a challenged place where the most recent American Community Survey data show a 52% poverty rate, median income of $18k and 24% unemployment. This is home to 1,460 households, with 59% African Americans, 33% Caucasians and others. 

Infant mortality and chronic disease disparities often stem from economic and social conditions which disproportionately impact lower-income people and people of color. Buncombe County's 2015 Community Health Assessment shows that in the past seven years the county's infant mortality rate has fluctuated. From 2012-13, there was a dramatic increase, from 5.0 to 10.1 deaths per 1000 live births. In 2014 (5-year data 2010-2014), African American infants were 2.6 times more likely than White infants to die before age one. By 2017, the ration has increased to 3.4. In addition, Chronic disease data show that African Americans have higher mortality rates from cancer, heart, kidney disease and lower respiratory ailments, than Whites. 

In Asheville and Buncombe County, children in poverty graduate from high school at a rate of 77%, while classmates graduate at 90%. There are also major disparities in math and reading proficiency rates in 3rd grade among racial/ethnic groups (White, Black, Latino, Native American and others). These disparities perpetuate through high school graduation and beyond. 

Major built-environment challenges that are manifested in lower wealth communities severed from access to healthy foods, adequate transportation and appealing green space. In Census Tract 9, the nearest grocery store is 2 1/2 miles away, and the minimum 30-minute (often longer) one-way bus trip requires two separate bus rides. The City of Asheville added Sunday bus service in 2015, but significant transportation gaps remain. 

Housing for all poses a major challenge. For the first time since 2007, Asheville's population of homeless people rose in 2015 by 5% over the prior year (533 to 562). Permanent supportive housing for households experiencing homelessness currently has a 6-months waiting list. Affordable housing units are operating at 99% occupancy, and public housing plus subsidized units have virtually no vacancy. The public housing 1-bedroom waiting list has over 1,000 persons. Wait times are between 6 months and two years for these units. Many households are doubled up so that occupants can afford the rent in subsidized units. 

Simply put, quality housing availability and adequate transportation networks to jobs and food require built-environment solutions that incorporate opportunities to build health for all. 

Upon receiving funds from the Robert Woods Johnson Foundation (RWJF) in mid-2016 for the Invest Health planning grant initiative, a team convened of representatives from five anchor institutions in Asheville with NCCHW serving as the "backbone" agency. This group became known as the “Away Team” and was responsible for driving the progress of the initiative, coordinating with RWJF throughout the process, and traveling to locations around the country to connect with and learn from other groups doing similar work. The "Home Team" was a cross-sector group comprised of the original Away Team members, plus around 15 stakeholders from nonprofits, community organizations, city and county government departments, educational and health institutions, and community funding institutions and foundations.

Invest Health Asheville engages local residents to build capacity and develop leadership among people often left on the periphery of planning. The initiative generates broad, authentic engagement in information/opinion gathering for city decision and policy makers on issues related to quality of life. This process supports the City Council's vision with approaches that include budgeting capital investments through an equity lens, securing private development agreements with positive community investments, and utilizing robust processes that ensure that decision‐making bodies include people with lived experience of the deleterious impact of health inequities.

Partners are well poised to assist with planning and engagement work, and include representatives from workforce development, education, health, food access, transit and community organizing. Invest Health connects with residents and our respective networks to explore strategies for improving housing, income/employment and education. Essentially, the team, augmented with resident voices, will reinforce that health comes first for pending and new built‐environment projects in neighborhoods where social and economic challenges are manifested in health disparities. Other pending city development projects are encouraged by the team to include built‐environment elements that support healthy community best practices: public transit mobility, food access, nurturing green, coupled with strong social capital and resilience initiatives for children and adults.

The concept of this planning grant was to develop a built environment project that addressed the social determinants of health, which include education, transportation, access to safe and affordable housing, places to play and exercise, quality jobs, healthy foods, etc. While 50 similarly comprised planning teams were also awarded these funds in cities across the United States, the Asheville team’s approach took a very different turn from the other groups around the country. 

Producing a built environment project which addresses one or more social determinants of health was the original goal of this effort. We have accomplished this and much more. The outcome was not only the development of this project and accompanying presentation but also the development of a planning model which was truly community-centered and was driven by our values. This was a very different approach to the phases of planning and development as compared to the Invest Health planning initiatives of our colleagues around the country, and frequently looked from the outside as though we were operating perpetually behind schedule. However, we hope that our story will demonstrate that moving at the speed of trust is not only doable when undertaking complex community planning initiatives, but is actually preferable in that it disrupts inequitable power dynamics and places community at the center of the planning process while producing enactable solutions to address the social determinants of health.

The Asheville Away Team began this planning initiative by trying out a variety of methods to get a feel for what projects and assets already existed in the city and what planning factors were most important to be taken into consideration according to key stakeholders in our area. This was accomplished through a community listening session, introductions and invitations to community and health agencies and programs to join the planning process, and culminated in an expanded planning table now known as the “Home Team” undertaking an asset mapping session to identify existing Built Environment, Economic Mobility, Educational, Advocacy and Awareness, Transportation, Food, and Health related assets and programs in our city. 

While this early work helped to establish a baseline identification of existing efforts in our city it did not provide a clear path forward in terms of meeting the goals of this planning process. Recognizing that this group needed feedback and support to chart an intentional and community-driven plan of action an organization within the Home Team met with Away Team representatives to recommend the addition of professional facilitation with a strong lens for equity and inclusion. As a result of this input in January of 2017 the Away Team hired Marisol Jimenez, founder of Tepeyac Consulting to facilitate Asheville’s Invest Health Initiative from that point forward.

The first planning meeting of the Home Team facilitated by Marisol Jimenez occurred in February, 2017, and involved the group playing a game called Power Pictionary, which was developed by Training for Change. The intent of this exercise is to ask participants to divide into two unevenly dispersed groups with uneven distribution of information and supplies and then to play a version of the game, Pictionary. Throughout the rounds of the game it becomes clear to the group receiving less instruction and supplies that they are not positioned for success, juxtaposed with the easy success of the other group. Tensions mount, and the vastly different experiences of the two groups become the centerpiece of discussion for the rest of the session. The power dynamics experienced and explored in this short exercise were then extrapolated outward to our city and our society, and around the room participants began to experience aha moments of true understanding regarding the historic and systemic marginalization and oppression of various groups of people, and particularly communities of color. The effects of long-term inequitable distribution of resources, decision-making power, and opportunities for success became clear. And, the group recognized that our planning initiative must make every effort not to replicate those patterns.  

At the next meetings of the Home Team, we established our group decision-making process and Group Norms, and applied an analysis of Amplification, Interruption, and Innovation to those previously exposed power dynamics to craft a set of Values for our group moving forward. These principles became fundamental to every aspect of our work throughout the remainder of the planning process, and provided a foundation of stability to support our group through moments of uncertainty. Our identified values were: Be a voice of dissent: name and interrupt inequitable power dynamics; Move beyond diversity; Redistribute resources and decision-making authority; Hold ourselves and others accountable; Recognize and support existing organizations and community-led efforts; Address barriers to participation; and Trust the community: “Move at the speed of trust”. 

Once this bedrock was laid for how to operate together as a group we began the process of developing a community-centered plan of action for the identification and support of a built environment project addressing the social determinants of health in our city. After agreeing that we wanted this venture to emerge directly from the community itself we divided out into three sub-committees to distribute planning responsibilities amongst the Home Team members. These sub-committees were Community Engagement, Application Development, and Project Criteria. The work of the Home Team began to move quickly at this point, with sub-committees meeting regularly outside of the whole-group while continuing to come back together monthly with the entire planning team to integrate planning efforts. While this phase of work was not entirely smooth it was driven forward by both our continued adherence to our shared Values and a growing sense of urgency to produce a  community-based project before the RWJF Master Class funding pitches scheduled for early December of 2017.

In early September the development of an application for built environment project proposals was complete, as well as the processes to ensure that both the submittal and selection of proposals would be completely community-driven. In an effort to adhere to our principle of addressing barriers to participation the Home Team ensured that both the project application and the application to serve on the Community Selection Committee were distributed widely in both paper and electronic form and in both English and Spanish. Informational flyers and physical applications were strategically placed in community centers located in low wealth neighborhoods throughout the city, and a Capacity Building Workshop was held with childcare and interpretation for prospective applicants to learn more about the Invest Health process and receive support in completing and submitting a project proposal. Similarly, an Information Session with childcare and interpretive services was held for Community Selection Committee applicants to prepare them for their upcoming task of reviewing project proposals and identifying the project they felt best met the goals of the Invest Health initiative as well as the needs and desires of the community.

Applications for project proposals were due by October 16th, 2017, and after determining a strategy to eliminate potential conflicts of interest from the selection process a smaller group of uncompromised Home Team members had the difficult task to narrow down the excellent eight project proposals received to the top three applications which best fit the group’s goals and Values. Finally, on October 26th an Invest Health Project Showcase event was held featuring specially created vocal performances, community-catered cuisine, childcare, interpretation, community-artist rendered project designs for the final three applicants, project summaries and contact information for all submitted proposals, a graphic facilitator’s depiction of the Invest Health group’s entire planning process, and the multi-generational Community Selection Committee which would be hearing descriptions of the final three projects and then retreating to discuss and determine which project they would select for presentation at the Invest Health Master Class funding pitches in early December. The Showcase was attended by Home Team members, community groups and representatives, funding representatives, and additional institutional and organizational stakeholders. After much deliberation the Community Selection Committee chose the Emma Community Park proposal as the community’s Built Environment project to be presented at the RWJF Master Class in New Orleans.

Throughout the month of November and leading up to the RWJF Master Class in New Orleans on December 6th, 2017, the Invest Health Home Team has been working directly with the Emma community applicants to develop their proposal into a full scale presentation including a slide show, display booth, supporting statistical analysis, and oral presentation. The oral and Powerpoint presentation will be pitched to panels of leaders in the fields of economic development and urban planning at the RWJF Master Class in New Orleans, along with others from Invest Health projects from around the country. These panels will then provide Invest Health project teams with technical feedback and funding recommendations and will help to build necessary connections to investors and resources in order to see these built environment proposals become implemented.

The participation of Invest Health Away Team members in the Master Class was always understood. However, the Asheville planning team identified early on that in accordance with our principles of being a voice of dissent by naming and interrupting inequitable power dynamics, redistributing resources and decision-making authority, and removing barriers to participation it was necessary to press for the inclusion of the Emma community project applicants as participants and presenters at the Master Class in New Orleans, which would require additional resources to support travel, lodging, and interpretation. Fortunately, after some deliberation RWJF agreed to make these additional accommodations, and the Emma community group presented their vision and project in New Orleans.    

Upon receiving funds from the Robert Woods Johnson Foundation (RWJF) in mid-2016 for the Invest Health planning grant initiative, a team convened of representatives from five anchor institutions in Asheville. This group became known as the “Away Team”, and was responsible for driving the progress of the initiative, coordinating with RWJF throughout the process, and traveling to locations around the country to connect with and learn from other groups doing similar work.

The "Home Team" was a cross-sector group comprised of the original Away Team members, plus around 15 stakeholders from nonprofits, community organizations, city and county government departments, educational and health institutions, and community funding institutions and foundations.

Emma is a low wealth neighborhood which was not included during the City of Asheville’s annexation of neighboring parcels, and which has a high ratio of Spanish speaking families and higher than average rates of gentrification. Emma’s residents are frequently left out of resource planning and distribution processes due to barriers around language and equitable information sharing. Consequently, public infrastructure in this neighborhood is lacking compared to many other neighborhoods in the city. The Emma community’s Invest Health proposal identifies an elegant solution to their need for accessible public infrastructure and shared recreational space for families and children, and meets the social determinants of health related to accessing places to play and exercise. The Invest Health team’s intentionally Community-centered and Values-driven process made it possible for this typically marginalized community’s voice to be heard, lifted, amplified, and supported in this planning effort. 

Invest Health Asheville’s Home and Away Team Planning Participant List

Away Team:

         Representatives from the City of Asheville

          Representatives from Buncombe County Government Offices

          Representative from University of North Carolina at Asheville’s NC Center for Health and Wellness

          Representative from United Way of Asheville and Buncombe County

          Representatives from Self Help Credit Union

Home Team:

         Facilitation provided by Marisol Jimenez, founder of Tepeyac Consulting

All Away Team members are included in the Home Team

          Representative from Housing Authority Residents Council

          Representative from Southside community

          Representative from SPARC Foundation

          Representative from Housing Authority of the City of Asheville

          Representatives from Bountiful Cities

          Representative from Habitat for Humanity

          Representatives from Buncombe County DHHS

          Representative from Asheville City Schools Foundation

          Representative from Mountain BizWorks

          Representative from Simple Business Solutions consulting

          Representative from Green Opportunities

          Representative from Positive Youth Solutions

          Representative from Community Centered Health Home

          Representative from Asheville Buncombe Institute for Parity Achievement

          Representative from Hoodhuggers International

          Representative from My Daddy Taught Me That