Brady Blackburn

On Tuesday, February 18, 2025, FHLI programs, the North Carolina Rural Health Association (NCRHA), the North Carolina Oral Health Collaborative (NCOHC), and the Center of Excellence for Integrative Care (COE) co-hosted our annual Legislative Breakfast.

Health advocates and policymakers from across the state met at the North Carolina Museum of Natural Sciences Nature Research Center. They got out early to share a hot meal and discuss ways to improve the health and well-being of all North Carolinians.

A standing-room-only crowd of over 120 elected officials, health professionals, and advocates came out to hear state legislators and health experts share their perspectives on pressing challenges and opportunities to work together for a healthier future.

We are excited to continue advocating for policies that meaningfully improve the lives of everyone in our state. NCRHA, NCOHC, and COE set specific policy agendas annually. Below, you can learn more about our speakers and 2025-2026 legislative priorities.

Rural NC: Whole-Person, Whole-Community, & Whole-State Health

FHLI Board Member Dr. Cherry Beasley introduced Representative Timothy Reeder from the North Carolina General Assembly. He spoke about the North Carolina House leadership’s priorities for 2025 and expressed his support for FHLI’s slate of policy priorities.

He also expressed interest in finding policy solutions to address prior authorization, which, in its current form, often creates unnecessary barriers and inefficiencies in health care. To address this, he intends to find policy options that save money while reducing the burden on patients seeking care.

FHLI Chief of Staff Dr. Brandy Harrell introduced Josh Dobson from the North Carolina Health Care Association. He discussed the current federal landscape and the risk of Medicaid cuts, specifically highlighting a trigger law in North Carolina that will automatically end Medicaid expansion if federal funding is cut below the current “90-10” split.

Since passing in North Carolina in 2023, Medicaid expansion has opened the door for insurance coverage to more than 628,000 people, a disproportionate percentage of whom live in rural communities.

This year, NCRHA is focusing on expanding and enhancing rural broadband and building a more robust rural health workforce at the federal and state levels:

Reliable, high-speed broadband is necessary for accessing telehealth services, learning, connecting socially, growing businesses, and more. Investing in broadband infrastructure serving our rural communities will ensure everyone has the opportunity to thrive, regardless of who they are or where they live.
Today, 95 of North Carolina’s 100 counties are still geographic or population Health Professional Shortage Areas (HPSAs) for primary care. To ensure every North Carolinian can access care, we must strengthen our rural health system through training programs, loan repayment incentives, and workforce development.

At the state level, NCRHA is also advocating for:

Investing in natural disaster resilience.
Building a stronger safety net.
Supporting maternal and child health.
Addressing youth mental health.

For more information on NCRHA’s priorities, see their 2025 policy agenda, and for more context on the state of health in rural North Carolina, check out the 2025 North Carolina Rural Health Snapshot.

Oral Health: Essential for Overall Well-Being & a Human Right

NCOHC Vice President Dr. Steve Cline introduced Representative Maria Cervania from the North Carolina General Assembly. Drawing on her expertise as an epidemiologist and biostatistician, she talked about how oral health is both overall health and a human right.

Several speakers also referenced House Bill 60, which would modernize North Carolina Medicaid dental reimbursement rates. This legislation is a top priority for the NCOHC team, and the bipartisan bill has been co-sponsored by Representatives Cervania and Reeder, alongside 57 additional primary and co-sponsors.

North Carolina Medicaid dental reimbursement rates haven’t been meaningfully increased since 2008, meaning that many public health providers are forced to operate at a monetary loss when accepting patients with Medicaid insurance. House Bill 60 would raise rates by more than 10% compared to average private practice prices.

To ensure everyone across our state has the opportunity to live a healthy life and access all types of care, including oral health, NCOHC is advocating for:

Increasing North Carolina Medicaid dental reimbursement rates.
Revising statutory law to allow for alignment of dental rules 16W and 16Z.
Allowing for reimbursement of more school-based dental examinations.
Collecting more data to inform workforce development needs.

Considering the expansion of Medicaid last year, modernizing dental reimbursement rates is as pressing as ever. By taking this critical step, we can increase the number of providers and ensure everyone has access to care.

To learn more about NCOHC’s priorities, download their 2024 Portrait of Oral Health and check out the final pages for the program’s full 2025 policy agenda.

Behavioral Health: Preventative Mental Health Care for Children

To round out the event, COE Interim Director Dr. Lisa Tyndall announced the launch of a mental health well-check pilot with the North Carolina Department of Health and Human Services (NCDHHS). She also introduced Dr. Alexandra Cupito and Dr. Lauren Hanley, who spoke about their experiences as providers trying to offer and get reimbursed for delivering preventive mental health care.

This year, COE is promoting a new policy allowing children up to 17 years old to receive a free mental health screener with their caregiver’s consent during their annual well-visit. If approved, this policy would ensure that primary care providers have dedicated time for mental health prevention, including identifying potential concerns, sharing resources, and delivering care to avert mental health crises before they arise.

Accessible, routine preventive care would also help destigmatize mental health conversations and reduce the risk of children developing long-term, untreated mental health disorders that adversely impact their health, overburden providers, and increase costs.

Children and teens in North Carolina are experiencing a mental health crisis with anxiety, depression, and other challenges on the rise, but this trend does not have to continue. By ensuring children, youth, and families get broader access to whole-person care, we can build the foundation for a healthier North Carolina.

Check out COE’s Mental Health Well Check [PDF] primer to learn more.

Connect, Collaborate, Advocate for a Healthier NC

Many opportunities exist to engage with FHLI and advocate for health. If you want to be part of the solutions to make our systems work better for more people, sign up for our newsletter and join us at a future event. If you want to learn more about the state of health in North Carolina, be sure to read the 2025 Rural Health Snapshot. We’re glad you’re here!

During Black History Month and throughout the year, we honor the leaders, advocates, and everyday heroes whose contributions shape our society. The 2025 theme is “African Americans and Labor.” All kinds of work impact health, from physical well-being to income and employer-provided insurance. The two have always been and remain inextricably connected.

This year, we’re spotlighting Rev. Dr. William J. Barber II, a highly influential national organizer, community advocate, and political activist with strong roots in North Carolina. Rev. Dr. Barber embodies a legacy of Black leadership, and his organizations create history every day, building on the remarkable achievements of those who came before.

Reviving & Co-Chairing the Poor People’s Campaign

Rev. Dr. Barber is best known for co-chairing the Poor People’s Campaign: A National Call for Moral Revival and leading the Moral Monday protests at the North Carolina General Assembly, which began in 2013. The campaign is a revival of the 1968 Poor People’s Campaign organized by the civil rights group the Southern Christian Leadership Conference while under the leadership of Rev. Dr. Martin Luther King, Jr.

Today, the campaign lays out demands and a policy agenda to address “the interlocking evils of systemic racism, poverty, ecological devastation, the war economy, and our distorted moral narrative,” all of which impact health and well-being.

Although these efforts began long ago, the work remains unfinished. The movement continues to unite a broad coalition of people across lines of difference to build a better future where everyone has the opportunity to succeed.

Living a Legacy of Service & Advocating for Justice

Rev. Dr. Barber was born in Indianapolis, Indiana, just two days after the March on Washington for Jobs and Freedom, where over 200,000 demonstrators gathered and Rev. Dr. Martin Luther King, Jr. delivered his “I Have a Dream” speech.

He and his family later moved from Indianapolis, Indiana, to Washington County, North Carolina, his father’s hometown. There, his father served as the first African American teacher, and his mother served as the first African American office manager at the county’s white high school.

Currently, Rev. Dr. Barber serves as president and senior lecturer of Repairers of the Breach and bishop with The Fellowship of Affirming Ministries. He is a professor in the practice of public theology and public policy and the founding director of the Center for Public Theology and Public Policy at Yale Divinity School.

He also served as the pastor of the Greenleaf Christian Church (Disciples of Christ) in Goldsboro, North Carolina, for 30 years. In all his work, Rev. Dr. Barber continues to build on a legacy of service and commitment to justice.

Building on the Past to Create a Better Future

At FHLI, we celebrate leaders like Rev. Dr. William J. Barber II, who drive solutions that address the root causes of our most pressing challenges, from structural racism to social drivers of health. We must remember the past and let it inform us moving forward to create a future that supports whole-person, whole-community health across our state.

Dear Valued Stakeholders,

We are writing to share an important organizational update. After careful consideration, our President and CEO, David Reese, has decided to step down from his role. Effective immediately, Chet Mottershead will serve as interim CEO to ensure a smooth leadership transition.

I want to assure you that our organization remains strong and fully operational. Our exceptional team of program directors and staff are well-prepared to maintain the continuity of our critical work during this period of change. Each program director will personally reach out to provide updates on ongoing projects and address any questions or concerns you may have.

We recognize that leadership transitions can create uncertainty, and we are committed to transparency and open communication. If you would like to discuss this transition or have any specific inquiries, you may reach me by contacting our CFO, Jean Shaw, at jean.shaw@foundationhli.org.

The Foundation for Health Leadership and Innovation’s Board of Directors remains deeply committed to our mission. We are confident in our organization’s resilience and look forward to continuing our important work with your continued support and trust

Sincerely,

Kim Schwartz, Chair, On behalf of the FHLI Board of Directors

“Change happens at the speed of trust, and trust happens at the speed of human relationships.” — Dr. Skip Cummings, East Carolina University, paraphrasing a Reverend Jen Bailey quote

The first two blog posts in this series covered Jim Bernstein’s background, work with the North Carolina Office of Rural Health (NCORH), and the impact of his legacy on individuals, communities, and rural health policy. Here, we explore the history of the Foundation for Health Leadership and Innovation (FHLI) and how our current work aligns with Bernstein’s vision.

The Foundation

In 1979, a special state legislative commission recommended the creation of a “Foundation for Prepaid Health Plans.” As the NCORH Director, Bernstein worked with UNC School of Medicine Professor Glenn Wilson to establish the “North Carolina Foundation for Alternative Health Programs” in 1982, with funding from the Henry Kaiser Foundation, the Hartford Foundation, and the Robert Wood Johnson Foundation.

The nonprofit, non-governmental organization accepted grants from private foundations. It aimed to develop and implement innovative programs, including launching health maintenance and other managed care organizations, to increase access to quality health care for all North Carolinians. Although it later changed names, the Foundation was established to advance collaborative, equity-centered, and community-driven solutions to improve North Carolinians’ overall health and well-being, as it continues to do today.

In 1992, the Foundation launched Carolina ACCESS to help communities create systems for providing access to comprehensive care for low-income, uninsured residents. The team successfully implemented the program in 12 counties, and the General Assembly approved its implementation statewide, leading to the creation of Community Care of North Carolina. The Foundation then became the North Carolina Foundation for Advanced Health Programs and, in 2015, the Foundation for Health Leadership and Innovation (FHLI).

Collaborative, Equity-Centered Solutions

Approximately 3.9 million people live in North Carolina’s 70 rural counties (defined by an average population density of 250 people per square mile or less). Our rural communities have unique opportunities and challenges. Many have been historically underserved by our health care systems, impacting longevity and quality of life.

Bernstein believed that community members have the best insights into how to support their community’s health and well-being, both now and in the future. This aligns closely with the phrase, “Nothing About Us Without Us.” Coined by the global disability rights movement, this message emphasizes inclusion, calling for full participation for and by communities in any decision-making that impacts them.

Following that same vein, during his 2023 Jim Bernstein Community Health Career Achievement Award speech, Doyle “Skip” Cummings, PharmD, shared some wise words he once heard from a Pitt County businessperson: True collaboration is when you lay your resources on the table and remove your hand. Building on this idea, Shannon Moretz of Compassion Health Care said, “…relationships require someone to cultivate and tend to them—it is long-term work,” during a health equity workgroup meeting facilitated by the NC Rural Health Association, an FHLI program.

FHLI has continued to launch programs and initiatives that carry forward Bernstein’s legacy of supporting community-based work grounded in these principles. Our Community Voice cross-program initiative aims to create the conditions for communities to bring their own seats to their own decision-making tables, ensuring those experiencing and directly impacted by existing health disparities lead the solutions. We aim to support communities throughout rural and underserved areas in defining their goals, identifying resources, and developing both local and system-wide solutions.

Community-Driven Decision-Making in Bertie County

Since 2022, FHLI has been collaborating with Bertie County through the Bertie County Integrated Behavioral Health Network, which celebrated its two-year mark in May 2024. This body of work centers community in the decision-making process, engaging residents, health and social organizations, and local leaders to address critical behavioral health needs across the county.

In November 2023, FHLI secured grant funding to extend the Bertie County Integrated Behavioral Health Network to October 2025. Throughout 2024 and 2025, FHLI staff and Bertie County residents will focus on:

Providing harm reduction trainings and resources.

Expanding youth and family-based services, including telehealth, in Bertie County schools.

Launching a “Stop the Stigma” campaign to raise awareness and help Bertie County residents access behavioral health resources.

Training two community members as Mental Health First Aid (MHFA) instructors.

MHFA training and work will also continue beyond FHLI’s work in the county.

In addition, FHLI is launching a new initiative called the Roadmap to Innovation, which aims to collaborate with rural communities to develop and implement their own paths to health equity. The program will start by supporting communities in the western part of the state in identifying their most pressing needs and connecting local community-based organizations with additional resources and funding to improve local impact and sustainability.

Stay tuned for more!

The Need for Systems-Level Change

Building on Bernstein’s legacy, we remain committed to advocating for more equitable systems in North Carolina. At the NC Oral Health Collaborative 2023 Oral Health Day event, keynote speaker Kathy Colville shared a powerful truth: “We have truly amazing and exceptional people holding up an inadequate system.” Putting this into context, Bernstein and his team achieved incredible things throughout their careers despite working within a flawed system—just as health equity leaders continue to do today.

Our vision is a state where everyone—from community members to public health workers, social service providers, and beyond—can reach their highest level of health and well-being. Through community-based work and a focus on sustainable, systems-level change, we strive to create integrated, interdisciplinary support networks that enable organizations to align their internal and external practices with their values.

Bernstein’s Legacy Continues to Grow Strong Roots in NC

Bernstein deeply valued everyone working directly in health clinics, and their work remains essential to establishing and maintaining rural health centers across the country. In 2006, a year after Bernstein’s passing, FHLI launched the Jim & Sue Bernstein Community Health Center Scholars program, which celebrates the invaluable contributions of rural health clinic staff members by helping them pay for clinical education and their dependents pay for college.

The Jim Bernstein Health Leadership Committee has awarded over $130,000 to scholars, including employees and dependents from eligible centers in North Carolina.

That same year, FHLI launched the Jim Bernstein Health Leadership Fellows. Inspired by Bernstein’s vision, this initiative supports future leaders dedicated to improving health in North Carolina’s rural and underserved communities.

Since the program began, 94% of Bernstein Fellows have remained in North Carolina to continue their work in creating healthier communities. Our 2022-2024 class will graduate this year’s Bernstein event! Get your tickets to learn more about how they’re advancing health access and equity in communities across our state.

Throughout all our work, FHLI proudly continues Bernstein’s legacy by helping provide the necessary resources for communities to drive their own solutions. Our programs include:

Center of Excellence for Integrated Care (COE)
NCCARE360
NC Oral Health Collaborative (NCOHC)
NC Rural Health Association (NCRHA)
Project ECHO Network in North Carolina (PEN-NC)
Roadmap to Innovation

Since 2006, the Bernstein Event has also been held every October to honor our history and celebrate today’s public health leaders advancing access and equity for all North Carolinians.

Inspired by Bernstein’s legacy of community-driven solutions for systems-level change? Join us to help continue his mission.

If you missed parts one and two of this blog series, be sure to check them out for the full story.

“I was giving a talk at the University of South Carolina Family Practice Symposium on my work. A family physician in the audience stood up and said the countryside is littered with the bodies of family physicians who thought they could make a difference. Why did you? At the time, I had no answer. Since then, I’ve pondered this question, and this is what I know: Jim Bernstein, Bernie Patterson, and the entire staff at the Office of Rural Health always had my back.” — Dr. Jane McCaleb

Part one of this blog series examined Jim Bernstein’s background, early work, and the North Carolina Office of Rural Health. Here, we dive into a personal story from a physician providing health care in rural North Carolina and explore Bernstein’s nationwide impact.

Accelerating Change in Rural North Carolina

Dr. Jane McCaleb, 2020 recipient of the Jim Bernstein Community Health Career Achievement Award, was assigned to Jackson, NC, in Northampton County, for a two-year term by the National Health Service Corps. She stayed for 35 years. The Office of Rural Health recruited her, and, according to Dr. McCaleb, she largely remained due to the robust support its staff provided.

She joined the small practice in Jackson in the late 1970s when, according to her, Eastern North Carolina was still a derivative of the plantation sharecropping economy and “where grinding poverty and racism were apparent everywhere, every day, and in every way.”

The KKK was still active in the area then, and Dr. McCaleb, a white female family medicine practitioner, worked with a Black male internist to serve the rural communities with the highest maternal risk characteristics and neonatal mortality in the state. They were the first racially integrated practice outside of a university in North Carolina.

Firsthand Account from Rural Health Physician & Leader Dr. Jane McCaleb

During her Jim Bernstein Community Health Career Achievement Award acceptance speech, Dr. McCaleb shared a story that painted a clear picture of the community and conditions at the hospital when she arrived:

“At the hospital, things were changing slowly. I clearly remember a hot summer day when a 14-year-old Black girl in her first pregnancy came to my office. She had already been to the neighboring health department that morning. She was two weeks overdue, had a blood pressure of 160 over 100, and marked swelling, denoting preeclampsia. She had been certified by the OB (obstetrician) for lay midwife delivery at home because she had no money. It would have been a hot, miserable delivery and very dangerous. She was scared, and so was I.

I did not even bother to send her to the hospital. I called the rescue squad and sent my LPN (Licensed Practical Nurse), Barbara Harris, to get IV (intravenous) fluids and mag (magnesium) sulfate from the hospital, and I called ECU (Eastern Carolina University).

I stuck her in the back of an ambulance with volunteer EMTs and Barbara to run the IV and mag drip and put her on the road. I never saw her again until about 15 years later, when she came back for a visit. Everything had turned out fine, and her little boy was thriving.

Can you figure out what the trick to driving down the neonatal death rate? No great OB skill on my part, no great pediatric skill. I referred a third of all my OB patients to Greenville to deliver until I could get a team in place, our staff trained, and the hospital up to snuff. I gave a damn, and Jim knew.”

When Dr. McCaleb arrived in Northampton County, the neonatal death rate was almost 22 per thousand, nearly double the state rate of 12. After three years, the Office of Rural Health (ORH) staff recruited a pediatrician who was married to a neonatal nurse. Within four years, the team recruited two family practitioners who brought a labor and delivery nurse with them. Five years after Dr. McCaleb started, the rate had dropped from 21.8 to 7.6, below the state rate of 8.4, thanks to her dedication and support from NCORH.

At the end of her award acceptance speech, she reflected on her experience: “I was giving a talk at the University of South Carolina Family Practice Symposium on my work. A family physician in the audience stood up and said the countryside is littered with the bodies of family physicians who thought they could make a difference. Why did you? At the time, I had no answer. Since then, I’ve pondered this question, and this is what I know: Jim Bernstein, Bernie Patterson, and the entire staff at the Office of Rural Health always had my back.”

Driving National Rural Health Solutions

Beyond North Carolina, Bernstein also left a lasting impact on rural health at the national level. He served as president of the National Rural Health Association (NRHA) and advocated for legislative changes in Medicaid and Medicare, leading to more equitable reimbursement for rural health centers and hospitals.

Thanks to Bernstein and his team’s work, all 50 states now have rural health offices. The National Organization of State Offices of Rural Health (NOSORH), founded in 1995, assists these Offices in supporting the health care infrastructure for 61 million rural Americans.

Bernstein also mobilized, mentored, and inspired hundreds of rural health leaders nationwide. He and NCORH staff established a highly successful framework for working within existing policies and designing programs for sustainable, lasting change. Bernstein knew how to get things done and generously shared his knowledge, insights, and resources with fellow leaders and advocates.

After he passed away, the National Advisory Committee on Rural Health and Human Services (NACRHHS) honored him: “Rare is the leader who so many would claim as mentor and friend.” The NOSORH Educational Exchange Scholarship Program provides State Offices of Rural Health employees with resources to help them cultivate the essential and effective characteristics Bernstein embodied:

Capacity to see and share the “big picture”
Ability to identify and implement strategies that fulfill an inspired vision
Understanding of rural health issues and the resources needed to address them
Commitment to nurture and sustain relationships with stakeholders and partners
Ability to think entrepreneurial
Dedication to lifelong learning
Desire to cultivate the leadership skills of others

Nancy Lane, a health care management consultant, said, “What was magic about Jim was that he could work with such a wide breadth of people. He encouraged people to tackle the impossible, all while making it look like fun.”

Our next post will dive into Bernstein’s foundation leadership and current FHLI programs and priorities.

What Is NCRHA?

NCRHA is the official state affiliate of the National Rural Health Association (NRHA). NCRHA began as an informal convening during the tenure of FHLI’s founding director, Jim Bernstein. Since then, it has evolved into a collaborative network of associations, organizations, and individuals representing health care, education, economic development, local government, and other partners invested in supporting rural health.

NCRHA in Action

NCRHA was busy in 2023 and 2024! Here’s a snapshot of our accomplishments during that time:

National Rural Health Day Celebration: In November 2023, NCRHA co-hosted a National Rural Health Day celebration with the North Carolina Office of Rural Health (NC ORH) at the Bertie County Aging Council, where local community members joined state officials and several federal government officials for the day-long event. 2023 marked the 50th anniversary of the NC ORH, established by FHLI’s founding director, Jim Bernstein. The NC ORH is the country’s oldest rural health office.

Advocacy on Capitol Hill: In February 2024, NCRHA and fellow advocates traveled to Washington, DC, for the National Rural Health Association Policy Institute to help bring North Carolinian voices to Capitol Hill. The North Carolina delegation met with Representatives Wiley Nickel and Deborah Ross as well as staff from Senator Thom Tillis, Representative Valerie Foushee, and Representative Chuck Edwards’ offices.

Collaborative Initiative: In May 2024, NCRHA co-hosted a Legislative Breakfast with fellow FHLI programs, including the North Carolina Oral Health Collaborative (NCOHC) and the Center of Excellence (COE) for Integrated Care. Chris Shank from the North Carolina Community Health Center Association (NCCHCA) spoke about her work and the critical role NCRHA plays in advocating for rural communities across North Carolina.

NCRHA, NCOHC, and COE highlighted the following key policy priorities:

Investing new funding in North Carolina Medicaid for dental services

Growing the dental provider network

Building on successful policy expanding rural broadband

Building a more robust rural health care workforce

Extending and increasing community health center funding

Providing annual mental health well-visits

Informative Publication: NCRHA annually publishes a comprehensive report on rural health in our state. The 2024 NC Rural Health Snapshot includes data on statewide rural demographics, rural health, and health care infrastructure. In addition to outlining differences, disparities, and strengths of rural and underserved communities across the state, it identifies opportunities for North Carolina to improve how our public health systems serve our rural population.

Advocate, Network, Engage, & Drive Change

NCRHA convenes statewide partners to create a unified voice that promotes better rural health outcomes for rural North Carolina. Using FHLI’s Community Voice approach, based on human-centered design, NCRHA advocates for systems-level changes to ensure every community has its own seats at its own decision-making tables.

Membership is open to anyone passionate about health equity and access to care for our vibrant rural communities. As a member, you’ll connect with fellow advocates, keep rural health at the center of the conversation, and advance systems-level change.

Annual membership benefits will continue to grow and evolve. Current benefits include:

Professional Development: Peer mentoring, a private LinkedIn group, NRHA webinars, resources, annual conferences, and advocacy opportunities on Capitol Hill

Networking: Exclusive virtual and in-person events to connect with other health care professionals and advocates

Voting: Influence organizational decisions, including operational documents and policy priorities

Engagement: Participate in quarterly meetings and workgroups and get recognized on the NCRHA website with exclusive NRHA state affiliate news

Event Discounts: Enjoy reduced rates for events like the NC Rural Center’s Rural Summit and more

NCRHA membership types include organizations (with tiered rates based on staff size), community-based organizations (CBOs), individuals, students, and retirees.

* NCRHA quarterly meetings are open to any party interested in participating. Paid membership comes with extra benefits, including voting power and access to additional perks and resources.

Amplify Impact with NCRHA Workgroups

As a member, you can also lean into focus areas you feel passionate about by participating in NCRHA workgroups that foster community collaboration to drive impactful rural health solutions. The workgroups include:

Health Equity: Provides advice, guidance, and recommendations to advance health equity in underserved communities, including creating social and physical environments that promote good health for all in rural North Carolina.

Behavioral Health: Convenes individuals and organizations working in behavioral health, including substance use/addiction, focused on access, quality, affordability, co-occurrence, social stressors, and the COVID-19 Pandemic’s ongoing impact in rural communities.

Policy and Legislation: Raises health issues affecting rural communities within the group and monitors actions of the NC General Assembly as they pertain to rural health throughout our state, including assisting staff with developing an annual legislative agenda.

Whatever your key areas of focus, as an NCRHA member, you can amplify your impact by connecting and collaborating with fellow rural health advocates.

Support Rural NC Communities in Leading Toward a Healthier Future

Whether you’re among the 40% of North Carolinians who live in rural communities, you work to support rural health, you’re passionate about every person having access to the care they deserve, or all the above, you can help communities across our state lead toward a healthier future. Learn more and join NCRHA today!

Three groups representing oral health, behavioral health, and rural health concerns engaged elected officials and encouraged policy action to advance health equity in North Carolina

RALEIGH – A standing-room-only crowd joined three Foundation for Health Leadership and Innovation (FHLI) programs on May 7, 2024, for the organization’s annual legislative breakfast at the North Carolina Museum of Natural Sciences.

The North Carolina Rural Health Association (NCRHA), the North Carolina Oral Health Collaborative (NCOHC), and the Center of Excellence for Integrated Care (COE) co-hosted event to raising awareness and engaging participants in policy action to support rural communities.

Featured speakers at the breakfast included:

• Representative Tim Reeder, MD

• Chris Shank, North Carolina Community Health Center Association (NCCHCA)

• Zil Joyce Dixon Romero, National Rural Health Association

• Dr. Frank Courts, NC Dental Society Council on Prevention and Oral Health

• Senator Gale Adcock, MSN

During the event, Representative Reeder, an emergency physician from Pitt County, spoke about whole-person health care, emphasizing the connection between the head, the mouth,and the rest of the body. Shank spoke about her work at NCCHCA and the important role NCRHA serves in advocating for rural communities across North Carolina.

Courts and Senator Adcock spoke about their participation in a recent North Carolina Institute of Medicine task force on oral health. The task force, which released a full report on April 24, 2024, includes a robust slate of recommendations, including several with policy implications.

The three FHLI programs used the event to champion key legislative priorities, including:

• Investing new funding in North Carolina Medicaid for dental services

• Growing the dental provider network

• Building on successful policy expanding rural broadband

• Building a more robust rural health care workforce

• Extending and increasing community health center funding

• Providing for annual mental health well visits

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Contact:

Brady Blackburn, Director of Communications
Foundation for Health Leadership & Innovation
brady.blackburn@foundationhli.org
919.533.9934

“Don’t tell the community what they need.”

The Foundation for Health Leadership and Innovation’s (FHLI) founding director, James (Jim) D. Bernstein, was a rural health pioneer. Over his 35-year career, he championed community-driven care for low- and moderate-income, isolated, and underserved populations. As the founder of the first state office of rural health in the United States, Bernstein’s work has impacted communities nationwide. He believed:

Everyone has a right to health care.

Care should be respectful, effective, and efficient.

Each health care system belongs to the communities where people live and providers practice.

Today, FHLI continues to work to ensure Bernstein’s legacy of innovation and community-driven approach to systems-level change endures. In this three-part blog series, you can learn about his experience and approach, the history of the North Carolina Office of Rural Health (NCORH), and the evolution of FHLI.

Peace Corps, U.S. Public Health Service, & Global Community Health Fellowship

Bernstein earned his BA in Political Economy and Sociology from Johns Hopkins University. Then, he served a two-year term with the third class of Peace Corps volunteers as a high school English and gym teacher in Morocco, where he also met and married his wife, Sue. When he returned, he earned his MA in Hospital Administration from the School of Public Health at the University of Michigan.

Upon completing graduate school, he entered the US Public Health Service and was awarded a Global Community Health Fellowship in 1969. His studies and experiences in the Peace Corps sparked a keen interest in working with rural communities.

Community-Based Rural Health Care in North Carolina

After serving as Administrator for the Sante Fe Indian Hospital and Service Unit Director for health facilities, a series of events led Bernstein to meet with Dr. Cecil Sheps, Director of the University of North Carolina at Chapel Hill (UNC) Health Services Research Center (for whom the UNC Sheps Center is now named).

Through this connection, Bernstein began his first community-based health project, building relationships in Walstonburg of Greene County. This rural, predominantly Black community had no doctor, and there was still KKK activity at the time. Yet, Bernstein earned the community’s trust and collaborated with the biracial community board to help drive solutions and decision-making.

The model they implemented, which was subsequently followed by the Office of Rural Health (ORH), involved a physician assistant, family nurse practitioner, or another trained provider supervised by a nearby physician who supplied clinical support and backup when needed. The community-based providers were trained to perform the essential functions of physicians so they could deliver health care to rural communities that had none.

Dr. Edgar Beddingfield, a past president of the North Carolina Medical Society, became the first physician to implement this approach. He supervised Donna Shafer, the first nurse practitioner to serve the Walstonburg community and a close friend of Bernstein and his wife, Sue. You can learn more in this dedication to Bernstein by Donald L. Madison, MD, published in the North Carolina Medicine Journal [PDF].

Entrance to Walstonburg, NC, the first community Bernstein built a relationship with

The First Office of Rural Health

UNC leaders pitched the idea of a statewide government program to help develop rural health clinics to the governor of North Carolina. In 1973, Bernstein established the North Carolina Office of Rural Health (NCORH), the first office of rural health in the country.

Bernstein faced many obstacles when getting the program off the ground. For it to work, he needed to advocate for policy change to enable providers to practice within the full scope of their training. He also needed enough buy-in from physicians and medical examiners, many of whom pushed back on the idea.

Even in those early days, Bernstein understood that community acceptance and investment were essential. One of his many gifts was his ability to connect with people across lines of difference. He developed strong, trusting relationships wherever he went—from the heart of rural communities to the halls of Congress.

In addition to his knack for building trust with community members, he had a keen ability to hire good people from a wide range of backgrounds dedicated to the cause. By collaborating closely with a hand-picked team dedicated to supporting and addressing the needs of rural and underserved communities across the state, he laid the foundation for creating local county health centers in North Carolina.

Working alongside rural community and health leaders, he helped establish a roadmap for designing and implementing innovative solutions to address even the most complex health challenges. According to those close to Bernstein, he saw challenges as opportunities for change.

Under his leadership, NCORH supported groups of local citizens in establishing nearly 85 rural-community-operated health centers in North Carolina. To do this, Bernstein and his team traveled to each community to listen and learn. They operated on a few fundamental principles:

Act only upon request.

Never tell the community what they need.

Be present and listen.

If people wanted a health care center, they assembled the necessary resources, uplifted local leaders, and ensured community ownership during the design process and ongoing operations.

Bernstein Describes NCORH’s Philosophy & Approach

“We weren’t going to run anything… They, the community, would be primarily responsible, and we would provide the pieces that they couldn’t put together themselves, as well as the know-how to make it work.

Nor were we going to push ourselves or come out from Raleigh saying, ‘We’ve got this new idea for your community, and this is what you should do: You should have a health center; you should have a nurse practitioner; it should be run by the community…’ We acted only where we had a request.

We might get a call saying, ‘We haven’t had a doctor in a long time, and we’re interested in just talking to you.’ Then we’d send a staff person out. So that was another principle: Don’t tell the community what they need. If they don’t want what we have, that’s fine. The next thing was to be able to put together all the pieces that were needed to do the job.

So, if a community wanted to do it, we had the ability to make it happen. And the most important part of that was our field staff… the people who interfaced with community folks. Our philosophy was, we go to them.”

Today, NCORH provides funding, training, and technical assistance to improve the quality, accessibility, and cost-effectiveness of health care in rural and underserved communities.

In part two of this series, we will examine NCORH’s personal impact on rural health providers and how Bernstein acted as a mentor for rural health leaders across the country.

National Rural Health Association Policy Institute & Visit to NMAAHC

Earlier this month, one of our programs, the North Carolina Rural Health Association, traveled to Washington, D.C., for the National Rural Health Association Policy Institute to help bring North Carolinian voices to Capitol Hill.

While in D.C., some of our staff visited the National Museum of African American History and Culture (NMAAHC). We reflected on Black History Month and the culture, heritage, struggle, and joy spanning centuries of the Black experience in the United States.

Here are a few highlights from the diverse NMAAHC exhibits we saw:

Black Arts

NMAAHC features displays about Black arts and the intersection of culture, activism, struggle, and joy through everything from music and dance to visual arts, architecture, food, and much more. One exhibition, “Spirit in the Dark,” spotlighted the role of religion in Black music, activism, and popular culture.

Black Leadership

While meeting with staff members in Representative Valerie Foushee’s office, we noticed a picture of Shirley Chisholm, the first Black woman to be elected to the United States Congress and the first Black woman to run for a major party nomination for the Presidency. Foushee is a current member of the Congressional Black Caucus, which was co-founded by Chisolm.

NMAAHC spotlighted Chisholm’s leadership, voice, and vision for a “government that would serve the needs of all its citizens.”

“I am not the candidate of Black America, although I am Black and proud. I am not the candidate of the woman’s movement of this country, although I am a woman and equally proud of that. I am the candidate of the people and my presence before you symbolizes a new era in American political history.” – Shirley Chisholm

Chisholm spoke about health and health care in her political life, saying that, “Health is a human right, not a privilege to be purchased.” She also spoke about the importance of community voices in decision making, saying, “If they don’t give you a seat at the table, bring a folding chair.”

Health & Health Care

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman,” is a Reverend Martin Luther King, Jr. quote often remembered without its second half: “…because it often results in physical death.” The second half is important, because it underscores the gravity and life-ending consequences of inequitable health care structures.

Several NMAAHC displays portray a long history of innovation, leadership, and activism to secure access to and equity in care. One leader, Homer G. Phillips, secured funding in the early 1900s to construct a new hospital for African Americans in St. Louis.

Phillips was a lawyer and civil rights activist who worked to oppose segregation, secure rights for Black people in public spaces like trains, and improve conditions for Black farmers. He was also a co-founder of the Citizen’s Liberty League, which worked to advance the interests of Black Americans in the Republican Party.

Influential writer and Civil Rights Activist James Baldwin said, “The great force of history comes from the fact that we carry it within us, are unconsciously controlled by it… history is literally present in all that we do.” The struggle, joy, and everything in between of the past constantly impacts us as individuals and a society in the present. While significant strides have been made, systemic inequity remains and the road to a just future continues.

“History is not the past. It is the present. We carry our history with us. We are our history. If we pretend otherwise, we are literally criminals. I attest to this: the world is not white; it never was white, cannot be white. White is a metaphor for power, and that is simply a way of describing Chase Manhattan Bank.” ― James Baldwin, I Am Not Your Negro

As we wrapped up our time in D.C., we reflected on history being made today in communities across North Carolina working to improve access and equity in care. While on Capitol Hill we ran into Dr. Karen Smith, Hoke County Medical Director and lead Family Medicine Physician, who was named North Carolina’s “Community Star” in 2023.

Community Stars are named annually for each state by the National Organization of State Offices of Rural Health. FHLI helped recognize Dr. Smith during the 2023 National Rural Health Day Celebration for her leadership and contributions to improving health and well-being in her community.

On top of her role as a family physician, Dr. Smith actively advocates for policy change, embodying the multifaceted efforts to create a more equitable future for Black Americans, a theme emphasized throughout the NAAMHC exhibits.

Legislative Breakfast 2025: A Morning of Statewide Health Advocacy