Helene Relief, Fellowship Graduation, and Leadership Awards: The 2024 Bernstein Event 

Each year, as we gather for the annual Bernstein Event, we are reminded of the massive contributions of our state’s individuals and communities to improving health care. 

This year, we are reminded of that more than ever. 

When Hurricane Helene devastated communities across Western North Carolina (WNC), the catastrophic storm also impacted many FHLI employees and partners. In response, we focused most of the 2024 Bernstein Event on helping those affected by the natural disaster. 

To encourage direct fundraising efforts during the event, we created a list of county-by-county resources, prioritizing community-based organizations across the region. Those organizations with deep ties throughout their communities will play vital roles as WNC recovers and begins to rebuild. Both during the Bernstein Event and after, we are asking our network to contribute directly to CBOs across WNC so they have access to the resources they need to support their communities.

Read more about this year’s event and watch presentations from our featured speakers, Bernstein Fellows graduates, and awardees below. 

Hurricane Helene 

During the event, North Carolina Department of Health and Human Services Secretary Kody Kinsley gave a detailed update on hurricane response efforts. He emphasized the need for a long-term focus on rebuilding impacted communities across the region. 

“This is something that is not going to be done in a few days. It’s not going to be done in a few weeks,” said Secretary Kinsley. “This is an entirely different trajectory for the health and well-being of the region, and our state will and must respond to it in a different way.” 

He outlined many aspects of health care in Western North Carolina (WNC) that the state government has supported as of October 2, 2024: 

  • They coordinated with Duke Energy to restore commercial power to all 22 acute care hospitals in WNC within two days of the hurricane. Some of those 22 have since lost commercial power but remain open on generator power. 
  • They contacted all 91 regional nursing homes and delivered resources, including generator fuel, satellite phones, and Starlink systems, to help them maintain critical functions. 
  • They supported reopening at least one pharmacy in each of the 25 counties in the disaster zone. As of October 2, at least 126 regional pharmacies were open. 
  • They supported the reopening of all 27 opioid treatment programs in WNC, supplying 29 emergency shelters with naloxone and opioid overdose reversal medication and connecting those shelters with opioid treatment providers so people can receive treatment regardless of where they are.   
  • They served over 30,000 hot meals in McDowell, Watauga, and Buncombe Counties.  
  • They delivered thousands of pounds of food and water supplies to every county in WNC. 

After Secretary Kinsley, Health and Human Services Regional Secretary Antrell Tyson took the stage to provide remarks about the federal government’s response to Hurricane Helene. He spoke about the importance of federal government partnerships with the state government and local communities to serve everyone impacted by the disaster. 

Bernstein Fellows Graduation 

This year, we also celebrated the latest graduates of our Bernstein Fellowship program. Seven professionals across various disciplines completed this two-year program, which helped them develop a broader understanding of rural and underserved community needs and cultivate the necessary leadership skills to engage and collaborate with others to improve their communities’ health and economic state. 

2024 Awardees 

Every year, FHLI’s annual awardees underscore essential work being done across North Carolina to ensure more people have access to equitable health services. This year, we recognized the contributions of Joseph Bell, MD, who received the 2024 FHLI Community Achievement Award, and Barbara Pullen-Smith, PhD, who received the 2024 Jim Bernstein Community Health Career Achievement Award. 

Learn more about their careers and the impact they’ve had on enhancing access and equity across our state. 

We are already planning for next year’s event! Stay safe, and we hope to see you in 2025! 

“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. 

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“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.

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Seventy-seven of North Carolina’s 100 counties are rural. That’s 3.65 million people—nearly 40% of North Carolinians—who call a rural community home. Building a healthy North Carolina can only happen when those communities have the power to drive decision-making around solutions to their most pressing challenges.  

FHLI envisions a North Carolina where communities guide solutions to the problems they face, creating a state where everyone has equal opportunity to attain their full health and well-being potential and where no one is disadvantaged due to demographically, socially, or economically defined circumstances.  

To help make this vision a reality, FHLI leads the North Carolina Rural Health Association (NCRHA). The membership-based association advocates for health access and equity for every North Carolinian, regardless of who they are or where they live.   

Though we run an annual membership drive in July, you can join anytime. Learn more about rural health in North Carolina, NCRHA membership benefits, and more!  

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

###

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.

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At FHLI, our mission is to advance collaborative, equity-centered, and community-driven solutions to improve overall health and well-being for every North Carolinian. Throughout Black History Month and year-round, we celebrate and uplift the voices, visions, lived experiences, and wisdom of Black individuals and communities across our state.  

For the Black History Month 2024 theme, Celebrating African Americans and the Arts, we especially want to recognize the ways that Black artists and visionaries act as essential and driving forces for systems-level change. 

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.

Last year was a big year for North Carolina. After a decade of action and advocacy, as of this past December, Medicaid Expansion is finally in effect. This is no small accomplishment, even though it is just one step on the road toward truly healthy and equitable communities. Looking ahead, this policy victory will continue to play a major role as those of us at FHLI continue to act, change systems, and improve health.  

2023 was also a big year for FHLI. As we kick off the new year, we’re reflecting on everything we were able to accomplish alongside partner organizations and communities across our state. Read on for highlights from 2023 and look forward to what we have planned for 2024. 

Roadmap to Innovation 

This year FHLI took an important step to innovate our portfolio as an organization. We announced FHLI’s Roadmap to Innovation, which will help communities develop and implement their own paths to health equity. This line of work was built out of our Community Voice model, centering local, participatory decision-making to identify and act on community-driven solutions to health disparities and inequities.  

We are leveraging a $900,000 investment in ourselves to work deeply in three groups of contiguous counties across North Carolina to provide support and address social drivers of health. Stay tuned in 2024 as we begin the work to: 

  1. Facilitate community-driven identification of structural issues and systems change advocacy to impact those issues.  
  1. Increase community-based organization access to larger state, federal, and NGO sources of grant dollars.  
  1. Increase efficiency and integration of existing services through community-driven care networks that include traditional and non-traditional partners. 
  1. Increase overall community-based organization capacity to deliver services.  

Bertie County Integrated Behavioral Health Network 

Throughout this year, FHLI’s Community Voice and Center of Excellence for Integrated Care (COE) teams facilitated a network of local leaders in Bertie County to address their community’s behavioral health needs. The Network leverages FHLI’s Community Voice model, centering participatory engagement to allow communities themselves to identify needs and efficiently drive decision-making around desired outcomes, resource needs, and local and system-wide solutions.  

End-of-year update: The Bertie County Integrated Behavioral Health Network received a $300,000 grant from Merck to continue their work in 2024!  

Read more 

Bringing National Rural Health Day to Rural North Carolina 

In 2023, the National Rural Health Association co-hosted a National Rural Health Day celebration with the North Carolina Office of Rural Health (NC ORH). It was an extra special year for two reasons. First, 2023 also marked the NC ORH’s 50th anniversary. Founded by our nonprofit’s founding director, Jim Bernstein, the NC ORH is the oldest office of rural health in the country.  

The second reason this year’s celebration was special is because we brought the festivities to rural North Carolinians. Rather than having an event in Raleigh, we hosted the festivities at the Bertie County Aging Council – Senior Center, where the Bertie County Integrated Behavioral Health Network has met throughout the year. Local community members joined state officials and several federal government officials for the day-long event.  

Read more 

Adding Maternal Health to the FHLI Portfolio 

Last year we launched the Maternal and Child Health Equity Action Network (MCHEAN) following our comprehensive landscape report, “Progress and Opportunities: Maternal and Child Health Equity in North Carolina.” 

Through this work, we can collaborate with mothers, birthing professionals, and advocates to map out a better future for maternal and child health. This area deserves special focus in North Carolina. According to the latest March of Dimes report card, we are among the worst states in the country for preterm births, with significant racial and economic disparities across the state. This issue is at the forefront of our minds, and we have incorporated a maternal and child health focus into our work in Bertie County and our Roadmap to Innovation, one of FHLI’s newest programs. 

Read more 

Medicaid Expansion 

Medicaid Expansion in North Carolina is a hard-won victory for public health, health care professionals, and everyone in our state. Advocates have been working to make this a reality since 2010 when the Affordable Care Act was passed.  

Expansion finally took effect statewide on December 1st, 2023, and is expected to provide over 600,000 people in the health care coverage gap, including veterans, frontline workers, small business owners, parents, and many more, with access to health insurance. This includes residents with incomes too high to qualify for Medicaid but too low to receive health care subsidies through the Affordable Care Act marketplace.   

Read more 

This comprehensive health coverage includes dental, behavioral health, and vision care. 

All of us at FHLI are thrilled to see this important step forward for North Carolina take effect, but we will also continue working hard to improve health access and equity for all North Carolinians.  

Specifically, we are focusing our energy on steps to move North Carolina closer toward truly healthy communities. In the new year, we will be developing a 2025-2026 policy advocacy agenda, among other efforts to improve access and equity in care for all North Carolinians.  

Read more 

National Rural Health Association (NRHA) Rural Health Policy Institute 

Early in 2023, we brought our collective voice to Capitol Hill, joining the NRHA for its 34th annual Rural Health Policy Institute.  

The Rural Health Policy Institute is an opportunity for rural health leaders across the country to bring community stories to Capitol Hill, guiding the future of rural health policy with NRHA leadership and advocating for important issues with new and returning members of Congress and the presidential administration.  

Read more 

2023 Legislative Breakfast 

Last April, the North Carolina Rural Health Association (NCRHA) and North Carolina Oral Health Collaborative (NCOHC) co-hosted this year’s legislative breakfast. At the event, we presented health care leadership awards to Representative Donna McDowell White (NC House District 26), Senator Jim Burgin (NC Senate District 12), Senator Jim Perry (NC Senate District 2), Dr. Amanda Stroud (Dental Director, AppHealthCare), and Michelle Fortune (CEO, St. Luke’s Hospital).  

Read more 

During the event, Fortune and Stroud both shared deeply personal stories about their experiences with health and health care in North Carolina.  

When Fortune’s father began experiencing chest pain, he was taken to St. Luke’s, his daughter’s hospital. He was cleared and almost sent home before a doctor took time, paid attention, and discovered he was having a heart attack. 

St. Luke’s didn’t have a cardiologist at the time. The only solution to a condition that kills nearly 19,000 North Carolinians each year was to load Fortune’s father into a helicopter and fly him to a different hospital equipped to treat heart disease. 

St. Luke’s has a cardiologist now, thanks to a sustained increase in funding. Fortune and her father’s story is all too common for people across North Carolina, however, and too many rural hospitals struggle and are unable to provide vital life-saving services. 

Stroud also spoke to attendees about her motivation to work as a public health dentist in rural North Carolina. 

Stroud grew up on food stamps, with parents who worked long hours in grueling jobs to make ends meet. She didn’t see her first dentist until a school-based program came to her school. Today, she provides that same school-based care to children in Ashe, Alleghany, and Watauga Counties. 

Stroud choked up as she talked about the safety net, how it saved her life, and how hard it can be to continue her life-saving work faced with limited funding and staffing shortages. 

“Where I’m from, dentures are the norm,” said Stroud. “We need to make dentists the norm.” 

Read more 

All Aboard the Momnibus! 

The signs said it all. “Black Maternal Health is Nonpartisan.”  

This was the message advocates, providers, and parents took to the legislature for Black Maternal Health Day of Action on April 19, 2023.   

We joined advocates, mothers, and providers from across the state to meet with elected officials and discuss the importance of policy action to reduce racial disparities in maternal health across North Carolina.   

Read more 

Thought leadership: 2023 Rural Health Snapshot and Maternal Health Landscape Report 

In 2023 we published another annual edition of the North Carolina Rural Health Association’s (NCRHA) Rural Health Snapshot. FHLI staff unveiled the 2023 report at our legislative breakfast and distributed copies to legislators working to improve rural health in our state.  

Our other report published in 2023, a Maternal and Child Health Equity landscape report, earned a prominent feature at the 2023 Black Maternal Health Day of Action at the North Carolina General Assembly. 

The Project ECHO Network in North Carolina (PEN-NC) 

Early in 2023, we launched a new program in partnership with the North Carolina Area Health Education Centers (NC AHEC). Leveraging NC AHEC’s technical assistance expertise alongside FHLI’s legacy of incubating innovative programs, PEN-NC will serve as the first statewide network of ECHO™ projects. 

The ECHO™ Model, originally developed out of the University of New Mexico, is a framework for virtual learning communities where peers can share support, guidance, and feedback.  

Read more 

Oral Health Day 2023 

Bright spots, pressing issues, and goals moving forward for oral health in North Carolina were on full display during Oral Health Day last June. The theme for this year’s event was, “Challenges and Opportunities for the Dental Team.” Keynote speaker Kathy Colville and the other panelists brought expertise and ideas for how North Carolina can become a healthier, more equitable state. 

Read more 

The 2023 Bernstein Event 

Thank you to all who joined us for this year’s Bernstein Event, for your generous contributions, and for your continued support of Jim Bernstein’s legacy! This year we recognized Dr. Skip Cummings and the Greensboro Health Disparities Collaborative for exceptional leadership improving access and equity in health care, and we presented our first-ever posthumous award to the late Dr. Jim Jones.  

Last year was a big year for North Carolina. After a decade of action and advocacy, as of this past December, Medicaid Expansion is finally in effect. This is no small accomplishment, even though it is just one step on the road toward truly healthy and equitable communities. Looking ahead, this policy victory will continue to play a major role as those of us at FHLI continue to act, change systems, and improve health.  

2023 was also a big year for FHLI. As we kick off the new year, we’re reflecting on everything we were able to accomplish alongside partner organizations and communities across our state. Read on for highlights from 2023 and look forward to what we have planned for 2024. 

During the 50th-anniversary celebration of the NC Office of Rural Health held on November 16th, 2023, National Rural Health Day, we had the privilege to announce that the Bertie County Behavioral Health Network received a $300,000 grant from the Merck Office of Social Business Innovation and Merck Foundation. Our partners at the Bertie County Council on Aging – Senior Center accepted it on behalf of the Network. 

The goal of the Network is to build health infrastructure in Bertie through community engagement and implement projects focused on reducing stigma about mental health and substance use, providing telebehavioral health services to youth in Bertie County Schools, and developing the local behavioral health workforce. 

This funding will help continue the collaborative work that two FHLI programs, the Center of Excellence for Integrated Care (COE) and Community Voice, have been doing with our partners over the past year and a half to develop community-driven solutions that address the health needs of residents across the county.  

Learn more about the many Network projects and initiatives this funding will help sustain in Bertie County. 

What Is the Bertie County Integrated Behavioral Health Network? 

Bertie is a rural county in eastern North Carolina. Communities throughout the county have consistently faced challenges related to health outcomes, especially regarding mental health and substance use, due to long-standing health access and equity issues.  

There is also a strong spirit of community across the county, along with a shared desire to address these challenges. The goal of the Bertie County Behavioral Health Network is to bring local organizations, providers, and residents together to drive community-based solutions. FHLI acts as the facilitator for the Network. 

Network partners include over 30 local and regional organizations including A Better Chance A Better Community, Access East, East Carolina University, Albemarle Regional Health Services, Greater Wynns Grove Baptist Church, FHLI, and many more. 

What Will the $300,000 Merck Grant Help Fund? 

The three goals of the Network are to:  

  1. Improve access to health care across the county. 
  2. Expand capacity and services for youth and families to address unmet health needs.
  3. Enhance outcomes by reducing stigma in the community regarding behavioral health and improving health prevention awareness.

Better Access to Health Care for All Bertie County Community Members

One of the major barriers to accessing health care throughout the county is lack of provider availability. The Network is especially focused on increasing the behavioral health workforce in Bertie and establishing career pathways for local youth to work in the behavioral health field. 

Greater Capacity and Services for Youth and Families to Help Address Unmet Health Needs

The Network is expanding access to youth services by integrating telehealth services in schools, including telebehavioral health. Additionally, there is a concerted effort to expand family-based services in the community as well as to engage community members in parenting classes at the local health department and other community organizations.ngage community members in parenting classes at the local health department and other community organizations. 

Improve Health Outcomes Via “Stop the Stigma” and Other Health Awareness Campaigns

Another significant barrier to accessing behavioral health care is stigma and lack of information about mental and behavioral health needs. The Network will continue its “Stop the Stigma” campaign for behavioral health as well as raise awareness and help drive community engagement through Mental Health First Aid training

To improve the community’s availability and awareness of overdose prevention resources, the Network will provide training on both harm reduction and administering Naloxone, a life-saving medication that can reverse an overdose from opioids. 

Additionally, the Network will continue promoting diabetes education and treatment, and 

cardiovascular disease prevention awareness campaigns and host educational events for both. 

What Is Behavioral Health? 

Behavioral health helps people address mental health and substance use disorders as well as lifestyle challenges, stress, crisis situations, and more. Behavioral health integration refers to primary and specialty care teams collaborating with behavioral health clinicians to provide whole-person care and improve health outcomes for the people they serve.  

Depending on the context, mental and behavioral health are sometimes used interchangeably, as the language continues to develop. In general, though, behavioral health is seen as a more all-encompassing term that includes the full spectrum of health and wellness. 

Why Is Integrated Care Important? 

Integrated health care is based on extensive collaboration and communication among health professionals. It benefits patients, caregivers, providers, and the whole health care system. Information-sharing enables providers to better develop and follow through with comprehensive treatment plans that address the full scope of people’s needs and support their whole health. 

Integrated care teams often include physicians, nurses, mental health providers, behavioral health specialists, and other health professionals. This approach has been shown to improve health outcomes, quality of care, and access to services as well as to low overall costs. 

Stay Connected & Support Community-Driven Solutions 

Integrated care, community-driven solutions, and systems-level policy changes are key to creating more accessible and equitable health care in Bertie County and across the state. Stay engaged and informed by following us on LinkedIn and signing up for North Carolina public health news updates

Bertie County Behavioral Health Network Members 
A Better Chance A Better Community 
Access East
Albemarle Alliance for Children and Families
Albemarle Regional Health Services
Alliance for a Healthier Generation
Bertie County Cooperative Extension 
Bertie County Council on Aging – Senior Center
Bertie County Schools
Bertie County Sheriff’s Office
Bertie County YMCA
Bertie Rural Health Association
Blue Cross and Blue Shield of NC
CareNet Counseling
East Carolina University Brody School of Medicine
Eastern Area Health Education Center
ECU Health Bertie Hospital
ECU Health Chowan Hospital
Eustress – The Good Stress Company
Family Support Network of Eastern North Carolina
Galileo Health
Greater Wynns Grove Baptist Church
Mid-East Commission
NC Agromedicine Institute
NC Farm and Ranch Stress Assistance Network
NC Office of Rural Health
Pittman’s Pharmacy
Retired Governmental Employees Association
Roanoke Chowan Community Health Center
Roanoke Chowan Community College
Trillium Health Resources