What does it take to strengthen the systems people rely on in southeastern NC?

Health is often talked about as a matter of personal choice. But the truth is, our well-being is shaped by much more than individual decisions — it depends on what resources are nearby, which institutions are supported, and what kinds of help people can count on close to home.

This week, producer Rend Smith talks with Les High, a third-generation journalist, founder of the nonprofit newsroom Border Belt Independent, and a volunteer first responder from Columbus County. They talk about what Columbus County is getting right, where support is still lacking, and what strong local systems can mean for public health in rural southeastern North Carolina.

Producer: Rend Smith

Host: Layna Hong  

Guests:

Les High, publisher and founder of the Border Belt Independent

Transcript

SPEAKER_00 0:00

Health is often talked about as individual choices. We decide to eat fruits and vegetables, go to the gym, or abstain from smoking or drinking. But our everyday decisions are shaped by so many other factors. Ones that are often bigger than just us. It's about what we have access to, what institutions are funded, and the kinds of support that exists close to home. I'm Lena Hong. Welcome to Rural Narratives. This week's episode is an interview between our producer, Ren Smith, and Les High. Les is the founder and publisher of The Border Belt Independent. It's a nonprofit newsroom that was started in 2021. They do long-term coverage of issues impacting rural southeastern North Carolina. The issues are personal to Les, who was born and raised in Columbus County. And he's not just a journalist. He's also a local volunteer EMT. In the first half of the episode, they talk about what Les has seen and experienced in all of his roles. And then they'll talk about how public health is viewed in Columbus County and the challenges faced by both residents and institutions. This interview session was held virtually. You'll hear some background noises throughout the episode.

SPEAKER_01 1:28

The first question is what kind of stories do you tell about your community?

SPEAKER_02 1:32

So I am the publisher of the Border Belt Independent. We are a free online news site that uh covers Columbus, Bladen, Robson, and Scotland counties, four very rural, very poor counties in the southeastern corner of the state. We have a staff of three, and uh we focus on issues such as health, mental health, adverse childhood experiences, as well as others like politics, uh, the environment, the economy, all issues that um that affect rural areas. And our our goal is to is to have an impact on those issues, to tell stories that that would have an impact on people's lives. And they'll use those to augment their coverage because those newspapers are still very important. We don't particularly go to meetings and that type of thing. We cover issues. And so I could see that that was a need that needed filling. And so um, we are looking to provide some analysis in in those stories and to dig deeper than we normally would. Even back in the day when newspapers were really strong, we didn't do as much in-depth reporting as we're doing with the Boardville Independent.

SPEAKER_01 3:04

What are people likely to misunderstand about the region that you cover?

SPEAKER_02 3:08

I think one thing that's true about North Carolina is there's this growing rural-urban divide. I graduated in 1980 from Whiteham High School and came back home to my family business, as did uh most of my friends. But then with uh Walmart and the disruption that happened in small retailers, where a lot of uh people came back to work after school, and certainly that was before Amazon, but all these disruptions have really created a disconnect between rural and urban North Carolina because those people my age left. Uh they are now living in Raleigh, Charlotte, Wilmington, much larger places. And then you've got North Carolina's growing so rapidly, people moving into those areas from out of state just don't understand the issues that we face. And a lot of it deals with funding. For example, our schools, by by any measure, uh don't get the funding that they do in urban areas. We get a dollar amount per student, but our county can't provide the stipends that the urban counties can't provide for the best teachers to come. And uh, it's just not even close. If you look at the four counties that we cover, Columbus County notably, they're the bottom tenth percentile of health outcomes. And that's often a reflection of more poverty.

SPEAKER_01 4:26

In the communities you work with, what does it mean to be healthy or unhealthy?

SPEAKER_02 4:31

I think people have a pretty good understanding of what it's like to be healthy or unhealthy. They they just don't have the means to get healthy. So let me tell you what I think that means. I I think people don't eat healthy meals, they eat snacky foods because that's just what they can get. Uh, they can get their hands on potato chips and and mountain dews and and moon pies. That's just, well, part of it's cultural, right? That's just kind of what you you eat growing up in in the south. But to go out to get a Mediterranean meal, for example, uh for that type of diet, it's just not here, it's not available at all. In terms of exercise, we just don't have the facilities that there's no pool. The Board of Independent had a really good story about a very difficult topic. There is not a public pool in Columbus County, and it's and we tried really hard to partner with the YMCA, Wilmington, and whatnot, and it financially just doesn't work out. So anything from swimming to just getting exercise to have low-cost gyms available, all of that's just not something we have good access to.

SPEAKER_01 5:34

What do you believe is ultimately the controlling factor in people's health in Columbus County?

SPEAKER_02 5:40

In addition to diet and and exercise, I think the fact that we have a lot of poverty here often leads to drug abuse, which would include alcohol, smoking, vaping is an awful problem here. So I don't know to what degree they they think about it. To some degree, all these problems just kind of land on them because of where where we grow up, it's just pervasive. And when your height's pretty difficult, those are often the things you turn to to try to make your life a little better, and of course it doesn't. And then you just get down that road and it's hard to make that U-turn. Yeah, I've lived here my entire life. I've been a volunteer with the Whiteful Rescue Unit, which is our volunteer rescue squad in Whiteful. We provide primary EMS and rescue services. I've been a member for 43 years. I started when I was 19. And I've 30 years of that is spent as an EMT or advanced EMT on an ambulance. So I've had a chance to literally be in the community, in people's homes, on the highways, and to see just how difficult health care, access to healthy lifestyles, and just the results of all the things that compile to create all these bad health outcomes. And that and it could be violence where we have stabbings or shootings, or we just have heart problems, a lot of diabetes, a lot of seizures, a lot of mental health crisis. So, Ren, when I first joined the squad, we would get a mental health crisis call maybe once a month. We're going to two, three, maybe four a day now.

SPEAKER_01 7:09

In Columbus County and others that you work with, what beliefs do you think have passed down over time about health?

SPEAKER_02 7:15

Smoking was always uh pervasive in Columbus County. We're, if not the top tobacco producing county in the state, definitely top five to top ten. So everybody smoked. Eventually through the schools and and other means, people learned that um that the smoking was was bad for you. It was pretty obvious when members of your family died of lung cancer or or had hypertension and all those things associated with with smoking and heart disease. Unfortunately, though, you're seeing that vaping and then some other unhealthy habits are taking the place of smoking. It seems like folks will find some type of vice to fill that void. And again, I think a lot of that is associated just it's generational, but at the same time, a lot of that's just fueled by poverty.

SPEAKER_00 8:05

You're listening to a conversation between our producer Ren Smith and Les High. He's the publisher of The Border Belt Independent. They cover rural southeastern North Carolina, where Les was born and raised. Coming up, Les explains why strong public health institutions in Columbus County still struggle, even with trusted local leadership.

SPEAKER_01 8:30

Uh, so when you hear that phrase, governmental public health, what comes to mind first?

SPEAKER_02 8:36

We have an outstanding public health department here, and that's because we've had really strong leadership. I'm talking about folks who who didn't stay for five or ten years and then moved on. They were, I think, all of our health directors that I remember were all born and raised here and came up through the system. So they really know the county and they really care about the people that they serve. So the health department here is really an outstanding health department. The problem is funding, right? So it goes back to the same issues that face the schools, just the urban rural divide, just so much better funding for public health in urban counties. Our health department building has to be 75 years old. They're trying to get a new facility, but it's just been a struggle for years. So it's old. I mean, it's it's sanction. So uh just that has been a big struggle to get up, to even get in a healthy building. But considering the obstacles that that they face, again, a lot of those folks who work there, the nurses, the technicians, the directors who provide strong, such strong leadership are all local folks who who care and understand the roadmap and understand the challenges. You mentioned how much success the local health department has had. What do you think makes them work? I think the fact that these messages are delivered by local people. This isn't some PIO from FEMA coming down and telling them what they need to know about hurricane resiliency or someone from the state who might have a symposium and then they're gone. It's more of a um photo op. We do look after each other. And uh to have all of these local people involved with media, with the health department, with the hospital is critical.

SPEAKER_01 10:17

What kind of health experiences do people tend not to talk about?

SPEAKER_02 10:22

Well, drug misuse and the mental health challenges that we have, the adverse childhood experiences that are often related to drug misuse and poverty, those are the things that people don't talk a lot about. And that's why the Board Belt Independent was created, is to talk about those subjects.

SPEAKER_01 10:41

Do the major challenges faced by the community feel like isolated problems or part of a larger story?

SPEAKER_02 10:50

That is a great question. It's really hard to say that that the health challenges that we face are isolated. We all face the same challenges of an education system that's that's underfunded, public health that's underfunded. And you don't have any real pockets of wealth here either. So it's not like you've got you know one city up on the hill that kind of leads to everything. Life was 5,000 people when I was born, it's probably 5,300 now. So there's just not a lot of growth. One thing that may change is we are beginning to see uh some inflow of population from Ori County, which is Myrtle Beach, and you're gonna see more from Brunswick County and you had ever county because they've just they've just run out of room. So it'll be really interesting to see how that affects public health. And notably, are we talking about retirees? Are we talking about working people? So that I think in a large degree will affect the quality of health care because my my guess is they're they're gonna expect better.

SPEAKER_01 11:51

And do people in the community feel as though change is more likely now?

SPEAKER_02 11:55

Well, that change is is gonna be hard. Again, you've got people moving in from particularly up north to retire, or people who are just looking for affordable housing. So that whole demographic is going to change because we've been so rural and really so open. We're the third largest county in the state in terms of land. We're 954 square miles. It's a huge county. So a lot of it's green, a lot of it is uh farm and field and and trees. And so people have enjoyed their open spaces to hunt and fish and that that type of thing. And so when you see, and we we have these on the books, we're gonna have 2,000 homes eventually over a five or 10-year period come into one development in southern Columbus County. And it's gonna be really interesting to see how that changed in demographic, how that affects the overall health of this county and other issues like education and you know, services that that matter to people.

SPEAKER_01 12:52

What do you think public health leaders should better understand about this community?

SPEAKER_02 12:57

I think our local health leaders from the hospital to the health department have a really good understanding of what our challenges are. It's just conveying that message to folks and to change these generational measures of things like smoking and alcohol misuse and drug misuse and bad diets. It's just that is so hard to change. And that's been proven to be the case because again, I was born in 1961. And I'd say some of those health measures have have improved, like smoking, but but when something takes their place, you know, uh particularly as um you have this divide of the the wealthy and then the the poor, and the poor just don't seem to get over that hump. It's just really hard. That change is so difficult. They've got so many obstacles to overcome. And then you've got cuts like to our food programs. Uh you're seeing in in the Trump administration, just this evisceration of support programs, anywhere from food again to education. We're just beginning to see the impact of that. And I think part of that impact is turning more to drugs and and just all the negative things that happen when people don't have the support. And it's easy to be in in Washington and and rule from the ivory tower and to not be the impact that we see here on a daily basis.

SPEAKER_01 14:16

If people remember one thing from this interview, what should it be?

SPEAKER_02 14:20

It's that A, it's really hard to break this generational hold that you have on poor eating habits and alcohol use and bathing and smoking. Those things are just really, really difficult to change, preconceived notions about vaccinations and how those are really harbored over generations. But at the same token, you've got, you see, the investment we have in public health and our health department and our our public hospital. What they do get, they really do wonders with, especially because they are the leadership is local and the people who work there are local. They understand these matters. And you're seeing folks like Kate Burentals Charitable Trust, which have funded the Border Belt Independent, to try to get reliable news out there. You know, there are some measurable changes that have been made, but it's just not enough, particularly when you take the rural urban divide in North Carolina and see what the haves have and what the have nots don't have. I think that divide is what really needs to be addressed any number of levels, federally, state level, and local schools, public health, all that just doesn't have the funding that's needed. And really you need more funding because you're you're you're at a much lower benchmark to try to get your head above water.

SPEAKER_00 15:34

This was an interview between our producer Ren Smith and Les High, the producer and founder of the Border Belt Independent. I'm your host, Lena Hong. Thanks for listening to this week's episode of Rule Narratives.