Establish Health Enterprise Zones in chronically underserved urban and rural areas to address severe health disparities.  

Health Enterprise Zones (HEZ) were pioneered by Maryland as a locally driven approach to concentrate resources in areas with severe health disparities, high rates of chronic illness, and steep health care access barriers. HEZs mix direct investment with tax credits to achieve measurable results in: increasing direct access to medical care; improving care quality; increasing the ability of patients to self-manage chronic disease; and implementing community-wide interventions such as inclusive playgrounds, greenways, farmer’s markets and mobile food vans. Health Enterprise Zones tend to enjoy bipartisan support as a way to both spark private investment and drive reductions in health care costs and disparities.1 

In Maryland, communities competed for the HEZ designation by forming community partnerships and filing joint applications. The application process requires coalition building and cooperation among diverse stakeholders. In developing proposals, local areas should hold public hearings and make local data available to partner organizations.

North Carolina has natural advantages in implementing Health Enterprise Zones. Many urban areas have well capitalized health systems, strong public health departments and proactive local governments that can help drive the process in the state’s largest cities. In many rural communities, regional approaches to development and health service delivery are strong. There also is great potential for enlisting support from private foundations to enhance public investment. In rural areas, the Kate B. Reynolds Charitable Trust is investing $100 million over 10 years in specific underserved counties to improve the built environment and establish programs that look like Health Enterprise Zones. Other funders such as the NC Public Health Foundation and Golden LEAF are assisting in this effort.

The state should build on these efforts by establishing an HEZ initiative to provide centralized support and funding for additional HEZ locations. North Carolina’s HEZs can become a laboratory for community health, testing projects that have the ability to scale and translate to other cities and counties.


1 Sharfstein, Joshua M. (August 7 2013). “Behind the Curtain of Maryland’s Health Enterprise Zone Initiative.”