During a June 2021 seminar to spread awareness about nationwide and local reparations efforts, Dr. Dwight Mullen introduced his data on wellness in Buncombe County’s Black community by hearkening back to the Asheville Colored Hospital.

In 1943, the hospital opened its doors to Black patients who had long been denied care at white-only hospitals. The facility included delivery, emergency and operating rooms, and was staffed by Black nurses and physicians who served the community until the hospital merged with Mission Hospital in 1951.

Today, the site is a parking lot for Green Man Brewery.

Such historical displacements, Mullen suggested, are emblematic of “the personalization of urban renewal” and a root cause of health disparities in the local Black population. “Maybe one reason [for the disparities] is that only 1.9% of physicians in Buncombe County are Black,” said Mullen, former chair of the Asheville-Buncombe County Community Reparations Commission (CRC), who noted that 6% of Buncombe’s residents are Black.

The CRC was tasked with developing short- and long-term recommendations for investing nearly $4 million in reparations funds allocated by the city of Asheville and Buncombe County in 2020. The commission officially dissolved last October after issuing 39 recommendations and completing a final report, which included a comprehensive audit documenting historical harms, supporting data and firsthand accounts from Black community members.

Nine of the commission’s recommendations are focused on improving health and wellness disparities.

During the 2021 seminar, Mullen noted that addressing such disparities involves more than expanding access — it also requires access to providers within one’s own community, including Black health care professionals. Mullen explained that when patients cannot find Black doctors, nurses or allied health professionals, many are reluctant to seek care.

“They don’t want to go talk to the white folk about the most personal of personals; and it’s not because they don’t like white folk, it’s because they have a history,” Mullen said. “People remember, this is the South,” he added, noting that it wasn’t until the 1970s that involuntary sterilizations, which often targeted people of color, ended in Buncombe County.

A key long-term recommendation of the CRC is to establish more Black health professionals in the local community. The recommendations were determined after a CRC Health and Wellness research team analyzed more than 75 documents, including Buncombe County’s Community Health Assessment and Community Health Implementation Plan, and identified three health priorities: birth outcomes/infant mortality, mental health and substance misuse, and chronic health conditions (heart disease and diabetes).

Zooming in, the CRC found that those health challenges are exacerbated in marginalized communities.

From 2015-19, for example, the Black infant mortality rate in Buncombe was 7.4 per 1,000 live births compared with white infants at 5.2 per 1,000. And during the same period, diabetes mortality rates for Black men were nearly seven times higher than rates for the white population combined. Buncombe’s disaggregated heart disease mortality rates for the period reflected that Black men had almost double the death rate compared with the white population combined as well.

Those statistics are pulled from the CRC’s Cease Harm Comprehensive Audit, which informed the commission’s recommendations and identified “how local government policies and practices have caused and continue to cause harm to Black and African American residents in Asheville and Buncombe County.”

Statistics beyond the doctor’s office also factored into the recommendations, notably food access in the Black community and Parks and Recreation health-related programming.

City and county staff are now involved in an initial review of the legal authority and jurisdiction they have to consider and implement the recommendations. (Last September, after the CRC briefed Buncombe County Commissioners on the recommendations, the U.S. Department of Justice issued a letter calling some of them into legal question. “After our initial review, we are deeply concerned that many of the recommendations, if implemented, could violate federal civil rights laws,” it said.) The legal review is expected to be completed in early 2026, in time for the next budget-planning process.

Here is a look at the nine Health and Wellness recommendations presented by the CRC in its final report.

1. Establish Health Care Subsidy Fund to provide comprehensive multigenerational direct primary care access.

The proposed fund would provide financial assistance to lower the cost of health insurance. This recommendation aims to align local efforts with state and federal programs that support preventive health care, aging with dignity and the elderly — particularly within Black communities and other historically marginalized groups in Buncombe County.

The recommendation calls on the county to support state efforts like former N.C. Gov. Roy Cooper’s “All Ages, All Stages NC: A Roadmap for Aging and Living Well” strategic vision; federal programs like Medicaid; and local programs like the Age-Friendly Buncombe County initiative. It also suggests ways to expand and personalize aging support services, like creating a training program for how to take care of the elderly.

2. Recruit, retain, and provide systemic support for African American health professionals of all disciplines to improve health outcomes.

This recommendation aims to increase the presence, retention and visibility of Black health care providers in Asheville and Buncombe County through a multilevel strategy that engages local, state and federal partners.

3. Meet the holistic health needs of African American elders to support their ability to age in place as long as possible with comprehensive community support.

This recommendation suggests supporting state efforts like former Gov. Cooper’s strategic plan, federal programs like Medicaid and local programs like the Age-Friendly Buncombe County initiative for multigenerational direct primary care access.

4. Establish a Resiliency Sabbatical Fund to address toxic stress, trauma and chronic illnesses for individuals and families.

This recommendation proposes expanding access to Black primary care physicians through the Direct Primary Care model in Asheville and Buncombe County. This approach prioritizes preventive care, patient trust and long-term wellness by eliminating traditional insurance barriers and fostering strong provider-patient relationships.

5. Develop and fund an Asheville Black Mental Health Network to systematically address toxic stress and trauma.

This recommendation proposes the creation of a community-led Asheville Black Mental Health Network. The network would serve as a centralized grassroots initiative aimed at improving access, coordination, education and advocacy related to Black mental health care across the local, state and federal levels. Locally, this would look like coordination with Black therapists and mental health specialists, and working with existing nonprofits such as A Therapist Like Me. Similar partnerships would be sought at a state and federal level.

6. Establish a Black Joy Fund to create multidimensional, joy-filled experiences and spaces that cultivate a healthy community.

This recommendation builds on existing local initiatives that preserve and honor Black history, such as the African American Experiences in the Smokies Project. It also endorses the restoration of historically Black spaces, celebrating cultural resilience and advancing reparative justice through community-centered programming and policy change. In addition, it calls for larger-scale reparations funded at the state and federal levels.

7. Hold institutions accountable to address harms and create policies that are restorative.

The goal of this recommendation is to establish formal policies and practices that train staff, administrators and service providers on how to prevent and reduce harm and disparities. The recommendation promotes partnerships formed with organizations such as the WNC Health Policy Initiative to elevate work spaces.

8. Create an environmental justice plan to correct past and ongoing environmental injustices and set standards to prevent the confusion of environmental racism.

This recommendation calls for a commitment to advance energy justice by ensuring equitable access to energy-efficient housing, sustainable transportation and clean energy infrastructure for all residents — particularly Black and historically marginalized communities. Locally, this looks like educating community members about environmental racism, its historical roots and its current impacts on low-income and Black communities — such as disproportionate exposure to pollution, lack of access to green spaces and inadequate infrastructure. To support these goals, the CRC urges, Asheville and Buncombe County should actively pursue environmental justice funding opportunities and secure matching funds from public and private sources.

9. Create Black healing and birthing centers to reduce and remedy harms against Black birthing people and infants.

This recommendation focuses on increasing access to community-based doulas in Buncombe County as a strategy to improve maternal and infant health outcomes, particularly among African American families. An important step in this plan is the identification and designation of public sites throughout Buncombe where doulas can be stationed or embedded. These locations — such as community centers, clinics or public health facilities — would serve as accessible hubs for providing prenatal, birthing and postpartum support services. It also recommends aligning with state and federal partnerships that support maternal services.

To read the recommendations in full, visit avl.mx/fbt.