Community Context

Granville County is located north-northeast of Raleigh, Durham, and Chapel Hill and is bordered to the north by Virginia. It is often considered two counties—a more rural section to the north and a more-developed southern section. The county has been growing as a “bedroom community” for the Triangle, which is home to many of the state’s largest universities, health systems, and research organizations. 

Though there is a history of agriculture in the county, including tobacco farming, employment is now primarily driven by healthcare, manufacturing, and local government. As the county grows, infrastructure challenges related to transportation, water quality, and stormwater management have been increasing. The county leans Republican, though some towns such as Oxford tend to lean more Democratic.

Granville County residents are predominantly White, but there are substantial Black and small Latino populations. People of color and those with low incomes in the county disproportionately experience health-related challenges. 

Access to healthcare along with mental health and substance use challenges have consistently been top health priorities, particularly as the opioid epidemic continues to impact the community. A focus on nutrition and physical activity has broadened in recent years to include many different aspects of youth well-being, including social and emotional health and an emerging emphasis on adverse childhood experiences. 

The county was seen as a COVID-19 hotspot early in the pandemic driven by outbreaks in institutions.

Granville County’s Journey to Promote Health, Well-Being, and Equity

Granville County’s efforts are led by its local health department and independent health system, but also involves municipal and county governments, educational institutions, nearby anchor institutions, and a small philanthropic and nonprofit sector.

Stakeholders in Granville County were working on several initiatives to support well-being of community residents in 2017, including the work of an influential collaborative for health; expansions of greenways and trail networks in the community; and efforts to support youth development, many of which have grown over the past five years. Newer efforts have been initiated to consider the role of systems and tackle growing health concerns, such as the opioid epidemic. A strong commitment to improving health and nutrition in schools and creating opportunities for physical activity has diffused throughout Granville County over the past five years, and efforts to address mental health and substance use have gained traction. There have been limited attempts to address health equity in Granville County, as discussions of race have been met with resistance and the structural determinants of health and equity are not often recognized, though over the past five years, partners have ramped up work to identify barriers to accessing health promoting resources.

Baseline research started in 2016 to track community programs and initiatives. The most recent report, from 2022, provides more in-depth insights and analysis into the community's efforts to build a Culture of Health.

Lessons Learned: Where is Granville County Five Years Later?

Granville County’s journey to promote health, well-being, and equity is one that illustrates the importance of dedicated leadership and collaboration for creating a shared value around health. Progress has happened slowly, but measurably, as cross-sector partners remain committed to working together and finding new ways to address both long-standing and emerging community needs. 

Other communities can learn from Granville County’s approaches to building and sustaining coalitions, as well as the challenges they encountered, to inform their own journeys. And, as COVID-19 recovery continues, with historic funding flowing to local communities, future research could consider the ways in which momentum around health, equity, and well-being influences community health narratives and decisions moving forward.

Granville County has leveraged personal relationships, a strong sense of local culture, and enthusiasm from leadership in diverse sectors to make progress toward health and well-being. However, the county is challenged to navigate population transitions, collaborate efficiently, and redirect effort toward reforming systems rather than implementing individual interventions.


  • Collaboration rooted in personal relationships and trust 

  • Preserving rurality: open space, local food systems, community connections

  • Proximity to the Research Triangle: economic development and capacity for health


  • Population transitions

  • Overlapping coalitions tapping the same community leaders and resources 

  • Health viewed as an individual responsibility

  • Inadequate infrastructure and chronic underfunding