COMMUNITY RESULTS STATEMENT

Buncombe County’s mission statement outlines the desired health and wellness result for the community. “Buncombe County is a caring community in harmony with its environment where residents succeed, thrive, and realize their potential” (Buncombe County, 2025b).

LEADERSHIP & PARTNERSHIP FOR THE COMMUNITY HEALTH ASSESSMENT PROCESS

The NC General Assembly requires that local public health departments conduct community health assessments every 3-4 years. The 2024 Buncombe County CHA is a collaborative process conducted in partnership with multiple community organizations through the Community Health Improvement Plan (CHIP) Advisory Council. The CHIP Leadership & Data Team provides guidance and recommendations to the council and BCHHS for development, implementation, and evaluation of the CHIP for equitable population health outcomes.

REGIONAL SUPPORT

Our county participates in WNC Healthy Impact. This partnership brings together hospitals, public health agencies, and key regional partners in western North Carolina to improve community health. We work together locally and regionally to assess health needs, develop plans, take action, and evaluate our progress. This regional effort is coordinated by WNC Health Network, a non-profit that exists to support people and organizations to improve community health and well-being across western North Carolina. Learn more at www.WNCHN.org.

THEORETICAL FRAMEWORK/MODEL

WNC Health Network supports local hospitals and public health agencies working on complex community health issues. Community Health Assessment and Improvement processes include the use of Results-Based Accountability™ (RBA). RBA is a practical approach that focuses on achieving real improvements for people, agencies, and communities. The framework relies on both primary (story and number data) and secondary data to provide a comprehensive understanding of community health.

COLLABORATIVE PROCESS SUMMARY

Buncombe County’s collaborative process is supported regionally by WNC Healthy Impact. Additionally, Buncombe County CHIP Leadership members were participants in the WNC Data Workgroup (hosted by WNC Healthy Impact) to determine updates to the overall WNC Regional Community Health Assessment survey and process, as well as choosing Buncombe County’s three local survey questions and identifying Online Key Informant Survey format and distribution lists.

The CHIP Advisory Council reviewed primary and secondary data in both aggregated and disaggregated form to compare health outcomes across multiple demographics, such as race, gender, ethnicity, and sexual orientation within the community. The CHIP Leadership and Data Team then analyzed all health data to narrow down to a ‘short list’ of health focus areas for prioritization. The CHIP Advisory Council then utilized the ‘short list’ to conduct two rounds of prioritization exercises to arrive at three health focus areas for the 2024-2026 Community Health Assessment and Community Health Improvement Plan cycle.

Phase 1 officially began in January 2024 with collecting health data. See Chapter 1, Community Health Assessment Process, for further details.

KEY FINDINGS

Population (United States Census Bureau, 2024)

Population Health Overview

In 2023, Buncombe County's health ranking fell to 21 out of 100 NC counties for healthiest outcomes including quality and length of life and other health factors (County Health Rankings and Roadmaps, 2025). Buncombe County still fares better than most counties in North Carolina, as well as in the nation. For Buncombe County, health factors that could improve the quality of life for residents include addressing adult smoking, obesity, and the number of uninsured residents.

While Buncombe County is identified as metropolitan, demographic data reflects that roughly 22% of Buncombe County households are located in rural areas of the county, and broadband access continues to lag behind the state and the nation (County Health Rankings and Roadmaps, 2025). The ratio of primary care physicians and mental health providers to Buncombe County’s population continues to be much lower compared to the state and nation, but the percentage of Buncombe County residents who are uninsured is still higher (13%) than the state (11%) and the nation (10%) (County Rankings and Roadmaps, 2025).

Housing problems continue to negatively impact the health of the county, with overcrowding, high housing costs, lack of affordable housing, and unreliable access to basic utilities being identified as significant barriers. The realistic living wage for Buncombe County is identified as $47.74, which is slightly higher than the state (County Rankings and Roadmaps, 2025a).

Community key informants were asked to identify and rank the top health conditions for Buncombe County, which aligns closely with the most recent available data.

Buncombe County continues to see an increased rate for suicide deaths compared to the state and the nation, even though the percentage of adults who identify as having a lack of social and emotional support is lower (20%) compared to the state (23%) and the nation (25%) (County Rankings and Roadmaps, 2025a).

Overall, primary and secondary data reflects that birth outcomes (infant and maternal mortality), mental health and substance misuse, and lack of affordable housing adversely impact the community as a whole and disproportionately impact community members who are historically marginalized. When primary survey data was disaggregated by race, ethnicity, and sexual orientation, the disparities in lived experiences across our community are clear.

The 2024 Buncombe County CHA health priorities/health focus areas were identified due to common underlying or root causes for health inequities related to systemic racism, oppression, and trauma.

• Maternal and Infant Mortality
• Mental Health & Substance Use
• Affordable Housing