Vision Statement

To assess where we are, to know where we need to be, and to meet the needs of our community.

Leadership

The primary partners in the Wilkes Community Health Assessment (CHA) project were the Wilkes County Health Department, Atrium Health Wake Forest Baptist Wilkes Medical Center and the Health Foundation, Inc. of Wilkes County, with the health department supplying staff to coordinate the project.  The primary partners contracted with an independent consultant for assistance in conducting the 2021 CHA.   

Collaborators 

Collaboration between Wilkes County Health Department, Wake Forest Baptist Health Wilkes Medical Center, the Health Foundation Inc., and other local partners made this assessment possible.  Representatives from many agencies spent numerous hours attending meetings, promoting, and distributing the community health survey, participating in stakeholder interviews, and attending consultant presentations.  A full list of partner agencies is included in Appendix 1 – Collaborating Agencies. 

Contracted Services

Our county received support from Annika Pfaender, independent consultant, for the 2021 CHA.  In partnership with staff from Wilkes Health, she facilitated the development of a community health survey instrument and conducted the survey analysis; gathered secondary data from public domain sources; compiled data provided by local sources; prepared a summary presentation of secondary and primary data findings to be disseminated as part of the prioritization process; prepared this document and a lengthier, more robust report for use by partner agencies.  

Theoretical Framework/Model

The Ecological Model was used as a framework throughout the process of developing the 2021 Wilkes County Community Health Assessment.  The ecological model addresses the interaction between, and interdependence of, factors within and across  all levels of a health issue. This model recognizes multiple levels of influence on health  behaviors, including individual factors, interpersonal factors, institutional and  organizational factors, community factors, and public policy factors all across the continuum of care. 

Collaborative Process Summary

Locally, our approach to the community health needs assessment process is community-wide and multi-faceted.  Our county included community input and engagement through: (1) Partnership in conducting the CHA process; (2) Through primary data (survey) collection efforts;  (3) Though secondary data collected from community partners; (4) In the identification and prioritization of health issues. Community engagement will remain a focus as we move forward to the collaborative action planning phase of the community health improvement process.  Partners and stakeholders with current efforts or interest related to priority health issues will continue to be engaged. We also plan to collaborate with our partners to help assure programs and strategies in our community are developed and implemented with community members and partners. 

The collaborative process began in June 2021 with the development of the community health survey. Meetings were held twice a month through the summer and once a month subsequently.  The prioritization process took place in February 2022 and the comprehensive final report prepared by the consultant will be available March 31, 2022.

Key Findings

Wilkes County, home to approximately 66,000 people, is a primarily rural county located in the foothills region of west-central NC.  Geographically, it is the third largest county in the state.  Most services are located around the town of Wilkesboro (the county seat) and North Wilkesboro (the largest town in the county).  The Wilkes County population is projected to grow, but at a rate slower than the state as a whole (~3.5% vs. ~10%, respectively) between 2020 and 2050.

Wilkes County is not especially racially and ethnically diverse.  In 2019, 4.0% of the population was African American, and 6.5% was of Hispanic origin, compared to NC averages of 21.4% and 9.4%, respectively.  Wilkes County population is older than the average NC community: the 2019 median age in Wilkes County was 44.9, six years older than the median age of 38.7 in NC.  The population of citizens aged 65 and older is projected to grow by 19% by 2050, at which point there may be an estimated 20,600 seniors in the county. 

Poverty remains significant in Wilkes County, with 17.7% of the 2019 population living in poverty, higher than 14.7% across NC.  Poverty rates tend to be even higher among the BIPOC population and among children under five. Incomes in Wilkes County are thousands of dollars lower than the state figures and the average weekly wage in Wilkes County in 2020 was $805, $400 lower than the average weekly wage in North Carolina.  The full economic impact of COVID is still unclear and will continue to be felt for years.  Wilkes County saw the same unemployment pattern as North Carolina and the nation: a quick and significant increase in unemployment in the Spring 2020.  The county unemployment rate has since recovered, to 3.0% in December 2021 while the state rate decreased to 3.2%. 

In 2019, an estimated 20% of the Wilkes County population between ages 19-64 lacked health insurance of any kind.  A quarter of the county population was eligible for Medicaid in 2020.  

Life expectancy in Wilkes County has extended by only one year in the past three decades .  For person born in 2017-2018, the overall life expectancy was 76.7 years, compared to 75.7 years in 1990-1992.  Life expectancy in the African American community, despite continued poverty and poor health outcomes in Wilkes County, improved from 69.6 years in 1990-1992 to 72.4 years in 2017-2019. 

Comparison of Wilkes County health data over the past twelve years has identified improvement in certain health parameters, such as the 15 leading causes of death.  Between 2001-2005 and 2015-2019, mortality rates in the county declined overall for heart disease, total cancer, stroke, and unintentional motor vehicle injuries.  However, mortality rates increased over the same period for chronic lower respiratory disease, unintentional injuries, Alzheimer’s disease, pneumonia and influenza, suicide, diabetes, kidney diseases, septicemia, liver disease, and AIDS.  Lifestyle factors and unhealthy behaviors are likely contributors to several of the chronic diseases for which mortality rates in Wilkes County have been increasing, for example chronic lower respiratory disease (CLRD) and diabetes. 

Among the leading causes of death, heart disease is disproportionately fatal in the Wilkes County African American community, for whom the most recent mortality rate (2015-2019) was 79% higher than the comparable mortality rate for whites.  Mortality rates are higher, by more than 20%, among males for most leading causes of death; females die disproportionately from Alzheimer’s disease. 

Between 2001-2005 and 2015-2019, site-specific cancer mortality rates in Wilkes County decreased overall for lung, breast, prostate, and colorectal cancers. Incidence rates also decreased for the four major site-specific cancers.  However, despite the decreases, cancer mortality for lung and colorectal cancers remains higher in Wilkes County compared to the state; lung and breast cancer incidence rates remain higher compared to NC.

Smoking is a known contributor to chronic lower respiratory diseases and lung cancer.  We have no definitive measured data on the prevalence of smoking in the overall Wilkes County population.  According to results from the 2021 Wilkes County Community Health Survey, 9% of the respondents reported being current smokers.  (It should be noted that the survey sample was predominately female and well-educated).  Data on smoking among expectant mothers shows that 20% of pregnant women in Wilkes County in 2019 were smokers, a frequency more than double the state figure.

Among lifestyle factors contributing to diabetes prevalence and mortality, overweight and obesity are perhaps the most important.  According to the CDC the prevalence of diagnosed adult obesity in Wilkes County in 2019 was 24.4% and had averaged 28% from 2006 through 2019.  Within the 2021 Wilkes County Community Health Survey sample, 38% of respondents reported having received a medical diagnosis of overweight/obesity and 10% reported that they do not participate in any physical activity or exercise.  On that same survey, respondents identified recreational facilities and better/healthier food choices among the services needing improvement in Wilkes County.

Wilkes County Health Populations At Risk For Poor Health Outcomes

The poor, the uninsured, minorities, and males in Wilkes County are at greater risk for poor health outcomes than their wealthy, insured, white, and female counterparts.  10 Other vulnerable populations include people living in the rural parts of the county, especially those with limited transportation options.  At-risk populations associated specifically with the priority health problems selected in Wilkes County will be discussed separately. 

Wilkes County Health Priorities

The Wilkes County CHA team used the results of extensive secondary data collection and analysis and a large community health survey to establish community health priorities.  The contracted consultant prepared a recorded presentation of the results from both information gathering activities.  Representatives from the Wilkes County Health Department shared the video presentation with collaborating team members at partner agencies, who then voted individually on their preferred, evidence-based priorities.  The CHA team tabulated the results.

The following were established as Wilkes County’s health priorities for the next three years 2022-2025): 

1. Obesity and Chronic Disease

2. Mental Health and Substance Abuse

3. Access to Care

4. Tobacco and Smoking 

Next Steps

Following the submission of this report, Wilkes County Health Department, Wilkes Medical Center, and the Health Foundation, Inc. will hold several listening sessions or conversation cafes.  The conversation cafes will serve a dual purpose in which community partners, members, and stakeholders receive information about the CHA, while being engaged to identify strategies and solutions for addressing the four health priorities. Staff will provide a brief overview of the results, with an emphasis on the four priorities listed above and participants will be able to suggest enhancement of current programs, new evidenced based strategies, and prospective partnerships. 

The results of the meetings will be consolidated into a set of priority recommendations to help the health department construct their community health improvement plan (CHIP).  The health department will continue to analyze the data and context of each health priority to ensure a proper selection of improvement activities.  Once the CHIP has been finalized, it will be distributed to existing coalitions for input and buy-in for each health priority.  Once implementation of the CHIP has begun, the group will continue to monitor and collect health data, and adjust the plan as needed. 

Copies of this CHA report will be made available on the Wilkes County Health Department website: www.wilkeshealth.com. Electronic and/or hard copies will be available to the public at partner agencies: The Health Foundation, Atrium Health Wake Forest Baptist Wilkes Medical Center, the Partnership for Children, the Senior Center, local libraries, the YMCA, Daymark, and Wilkes County Schools.

Obesity and Chronic Disease 

Mental Health and Substance Abuse 

Tobacco and Smoking