During the 2021 Community Health Assessment process, Nash County Health Department and community partners selected county-specific priorities to be addressed over the new three years (2021-2023).  The progress on the three priorities include:

Priority 1: Metabolic Syndrome

Metabolic syndrome is a group of conditions that can cause coronary heart disease, diabetes, stroke, and other serious health problems.  In Nash County, heart disease ranked #1 as the leading cause of death among chronic and infectious diseases. Following heart disease, other chronic health conditions such as cancer ranked #2, cerebrovascular disease (stroke) ranked #3, and diabetes ranked #4.  Also, being overweight and obese among children and adults increases the risk of these chronic health conditions.  Both overweight and obesity are generally defined by BMI ranges that are associated with an increased likelihood of certain diseases and other health problems. (Table 1: shows how BMI is used to classify weight status for adults).¹⁰ 

Data from the 2022 County Health Ranking report indicated that Nash County obesity was 35%, which decreased from 2019 data at 38%.¹¹  In addition, survey data from the 2021 Community Health Assessment indicated that it is easy to buy healthy foods in the county (45.2% respondents), but low income/poverty (58.1% respondents) contributed to the highest impact on quality of life, which affects access to healthy foods. During a normal week, and other than their job, respondents (58.6%) reported that they do engage in physical activity or exercise for at least one hour four times per week.  Respondents who do not exercise reported they were too tired to exercise (41.4%), they did not have not time to exercise (31.8%), and their job was physical or hard labor (19.1%).¹²  Establishing access to healthy foods and physical activity is an objective for Nash County to reduce barriers many residents face for prevention and controlling Type 2 diabetes, high blood pressure, heart disease, certain cancers, and stroke.  Through partnerships, Nash County Health Department, Down East Partnership for Children, and Harrison Family YMCA agreed to establish health and wellness programs that include:

Diabetes Awareness Program - A community education program hosted by Nash County Health Department and Harrison Family YMCA at least two times a year to increase citizens access to diabetes prevention services.

Progress:

• Established a partnership with the Harrison YMCA to offer a 5-session virtual diabetes program twice a year, reaching over 50 participants

• 95% of respondents reported increased knowledge about managing and controlling diabetes 

• 50% of respondents reported neither weight loss improvements nor controlled blood glucose because of the program  

Faithful Families Program – A church-based program lead by Down East Partnership for Children to encourage healthy eating and physical activity in communities for children and adults. 

Progress:

• Recruited approximately 1,298 citizens from Nash and Edgecombe counties and 100% of program participants showed improvement in making healthy food choices
• Promoted and supported healthy food policies, systems, and environmental changes in Faithful Families Program churches that completed and implemented action plans

Harrison Family YMCA Wellness Programs – The YMCA-hosted wellness programs to increase citizens' access to physical activity and wellness opportunities.

Progress:

• Recruited approximately eight individuals in the Blood Pressure Self-Monitoring Program with 100% of participants reporting controlled blood pressures
• Recruited approximately 39 individuals in the Enhance Fitness Program, showing 92% regular participation
• Recruited approximately eight individuals in the Walk with Ease Program, showing 90% regular participation

Healthy Communities Program – A health promotion program established by Nash County Health Department to increase citizens' access to health and wellness opportunities through education and policy system changes.

Progress:

• Participated in five community health fairs educating over 700 citizens about heart disease, stroke, diabetes, obesity and healthy living
• Hosted seven programs to educate citizens about the My-Plate Method to teach about healthy food choices
• Shared monthly social media messages on healthy eating and physical activity to reduce heart disease and stroke
• Two faith-based organizations were encouraged to adopt healthy food options at social gatherings and events

Priority 2: Poverty

The North Carolina Department of Commerce annually ranks the State’s 100 counties based on economic well-being and assigns each a Tier designation. The 40 most distressed counties are designated as Tier 1, the next 40 as Tier 2, and the 20 least distressed as Tier 3. Nash County has been assigned a Tier 1 designation for 2021.¹³

County Tiers are calculated using four factors:

• Average unemployment rate

• Median household income

• Percentage growth in population

• Adjusted property tax base per capita

The term poverty refers to the state or condition in which people or communities lack the financial resources and essentials for a minimum standard of living.  Historically, adopting poverty in the context of improving finances has not been a priority for Nash County Health Department, but we strive to enhance affordable services for citizens' access.  Data indicates that poverty-stricken people and families may go without proper housing, clean water, healthy food, and medical attention.  As a result, Nash County community health partners agreed to improve equitable program opportunities and services for citizens to address conditions and causes of poverty to increase self-sufficiency over the next three years (2021-2023). The program includes:

Cooperative Extension Financial Literacy Program – A Nash County Cooperative Extension Financial Literacy Program established to teach citizens skills in financial planning for achieving financial freedom.

Progress:

• Worked toward establishing community partnerships to offer a Financial Literacy Program and recruit program participants
• Approximately 104 individuals participated in the Financial Literacy Program on basic financial management strategies (such as budgeting, recording keeping, goal setting, writing goals, and consumer decision-making)
• Approximately 124 individuals implemented basic financial management skills such as developing a budget and keeping records
• Approximately 11 individuals reported an increased knowledge and/or skill regarding family economic security (such as how to access SNAP benefits, SHIP, Medicare Part D, food cost management, cost comparison skills, shopping for reverse mortgages, and select long-term care insurance)

Gardening and Nutrition Support Program – An established community-based garden program by Down East Partnership for Children to increase healthy food access in low-income communities. 

Progress:

• Approximately 894 individuals reported access to healthy foods due to the Gardening and Nutrition Support Program
• Worked toward recruiting community volunteers to support program activities

Harrison Family YMCA Food Box Program – The Harrison Family YMCA established a healthy food box program to increase citizens’ access to fresh fruits and vegetables for low-income communities.

Progress:

• Worked toward establishing community partnerships to offer healthy foods access and recruit program participants
• Provided 50 opportunities for citizens to access fresh fruits and vegetables, reaching approximately 135 participants

 Ripe Revival Fresh Fruits and Vegetables Mobile Market – Ripe Revival is a nonprofit program established to provide healthy foods opportunities for citizens regardless of income through Mobile Market buses.

Progress:

• Worked toward establishing community partnerships to expand healthy food access opportunities
• Hosted 17 community events to offer healthy foods, reaching approximately 620 participants

Nash County Senior Services Wellness Programs – Established programs hosted by Nash County Senior Center to increase citizens’, age 60 and older, access to physical activity and wellness opportunities.

Progress:

• Approximately 536 individuals were impacted by participating in the Fitness and Education Programs
• Approximately 150 individuals were impacted by participating in the Home Delivered Meals Program
• Approximately 15 individuals were impacted by participating in the Transportation Services Program
• Approximately 145 individuals were impacted by participating in the Caregiver Support Program
• Approximately 38 individuals were impacted by participating in the Project Lifesaver Program

Priority 3: Behavioral Health

In Nash County, Heroin and/or Fentanyl contributed to the leading causes of drug overdose deaths between 2011-2020. Cocaine and alcohol use have also shown a steady increase among residents.  The rate of opioid overdose deaths for Nash County was 18.7, slightly lower than the State’s rate of 19.3.14  Behavioral health with a focus on substance use was chosen as a priority by the Nash County Community Health Assessment stakeholders because citizens reported a need for access to substance use education and prevention services.  Also, Community Health Assessment data from 497 (16.02%) survey respondents cited substance abuse, including drugs and alcohol, as one of the top quality of life issues faced in Nash County. As a result, partners of the 2021 Community Health Need Assessment agreed to establish programs and services to increase citizens' access to substance abuse education, prevention, and treatment services. Programs include:

Empowering Youth and Families Program (EYFP) – A Nash County Cooperative Extension Program established to provide opioid prevention education for youth and their caregivers.

Progress:

• Worked toward establishing an EYFP by identifying community needs and locations to offer services  

Coalition for Addiction Recovery Education (C.A.R.E.) Substance Use Programs - C.A.R.E. is a partnership of various county agencies, hospitals, organizations, and businesses to provide education, prevention assistance, and resources for individuals who struggle with addiction. In addition, the coalition strives toward bridging community gaps in services to leverage healthy equity among citizens.

Progress:

• Approximately 24 individuals were impacted by participating in the Medication Assisted Treatment Program Services
• Worked toward increasing awareness about the need for Peer Support Program Certified Trainers
• Participated in 10 community mental health fair events
• Approximately 60 individuals were impacted by participating in the Naloxone distribution program

Tobacco Prevention Program – A Nash County Health Department program coordinated in community and school sites to educate youth about the dangers of tobacco use, e-cigarettes and vaping.

Progress:

• Approximately 15 youth individuals were impacted by participating in the Tobacco Prevention Program in a community site
• Approximately 12 social media messages were posted to increase awareness about the danger of tobacco use
• Worked with community partners to adopt the Catch My Breath Program, an evidence-based program for youth

References 

10.   Community and Clinic Connections Prevention and Health Branch. NC Division of Public Health. Overweight and Obesity Among Adults Fact Sheet. (2019). Retrieved from: https://www.communityclinicalconnections.com/wp-content/themes/cccph/assets/downloads/0619/CCCPHB_FactSheet_Obesity_AdultObesity_FINAL_March2019.pdf

11.  County Health Ranking and Roadmap. Nash Cunty, NC (2022). Retreived from: https://www.countyhealthrankings.org/explore-health-rankings/north-carolina/nash?year=2022

12.   Nash County 2021 Community Health Needs Assessment. Retrieved from: https://nashcountync.gov/DocumentCenter/View/8232/Nash2021-CHA-with-attachments

13. North Caorlina Department of Commerce. (2021). Retrived from: https://www.commerce.nc.gov/grants-incentives/county-distress-rankings-tiers

Morbidity and Mortality Changes Since Last CHA

The most recent morbidity and mortality data were collected for the North Carolina State Centers for Health Statistics.  In 2019, the leading cause of death in Nash County was heart disease, followed by cancer among all races. Data suggested that Nash County has a heart disease rate higher than the state’s average of 22.0 to 20.5, respectively.

Like other North Carolina counties, Coronavirus Disease 2019 (COVID-19) continued to be a concern in Nash County.  As of December 31, 2022, Nash County Health Department reported a total of 32,500 confirmed positive cases and 322 deaths. During the same period, COVID-19 vaccinations were provided to the population at 62% with one dose, 58% with the initial series completed, 55% with one booster dose, and 14% with the updated booster.   

Between March 26, 2022 to March 18, 2023, a total of 6,723 cases were reported and 67 deaths in one year.  

The emerging health issues that occurred in 2022 include:

Coronavirus (COVID-19) Monitoring and the Bivalent Booster Vaccine Dose

Nash County Health Department continued to monitor COVID-19 cases within the county, especially at congregate living facilities, hospitals, and detention centers where a significant number of cases have been reported for the past year.  As of December 31, 2022, a total of 32,500 confirmed COVID-19-positive cases and 322 deaths had been reported since the pandemic started.  The health department remained ready to contain outbreaks of this virus and its many evolving variants.  The Bivalent Booster dose arrived in September 2022 to help with the Omicron Variants. Public Health officials encourage citizens to take the new Bivalent Booster because it lessens the severity of the disease if one is infected and protects against newly formed strains of the virus.  In addition, Nash County Health Department continued to provide COVID-19 vaccinations by appointment.  Between September 2022 and December 2022, Nash County Health Department and area medical partners gave 7,515 bivalent boosters to protect citizens.  Also, we continued to encourage citizens to take routine influenza and travel vaccinations to prevent diseases in all age groups.

EBOLA Virus Disease (EVD)                                                                                                                                                                                               

Ebola Virus Disease (EVD) is a rare and deadly disease in people and nonhuman primates.  The viruses that cause EVD are located mainly in sub-Saharan Africa. People can get EVD through direct contact with an infected animal (bat or nonhuman primate) or a sick or dead person infected with the Ebola virus.  In 2022, Nash County Health Department was notified twice of persons who had returned to the US from an Ebola outbreak country. Our public health officials and nurses monitored these cases and addressed questions and concerns.  Also, the county's Local Emergency Preparedness Committee (LEPC) and area hospitals were made aware of heightening awareness of potential cases within the county.  In addition, collaborative communication efforts among county partners, through emails and faxes, helped increase medical providers' awareness in case a hazardous situation could have arisen.

Monkeypox known as Mpox                                                                                                                                                                                                

Mpox is a rare disease caused by infection with the monkeypox virus.  The Mpox virus is part of the same family of viruses that causes smallpox. Its symptoms are similar to smallpox symptoms but milder and are rarely fatal.  In 2022, Nash County Health Department investigated eight cases within the county for potential Mpox, but only seven had compatible symptoms. Individuals were educated on prevention and placed on isolation precautions to prevent the virus from spreading to others.  Also, individuals were educated on how to receive Tecovirimat antiviral if infected. Nash County Health Department worked with the NC DHHS State Immunization Branch to coordinate a supply of Jynneos vaccine for potential outbreaks and referred individuals to a Federally Qualified Health Center for vaccination.  The Communicable Disease Nurse Coordinator established community partners within the county and neighboring medical facilities to assist individuals with Mpox concerns.  Nursing staff also managed phone calls and educated citizens on prevention methods. In addition, public health officials posted alerts on the county's social medial platforms, sent numerous emails, and faxed messages to medical providers about Centers for Disease Control and Prevention’s Mpox prevention and treatment recommendations.

The new initiatives started in 2022 include:

Child Safety Seat Program 

Child unintentional injury death rates decreased 11% from 2010 to 2019, but injury is still the leading cause of death for children and teens in the United States. The leading causes of child unintentional injury include motor vehicle crashes, suffocation, drowning, poisoning, fires, and falls.¹⁵  In Nash County, motor vehicle injuries are the second leading cause of death for children ages 0-19 according to the DHHS State Centers for Health Statistics. As a result, Nash County Health Department has partnered with the City of Rocky Mount Fire Department to expand the Child Safety Seat Program. Individuals must be a Nash County Health Department patient to obtain a child safety seat. The program's target population is parents of children 0-8 years or Child Health, Maternity, and Post-partum program participants. The program educates parents and/or caregivers on car seat safety. Also, individuals are trained in proper child safety seat installment to reduce the rates of child injuries and child fatalities due to motor vehicle crashes. In 2022, a total of 27 car seat vouchers and one booster seat voucher were issued in the program.

Convenience Center Permit Program

In January 2022, Nash County enacted a Convenience Center Permit program. The goal of this program is to eliminate misuse of the convenience centers by citizens who do not pay the annual $125 rural household fee on their county tax bill. A total of 16,799 permits were mailed to residents who are charged this annual fee. A social media campaign (including area newspapers and the County’s various social media platforms) was held to educate citizens about this new program. Beginning May 1, 2022, this permit was required to gain access to any of the nine convenience centers in Nash County. Citizens living in any of the County’s municipalities, and are not charged the $125 rural household fee, are able to purchase a permit for $75 to utilize the convenience centers. The current permit is valid through December 2023. Permits issued for January 2024 will be valid for a two-year period.

Non-Invasive Prenatal Testing and Genetic Carrier Screening for Maternity Patients

In July 2022, Nash County Health Department began using Non-Invasive Prenatal Testing (NIPT) and Genetic Carrier Screening for maternity patients. The NIPT is a genetic test that can determine whether a baby has a high or low risk of having certain chromosomal conditions and provide the gender identity of the baby. Most importantly, the Genetic Carrier Screening can determine the mother’s chance of passing on a genetic condition to the baby through a Natera test. The new Natera test measures for 17 different conditions, while the previous Quad test only measured four conditions. Between July - December 2022, approximately 77 specimens were submitted to Natera for testing. This Non-Invasive Prenatal Testing and Genetic Carrier Screening allowed nursing staff to inform patients if there was a risk that the fetus could be born with specific genetic abnormalities.

Safe Firearm Storage Program

In North Carolina, firearm‐related deaths per 100,000 population from 2019 (13.1) to 2020 (15.6), increased by 18.5%.¹⁶  Furthermore, Nash County's firearm-related death rate has steadily increased to 20.4 during that same period. Safely storing firearms can reduce unintentional deaths, injuries, and hospitalizations. In addition, when firearms are stored safely, they are less available as a means of suicide or intentional harm to others. In 2022, Nash County Health Department established a Safe Firearm Storage Program to provide gun storage safety education and gunlocks to patients in the health department’s child health program. The goal of the program is to reduce the Child Fatality rate due to inappropriate access to unsecured firearms. A total of 620 parents/caregivers of the Nash County Health Department's Child Health Program were distributed information on firearm safety and 138 gunlocks were provided to reduce unintentional firearm injuries.

References 

15.  Centers for Disease Control and Prevention. Injuries Among Children and Teens. (2022). Retrieved from: https://www.cdc.gov/injury/features/child-injury/index.html

16.  NCDHHS. NC Injury Prevention and Violence Branch.NC Violent Death Reporting Systems. (2020).  Retrieved from: https://injuryfreenc.dph.ncdhhs.gov/DataSurveillance/VDRS/FirearmDeaths2020.pdf