Purpose of the Community Health Assessment

A community health needs assessment (CHNA) is a systematic process for evaluating community health. Data is collected, analyzed, and used to illustrate the state of health and wellbeing within a community. During this process, community members and the assessment team work to identify community needs, areas for improvement, resources, and strengths. Using this information, priority areas are selected to be the focus of strategic planning, ensuring a data and community-informed approach to health improvement. The final report describes the process and contains the findings from the assessment. The community assessment process and the final report aim to promote collaboration, action planning and resource sharing between local leaders, community-serving organizations, and community members as they work to improve community health.

Participation and Community Engagement

NHC HHS and Novant Health consulted with NCIPH to facilitate the assessment process. In addition to the steering committee, a stakeholder group comprised of representatives from various health and human service organizations met regularly to plan, review, and analyze data, and discuss priorities. The CHNA team engaged community members throughout the assessment process. The Community Health Opinion Survey (CHOS) engaged 1,334 community members to learn more about their personal health status and concerns, as well as their concerns for the community overall. Additionally, community members were invited to participate in community conversations to share their experiences living in New Hanover County. The conversation populations were identified by the stakeholder group to ensure a diverse set of voices and experiences were represented; they included Latinx community members, Black and African American community members, individuals with disabilities, older adults, LGBTQIA+ community members, and individuals experiencing homelessness. Finally, community members were invited to vote on a set of priorities for the CHNA cycle based on the information gathered during the assessment.

Process

The CHNA Team worked from January to October 2022 to collect and analyze data, present it for discussion to the stakeholder group, and set priorities that represent the county’s needs and concerns. The data collection process included primary data – data collected directly from the community through the community health opinion survey and community conversations – as well as secondary, or existing, data. The secondary data sources included the North Carolina Center for Health Statistics, the United States Census Bureau, and local government, among others.

Comparisons and Findings

Throughout the data collection and analysis process, the CHNA team compared data from New Hanover County to three peer counties (Brunswick, Buncombe and Gaston), which were chosen for their similarity to New Hanover in demographic and community context (e.g., rural and urban populations, regional service hub, or proximity). Data was also compared to the state of North Carolina, as well as targets from the Healthy North Carolina 2030 objectives, which serve as a health improvement plan for the state.

In some areas, New Hanover County is performing well compared to peers. For example, New Hanover has the highest percentage of individuals with a Bachelor’s degree as their highest level of education as compared to peer counties (27.8%). The high school graduation rate has also been increasing since 2015. New Hanover County is also meeting the Healthy NC 2030 goal of having at least one primary care provider per 1,500 population. The county has 152.8 registered nurses per 10,000 population and 32.8 physicians per 10,000 population. It is important to note that even though New Hanover is meeting the goal for primary care providers, many community conversation participants were concerned about access to care. They cited long wait times to see providers and a lack of providers accepting Medicare and Medicaid. 

Mental health and substance use are important issues in New Hanover County. New Hanover has seen a sharp increase in drug overdose deaths, from 19.4 per 100,000 in 2014 to 39.7 per 100,000 in 2020 – the highest among peers. When the data is broken down by sex, the rate of total medication and drug poisoning deaths of all intents is 63.5 per 100,000 for males compared to females at 23.9 deaths per 100,000. The rate of deaths for white, non-Hispanic residents is 44.9 per 100,000 population compared to 66.7 per 100,000 population for Black residents.

Economic indicators can represent upstream factors that influence health. Unemployment in New Hanover County had been decreasing since 2011, but there was a sharp increase in 2020. This trend is similar to peer counties and the state. It is important to acknowledge that this increase in unemployment may be attributed to the COVID-19 pandemic. Income has been increasing in recent years. In New Hanover, median household income has risen from $50,088 in 2015 to $56,689 in 2020, and per capita income from $29, 880 in 2015 to $36, 324 in 2020. However, not all residents are experiencing this rise in income equally. Household income in the highest quintile (80^th percentile) is increasing more than incomes in the lowest quintile (20^th percentile).

Housing is another concern in New Hanover County. Nearly 70% of survey respondents disagreed with the statement that they can find affordable housing. Community conversation participants across groups reported concerns about the lack of affordable housing in the county. Looking at the secondary data, housing costs in New Hanover County are higher than peer counties. As of 2020, 21.3% of homeowners and 44.3% of renters are spending more than 35% of their monthly income on housing. Additionally, 19.1% of New Hanover households have at least one of four severe housing problems (incomplete kitchen facilities, incomplete plumbing facilities, having more than 1.5 persons per room, and a cost burden greater than 50%).

Prioritization

The stakeholder group was invited to participate in two data walk presentations. During these data walks, data from primary and secondary sources were grouped thematically. NCIPH facilitated the data presentations and discussion, during which community members reacted to the data and provided insight into community context. After the data walks, an online prioritization survey was used to gather votes from New Hanover County residents. The stakeholder group convened again to review the results from community voting, and then vote for themselves on the top three health priorities. The steering committee reviewed these recommendations and selected the following three priority areas:

• Housing
• Mental Health and Substance Use
• Access to care

Next Steps

This assessment serves as a foundation for the health improvement process and the next step is to develop health improvement action plans for each of the three priorities. Working with community partners, New Hanover County will develop measurable objectives to address each priority, identify evidence-based strategies to achieve those objectives, and plan evaluation and accountability throughout the next three years.

The priorities identified by the community are:

• Housing
• Mental Health and Substance Use
• Access to Care

Mental health and substance use were separate but was voted by the stakeholder group to be combined as the two have a big impact on one another.