Public health is the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. One way that local health departments assess their community strengths and resources, needs, health outcomes, emerging issues, and resident concerns is through the Community Health Assessment (CHA). The assessment affords Public Health, county officials, community partners and residents an opportunity to ascertain what is impacting health and wellness in Union County. The process examines primary and secondary evidence to develop a factual reflection of population health resulting from emerging trends and epidemiological statistics. In addition to being best practice, the CHA is also required by the State of North Carolina in order for local health departments to receive funding and accreditation.

The CHA is required to be completed on either a three or four year cycle. Union County completed assessments in 2008, 2012, and 2016. Union County decided to alter its four year CHA schedule cycle in order to align with Novant Health, one of our local hospital systems, as they embarked on conducting their Community Health Needs Assessment (CHNA). By doing this, we were able to collect community health data collaboratively and more comprehensively. Atrium Health, the other local hospital system, collaborated with us as well, despite the fact that they did not need to complete their CHNA this year.

Planning meetings for the 2019 CHA started in March 2019 with representatives from Union County Human Services, Novant Health, and Atrium Health. The work plan and timelines were developed, as well as survey and focus group question drafts for the collection of primary data. Primary data establishes a foundation regarding what county residents are concerned about relating to individual health and population health and open a dialogue about health issues, access to care, chronic disease, health equity, disparities, social determinants of health, and environmental impacts. Surveys (divided by age categories: teens 13 —18, adults 19—61 and seniors 62 and older) and focus group questions were finalized early May 2019 by a CHA Steering Committee, which consisted of representatives from County departments, non-profit organizations, business groups, community committees,  educational institutions, and the faith community.

The CHA survey was open for responses from May 15- June 30, 2019. All surveys were available in both English and Spanish and available electronically and via paper. Surveys were collected by random sampling via the jury pool participants and by convenience sampling at community locations and events. Over 4300 surveys were collected. Specific niche groups were identified to participate in Focus Groups. The niche groups were selected based upon demographics, occupation or elected position. All groups were asked the same questions. Fourteen focus groups were held capturing opinions and discussion of 100 individuals.

Input gathered from the surveys and focus groups data were analyzed. Recurring themes and trends were identified. Following this, secondary data in these areas was utilized. Secondary data is a required component of the CHA. Secondary data is statistical data collected by outside agencies such as the Center for Disease Control, Census Bureau, County Health Rankings and Roadmaps, County Statistics, NC State Center for Health Statistics, etc. This data provides factual information to support primary data, or dispel residents report as impacting health. Input gathered from both the primary and secondary data was combined and analyzed to determine the top focus areas to consider for prioritization.

It should be noted that secondary data was also collected and reviewed for other important areas of public health issues, such as Maternal Health, Communicable Disease, and Infant Mortality. While these are important issues and are addressed daily in our clinics and by Public Health staff, they were not included in the final focus areas. The rise in STD’s, disparities in infant mortality deaths amongst races, and the rise in diabetes, Alzheimer’s Disease, and  cancer rates for breast cancer and prostate cancer will continue to be monitored and addressed in Union County.  Information regarding these areas are included in the report.

The specific top focus areas identified by Union County residents based on both primary and secondary data include: Chronic Disease Prevention, Mental Health, Substance Use Disorder, Environmental Health, and Access to Care. Some of the feedback obtained from community members are as follows:

Community members verbalized repeatedly that the community should address specific health concerns such as cancer, diabetes, obesity, and high blood pressure. Contributors to this problem are the lack of exercise (opportunities for exercise) and the lack of healthy food in diets (lack of access to healthy foods or farmer’s markets, especially in the Eastern part of the County). Many areas of the County do not have easy accessibility to grocery stores or to healthy restaurants.  A few mentioned the need to create larger protected parks and increasing the safety of walking areas so people feel more comfortable exercising outside.

Addressing mental health was another concern which was mentioned by survey and focus group respondents.  Mental health problems, Alzheimer’s, dementia, suicide, and substance abuse disorders were also discussed as common among the adult population. One pediatrician mentioned that ~20% of her daily visits revolved around mental and behavioral health issues such as anxiety, depression, self-harming activities, and ADHD due to a lack of access to mental health providers. Several groups mentioned a lack of bilingual mental health providers. On surveys, Teens were more likely than adults and senior adults to describe their mental health as poor or very poor and identified depression and anxiety as concerns.

The limited ways to treat substance use disorder was identified as a concern by community members. Several Focus Group participants mentioned the need to make Narcan more available. Teens identified that e-Cigarettes, prescription pills, and alcohol abuse have become significant problems in the schools. 

Respondents discussed a need to improve access to preventative healthcare services (such as mammograms), primary care services, mental and behavioral health services and collaboration between both healthcare systems and other community partners. Community members are often unaware of the resources which are available to them, multiple ways to disseminate this information needs to be developed. 

Many focus groups mentioned that there is a lack of access to specialty care (such as infectious disease specialists or fetal medicine specialists) in Union County. The Latino Focus group participants mentioned that many Hispanic residents do not speak English (or in some cases, do not even know how to read), which is a large barrier to accessing care. Lack of affordable countywide public transportation was declared a major barrier to health. Residents without transportation cannot access basic needs such as groceries, medical appointments, or pharmacies. Prevention services are not typically an option, therefore medical needs wait until a situation becomes acute.

Environmental concerns focused on water quality, air quality, access to water, and access to greenspace. The sentiment around water quality was more residents need access to county or municipal water and sewer. Many survey responses indicated concerns about what is in both the County public and private well water due to smell or taste. Outdoor air quality has been an on-going challenge. Residents verbalized that they would like the County to consider infrastructure improvements to the built environment, such as sidewalks, more parks, increased greenspace, and walking trails.

The analysis of the data was presented to the Steering Committee on October 29, 2019 at Union County Human Services (see Appendix A) and this group determined the final priorities for Union County to be considered for action plans by discussion and vote. Magnitude, severity, intervention effectiveness, public concern, urgency, and current resources/efforts were considered during the voting process.    

The 2019 priority areas selected by the Steering Committee included:  

•     Substance Use Disorder (Prescription Drug Misuse, Opioids, and Tobacco Use/Smoking/E-Cigarettes),

•     Environmental Health (Water Quality, Access to Water, Greenspace), and

•     Access to Care (Insurance Coverage, Affordable Mental Health Services, and Transportation)

Two of these priority areas, specifically around the growing needs around substance use disorder treatment for opioids as well as access to healthy water, were identified in the 2016 CHA. Some goals surrounding these priority areas have been accomplished, however, due to reducing the cycle from 3 to 4 years, it has hindered the County from meeting all the goals of the action plans for these priority areas. The goal is to continue work in these areas by coalition building, identifying gaps and needs, and obtaining future funding.

Over the next six months, Union County Human Services, along with Community Partners, will develop action plans associated with the focus area priorities. The Union County Human Services Strategic Plan, 2030 Healthy Communities Plan, SHAC Committee Goals, and Healthy Communities Strategies will be utilized to develop these action plans.

For additional information regarding this 2019 CHA process, final report, or associated action plans, please contact the Human Services Agency Community Support and Outreach or Public Health Division Director: Stephanie.Starr@UnionCountyNC.gov and Dennis.Joyner@UnionCountyNC.gov.

The initial 2019 priority areas selected by the Steering Committee included:  

Substance Use Disorder 

Environmental Health 

Access to Care 

COVID-19 shifted the community priorities and needs. In August 2020, the Steering Committtee revoted on the community priorities and needs and agreed on the following priority areas:

Substance Use Disorder 

Mental Health 

Access to Care