The Cleveland County Health Department is pleased to present the 2023 Community Health Assessment for Cleveland County.  This document provides an overview of past, current and future significant health issues facing the county today and may be used as a guide for collaboration among agencies and services to best meet the health needs of Cleveland County residents. 

Our Vision for Cleveland County is a community where good health is within reach of everyone.

Our Mission is to improve and promote the health of Cleveland County through education, service and prevention. 

Leadership for the 2023 Community Health Assessment was provided by the Cleveland County Health Department under the direction of Tiffany Hansen, Health Director.  Working with Anne Short, Director of Community Health Services, Ms. Hansen established a Core Committee to provide advice and oversight to the CHA process and to assist in engaging community members in the Community Survey, the identification of health needs and the dissemination of information collected in the CHA process.  Members of the Core Committee are identified on pages 16-17  under the CHA Process Section of this document.  Additional oversight and direction was provided by the Public Health Board for Cleveland County, the advisory body to the Health Department.

Preparation of the document reflecting the results of the 2023 CHA resided primarily with members of the Cleveland County Health Department staff.  The principal author of the document is Anne Short, Director of Community Health Services, assisted by Zakoya Spikes, Coordinator of the Healthy Communities grant and facilitator of the 2030 Healthy North Carolina Scorecard for Cleveland County.  These individuals were ably assisted by additional CCHD staff members who contributed assistance in multiple ways:  Hallie Boggs, Bailey Caudle, Alisha Heavner, Haley Jones and Nautica Mason.  Andrea Power, assistant to the Health Director, played a major role in facilitating the work of the Core Committee including transcribing the minutes of each of the committee and work group meetings.  Additional assistance was provided by staff members from the finance and clinical units of the Health Department in the provision of data drawn from the Patagonia electronic health record used by CCHD.  This document could not have been completed without the collaborative work of these individuals!

Community partners represented in the Core Committee and the Public Health Board for Cleveland County included:

The 2023 Community Health Assessment was conducted and funded by the Cleveland County Health Department as part of the Consolidated Agreement with the North Carolina Division of Public Health.

The theoretical framework selected by the Core Committee for the 2023 CHA was that of the Healthy North Carolina 2030:  A Path Toward Health based on twenty-one population health indicators.  These indicators were used as the options on the priority ballot used to identify key health needs in the county.  This framework was used in the 2019 Community Health Assessment and enabled comparison to the information collected in that process.  Core Committee members also reviewed and considered the social determinants of health model to identify non-health indicators having an influence on the ability of providers to meet the healthcare needs of county residents. 

The Core Committee for Cleveland County’s CHA began their work in May 2023 and will complete their work in November 2024 with the final publication and broad distribution of the document.  A more detailed timeline of their work is included in the Community Health Assessment Process section of this document, pages 16-26. A major component of the 2023 process was data collection on two levels to provide a more comprehensive review of the health status of Cleveland County residents.  Primary data was collected in a community survey provided both electronically and in hard copy format to residents for completion in September 2023.  Secondary data was collected from a variety of local, regional, state and national sources primarily from May 2023 through August 2024. Data for Cleveland County was compared to state data as well as information collected from the neighboring counties of Gaston, Lincoln and Rutherford as these counties are more closely identifiable to residents of Cleveland County.

During the primary data collection process, residents were asked to complete an 86-question survey developed and approved by the CHA Core Committee.  CHA leadership used the SurveyMonkey platform to disseminate the survey and market it broadly throughout the community, using a QR code in advertising to link potential respondents directly to the survey.  Hard copies of the survey were distributed to multiple sites across the county for individuals who were not comfortable using the electronic survey.  At the close of September 2023 survey period, CCHD received 3,927 electronic responses and 453 paper surveys which were entered by hand into the SurveyMonkey database.  The high number of electronic responses prompted a closer review and it was determined that a disproportionate number of surveys received came from more than 89 zip codes across the world.  Working with the county’s skilled Information Technology staff, CCHD staff “cleaned” the corrupted surveys from the data base, leaving 2,197 valid responses to review.  Additional primary data was collected through a series of focus groups held in October 2023 with participants responded to a set of questions focusing on employment, housing, educational options, access to healthcare, personal safety and community leadership opportunities.

The secondary data collection process involved gathering information from a broad array of sources which included but not limited to CCHD Patagonia electronic health records, Cleveland County Department of Social Services, North Carolina State Center for Health Statistics, Centers for Disease Control and Prevention, Cecil G. Sheps Center for Health Services Research and the United States Census Bureau.  Of particular assistance in the process was data gleaned from the newly established North Carolina Data Portal which provided comparison data from a variety of sources for Cleveland County, the neighboring counties and the state of North Carolina.  Data sources are indicated below each chart or diagram in the document or in the narrative explaining the information. 

Key findings from this CHA process include the following points:

• County residents are concerned about economic issues affecting their quality of life including poverty, housing problems, employment opportunities and transportation options.
• Diseases of the heart, cancer – all sites and diabetes continue to be the leading causes of death for county residents. 
• The COVID-19 pandemic affected county residents of all ages, genders, and economic status in the county and has created a degree of hesitancy about trust in government and public health programming.
• County residents emphasized that a lack of providers, providers not accepting new patients, the lack of health insurance and the cost of healthcare services were barriers to improving their personal health status.
• Multiple programs and services such as preventative screenings are available to residents to address chronic diseases in the county.
• A greater emphasis on providing access to healthy food and additional opportunities for physical activity is key to reducing the potential for chronic disease among county residents.

Two issues were identified for further attention by the key stakeholders engaged in a priority-setting process in January 2024.  First, teen births are a continuing issue from the 2019 Community Health Assessment process.  As early as 2008 when a Task Force on Teen Pregnancy Prevention was established to address the high rates of teen pregnancy in the county, this issue has been a major consideration in preventative programming offered by the Cleveland County Health Department.  With the award of a Teen Pregnancy Prevention Initiative grant in 2015, the health education unit of CCHD has engaged in the delivery of reproductive health and safety education in a collaboration with Cleveland County Schools.  However, the county still ranks 25^th among 100 counties in the teen pregnancy rate and the teen birth rate has not decreased significantly.  A Community Health Improvement Plan is under development to continue to address this issue using the Teen Pregnancy Prevention Coalition as a collaborating partner in developing enhanced strategies to engage the communities of Cleveland County in this effort. 

The second identified health issue in the county is drug overdose deaths.  Cleveland County has been fortunate to have a federal Drug Free Communities grant for the past ten years which offered leadership the opportunity to address youth substance use issues identified through the PRIDE Student Drug Use Survey.  This initiative focused on underage drinking, tobacco use (especially vaping), marijuana and misuse of prescription medications among students in the middle and high schools in the county and offered multiple opportunities for community engagement around these issues, especially with parents and guardians of these students. However, it became clear during the COVID-19 pandemic that a spike in drug overdose deaths in the county required a more targeted approach to deal with this issue.  With the award of Opioid Settlement Funds to the county, a more comprehensive approach to address drug overdose deaths has emerged.  Under the leadership of Health Director Tiffany Hansen, Deputy Health Director DeShay Oliver and Opioid Coordinator Carmen Barbuto, a strategic planning process to address opioid-related issues is underway.  These individuals, along with members of Drug Free Cleveland County, are participating in the development of a Community Health Improvement Plan specifically designed to reduce the number of drug overdose deaths in the community using an array of community-based strategies. 

Next steps in the 2023 Community Health Assessment process include the following:

• Approval of the final Community Health Assessment document by members of the Core Committee;
• Submission of the final document to the North Carolina Division of Public Health for approval;
• Presentation of the final document to the Public Health Board for Cleveland County and the Cleveland County Board of Commissioners;
• Presentation of the Community Health Improvement Plans to the Public Health Board for Cleveland County and the Cleveland County Board of Commissioners;
• Publication of the final document in hard copy and electronic format to distribution in the county; and
• Distribution of the final document to all elected officials representing the county, the public libraries and the libraries of Cleveland Community College and Gardner-Webb University.

Annual updates to this document will be provided through the publication of the Healthy North Carolina 2030 Scorecard for Cleveland County for 2024, 2025 and 2026. 

2023ClevelandCountyCommunityHealthAssessment_1729873666.pdf

Teen Births

Drug Overdose Deaths