Community Results Statement

The Community Health Assessment process will lead to partnerships and strategies that help Transylvania County become a vibrant, engaged community that supports the physical, emotional, and social well-being of all its residents.

Leadership for the Community Health Assessment Process

Transylvania County uses a traditional leadership model, in which Transylvania Public Health staff coordinate the effort with collaboration from representatives of Transylvania Regional Hospital and other stakeholders in the community.

Partnerships

Representatives from 24 community agencies and organizations, including healthcare systems, healthcare and behavioral health providers, education, elected officials, law enforcement, government agencies, and other civic and non-profit organizations, as well as the general public participated in efforts to gather data and determine priorities to create this community health assessment. Key leaders are listed below, and all participants are listed on the first page of the CHA document.

Regional/Contracted Services

Our county participates in WNC Healthy Impact, a partnership that brings together hospitals, public health agencies, and key regional partners in western North Carolina to improve community health. We work together locally and regionally to assess health needs, develop plans, take action, and evaluate progress. This regional effort is coordinated and supported by WNC Health Network, a non-profit that exists to support people and organizations to improve community health and wellbeing across western North Carolina. Learn more at WNCHN.org.

Theoretical Framework/Model

WNC Health Network supports local hospitals and public health agencies working on complex community health issues. Community Health Assessment and Improvement processes include the use of Results-Based Accountability™ (RBA). RBA is a practical approach that focuses on achieving real improvements for people, agencies, and communities. The framework relies on both primary (story and number data) and secondary data to provide a comprehensive understanding of community health.

Collaborative Process Summary

Transylvania County’s collaborative process is supported regionally by WNC Healthy Impact. This process began in January 2024 with collecting community health data.

Locally, our process includes gathering additional local data based on specific community questions and working with community members to discuss health-related concerns and identify the top health priorities for this CHA cycle.

Key Findings

Primary and secondary data from multiple sources were collected on demographics, social and economic factors that affect health, health outcomes including morbidity and mortality, health-related behaviors, clinical care, health inequities, and the physical environment. (Note that these data were collected prior to Hurricane Helene and do not reflect impacts from this disaster.)

Then, the most important health issues were identified based on the number of residents affected and the severity of the conditions; trends over time; comparisons to regional, state, and national data and norms; disparities based on age, gender, race, etc.; community concerns; connections to health behaviors and social/economic factors; alignment with Healthy NC 2030 indicators; and past CHA priorities.

These top health concerns included cancer, dementia/cognitive decline, diabetes, heart disease and stroke, maternal health, mental health, obesity, oral health, respiratory disease, and substance use. 

Health Priorities

Community members examined data related to each of these health concerns and prioritized the following health issues as being most important to address for the 2024-2026 CHA cycle:

Mental Health

Mental health is connected to issues that include suicide deaths, substance use, depression, anxiety, physical activity, and employment. However, residents have limited options for treatment and counseling options, especially for those who have lower incomes, no insurance, or transportation issues. Community efforts to improve both youth mental health and mental health for all ages are promising, but there is still much work to be done in this area.

Substance Use

Substance use is connected to mental health concerns, overdose deaths, adverse childhood experiences, depression, anxiety, liver disease, alcohol-related motor vehicle crashes, lung cancer, COPD, and employment. However, most residents have limited options for treatment and counseling options, especially for those who have lower incomes, no insurance, or transportation issues. Local efforts and partnerships to address substance use from primary prevention through harm reduction have resulted in improving trends, but this work must be continued and expanded to resolve this concern.

Maternal Health

Maternal health is related to poor outcomes for pregnant women and newborns, including premature deliveries and low birth weight. Substance use among pregnant women is also a concern. There are no labor and delivery services located within Transylvania County, so almost all pregnant women must travel to another county to deliver their babies. Despite high rates of prenatal care being reported, most residents believe that prenatal services are insufficient within the county.

Next Steps

This CHA document will be shared with stakeholders via email and presentations to selected groups and agencies. It will also be made available for public access at the Transylvania Public Health office (106 E Morgan St, Brevard, NC) and website (transylvaniahealth.org), on the WNC Health Network website (wnchn.org), and in the reference section of Transylvania County Library.

Next steps include continued collaboration with interested stakeholders to develop a Community Health Improvement Plan (CHIP) that will address the identified priorities and improve health for Transylvania County residents. This process involves learning more about these conditions and their root causes, selecting evidence-based strategies and promising practices, and creating performance measures that can help gauge if the strategies are working to improve health outcomes. The CHIP will be published using an electronic Scorecard on Transylvania Public Health website (transylvaniahealth.org) where it can be accessed by any community members.

Identified Priorities

The following health concerns were selected as the top community priorities for Transylvania County during the 2024 CHA process, based on relevance, impact, and feasibility. (Click here to learn more in the 2024 Community Health Assessment document.)

Priority 1: Mental Health

Mental health concerns include depression, anxiety, stress, and suicide, among others. It was a priority health issue in 2015, 2018, and 2021, and was identified as a major or moderate problem for county residents by all key informants. Nearly 1 in 5 Transylvania County residents reported having fair or poor mental health. Only 60% of residents said they would know where to go or refer someone for substance us or mental health counseling, and 1 in 6 said they were unable to get the care they need in the past year. The suicide morality rate continues to be higher than the state rate and suicide was the second leading cause of death for ages 0-19 and 20-39. About a third of emergency department visits for suicide attempt or self-harm were ages 18 or younger. Mental health is linked to substance use, economic factors like employment and poverty, social support, adverse childhood experiences (ACEs), health behaviors like physical activity and nutrition, and multiple health outcomes including chronic health conditions. However, residents have limited options for treatment and counseling options, especially for those who have lower incomes, no insurance, or transportation issues. Community efforts to improve both youth mental health and mental health for all ages are promising, but there is still much work to be done in this area.

Priority 2: Substance Use

Almost half of residents reported their lives being affected by substance use. It is related to overdose deaths, alcohol-related motor vehicle crashes, liver disease, lung cancer and COPD. The mortality rate for unintentional poisoning has fallen to below state and regional levels. Excessive drinking, using opiates (with or without a prescription), vaping, smoking rates among pregnant women are concerns. Smoking and vaping rates are increasing, while opiate prescriptions are low and decreasing over time. Substance use is connected to mental health, social/economic factors, and ACEs. It was identified as a major or moderate problem for our community by all key informants and was selected as a top priority health issue in 2015, 2018 and 2021. Substance use is also connected to mental health concerns including depression, anxiety, and stress; adverse childhood experiences (ACEs), and employment. However, most residents have limited options for treatment and counseling options, especially for those who have lower incomes, no insurance, or transportation issues. Local efforts and partnerships to address substance use from primary prevention through harm reduction have resulted in improving trends, but this work must be continued and expanded to resolve this concern.

Priority 3: Maternal Health

Maternal health is related to poor outcomes for pregnant women and newborns, including premature deliveries, and low birth weight, and infant mortality. Maternal health was identified as a major or moderate problem for county residents by 2/3 of key informants, and is related to substance use, social/economic factors, and barriers to accessing prenatal care. Rates of infant death, low/very low birth weight, and infant drug withdrawal diagnoses are all higher than the region. Black babies were more likely to have low birth weight, and Hispanic women were less likely to receive prenatal care. Around 1 in 10 babies were born to mothers who smoked while pregnant, which is linked to premature delivery and low birth weight. While more than 90% of all pregnancies among Transylvania County residents receive prenatal care in the first trimester, there are no labor and delivery services located within Transylvania County, so almost all pregnant women must travel to another county to deliver their babies. Despite high rates of prenatal care being reported, most residents believe that prenatal services are insufficient within the county. In fact, 1/4 of residents said that prenatal and labor/delivery services in the county were insufficient, and almost half said these services weren’t available at all. Because Transylvania County