This 2025 State of the County’s Health (SOTCH) Report for Orange County shares progress on the Community Health Improvement Plans (CHIP) developed to address the three priority areas identified by the 2023 Community Health Assessment (CHA). The three priorities are access to care, behavioral health, and connections to community support. This SOTCH also shares brief highlights of changes in mortality and morbidity, emerging concerns, and new initiatives since the 2023 CHA was submitted in March of 2024. Click here for the Orange County Community Health Improvement Plan for 2023-27.

Please click on the links below for 2025 progress reports.

Access to Care

Click here for progress on Orange County Community Health Advocacy and Mobilization Partners (OC CHAMPS).

Click here progress on Medicaid Expansion.

Behavioral Health

Click here for progress on Trainings related to Mental Health and Substance Misuse.

Click here for progress on Connection to 988.

Connections to Community Support

Click here for progress on Trainings Related to Healthy Eating.

Click here for progress on Connection to 211 or Other Resource Platform.

There have been no significant changes in morbidity and mortality data at the time of this SOTCH submission in March of 2026.

Table 1 below shows data for the top ten causes of death in Orange County for the years 2017-2021, which is the data used for the 2023 Orange County Community Health Assessment. Table 2 shows data for the top ten causes of death in Orange County for the years 2019-2023, which is the most recent available data. These rates are unadjusted per 100,000 people and include Orange County residents of all ages. Suicide and chronic liver disease continued to be in the top ten causes of death for Orange County residents, but not leading causes of death for North Carolina residents.

Table 3 below compares Orange County data for both the 2017-21 and the 2019-23 periods for ease of viewing and comparison.

Both data sources used above may be viewed online at the North Carolina State Center for Health Statistics. Click here to review the 2023 County Health Data Book. Click here to review the 2025 County Health Data Book.

Table 4 below compares the Infant Mortality numbers and rates for Orange County for the 2017-2021 and 2019-2023 time periods. For context, during the 2017-21 period, Orange County had 5,775 live births. Of these 5,775 live births, 3,325 births were white infants, 773 births were African American infants, and 971 births were Hispanic or Latinx infants. For the 2019-23 period, Orange County had 5,806 live births. Of these 5,806 births, 3,273 births were white infants, 779 births were African American infants, and 1,074 infants were Hispanic or Latinx infants. A note of caution: while Hispanic or Latinx infant deaths may appear to have increased, so have the number of Hispanic births. At this time, conclusions cannot be drawn based on the available data.

Infant mortality data sources may be viewed online at the North Carolina State Center for Health Statistics.

Click here for infant mortality statistics for 2017-21.

Click here for infant mortality statistics for 2019-23.

Click here for live birth statistics for 2017-21.

Click here for live birth statistics for 2019-23.

Tropical Storm Chantal

In July of 2025, Tropical Storm Chantal brought some 10 inches of rain to Orange County, with some areas of the county receiving higher or lower amounts of rain. The storm resulted in the displacement of almost 200 residents, 70 water rescues, and over $12 million in residential property damage, over $20 million in commercial property damage, and over $22 million in public property damage. Local municipal water supplies administered by the Town of Hillsborough and the Town of Mebane were also impacted by the storm.  As a result of these damages and impacts, the county qualified for state and federal disaster assistance. Many of the locations, including businesses, took months to clean and assess, with some locations still closed by the end of 2025, with some locations opting to relocate or to not reopen. Read more information about the storm in the Executive Summary produced by Orange County Emergency Services.

Federal and State Level Challenges Impacting Orange County

SNAP Interruption and Changes

The Supplemental Nutrition Assistance (SNAP) faced interruptions in services nationwide due to the federal government shutdown in the fall of 2025. In Orange County, the Orange County Food Security Program led by Orange County Cooperative Extension joined with Orange County Department of Social Services and other partners to respond to the challenge. Many government agencies, churches, and other community groups hosted food drives to benefit area food pantries. December 1, 2025, marked changes to employment requirements for some SNAP recipients. Read more about the changes here.

Food insecurity is a challenge in Orange County, with many residents citing food access and affordability challenges during the primary data collection processes of the 2023 CHA. Food resources have remained a leading call request into 211 and other resource platforms for the county. Local leaders remain concerned about food insecurity and continue to work together to address food security challenges. For local food resource information please see this website managed by Orange County Cooperative Extension.

Immigration Enforcement

Orange County, like many other areas across the state and nation, is home to immigrant populations. During 2025, immigration enforcement activities increased throughout the U.S. and media outlets showed federal immigration efforts, leading to widespread concern and fear from many members of the public. The fear and concern led to community members canceling or avoiding appointments and school absences to avoid immigration officers.

In response to the concerns regarding immigration officers and practices, the Orange County Board of Health released a “Resolution on Immigration Enforcement and Access to Public Health Resources,” stating public health services are a fundamental human right and advocating for access to health services regardless of demographics. Read the full resolution.

The following are new initiatives for the 2025 calendar year. There have not yet been any discontinued initiatives related to the 2023 CHA cycle.

Healthy Carolinians of Orange County Updates

The Healthy Carolinians of Orange County (HCOC) Coalition works together to address the CHA priorities and other related activities. While this coalition has existed for many years, a new steering committee was formed in 2025 to help organize and plan meetings and activities. The steering committee is also an opportunity for leadership within the coalition in an effort to increase resident and community partner representation in the committee and its projects and activities. The Little Free Library and Harm Reduction Kits sections below provide additional information on these HCOC projects.

Little Free Library

HCOC installed a little free library during the summer of 2025 at the Hillsborough Community Garden. The library is a physical box with space for community members to obtain and leave books and is open to people of all ages. Other items included in this library are educational materials on nature and gardening, mental health journals, stickers, and other items. The library has an electronic counter attached, and it is estimated that the library has been used 300 times in 2025.

Harm Reduction Kits

Members from the Access to Care and Behavioral Health CHIP subcommittees prepared materials to create 100 harm reduction kits containing personal safety items such as naloxone kits, basic first aid items, emergency blankets, and hygiene supplies. These kits were distributed through partnerships with local agencies who assist the unhoused.

Outreach Team

In early 2025, the Orange County Health Department created an Outreach Team. This is an internal group of staff members from multiple divisions of the Health Department. This group provides space to communicate better internally and to share ideas and brainstorm ways to improve community collaboration, engagement, and education. This group also works together to share community events, Health Department participation in community events, and share information on Health Department programming, workshops, and classes.

Through the Outreach Team, the Health Department has better engaged with historically underserved communities of Orange County. For example, multiple program areas of the Health Department have provided presentations at summer day camps and senior citizen groups in rural areas of the county, like Cedar Grove and Efland. Other projects included offering COVID-19 vaccinations and A1C diabetes screening events. A MedAssist event providing free over the counter medications and sponsored by UNC Health was offered in the Cedar Grove community in October of 2025. This is the first time that event has been held in a rural part of the county and over 700 people participated in the event. Through these efforts, the Health Department can better meet diverse community needs and engage with and empower communities.

Healthy Homes Program Mascot

The Healthy Homes program of the Orange County Health Department selected a mascot in 2025. The mascot is a family friendly hedgehog named Hamilton. Hamilton has been very well received by people of all ages and is particularly popular at community events. The Healthy Homes program is free and teaches families how to reduce health and safety risks in the home.

Grant Award to Develop Rapid Environmental Health Strike Team

Orange County Health Department was awarded grant funds of approximately $28,000 from the North Carolina Alliance of Public Health Agencies (NCAPHA) Strategic Initiatives Fund. These funds will be used to develop a rapid environmental health strike team. The strike team initiative will create a regionalized, scalable, and self-sufficient system to provide rapid environmental health services in disaster-affected areas of North Carolina.

Measles Symposium

Orange County Health Department hosted a Measles Symposium in May of 2025. In this event, public health and clinical experts from the Health Department, the UNC Special Pathogens Response Center, and the Communicable Disease Branch of the North Carolina Department of Health and Human Services presented information on measles including disease information, trends, and best practices. There was also a panel discussion with these experts to provide opportunities for symposium attendees to ask questions. A tabletop exercise was the final activity of the workshop to build on the clinical information shared in the presentations. During the tabletop discussion-based exercise, participants worked together to apply information learned, think through scenarios, and test ideas in a no-fault environment.

Cooking for Groups

Orange County Health Department partnered with Orange County Cooperative Extension to offer a “Cooking for Groups” class in May of 2025. The class was open to the public with the intent to teach food safety to community organizations who host food events that do not require a Health Department permit, such as community shared meals or potlucks and non-profit food sales events like BBQ dinners, fish fries, bake sales, and similar events. In addition to food safety instruction, participants received basic sanitation and safety supplies like bleach, food thermometers, and hair nets.

Street Medicine Pop-Up Event

A Street Medicine Pop-Up event for unhoused community members was conducted in July of 2025 and held at University Baptist Church in Chapel Hill. This effort was a partnership of multiple community partners including Orange County Housing, Orange County Emergency Services, Orange County Department of Social Services, Alliance Health and UNC’s Center for Excellence in Community Mental Health. During the event, individuals were connected to various resources, including medical and behavioral services, other health information, dental care, housing, and other services. Self-care kits, haircuts, and socks were also available at the event. Orange County Health Department conducted dental screenings and cleanings at the event.

Breastfeeding Designation and Award

The Town of Carrboro was officially designated in 2025 as a Breastfeeding Family Friendly Community by Breastfeed Orange. The proclamation states breastfeeding is a health equity concern, and various partners are committed to providing environments to support families through their breastfeeding journey. Read the proclamation by the Town of Carrboro.

Orange County Health Department received the NC Breastfeeding Coalition Family Friendly Clinic Award in 2016. Read more information about the Family Friendly Clinic Award.

Orange County Food Security Program

Orange County Cooperative Extension launched the Orange County Food Security Program in 2025 to coordinate and collaborate on food security challenges. Numerous community and regional partners have been included in this program. A major accomplishment of the group has been the development of an updated food resource guide. This guide is updated regularly and is available in multiple languages. This group also served as an important informational resource during the SNAP benefit interruption in the fall of 2025. Click here to access the food resource guide.

FitLot – Outdoor Fitness Parks

In August of 2025, Orange County Department on Aging held a ribbon cutting ceremony for the new FitLot, which is an outdoor exercise equipment area or park. The FitLot is located at the Seymour Senior Center in Chapel Hill and is open to people of all ages and mobility levels. This is the second outdoor fitness park of this type to be installed in the state of North Carolina.

Orange County Board of Health Projects

Screen Free Week

The Orange County Board of Health released a Resolution Addressing Social Media Use, Screen Time, and Youth Mental Health in support of Screen-Free Week during May 5-11, 2025. Screen time and social media use among youth have recently emerged as areas of public health concern, with the U.S. Surgeon General issuing an advisory about youth social media use in 2023.  A number of studies cited in the Board of Health resolution suggest that social media use can negatively impact youth mental health, brain development, sleep, and social development. These negative impacts may lead to lowered test scores, anxiety, depression, and even suicidal ideation. The resolution was signed in support of decreasing screen time, especially in school settings, and promoting the “Wait Until 8^th” initiative that suggests waiting until at least 8^th grade to provide children with smart phones and other devices. Information on “Wait Until 8^th” initiative, screen-free activities, and mental health materials was shared at multiple community events. Read the full Board of Health resolution.

Board of Health Resolution - Affordable Housing

In October 2025, the Orange County Board of Health released a six-page Resolution Promoting the Development of Adequate Affordable Housing, which proclaims “the lack of affordable housing in Orange County as a threat to public health.” The resolution states the county is facing a housing crisis, the lack of housing worsens an individual’s health and increases issues such as incarceration and healthcare costs. The Board of Health provided 14 recommendations for county and town government to include in their land use and zoning plans to address the lack of affordable housing. The Board of Health shared the resolution with the town councils of Carrboro, Chapel Hill, and Hillsborough, as well as the Orange County Board of County Commissioners. Read the full resolution.

Photovoice

The Orange County Board of Health sponsored a Photovoice project to learn from county residents about their experiences accessing healthcare. Participants took photographs that represented challenges they face when accessing healthcare and discussed the photos and their related experiences. Individuals from various backgrounds shared their stories, allowing the Board to hear from those who have experienced incarceration, lived unsheltered, and those with limited English proficiency. These stories are being used to shape service and outreach changes in the Health Department. The Board will continue to collect photographs and stories from community members in 2026. Click here to submit a photo.