We made the following progress on our Community Health Improvement Plan (CHIP) in 2020:

• Adopted Results-Based Accountability
• Transitioned CHIP from paper-based to web-based documents
• Set up results, indicators, programs, and performance measures in Clear Impact Scorecard
• Linked to the HNC 2030 Scorecard to create greater awareness of population accountability
• Created the Union County Healthy Advisory Coalition to utilize the cooperative strength of community partners to identify overall health, quality of life and health equity issues, and support work to address those issues in Union County
• Despite COVID-19 restrictions, the Behavioral Health Collaborative continued to serve students and families in our schools 
• Continued Mental Health and Tobacco prevention and educational messaging via social media platforms

Some of our CHIP programs were paused due to COVID-19 (see below).

There were no updates to the local morbidity and mortality rates since the last CHA report, as the most recent figures were pulled for the CHA. The COVID-19 impacts on deaths in our county can be viewed here: https://ucgov.info/covid19-dashboard-desktop. The % case mortality from COVID-19 in Union County is 0.95 %. This is lower than most counties in our region and the state, which is at 1.32%.

The following are some emerging issues since writing our 2019 CHA report:

• COVID19 related impacts on community mental health
  • School and social structure disruption and impact on social support norms
  • Financial and economic hardship on individuals and families due to workforce closures, layoffs and work reductions
  • Substance use disorder impacts on individuals and families resulting from COVID and related coping & behavioral actions
  • Suicide as a result of the above. (although I’m not sure if data demonstrates an increase in suicide over the pandemic(?))
  • Impact of COVID related stress on tobacco, alcohol use and dietary habits.
  • Physical Activity and nutrition impacts on chronic diseases resulting from less focus on healthy lifestyles and behaviors during the stress and life disruption from COVID.
• Possible increased chronic disease due to delays in routine preventive care
• Possible decrease in dental health due to delays in preventive dental care and treatment
• Access to safe water for homes with poor well water quality
• Continued attention on health disparities and health equity
• Complexity of inmate health care and costs

New Initiatives

Public Health Department COVID-19 Response

Contact Tracing

Beginning in March 2020, Union County Public Health provided lab testing guidance for community providers, COVID-19 case investigation and subsequent contact tracing, issued isolation and quarantine orders and education related to these orders and advised multiple employers in the county on containment and mitigation efforts related to COVID-19.  The Health Director and Communicable Disease team advised first responders, LTC facilities, schools and child care centers on management of COVID-19 occupational and community exposures.  Public Health established an IC structure in March 2020 to ensure that our scope of operations met the needs of the community.  The PH EOC provided operational guidance to the Union County Emergency Operations Center during the pandemic. 

Vaccination Clinic for COVID
Union County Public Health started offering COVID-19 vaccinations to the public on January 7, 2021. There have also been many educational opportunities offered to our community regarding the vaccine to clarify misinformation. Atrium Health Union & Union County Public Schools have been valuable community partners in our vaccination efforts, joining in to assist in Mass Vaccination events and working diligently to provide vaccinations quickly and efficiently. Other local retail pharmacies started providing vaccinations in March to assist vaccinating more Union County citizens. The State of North Carolina, through the Division of Public Health, established the Vaccination Phases and Guidelines, along with the Priority Groups, which we continue to follow.  Our Public Health and Community Support and Outreach Division were also following the State’s recommended guidelines to reach Historically Marginalized Populations (HMP) with additional outreach efforts and off-site clinics. Partnering with local churches, the City of Monroe, local non-profits and civic groups, we continue to be successful in our efforts to reach, educate and assist those minority groups in obtaining vaccinations. Collaboration with local businesses and industry to vaccinate their workforces are on-going and have proven to strengthen partnerships. Group homes, non-profits and many medical facilities across the county have also utilized our agency for their vaccinations.    

Environmental Health COVID-19 Response

In response to the identification of COVID-19 in North Carolina, the Environmental Health Division mobilized and adapted to provide a coordinated response to the pandemic as it impacted Union County. While the community spread of the disease increased, Environmental Health Specialists (EHS) assisted with the implementation of Executive Orders issued by the Governor. This included closure of some facilities or operational changes to others. We conducted outbreak investigations of congregate living facilities with the communicable disease nursing team and provided guidance on disease prevention practices, cleaning and disinfection procedures and building ventilation systems. We continue to conduct COVID-19 risk assessments at the start of all facility inspections with a focus on minimizing disease spread through preventive measures, identification of symptomatic employees and proper quarantine measures. Citizen complaints related to COVID-19 and associated Executive Orders are investigated by the environmental health team.

Clean Water for Carolina Kids Program

This program is led by the nonprofit research institute RTI International, with program partners including: the North Carolina Division of Public Health, the North Carolina Division of Child Development and Early Education, the North Carolina Public Health Laboratory, NC Child, and the Duke Environmental Law and Policy Clinic. Because of the potential for lead in water and the harm lead exposure causes children, program partners advocated for an updated North Carolina rule that requires all licensed child care centers to test for lead at locations where water is used for drinking or food preparation. The rule (15A NCAC 18A .2816 of the North Carolina Rules Governing the Sanitation of Child Care Centers) addresses lead poisoning hazards in child care centers. As part of this preventative program, environmental health staff provide guidance, technical information and follow-up water testing. In cases where high concentrations of lead are found in water taps, corrective action is taken to remediate the hazard.

UNC-Chapel Hill Superfund Research Program

The Environmental Health Division is partnering with the University of North Carolina-Chapel Hill Superfund Research Program and Clean Water for North Carolina on a multi-faceted well water outreach project. Environmental justice factors will be used to identify focus areas of Union County that may have higher environmental burdens and vulnerable populations. Engineering research to identify improved well construction practices and develop lower-cost treatment options for arsenic and co-contaminants is being conducted. This research will be used to develop tools to improve public health practices and educate decision makers on future land development options.

Union County Safe Kids and Communities 

In partnership with the Safe Kids/Safe Communities Organization, Environmental Health and other agencies will work to reduce the number of injuries or deaths resulting from poison-related incidents in children by providing education materials on poison prevention and Operation Medicine Drop to child care facilities, parents or guardians in Union County. In an effort to reduce injuries or deaths related to swimming pool safety, Environmental Health Specialists will distribute pool safety materials at community pools during inspection visits.

Other Initiatives

Food Council

During the onset of COVID-19, the Division Director for Community Support and Outreach (CSO) at Union County Human Services Agency was assigned by the North Carolina Emergency Operation Center (EOC) the responsibility to be the feeding coordinator for the County. One component of this job was to coordinate food resources, determine food needs, and to address gaps. The Division Director for CSO contacted food pantries, nonprofits, churches, schools, and restaurants to obtain this information. During this process, it became apparent that there was a lack of coordination, communication, and collaboration amongst all of these entities. In an effort to address these issues, the Union County Food Council was formed in May 2020. 

Over the last 9 months, the Food Council worked to developed infrastructure, specifically vision, mission, by-laws, website, and logo. The vision for the Food Council of Union County is a thriving food system from the farm to the kitchen table, which encompasses healthy lifestyles, access to nutritious food, and an economically prosperous community for all Union County residents. The mission of the Food Council is to create a healthy and sustainable food community that involves all Union County residents in a collaborative effort by providing educational resources that address wellness and nutrition, developing supportive relationships between agricultural producers, vendors, and consumers, and advocating for all residents of Union County by bringing every voice to the table. The council connects every aspect of Union County's food system; from farmers to producers and all the way to consumers and collaborates with nonprofit organizations, faith based organizations, government agencies, and universities improve the local food system and share resources with the community. Over the next year, the Executive Committee is focused on increasing membership and forming a 501c3.

Healthy Union Advisory Coalition

The Healthy Union Advisory Coalition (HUAC) was created to utilize the cooperative strength of community partners to identify overall health, quality of life and health equity issues, and support work to address those issues in Union County. In addition, the HUAC was created to ensure that the community continues to work on the identified priority areas in the Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP), identify and/or support additional priority areas as they arise, and to provide the ongoing structure to develop future CHA and CHIPs. The infrastructure of the HUAC and Executive Committee were developed in 2020, along with guiding principles, mission, board structure, and HUAC job description for coalition members. The HUAC and the HUAC Executive Committee each met one time in 2020. Over the next year, some of the goals for the HUAC is to to identify all community initiatives, programs, and committees that are currently working on CHIP focus areas, review the CHIP and determine whether there are strategies and measurements that need to be added to the CHIP, and develop subcommittees if needed to work on focus area strategies.

Paused initiatives

Health Equity Committee

During 2019, the Health Equity Committee provided educational workshops during meetings. Due to decreased attendance and interaction during meetings, the leadership committee met during early 2020 and unanimously agreed to refocus the committee focus on access to care issues. The revamped Health Equity Collaboration meeting was scheduled to meet on 3/25/20, but this was cancelled due to COVID-19. Due to limited Health Department resources during COVID, the committee was put on hold. Our goal is to re-evaluate this in the next 3-6 months and determine how this committee fits in with the Healthy Union Adivisory Coalition needs. 

Tobacco Ordinance

In January 2020, the Human Services Agency Board approved an updated Tobacco Ordinance, making the use of tobacco products prohibited on County grounds, buildings and county vehicles. A phased timeline was developed in early March, with the ultimate goal of obtaining approval from the BOCC during a meeting in May and implementing the policy in January 2021. Unfortunately, due to COVID and issues/concerns related to this, the Tobacco Ordinance was put on hold. We hope to revisit this in the Spring/Summer of 2021 with a goal of implementing in July 2022. 

Tobacco Awareness and Partnership with Union County Public Schools

One of Union County's  Healthy Communities Strategies is to increase compliance of the NC 100% tobacco-free schools’ law by partnering with youth, parents and school personnel to educate about dangers of tobacco use and new and emerging tobacco products. To address how we can educate students and parents and be impactful within the schools, representatives from Union County Human Services met with Carleen Crawford (Region 4 Tobacco Director), two Union County Public Schools (UCPS) Nurse Supervisors, andUCPS Substance Use Supervisoron met several times at the end of 2019 and the first few months of 2020. Several initiatives were in development phases, including updating the UCPS core curriculum to include e-cigarette education, bringing in a student speaker in the fall to speak at all the county middle schools, implementing several parents forums to provide information about the impact of e-cigarettes on teens, and developing a teen alliance with Wingate University and UCPS. Unfortunately, due to COVID and lack of resources, these were all put on hold in 2020. Our hope is to implement some of these in 2021-2022 school year. 

Minority Diabetes Initiative

In October 2019, Union County Human Services Agency entered into a MOA with the Cabarrus Health Alliance to bring a new minority diabetes program called Journey to a Healthier Me to Union County. We started our first cohort with employees at Union County Human Services Agency in early Feb 2020, with the goal of launching this into the community in the Spring 2020.  Unfortunately, due to COVID, this program was put on hold. We hope to reinitiate this program during Spring 2021.