In 2020, New Hanover County Health and Human Services’ primary focus has been in response to the COVID-19 pandemic.  Public Health has played an intricate role in promoting and implementing preventative measures to reduce the spread of COVID-19.  Some measures include: free-COVID testing sites, contact tracing and case investigation, and coordinating vaccine distribution sites.  Due to the pandemic, the Community Health Improvement Plans (CHIPs) have been impacted due to state restrictions that required many partners and organizations to focus on their own response to COVID-19.  This year, Public Health adopted a new method called Results Based Accountability (RBA) to address the priority areas.  RBA is a decision-making process that incorporates the quality of life of a community as well as improves the performance of programs through utilizing data indicators.  In addition to incorporating this new process, Public Health has transitioned from paper-based system to the Clear Impact Scorecard, a web-based application that applies the RBA principles to help set up result statements, uses indicators from data sets, and sets performance measures.  The Scorecard is a living document that will change as the community priorities change and as progress is made.  This tool is to make it easy to see and get up to date information on results, data, partners and programs, and ways to measure success.

The following is progress that was made this year to address the identified top health priorities from the 2019 Community Health Assessment.  The top health priorities were Chronic Disease, Drug Misuse and Environmental Health Exposures. 

Chronic Disease Result Statement: All New Hanover County residents have equitable access to healthy foods.

Feast Down East (FDE): is a non-profit organization working to support and grow the local food system in Southeastern North Carolina. FDE operates the Local Motive Mobile Farmers Market Program which provides access to affordable, healthy, local foods to food insecure communities. In partnership with Wilmington Housing Authority (WHA), the Mobile Market operates as a pop-up market year round and accepts SNAP/EBT, debit/credit cards and cash as forms of payment. The Mobile Market also participates in the Fresh Bucks program for SNAP/EBT recipients. SNAP recipients receive a dollar-for-dollar match for benefits redeemed at the Mobile Farmers Market, for up to a total of $20 Fresh Bucks.  After a brief pause due to COVID-19, the Mobile Market was able to relaunch with COVID-19 safety measures, to ensure access for some of our most vulnerable during these unprecedented times.

Diabetes Self-Management Education and Support (DSMES): NHC Diabetes Community Educator worked with the Diabetes Smart program to become an American Diabetes Association (ADA) recognized site to offer Diabetes Self-Management Education and Support (DSMES) Services. This recognition was awarded March 10, 2020. DSMES is an evidence based approach to empowering people living with diabetes to navigate self-management decisions. DSMES is a cost effective program that helps improve health behaviors and health outcomes for people with diabetes.  The program received 17 referrals before COVID-19 changed our service operations.  Of those, five patients were enrolled in the program, completing 15 sessions.  Waiver 1135 allowed concessions for non-traditional telehealth services.  Diabetes education and self-management continue to be offered by the Community Diabetes Educator through virtual classes.  In addition, the Community Diabetes Educator has worked to expand the referral system to increase client participation.

Drug Misuse Result Statement: All New Hanover County residents live in communities with equitable access to substance use disorder services.

Opioid Poisonings and Awareness Media Campaign: A selected strategy for the 2019-2020 Healthy Communities’ grant cycle was to implement media and messaging campaigns that increased awareness of the risks of opioid poisoning, signs and symptoms of opioid overdose, where to access and how to administer naloxone in the event of an overdose.  The Health Promotion team developed a digital campaign that promoted New Hanover County's Opioid Navigation website, Health.NHCgov.com/opioids. Contextual targeting was utilized to put ads in front of people browsing content that included specified keywords related to opioid-based drugs such as: illegal drugs, heroin, harm reduction, treatment & recovery, naloxone, opioid poisoning, etc. The campaign originally ran from September 1-December 31, 2019 and resulted in 207,297 impressions (views).  Due to the high volume of utilization the Health Promotion Team decided to relaunch this same campaign for the 2020-2021 year starting from August 1, 2020 to May 29, 2021. As of December 31, 2020, the relaunched campaign has resulted in 261,732 impressions (views). Add data regarding # of reversals in NHC

The Medication Disposal Event: was held once this year since the spring event was cancelled due to COVID-19.  New Hanover Regional Medical Center partnered with New Hanover County Government (Public Health, Law Enforcement, Senior Resource Center, etc.) to host a medication take back event in October.  This event collected over 3680 pounds of unwanted medications. 

Tobacco- Free Media Campaign: Another selected strategy for the 2019-2020 Healthy Communities’ grant cycle was to implement evidence-based media messaging campaigns approved by the Tobacco Prevention and Control Branch to prevent the use of all tobacco products by young people. This strategy was again selected for the 2020-2021 Healthy Communities grant cycle. The digital campaign that the Health Promotion team elected to use was the Rethinkvape.org campaign. Contextual targeting was utilized to put ads in front of people browsing content that included specified keywords (i.e. vape, juul, ecig, vape juice, etc.). This campaign ran from September 11, 2019-May 31, 2020 and resulted in a total of 397,082 impressions (views). The decision was made to relaunch this campaign for the 2020-2021 year with the campaign set to run from August 1, 2020-May 29, 2021. As of December 31, 2020, the relaunched campaign has resulted in 230,296 impressions (views).

Tobacco and Vaping Policy Change New Smoking and Vaping Ordinance: On Monday, November 16, 2020, the New Hanover County Board of Commissioners voted to implement an ordinance mirroring a Health and Human Services Board rule prohibiting the use of combustible tobacco and e-cigarettes in New Hanover County, effective February 1, 2021. The ordinance aligns the expectations of vaping with traditional cigarette smoking in most public places, and protects residents from unwanted inhalation of second hand smoke and e-cigarette vapors. Areas where smoking and vaping will be prohibited include county, town and city vehicles, buildings, and grounds, and public places like restaurants, bars and entertainment venues.

New Hanover Community Child Protection Team Advocacy: The child protection team provided its annual report to the Board of County Commissioners via livestream television reaching thousands of New Hanover County residents.  It identified substance use as a prevalent contributing factor in child maltreatment resulting in: child fatalities (unsafe sleep practices), parental incarceration, infants born addicted to controlled substances, and neglected and unsupervised children.  Recommendations were submitted to the Board of Commissioners to activate advocacy for legislation to mandate oversight of medication providers to limit prescriptions for opiates and opioids.  They further requested advocacy for effective assessment and treatment services, including return of clinical services to face-face contact as COVID-19 impacts are lessened. This effort served as public service awareness as well as engaged local leaders in advocacy for heightened services.

Trillium Health Resources Co-Responder grant: In December 2020, Trillium partnered with New Hanover County Health and Human Services (NHC HHS) on a grant that will collaborate with Juvenile Justice, Police Departments, and New Hanover County Sheriff’s department in a program that embeds mental health professionals at the HHS building to respond to mental health and substance misuse situations.  HHS requested and received approval for two (2) full time therapists, one (1) care navigator, and one (1) peer support specialist.  Co-responders will be used in adult protective services, child protective services, and foster care situations, to provide intervention for families and individuals experiencing substance related crises.   

The Healing Place: In December 2020, New Hanover County approved $25 million to be spent towards constructing a peer-led residential drug and alcohol recovery facility.  The Healing Place will offer 100 beds to men and 100 beds to women seeking treatment for addiction.  It will be the only peer-led residential recovery program in Southeastern North Carolina to provide treatment to men and women at no costs to the individual.

Environmental Health Exposure: Result Statement:  All New Hanover County residents have access to reliable and accurate information regarding environmental health exposures in our community.

Per- and polyfluoroalkyl substances (PFAS) Research: Participated with Jane Hoppin and her team from the NC State Center for Human Health and the Environment to investigate biological presence of various PFAS compounds in human blood and urine.  https://superfund.ncsu.edu/

NHC Health Director sits on the Community Advisory Board of the NC PFAS Testing Network https://ncpfastnetwork.com/  The PFAS Testing Network is a statewide research collaboration to test for current levels of PFAS chemicals in drinking water and air samples across the state. The Network comprises Principal Investigators from NC State, Duke, UNC-Chapel Hill, UNC-Wilmington, UNC-Charlotte, ECU, and NC A&T who have received NC General Assembly funding through the NC Policy Collaboratory.  There are seven (7) testing teams that look at various aspects of PFAS impacts on our environmental flora and fauna, which potentially impacts humans.

NHC Health Director participates on the NC DEQ Community Advisory Group managing the work indicated in the NC Consent Order to Chemours Manufacturing to remediate and repair damage to surface, ground and aquifer water sources and prevent further degradation.

Continued local collaboration with CFPUA on monitoring finished water from their drinking water supply operations.  Continued monitoring of output of potentially harmful manufacturing effluent of formaldehyde and methyl bromide at county located facilities.

New Hanover County changes have not only been from the leading causes of death but also from the residents diagnosed with COVID-19.  The following graphs provide demographic data on New Hanover County residents who have been diagnosed with COVID-19.  As of March 1, 2021, New Hanover County had a total of 16,358 COVID-19 positive cases with 151 deaths associated with COVID-19. 

According to the NC State Center for Health Statistics, Cancer (all types) has remained New Hanover County’s leading cause of death.  During 2014- 2018, New Hanover County’s Cancer rate was 153.3 per 100,000 populations, a slight decline from 157.3 per 100,000 populations in 2013- 2017.  All Other Unintentional Injuries (which includes poisonings) climbed from 38.9 per 100,000 populations during 2013-2017 to 43.8 per 100,000 populations in 2014-2018. 

According to NC Detect data, there has been a noticeable increase in New Hanover County ED visits related to overdose and overdose deaths from 2019 to 2020, likely as a result of COVID-19.

2020 - Medication or Drug Overdose (ICD 9/10 or keywords)

• Syndrome Count: 674
• Total ED Visits: 80,879 (0.43%)

2019 - Medication or Drug Overdose (ICD 9/10 or keywords)

• Syndrome Count: 561

• Total ED Visits: 93,535 (0.60%)

2020 - Unintentional Medication or Drug Overdose (ICD 9/10)

• Syndrome Count: 348
• Total ED Visits: 80,879 (0.83%)

2019 - Unintentional Medication or Drug Overdose (ICD 9/10)

• Syndrome Count: 251
• Total ED Visits: 93,535 (0.27%)

According to the NC Injury and Violence Prevention Branch New Hanover County’s Unintentional Medication and Drug Overdose deaths was 29.2 per 100,000 population compared to NC’s deaths 18.5 per 100,000 population during 2015-2019. 

COVID-19

 In February 2020, New Hanover County, along with state and local partners, began monitoring the novel coronavirus (COVID-19) and preparing for potential community impact. The County developed a webpage, Health.NHCgov.com/Coronavirus, and established a call center in order to share information and resources so residents could keep up to date and learn how to prepare if local action was needed. On March 11th the World Health Organization declared the COVID-19 a global pandemic. A State of Emergency was then issued by New Hanover County March 20th, with measures put in place to reduce the risk of COVID-19. New Hanover County began prescreening residents experiencing COVID-19 symptoms on April 27th and expanded diagnostic testing for COVID-19 starting April 29th. In an effort to slow the spread of the virus in the community, contact tracing efforts began in full force. On October 5th, the first COVID-19 outreach testing event was held as part of New Hanover County's efforts to reach marginalized communities. A total of 19 outreach testing events took place throughout the community from October to December. On December 22nd, New Hanover County Public Health received its first shipment of the Moderna COVID-19 vaccine and began administering first doses to those in group Phase 1a of the COVID-19 vaccine plan.

Impacts of COVID-19

Like so many other communities, COVID-19 has impacted the health of many residents as well as impacted the economy.   According to Feeding America, the overall food insecurity rate for New Hanover County in 2018 was 14.1% and was projected to increase to 17.8% by 2020. Food insecurity in children is also projected to increase from 18.7% (2018) to 26% (2020). School aged children receive the bulk of their nutrition through school meals during the school year. These increases can be attributed to job loss and schools transitioning to remote learning from home, due to the global health pandemic.  NC DHHS implemented a program, P-EBT, to increase Food and Nutrition Services for those families with school age children to supplement loss of school lunches during school closures through the pandemic.  The P-EBT program from August 2020 to March 2021 has provided $11M of FNS benefits to those families in NHC with school age children. 

The Bureau of Labor Statistics reported an average unemployment rate of 3.6% in 2019 for New Hanover County. Unemployment rates peaked to 15.1% in April 2020 as a result of the shut down and stay at home orders put in place to slow the spread of COVID-19. Rates have had steady decrease during the second half of the year as restrictions have lifted, but have not reached pre-pandemic lows.

On November 30, 2020, The North Carolina Department of Commerce released the county tier designations for 2021. Each year, the NC Department of Commerce ranks all 100 counties according to their overall economic health. This is known as the economic distress ranking. Tier 1 counties are deemed the most economically distressed and Tier 3 counties are the least economically distressed. The three-tiered rankings are based on assessment of four economic factors: unemployment rate, median household income, population growth and assessed property value per capita. New Hanover County moved from a Tier 3 (least economically distressed) to a Tier 2. For New Hanover County, the county’s average unemployment rate from October 2019 through September 2020 was the primary driver impacting this change.

Racism as a Public Health Crisis

In response to the nationwide outcry and Black Lives Matter protests, the New Hanover County Government established an Office of Diversity and Equity on June 9, 2020, with a mission to promote an inclusive and fair work environment and build a culture and community where employees and residents are respected, valued and understood for their own identity. The new Chief Diversity and Equity Officer began August 25, 2020.  On July 13, 2020, the New Hanover County Board of Commissioners adopted a resolution declaring racism a public health crisis. The resolution acknowledged the adverse impact that racism has on health, housing, education and criminal justice for communities of color, with a promise to promote equity through policies approved by Commissioners. In addition, on July 13, 2020 by majority vote, New Hanover County Board of Commissioners approved changing the name of Hugh MacRae Park to Long Leaf Park. The name change became effective immediately. The park’s land was originally donated by Wilmington native Hugh MacRae, who is a controversial figure for his involvement in the 1898 Wilmington Massacre, which was a mass riot and insurrection carried out by white supremacists to overthrow the legitimately elected biracial government.

Sale of New Hanover Regional Medical Center to Novant Health

New Hanover County Board of Commissioners voted on October 5, 2020, approving the sale of New Hanover Regional Medical Center (NHRMC) to Novant Health, a North Carolina not-for-profit health system. The acquisition of NHRMC by Novant Health will expand the hospital’s relationship with UNC Health and UNC School of Medicine – which will enhance medical education already in place, expand a children’s clinical service-line partnership with UNC Children’s Hospital, and develop research clinical trials and population health studies programs. The net proceeds from this purchase, which include $1.5 billion from the sale and around $440 million in the hospital’s current net assets, will benefit the community – with the majority of proceeds, an estimated $1.25 billion, invested in the newly created New Hanover Community Endowment.

Reproductive Life Planning Education Class

The Health Promotion team facilitated the Reproductive Life Planning Education classes twice a month to help reduce the number of infants born with neonatal abstinence syndrome.  However, due to the COVID-19 gathering restrictions the classes have been paused until restrictions can be lifted. 

New Hanover DSMES program became ADA Recognized

The Community Diabetes Educator worked with the North Carolina Diabetes Smart program to become an American Diabetes Association (ADA) recognized site to offer Diabetes Self-Management Education and Support (DSMES) Services. This recognition was awarded March 10, 2020. DSMES is an evidence based approach to empowering people living with diabetes to navigate self-management decision. DSMES is a cost effective program that helps improve health behaviors and health outcomes for people with diabetes.  The program was inactive due to COVID-19 with restrictions limiting face to face interactions for five months. 

Youth Mental Health First Aid

New Hanover County Schools planned for all staff to complete the Youth Mental Health First Aid training during the 2020-2021 school year. However, due to COVID-19 and the transition to remote learning, this training was delayed, with plans to complete implementation by the end of the 2021-2022 school year. Youth Mental Health First Aid is designed to teach parents, family members, caregivers, teachers, school staff, peers, neighbors, health and human services workers, and other caring citizens how to help an adolescent (age 12-18) who is experiencing a mental health or addictions challenge or is in crisis. Youth Mental Health First Aid is primarily designed for adults who regularly interact with young people.