Every four years the Alexander County Health Department completes a comprehensive Community Health Assessment as required by the North Carolina Department of Health and Human Services. This assessment allows us to gather information used to better understand the community’s health concerns, document health status trends and catalyze developing strategies to assess the community health problems.

Community Health Assessments are the foundation for improving and promoting the health of community members. The role of the Community Health Assessment is to identify factors that affect the health of a population and to determine the availability of resources within the community to adequately address these factors. In 2018 the process consisted of three primary steps: survey the community, analyze the data collected, and select health priorities. While the Health Department is the lead agency in conducting the assessment, existing community partnerships are utilized throughout the process to ensure the evaluation truly reflects the community’s needs. The Healthy Alexandrians Task Force is commissioned with analyzing and determining health priorities for Alexander County. Healthy Alexandrians is comprised of a mixture of government agencies, private industry leaders, the non-profit community, and interested community members who are concerned with the ongoing health needs of our community. These individuals, along with the Alexander County Board of Health, examined the survey results and health data to make a final determination of health priorities for the next four years.

Statistical data presented in the report represents the most recent information available at the time the assessment was completed. Health survey results vary and represent the opinion of the person completing the survey.

VISION STATEMENT
The mission for the Alexander County Health Department is to promote, protect and ensure the health and well-being of all citizens of Alexander County. In the practice of public health, the health of the population is monitored and evaluated by examining key indicators such as leading causes of death, access to health care, and health trends such as physical activity.  Every four years, the Alexander County Health Department conducts a state-developed process known as the community health assessment (CHA). Findings from the CHA are used by the Health Department to lead strategic planning and to guide collaborative community action addressing identified priority issues. The CHA is also used to meet the requirements for state accreditation of local health departments.

The Alexander County 2018 Community Health Assessment is designed to:

• show the systematic collection, assembly, analysis, and dissemination of information about health in Alexander County
• evaluate the quality of life in Alexander County with an emphasis on health care
• identify trends in chronic diseases, causes of death, and high-risk behaviors; and
• define Alexander County’s health assets, needs, and priorities

LEADERSHIP AND PARTNERSHIP
The Alexander County Health Department guided this process using the Population Health Model. Alexander County Public Health is not the only party responsible for improved health outcomes in this community. Improving health is a collaborative process. With no hospital within Alexander County, the CHA is conducted by the Alexander County Health Department. However, the Health Department works in tangent with a variety of community agencies in providing care and services to residents of Alexander County.  The Alexander County Health Department did not receive support from a regional community health initiative or privately contracted vendor to conduct the 2018 CHA.

To prepare this Community Health Assessment, the Alexander County Health Department collaborated with representatives from Alexander County DSS, Alexander County School System, Alexander County Cooperative Extension, Alexander County Emergency Management, and citizens from the community. Once the Healthy Alexandrians Committee Members chose the focus areas, the Board of Health approved them.

2018 Healthy Alexandrians Committee Members
Alexander County DSS: Patricia Baker     
Alexander County Emergency Management: Russell Greene
Alexander County Schools: Jennifer Hefner, Nikki McClain
Citizens: Dale Clary, Melinda Sherrill
Alexander County Cooperative Extension: Der Holcomb
Alexander County Health Department: Billie Walker
2018 Board of Health Members
Dr. Jennifer Hull-Chair
Dr. Jeff Peal-Vice Chair
Janet Bowles
Macy Jones
Betty Long
Dr. Thomas Rider
Phillip Sprinkle
Scott Westmoreland, P.E.
Dr. Richard Williams
Larry Yoder

DATA COLLECTION
To build a comprehensive assessment, the Health Department utilized both primary (collected directly) and secondary (provided by other identified organizations) data sources to compile data.

• Primary data collection tool-the 2017-2018 Alexander County Community Health Assessment Survey distributed to the public in both paper and web-based formats from September 2017 until January 2018.
• Electronic and paper versions in both English and Spanish were used to facilitate broad participation.
• A link to the 2017-2018 Alexander County Community Health Assessment Survey was posted on the Alexander County Health Department website, Facebook page, and sent via email to all County employees and community partners. Paper versions were distributed at the Health Department and local community events and health fairs. Five hundred seven responses were collected through these formats, with a 95% completion rate.
• Secondary data gathered from local, state, and national sources were also collected from outside organizations and were used in assessing the severity of health issues in the county.

KEY FINDINGS
In February 2018, members of the Healthy Alexandrians Task Force reviewed indicators specific to the following seven areas:

• Chronic Diseases
• Substance Abuse
• Mental Health
• Access to Health Care
• Healthy Lifestyle Choices
• Leading Causes of Death
• Responsible Sexual Behavior

Members next reviewed the data obtained from the 2017-2018 Alexander County Community Health Assessment Survey and ranked them using the following criteria: severity, magnitude, urgency, and intervention effectiveness. Survey respondents made recommendations for the top ten health issues: cancer, obesity/overweight, heart disease, diabetes, depression/mental health, dental health, lack of physical activity, access to care, availability to healthy food, and Alzheimer’s disease.

HEALTH PRIORITIES
Participants of the final Priority Setting meeting in February 2018 made recommendations for the top three health issues to address in the next four years: Mental Health, Substance Abuse, and Healthy Lifestyles. The 2018 CHA Priorities were similar to the ones in 2014. The Healthy Alexandrians Task Force decided that these were still the most important and needed continued efforts. The next steps for each focus area are as follows:

Mental Health
• Use the grant to build a behavioral health program at the Alexander County Health Department
• Increase education programs for suicide prevention
• Increase public awareness of existing counseling resources for mental health
• Lobby for and seek additional funds for mental health care in the county

Substance Abuse
• Increase/maintain substance abuse prevention programs in Alexander County schools
• Create a public awareness/educational campaign to stress that substance abuse is an equal-opportunity disease and is a gateway to many risk-taking behaviors and chronic health problems
• Educate the public on proper disposal sites of unused and/or expired medication
• Use available grant funds to build harm reduction in response to the opioid crisis in the county
• Lobby for and seek additional funds for residents affected by substance abuse in the county

Healthy Lifestyles
• Create public awareness/prevention campaigns to combat high obesity, cancer, and heart disease rates
• Maintain partnerships with other local agencies with significant community outreach to encourage healthier lifestyles
• Synchronize CHA efforts with other strategic efforts in the city and county to establish and promote parks and recreational activities

2019-2022 ALEXANDER COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP)/STRATEGIC PLAN
Utilizing the data from the Community Health Improvement Process, a CHIP was developed in order to address the priority areas of concern. 

This Scorecard is being used to illustrate the priority health needs and efforts to address them utilizing the Results-Based Accountability/Scorecard process through the North Carolina Division of Public Health and Clear Impact.  More information is available at:

• Healthy North Carolina 2030
• Healthy North Carolina 2030 Scorecard
• North Carolina State Health Improvement Plan
• Clear Impact's Results-Based Accountability Resource Library 
• Clear Impact: The Results-Based Accountability Guide

For the 2014 Community Health Assessment, the focus group chose Mental Health, Substance Abuse, and Healthy Families, which includes diabetes, obesity, heart disease, etc. as the health priorities for the next four years. Very similar Community Priorities were chosen for the 2018 Community Health Assessment. Below is the work the Health Department has done in collaboration with other community agencies to address these needs: Mental Health, Substance Abuse & Healthy Lifestyles.

MENTAL HEALTH

The intentional self-harm (suicide) rate in Alexander County is currently reported at 19.5 deaths per 100,000 residents, a rate nearly double the state average and higher than any of our assigned peer counties. The Alexander County Health Department, in collaboration with Vaya Health, is working to combat the issues with mental health. Vaya Health is the managed care organization for Alexander County, and also serves 22 other counties. The Health Department houses a kiosk located in the lobby that is provided by Vaya Health and that patients can freely use. The kiosk allows users to take an anonymous patient health questionnaire and it will let them know if they have symptoms relatable to a number of mental illnesses. If the user does present with symptoms of mental illness, then the kiosk also has a phone attached that will allow them to call and set up a counseling appointment if needed. The kiosk sends monthly reports of the number of times it is used and the outcomes.                                                                                                                                                                                                                                                                                  

In December 2017 the Health Department again collaborated with Vaya Health to offer Mental Health First Aid Training. This course teaches participants the skills needed to respond and assist anyone who is exhibiting signs of mental illness and substance use. The class only allows 30 participants and 27 people from various backgrounds - including law enforcement and DSS - participated in the training. Another Mental Health First Aid Training was hosted in May of 2018 and this focused on how to appropriately respond to youth with behavior and mental health issues.

Connecting residents to mental health services has been a focus of the Health Department. In January of 2018 the Health Department received a grant to create an in-house behavioral health program. The Health Department is adding this program to increase services provided in the area and to decrease the ratio of residents per mental health providers.

SUBSTANCE ABUSE

 Prescription drug, illegal substance, tobacco and alcohol abuse
In 2017 President Donald Trump declared the opioid crisis a public health emergency. Alexander County is no exception to the national trend of opioid-related overdoses. In 2017 North Carolina Injury and Violence Prevention Branch released individualized county-based overdose data. The rate of unintentional overdose deaths was higher in Alexander County compared to the state and region.

The Alexander County Substance Abuse Task Force - consisting of public health, law enforcement, medical providers, school officials, mental health professionals, substance abuse treatment providers, and other professionals - has been an active group working to mitigate the opioid crisis in Alexander County. Alexander County also has a new Addiction Recovery Medical Services center. Dr. Bobby Kearney recently opened a new office in Taylorsville to help residents combat addiction through medical and mental health services. Dr. Kearney’s office offers in-house counseling to patients and their families. The Alexander County Sheriff’s Office houses a take back box for residents to dispose of old and unused medication properly. The Sheriff’s Office, in collaboration with the Health Department, has hosted several take-back events throughout the past four years.

               

EMS, local law enforcement and all fire stations have access and have been trained on naloxone use in the event of an overdose. The Lock Your Meds Campaign began in 2018 and the Health Department has helped distribute over 40 medication lockboxes free to residents. In January 2018, Alexander County EMS received a grant to start a Post-Overdose Response Team and the group will be working to build that team in the coming months.

The Health Department also continues to address tobacco use within our community. Health Department staff, to help reduce the number of persons using tobacco products locally, conduct policy development and education efforts. Alexander County has seen a reduction in the percentage of adult smokers since the 2014 Community Health Assessment from 26% in 2014 to 19% in 2018. However, there have been recent concerns both locally and nationally about the use of e-cigarettes or vaping devices such as JUUL among teens and young adults. Alexander County/Alexander Central High School has been in talks with the Region 4 Tobacco Cessation Consultant on implementing the CATCH My Breath® curriculum to reduce the e-cigarette rates.                                                  

HEALTHY LIFESTYLES

The Healthy Alexandrians Task Force had selected improving overall health of the population as the final health priority; we entitled this “Healthy Lifestyles”. Recently the Health Department has been able through new funding to hire a Health Educator. The Health Educator will be promoting health and wellness through classes in our school system and employment health fairs, as well as collaborating with local agencies. Alexander County has established a new certified Safe Kids Coalition. Representatives of the Health Department are active members of the Coalition. Safe Kids focuses on reducing child mortalities and injuries by educating families and the community on safety tips such as fire safety and poisoning prevention. The local daycares have received a Farm-to-Table grant and are promoting healthy eating habits to children. Alexander County Agricultural Extension Office recently hosted a Speedway to Healthy program through North Carolina A&T State University. Alexander County is also continuing its Farmers Market efforts. The county has also merged community resources at a vacant church. The church houses Shelter Home of Caldwell County-Alexander Branch, Communities in Schools, United Way-Alexander County and a new soup kitchen that offers healthy meals.

Maintaining moderate physical activity can reduce the development of obesity, diabetes, heart disease, certain cancers, and other chronic diseases. Rocky Face Park opened in 2012 and, since then, the park has offered new courses and activities including hiking, rock climbing, primitive backpacking, and geocaching. The Vertical Mile Challenge is very popular among residents of Alexander County.
The course is approximately a two-mile loop and, half a mile into the path, there is a 500-foot climb up the face of the mountain. Over a thousand people have completed the 1 Vertical Mile Challenge where participants must complete eight loops of the 2.2-mile trail, a total 17.6 miles or 1 vertical mile.
However, in 2016 Alexander County still has the lowest percentage in the state for a population with adequate access to locations for physical activity.