The three public health priorities from Davie County Health and Human Services - Division of Public Health (DCHHS-DPH) 2017 Community Health Assessment have been addressed, in a variety of ways, over the past four years. Those priority areas include drug misuse and abuse prevention, chronic disease management, and access to affordable care. Since our last Community Health Assessment (CHA) was in 2017, our most recent CHIP is also from 2017. From the 2017 CHA we developed two Action Plans, which made up our CHIP. One action plan centered on Substance Abuse and the other on Physical Activity and Nutrition. 

DCHHS-DPH has completed or is in the process of working on the following:

• Partnership with Project Lazarus to address drug overdoes deaths, with a docus on perscirption drug overdoes
• Creation of a Community Response Team (CRT) in partnership with Division of Social Services, law enforcement, EMS, and the detention center. Through this team, those who use drugs, and family and loved ones to those who use drugs, can receive the support they need, from any agency that can help.
• Partnering with Kintegra Family Medicine, a Federally Qualified Health Center (FQHC) to provide in-house adult primary care and adult and pediatric behavioral health care, at our new Government Center facility
• Partnership with Healthy Davie of the Davie Community Foundation. The Healthy Davie initiative was comprised of thirty-nine organizations and agencies working collaboratively to improve the lives of all Davie County citizens. This action plan included two initiatives:
  •  The School Walking Program. 
  • The Local Body Mass Index Study.
• Work to manage chronic disease in Davie County was done through other initiatives and programs, such as:
  • Tobacco cessation media campaign
  • Senior Services education program
  • COVID-19 prevention efforts. 

At the time of this report, we don’t yet have local data pertaining to morbidity and mortality for 2021. Using data from the NC State Center for Health Statistics, there are some trends over time that can be observed. Although there is some overlap in the data sets, we will compare data from 2013-2017 and data from 2016 – 2020. Please note that “rates presented here utilize the National Center for Health Statistics Bridged population estimates. Population estimates are periodically modified based on the best available information. Therefore, rates presented in this report may vary over time as revised population estimates become available.” (NC State Center for Health Statistics) 

Source: Atrium Health Wake Forest Baptist

Since our last Community Health Assessment (CHA) in 2017, we have seen new Public Health concerns emerge. In March of 2020, we saw our first case of COVID-19. Cases grew slowly at first, but suddenly there was need for testing and a call center to answer the community’s questions, as best we could. Much of the important daily work of the Public Health Division shifted to accommodate the concerns of the community surrounding the emerging virus. Thus far in the pandemic, we have seen two spikes in cases, one peaking in January of 2021 and the other peaking in September of 2021. Much of the COVID-19 related work has been the handling of outbreaks and clusters in daycares, schools, and skilled nursing facilities.  

COVID-19 has had a broad impact on the community at large. Many of the programs and organizations that support the low-income population or other historically marginalized populations (HMPs) have struggled to serve their clients in the county through the COVID-19 pandemic. Food pantries, low-income medical clinics including the Health Department clinic, pharmacies, dental clinics, faith-based organizations, transportation services, benefit services such as the WIC department and many other programs providing basic services were forced to close or limit hours due to the pandemic. Many individuals lost their jobs or had their work hours limited, resulting in economic challenges. When daycares closed or limited hours, this resulted in parents needing to stay home from work due to limited child care. Working and receiving healthcare and other basic needs also became a challenge due to transportation services being limited. Those with substance use issues had a hard time accessing treatment during the pandemic. While telehealth visits were beneficial to many, they presented as a road block to many others without computers or reliable wi-fi and those experiencing homelessness. Additional strain was felt by low-income individuals, particularly those working for hourly wages. Those without paid sick time, who work in close quarters with others, experienced additional challenges due to COVID-19. With increased social isolation there has been an increase in mental health challenges as well as an increase in domestic violence cases. The impact on mental health has been far reaching, but school age children in particular continue to experience worsened mental illness due to factors created by the pandemic.  

In late December of 2020, the first COVID-19 vaccines were provided to residents of Davie County through drive-thru clinics at the Division of Public Health. The operations of the Division shifted to accommodate the vaccine clinics which were held two times a week. At some clinics, nearly 2,000 vaccines were given. After demand decreased, we used additional contracted staff from the state to shift to vaccinating in-house.  

We are beginning to see how COVID-19 will be managed over the long-term. But, many of the negative effects seem to be long-term as well. Many have lost loved ones to the virus and an estimated 1 in 5 people have “long COVID” symptoms. Additionally, cases continue and new variants continue to emerge. 

The social and economic impacts of COVID-19 have been felt by the community. Concerns about poor mental health, access to healthcare, and transportation, have all been worsened by the pandemic. Mental health in particular was worsened due to social isolation, uncertainty, and economic challenges, among other factors.  

Since our last Community Health Assessment in 2017, we have worked on substance use issues, cancer awareness, and COVID mitigation and education. There have been opioid education brochures created and shared with partners to share with their clients, a skin cancer presentation at the senior center and a substance presentation at a school. Presentations on vaccines, nutrition, and heart health have been conducted at the Senior Center. We have done opioid media messaging, including the development of high-quality videos which have been shown in detention centers. Opioid education cards have been developed and disseminated. We have assembled the Community Response Team (CRT) in partnership with the detention center, social services, and EMS. The CRT works to support substance involved individuals and their families with challenges they may be facing. Their services are broad and range from Narcan dissemination and education to helping an individual to obtain a form of identification. We have developed bike/pedestrian plan with Davie Recreation and Parks to meet active transport goals. In 2021, we worked with iHeartMedia to launch a Every Try Counts tobacco cessation campaign, in which ads were seen 1.5 million times by residents of the county, encouraging them to quit smoking. We held an over-the-counter (OTC) medication giveaway and provided flyers and in-person education to drive-thru participants. We have done COVID-19 media messaging and COVID-19 education to Chamber of Commerce, manufacturing facilities, local schools, and the local detention center. For one year, we operated a 24/7 COVID Call Center, staffed by nurses and public health professionals. In the call center we conducted and later managed case investigation and contact tracing, answered questions about the virus, gave information about testing, quarantine guidance, travel guidance, and did data analysis, among several other tasks. After business hours, the line rolled over to a cell phone which an on-call nurse answered. We worked with the local nonprofit transportation agency to secure no-cost transportation to vaccination sites and have marketed this service. We have done outreach to churches, media companies, neighborhood groups, and other faith-based groups to educate about the COVID-19 vaccination. Specifically, nurses from the Division of Public Health have provided COVID-19 vaccinations every week at TheBridge in Cooleemee as well as at the Storehouse for Jesus. The Division of Public Health has also begun a program, guided by the North Carolina Department of Health and Human Services, called ‘Advancing Equity’ in which disparities due to racial, ethnic, and socioeconomic factors, will be addressed over the coming years. 

We are currently in the planning stages of conducting the 2022 CHA. Two DCHHS-DPH staff plan to attend training in results-based accountability in January of 2023.