The Executive Summary can be found on pages 5-11 of the 2021 Avery County Community Health Assessment. 

Avery County 2021 Community Health Assessment Executive Summary

Community Results Statement

Our mission is to partner with local agencies to not only identify health needs of our community, but to also explore and develop possible solutions to address health concerns in order to work toward improving health for all residents.

Leadership for the Community Health Assessment Process

The Community Health Assessment team is comprised of many participants representing area agencies in Avery County, North Carolina. The purpose of this Community Health Assessment is to learn about the health status and quality of life concerns of Avery County residents, collaborate with citizens by soliciting input from the community, and to provide an overview of resources that exist for handling those concerns. This document is the result of collaboration between Toe River Health District, WNC Healthy Impact, and the Healthy Carolinians of Avery County Partnership.

Partnerships

A health department-led comprehensive Community Health Assessment (CHA) provides community insight into the health status of the county. Using surveys, focus groups, interviews, community members, local government and business leaders, and health professionals came together to identify and prioritize health issues.  Participating in the assessment process puts the county in a position to take the next steps in developing policy, environment, and system changes that support their concerns. Currently in Avery County there is a coalition to bring together all the organizations and individuals that are committed to improving health in the county. This group consists of motivated individuals who are advocates on behalf of a broad range of community members and can represent appropriately the concerns of various populations within the county. The limited resources available in the county demonstrates a need for a coalition who will take responsibility and provide leadership for promoting and supporting policy, systems and environmental change that support healthy eating, and increase physical activity and prevent tobacco use throughout the county to combat most chronic disease conditions.

Membership of Healthy Carolinians of Avery County Partnership

Regional/Contracted Services

Our county received support from WNC Healthy Impact, a partnership and coordinated process between hospitals, public health agencies, and key regional partners in western North Carolina working towards a vision of improved community health. We work together locally and regionally to assess health needs, develop collaborative plans, take action, and evaluate progress and impact.  This innovative regional effort is coordinated and supported by WNC Health Network. WNC Health Network is the alliance of stakeholders working together to improve health and healthcare in western North Carolina. Learn more at www.WNCHN.org.

Theoretical Framework/Model

WNC Health Network provides local hospitals and public health agencies with tools and support to collect, visualize, and respond to complex community health data through Results-Based Accountability™ (RBA). RBA is a disciplined, common-sense approach to thinking and acting with a focus on how people, agencies, and communities are better off for our efforts.

Collaborative Process Summary

Avery County’s collaborative process is supported on a regional level by WNC Healthy Impact (WNCHI).  Locally, our process is a community-wide and multi-faceted approach to completing the community health assessment and giving this information to the community.

The collaborative process includes input from the community as an important element of the community health assessment process. Our county included community input and engagement: (1) Through partnerships on conducting the health assessment process; (2) Through primary data collection efforts; (3) In the identification and prioritization of health issues. Community engagement is an ongoing focus for our CHA Leadership Team as we move forward to the collaborative action planning phase of the community health improvement process.  Partners and stakeholders with current efforts or interest related to priority health issues will continue to be engaged. We also plan to work together with our partners to help assure programs and strategies in our community are developed and implemented with community members and partners.

Phase 1 of the collaborative process began in January 2021 with the collection of community health data. For more details on this process see Chapter 1 – Community Health Assessment Process.

Key Findings

A community wide 75-questionnaire was conducted in the spring and summer of 2021 to give residents an opportunity to express concerns and opinions about the quality of life in Avery County. This included questions about the quality of life, economy, education, health, housing, physical activity, social issues, transportation, and COVID. Surveys were conducted by telephone by a trained interviewer and efforts were made to reach a representative sample of the population.   Self-administered surveys were also available online. A total of 225 Avery County surveys were analyzed: 200 via telephone interview and 25 via the publicly available weblink.   

Some of the major findings that the Healthy Carolinians of Avery County discussed in the prioritization process included the large proportion of respondents whose life has been negatively influenced by substance abuse.  Approximately 27% of respondents were classified as excessive drinkers and 12% reported using opioids in the past year, with or without a prescription.  Twenty percent of respondents reported more than seven days of poor mental health in the past month and almost 20% did not get needed mental health care or counseling in the past year. Sixty-five percent of Avery County respondents had calculated BMIs in the overweight or obese range and less than a quarter of respondents got the recommended amount of physical and strengthening activity in an average week.  Twenty percent of respondents reported current smoking, 12% used smokeless tobacco and 7% used vape products.

In additional to secondary data and survey collection, eleven (11) community stakeholders participated in an online key informant survey.  Individuals were asked to consider specific health issues, provide comments about social determinants of health, and evaluate the strengths and opportunities of the Avery County community. The graphic below displays a summary of their ranking of health topics in the community.

During monthly meetings, standards for the Community Health Assessment Process and Accreditation were discussed and reviewed for publication in the 2021 Community Health Assessment. Each member reviewed and approved of the Community Health Assessment Survey and Community Resource Directory included in the assessment. After the analysis was completed, qualitative and quantitative data findings were presented to the CHA team. The team reviewed the data and developed the top ten major health issues based upon statistical data and community survey results.  Based on findings from the community survey combined with secondary health data, in November 2021, Healthy Carolinians of Avery County members identified chief health concerns for the county.

1. Substance Abuse
2. Obesity Issues
3. Mental Health
4. Childhood Trauma
5. Food Insecurity
6. Poverty Issues
7. Housing Expenses
8. Language Barriers
9. Stigma
10. Effects of COVID-19

Health Priorities

In November 2021, Healthy Carolinians of Avery County along with the CHA Team members participated in a prioritization activity to determine the three leading health concerns to be addressed during this cycle. The worksheet asked that each of the ten concerns be ranked, to find the top three concerns for future action. The results from the prioritization process were reviewed and discussed at the meeting. Results of these worksheets were calculated to come up with the top three priorities, which are as follows:

1. Mental Health
2. Substance Abuse
3. Food and Nutrition

Next Steps

The 2021 CHA will be disseminated in a variety of ways. To begin, the document will be made available online at http://www.toeriverhealth.org.  Hard copies will also be available at the Health Department, local library, and printed upon request. The CHA Facilitator will present the CHA data during a Board of Health Meeting, Healthy Carolinians of Avery County steering committee meeting, Avery County Health Department staff meeting, and upon request.

Further steps will be taken including the development of a community health improvement plan based on the findings from the CHA. The CHA Facilitator will convene community members and partners interested in moving forward on the selected health priorities. Action teams will emerge from the selected health priorities and the teams will begin brainstorming evidence-based strategies. While much work has already been done to improve the health of our community’s residents, more work is left to do to ensure that Avery County is the healthiest place to live, learn, work, and play.

Collaborative action planning with hospitals and other community partners will result in the creation of a community-wide plan that outlines what will be aligned, supported and/or implemented to address the priority health issues identified through this assessment process. 

A key step in action plans will be to determine what is currently going on regarding the top health concerns, and what we would like to see going on regarding these health concerns.

The health partnership will create subcommittees for each health concern and these committees will work on creating collaborative action planning and implementation efforts. Upcoming meetings will be scheduled, and partners will be notified.  We will conduct a root cause analyzes and identify possible evidence-based strategies to tackle the health concerns during the action planning process. 

While much work has already been done to improve the health of our community’s residents, more work is left to do to ensure that Avery County is the healthiest place to live, learn, work, and play.

The 2021 Avery County Community Health Priorities are: 

1. Mental Health

2. Substance Abuse

3. Food and Nutrition