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2023 Transylvania County State of the County Health Report

Progress Made in 2023

Click on each program/strategy below to review progress and updates for 2023 under the "Progress Made in 2023" note tabs.

Mental Health

Substance Use


In addition, Transylvania County partnered with WNC Health Network and other counties in our region to support the "View From Here" social media campaign, which addresses the top three shared health priorities in our region (Substance Use, Mental Health, and Healthy Eating/Active Living), as well as COVID/Flu Vaccinations.

Significant/Notable Changes in Morbidity and Mortality

The following represent significant or notable morbidity and mortality changes in our community in 2023:

  • Transylvania County was ranked #19 in the state for overall health outcomes and health factors, down slightly from #18 in 2022. (Source: 2023 County Health Rankings, Robert Wood Johnson Foundation)
    • Fewer county residents reported being in poor or fair health (13% in 2023 compared to 18% in 2022).
    • Adult obesity has declined from 32% in 2022 to 29% in 2023. Transylvania residents have a healthier food environment, less physical inactivity, and more access to exercise opportunities.
    • Although rates of excessive drinking remain steady and higher than state and national rates, alcohol-impaired driving deaths are about half of the state and national rates.
  • Public health staff were notified of and investigated nearly 350 cases of communicable disease in 2023. (Source: 2023 Communicable Disease Report, Transylvania Public Health) Notable trends and data include the following:
    • Total numbers of sexually-transmitted diseases among Transylvania County residents increased slightly from 2022, but remain lower than the high in 2019 and much lower than state rates. (However, these data could be under-reported due to limited access to testing services in recent years caused by COVID-related interruptions.)
    • Staff initiated 190 rabies investigations in 2023, up from 146 in the previous year. No animals tested positive for rabies and 15 individuals started post-exposure prophylaxis.
    • Staff investigated several cases of tick-borne disease, including 6 Lyme disease and 5 Spotted Fever Rickettsiosis. No cases of encephalitis were reported in 2023.
    • A total of 3 cases of toxic shock syndrome were reported in 2023, including 2 cases of streptococcal TSS.
    • There were no cases of pertussis reported to public health for the first time in a decade. 
  • Overall cause of death data from the NC Center for Health Statistics is now available for the years 2017-2021. This data shows some notable trends compared to the data reported in the 2021 Community Health Assessment for years 2015-2019. (Source: 2023 County Health Data Book, North Carolina State Center for Health Statistics)
    • Cancer and heart disease continue to be the leading causes of death. Deaths from heart disease increased, but remain well below the state rates.
    • Trends are improving for all three causes of death where Transylvania County rates were higher than state rates in the 2015-2019 data. The death rate from chronic liver disease and cirrhosis and for all other unintentional injuries are now lower than the state rate. The number of deaths from suicide fell from 40 over 5 years to 33 over 5 years; the death rate decreased from 10.4 points higher than the state rate to only 3.9 points higher.
    • Deaths from chronic lower respiratory disease fell, but the age-adjusted rate increased slightly. It continues to remain lower than the state rate.
    • The number of deaths and age-adjusted death rates from Alzheimer's disease, diabetes, and nephritis all decreased.
    • Septicemia deaths were not included as a leading cause of death for 2016-2020. The county rate is increasing, but remains lower than the state rate. 
    • Deaths from COVID-19 were not included in the 2015-2019 data. In 2016-2020, the number of cases (14) was too small to be calculated as a rate. For 2017-2021, the county rate was about half of the state rate.


Emerging Issues Impacting Health Since Last CHA

The following are new or emerging health issues in our community in 2023 that were not identified as priorities in our CHA:

  • Environmental health staff are seeing increased numbers of repair requests for on-site wastewater (septic) systems. This is mostly due to failures of older systems as they age, systems being used for purposes other than their intended use (e.g. more water flow, more residents, commercial versus residential), and the overall number of systems that increases every year.

  • WIC caseloads have dropped to pre-COVID levels after the required return to in-person services, resulting in fewer women, infants, and children being served each quarter. However, breastfeeding rates among local WIC clients remain significantly higher than the state with support from the agency's Breastfeeding Peer Counselor.
  • Affordable workforce housing remains a concern for residents and local government. The City of Brevard is continuing to work on possible sites for development. Applications for new septic and well installation remain high, which is indicative of demand for new residential construction. However, properties in Transylvania County are becoming increasingly harder to evaluate and permit for on-site systems, as the "easy" sites have been built on already.

  • Traffic volume on major roadways in Transylvania County has increased, but remains lower than the state and nation. Changes to traffic patterns by the installation of roundabouts on main thoroughfares and bumpouts in downtown have increased safety and walkability, but have also caused concerns among local residents about expense, inconvenience, and the loss of parking spaces.


New/ Paused/ Discontinued Activities Since Last CHA

The following are new initiatives or changes in our community in 2023:

  • Transylvania Public Health transitioned its response to the COVID-19 pandemic into a routine part of public health activities. In response to testing and reporting changes at the national and state level, staff ended local data reporting and shifted away from case investigation activities. The agency offered COVID-19 vaccines in early 2023 with little uptake, and opted to not provide the 2023 single-strain vaccine due to distribution and sourcing requirements. COVID-19 vaccine records were integrated into North Carolina's regular vaccine registration system. TPH began resuming normal operations around clinical services and expanded outreach and education efforts to encourage client participation. WIC clients retuned to in-person services in fall 2023 and continued to receive additional benefits for fruits and vegetables.

  • CARE Coalition is assisting the county with the allocation process for national Opioid Settlement Funds. This includes coordinating the stategic planning process and developing recommendations based on local needs, best practices, impacts, and a cost-benefit analysis. CARE staff hosted a "Community Information Session" in November 2023 to share these recommendations with the public and local decision-makers. They presented the recommendations to the Board of Commissioners in December 2023 and have been available to answer questions from commissioners and county personnel as they determine the best use of the settlement funds.

  • TC STRONG hired its first full-time director and half-time support staff in early 2023. These staff, along with lead organization personnel and community volunteers, have shared information at community and school events; provided training for school staff, community members, and youth; facilitated small groups; and supported wellness clubs (Voice of the Students) in local middle and high schools, with an estimated reach of 10,000 total contacts. TC STRONG was selected as 1 of 15 teams across the state to participate in a suicide prevention initiative by Carolina Across 100 and the UNC Suicide Prevention Institute. In November, the collaborative was awarded a 3-year, $300,000 grant from Dogwood Health Trust to support mental health and wellness for staff and students attending out-of-school programs. This funding also expanded the half-time position into a full-time Training and Project Manager. 
  • Work continued on mental health support for all ages, dubbed "TREND 2.0" after a former mental health agency that served the county until the 1990s. Several meetings were held to begin projects around an interactive directory of mental health services, 

  • Transylvania Public Health continued to lead the regional Workforce Development Agreement Addredum, which provided legal training to local public health staff (including 13 from TPH); developed a Public Health Workforce Strategic Plan to support interest, training, and competitive compensation for public health jobs; and supported a regional public health communications campaign developed and disseminated through WNC Health Network.

  • CARE Coalition's partnership with the Transylvania County Sheriff's Office to provide counseling and re-entry support at the local detention center served 181 detainees in its first year of operations. This effort was highlighted in the 2023 Re-Entry Convening report from Appaclachia Funders Network, and staff have provided assistance to other counties around starting similar programs.


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