State of Rowan County's Health

Every three years the Rowan County Public Health Department conducts a comprehensive community health needs assessment (CHNA), which is a process that engages diverse agencies, providers, and individuals in identifying community assets, strengths, and areas for needed improvement. When conducting the 2021 CHNA, Healthy Rowan, a community coalition, served as the steering committee and was responsible for selecting the top three community health needs for the county. Each year that a CHNA is not conducted, all local health departments must complete the State of the County Health (SOTCH) Report.

This report is intended to:

• Heighten awareness about health issues relevant to Rowan County and North Carolina
• Bring attention to areas where policy and environmental changes, partnering initiatives, and resources would be helpful in creating a healthier and stronger community.
• Describe local efforts that impact local health issues and quality of life of our community.
• Identify common ground for joining together to solve community health issues and identify some of the local initiatives and partnerships that are working to address these issues.

The report also provides updated data and information specific to Rowan County mortality and morbidity rates, COVID-19, emerging issues, and new initiatives.

Communication with stakeholders and community members regarding the identified community health priorities, and progress to date, is vital to community health improvement. Following review by the Rowan County Board of Health, hard copies of the 2022 State of the County Health Report will be disseminated to the Healthy Rowan Coalition, and to target community locations.

Rowan County

Rowan County is located in Western North Carolina and is surrounded by Cabarrus, Davidson, Davie, Iredell, and Stanly counties. Rowan County is made up of approximately 511 square miles of land and 12 square miles of water. Rowan County shares its largest body of water, High Rock Lake, with Davidson County. The county consists of the 11 municipalities of China Grove, Cleveland, East Spencer, Faith, Gold Hill, Granite Quarry, Kannapolis, Landis, Rockwell, Salisbury, and Spencer. Salisbury, the seat of county government, is situated near Interstate 85, approximately 45 miles north of the city of Charlotte, NC, and 52 miles south of the city of Greensboro, NC.

Demographics and Trends

Rowan County’s population has consistently increased with a growth rate of 7.5% since 2011. This growth rate is much higher than that of the neighboring county, Davidson (4.7%), and significantly less than that of another neighboring county, Cabarrus (27.6%). According to the 2021 US Census Bureau estimates, the population of Rowan County is 148,150 with an estimated growth rate of 3.0% for 2020 - 2030.

While this continuing growth can often bring positive economic impacts to a community, extreme and rapid growth can negatively impact how agencies and organizations provide services to community members. Often vulnerable populations, such as persons with disabilities, limited English proficiency, children under 5, and persons over 65, are disproportionately affected by the change in community size.

Age

On trend, comparable to both peer counties and the State, the percentage of the population age 65 and older is growing. Between 2020 and 2040, the size of North Carolina’s population of 65 and older will increase from 1.7 to 2.7 million. By 2040, more than one in every five North Carolinians will be 65 or older, up from 16.9% in 2020.
 

Life Expectancy

The average life expectancy for persons born between 2017-2019 is 75.4 years. The new Healthy NC 2030 goal for life expectancy is to increase life expectancy for citizens to 82.0 years. Life expectancy in Rowan County is higher for women than men, 78.4 years vs. 72.5 years, respectively, and higher for White than African American citizens, at 75.7 years vs. 73.6 years, respectively, highlighting health disparities that persist within our community. Life expectancy is often used to gauge the overall health of the community and takes into account factors that influence health, such as the economy of the area, access to health services, and health behaviors.

2021 Priority Health Areas

During the 2021 community health needs assessment, community stakeholders and county residents selected substance use, mental health, and healthy lifestyles to be the areas of health that are at the forefront of program planning and public health initiatives. After the selection of priority areas, staff formed the Community Health Improvement Plan objectives to assist in directing the work that will take place in the community over the next several years.

By implementing the Collective Impact Model, Rowan County's health system, Novant Health, and the United Way of Rowan was able to also adopt these priority health areas to direct where they allocate community funding.

United Way of Rowan County

From 2020-2022 the United Way of Rowan County contributed $1,006,000 to mental health programming, $991,000 to substance use programming, and $495,000 to healthy lifestyle programming. This funding was distributed to local nonprofits that work in the priority health sectors. In the years 2023-2025, the United Way will distribute $1.8 million dollars to 15 non-profit agencies to carry out critical programs.

Novant Health Rowan Medical Center

Annually, Novant Health Rowan Medical Center allocates resources to community non-profits that work in addressing the three priority areas. In addition to the priority areas, Novant Health Rowan Medical Center also funded programs that:

• Increase access to healthcare, transportation, medication assistance, and medical home connection programs;
• Support safe & healthy neighborhoods;
• Expand safe & healthy housing opportunities for neighbors in need.

Substance Use 

H.O.P.E.

Rowan County H.O.P.E., formerly known as the Rowan County Post Overdose Response Team (PORT), rebranded in 2022 to reflect the comprehensive wrap-around services that they offer Rowan County residents. This team is charged with:

• Responding to overdoses;
• Facilitating Narcan Administration trainings;
• Facilitating harm reduction and community resilience education;
• Distributing Narcan to community organizations and community residents;
• Maintaining a comprehensive referral network of wrap-around services;
• Substance use and overdose data collection;
• Certified Peer Support Services;
• and Implementing Harm Reduction services.

In 2022, 903 overdoses were reported to Emergency Services. Between August and September, there was a sharp decrease in overdoses, followed by a drastic increase between October and December. H.O.P.E distributed 680 doses of Narcan to community organizations and community members.

Support Regional Harm Reduction Initiatives

In partnership with Cabarrus Health Alliance’s (CHA) Syringe Service Program (SSP), and due to the lack of this type of harm reduction service currently being offered in Rowan County, we are able to refer local citizens to our neighboring county for this service. Currently, about 75% of CHA’s SSP clients are from Rowan County. Through this much-needed service, our residents are able to receive information on how to stop the spread of communicable diseases, in addition to being tested for Hep A, B, and C, HIV, as well as STIs. Local citizens can access clean supplies, sharps containers, forms of birth control, Narcan, and other resources. As a part of this partnership, Rowan County Health Department has purchased supplies for CHA’s SSP through our Healthy Communities Grant, which is funded through the state.

Medication Drop Boxes

Rowan County H.O.P.E. and Health Promotion Department works with community organizations and community members to reduce the risk of prescription medications falling into the wrong hands. One method of substance use prevention is the collection of prescription medications by utilizing medication drop boxes throughout the county. Currently, there are 17 medication drop boxes in the county where residents can dispose of unused or unwanted prescriptions. The public health department, Novant Health Rowan Medical Center, Center for Prevention Services, and YSUP Rowan all participate in medication take-back events hosted throughout the year. During these take-back events, staff and community partners provide education regarding safe medication storage and disposal alternatives. In 2021, 2,104.25 pounds of medications was collected through medication drop boxes and medication take-back events.

Geographic Information System

H.O.P.E. utilizes ArcGIS for Opioid Epidemic Outreach, which can be used to inventory prevention and treatment resources, communicate the severity of the epidemic, and promote resources to those in need. ArcGIS is a geographical information system (GIS) software that allows handling and analyzing data by visualizing geographical statistics through layer-building maps, like climate data or trade flows. Our community paramedic responds to overdose incidents and puts this information into an overdose dashboard on ArcGIS, which in turn, maps the hotspots of opioid overdoses in Rowan County. This dashboard and overdose hotspot map is publicly accessible and is updated daily. Understanding trends and associated demographics over time is important to the community, decision-makers, and local partners targeting prevention and intervention efforts.

Mental Health

Homelessness

Homelessness has become a steadily increasing concern in Rowan County. Rowan Helping Ministries, a local non-profit, is working to address homelessness and several other social and economic struggles that come with displacement. During the week of January 25th, 2023, Rowan Helping Ministries partnered with the U.S. Department of Housing and Urban Development to conduct an annual Point in Time Count, to grasp a better understanding of how many individuals in Rowan are experiencing homelessness. The count revealed that 238 people in Rowan were experiencing homelessness. Of these 238 individuals, 155 were staying in shelters or transitional housing and the remaining 83 were unsheltered. In addition to providing shelter to Rowan County residents, Rowan Helping Ministries offers a variety of services to assist individuals in getting back on their feet.

July 1st-June 30th 2022 Rowan Helping Ministries Community Impact

Upcoming Solutions

Rowan Helping Ministries will be expanding their reach with the development of additional housing, through a project called "Miracles on the Horizon". This expansion will consist of:

• Eagle’s Nest III: two transitional housing buildings, adding 12 apartments to the current 10 units now in Eagle’s Nest I and II.
• Five new duplexes to serve as permanent supportive housing for individuals, couples, and families, who are transitioning from homelessness.
• Renovation of the R.B. Miller building to create space for case management, counseling, and a Peer Living Room.

LivingWorks Trainings

LivingWorks ASIST (Applied Suicide Intervention Skills Training) is a two-day, face-to-face workshop, that teaches a community how to prevent suicides by recognizing signs, providing skilled interventions, and developing a safety plan, in order to keep a person alive until medical help can be offered. This evidence-based program has been in existence for 35 years and is offered throughout the world. As of fall 2022, Rowan County Public Health Department has provided two separate ASIST training sessions for community members. Currently, 33 individuals/agencies have completed this program.

Rowan County Public Health Department offered the LivingWorks Faith program to faith-based organizations. LivingWorks Faith is a 5–6-hour online learning program featuring information, simulations, and stories from over a dozen faith leaders and suicide survivors. The program blends scriptural wisdom and proven best practices, which are designed for all Christian ministry leaders, who want to effectively prevent, intervene, and minister around the issue of suicide, within their congregations. At the end of the 2022 calendar year, there were seven local churches that were trained in LivingWorks Faith. Those churches currently have a staff member onsite to address suicide prevention.

Rowan County Public Health Department also purchased LivingWorks Start for the YSUP (Youth Substance Use Prevention) Rowan Youth Council. LivingWorks Start is a 90-minute, online training, for anyone 13 and older, that teaches participants to recognize when someone is thinking about suicide. From there, the training then goes on to train youth on how to connect that individual to help and the support they need.

Into the Light Walk

In 2022 Rowan County United Way hosted their annual Into the Light Walk. The purpose of this walk is to remember those who have passed due to suicide and to acknowledge the struggles that many of our community member experience when it comes to mental health. Health Department staff provided information to community members on the various mental health trainings and resources that Rowan County Public Health has to offer.

Healthy Lifestyles

CATCH My Breath

As the popularity of vaping has increased over the last several years, the requests for vaping prevention education have also increased. In efforts to reduce youth vaping and tobacco use, Rowan County Public Health purchased the CATCH My Breath curriculum for all eleven middle schools in the Rowan-Salisbury School System. CATCH My Breath is a peer-reviewed, evidence-based, e-cigarette prevention program that provides materials for parents, teachers, and health professionals to educate students about the risks of using vaping products.

Rowan Moves

In efforts to encourage community members to increase their physical activity, Healthy Rowan has developed Rowan Moves, an online community-wide physical activity campaign. Rowan Moves is comprised of a variety of features to encourage community members to increase their physical activity.

• A step calculator to convert various activities and time spent participating in those activities into steps,
• A fitness calendar to record days active,
• Community activity groups,
• A Spotify playlist,
• Get Movin’ maps to explore Rowan County parks and recreation locations,
• and FitBit compatibility.

In addition to the features above, Rowan Moves works cohesively with two other evidence-based interventions that Healthy Rowan implements, Daily Mile and Lifestyle Medicine. Teachers, who participate in the Daily Mile, can log their class’s steps on the platform. Rowan Moves is also HIPAA compliant, allowing care providers who participate in Lifestyle Medicine to create private groups for the patients who have received exercise prescriptions. Providers can then view, in real-time, the patient's progress as they increase their activity.

Food Pharmacy

Upon completion of the 2021 CHNA, it was unveiled that in Rowan County, 16% of residents are food insecure and 23.9% of children live in food insecure homes. According to the NC Child Health Report Card, 52% of Rowan County children live in poverty or low-income households. Often these households must choose between food or other more pressing expenses such as shelter. In addition, it is not just about getting more food, it's about the right food.

Rowan County Public Health and Healthy Rowan staff developed a Mobile Food Pharmacy program with the support of community partners. The Mobile Food Pharmacy uses food as medicine to help families buy and make healthier meals at home, reduce the consumption of foods eaten outside the home, and improve both physical and mental health. In addition, this program provides healthy food at a subsidized cost and helps families address healthcare, housing, and transportation needs. All of these have seen a drastic increase in cost since the beginning of the COVID-19 pandemic. All aspects of the Mobile Food Pharmacy were designed in a way to alleviate some of the compounding health and financial stress of participants since the beginning of the pandemic.

Some of the successes of the Mobile Food Pharmacy include:

• Received the 2022 GlaxoSmithKline Foundation Child Health Recognition Award.
• Increased the number of Lifestyle Medicine providers in Rowan County from one to seven.
• Combined, five participants have lost over 40 pounds.
• Food Pharmacy participants have reported having an increase in confidence in their ability to prepare healthy meals for themselves and their families, understanding which foods are healthy, and increasing their consumption of fruits and vegetables.

Social Determinants of Health

While health is largely influenced by the choices we make, individual health and well-being are also directly shaped by the vitality of the places where we live, the educational opportunities available, and our economic prospects. These vital conditions for health impact our ability to make healthy choices where we live, learn, work, play, and pray.

Addressing Social Determinants of Health

• Data and surveillance: Embed a consistent SDOH approach to standardization, collection, analysis, and dissemination of data across the agency.
• Evaluation and evidence building: Advance evaluation and build evidence for strategies that address SDOH to reduce disparities and promote health equity.
• Partnerships and collaboration: Establish criteria, actionable steps, and strategies for partnerships, collaborations, and relationships that result in improved health outcomes over the long term.
• Community engagement: Foster meaningful, sustained community engagement across all phases of intervention planning and implementation.
• Infrastructure and capacity: Strengthen and sustain infrastructure such as workforce, training, and access to financial resources required to address SDOH and reduce health disparities.
• Policy and law: Identify evidence, tools, and resources to enhance communication about policies that affect SDOH with policymakers and other stakeholders.

Rowan County Public Health and its partners use the approach mentioned above to address the Social Determinants of Health in our community. Evidence of successfully implementing this approach is displayed through the measures that are highlighted in green.

Rowan community organizations and agencies are working to address the socioeconomic factors that have worsened since 2021.

Mortality

Rates of morbidity, mortality, and emergency hospitalization can be reduced if citizens have the ability to receive health screenings, attend routine medical examinations, and receive proper vaccinations. Morbidity refers to how many people are ill, while mortality refers to how many people have died from a health condition. Knowing the diseases and disorderes that cause the most illnesses and death – and who is the most affected – is important in understanding how to prevent and treat these diseases and disorders to improve the health of Rowan County.

Below are the leading causes of death in Rowan County related to chronic diseases – cancer, heart disease, stroke, kidney disease, emphysema, and diabetes. Most chronic diseases can be prevented by eating well, being physically active, avoiding tobacco and excessive drinking, and getting regular health screenings.

2016-2020 NC Resident Race/Ethnicity and Sex-Specific Age-Adjusted Death Rate Disparities

• Both African American and White males have higher rates of death associated with cancer, specifically colon, rectum, and anus cancers, as well as trachea, bronchus, and lung cancers.
• African American males and females have higher rates of cerebrovascular disease (Stroke).
• Both African Americans and White females have higher rates of death associated with Alzheimer's disease than their male counterparts.
• African American men die from heart disease at twice the rate of African American females.
• Suicide is highest among white males. All other races, and sexes are too small a number to calculate a county-wide rate.
• White males have the highest rate of unintentional injuries compared to women and all other races.

Morbidity

Morbidity is another term for an illness or medical condition, oftentimes referring to having a disease or a symptom of the disease. Some examples of common morbidities are obesity, heart disease, and even mental health conditions, such as anxiety and depression. Having more than one morbidity at a time is referred to as co-morbidity. An example of a co-morbidity would be that individuals with arthritis often also, experience obesity and heart disease. Morbidities are NOT deaths. By using the measurement of prevalence, there is the ability to determine how common morbidities are within a specific population.

NC 2030

In 1990, the North Carolina Department of Health and Human Services (NCDHHS) released the first Healthy North Carolina goals, which are a set of health indicators with ten-year targets designed to guide the efforts of the state and local governments to improve health and well-being. These indicators and targets allow NC DHHS, local health departments, and community partners across the state to work together to address concerning health outcomes. In recent years, public health has been focused on improving populations' access to healthy opportunities by focusing on health equity. Traditionally, discussions have only focused on clinical healthcare, even though individual-level care only accounts for 20% of health outcomes. Healthy behaviors and the ability for individuals to make healthy decisions begin with families and communities, that have access to needed resources. Health is primarily determined by social and economic factors which consists of where we grow up, live, work, and age. Some of the social, economic, behavioral, and environmental factors, that affect health include:

• safety of families and communities,
• exposure to environmental contaminants in air, water, and soil,
• quality of housing and education,
• access to transportation and healthy food, availability of employment opportunities and a living wage, exposure to, and use of, alcohol, tobacco, and other drugs,
• and opportunities for physical activity.

Below is the NC 2030 Health indicator data from the state of North Carolina in 2020, 2030 target, and how Rowan County compares in regard to these indicators. By addressing the selected priority community health concerns: substance use, mental health, and healthy lifestyles, we can address the majority of the health indicators listed below.

COVID-19 continued to be a major health issue for Rowan County residents throughout 2022, peaking mid-January, with a 31% countywide positivity rate. Rowan County Public Health combatted the spread of COVID-19, through partnerships with Mako Medical Laboratories, Logistics Health Incorporated, and StarMed Healthcare, to ensure residents had access to free testing.

Disparities in life expectancy between race and ethnicities existed prior to the pandemic. However, COVID-19 did shine a light on the inequities that continue to exist in communities and pushed national and local public health workforces to overcome barriers to care. Rowan County Public Health was able to understand the various barriers that different historically marginalized populations experience in regard to access to care. Below is a list of barriers that Rowan County was able to overcome with COVID-19 outreach efforts.

• Language barriers
• Mistrust in healthcare/government
• Lack of public transportation in rural parts of the county needed to get tested and vaccinated.
• Lack of broadband needed to access up-to-date vaccine and testing information.
• Dedicated COVID-19 information phone lines, with help available in English and Spanish.

Outreach efforts included COVID-19 testing and vaccination events at Rowan County Public Libraries, Hispanic supermarkets, Livingstone College (Historically Black College and University), and other community events aimed at underserved populations within Rowan County. In addition to these events, thousands of at-home rapid antigen testing kits were, and are still, being distributed throughout Rowan County. Events were held at central locations, that allowed for public transportation access, as well as, various times throughout the day to promote equitable access for citizens.

The National Center for Health Statistic's Provisional Life Expectancy Estimates report for 2021 states that: "Excess deaths due to COVID-19, and other causes in 2020 and 2021, led to an overall decline in life expectancy between 2019 and 2021 of 2.7 years for the total population, 3.1 years for males, and 2.3 years for females." This report also mentions that the U.S. life expectancy at birth for 2021 (76.1), is the lowest it has been since 1996. COVID-19 was the leading cause of the negative change in life expectancy for the total population, as well as the leading cause of negative change for the Black/African American and non-Hispanic White populations. It can be expected that over the course of time, we will continue to see the overall health impacts of the COVID-19 pandemic.

The Rowan County Public Health Department began vaccinating residents with the COVID-19 vaccine in December 2020. Approximately 44% of all Rowan County residents have received the primary series, and 48% of residents have received at least one dose of the vaccine. Rowan County Public Health continues to offer vaccination appointments every week and is, at this time, one of only a few facilities in the county still administering the primary Moderna and Pfizer vaccination series, as well as, the Bivalent boosters.

The COVID-19 Pandemic is not over, it continues to affect many people every day. Rowan County is committed to continuing to provide resources such as vaccinations, at-home COVID-19 testing kits, as well as masks to residents free of charge. In addition to printed resources such as billboards and infographic cards, Rowan County Public Health has a dedicated COVID Hotline that continues to be monitored Monday - Friday, 8am until 5pm; all in English and Spanish. The COVID-19 team at the Rowan County Public Health Department stands at the ready to assist residents with questions and concerns they may have about COVID-19.

9.

Injury and Violence Prevention

 Injury and Violence Prevention is an emerging health issue because of the health impacts that can be associated with experiencing injury or violence. These health impacts can present in short-term effects such as missing school or work and long-term effects such as chronic illnesses. Examples of injury and violence that impact community health include:

• Overdoses
• Suicides
• Homicides
• Adverse Childhood Experiences (ACEs)
• Violence Crimes

Gun Violence

The City of Salisbury has seen a rise in violent crime in recent years which could be attributed to a number of factors including:

• Childhood trauma
• Mental Health Crisis
• Parental absenteeism and family disruption
• Lack of youth engagement in conventional activities
• Diminished economic opportunities
• Lack of community participation
• Socially disorganized neighborhood(s)

The graph to the right displays firearm-related crimes reported by the Salisbury Police Department from the years 2018 through 2022. Unfortunately since 2019, discharging a firearm, shooting into occupied property, and assault with a firearm have increased drastically. These numbers, coupled with gun violence being named a public health concern, has resulted in two different gun violence prevention initiatives beginning work in Salisbury.

Suicide and Self-Inflicted Injury

Like many other communities across North Carolina, Rowan County has been impacted by the number of attempted and completed suicides. There has been a slight decrease in the reported amount of attempted suicides since 2020. However, with mental health being one of the counties priority health areas, we can assume that the number of individuals who experience suicidal ideations/behaviors and participate in self-harm behaviors is much higher. The Substance Abuse and Mental Health Services Administration defines suicidal behavior as, "a spectrum of activities related to thoughts and behaviors that include suicidal thinking, suicide attempts, and completed suicide." According to the CDC, Americans with higher-than-average rates of suicide are:

• Non-Hispanic American Indian/Alaska Native and non-Hispanic White populations.
• Veterans People who live in rural areas,
• Workers in certain industries and occupations like mining and construction.
• Young people who identify as lesbian, gay, or bisexual have higher rates of suicidal thoughts and behavior compared to their peers who identify as heterosexual.

Sexually Transmitted Diseases

A communicable disease is an infectious or transmissible disease spread from person to person, such as influenza, chlamydia, and COVID-19, or spread from animal to person, such as rabies. Rowan County Public Health serves to prevent the spread of infectious diseases through community education, disease surveillance, and outbreak response. Nationally and across North Carolina, there has been an increase in communicable diseases, especially sexually transmitted infections (STIs) in the last five years (2018-2022), with an uptick in 2021-22. STIs are spread primarily via sexual contact through oral, vaginal, and anal sex and by bodily fluids and blood. In Rowan County we have seen the same upward trend with STIs becoming an emerging issue.

Chlamydia & Gonorrhea

In the last five years, chlamydia and gonorrhea cases and rates have increased. Compared to neighboring counties and the U.S., Rowan County has a significant infection rate. 2021 data reveals Rowan County ranked among the top 20 counties in NC with high rates (per 100,000 people) of chlamydia and gonorrhea. STIs are disproportionately affecting Black men and women at a faster rate than their counterparts. Individuals between the ages of 20-24 years old have seen higher diagnoses compared to any other age group. Rowan County Public Health is committed to addressing these high rates, through education, screening, and exploring grant and partnership opportunities.

Syphilis

An emerging issue nationally is syphilis. Diagnoses have been on the rise especially in newborns (known as congenital syphilis). Statewide, there have been increases in new primary/secondary, early latent, and late/unknown syphilis diagnoses across all regions. Women were up to 1.8 times higher to be diagnosed with syphilis – in all stages – in 2022 compared to men in the last three years. In Rowan County, there is an increase in syphilis cases (primary, secondary, latent, and tertiary). Rowan County Public Health is monitoring cases and working with partnering organizations to ensure individuals who may be at-risk are getting educated and tested.

HIV/AIDS

Since the height of the AIDS Epidemic, diagnoses have been decreasing nationwide. However, North Carolina remains in the top 15 states with the highest HIV diagnoses. In 2022, Rowan County had HIV/AIDS (all stages) diagnoses double compared to the last five years (2018-2022). Previously, most diagnoses were found among persons 50-65 years old, but there was a shift with the largest percentage of HIV diagnoses among persons 30-34 and 40-44 years old across the regions. Rowan County Public Healthis committed to ending the HIV Epidemic through education, testing, and treatment. The county has multiple Disease Intervention Specialists (DIS) who contact and notify people diagnosed with HIV or AIDS and notify potentially exposed partners. Persons diagnosed with HIV or AIDS are referred to partnering organizations, like Novant Health to ensure individuals receive the appropriate care and remain in care.

Childhood Development

Education

Rowan-Salisbury School System (RSSS) is the public school system in Rowan County and is comprised of 33 schools and 17,703 students. From 2021-2022, 24 schools have been designated as low-performing, while from 2020-2021, 15 schools were designated as being low-performing. Because the number of low-performing is greater than 50% of the schools in the county, RSSS has been considered a low-performing district. North Carolina Statute required these low-performing schools and districts to create an improvement plan that addresses the necessary growth.

In comparison to the State of North Carolina reading and math performances, RSSS performs at a lower proficiency in grade level and college and career readiness. The National Assessment of Educational Progress reported that all school districts across the state have seen a decline in reading and math skills as a result of the disruption that COVID-19 presented to classroom teaching. North Carolina was among 30 other states and jurisdictions that saw statistically significant declines in both fourth and eighth-grade reaching scores.

Not only did COVID-19 impact how students were obtaining their education and their test scores, but it also impacted student attendance. During 2021-2022, 34.04% of Rowan-Salisbury School students experienced Chronic Absenteeism, meaning that these students are chronically absent from school.

According to this percentage, this means that 6,024 students were chronically absent. The percentage of students who are chronically absent increased by 7.12 percent from the 2020-2021 school year. A student is deemed as being chronically absent when they are enrolled in a North Carolina public school for at least 10 school days, and the total number of absences is equal to, or greater than, 10 percent of the total number of days that the student has been enrolled at any school during a given school year.

Trauma

Adverse Childhood Experiences or ACEs are potentially traumatic events that occur during one’s childhood (0-17 years old). ACEs can be described as experiencing violence, abuse, or neglect in a child’s household, witnessing violence in the home or community, or having a family member attempt, or die by, suicide. In addition to traumatic events experienced in home, the environment can also lead to ACEs. Examples of environmental influences are, substance use problems, mental health problems, and instability due to divorce or household members being incarcerated. ACEs can negatively impact child development. Such events can affect a child’s attention span, decision-making skills, and learning, due to their stress-response systems. The more ACEs a child experiences, the higher the risk of them suffering from chronic health conditions such as heart disease and diabetes, poor academic achievement, behavioral problems, and substance use later in adulthood.

Lack of Access to Basic Needs

According to the 2022 Rowan County Child Data Card published each year by NC Child, in 2020, 52.1% of children in Rowan were living in poor or low-income homes. This percentage is an increase from 2019, 50.4%. Due to the COVID-19 pandemic and the continuous rise in inflation, we can assume that there has been an increase in the number of poor or low-income homes since 2020.

Hep C Treatment Program

Hepatitis C (Hep C) is increasing rapidly among young adults across the nation. There have been new reports of Chronic Hepatitis C across multiple generations. New Hepatitis cases are 4 times as high compared to ten years ago. In Rowan County, individuals between the ages of 30-39 had higher acute and chronic Hepatitis C rates (per 100,000 persons) and diagnoses compared to previous years.

Hepatitis C care and treatment remains extremely expensive, especially for uninsured patients costing upwards of $80,000 for an 8- or 12-week regime. To alleviate the financial pressure, Rowan County Public Health has partnered with the Community Care Clinic of Rowan County (CCC) to utilize NC’s CHAMP Program to better refer, test, treat, and follow up with patients. The CCC refers clients to the Health Department for Hep C and other STDs screening. The results are then sent back to CCC where they will follow up with clients and apply for a patient assistance program to provide Hep C treatment for positive Hep C patients at no cost. In addition, a Nurse Practitioner at the Health Department has completed Hep C treatment training and begun treating patients within the clinic.

North Carolina Breast and Cervical Cancer Control Program (NC BCCCP)

Rowan County Public Health now offers the North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) which provides free or low-cost breast and cervical cancer screenings to eligible women.

Offered Services

• Cervical cancer screenings (Pap tests, HPV tests)
• Clinical breast exams
• Screening mammograms
• Diagnostic procedures, as indicated (diagnostic mammograms, ultrasounds, colposcopies, breast and cervical biopsies)
• Medical consultations

Eligibility

• Women who are uninsured or underinsured;
• Without Medicare Part B or Medicaid;
• Between ages 40 - 64 for breast screening services and 21 - 64 for cervical screening services;
• Have a household income below 250% of the federal poverty level.

Breast and Cervical Cancer Medicaid (BCCM) pays for treatment for NC BCCCP patients, who are diagnosed with breast or cervical cancer. To be eligible to apply for BCCM, it is preferable that a patient be referred and enrolled in NC BCCCP, prior to being diagnosed with breast and/or cervical cancer. However, patients may be eligible to apply for BCCM after diagnosis of breast and/or cervical cancer (if they meet all other NC BCCCP eligibility criteria). Rowan County Public Health partners with CCC to identify eligible patients for a shared care model. Patients are referred and receive appropriate BCCCP Care at no cost.

Lifestyle Medicine

More than 80% of chronic conditions such as diabetes, heart disease, stroke, and arthritis, could be avoided through the adoption of healthy lifestyle recommendations. Unfortunately, it has been well documented that current medical education does not include lifestyle medicine training. In addition, doctors have cited inadequate confidence and lack of knowledge and skills as major barriers to counseling patients about lifestyle intervention. To address this challenge, the Healthy Rowan Coalition provided funding for local healthcare providers to complete the American College of Lifestyle Medicine Core Competencies Course. The completion of this coursework has, and will continue to build internal and external capacity, through staff training within our local healthcare facilities. It will offer patients evidence-based self-care strategies around the 6 pillars of Lifestyle Medicine:

• nutrition
• physical activity
• substance use
• stress
• sleep
• healthy relationships

Specifically, two Nurse Practitioners, Public Health Nursing Supervisor, and the Women's Infant and Children’s (WIC) Director from Rowan County Public Health, two Nurse Practitioners from Salisbury Pediatrics, and a Medical Provider from the Community Care Clinic of Rowan completed the training. In addition, the Public Health Nursing Supervisor went on to complete the American Board of Lifestyle Medicine Certification to become a Certified Lifestyle Medicine Diplomat. This certification represents mastery of lifestyle medicine concepts and a commitment toward lifelong learning and system integration in this practice area.

The Core Competencies coursework covers 30 AMA credits in Lifestyle Medicine practice and integration and sets an unprecedented standard for healthcare in Rowan County. Core competencies are defined by a blue-ribbon panel of representatives from the American Academy of Physicians, American Medical Association, American College of Physicians, and others.

As of December 2022, all three clinics have instituted Lifestyle Medicine assessments and prescriptions. In addition, patients from Community Care Clinic are referred to the Stanford Model Chronic Disease Self-Management Program and receive a physical activity resources handout. The handout identifies opportunities to be active in Rowan County such as local parks and organizations (i.e. YMCA, Salisbury Pedal Factory) offering facilities, programs, and/or classes.

Gun Violence Prevention

Salisbury Cease-Fire

In the summer of 2019, the Salisbury NAACP and Salisbury Police Department began partnering together on a local initiative, Salisbury Cease Fire, to address the gun-related assaults that were increasing. The initiative encourages youth and adults to end gun violence by using data to address gun violence in specific areas. This model also uses partnerships with community stakeholders to serve as violence de-escalators to minimize potentially violent situations between related groups. The Salisbury Cease Fire program receives assistance from Salisbury Police Department crime analysts who provide real-time and up-to-date data on violent crime hot spots within the city limits.

Cure Violence Global

Cure Violent Global (CVG) is a violence prevention model that looks at gun violence as a public health issue. This evidence-based model addresses violence using the same methodology as epidemic-reversal strategies, essentially viewing violence as a virus that needs to be cured. In order to "cure violence" this model detects and interrupts potentially violent situations, identifies and changes the thinking and behavior of those most likely to engage in violence, and changes group norms that support and perpetuate the use of violence. CVG’s identified neighborhoods that have a high prevalence of violent crimes, or clusters. The model uses professionals, similar to Peer Support Specialists, who are culturally sensitive and credible messengers to interrupt the continuation of violent behaviors and change community norms around the use of violence.

To date, CVG has conducted a week-long assessment in Salisbury and will determine if our community will support a comprehensive violence prevention initiative.