Executive Summary

Vision Statement

To assess where we are, to know where we need to be, and to meet the needs of our community.

Leadership

The Person County Health Department coordinated the 2022 Community Health Assessment (CHA) process with a CHA Team and support from an independent consultant.  In larger counties, where community partners are more plentiful and not as frequently exhausted by service on multiple committees, it may be more feasible to establish both an advisory group and a work group for the CHA process.  However, this is not reality for most small, rural counties such as Person County.  Therefore, one CHA Team was formed that served simultaneously in advisory and working capacities.  

Collaborators

Collaboration between Person County Health Department, the Public Health Consultant, and local partners made this assessment possible.  Many partners spent numerous hours attending team meetings, collecting local data, promoting, and distributing both the initial community health survey and then later the priority setting survey, and assisting LeighAnn Creson, the Project Facilitator, in various ways.  A collective list of the key partners in the 2022 CHA process in Person County includes:

Contracted Services

Our county received support from Annika Pfaender, independent public health consultant, for the 2022 CHA.  In partnership with staff from the Person County Health Department, she assisted in the development of a community health survey instrument and conducted the survey analysis; gathered secondary data from public domain sources; compiled data provided by local sources; analyzed de-identified data provided by the local hospital; prepared a summary presentation of secondary and primary data findings to be disseminated as part of the prioritization process; and prepared this document.

Theoretical Framework/Model

The Ecological Model was used as a framework throughout the process of developing the 2022 Person County Community Health Assessment.  The Ecological Model addresses the interaction between, and interdependence of, factors within and across  all levels of a health issue. This model recognizes multiple levels of influence on health  behaviors, including individual factors, interpersonal factors, institutional and  organizational factors, community factors, and public policy factors all across the continuum of care.

Collaborative Process Summary

Locally, our approach to the community health needs assessment process is community-wide and multi-faceted.  Our county included community input and engagement through: (1) Partnership in conducting the CHA process; (2) Through primary data (survey) collection efforts;  (3) Through secondary data collected from community partners; (4) In the identification and prioritization of health issues. Community engagement will remain a focus as we move forward to the collaborative action planning phase of the community health improvement process.  Partners and stakeholders with current efforts or interests related to priority health issues will continue to be engaged. We also plan to collaborate with our partners to help assure programs and strategies in our community are developed and implemented with community members and partners.

The collaborative process began in March 2022 with the development of the community health survey. The CHA Team met through June and resumed meeting in October.  The prioritization process took place in November and December 2022 and this CHA report will be available to community partners and the public after March 6, 2023.  

Key Findings

Person County is a land-locked county located in the Piedmont Region of north-central NC and is part of the Durham-Chapel Hill Metropolitan Statistical Area.  As part of the metropolitan area, it is home to workers who often commute to lucrative jobs in Durham, Orange, and Wake counties.  It was home to an estimated 39,500 people in 2020 and is diverse in proportions similar to the state as a whole: 67% white, 25% black/African American, and 4% Hispanic. 

A noteworthy aspect of the Person County population is its age.  The median age in the county is 43.6 years, nearly five years “older” than the population of NC as a whole.  The population of citizens over the age of 65 is projected to grow 23% by 2050 while the total population of the county is projected to remain level.  It will be critical for the community to monitor the growth of this population to address its needs, since this segment of the population tends to consume health and human services at higher rates.

Although the economy of Person County includes a variety of jobs in electrical, textile, administrative, manufacturing, aerodynamics, food processing, aluminum, and paper products, 18% of the county’s workers are employed in retail trade, a low-paying sector with many part-time employees and limited benefits.  The average weekly wage across all sectors in 2021 was $930, $350 lower than the state average.  Despite the relatively lower weekly wages, median family and household incomes rose steadily between 2015 and 2020.  While unemployment increased abruptly in 2020 due to the Coronavirus (COVID-19) it had fallen to 4.1 by June 2022. The impacts of inflation, supply chain disruptions, and nationally rising housing prices are not yet reflected in the economic data examined as part of this CHA.

Despite an economy that is improving nationally and locally, poverty remains significant in Person County, especially among minorities and children.  The overall 100% poverty rate in Person County in 2020 was 16.3%, higher than in NC as a whole.  However, 23% of African American’s were living in poverty, the rate among American Indian/Alaska Natives was 38.4%, and the rate among Hispanic/Latinos was even higher at 58.4%.  Among children in the county under the age of 5, the poverty rate was 33% in 2020.

Poverty can diminish all aspects of quality of life including health.  The population in poverty is even more at risk for poor health outcomes if its members do not have health insurance.  In 2020, an estimated 12% of the Person County population between ages 0-64 lacked health insurance of any kind.  Children ages 0-18 fared better, with only 6% uninsured, due largely to increasing numbers of individuals enrolling in Medicaid and NC Health Choice. 

Even with health insurance coverage, the cost of healthcare remains a leading concern among Person County residents.  High costs and inadequate insurance coverage were the most common barriers reported by community health survey respondents who could not get needed dental care or prescription medications in the past year.  With healthcare provider-to-population ratios that are lower compared to NC, it is not surprising that the most common reason respondents couldn’t access necessary medical care was that it took too long to get an appointment.  The aging of the healthcare workforce will only exacerbate access issues: 23% of physicians and 40% of dentists in Person County were over the age of 65 in 2021.

Health in Person County

Life expectancy in Person County has not changed much in 30 years. For a person born in 2018-2020, the overall life expectancy was 75.9 years, compared to 75.5 years for a person born in 1990-1992.  The most significant improvement occurred among males, for whom life expectancy improved from 70.6 years in 1990-1992 to 72.9 years in 2018-2020. Unfortunately, life expectancy for females decreased from 80.4 years in 1990-1992 to 79.0 years in 2018-2020.

Comparison of Person County CHA health data over the past two decades has identified significant improvement in certain health parameters, such as the leading causes of death.  Since 2001-2005, mortality rates in the county have declined overall for seven leading causes of death.  However, mortality rates rose for unintentional injuries, diabetes, Alzheimer’s disease, kidney diseases, septicemia, and chronic liver disease and cirrhosis.  Among these causes of death, diabetes and kidney diseases are disproportionately fatal in the Person County African American community, where the 2016-2020 mortality rates were more than double the mortality rate for whites.  Despite the long-term decreases in mortality rates for heart disease, cancer, chronic lower respiratory diseases, suicide, and motor vehicle injuries, Person County mortality rates for those causes of death remained higher than the comparable state rates in 2016-2020. 

Among the lifestyle factors contributing to chronic diseases like heart disease, diabetes, and kidney diseases, overweight and obesity are perhaps the most important.  According to the CDC, average prevalence of adult obesity in the county from 2006 through 2019 was 25%.  This prevalence of adult overweight/obesity was corroborated by local data.  More than half (52%) of respondents to the 2022 Person County Community Health Survey self-reported having received a medical diagnosis of overweight/obesity, a higher proportion compared to the 2014 and 2018 surveys.  Respondents identified obesity/overweight as the sixth most important community health problem in 2022.  They also recognized lack of exercise and poor eating habits as important unhealthy behaviors in the Person County community.

Between 2001-2005 and 2016-2020, cancer mortality rates in Person County decreased for the four most common site-specific cancers: lung, colorectal, prostate and breast. Between 2001-2005 and 2016-2020 incidence rates decreased for lung, prostate, and colorectal cancer and increased for breast cancer. Among respondents to the 2022 Community Health Survey, cancer ranked first on the list of leading health concerns, with more than two-thirds of respondents selecting it from a list of 20 health problems.

While some measures of maternal and infant health in Person County have improved over time, such as the teen pregnancy rate, disparities remain an issue, and the county tends to fare poorly compared with North Carolina. While the pregnancy rate for teens (girls ages 15 through 19) fell by 64% between 2005 and 2020, the rate remains higher compared to the state average.  The frequency of high parity, short-interval, low-weight, and pre-term births in the county exceeded the state averages in 2020. Utilization of early prenatal care in Person County (68.5%) remains lower than the state average (73.1%) and has not improved significantly over time.  Just over 11% of births in 2020 were to mothers who smoked during pregnancy, higher than the state average of 7%.  The overall infant mortality rate in Person County increased from 7.4 deaths per 1,000 live births in 2012-2016 to 9.5 in 2016-2020. Most infant deaths in Person County occur among Black non-Hispanic residents.

Person County Populations at Risk for Poor Health Outcomes

The poor, the uninsured, minorities, and males in Person County are at greater risk for poor health outcomes than their wealthy, insured, white, and female counterparts.  Other vulnerable populations include people living in the rural parts of the county, especially those with limited transportation options.  At-risk populations associated specifically with the priority health problems selected in Person County will be discussed separately.

Person County Health Priorities

The Person County CHA Team used the results of extensive secondary data collection and analysis and a community health survey to establish community health priorities.  The contracted consultant presented the results, from both information gathering activities, to an invited audience of CHA Team members in October 2022.  The presentation was shared with collaborating team members at partner agencies, who then voted individually on their preferred, evidence-based priorities.  The CHA Team tabulated the results.

The following were established as Person County’s health priorities for the next four years 2023-2026):

1. Overweight & Obesity
2. Substance Abuse

Next Steps

Within six months of the completion of Person County’s CHA, a workgroup consisting of community partners will collaborate to develop a Community Health Improvement Plan (CHIP) for each of the two selected health priorities. CHIPs will focus on meeting the unmet needs of at-risk groups and will be aligned with Healthy North Carolina 2030 focus areas, as well as standards set forth by NC Local Health Department Accreditation and the Department of Health and Human Services/Division of Public Health Consolidated Agreement. They will include evidence-based multilevel interventions targeting health behavior, the physical environment, social and economic factors, and/or clinical care and be both short-term and long-term in nature.

Copies of this CHA report will be made available on the Person County Health Department website: go to www.personcountync.gov and find the Health Department under the Government tab/alphabetical listing. Hard copies will be available upon request by calling the Person County Health Department at 336-597-2204.

Priorities

Once the priority setting survey closed, the CHA Team reviewed the results and factored them into the ratings with everything else.  After lengthy discussion and careful consideration, the Team concluded that the priorities for the next four years would be Overweight/Obesity and Substance Abuse.