Executive Summary Mission - Vision Statement – Core Values

Scotland County Health Department’s Mission Statement: is to promote quality health through education, disease prevention and control, preparedness, and environmental protection. Our Vision Statement: to have healthy communities and healthy environments. Our Core Values: integrity, excellence, collaboration, innovation, and respect. Values reflect principles that our department displays as we interact with coworkers, agency partners, the community, businesses, and the public. 

Acknowledgements - Leadership, Partnerships, Collaborations

Scotland County Health Department and Scotland Health Care System would like to thank all those who volunteered their time and effort toward planning, developing, and completing the Scotland County Community Health Needs Assessment 2022 (CHNA). Special acknowledgment is given to the Community Health Assessment Core Work Group and the Community Health Advisory Board (CHAB) for their invaluable contributions and time to this body of work.  The (Scotland County) Community Health Advisory Board, Core Work Group, and community members are also recognized for their time and consideration in analyzing this assessment data to help determine our priority areas and create action plans delineating the focus and direction for Scotland County Health Department and Scotland Health Care System.  

We’d like to especially thank all staff, agencies, community volunteers and the Community Health Advisory Board who helped provide valuable input along with distributing and gathering the surveys county-wide.

The Community Assessment Core Work Group, the Scotland County Community Health Advisory Board, and members from a variety of organizations and collaborations, along with our local hospital - Scotland Health Care System, are listed under the Acknowledgements heading of the  Community Health Assessment along with our 2022 Board of Health members.

This document process began in April 2022 for planning purposes and was completed in March 2023. It is hoped the work of these individuals, separately and in committee, will serve to enhance health and community services, promote healthy lifestyles and a healthy environment in Scotland County. 

Partnerships and Number of Partners The Scotland County CHNA team was comprised of leaders from Public Health, our Health Care System, City and County Government, community organizations (Veterans Services, Partners In Ministry, NC Works, Mt. Calvary Center for Leadership Development, etc), our public school system and local educational institutions (UNCP, St. Andrews University, RCC), Behavioral Healthcare Providers, media, as well as community members, therefore representing the broad interests of the community.

Theoretical Model A community health needs assessment is a process by which community members gain an understanding of the health, concerns, and health care systems of the community by identifying, collecting, analyzing, and disseminating information on community assets, strengths, resources and needs. There are four basic steps to the assessment process:

• Determine the health status of the community
• Assess risk factors associated with identified health problems
• Identify the health care resources available in our community to promote action directed toward the identified problems
• Establish health priorities and the appropriate interventions

Scotland County’s Community Health Assessment uses a population health model. Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners or any other defined group. The health outcomes of such groups are of relevance to policy makers in both the public and private sectors. The Healthy North Carolina 2030: A Path toward Health project and the NC State Health Improvement Plan 2022 – was developed as a common set of public health indicators and targets for North Carolina over the next decade to improve the health and well-being of all people in North Carolina.

Methodology, Collaborative Process Summary Every three years, local health departments across the State of North Carolina are mandated to complete a comprehensive Community Health Needs Assessment (CHNA). It is a requirement of the consolidated agreement between the health departments and the NC Division of Public Health, and the project requires community involvement and collaboration. Although many hospitals were already partnering with health departments to complete this project, the Internal Revenue Service mandated in 2012, that all not-for-profit hospitals participate in a community health assessment every three years.

A variety of data and information was collected and analyzed in order to identify key priority health needs of the community. The prioritization process included a review and analysis of:  1) Primary - qualitative community feedback – data that has been generated through surveys, focus groups, interviews, etc. by the person(s), agency or other entity and 2) Secondary - quantitative statistical data – data generated by large government institutions, healthcare facilities, websites, databases, etc.

Primary Data  The Scotland County Community Health Assessment Survey was modified from the 2019 survey and distributed throughout the County to collect primary data from the community through hard copies as well as internet surveys. A little over 600 surveys were either distributed or answered via Survey Monkey, via links on social media and website and focus groups were also conducted to further identify or confirm priorities for our County. Survey Results are provided in the Appendix Section. Following is data related to the surveys. 

• Leading causes of death - heart disease, cancer, homicide/violence, diabetes, drug/alcohol use
• Priority health issues - high blood pressure, diabetes, heart disease, obesity, cancer
• Priority risk factors - lack of physical activity, substance use, crime/violence, tobacco/vaping, poor nutrition
• Leading factors affecting families seeking medical treatment - lack of insurance, unable to pay for visits to a doctor, no appointments available when needed, and transportation
• General concerns - economic/unemployment, health insurance, mental health, crime/violence, lack of positive youth activities, substance misuse
• Environmental concerns - safe places to walk and play, healthier food choices
• Services and educational opportunities - mental health, positive youth activities, rehab, wellness, pregnancy prevention, dental screenings, smoking cessation and more 
• Respondents indicated they support tobacco-free public places and buildings in Scotland County

Secondary Data: Secondary data is collected from various resources such as the NC State Center for Health Statistics, NC Department of Health and Human Services, NC Department of Commerce Labor and Economics, NC Department of Justice, annual reports and others indicated throughout the CHNA Report.

Identified Health Priorities and Areas of Opportunity:  The 2022 Community Health Assessment Survey results indicated respondents felt the top five community health priorities were: High Blood Pressure, Obesity/Overweight, Diabetes, Heart Disease/Stroke, and Cancer. The top five behavior risks identified were: Lack of physical activity, substance misuse (alcohol/drug use), crime/violence, tobacco/vaping and poor nutrition. The table below depicts the top ten priority health concerns in 2022 with the two health issues highlighted in red as opportunities for focus.

A third area of concern will focus on Scotland County’s youth as one’s youth is typically the most dynamic and healthy stage, it is also one of the most critical stages of human development. Adolescents are more vulnerable in certain situations and are at risk of making unsafe or unhealthy choices. These unhealthy behaviors may lead to long-term risk factors for health conditions as adults. Therefore Scotland County Health Department, Scotland Healthcare System and Scotland County Schools determined it is important to promote physical, emotional and intellectual well-being and necessary to engage youth in promoting positive behaviors, social roles and relationships.

In addition to the review of the above, additional meetings with stakeholders and community members were facilitated to develop action plans concerning the health issues indicated by the community responses. To select priorities and related strategies, the following criteria were considered:

• Data and community feedback indicated the issue is an important community need
• Scotland County Health Department and Scotland Health Care System has the capacity to impact the issue
• Addressing a selected issue holds the potential to affect other key health conditions, therefore creating a multiplying effect
• Strategies selected align with and support the Scotland County Health Department and Scotland Health Care System’s mission, vision and strategic plans
• Strategies selected take in consideration current assets in both the community and within Scotland County Health Department and Scotland Heath Care System, along with those identified in the Healthy North Carolina 2030 Objectives

In considering the above, the following are selected as priorities:

1. Obesity/Overweight (Hypertension, Heart Disease, Diabetes and Cancer)  Over the last few decades, there has been a drastic increase in the prevalence of obesity. This public health crisis increases an individual’s chance of developing type 2 diabetes, high blood pressure, certain cancers, stroke and heart disease. Overweight and obesity are significant risk factors for both children and adults in Scotland County and is the number one health problem in children. Based on Scotland County data, people are experiencing a higher percentage of poor health, poor physical health days, and more physical distress compared to other counties in North Carolina. Diabetes prevalence is 20%, adult obesity is 47%, physical inactivity is 28%, and access to exercise opportunities is 66%, with high rates of heart disease and hypertension, all of which show poorer performance levels than the State average. In addition, the County’s food environment index is 5.5/10.0 and 21% of our population experiences food insecurity, while 8% have limited access to healthy foods, according to County Health Rankings 2021. To combat obesity and related health conditions, several programs will be maintained, enhanced, and/or initiated that include screenings to identify potential risk factors or detect early-age disease, increase community access to fresh produce, offer support groups and provide education concerning nutrition, heart health and chronic disease prevention or management.

2. Mental Health and Substance Use/Misuse including Tobacco/E-Cigarettes  In the United States, one in five or approximately 45.6 million adults experience a mental health condition each year. Despite high prevalence, stigma and other barriers often prevent people from receiving needed mental health care. As a result, many engage in substance misuse. Prescription and illicit drug use are classified as an epidemic as drug overdose rates have tripled in the last few decades. Based on Scotland County data (County Health Rankings, 2021), people experience more poor mental health days, more frequent mental distress, and a lower quality of life compared to other counties in North Carolina. Additionally, according to the CDC, 2022 data, adult smoking (17%), the increase in middle and high school students’ use of e-cigarettes (17.4%), excessive drinking (17%), alcohol-impaired driving deaths (30%), and insufficient sleep (41%). There are also more reported drug overdose deaths when compared to the national level, but the data is consistent with that of the State. In comparison, Scotland County data indicates adult smoking at 27%; excessive drinking at 15%; alcohol-impaired driving deaths (28%); and insufficient sleep (32%). Addressing mental health and substance use/misuse is one of the County’s top priorities for public health. To address the existing issues, several initiatives, programs or collaboratives including the Opioid Settlement Federal funding, will be enhanced and/or initiated. These will continue to address the opioid crisis and other substance misuse problems including tobacco and e-cigarette use, training community members, nurses, physicians, EMS, law enforcement on use of Naloxone to prevent or reduce overdose deaths in Scotland County. Education concerning substance use along with promotion of overdose prevention will also ensue. Scotland continues to collaborate with Eastpointe (Mental Health, Substance Abuse and Suicide Prevention). As of October 2021, there are 19 Scotland-based providers (for-profit and non-profit) endorsed by Eastpointe to provide at least one service related to mental health, developmental disabilities, and substance misuse. There are also at least three additional providers with licensed staff providing professional mental health services in Scotland County. Several services remain in short supply – psychiatric services, outpatient substance abuse services, intensive in-home services, and day treatment programs. Often, clients need to go to more than one provider to receive services determined to be medically necessary and appropriate. To access mental health in Scotland County, individuals now have to refer to the Eastpointe Call Center at 1-800-913-6109 or TTY 1-888-819- 5112, or their health care providers.

3. Positive Youth Engagement and Healthy Behaviors To promote positive youth activities, several programs will be initiated collaboratively that will offer parent development, professional development for daycare workers, teachers, youth coordinators, etc. and provide education on topics including physical and dental health, bullying, seatbelt safety, substance use/misuse, overdose prevention, tobacco/e-cigarette use prevention, nutrition, mental health, safe sex and literacy. Based on Scotland County Health Ranking data, there is a significantly higher number of premature deaths, higher rates of child and infant mortality, and higher teen birth rates in Scotland County compared to other counties in North Carolina. Additionally, low birthweight is 14%, uninsured children is 5%, high school graduation is 80%, children in poverty is 46%, children in single-parent households is 48%, and disconnected youth is 11%. According to the North Carolina Child Health Report Card 2021 reported children ages 10 to 17 years were at 30.7% overweight or obese, a +0.3% change.

Next Steps…. The next step in this process will be to develop community improvement plans that will address the identified priorities for the next three years (2022-2025). Scotland County Health Department along with Scotland Health Care System, will work together to develop measurable objectives using evidence-based strategies to address these priorities. For more information or how to become involved, contact Scotland County Health Department at (910) 277-2440 or Scotland Healthcare System at (910) 291-7624.

Dissemination of Community Health Needs Assessment Report This Community Health Needs Assessment Report will be made widely available to the public, to key stakeholders, agencies and posted on Scotland County’s website: www.scotlandcounty.org under “Health Department”, Scotland Health Care System’s website: www.scotlandhealth.org, made available at Scotland County Memorial Library, at each municipality offices, and other agencies upon request along with providing the report to Scotland County’s Legislative and Senate Representatives.

• Obesity/Overweight (Hypertension, Heart Disease, Diabetes, Cancer)
• Mental Health and Substance Use/Misuse including Tobacco/eCigarettes
• Positive Youth Engagement and Healthy Behaviors