The Community Health Improvement Plan (CHIP) addresses all Union County priorities. Click on the links below for Progress in 2024:

For the priority area of Housing and Homelessness, see the Progress in 2024 note tabs below for each strategy and program.

• Housing Symposium
• Rapid Rehousing 
• Emergency Shelter

For the priority area of Mental Health, see the Progress in 2024 note tabs below for each strategy and program. 

• Develop a plan to improve the continuum of mental health providers in Union County
• Mental Health Awareness & Community Education
• Behavioral Health Collaborative
• Community Resilience Model
• Mental Health First Aid
• Question, Persuade, and Respond 

For the priority area of Substance Use Disorder, see Progress in 2024 note tabs below for each strategy and program.

• Opioid Settlement Work Group
• Substance Use Disorder Task Force
• Cameron's House of Hope
• Family Treatment Court
• Ground 40 Recovery Center
• Naloxone Distribution
• New Beginnings MAT Program
• UCPS and SRO Program
• Tobacco Free Ordinance

• Over the past year, the Chlamydia case rate has risen, whereas the Gonorrhea rate has begun to decline. STI rates in Union County remain significantly lower than the state averages.

• Fentanyl-positive deaths decreased 48% in 2024 when compared to 2023.

• The infant mortality disparity ratio continues to increase annually. African American residents are 5.31 times more likely to experience an infant death than White residents. 

Avian Influenza

Avian Influenza, often referred to as either Highly Pathogenic Avian Influenza (HPAI) or Low Pathogenic Avian Influenza (LPAI), is a significant disease affecting multiple sectors of the agriculture industry across the nation.  While historically, it has been a seasonal disease of poultry that followed the migration patterns of wild waterfowl, with higher disease levels routinely found in cooler months and some respite in the warmer months.  Those historical patterns shift as wild waterfowl do not migrate as often and the disease has practically become a yearlong risk for agricultural operations.  HPAI is primarily a high risk for the turkey production industry within Union County as Union County ranks 3^rd in the state of North Carolina in the production of turkeys.  It is just as much of a risk for the broiler industry across the county, especially since Union County is the 4^th largest broiler producing county in North Carolina.  These rankings are based on statistical data collected and provided by the North Carolina Department of Agriculture and Consumer Services Statistical Division.  LPAI also poses a risk for the poultry industry in the county by decreases in production and the risk of conversion to HPAI.  Union County also has significant egg production capacity which requires consideration.  In 2020, Union County had multiple LPAI positive turkey flocks that required depopulation, composting mortality, and extensive cleaning before the farms could have birds returned for production.  While USDA provided financial support to aid in keeping the affected producers in business, that option is not a guarantee in the future.  Considering the scope of the Poultry industry in Union County and its impact beyond the producers themselves, we must maintain vigilance and plan for the likelihood of a potential outbreak in the future.  Within the last couple of years, Avian Influenza has also been found to cross species with dairy cattle showing clinical signs such as decreased production and inappetence.  Feral felines, small ruminants, and even humans have been tested Positive for the disease, adding more necessity for the disease to be monitored more broadly to ensure that a more virulent or possibly deadly variant does not evolve.

Clean Classrooms for Carolina Kids Program™

The Clean Water for Carolina Kids™ program expanded in 2023 to become the Clean Classrooms for Carolina Kids™ program, and its rollout continued into 2024. Facilities must complete enrollment in all program sections (lead in water, lead-based paint, and asbestos) by May 31, 2025. The approaching deadline is anticipated to increase enrollment in the program's lead-based paint and asbestos portions, increasing the post-mitigation responsibilities of local public health staff.

The program was created to identify and eliminate lead and asbestos hazards in North Carolina, where children learn and play. It is a legislatively mandated effort to address lead and asbestos hazards in North Carolina public schools, licensed childcare centers, and licensed family childcare homes. Participation allows facilities to meet all rule requirements for identified lead and asbestos hazards.

Immunization Compliance

Kindergarten immunization compliance is decreasing, especially in Union County. Between 2020 and 2023 our compliance rate dropped from 96.1 to 90.7 percent. At the same time, vaccine exemptions for religious and medical reasons increased from 2.5 to 6.5 percent. Union County's vaccine compliance and exemption rates have worsened faster than those of our surrounding counties and the state. Additionally concerning are the increased number of vaccine-preventable diseases (VPD) in our county. VPDs include pertussis, varicella, measles, mumps, and others. During the first three quarters of 2024, our case numbers were 28, 61, and 82, respectively. Public health continues to use opportunities at health fairs and other public events to educate the community about the protection vaccines provide, no-cost vaccines for children, and the fact that appointments are available for everyone.

Per- and Polyfluoroalkyl Substances (PFAS) in Drinking Water

In April 2024, the U.S. Environmental Protection Agency (EPA) established enforceable limits on public water systems' PFAS compounds—PFOA, PFOS, PFHxS, PFNA, PFBS, and GenX. These regulations mandate continuous monitoring and public notification if PFAS levels exceed the set standards. 

In response, the North Carolina Department of Environmental Quality (DEQ) has proposed state-specific standards to complement federal regulations. In September 2024, the DEQ presented revised proposals to the Environmental Management Commission (EMC) for groundwater standards targeting three PFAS compounds: PFOA, PFOS, and GenX. These proposed standards aim to reduce PFAS contamination at the source, protect public health, and minimize treatment costs for drinking water systems. 

Union County, North Carolina, is actively addressing the presence of per- and polyfluoroalkyl substances (PFAS) in drinking water. Residents are encouraged to stay informed about their water quality and consult local health officials for guidance on reducing PFAS exposure. The county’s Environmental Health department offers resources and testing services for private wells to ensure safe drinking water. 

New Initiatives

CHILDRENS LITERACY AND MENTAL HEALTH

Child Health Behavioral Health (CHBH)

Union County partnered with NC PAL and AHEC to begin a pilot program addressing children's behavioral health needs in August 2024. Using the Collaborative Care Model (CoCM), CHBH allows our physician to treat mild to moderate behavioral issues identified in patients receiving care in our Child Health Clinic. Our social worker serves as a Behavioral Health Care Manager and is the liaison between our physician and an assigned pediatric psychiatrist. This collaboration improves health outcomes for children by decreasing barriers to behavioral health services. Patients can receive treatment from providers they know and trust in a familiar environment. Stigma, lack of providers, long referral processes, and transportation issues are several barriers this initiative addresses.

Reach Out and Read

In May 2023, Union County initiated the Reach Out and Read (ROAR) program in our Child Health Clinic. ROAR shares the power of reading with families in our community, helping them make reading a part of their daily lives. Our provider gives children aged 0-5 years to visit an age-appropriate book at each well. Research shows that reading with children improves their brain development, language, and literacy. Spending time together while reading aloud helps to create strong parent-child bonds. Giving every young child a foundation for success improves equity and strengthens our community.

COMMUNITY HEALTH

Vaccines and Blood Pressure Checks for Child Care Center Workers

Union County's Child Center Health Consultants (CCHC) have a project underway to support the health and wellness needs of adults who provide childcare services. This underserved group has an integral role in our community, and many do not have access to affordable health care services. CCHC partnered with the county's Immunization and REACH programs to provide these crucial workers free tetanus/pertussis vaccines and blood pressure assessments. Participants could also receive free COVID-19 test kits, Narcan kits, and health education materials. 

ENVIRONMENTAL HEALTH

Lead Safe Union County Campaign

In 2024, Union County Environmental Health utilized funding provided through the North Carolina Division of Public Health to create the Lead Safe Union County Campaign to raise awareness of lead poisoning as a critical concern for the health and safety of young children. The Union County Public Communications team supported the initiative and outreach efforts and focused on lesser-known sources of lead exposure to children in Union County, NC. Screening/testing for lead was encouraged. Key components included:

1. The Lurking Lead House Display: This visual representation of common lead sources accompanied by a key for explanations.

2. Partnership with UC Public Library—The display was featured, books on lead prevention were donated, and a special story time event was organized to educate families.

3. Partnership with Licensed Childcare Centers – Each center received:

      •   A book for classrooms serving children under six

      •   A curriculum packet with activities and resources

      •   QR code stickers linking to lead safety information

The project was very successful! Moving forward, we plan to expand our partnerships to include healthcare providers, setting up educational displays throughout the community, and possibly hosting a contest to name the campaign's parrot mascot.

Private Drinking Water Wells Rehabilitation and Repair Program

Union County Environmental Health's Pilot Private Drinking Water Well Rehabilitation and Repair Program continued its rollout in 2024. Recognizing and addressing concerns with drinking water wells can be expensive, and with approximately 25% of Union County residents obtaining their drinking water from wells, it is a critical public health issue. Applications were accepted from Union County residents who own and live in a residence with a private well, and whose household incomes are less than 80 percent of the area median income. Program services include a well and site assessment and panel water sample collection. Based on the assessment and sampling results, a weighted rating scale assigns a health risk rating to each well and determines possible remedies. Once work is completed on the well, follow-up water sampling is conducted to confirm correction, and a final report is issued to the property owner. The report includes testing results and helpful information on ways to protect the well from potential sources of contamination, routine water testing, and treatment system maintenance. The program is vital to identifying potential contaminant exposure and taking protective action.

Septic System Repair Program

The Union County Septic System Repair Program, which had previously been paused, restarted in 2024. Through the County's Community Development Block Grant (CDBG) initiative, the program provides financial assistance to low—and moderate-income homeowners to rehabilitate their septic systems, protect public health and the environment, extend system longevity, and preserve property values.

Union County Food Safety Forum

An innovative event allowed Union County residents to learn about food safety and reducing the risk of foodborne illnesses. Union County's Environmental Health division hosted the first-ever Food Safety Forum on Thursday, Jan. 18, 2024, at the Union County Government Center.

Attendees included people from various backgrounds, including restaurant operators, food facility employees, and residents interested in understanding how the food industry is regulated. The forum focused on protecting food and reducing foodborne illnesses, particularly after power or water outages and during emergency recovery. It will continue to be held annually and cover various food safety topics.

SEXUALLY TRANSMITTED INFECTION (STI) SCREENING AND PREVENTION

Doxy PEP

In July 2024, the STI Clinic began offering DoxyPEP, a doxycycline treatment that can prevent bacterial STIs. Reducing rates of STIs in North Carolina is a public health priority, and ensuring that new evidence-based preventive tools are incorporated into local health department services is critical to improving the health of our community. Studies have shown the efficacy of taking doxycycline within 72 hours of condomless sex in protecting against chlamydia, gonorrhea, and syphilis infections in men who have sex with other men and transgender women.

Fast-Track STI Screening Services

In response to increasing STI rates, especially syphilis infections in women, Union County implemented fast-track STI screening services in February 2024. The no cost service provides confidential, shortened visits for asymptomatic patients who do not want to have an examination. The fast-track STI screening services make testing more appealing for a broader population, which allows earlier identification and treatment of infections.

Paused Initiatives

Wastewater Monitoring Initiative

In 2022, Union County Public Health and Union County Water partnered with the University of North Carolina at Charlotte (UNC-Charlotte) to implement a wastewater surveillance initiative to monitor COVID-19 levels within the community. This collaboration involved collecting weekly samples from local wastewater treatment facilities, which UNC Charlotte then analyzed to detect the presence of SARS-CoV-2, the virus responsible for COVID-19. This approach provided valuable data on infection trends, including asymptomatic cases, enhancing public health responses, and informing community interventions.