State of the County Health Report 2021
Conducting a community health assessment is an ongoing process that engages diverse agencies, providers, and individuals in identifying community assets and strengths, as well as unmet needs. Leadership for this collaborative process is provided by the Cabarrus Health Alliance (CHA) through Healthy Cabarrus. The following State of the County Health (SOTCH) Report, serves as an update and documented progress following the findings of the 2020 Community Needs Assessment. The 2021 Cabarrus County SOTCH was submitted to North Carolina Department of Human Services (NCDHHS) on March 7, 2022.

Information provided within this report is specific to the identified priority health issues: housing, behavioral health, and early childhood education and development. The report also provides  updated data and information specific to Cabarrus County mortality and morbidity rates; COVID-19 response, resiliency, and recovery; 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 Cabarrus County Public Health Authority Board of Commissioners and Healthy Cabarrus Executive Committee, copies of the 2021 State of the County Health Report will be disseminated to the Healthy Cabarrus Advisory Board, as well as hard copies to target community locations. Targeted locations include local libraries, community centers, park and recreation departments, federally qualified health centers, in addition to other sites with high community member presence.

Cabarrus County Profile
Cabarrus County’s population has seen consistent growth since 2000. Between 2010 and 2020, Cabarrus County’s population increased by 26.8% percent or nearly 50,000 people. In comparison, during that same time period, North Carolina’s population only increased by only 9.5%. As documented in previous reports, extreme, rapid growth impacts how agencies and organizations provide services to residents, and often times vulnerable populations such as persons with disabilities, limited English proficiency, children under 5 and persons over 65 are disproportionately affected.

Total Cabarrus County Population: 225,804

Sources
Persons in Poverty, Median Household Income - U.S. Census 2015-2019
Educational Attainment - U.S. Census, American Community Survey 1 Year - 2019
Unemployment Rate - US Bureau of Labor Statistics - December 2021

Following the 2020 Cabarrus County Community Health Assessment, major strides and strategic decisions were made to impact and improve the wellbeing of Cabarrus County residents.  With the support from the Cabarrus County Commissioners, Cabarrus County distributed $33.5 million in American Rescue Plan Recovery Funds to more than 50 agencies, with a priority placed on supporting sustainable initiatives that would address the county’s greatest needs.

• Housing Programs: $14,072,673
• Behavioral and Mental Health Programs: $11,450,785
• Childcare and Afterschool/Summer Programs: $1,781,002

For the full summary of the Cabarrus Recovery Grants allocation, click here. 

Housing and Homelessness

Healthy Cabarrus worked with local housing leaders to convene the Cabarrus Housing Collaborative. The newly formed collaborative, includes representation from across the public, private, and non-profit housing sectors, with the goal to create a cross-sector, multi-faceted plan to address housing challenges in Cabarrus County. The group plans to develop its mission, vision, and core values in early 2022, as a foundation for its future work to address needs faced by those experiencing housing crisis; seeking affordable housing; or actively seeking support for necessary critical repairs. 

Cooperative Christian Ministry
Cooperative Christian Ministry’s long time mission has been ‘to provide immediate assistance to members or our community who are experiencing crisis in the areas of food, housing, or finances while engaging them in a series of actions that will empower them to move beyond crisis.’ The organization recently released its 2025 New Horizon Strategic Plan which includes a rapid expansion of transitional and crisis housing solutions. 

• Huddle Housing (HH) will be carriage housing units positioned (huddled) around a community building with shared facilities on a site in Kannapolis to provide housing for extremely low-income individuals earning
  $9,500 to $15,000/year. Often times this target population are people on disability, working minimum wage, and veterans. They can afford housing costs of about $250 - $375 per month (rent, utilities combine), and currently there is no housing solution in Cabarrus County for these individuals. 
• Homeless to Housing (H2H) will be a multifamily campus that can serve 48 to 50 households of families, senior adults, and adults with disabilities who are currently homeless or in a housing crisis. Once at full capacity, the facility will serve about half of the current level of need for these populations. CCM is actively working on securing a location for this facility.

WeBuild Concord
The City of Concord launched the Concord Family Enrichment Association, now WeBuild Concord in May of 2021. WeBuild Concord is a as a nonprofit established to develop equitable strategies for affordable housing and merge private, public and social resources for wealth creation and economic mobility for residents. Beginning with the 2020-2021 fiscal budget, the city gave 1 cent of the tax rate to affordable housing. This investment is set to recur each year, equaling $2.8 million for affordable housing: $1.4 million from the recurring tax rate and $1.4 million from the city’s return on investment the previous year.

Future housing projects scheduled for the beginning of 2022, will be developed with resources from WeBuild Concord, the City of Concord, and Cabarrus County. The Lincoln Street Townhomes Project, a 26-unit townhome development, will provide residents earning less than 80 percent of the area median income (AMI) an opportunity to own their homes. The Lincoln Street Project will be in the historic Logan Community. WeBuild Concord also announced a partnership with the City of Concord to provide several single-family homes during the same period.

Salvation Army
In August 2021, the Salvation Army broke ground on a new 16,000 square foot ‘Center of Hope Emergency Shelter’. The new facility will help to address the community’s emergency housing needs for homeless residents and increase local capacity to serve families with nowhere else to turn. The new facility will increase the crisis beds available from 28-bed to 64-bed, including the addition of six living units for families with additional beds for women and men. Families are some of the fastest growing homeless populations in Cabarrus and neighboring counties. 

• The new Center of Hope will offer six 2-bedroom family living units that include a family room and private bathroom. 
• Seclusion of the family unit allows two-parent families to stay intact and allows teenage young men to stay with their families rather than being separated into the men's dorm. 
• Privacy and security is increased for families, including a private playground for children, separate dining from individual men and women, and secure access to the family floor. 
• Programs and partnerships that help meet the immediate and long-term needs of shelter residents to help them identify and overcome barriers to stable housing.

Additional services and programs that Salvation Army residents will have access to:

• Medical and mental health care;
• Finance and budgeting classes;
• GED and vocational classes;
• Life skills classes;
• Intensive case management.      

Behavioral Health

Cabarrus County is a designated Health Professional Shortage Area in mental healthcare. For the last nine years, access to mental healthcare has been identified as a priority need in the Cabarrus County Community Health Assessment. In 2017, the Cabarrus County Commissioners established the Cabarrus County Mental Health Advisory Board, a formal county board, to oversee efforts and advocate for improved access to mental health services. 

After years of work and advocacy to improve the mental healthcare system for residents, commissioners made the decision to vote to disengage from Cardinal Innovations Healthcare, the County’s Managed Care Organization (MCO). The disengagement process required approval from the North Carolina Department of Health and Human Services (NC DHHS), and in September 2021, Cabarrus and Union counties were notified that, NC DHHS Secretary Mandy Cohen approved both requests for realignment with Partners Health Management . The realignment was effective September 1, 2021.

To reevaluate efforts due to continued changes within the behavioral health system, Healthy Cabarrus hosted a virtual action planning meeting in January 2021, nearly 4 years after the first retreat in April 2017.  The meeting focused on assessing previous efforts of the Mental Health Task Force; identifying current gaps and new challenges; as well as educating partners on Results Based Accountability. The action planning retreat, helped to realign task forces to respond to emerging needs and narrow focus to priority populations.

New focus areas for the Mental Health Task Forces: Trauma Informed Communities, Persons who are Justice Involved, Data and Assessments

Cabarrus County Behavioral Health Facility Expansion
The 2021 North Carolina State Budget allocated $30-million to Cabarrus County for the development and building of a regional behavioral health crisis service center. Leaders from Cabarrus County, Atrium Health, Cabarrus Health Alliance and Partners Behavioral Health have started working to identify best practices to maximize service delivery, and are scheduled to visit Guilford County’s new mental health facilities in early 2022. Tentatively the behavioral health crisis center will include separate adult and child/youth facilities, as well as a behavioral health urgent care (BHUC). 

CHA Expand Behavioral Health Services
Prior to 2021, CHA employed two Licensed Clinical Social Workers (LCSWs) for our pediatric and maternal health patients. Grant funds through the Cabarrus Recovery Grants, increased the number of LCSWs to a total of 5 to provide evidence-based treatment and support services. Through this services expansion, individuals eligible to receive services through these grant funds will be limited to Cabarrus County residents who are uninsured, underinsured, or low-to-moderate income. Short-term expected outcomes include: 

1. Expanded capacity in Cabarrus County to provide mental health treatment services and support for vulnerable residents;
2. Decreased impact of COVID-19 on the mental wellness of vulnerable Cabarrus County residents; and, 
3. Decreased health disparities for Spanish-speaking Cabarrus County residents. 

The long-term vision for CHA’s new Behavioral Health Department includes engagement in policy practice at the state and local level, as well as efforts to continue to develop and expand community based behavioral health education.

Early Childhood Education

Cabarrus County Government hired Early Childhood Education Coordinator, Carla Brown, to lead and coordinate efforts to improve the County’s early childhood systems. Ms. Brown works closely with the 15-member Early Childhood Task Force Advisory Board (ECTFAB), which was established to advise the Board of County Commissioners on matters related to the primary development of children in Cabarrus County. 

The ECTFAB, expanded to include four primary work groups: Healthy; Basic Needs; Social, Emotional and Nurturing Relationships; Learning and Ready to Succeed. The Task Force and Work Group members are responsible for developing action plans and identifying necessary strategies to impact the NC Early Childhood Action Plan benchmarks, ensuring shared community partner responsibility to improve the lives of the County’s youngest residents. 

Lockhart Child Development Center

The Lockhart Child Development Center opened in early 2021, after extensive collaboration and planning. The Cabarrus County Early Childhood Task Force Advisory Board initially recommended this collaborative approach to Cabarrus County Commissioners as a way to meet State education benchmarks and support the educational needs of area families. Local partners supported the initiative with resources that took the idea from concept to reality.
Partners in the project include:

• All Saints’ Episcopal Church provides the f acility and administration of the education center
• Rowan-Cabarrus Community College uses the site to train Rowan-Cabarrus Community College students who wish to pursue a career in early childhood development
• Cabarrus County Government assisted with the initial startup costs and provides tuition assistance to County employees who enroll their children in one of 40 spots dedicated to children of County employees
• The County plans to use the site to inform businesses about the importance and value of helping employees with childcare expenses.

Click to play video above.

Community Health Improvement Plans for housing and behavioral health are available here. Indicator and performance measure data is updated quarterly and annual based on the source.

Mortality

Rates of morbidity, mortality, and emergency hospitalizations can be reduced if community members have adequate access to services such as health screenings, routine testing, and vaccinations.  Prevention indicators can call attention to a lack of access or knowledge regarding one or more health issues and should inform program interventions.

The data within this section comes from the State Center for Health Statistics 2021 County Health Data Book and the Robert Wood Johnson Foundation – County Health Rankings. The data within the 2021 County Health Data Book spans 5 years, either 2014-2018 or 2015-2019 and is considered current for community health assessments and state of the county health reports due in March 2022. 

 The red arrow indicates the data is worse than the previous reporting period. The green arrow indicates health improvements since the previous reporting period.

Disparity ratios are calculated by dividing the rate for a population by the best rate for a selected health indicator to determine how much more likely a particular event is to occur in a population compared to another population. In the table to the left, infant mortality disparity for both the state and Cabarrus County compares the death rates of white and African American babies. In Cabarrus County, African American babies are 1.66 times more likely to die before 1 year of age when compared to white babies.

The data available for leading cause of death shows that diseases of the heart has surpassed cancer – all sites, as the number one leading causes of death among Cabarrus County residents. Although state and county data are not yet available for leading causes of death for 2020 and 2021, the Centers for Disease Control and Prevention reports COVID-19 as the third leading causes of death in 2020, proceeding heart disease and cancer. Diabetes dropped from the 8th leading cause of death to the 9th. 

2015-2019 NC Resident Race/Ethnicity and Sex-Specific Age-Adjusted Death Rate Disparities 

• African Americans, both males and females, have higher rates of death associated with Disease of the Heart and two-times higher rate for nephritis/nephrosis (kidney disease) 
• African American females consistently have the highest rates of death caused for Breast Cancer and three-times higher rate for Diabetes
• Females, both African American and White, have a much higher rate of Alzheimer’s disease than their male counterparts
• Suicide is highest among white males. All other races, sexes are too small a number to calculate a county-wide rate

It is important to point out that like the leading cause of death data, the life expectancy data available is prior to the COVID-19 pandemic. According to the Proceedings of the National Academy of Sciences (PNAS) COVID-19 has generated a huge mortality toll in the United States, with a disproportionate number of deaths occurring among the Black and Latino populations. Experts anticipate that COVID-19 will reduce US life expectancy by 1.13 years, with estimated reductions for the Black and Latino populations being 3 to 4 times that for Whites. Disparities in life expectancy between race and ethnicities existed prior to the pandemic. In 2019, data showed a two year life expectancy difference between white and African American Cabarrus residents, 78.9 and 76.9 respectively. 

Morbidity

Morbidity is another term for illness or medical condition. and often times refers to having a disease or a symptom of disease, or the assessment of the amount of disease within a population.  Some examples of common morbidities are heart disease, diabetes, and obesity, but morbidities can range from Alzheimer's disease to cancer to traumatic brain injury. When a person has more than one morbidity at a time, it is referred to as co-morbidity. Morbidities are NOT deaths. Prevalence is also used as a measure to determine the level of morbidity in a population.

2021 Robert Wood Johnson County Health Rankings: Quality of Life, Health Behaviors and Clinic Care Measures

*Items shaded in yellow indicate that Cabarrus County is doing better than or the same as the state of North Carolina, but not has good as Benchmark Counties or Top Performers in the U.S.
*Items shaded in red indicated that Cabarrus County is doing worse than the state of North Carolina and Top Performers

To learn more about the County Health Rankings or to see how other counties across North Carolina are performing, click here.

Sources
NC State Center for Health Statistics
Robert Wood Johnson Foundation - County Health Rankings

COVID-19

The COVID-19 pandemic remains an emerging and on-going issue as variants cause rapid increases in case counts and deaths.Cabarrus County experienced the first COVID-19 related death in North Carolina in early March 2020, placing the county in a state of emergency. The Public Health Authority of Cabarrus County d.b.a Cabarrus Health Alliance (CHA) has been responsible for supporting the multi-sector and cross jurisdictional response to COVID-19. As the local health department, CHA, is responsible for overseeing contact tracing, contact investigation, and public education on mitigation strategies. 

On January 6, 2021, CHA began administering the COVID-19 Pfizer vaccine at the Cabarrus Arena and Events Center. More than 1,000 people were vaccinated the first day and tens of thousands more were vaccinated through similar large scale drive-thru clinics operated by the health alliance. Understanding capacity issues and the challenges of rapid mobilization, CHA partnered with school systems, nonprofits and private sector companies to meet testing and vaccine demands as public requests increased. CHA continues to monitor and make local and state COVID-19 data easily accessible to the public. County health officials are preparing to move from response to recovery and plan to engage individuals from across the county, including traditional and non-traditional leaders, in hopes of creating a Recovery Coalition, which will make recommendations for how to move forward from pandemic to endemic.

Racism declared a Public Health Crisis

In late 2020, the Cabarrus County Public Health Authority Board of Commissioners, the governing body of the Cabarrus Health Alliance, joined a growing number of U.S. cities, counties and public health departments in declaring racism a Public Health Crisis. Throughout 2021, CHA staff, departments and leadership worked diligently to implement efforts and advocate for systems and policy changes, to accomplish the 13 items outlined within the proclamation. Racism has created a health divide negatively impacting black and brown residents. Minorities in Cabarrus County have lower life expectancies when compared to their white counterparts, meaning they are more likely to die before age 75. Data also shows that black residents are more likely to die from heart disease and diabetes, than white residents.  To view the entire proclamation, as well as the internal and external strategies outlined, click here. 

Smoking and Tobacco use

The NC Tobacco Prevention and Control Branch (NC TPCB) reports that tobacco use is the leading cause of preventable disease and death in North Carolina and the United States. In Cabarrus County, the highest rate of death due to cancer, is caused by cancer of the trachea, bronchus and lung. Studies have shown that smoke-free laws can not only protect people from secondhand smoke, butcan motivate and help tobacco users quick and even prevent or reduce initiation of use among youth.  Cabarrus County has adopted four of the six recommended North Carolina Countywide 100% Tobacco Free Policies outlined by the NC TPCB. An opportunity remains to advocate and educate on the positive health impacts for residents and employees with the adoption of tobacco free government grounds ad public places.

Every day, about 1,600 young people under 18 try their first cigarette, and nearly 200 become daily cigarette smokers (CDC). For many years in Cabarrus County smoking and tobacco use data showed decreases in reported use by youth. In recent years, smokeless tobacco products and electronic vaping have been the primary products of tobacco use for middle and high school students. According to the 2021 Cabarrus Youth Substance Use Survey, only 2% of middle and high school students reported current cigarette use, while 6% reporting current vape use (10.6% High School, 2.1% Middle School). Cabarrus County students also reported highest perceived risk associated with cigarette use, even when compared to prescription drugs, alcohol and marijuana use. 

The Rescue Agency, shined a light on some shifts in tobacco trends associated with teen vaping behavior data due to the COVID-19 pandemic. Data showed decreased vaping use by experimenting teens due fewer peer interactions and less access, while regular users reported increasing their vape use due to boredom and coping with stress from being home. The Healthy Cabarrus Substance Use Coalition and community partners are working to identify strategies to change youth perception and decrease the number of youth who report first time tobacco use, either through use of cigarettes or electronic vaping devices. 
 

Office of Rural Health - Dental Grant Service Expansion 
With funding from the Office of Rural Health, Cabarrus Health Alliance (CHA) will increase access to evidence-based dental care that prevents and reduces the incidence of oral disease through targeted recruitment, patient education, and comprehensive treatment; reaching at least 1,000 low-income, underinsured, or uninsured residents patients annually. Care will be provided at CHA’s two dental offices, and by leveraging existing infrastructure, staff, and community relationships to institute a systems-change that brings pop-up dental services to vulnerable residents at trusted locations that already serve them.  

Through these funds, the dental program will provide each patient will be afforded up to $500 of free dental services. If completing their treatment plan extends beyond that value, the patient will be automatically enrolled in a 60% discount using our sliding fee scale. Partner pop-up locations:

• Cooperative Christian Ministry
• El Puente Hispano
• Local churches – through Atrium Health’s Faith Community Health Ministry

Community Health Workers
The American Public Health Association defines a Community Health Worker (CHW) as “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationships enables the worker to serve as a liaison and link between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.”In 2021, both Cabarrus Health Alliance and Atrium Health launched CHW programs with the goal of supporting community members in reducing health-related risk behaviors. CHW’s also work to identify social determinants of health (SDOH) gaps for priority populations, so recommendations can be made based on knowledge and experience for systems level change to improve opportunities for a healthy life for community members.

Cabarrus Health Alliance Community Health Worker
CHA has hired and began training six (6) racially and linguistically diverse CHWs who come from the culture and community they intend to serve. CHW’s will be deployed to the following agencies/locations:

• El Puente Hispano
• Cooperative Christian Ministry
• Cabarrus County Department of Health and Human Services
• Community Free Clinic
• Cabarrus Health Alliance – Communicable Disease Department
• Cabarrus Health Alliance – Women’s Health Clinic

Public Private Partnership

Public–private partnerships (PPPs) have been placed at the forefront of many conversations, as they have become a popular way to get major infrastructure projects built and develop a shared responsibility for improving resident/employee well-being. Compared with traditional solutions, which can strain government and non-profit resources, these public-private arrangements are intended to boost efficiency and effectiveness.

The involvement of large employers during workforce housing discussions has been a focus of the Cabarrus Housing Collaborative. When companies like Amazon launch a $2 billion Housing Equity Fund to preserve and create over 20,000 affordable homes across the country, it is imperative that they have a seat at the local table to strategize future housing growth and development.

The public and non-profit sectors are encouraged and challenged to engage the private sector with education and advocacy of how for-profit companies are a vital part of the community. From large corporations to small businesses, these entities should have the opportunity to contribute far beyond just jobs, salaries, and wages. They are members of the community and should have a space to share their concerns and be active in supporting solutions.