The 2019 Community Health Assement (CHA) determined that Lincoln County needed to address three community health priorities: Substance Use; Emergency Preparedeness; and Health Services. Each of these priorities had activites, or Programs, that were to improve and have an impact on the overall health of the community. These programs had measurable outcomes as Performance Measures to determine if the programs were on the right track. 

Due to COVID-19, accomplishing the goals set by the Community Health Improvement Plan and implementing programs was difficult. Many organizations were working with limited capacity. Coalition and committee meetings were put on hold. Most of the programs were not implemented or no progress was made and performance measures did not improve. Two notable changes in Programs were the Safe Syringe Access Program and Smoke Alarm Saturday. Lincoln County saw a loss of the Safe Syringe Access Program in 2021. Between 2019 and 2020, Smoke Alarm Saturday did see an increase of participation of fire department in the yearly event. Due to COVID-19, there was a decrease in 2021. 

Over the past two years, response efforts and data collection in Lincoln County have been focused largely on COVID-19. At the time of this writing, Lincoln County reports 24,129 total cases. Of these cases, 162 are deaths and 23,959 people have recovered. 8 are active COVID-19 cases. The number of daily active has largely dropped after the surge of the Omicron Variant of the virus in late 2021. 

 Changes in Lincoln County's Mobidity and Mortality rates from 2019-2021 are located below.

Alcohol Use

Binge drinking has been shown to have negative effects on the body and mental state, and lead to an increased likelihood of alcohol-related unintentional injuries and death. In 2018, 17.1% of NC Region 4 BRFSS respondents indicated that they have binge drank in the past (even once), compared to 14.8% of NC (NC BRFSS, 2018). The percentage of Region 4 BRFSS and NC respondents reporting binge drinking (even once) has increased for 2018.(BRFSS, 2018). This reported increase of binge drinking regionally and at the state level indicates a need for improved education and prevention strategies regarding the negative consequences associated with alcohol abuse and binge drinking.

Personal Preparedness

According to structural fire data provided by the Lincoln County Fire Marshal’s Office, smoke detectors were present 55% of the time and operated correctly 84% of the time between 2017 and 2019 in Lincoln County. These numbers indicate a need for increased awareness and education regarding the importance of having a functional smoke detector in homes and businesses. 2019 CHO Survey respondents indicated that they were 68.5% likely to have both smoke detectors and carbon monoxide detectors in their homes, while 28.9% indicated that they only had smoke detectors in their homes. Between 2017 and 2019, there were 12 injuries and 5 casualties reported from fire related calls from all 12 fire departments in Lincoln County. Lincoln County fire departments have participated in Smoke Alarm Saturday, which is held on the first Saturday in June, in recent years. Smoke Alarm Saturday is a North Carolina Department of Insurance Initiative out of the Office of the State Fire Marshal that aims to provide free smoke alarms to Lincoln County residents who need them. The Smoke Alarm Saturday Initiative hopes to increase the number of working smoke alarms in homes and decrease the number of injuries and casualties from fire related calls, because even 1 death that could potentially be prevented is too many.

Health Services

55.13% of 2019 CHO Survey respondents believe there is good healthcare in Lincoln County when considering the cost, quality, and availability of healthcare in the county. A majority of respondents believe the service most needing improvement in Lincoln County is culturally appropriate health services.

Issues Emerging From COVID-19

Unemployment - As with many other counties in North Carolina, Lincoln County was not immune to the issues that emerged from COVID-19. In March of 2020, the unemployment rate was 3.7% In April and May of 2020, the unemployment rate increased to 13.1% and 13.2% respectively. Lincoln County has since seen a decrease in the unemployment rate and was reported as 2.6% in December of 2021.

Food insecurities - Food insecurities have not improved. In 2019, 12% of Lincoln County residents lacked adequate access to food. In 2021, this had increased to 13%. COVID-19 resulted in the disruption of the United States food supply chain. Disruptions included: staff shortages; logistics and international transport of goods; and decrease in production at processing plants.

Homelessness - Lincoln County does a yearly Point-in-Time (PIT) count for homelessness in January of each year. This data is divided into "Sheltered" and "Unsheltered" categories. At this time, only the unsheltered data is available. Between January of 2019 and January of 2020, Lincoln County had a decrease from 14 to 10 persons in the unsheltered category. In January of 2021, this count had increased by 300% to 30 people. One of the reasons for an increase in unsheltered homelessness is due to COVID-19 restrictions on occupancy for shelters. Shelters had to decrease their numbers to allow for social distancing and to prevent the spread of COVID-19. The shelters did connect those who had to leave the shelter with resources, such as providing tents or connecting them with other resources within the county.  

Substance Abuse:

· The Lincoln County Partnership for Health chose to focus on two initiatives to positively impact the Substance Abuse strategy.

Þ Continuing Initiative: Medication disposal

             *The purpose of this intervention is for local pharmacies to install drug disposal boxes in their facilities for customers to safely dispose of needles and syringes. 

Þ New Initiative: CATCH My Breath Curriculum

     *The CATCH My Breath Curriculum was established in two schools to be taught prior to the COVID-19 pandemic. Schools starting remote learning and visitor access restrictions when students came back to                          school prevented the CATCH My Breath Curriculum from actually being taught. Strides have been made to implement the program back into the schools with the lessening of the COVID-19 restrictions. 

Emergency Preparedness:

· The Lincoln County Partnership for Health chose to focus on two initiatives to positively impact the Emergency Preparedness strategy.

Þ Continuing Initiative: Smoke Alarm Saturday

Þ New Initiative: Reporting System

*The purpose of this intervention is to develop a reporting system that providers like EMS, DSS, etc. could

Notify the fire department of the need for smoke detectors in specific households.

Health Services:

· The Lincoln County Partnership for Health chose to focus on two initiatives to positively impact the Health Services strategy.

Þ Continuing Initiative: Parks Rx intervention program.

* The purpose of this intervention is to increase the number of providers that prescribe their patients Park Rx prescriptions to encourage healthy outdoor activity, healthful eating and improve overall wellness to positively impact chronic disease conditions (verses using prescription medications, when appropriate).

Þ New Initiative: Preventive Health Screening Opportunities

*The Preventive Health Screening Opportunities initiative was to raise awareness about recommended well-care visits and age appropriate preventive health and wellness screenings to all community members through community outreach and education. Community  members would also be connected to resources as needed. 

The Lincoln County Partnership for Health and the Lincoln County Board of Health chose and approved the initiatives that are being used to address the 2019 Community Health Assessment priorities.  Action plans were submitted to the state of NC in July 2020.