EXECUTIVE SUMMARY

Vision Statement

The vision of this report is to offer meaningful understanding of the most pressing health needs across Duplin County, as well as to guide planning efforts to address those needs. Community health needs assessment (CHNA) is a core tool of public health, but the assessment can serve many purposes. The health status of a community plays a large role in social and economic prosperity; hence it is important that a community strives to continually improve and maintain its health. Successful health programming is a collaborative process among multiple partners and must also include input from community agencies and community members.

Leadership

• Duplin County Health Department- Tracey Simmons-Kornegay, PHD, Health Director; Brittney Matthis, MSN, RN, Nursing Director; Maury Castillo, Health Educator; Samantha Kennedy, Administrative Assistant.
• ECU Health Duplin Hospital- Janetta Matthews, Community Health Improvement Coordinator, Laura Maready, Director of Marketing & Development, Christina Miller, BSN, RN, MBA, Director of Patient Care Services, Acute.
• ECU Health- Crystal Dempsey, Vidant Health Manager of Community Health Improvement, Melissa Y. Roupe, MSN, RN Senior Administrator, Community Health Improvement.

Partnerships

 Regional Contracted Services

The 2021-2022 Duplin County CHNA was developed through a partnership between the Duplin County Health Department, ECU Health Duplin Hospital, and Health ENC.  Health ENC is a collaborative initiative of health departments and hospitals in eastern North Carolina. The funders for the Health ENC are the Foundation for Health Leadership and Innovation (FHLI). The FHLI coordinates a regional CHNA in 35 counties of eastern North Carolina. Details of the regional leadership are included in the introduction section.

 Theoretical Framework

The social ecological model was used as a guide in the development of the CHNA. This model understands health to be affected by the interaction between the individual, the community, and the physical, social, and political environments. There is a complex role played by context in the development of health problems as well as in the success or failure of attempts to address these problems. There are four core principles that underlie the ways the social ecological model can contribute to efforts to engage communities:

• Health status, emotional well-being, and social cohesion are influenced by the physical, social, and cultural dimensions of the individual’s or community’s environment and personal attributes (e.g., behavior patterns, psychology, genetics).
• The same environment may have different effects on an individual’s health depending on a variety of factors, including perceptions of ability to control the environment and financial resources.
• Individuals and groups operate in multiple environments (e.g., workplace, neighborhood, larger geographic communities) that “spill over” and influence each other.
• There are personal and environmental touch points, such as the physical environment, available resources, and social norms, that exert vital influences on health and well-being.

 Collaborative Process summary

The leadership team initial planning meetings started after the 2018 CHNA was submitted in late 2019. In February 2020 the COVID-19 pandemic stopped all work on the CHNA as health department and hospital members were reassigned to communicable disease response and in-person meetings were suspended. It was not until January 2021 that the Health ENC steering committee was able to re-start the process. All meetings were held virtually, which did create some barriers for some community members to attend. First meeting was held virtually in February 2021 to discuss timeline, community survey development, and the training opportunities for partners in the Results Based Accountability (RBA) method. The surveys were ready for distribution in April 2021. The decision was made not to do in-person focus groups due to COVID-19 restrictions. Surveys were collected electronically from April 26th -June 18th.  The CHNA document was completed and submitted to the NC DHHS, June 1, 2022 and ECU Health will submit their document to their Board of Directors at the end of the fiscal year.    

Key findings

1. Demographic data- 5-year trends-population has decreased by 0.9%. Projected to increase by 4.3% over next 10 years. Gender essentially equal females to males.

2. Race/Ethnicity: stable at 71.2 % white, 23.8 % Black/ African American, 22.2 % Latino/Hispanic. Duplin has a significantly higher Hispanic/Latino population than the state and ENC region.

3. Social and economic factors are strong determinants of health outcomes. Those with a low socioeconomic status are more likely to develop chronic conditions.  Duplin was a Tier 1 county in 2019/2020. Tiers are calculated by unemployment rates, median household income, percentage of population growth and property tax base per capita.

4. Median household income lower in Duplin as compared to state and ENC counties. Poverty levels set by census bureau current 21% of the population lives below the poverty level, this is higher than state and ENC counties. Children living in poverty at 34%. At risk groups seniors, children, people with disabilities and minority groups

5. Severe housing problems (low wages, flooding in past years) is worsening.

6. Food insecurity, households with children that participate in SNAP benefits higher than state average and higher than Health ENC regions.

7. Residents without health insurance at 20%, unchanged from previous years, coverage is lower in Duplin as compared to state rate and Health ENC region.

8. Education: HSD attainment less than state and Health ENC region, though dropout rate and suspensions show decrease.

9. Primary data- Community Survey respondents’ top concerns related to:

• Low income /poverty

• Drug/alcohol/substance use

• Lack of county resources

10. Secondary data indicates the top leading causes of death (unchanged)- Heart Disease, Cancer, Stroke, motor vehicle injuries, Alzheimer’s Disease. Very similar to state and Health ENC region.

11. Healthcare workforce indicates low number of primary care provider per 10,000 population in Duplin. Access to care is limited.

 Health Priorities

The community engagement and health priority session were held virtually on November 10, 2021.  The group discussed the available and/or needed resources to impact goals. Special attention has been given to the needs of vulnerable populations, unmet health needs or gaps in services and input gathered from the community. The group decided on three health priories for 2021-2023.

1. Chronic Disease Prevention
2. Access to Care
3. Mental Health/Illness

 Next Steps

Findings from this report will be used to identify, develop and target initiatives to provide and connect community members with resources to improve the health challenges in their community. The goal was to convene community work groups in December 2021, the resurgence of COVID positivity rates in Duplin County have delayed this process. The leadership team will be setting up community health focus groups in the coming months to discuss each of the objectives and to develop health improvement plans.