What is helping?

• Hospital has good nurses
• ECU Dental School
• Bakersville Clinic works to meet needs
• Mitchell Transportation Department always expanding, developing new routes
• Meals on Wheels
• Senior Center
• Telemedicine/Telehealth
• Headstart
• Increased partnerships and awareness about how to communicate about available resources
• Managed care might be helpful but there is a lag time between applying and being determined eligible.
• Health Insurance Marketplace navigators
• Community Health Outreach Workers from MCHP (need more who are locally embedded)

What is hurting?

• Failure to recognize that all people and communities are worth of equal access
• Lack of transportation (personal or public) and long distances to access care
• Transportation broker not connecting people to the rides they need
• NC Managed Care
• Lack of Medicaid Expansion
• Services being removed from Blue Ridge Regional Hospital
• Lack of broadband internet and internet literacy
• Some of the services being created are initiated by agencies outside the local community, and they are always trusted or represented well to the community being addressed.

Access to healthcare has been a Mitchell County priority since the 2013 Community Health Assessment and the lack of local healthcare providers across the spectrum of specialties continues to be a concern.  However, it is just one aspect of the healthcare equation: the community needs to use the services available to them in order to improve health conditions.  Addressing barriers like the lack of insurance, the affordability of services, discrimination and stigma, and lack of awareness can increase utilization of existing services and improve health outcomes for citizens of Mitchell County.

Partners with a role to play: 

• Mitchell Community Health Partnership
• Toe River Project Access 
• Mitchell County Health Department
• Blue Ridge Regional Hospital
• Mitchell County Department of Social Services
• Mitchell County Schools
• Local Health Providers
• Pharmacies
• Churches
• Parents/Grandparents
• Youth
• Community Leaders

A community wide 76-questionnaire was conducted to give residents an opportunity to express concerns and opinions about the quality of life in Mitchell County. This included questions about the quality of life, economy, education, health, housing, physical activity, social issues, transportation, and COVID. Surveys were conducted by telephone by a trained interviewer and efforts were made to reach a representative sample of the population. Self-administered  surveys were also available online. A total of 244 Mitchell County surveys were analyzed: 200 via telephone interview and 44 via the publicly available weblink.

Some of the major findings that the Mitchell Community Health Partnership discussed in the prioritization process included that 54% of respondents stated that their life has been negatively influenced by substance abuse. An increasing proportion of participants have had more than seven days or poor mental health in the past year and 15% of respondents did not get needed mental health care or counseling in the past year. Three quarters of Mitchell County survey respondents had a Body Mass Index in the overweight or obese range; 39% had been diagnosed with high blood pressure.

In additional to secondary data and survey collection, nine (9) community stakeholders participated in an online key informant survey. Individuals were asked to consider specific health issues, provide comments about social determinants of health, and evaluate the strengths and opportunities of the Mitchell County community. The graphic displays a summary of their ranking of health topics in the community.

During monthly meetings, standards for the Community Health Assessment Process and Accreditation were discussed and reviewed for publication in the 2021 Community Health Assessment. Each member reviewed and approved of the Community Health Assessment Survey and Community Resource Directory included in the assessment. After the analysis was completed, qualitative and quantitative data findings were presented to the Community Health Assessment team. The team reviewed the data and developed the top ten major health issues based upon statistical data and community survey results.

Every three years we pause our work to improve community health so that we may step back and take a fresh look at all of the current data from our county that reflects the health of our community. We then use this information to help us assess how well we are doing and what actions we need to take moving forward.

Beginning in January 2021, our team-spent time understanding the data and uncovering what issues were affecting the most people in our community. We also interviewed community leaders to find out what they are most concerned about. To identify the significant health issues in our community, our key partners (see a full list in the Executive Summary) reviewed data and discussed the facts and circumstances of our community.

We used the following criteria to identify significant health issues:

● Data reflects a concerning trend related to size or severity

● Significant disparities exist

● Issue surfaced as a topic of high community concern

● County data deviates notably from the region, state or benchmark

Once our team made sense of the data, we presented key health issues to a wide range of partners and community members. On November 16, 2021, Jessica Farley from Toe River Health District facilitated the first of three prioritization meetings, via Zoom. She presented highlights from the Mitchell County WNC Healthy Impact presentation, summarizing the community health survey results and key informant interviews, and shared slides containing statistical data pertaining to substance abuse, mental health, healthy lifestyles and COVID. Participants were prompted to ask questions and comment via JamBoard, addressing what data that stood out to them.

At a follow-up meeting on November 23, Farley reviewed highlights from the 2018 CHA and compared them to the 2021 results. Attendees participated in a JamBoard discussion to answer a series of questions. A Wordle Poll activity facilitated the identification of the 8 most important issues in Mitchell County:

• Substance Abuse. Mitchell County had higher opioid prescribing rate, higher opioid dispensing rate, higher infant withdrawal diagnoses discharge rate, and higher unintentional poisoning mortality compared to the state. More than half of survey respondents said their life has been negatively impacted by substance abuse.

• Mental & Behavioral Health. The suicide mortality is rising in Avery County and was higher than NC and WNC. A rising proportion of survey respondents report more than a week of poor mental health a month. Mental health services are sparse in Mitchell County, but it is becoming increasingly apparent that mental health services need to be readily available and easy to access without stigma.

• Domestic Violence. Extra stress in the COVID-19 pandemic caused by income loss, and lack of ability to pay for housing and food, has exacerbated the often-silent epidemic of intimate partner violence. High stress conditions of a very abnormal world we are living in right now is enough to make anyone snap. Some people can only take so much until they explode and unfortunately, some explode in abusive and harmful ways, especially when we are isolated with no place to escape (for the abuser or the victim).

• Access to Care & Services. An estimated 15% of the county lacks health insurance and the rate is even higher among those aged 35-64, which makes it difficult to get needed healthcare, especially regular check-ups and preventative care. With a lack of specialists, mental health care, and dentists in the county, traveling out of the county is necessary. While some community members lack the transportation needed to get medical care even those who do have transportation must take extra time off work to travel long distances.

• Chronic Diseases. Mitchell County has higher (and rising) mortality rates due to heart disease, diabetes, CLRD, kidney diseases, and liver disease compared to NC and WNC. Hypertension, high cholesterol, and obesity are chronic disease risk factors that impact many residents in the county.

• Obesity Issues. Obesity rates in Mitchell County are higher than the state and rising: 28% of the county was estimated to be obese and 75% of survey respondents were overweight or obese. Less than 20% of survey respondents met the physical activity recommendations and a quarter reported no leisure-time physical activity.

• Cancer. Mortality rates due to breast cancer, prostate cancer, and colorectal cancer have risen in Mitchell County. Breast cancer incidence has increased while incidence for the other site-specific cancers has decreased, indicating a need for continued cancer screening efforts.

• Addressing 0-5 kids. COVID-19 has affected young children directly and indirectly. Beyond getting sick, many young children’s social, emotional, or mental well-being has been impacted by the pandemic. Disruptions in the daily caretaking routines and the sudden loss of usual caregivers due to the need to physically distance can be traumatic for young children. Trauma faced at this developmental stage may have long-term consequences across their lifespan.

• Addressing homebound elderly. The pandemic has presented a significant burden on older adults with ongoing health risks and conditions. Isolated older adults are at even greater risk for developing depression, anxiety, stress-induced illness, suicidal ideation, substance use, and other underlying medical complications. Increased risks of mortality and long-term health risks have resulted from a lack of mobility and mental activity, as well as a lack of social connections. Seniors in disadvantaged neighborhoods or residencies may also have limited financial or social means for technological devices to help connect with essential providers in their medical and social networks.

• Lack of caregivers. Adults who need a caregiver may be especially impacted due to their higher risk of experiencing severe COVID-19 illness and the potential compounding of other social and structural vulnerabilities. Canceled appointments may interrupt communication and coordination with healthcare providers; caregivers may be unable to rely on their usual network of formal and informal in-home support and face escalating challenges in accessing needed in-home care. Additionally, support programs, such as adult day health care, may not be available, hospitalized patients may be discharged home sooner and sicker than before, and post-acute care options may be more limited. Caregivers may also experience negative physical and mental health outcomes, facing their own exposure risks, increased stress and social isolation, potential income loss, job loss, and lack of childcare.

On November 30, 2021, the top eight health issues identified by the Community Health Assessment were presented. Participants were then as to participate in a Poll and vote on which issue they believe should be on our prioritization list for the next three years.

Jessica Farley reminded the group that the issues should be considered using the following criteria:

● Criteria 1 – Relevant – How important is this issue? (Size of the problem; Severity of problem; Focus on equity; Urgency to solve problem; Linked to other important issues)

● Criteria 2 – Impactful – What will we get out of addressing this issue? (Availability of solutions/proven strategies; Builds on or enhances current work; Significant consequences of not addressing issue now)

● Criteria 3 – Feasible – Can we adequately address this issue? (Availability of resources (staff, community partners, time, money, equipment) to address the issue; Political capacity/will; Community/social acceptability; Appropriate socio-culturally; Can identify easy, short-term wins)

The following priority health issues are the final community-wide priorities for our county that were selected through the process described above:

1. Mental Health/ Substance Abuse/Domestic Violence

2. Access to Care/ Use of Services

3. Chronic Disease/Obesity/Healthy Lifestyles

What is currently working in our community?

• Mountain Community Health Parternship (FQHC)
• Mitchell Transportation
• Mitchell County Health Department
• Guardian Ad Litem Program
• SEARCH Work Group
• Resource Guides
• Center for Health Innovation/Health-e-Schools
• AMY Regional Library system and Blue Ridge Partnership for Children increase internet accessibility and family support

Evidence-Based Strategies