HNC 2030 Scorecard: Alexander County

Description

Every four years the Alexander County Health Department completes a comprehensive Community Health Assessment as required by the North Carolina Department of Health and Human Services. This assessment allows us to gather information used to better understand the community’s health concerns, document health status trends and catalyze developing strategies to assess the community health problems.

Community Health Assessments are the foundation for improving and promoting the health of community members. The role of the Community Health Assessment is to identify factors that affect the health of a population and to determine the availability of resources within the community to adequately address these factors. In 2018 the process consisted of three primary steps: survey the community, analyze the data collected, and select health priorities. While the Health Department is the lead agency in conducting the assessment, existing community partnerships are utilized throughout the process to ensure the evaluation truly reflects the community’s needs. The Healthy Alexandrians Task Force is commissioned with analyzing and determining health priorities for Alexander County. Healthy Alexandrians is comprised of a mixture of government agencies, private industry leaders, the non-profit community, and interested community members who are concerned with the ongoing health needs of our community. These individuals, along with the Alexander County Board of Health, examined the survey results and health data to make a final determination of health priorities for the next four years.

Statistical data presented in the report represents the most recent information available at the time the assessment was completed. Health survey results vary and represent the opinion of the person completing the survey.

Executive Summary

VISION STATEMENT
The mission for the Alexander County Health Department is to promote, protect and ensure the health and well-being of all citizens of Alexander County. In the practice of public health, the health of the population is monitored and evaluated by examining key indicators such as leading causes of death, access to health care, and health trends such as physical activity.  Every four years, the Alexander County Health Department conducts a state-developed process known as the community health assessment (CHA). Findings from the CHA are used by the Health Department to lead strategic planning and to guide collaborative community action addressing identified priority issues. The CHA is also used to meet the requirements for state accreditation of local health departments.

The Alexander County 2018 Community Health Assessment is designed to:

• show the systematic collection, assembly, analysis, and dissemination of information about health in Alexander County
• evaluate the quality of life in Alexander County with an emphasis on health care
• identify trends in chronic diseases, causes of death, and high-risk behaviors; and
• define Alexander County’s health assets, needs, and priorities

LEADERSHIP AND PARTNERSHIP
The Alexander County Health Department guided this process using the Population Health Model. Alexander County Public Health is not the only party responsible for improved health outcomes in this community. Improving health is a collaborative process. With no hospital within Alexander County, the CHA is conducted by the Alexander County Health Department. However, the Health Department works in tangent with a variety of community agencies in providing care and services to residents of Alexander County.  The Alexander County Health Department did not receive support from a regional community health initiative or privately contracted vendor to conduct the 2018 CHA.

To prepare this Community Health Assessment, the Alexander County Health Department collaborated with representatives from Alexander County DSS, Alexander County School System, Alexander County Cooperative Extension, Alexander County Emergency Management, and citizens from the community. Once the Healthy Alexandrians Committee Members chose the focus areas, the Board of Health approved them.

2018 Healthy Alexandrians Committee Members
Alexander County DSS: Patricia Baker     
Alexander County Emergency Management: Russell Greene
Alexander County Schools: Jennifer Hefner, Nikki McClain
Citizens: Dale Clary, Melinda Sherrill
Alexander County Cooperative Extension: Der Holcomb
Alexander County Health Department: Billie Walker
2018 Board of Health Members
Dr. Jennifer Hull-Chair
Dr. Jeff Peal-Vice Chair
Janet Bowles
Macy Jones
Betty Long
Dr. Thomas Rider
Phillip Sprinkle
Scott Westmoreland, P.E.
Dr. Richard Williams
Larry Yoder

DATA COLLECTION
To build a comprehensive assessment, the Health Department utilized both primary (collected directly) and secondary (provided by other identified organizations) data sources to compile data.

• Primary data collection tool-the 2017-2018 Alexander County Community Health Assessment Survey distributed to the public in both paper and web-based formats from September 2017 until January 2018.
• Electronic and paper versions in both English and Spanish were used to facilitate broad participation.
• A link to the 2017-2018 Alexander County Community Health Assessment Survey was posted on the Alexander County Health Department website, Facebook page, and sent via email to all County employees and community partners. Paper versions were distributed at the Health Department and local community events and health fairs. Five hundred seven responses were collected through these formats, with a 95% completion rate.
• Secondary data gathered from local, state, and national sources were also collected from outside organizations and were used in assessing the severity of health issues in the county.

KEY FINDINGS
In February 2018, members of the Healthy Alexandrians Task Force reviewed indicators specific to the following seven areas:

• Chronic Diseases
• Substance Abuse
• Mental Health
• Access to Health Care
• Healthy Lifestyle Choices
• Leading Causes of Death
• Responsible Sexual Behavior

Members next reviewed the data obtained from the 2017-2018 Alexander County Community Health Assessment Survey and ranked them using the following criteria: severity, magnitude, urgency, and intervention effectiveness. Survey respondents made recommendations for the top ten health issues: cancer, obesity/overweight, heart disease, diabetes, depression/mental health, dental health, lack of physical activity, access to care, availability to healthy food, and Alzheimer’s disease.

HEALTH PRIORITIES
Participants of the final Priority Setting meeting in February 2018 made recommendations for the top three health issues to address in the next four years: Mental Health, Substance Abuse, and Healthy Lifestyles. The 2018 CHA Priorities were similar to the ones in 2014. The Healthy Alexandrians Task Force decided that these were still the most important and needed continued efforts. The next steps for each focus area are as follows:

Mental Health
• Use the grant to build a behavioral health program at the Alexander County Health Department
• Increase education programs for suicide prevention
• Increase public awareness of existing counseling resources for mental health
• Lobby for and seek additional funds for mental health care in the county

Substance Abuse
• Increase/maintain substance abuse prevention programs in Alexander County schools
• Create a public awareness/educational campaign to stress that substance abuse is an equal-opportunity disease and is a gateway to many risk-taking behaviors and chronic health problems
• Educate the public on proper disposal sites of unused and/or expired medication
• Use available grant funds to build harm reduction in response to the opioid crisis in the county
• Lobby for and seek additional funds for residents affected by substance abuse in the county

Healthy Lifestyles
• Create public awareness/prevention campaigns to combat high obesity, cancer, and heart disease rates
• Maintain partnerships with other local agencies with significant community outreach to encourage healthier lifestyles
• Synchronize CHA efforts with other strategic efforts in the city and county to establish and promote parks and recreational activities

2019-2022 ALEXANDER COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP)/STRATEGIC PLAN
Utilizing the data from the Community Health Improvement Process, a CHIP was developed in order to address the priority areas of concern. 

This Scorecard is being used to illustrate the priority health needs and efforts to address them utilizing the Results-Based Accountability/Scorecard process through the North Carolina Division of Public Health and Clear Impact.  More information is available at:

• Healthy North Carolina 2030
• Healthy North Carolina 2030 Scorecard
• North Carolina State Health Improvement Plan
• Clear Impact's Results-Based Accountability Resource Library 
• Clear Impact: The Results-Based Accountability Guide

Priorities

For the 2014 Community Health Assessment, the focus group chose Mental Health, Substance Abuse, and Healthy Families, which includes diabetes, obesity, heart disease, etc. as the health priorities for the next four years. Very similar Community Priorities were chosen for the 2018 Community Health Assessment. Below is the work the Health Department has done in collaboration with other community agencies to address these needs: Mental Health, Substance Abuse & Healthy Lifestyles.

MENTAL HEALTH

The intentional self-harm (suicide) rate in Alexander County is currently reported at 19.5 deaths per 100,000 residents, a rate nearly double the state average and higher than any of our assigned peer counties. The Alexander County Health Department, in collaboration with Vaya Health, is working to combat the issues with mental health. Vaya Health is the managed care organization for Alexander County, and also serves 22 other counties. The Health Department houses a kiosk located in the lobby that is provided by Vaya Health and that patients can freely use. The kiosk allows users to take an anonymous patient health questionnaire and it will let them know if they have symptoms relatable to a number of mental illnesses. If the user does present with symptoms of mental illness, then the kiosk also has a phone attached that will allow them to call and set up a counseling appointment if needed. The kiosk sends monthly reports of the number of times it is used and the outcomes.                                                                                                                                                                                                                                                                                  

In December 2017 the Health Department again collaborated with Vaya Health to offer Mental Health First Aid Training. This course teaches participants the skills needed to respond and assist anyone who is exhibiting signs of mental illness and substance use. The class only allows 30 participants and 27 people from various backgrounds - including law enforcement and DSS - participated in the training. Another Mental Health First Aid Training was hosted in May of 2018 and this focused on how to appropriately respond to youth with behavior and mental health issues.

Connecting residents to mental health services has been a focus of the Health Department. In January of 2018 the Health Department received a grant to create an in-house behavioral health program. The Health Department is adding this program to increase services provided in the area and to decrease the ratio of residents per mental health providers.

SUBSTANCE ABUSE

 Prescription drug, illegal substance, tobacco and alcohol abuse
In 2017 President Donald Trump declared the opioid crisis a public health emergency. Alexander County is no exception to the national trend of opioid-related overdoses. In 2017 North Carolina Injury and Violence Prevention Branch released individualized county-based overdose data. The rate of unintentional overdose deaths was higher in Alexander County compared to the state and region.

The Alexander County Substance Abuse Task Force - consisting of public health, law enforcement, medical providers, school officials, mental health professionals, substance abuse treatment providers, and other professionals - has been an active group working to mitigate the opioid crisis in Alexander County. Alexander County also has a new Addiction Recovery Medical Services center. Dr. Bobby Kearney recently opened a new office in Taylorsville to help residents combat addiction through medical and mental health services. Dr. Kearney’s office offers in-house counseling to patients and their families. The Alexander County Sheriff’s Office houses a take back box for residents to dispose of old and unused medication properly. The Sheriff’s Office, in collaboration with the Health Department, has hosted several take-back events throughout the past four years.

               

EMS, local law enforcement and all fire stations have access and have been trained on naloxone use in the event of an overdose. The Lock Your Meds Campaign began in 2018 and the Health Department has helped distribute over 40 medication lockboxes free to residents. In January 2018, Alexander County EMS received a grant to start a Post-Overdose Response Team and the group will be working to build that team in the coming months.

The Health Department also continues to address tobacco use within our community. Health Department staff, to help reduce the number of persons using tobacco products locally, conduct policy development and education efforts. Alexander County has seen a reduction in the percentage of adult smokers since the 2014 Community Health Assessment from 26% in 2014 to 19% in 2018. However, there have been recent concerns both locally and nationally about the use of e-cigarettes or vaping devices such as JUUL among teens and young adults. Alexander County/Alexander Central High School has been in talks with the Region 4 Tobacco Cessation Consultant on implementing the CATCH My Breath® curriculum to reduce the e-cigarette rates.                                                  

HEALTHY LIFESTYLES

The Healthy Alexandrians Task Force had selected improving overall health of the population as the final health priority; we entitled this “Healthy Lifestyles”. Recently the Health Department has been able through new funding to hire a Health Educator. The Health Educator will be promoting health and wellness through classes in our school system and employment health fairs, as well as collaborating with local agencies. Alexander County has established a new certified Safe Kids Coalition. Representatives of the Health Department are active members of the Coalition. Safe Kids focuses on reducing child mortalities and injuries by educating families and the community on safety tips such as fire safety and poisoning prevention. The local daycares have received a Farm-to-Table grant and are promoting healthy eating habits to children. Alexander County Agricultural Extension Office recently hosted a Speedway to Healthy program through North Carolina A&T State University. Alexander County is also continuing its Farmers Market efforts. The county has also merged community resources at a vacant church. The church houses Shelter Home of Caldwell County-Alexander Branch, Communities in Schools, United Way-Alexander County and a new soup kitchen that offers healthy meals.

Maintaining moderate physical activity can reduce the development of obesity, diabetes, heart disease, certain cancers, and other chronic diseases. Rocky Face Park opened in 2012 and, since then, the park has offered new courses and activities including hiking, rock climbing, primitive backpacking, and geocaching. The Vertical Mile Challenge is very popular among residents of Alexander County.
The course is approximately a two-mile loop and, half a mile into the path, there is a 500-foot climb up the face of the mountain. Over a thousand people have completed the 1 Vertical Mile Challenge where participants must complete eight loops of the 2.2-mile trail, a total 17.6 miles or 1 vertical mile.
However, in 2016 Alexander County still has the lowest percentage in the state for a population with adequate access to locations for physical activity.                     

Why Is This Important?

INTENTIONAL SELF-HARM (SUICIDE)
The suicide rate in Alexander County during the years 2013-2017 was 19.5 deaths per 100,000 residents, making it one of the top 10 causes of death locally. Even though this is a slight decrease from the previous years, it is still a concern because it is still significantly higher than the state average. Untreated mental illness (including depression, bipolar disorder, schizophrenia, and others) is a leading cause for the majority of suicides. An overall lack of mental health resources exists in the county to address the needs of our citizens. (Source: NC Center for Health Statistics)

AT-RISK POPULATIONS

After collecting primary and secondary data, the 2018 Community Health Assessment planning group identified the following group as one of the sectors of our population that may be at risk of poor health outcomes in Alexander County: adults and children in need of mental health services. Limited mental health services are available in Alexander County. Those individuals who struggle with mental health have inadequate resources to effectively manage their mental health needs without traveling out of the county.  A number of individuals at-risk also do not have the resources to travel for care.

What We Do

In collaboration with Vaya Health, ACHD began a behavioral health program.  A grant from The Duke Endowment was pursued and obtained to begin the program.  After inital policy/procedure development and credentialing in 2019, the program was ready to see patients in 2020; however, it was placed on hold due to requirements of Covid-19 response.  The program opened to patients in early 2021 before again being placed on hold due to the departure of our licensed clinical social worker in the fall.  The position is posted and program resumption is planned as soon as the position is filled.

Who We Serve

Qualified adult and pediatric patients in Alexander County who need behavioral health services

How We Impact

The behavioral health program at ACHD provides non-crisis individual therapy for children, adolescents and adults as well as comprehensive clinical assessments and family therapy.  It is designed to increase access to care in a community that is medically underserved, including for behavioral health care.  Services are billed on a sliding scale based on income and Medicaid, NC Health Coice and private pay are accepted in program in order to help patients obtain more affordable care.

What We Do

The Health Department's Behavioral Health program in collaboration with Alexander Senior Center, is providing gatekeeper training for Senior Center staff and volunteers by collaborating with Vaya Health to offer QPR (Question, Persuade, Refer), the community-based program for suicide and intentional self-harm awareness and prevention.

Who We Serve

With more than twenty percent of the Alexander County population in the target demographic and a most recent suicide rate of 19.5 deaths per 100,000 residents (compared to North Carolina's rate of 13.3 for the same time period), seniors in Alexander County are at serious risk of suicide.  When combined with limited access to mental health services and an extended period of greater isolation due to the complications of Covid-19, this target population is particularly vulnerable now.  As such, seniors in Alexander County is the target demographic for our community efforts in suicide prevention.

How We Impact

With Alexander Senior Center, we organized Celebrate Living Day on May 20, 2022.  The Health Department organized the event and Vaya Health provided the trainer and QPR materials.  Participants also received a brief introduction to Community Resilience through Vaya Health.  Fourteen seniors/Senior Center volunteers and two staff members were trained and the event was also attended by the Health Department, RHA and Vaya's local geriatric team.  Each provided senior care information and resources.  The Senior Center hosted the event, provided the food and the follow-up.

What We Do

Seniors in our community are particularly at risk of suicide and intentional self-harm.  Isolation during the Covid-19 pandemic further exacerbated this issue and made it somewhat more difficult to detect.  With our community partners, and through the Healthy Communities grant program of NCDHHS, the Health Department was able to organize this event to focus on identification of signs/symptoms, when/how to respond, and community resources available for assistance. 

Who We Serve

With our community partners Alexander Senior Center, Vaya Health & RHA, the team organizing the "Celebrate Living" suicide prevention awareness day provided this resource for seniors in our community and staff/volunteers of the Alexander Senior Center.

How We Impact

Following the event, all 16 attendees reported positive reactions to the program, including how thankful they were to have the information and to know that it was not their fault if they or others experienced suicidal ideation.  The attendees became aware of signs/symptoms of suicidal ideation, how to communicate with those at risk, and how to assist those at risk with referrals in the community for care.

What We Do

Alexander County Public Health's Behavioral Health Program in collaboration with Alexander Senior Center, will provide gatekeeper training for Public Health and Senior Center staff and volunteers in the priority population in order to provide QPR for the public priority population.  Follow-up will include evaluation of the program by both gatekeepers and members of the public priority population.

Who We Serve

Alexander County Senior Citizens

How We Impact

Appropriate individual interactions are crucial in reducing the rate of intentional self-harm in our target population.  The ability to recognize individuals at risk of suicide and the knowledge of how to respond form the basis of these crucial interactions.  By training Alexander County Public Health staff alongside Alexander Senior Center staff and their participating seniors in QPR gatekeeper training, we will increase the number of persons in direct contact with our senior population who are able to recognize the signs of senior adult suicide and act appropriately by utilizing the QPR training.

What We Do

The Duke Endowment helped to bring the Behavioral Health program at ACHD, in collaboration with Vaya Health, to fruition in order increase the number of providers in Alexander County and shorten the length of time that qualified clients wait to see a provider.  While this is critically assistive, a single provider addition cannot provide enough care to address the underserved in Alexander County.  Additional funding sources will be necessary in order to further grow the program's capacity; therefore, the Health Department will continue to pursue more grant funding in order to expand services for behavioral health. With the loss of the Rural Health Grant effective July 1, 2021, the need to seek additional funding to assist current patients in continuing their care through the program became an additional concern.

Who We Serve

Qualified patients in Alexander County who need the services of behavioral health

How We Impact

By seeking additional grant funding, the potential exists to expand hours and/or number of providers for behavioral health care in Alexander County.  With the loss of the Rural Health Grant, funds were sought to assist current patients with the ability to continue their care as well.

Why Is This Important?

SUBSTANCE ABUSE

In 2017, President Donald Trump declared the opioid crisis a public health emergency. Alexander County is no exception to the national trend of opioid-related overdoses. In 2017, North Carolina Injury and Violence Prevention Branch released individualized county-based overdose data. The rate of unintentional overdose deaths was higher in Alexander County compared to the state and region.

What We Do

The Substance Abuse Task Force works with Substance Abuse Prevention Coalition partners to educate our community on concerns including vaping and on appropriate use of substances to include prescription drugs, as well as with Coalition partner Alexander County Schools to implement tobacco-free (including e-cigarettes), alcohol-free, and drug-free curriculum.

Who We Serve

Youth in the Alexander County School System

How We Impact

The Substance Use Disorder Prevention Coalition developed a series of drug and alcohol prevention programs to be implemented in Alexander County Schools grades 6-12 through the 2023-2024 school year. Annual updates will be made to this program based on student and teacher evaluations. Alexander County Health Department worked with Alexander County Schools, Alexander County EMS, and Alexander County Sheriff to implement this program, including CATCH® My Breath, a nationally recognized evidence-based vaping prevention program. 

What We Do

In 2019 and early 2020, our Health Educator developed education on risky behaviors and the effects of bullying on our youth.  Education was provided to youth and adults in our community along with CATCH My Breath education which was provided through Alexander County Schools.  With the emergence of Covid-19 and changes in agencies' accessibility, the courses were placed on hold until the fall of 2022.

Who We Serve

Adults and youth in Alexander County

How We Impact

By increasing the number of people in Alexander County who are aware of the the dangers of risk-taking behaviors, aware of gateway nature of risk-taking behaviors to chronic health problems, and aware of how to avoid or leave risk-taking behaviors, we are providing individuals with the opportunity to make healthier choices and live healthier, happier lives.

What We Do

This program provides education on ways to prevent overdose, particularly with opioids, provides naloxone as appropriate through grant funding, and provides access to free medication lockboxes and the chemical to dissolve them when expired and/or unused.

Who We Serve

Adults and youth in Alexander County

How We Impact

By providing education, naloxone, medication lockboxes and Dissolve, the program helps prevent overdoses through lifesaving measures and limiting ease of inappropriate access.

What We Do

In 2021, with RHA, Alexander County Health Department and the SOARs grant program, medication lockboxes, Dissolve, and media coverage for our area regarding Lock Your Meds campaign were provided in order to help raise awareness of the issue and ways to help reduce inappropriate access to substances. That grant was pursued again in 2022 and funded.

Who We Serve

All persons in Alexander County

How We Impact

What We Do

The Substance Use Disorder Prevention Coalition (formerly Substance Abuse Prevention Coalition/Task Force) helps to educate the community on proper use of substances, proper disposal of medications/medication lockbox use, and makes available naloxone when appropriate through a grant fund.  Originally the Coalition had a member(s) who use drugs and represented the community; however, when the Coalition was halted from meeting during Covid-19, that membership changed.  The Coalition began again in June of 2022 and a goal is to include members from the community of people who use drugs in order to learn what barriers exist that prevent them from choosing not to use drugs and how to help them live safer, healthier, happier lives while reducing the risk of overdose and communicable diseases that can be associated with drug use outside of harm reduction strategies.

Who We Serve

Adults and youth at risk of/who use substances in Alexander County

How We Impact

The Substance Use Disorder Prevention Coalition (formerly Substance Abuse Prevention Coalition/Task Force) helps to educate the community on proper use of substances, proper disposal of medications/medication lockbox use, and makes available naloxone when appropriate through a grant fund.

Why Is This Important?

The three leading causes of death have not changed over time. They may vary in which spot they hold but cancer, diseases of the heart, and chronic lower respiratory diseases are always the top three. In 2017, the data was no different. The leading cause of death in Alexander County was cancer followed by diseases of the heart then chronic lower respiratory diseases. Cancer, diseases of the heart, and chronic lower respiratory diseases were also the 2017 top three leading causes of death in North Carolina. Physical inactivity, poor diet, and smoking are all contributors to the leading causes of death thus the Health Department will continue to focus on healthy lifestyles moving forward. (Source: NC Center for Health Statistics)

What We Do

Create and/or share credibly-sourced social media content on a variety of healthy lifestyles topics in order to help Alexander County citizens be more informed about, and hopefully choose to make, healthier lifestyles

Who We Serve

All people in Alexander County, NC

How We Impact

By providing credible and consistent health information, we help to cut through the mis- and dis-information on social media with healthy lifestyles information that our citizens need.

What We Do

Work collaboratively with other agencies in order to provide the most current, credible and actionable healthy lifestyles information to all people in Alexander County

Who We Serve

All people in Alexander County

How We Impact

By collaborating with local agencies, growing and maintaining partnerships for outreach, we can help to reduce the gaps in our healthy lifestyles messaging in order to better lives for all people in Alexander County.

What We Do

Create and/or share content promoting Alexander County Parks & Recreation Department activities in order to help people be more informed about, and hopefully choose to utilize, community opportunities for recreation and physical activity

Who We Serve

all persons in Alexander County

How We Impact

Due to seasonality of activities and the impact of the Covid-19 pandemic on programs of, and accessibility to sites of Alexander County Parks & Recreation, this activity has not yet been meaningfully implemented.

What We Do

Create and/or share credibly-sourced website, social media, Code Red and mass-media content on the ways to prevent and treat Covid-19 infection and to prevent or reduce the spread of the Covid-19 virus in order to help all people in Alexander County make better, safer choices to protect themselves, their loved ones and the community at large from this pandemic illness

Who We Serve

all persons and organizations in Alexander County

How We Impact

By educating the community on the importance of washing hands, wearing masks, waiting six feet or more apart, isolating and/or quarantining as appropriate and by providing factual information on Covid-19 vaccinations; by helping to reduce the effect of mis- and disinformation regarding Covid-19, the vaccinations and treatments

Progress on CHIPs

Based on its 2018 Community Health Assessment and 2019 State of the County report, Alexander County's Community Health Improvement Plan focus areas for 2020 remained as Mental Health, Substance Use Disorder and Healthy Lifestyles until the Covid-19 pandemic occurred.  The pandemic called for its own set of focus areas including communicating factual messages to help stop the spread of Covid-19 disease, providing diagnostic testing and, when it became available, providing vaccine doses according to North Carolina's phased rollout of vaccinations.

Throughout this process, Alexander County Public Health has been gathering and reporting data to the State in order to help inform decisions related to social distancing and vaccine provision. Hospitalization and mortality data have been particularly difficult to obtain on a routine schedule as Alexander County has no hospital of its own and therefore must rely on data from the four healthcare systems across our borders as it relates to Alexander County citizens.  For this reason, those two metrics generally vary slightly from the State's dashboard data.

Despite the all-hands-on-deck requirement for responding to the global pandemic, Alexander County Public Health did provide the community with messaging to support good mental health, promote Lock Your Meds and give away medication lockboxes at approved outdoor events and individually by request, as well as messaging about tobacco/vaping cessation and chronic disease screenings through its Facebook page @alexandercountyhealth and through traditional media such as WBTV and Taylorsville Times.  Most partner relationships including those with Vaya Health, Alexander County Senior Center, Alexander County Department of Social Services, North Carolina Department of Health and Human Services, and North Carolina Emergency Management were maintained through telecommunications and web-based programs such as Zoom and Microsoft Teams.

Additionally, members of our staff trained in Results-Based Accountability (RBA) in 2021 and, as a result, Alexander County Public Health has begun making plans to utilize RBA for its 2021 State of the County Report, 2022 Community Health Assessment, as well as its Healthy Communities grant activities.   This moves Alexander County's community health initiatives to web-based documents that are easily understood and utilized by our stakeholders and audiences, simplifying work with partner agencies and helping us to better track results of implemented programs.  The priorities and programs will soon be added to our Clear Impact Scorecard and linked with the Healthy North Carolinians 2030 Scorecard for better transparency and to provide our citizens clearer understanding of population accountability. 

Morbidity and Mortality Changes Since Last CHA

In Alexander County, as in most areas of North Carolina, the United States and the world, the most significant change in morbidity and mortality came as a result of the Covid-19 pandemic.  As of May 26, 2021, the number of cases of Covid-19 in Alexander County was 4,409, or a rate of 11,758.3 per 100,000 residents.  To date, 86 Alexander County citizens have lost their lives to Covid-19.  This represents a case fatality rate of 229.4 per 100,000 residents.

Emerging Issues Since Last CHA

When SARS-CoV-2 infected our population and caused Covid-19 disease, it naturally affected health outcomes by infecting approximately 12% of Alexander County citizens and causing a range of illness states from asymptomatic to severe and long-haulers. It further complicated population health by temporarily or permanently closed places of employment, thereby leading to joblessness; causing a moratorium on evictions that is slated to end in North Carolina on July 1, 2021, placing both tenants and landlords at risk of losing designated housing properties; disrupting the supply chain and thereby leading to food insecurity for individuals and families; and requiring the development of a hybrid school model that increased children and families' anxieties and limited access to regular meals for some children. Lower income populations, rural populations, migrant worker and local populations of color were disproportionately affected as they had less access to high-speed internet and online devices for food, medical and disinfectant supplies ordering/delivery, school programs and online education and for entertainment during stay-at-home orders.

New/Paused/Discontinued Initiatives Since Last CHA

In order to help stop the spread of Covid-19, Alexander County Public Health has provided Covid-19 vaccines according to the phased rollout of vaccine availability for North Carolina.  To date, the health department itself has given 13,038 Covid-19 vaccine injections and, along with our community partner agencies including Iredell Family Care Center in Taylorsville; Peoples Drug, Town & Country Drug, and Office Practice of Pharmacy; have assured that 29.7 % of our population has been vaccinated with at least one dose while 28% have been fully vaccinated. 

Progress on CHIPs

Utilizing its 2018 Community Health Assessment (CHA), 2019 and 2020 State of the County Health (SOTCH) reports, Alexander County's Community Health Improvement Plan focus areas for 2021 remained Mental Health, Substance Use Disorder and Healthy Lifestyles, the latter of which continued to include messaging around health measures for safety and wellness during the Covid-19 pandemic.  Covid-19 focus areas that continued throughout 2021 included communicating factual messages to assist in slowing the spread of Covid-19 disease, providing diagnostic testing and providing vaccine doses according to North Carolina's phased rollout to eligible populations.

As we continue to gather data on Covid-19 and its impact on Alexander County, hospitalization and mortality data remain particularly difficult to obtain in a consistent manner since Alexander County has no hospital of its own and therefore must rely on data from the four healthcare systems across our borders for data relating to Alexander County citizens.  As was the case in 2020, these two metrics continue to vary slightly from the State's dashboard data.  Due in part to this circumstance, and mostly in response to requests for clearer data by our community, the Health Department updated its Covid-19 Dashboard to better illustrate trends in Covid-19 cases and rates of vaccination in 2021 as evidenced by the following example from December 20, 2021:

To help our community reduce the rate of Covid-19 transmission, Alexander County Health Department provided drive-thru and curbside PCR testing and administered over 16,300 doses of vaccine.  We continue to provide curbside testing and doses of first, second, third/immunocompromised, and booster Pfizer vaccine for patients ages 5 and older and Moderna vaccine for patients ages 18 and older, according to authorizations, approvals and guidance by North Carolina Department of Health and Human Services (NCDHHS), Centers for Disease Control and Prevention (CDC), and U.S. Food and Drug Administration (FDA).  The Health Department also continues to counter the effects of Covid-19 mis- and disinformation with facts, transparency and sympathy, responding in a timely manner to inquiries by the general public; education, business and industry leaders; and the media; and by providing one-voice situational updates through the County's Covid team members and Code Red messaging service, on our website and social media platforms.

Beyond Covid-19, Alexander County Public Health further continued to address community

• mental health needs by:
  • training staff in the intentional self-harm/suicide prevention program Question, Persuade, Refer (QPR)
  • collaborating with Alexander Senior Center to offer the same training for our at-risk senior population in spring 2022, and
  • applying for the NC GlaxoSmithKline Foundation Child Health Award to assist with the provision of behavioral health care to low income patients after the Rural Health Grant was not renewed for 2022

    

• substance use disorder needs by:
  • participating in Golden Opportunity Day with Alexander County Department of Social Services to provide health education and promote Lock Your Meds, distributing 18 medication lock boxes to area seniors through a grant partnership with RHA Prevention Resource Center
  • creating the media campaign "5 Tips to Prevent an Overdose" through the Healthy Communities program of NCDHHS, and
  • promoting the campaign which includes, in part, recognition of overdose signs and symptoms, introduction to NC Good Samaritan and Naloxone Access Laws, and resources for additional information, alongside Lock Your Meds & #naloxonesaveslives in our social media, on our website, County Television and Charter Media channels 
        
• healthy lifestyles needs by:  
  • promoting nutrient-dense foods, physical activity and tobacco cessation messaging and opportunities via our website and social media
  • participating in NC MedAssist Mobile Free Pharmacy event with The Bridge Community of Alexander County
  • certifying our health educator as a trainer for CATCH® My Breath and training three new community leaders in the program
  • collaborating with Cabarrus Health Alliance to facilitate the free provision in 2022 of Journey to a Healthier Me, the minority diabetes prevention program, and
  • collaborating with UNC Center for Health Promotion and Disease Prevention to become a research site for their 2022 phase 2 study of Med-South Lifestyle Program, a program created to provide free, local education designed to improve heart health and lower A1C

Key partner relationships including Alexander County Department of Social Services, Alexander County Safe Kids Coalition, Alexander County Senior Center, The Bridge Community, Cabarrus Health Alliance, CATCH Global Foundation/CATCH® My Breath, NC Area Health Education Centers, North Carolina Department of Health and Human Services, North Carolina Emergency Management, NC MedAssist, North Carolina Region 4 Tobacco-Free Alliance, RHA Prevention Resource Center, Shelter Home of Caldwell & Alexander Counties, UNC Center for Health Promotion and Disease Prevention, and Vaya Health were largely maintained through telecommunications and web-based programs such as Zoom and Microsoft Teams.

Planning began for our accreditation survey that will occur in the fall of 2022 after postponement in 2020 and 2021 due to Covid-19.  In order to further greater transparency, more active involvement by our citizens, and a deeper understanding of population accountability, our accreditation process, as well as our 2022 CHA, and our Healthy Communities grant activities are managed using the Results-Based Accountability (RBA) process.  Through collaboration with North Carolina Department of Health and Human Services, North Carolina Area Health Education Centers and Foundation for Health Leadership & Innovation, RBA was made available to us and our health educator was able to complete the Results-Based Accountability professional certification course in November 2021.

Morbidity and Mortality Changes Since Last CHA

In 2021 in Alexander County, as in much of North Carolina, the United States and the world, the most significant change in morbidity and mortality continued to be the result of the Covid-19 pandemic.  Based on updated data reflecting the number of positive tests and deaths per week for 2020 and 2021, we are now able to more accurately compare the case and mortality rates for both years.
As of December 31, 2020, there were 3,034 total confirmed cases and 46 confirmed deaths from Covid-19 in Alexander County. Utilizing 36,444 as the county population total from the 2020 Census, the rate of Covid disease was 8,325.1 cases per 100,000 residents for the year.  The morality rate from Covid-19 for the same period was 126.2 per 100,000 residents. 

During 2021 there were an additional 4,459 confirmed infections and an additional 81 confirmed deaths in Alexander County, representing a case rate of 12,235.2 per 100,000 residents and a mortality rate of 295.2 per 100,000 residents for that year.

Cumulatively from the start of the pandemic until the period end on December 31, 2021, the total number of cases rose to 7,493 and the number of deaths rose to 127 for a total Covid-19 infection case rate of 20,560.3 per 100,000 residents and a morality rate from Covid disease of 348.5 per 100,000 residents across both years.  

Emerging Issues Since Last CHA

When SARS-CoV-2, the virus that causes Covid-19, infected our population and caused Covid-19 disease, it naturally affected health outcomes for our citizens by causing a range of illness states from asymptomatic to severe and long-haulers.  The emergence of the Delta and Omicron variants in 2021 furthered the impact by infecting and hospitalizing more children and by spreading much more rapidly through the population, respectively.  Both variant surges, in combination with passage of time, caused us to see some diminished vaccine effectiveness and increased rates of both breakthrough and reinfection cases.   

Many places of employment, having fully reopened, returned to virtual or hybrid work models.  Some closed entirely, leading to additional mental and emotional strain and increasing joblessness. Congruently, an exodus of retirement-eligible workers has placed additional strain on employers.  Employees are covering additional shifts and some have reported an unwillingness to share their personally identifiable information when attempting to report the results of a positive take-home Covid-19 test for concern they will not be able to attend work or that their children will be unable to attend school. 

Residential pressures have also increased as the moratorium on evictions ended in 2021, placing both tenants and landlords at risk of losing designated housing properties.  A disruption of the supply chain further exacerbated food insecurity for individuals and families. The pressures of last year's hybrid school model that increased children and families' anxieties and limited access to regular meals for a number of children have led to a few disruptions at public meetings amid calls for students to remain in class and unmasked, regardless of their exposure to positive cases.

Lower income populations, rural populations, migrant workers and local populations of color were disproportionately affected in all ways as they had less access to high-speed internet and online devices or services for food, medical and disinfectant supplies ordering and delivery, school programs and online education, and for entertainment during quarantine and isolation periods.

Mis- and disinformation continued to spread regarding Covid-19 and its origins as well as the safety and efficacy of vaccines and authorized or approved treatments for Covid-19 disease.  Local farm supply retailers ran out of Ivermectin, an agricultural de-worming medication, after inaccurate reports and endorsements in national media and online falsely indicated it to be a treatment and/or preventative for Covid-19 infection. 

New/Paused/Discontinued Initiatives Since Last CHA

In September 2021 Alexander County Public Health's behavioral health program was paused due to the search for a new licensed clinical social worker (CSW). The position remains open and will remain so until filled.  Patients cared for as part of the program were referred to other resources as appropriate prior to departure of our previous CSW.

The Health Department continues to provide Covid-19 vaccinations for all eligible populations, expanding provision to include newly eligible age groups and additional doses as authorized or approved by NCDHHS, the CDC and the FDA.  While Alexander County still has room for improvement in terms of our overall vaccination rate, Alexander County Health Department and our community partner agencies including Iredell Family Care Center, Peoples Drug, Town & Country Drug, Office Practice of Pharmacy and Walmart Pharmacy have assured that 46% of our citizens have been vaccinated with at least one dose and 43% have been fully vaccinated of Covid-19 vaccine. The later represents a 53% increase over the number fully vaccinated in 2020. 

As part of our total commitment to healthy lifestyles and to assist our citizens in securing local heart-healthy education that may assist in reducing A1C s and the risk of diabetes, Alexander County Health Department will begin offering the Med-South Lifestyle Program in 2022 as part of a UNC Center for Health Promotion and Disease Prevention research grant funded though CDC, as well as facilitating appropriate referrals to Cabarrus Health Alliance for the minority diabetes prevention program Journey to a Healthier Me.  The vetting process to become a participating site and the education and training for our implementation team members were completed in 2021 for Med-South Lifestyle Program, as was the collaboration agreement with Cabarrus Health Alliance.  The Health Department began patient recruitment in December of 2021.