HNC 2030 Scorecard: Brunswick County 2019-2022

Brunswick County Health Services is pleased to share the Community Health Improvement Plan (CHIP).

The Brunswick County Community Health Assessment (CHA) is conducted at least every four years to determine the community’s needs and develop programs and plans to address the health priorities.The final priority areas identified from the CHA and used in the planning and creation of the CHIP are:

Substance Misuse
Access to Health Care
Chronic Conditions

*All prioiritiy areas have an overarching theme and focus on the aging population.

For each priority, this Scorecard spotlights:

A Result Statement, a picture of where we would like to be,
Important local Indicators or measures of how we are doing linked to Healthy NC2030 indicators and
Select Programs or activities and
Key Performance Measures that show how those programs are making an impact.

Instructions: Click anywhere on the scorecard to learn more about programs and partners that are working together to improve the health of Brunswick County. The letters below represent key components of the Scorecard.

Use the icons to expand items and the icons to read more. This scorecard is not intended to be a complete list of all the programs and partners who are working on these issues in Brunswick County

Community Health Assessments

2019 Community Health Assessment

Executive Summary

The Community Health Assessment The Community Health Assessment is conducted to examine the health and quality of life of Brunswick County citizens. The process includes gathering information from community residents (primary data), and comparing this data to available health statistics (secondary data) to identify the most pressing concerns. The information gathered is used by county leadership and stakeholders to strategically plan the best use of resources to address top community concerns, while tracking progress to reach the overall goal of improving health and quality of life in Brunswick County.

Community Health Assessment Vision A healthy Brunswick County promotes access to affordable care, treatment, and community resources to improve the well-being of all residents.

The Assessment Process Every four years, Brunswick County Health Services collaborates with community stakeholders and a multidisciplinary community health assessment (CHA) Steering Committee to lead the assessment
process. The process includes collecting and analyzing primary (survey and focus groups) and secondary (health statistics) data and collectively setting priorities for the improvement of health and
quality of life for residents. The results of the CHA are subsequently used to create a plan of action (community health improvement plan) in order to effect measurable change over the next four years.
Brunswick County Health Services, in consultation with the Center for Healthy Communities at the University of North Carolina Wilmington’s College of Health and Human Services, collaborated
with Community Health Assessment Steering Committee members and other community partners to complete the eight steps of the community health assessment process outlined by the North
Carolina Division of Public Health. The community participated in the CHA process through input on the community health opinion survey (CHOS) and in focus groups. The 55-question CHOS was administered to randomly selected households through in-person door-to-door visits and through direct mailings.

......

Priorities

Substance Misuse
Access to Health Care
Chronic Conditions

Chronic Conditions

CHIP

Brunswick County residents live in communities with access to health and wellness opportunities.

Why Is This Important?

Access to healthy foods is strongly influenced by where someone lives. People in rural or underserved areas of North Carolina are particularly affected by lack of access to stores where they can purchase ingredients for healthy meals.

Exercise is linked to positive physical, psychological, and social outcomes. Communities that create spaces for physical activity have healthier people with decreased risks of obesity, heart disease, and other chronic conditions that increase morbidity and mortality.

Access to health education and screenings plays a role in boosting or inhibiting someone's ability to make healthy choices.

What does it look like when you achieve this result?

When Brunswick County residents have access to healthy foods and exercise opportunities, we anticipate seeing:

A reduction in the number of deaths due to chronic diseases
Improvements made to park facilities
Expansion of senior center facilities
Increased access to exercise classes and recreational activities
Improved access to affordable and nutritious foods
Increased access to health education and screenings

How can you measure these quality of life conditions?

Results of the community health opinion survey (CHOS) showed that 19.6% of Brunswick residents considered chronic disease to be the biggest health concern in their community. When participants of focus groups were asked the same question, chronic disease was also the most selected response.

Brunswick County survey respondents were asked what areas needed improvement in their communities, with 28.5% of focus group and 21% of CHOS respondents selecting better/more recreational facilities such as parks, trails, community centers. CHOS respondents were also asked how they would improve their health if they could, to which 54% of respondents said eating healthy food and 50% said by exercising. These responses also align with the Healthy NC 2030 Chronic Disease indicators:

Access to Exercise Opportunities

Increase Physical Activity

Brunswick County: 76%

2030 Target: 92%

Access to Healthy Food

Improve Access to Healthy Food

Brunswick County: 6%

2030 Target: 5%

To measure these conditions, we will collect and review annual data. Local program data will be used to measure participation in evidence-based programs and initiatives. Changes in community perception of identified health concerns will be measured through pre/post tests and surveys asking corresponding questions from the CHOS and focus group surveys. This will enable us to examine the effectiveness of the programs and initiatives.

How are you doing on the most important measures of this (these) condition(s) in our community?

Seven of the top ten leading causes of death in Brunswick County are chronic diseases. Diabetes mellitus is the seventh leading cause of death in Brunswick County. The diagnosed diabetes prevalence in Brunswick has been trending upwards since 2014, from 11.4 to 12.8 in 2016. Community health opinion survey (CHOS) respondents selected diabetes as the most needed health screening in the county. Disparities in diabetes mortality also exist among race and gender. Between 2013-2017 the diabetes mortality rates were 24.8 male, 12.6 female, 17.1 White, and 25.1 African American.

Data from 2018 shows that 14% of Brunswick County residents are food insecure and 6% have limited access to healthy foods. Food insecurity is considered the disruption of nutritious food consumption due to lack of money and other resources, where limited access to healthy foods refers to people who do not live in close proximity to a grocery store. Brunswick County also has a significantly higher percentage of children living in households that are considered poor or low-income and food insecure when compared to the state and peer counties. Nutrition is vital to human growth and development, and poor or low-income homes may struggle to maintain adequate nutrition.

Exercise fosters growth and development, improves brain health, and reduces the risk of many chronic diseases. Based on the data available, Brunswick County is slightly ahead of the state average for access to exercise opportunities, but has a lower percentage compared to Carteret at 91%, New Hanover at 87% and the Healthy NC 2030 goal of 93%.

Who are the partners that have a role to play in doing better?

Brunswick Wellness Coalition

Cooperative Extension

Brunswick Senior Resources

Brunswick County Health Services

Brunswick County Parks and Rec

Cape Fear Food Council

What works to do better?

Increasing participation in the evidence-based programs and initiatives below will help us achieve our result of Brunswick County residents living in communities with access to health and wellness opportunities.

1) Walk with a Doc is open to community members of all abilities. Participation is free and pre-registration is not required. Walkers will enjoy a 1-hour, refreshing and rejuvenating walk with a doctor and/or other healthcare professional, who will provide support to participants and answer questions during the Walk.

2) Health Hacks are free seminars including cooking demonstrations and tastings and wellness topics presented by healthcare professionals.

Topics Include:

-Jump starting your metabolism

-Quick and healthy recipes

-Healthy holiday eating

-Tips to de-stress

-Grocery store revamp

-Eating to improve mood

3) The YMCA’s Diabetes Prevention Program (DPP) is a CDC recognized program based upon proven strategies to help reduce your risk of developing type 2 diabetes. Goals include weight loss, increased physical activity, improved nutrition and stress reduction. YMCA membership is NOT required to participate.

- Attend 25 one-hour sessions over the course of a year (16 weekly sessions and 9 monthly sessions).

-Small-group (8-15 people), supportive environment, led by a trained Lifestyle Coach.

-Enjoy additional supports for physical activity with a free 4-month YMCA membership for non-members.

4) Brunswick County Health Services provides an ADA recognized Diabetes Education Program to men and women who have Type I or Type II diabetes.

Diabetes Education sessions provide participants with helpful information on diabetes self-management, exercise, and help with nutrition including carbohydrate counting and the MyPlate portioning method.

Education Provided:

-Diabetes medication

- Blood glucose monitoring

-Nutrition

-Long-term and short-term complications of diabetes

-Exercise

5) Families Eating Smart Moving More (FESMM) targets Grandparents raising grandchildren, Single parent families, Foster Families, and all family structures. The curriculum is also used for High School youth.

There are 21 lessons under four major headings.

-Eating Smart at Home

-Eating Smart Throughout the Lifecycle (For Pregnant and Nursing mothers)

-Eating Smart on the Run

-Moving More, Every Day, Everywhere, Watching Less

6) Teen Cuisine

The curriculum is designed to address the Essential and Core standards for each grade. In addition, the lessons are developed to positively affect five key health behaviors:

• Increase the youth’s knowledge of human nutrition;

• Increase the variety of foods in the youth’s daily diet;

• Improve the youth’s ability to select low-cost, nutritious foods for meals and snacks;

• Improve food preparation and food safety practices to reduce the risk of foodborne illnesses; and

• Increase daily physical activity

7) SNAP-Ed Programs

Mission: Steps to Health is North Carolina State University’s Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Program. We educate and inspire limited resource North Carolinians to eat smart and move more through nutrition and food resource management education programs targeting elementary-age children, adults, Latino families, and older adults. Our goal is to help participants make healthy choices within a limited budget and choose physically active lifestyles consistent with the current Dietary Guidelines for Americans and MyPlate.

Programs include:

Take Control, Faithful Families, Steps to Health

8) 4-H Healthy Habits Programs

Mission: 4-H Healthy Habits youth programming, aims to reach large numbers of youth in grades 2 through 12 through a minimum of eight hours of programming around physical activity and nutrition. 4-H Healthy Living Ambassador program, focuses on positive youth development of older youth through activities focused around 4-H Healthy Living, including health, nutrition and fitness, social and emotional well-being, and leadership skills.

Programs include:

Learn, Grow, Eat, Go and using Teens as Teachers

FHLI-NC

HNC2030

County Health Ranking Map - Limited Access to Healthy Foods

County Health Ranking Map

Limited access to healthy foods

Percentage of population who are low-income and do not live close to a grocery store.

The 2020 County Health Rankings used data from 2015 for this measure.

CHR Link to County Level Data

Diabetes Self Management Education (DSME) Program

What We Do

Brunswick County Health Services provides an ADA recognized Diabetes Education Program. Diabetes education sessions provide participants with helpful information on diabetes self-management, exercise, and help with nutrition including carbohydrate counting and the MyPlate portioning method.

Who We Serve

Men and women who have Type I or Type II diabetes.

How We Impact

Education Provided:

-Diabetes medication

- Blood glucose monitoring

-Nutrition

-Long-term and short-term complications of diabetes

-Exercise

Better off

Percent of participants that had an A1C level improvement

2021

18%

80%

Diabetes Prevention Program (DPP)

What We Do

The YMCA’s Diabetes Prevention Program (DPP) is a CDC recognized program based upon proven strategies to help reduce your risk of developing type 2 diabetes. Goals include weight loss, increased physical activity, improved nutrition and stress reduction.

Who We Serve

Individuals at risk of developing type 2 diabetes.

How We Impact

- Attend 25 one-hour sessions over the course of a year (16 weekly sessions and 9 monthly sessions).

-Small-group (8-15 people), supportive environment, led by a trained Lifestyle Coach.

-Enjoy additional support for physical activity with a free 4-month YMCA membership for non-members.

Better off

Average weightloss change among participants

2021

Walk With A Doc

What We Do

Walkers will enjoy a 1-hour, refreshing and rejuvenating walk with a doctor and/or other healthcare professional, who will provide support to participants and answer questions during the walk.

Walk with a Doc - Brunswick Wellness Coalition

Who We Serve

Walk with a Doc is open to community members of all abilities.

How We Impact

Only about 1 in 5 adults and teens get enough exercise to maintain good health. Get at least 150 minutes (2.5 hours) of heart-pumping physical activity per week and reap the benefits. Participation is free and pre-registration is not required.

September 2022 Update

How much

Number of participants completing the walk

HY1 2022

92%

Health Hacks

What We Do

Health Hacks are free seminars including cooking demonstrations and tastings and wellness topics presented by healthcare professionals.

Who We Serve

Free monthly seminars for the community.

How We Impact

Topics Include:

-Jump starting your metabolism

-Quick and healthy recipes

-Healthy holiday eating

-Tips to de-stress

-Grocery store revamp

-Eating to improve mood

September 2022 Update

The Health Hacks series concluded in December 2021. No Health Hacks sessions will take place in 2022.

How much

Number of Participants

2021

458#

835%

How well

Percentage of participants that indicated knowledge change

2021

98%

14%

Families Eating Smart Moving More (FESMM)

What We Do

Cooperative Extension’s Expanded Food and Nutrition Education Program’s (EFNEP) mission is to improve the health of limited resource youth and families with young children through practical lessons on basic nutrition and healthy lifestyles, resource management and food safety.

Who We Serve

Families Eating Smart Moving More (FESMM) targets grandparents raising grandchildren, single parent families, foster families, and all family structures. The curriculum is also used for high school youth.

How We Impact

There are 21 lessons under four major headings.

Eating Smart at Home
Eating Smart Throughout the Lifecycle (For Pregnant and Nursing mothers)
Eating Smart on the Run
Moving More, Every Day, Everywhere, Watching Less

The CORE lessons are:

1. Introduction to EFNEP

2. Choosing More Fruits and Vegetables

3. Fix it Safe

4. Plan: Know What’s for Dinner

5. Shop for Value, Check the Facts

6. Shop: Get the Best for Less

7. Fix it Fast, Eat at Home

8. Making Smart Drink Choices

9. Choosing to Move More Throughout the Day

10.Choosing a Healthier You for Life

Evaluation of impact and effectiveness of the curriculums are measured using the pre and post participant data approved for use through the federal Expanded Food and Nutrition Education Program.

How much

Percentage of families completing the program

2021

80%

Teen Cuisine

What We Do

Who We Serve

The curriculum is designed to address the essential and core standards for Kindergarten – 5^th grade and 6^th – 9^th grades.

How We Impact

The lessons are developed to positively affect five key health behaviors:

• Increase the youth’s knowledge of human nutrition;

• Increase the variety of foods in the youth’s daily diet;

• Improve the youth’s ability to select low-cost, nutritious foods for meals and snacks;

• Improve food preparation and food safety practices to reduce the risk of foodborne illnesses; and

• Increase daily physical activity

Better off

Percentage of students having increased knowledge about the five key health behaviors

2021

71%

SNAP-Ed Programs

What We Do

Steps to Health is North Carolina State University’s Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Program.

Who We Serve

We educate and inspire limited resource North Carolinians to eat smart and move more through nutrition and food resource management education programs targeting elementary-age children, adults, Latino families, and older adults.

How We Impact

Our goal is to help participants make healthy choices within a limited budget and choose physically active lifestyles consistent with the current Dietary Guidelines for Americans and MyPlate.

Programs include:

Take Control, Faithful Families, Steps to Health

How much

Percentage of participants completing the Take Control Program

2021

78%

How much

Percentage of participants completing the Color Me Healthy program

2021

68%

4-H Healthy Habits Programs

What We Do

The Brunswick County 4-H Youth Development Program is an educational program of the N.C. Cooperative Extension Service for boys and girls ages 5-19. We provide research-based, hands-on curriculum that teaches youth valuable life skills.

Who We Serve

Youth in grades 2 through 12, and older youth.

How We Impact

4-H Healthy Habits youth programming, aims to reach large numbers of youth in grades 2 through 12 through a minimum of eight hours of programming around physical activity and nutrition. 4-H Healthy Living Ambassador program, focuses on positive youth development of older youth through activities focused around 4-H Healthy Living, including health, nutrition and fitness, social and emotional well-being, and leadership skills.

Programs include:

Learn, Grow, Eat, Go and using Teens as Teachers

How much

Percentage of youth completing Learn, Grow, Eat, Go and using Teens as Teachers

Substance Misuse

CHIP

Brunswick County residents live in communities with equitable access to resources for substance use disorder services.

Why Is This Important?

Substance use disorders (SUDs) are chronic or recurrent conditions that, like other chronic illnesses, require ongoing care and treatment for individuals to regain health and maintain recovery. As with any chronic disease, prevention, identification, treatment, and recovery services and supports are essential to ensuring positive health outcomes.

What does it look like when you achieve this result?

When Brunswick County experiences a decrease in drug overdose deaths, we anticipate seeing:

Increased and improved access to local treatment
Reduced access to illicit drugs and access to substances (i.e. vaping, tobacco, alcohol, prescription medications)
Increase in participation in educational programs and support services
Demographics (age, ethnicity) 18-30 age group, white males

How can you measure these quality of life conditions?

Local initiatives will address prevention, early intervention, support, and treatment for substance use disorders. Effectiveness of interventions will be measured by pre/post tests given to program participants and local data obtained from partners. Data will be compared to community health opinion survey (CHOS) and focus group responses to identify changes in community perception. Annual data will also be analyzed to determine progress made on the NC 2030 Substance Misuse indicator:

Drug Overdose Deaths (per 100,000 population)

Decrease Drug Overdose Deaths

Brunswick County: 32

2030 Target: 18

How are you doing on the most important measures of this (these) condition(s) in our community?

Drug misuse was the most selected for the biggest health concern on the community health opinion survey (CHOS). Substance misuse was also the #1 choice for the area needing the most improvement.

The most recent preliminary data shows a downward trend in opioid overdose deaths and ED visits. Progress made in Brunswick County is attributed to programs and initiatives implemented in recent years.

Brunswick County’s rate of unintentional medication and drug overdose deaths was 25.1 per 100,000 people (2014-2018) compared to the statewide rate of 16.7 per 100,000. The rate of unintentional opioid-specific overdose deaths in Brunswick is 22.2 per 100,000 residents, higher than the statewide rate of 13.6 per 100,000. The rate of outpatient opioid pills dispensed per resident in Brunswick County in 2018 was 56.4, compared to 43.7 statewide. Data also shows a 20-point percentage increase, from 2016 to 2017, in opioid poisoning emergency department visits resulting in deaths. There has been a decrease in the number of medication and drug overdose deaths in Brunswick County in recent years. Synthetics other than opioids are also contributing to unintentional overdose deaths.

Who are the partners that have a role to play in doing better?

Brunswick County Sheriff's Office

Brunswick County Substance Use and Addiction Commission

Coastal Horizons

Cooperative Extension

NC Harm Reduction Coalition

Trillium

What works to do better?

Marketing medication disposal locations and providing community training on how to administer naloxone.

1) Medication Drop Boxes

Unwanted, unused, or expired medications can be accidently and intentionally misused. According to the U.S. Food and Drug Administration, many abusers obtain medications from the homes of family members and/or friends. Improper disposal can also contaminate the environment and release substances into our ground water supplies. BCHS partners with the Brunswick County Sheriff’s Office to encourage residents to protect their families by using the secure collection drop boxes located at several Sheriff’s Office and police department locations.

2) Naloxone Kit Distribution and Medication Lock Boxes

Brunswick County law enforcement and EMS currently carry Naloxone, which is the reversal agent for heroin and other opioid overdoses. One of our community partners, Coastal Horizons, distributes Naloxone kits to their clients, as well as friends and families of individuals who may be at risk of an overdose. BCHS distributes medication lock boxes to families with children under age 18 living in their household. We also promote the “Lock Your Meds” campaign by providing educational pamphlets to parents about reducing the risk of accidental medication overdose in children.

Increasing participation in the Health Rocks and Empowering Youth and Families Program (EYFP).

3) Health Rocks

Health Services, in partnership with Brunswick County Cooperative Extension and Brunswick County Schools, will begin facilitating the Health Rocks!® curriculum in schools.

Health Rocks!® is a three-part evidence and research-based leader’s curriculum for a healthy living program. It is designed to help youth resist risky behaviors by guiding them in the development of life skills. Areas of focus include critical thinking, decision-making, communication, managing feelings, stress management, and goal setting. It also provides accurate health information on the consequences of youth tobacco, alcohol, and drug use. The curriculum aligns with National Health Standards and North Carolina Essential Standards (Healthful Living-Health Education) targeting ages 8 through 14.

4) Empowering Youth & Families Program (EYFP)

The NC Empowering Youth and Families Program (EYFP) focuses on opioid prevention education for youth and their caregivers in rural North Carolina. The goals of our program are to reduce youth substance use in rural North Carolina, to improve parenting skills of caregivers to assist youth in making healthy choices, to improve family relationships, and to empower families to lead community change to leverage support for healthier lifestyles within those communities. The Empowering Youth & Families Program is a research-based/evidence informed program geared towards youth ages 10-14 and their adult caregivers. EYFP is grant funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). Utilizing evidence based Strengthening Families 10-14 curriculum (prior cohorts) along with Powerful Families, Powerful Communities curriculums, EYFP is a program that aims to encourage self-determination and parenting skill building to strengthen youth and families in an effort to promote community resilience. The primary focus of the program is opioid prevention, with emphasis on healthy decision making and building resilience. At the end of the twelve weeks, participating families take part in a free weekend retreat at an Eastern 4-H Center, where they learn community action planning and create a vision for opioid misuse prevention in their community. The goal is to empower families to lead community change to leverage support for healthier lifestyles within those communities.

Marketing treatment resources and expanding local partnerships for treatment options.

5) Methadone Treatment Center

Coastal Horizons and Trillium are partnering to open a methadone treatment center in Brunswick County. The first application was submitted to state opioid treatment authority to get letter of approval in 2020. Conversations are ongoing with community partners. Next steps include obtaining North Carolina Division of Health Services Regulation (DHSR) and federal licensing. The location of the proposed facility will be at the Shallotte Coastal Horizons office.

6) Women's Rehab Center

The Brunswick Christian Recovery Center will open The Rose House in the place of The Rose Bed & Breakfast in Calabash. It will be a 16-week substance abuse recovery program that will house 20 women.

FHLI-NC

HNC2030

Drug Poisoning Deaths Total per 100,000 popluation

2020

32.5

141%

Medication Drop Boxes

What We Do

BCHS partners with the Brunswick County Sheriff’s Office to encourage residents to protect their families by using the secure collection drop boxes located at several Sheriff’s Office and police department locations.

Who We Serve

All residents

How We Impact

Pounds of over-the-counter/prescription medication collected

Naloxone Kit Distribution and Medication Lock Boxes

What We Do

Who We Serve

Residents

Coastal Horizons clients, as well as friends and families of individuals who may be at risk of an overdose

Families with children under age 18 living in their household

How We Impact

Address the opioid crisis by reducing opioid overdose deaths through the availability of naloxone and educate families about reducing the risk of accidental medication overdose in children.

How much

Number of naloxone kits distributed

2021

How much

Number of medication lock boxes distributed

2021

417

Methadone Treatment Center

What We Do

Marketing treatment resources and expanding local partnerships for treatment options.

Who We Serve

Individuals seeking treatment for substance misuse.

How We Impact

How much

Number of new patients

2021

217

Health Rocks

What We Do

Health Rocks!® is a three-part evidence and research-based leader’s curriculum for a healthy living program, designed to bring youth, families, and communities across the United States together to reduce use of tobacco, alcohol, and drugs among youth.

Who We Serve

The curriculum aligns with National Health Standards and North Carolina Essential Standards (Healthful Living-Health Education) targeting ages 8-14.

How We Impact

Health Services, in partnership with Brunswick County Cooperative Extension and Brunswick County Schools, will begin facilitating Health Rocks!® curriculum in schools.

How much

Number of schools that have adopted program

2021

Empowering Youth & Families Program (EYFP)

What We Do

The NC Empowering Youth and Families Program (EYFP) focuses on opioid prevention education for youth and their caregivers in rural North Carolina.

Who We Serve

The Empowering Youth & Families Program is a research-based/evidence informed program geared towards youth ages 10-14 and their adult caregivers.

How We Impact

Utilizing evidence based Strengthening Families 10-14 curriculum (prior cohorts) along with Powerful Families, Powerful Communities curriculums, EYFP is a program that aims to encourage self-determination and parenting skill building to strengthen youth and families in an effort to promote community resilience. The primary focus of the program is opioid prevention, with emphasis on healthy decision making and building resilience.

How much

Percentage of families completing the program

2021

100%

Women's Rehab Center

What We Do

Marketing treatment resources and expanding local partnerships for treatment options.

Who We Serve

Women seeking treatment for substance misuse.

How We Impact

The Brunswick Christian Recovery Center will open The Rose House in the place of The Rose Bed & Breakfast in Calabash. It will be a 16-week substance abuse recovery program that will house 20 women.

Percent of capacity

Access to Health Care

CHIP

Brunswick County residents experience access and availability of high quality affordable health care, equitably.

Why Is This Important?

Access to comprehensive, quality health care services is critical to achieve and maintain health, prevent and manage disease, and achieve health equity.

What does it look like when you achieve this result?

When Brunswick County residents have increased access to health care, we anticipate seeing:

An increase in life expectancy especially among vulnerable populations
Increase in Medicaid enrollment
Improved prenatal care
Increase in health care providers accepting all patients
Residents receive necessary care when and where they need it, in a manner they can understand
Increase awareness about insurance options to ensure access to needed health care providers and services

How can you measure these quality of life conditions?

Access to primary care is associated with fewer health care disparities and improved health outcomes. Barriers to access health care are greater among the uninsured, but insurance alone may not translate into access to care. Several of these barriers are social determinants of health or non-medical drivers of health; such as, lack of finances for healthcare, absence or unaffordable insurance, and lack of transportation. These barriers align closely with the NC 2030 access to health care indicators.

Access to Health Care 2030 Indicators

Primary Care Clinicians

Increase the Primary Care Workforce

Brunswick County: 1: 2,150

2030 Target: 1: 1,500 (25% decrease)

Uninsured

Decrease the Uninsured Population

Brunswick County: 15%

2030 Target: 8%

Life Expectancy (years)

Increase Life Expectancy

Brunswick County: 78.6

2030 Target: 82

To measure these quality of life conditions, we will work with partners to develop strategies to address barriers to access health care. We will obtain annual data from local partners and identify trends. Responses from the community health opinion survey (CHOS) and focus groups will be compared to local data to monitor progress made toward the NC 2030 indicators.

How are you doing on the most important measures of this (these) condition(s) in our community?

Although overall life expectancy in Brunswick County is slightly higher than the state average, and similar to peer counties, there are still improvements to be made to reach the HNC 2030 goal of a life expectancy of 82 years. Disparities within the county also exist. Males have a much lower life expectancy in Brunswick compared to females, living on average approximately five years less.

The community health opinion survey (CHOS) asked residents what challenges they face with access to health care, to which 23% responded “waiting too long to get an appointment,” 22% responded “lack of insurance,” and 17% responded “unable to pay." Focus group participants also reported barriers such as lack of finances for healthcare, absence or unaffordable insurance, and lack of transportation to get to appointments. When CHOS respondents were asked what they would do if they wanted to improve their health, 14% selected “go to primary care providers” and 13% selected “get preventative screenings." Mental health was identified as the number one most needed health screening in the Brunswick CHOS, selected by 56.6% of respondents.

Brunswick County continues to be designated as a medically underserved area, with only one primary care provider (PCP) per 2,150 residents. In comparison, the NC county average is one PCP per 1,420 residents. Primary care provider data does not include physicians living on the edge of counties or who practice in multiple locations. Many Brunswick County residents may seek care in surrounding counties, which is not represented by this measure.

Absence of primary care can lead to higher rates of emergency department visits. Data shows that 24% of emergency department visits in Brunswick County (Dosher) were individuals ages 65-84 years old. In both the Brunswick CHOS and focus groups, participants voiced concerns regarding elderly populations not receiving enough health care. When asked which areas need the most improvement in their community, 26% of respondents selected “elder care options.” Across all CHOS respondents, 78% reported “Medicare or Medicare Supplement Plan” as their personal or primary household health insurance coverage.

Who are the partners that have a role to play in doing better?

Brunswick Wellness Coalition (Novant, Dosher, New Hope Clinic, CommWell Health)

Brunswick County Social Services

Brunswick Senior Resources

Neighbor to Neighbor Organization

Brunswick Transit System

What works to do better?

Create a media campaign with Brunswick County Social Services to promote Medicaid open enrollment.

Medicaid

Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. There are many different Medicaid programs, and the eligibility requirements vary slightly between programs.

Health Choice for Children

North Carolina Health Choice offers health coverage for children whose families make too much money to qualify for Medicaid, but do not make enough money to afford private or employer-sponsored health insurance.

Partner with hospitals and community clinics to provide residents with primary care services.

Brunswick County Health Services, Novant, Dosher, New Hope Clinic, and CommWell Health refer patients to one another for services and education.

Promote resources to residents needing transportation to health care appointments.

FHLI-NC

HNC2030

Under 65 Without Health Insurance Total

2019

11.3%

FHLI-NC

HNC2030

Ratio of full-time equivalent primary care clinicians to county population

2017

62:1

Media Campaign

What We Do

Health Education team will create a media campaign in partnership with the County Public Information Officer and DSS to promote Medicaid open enrollment.

Who We Serve

The intent is to reach low-income individuals and families who cannot afford health care costs, and children whose families make too much money to qualify for Medicaid.

How We Impact

Promote available health care resources and provide deadlines for Medicaid open enrollment.

How much

Number of social media post engagements

HY2 2020

110

Hospitals and Community Clinics Partnership

What We Do

Partner with hospitals and community clinics to provide residents with primary care services.

Who We Serve

Brunswick County Health Services, Novant, Dosher, New Hope Clinic, and CommWell Health refer patients to one another for services and education.

How We Impact

Address absence of primary care which can lead to higher rates of emergency department visits.

September 2022 Update

Due to COVID-19 response over the past two and a half years, there were never any protocols established to collect and share bidirectional data between clinical partners on the percentage of patients referred that report to first appointment. As of September 2022, it was determined it would be counterproductive to make an attempt to attain past data and attempt establish a method of collecting current 2022 data.

Percentage of patients referred that report to first appointment

Transportation Resources

What We Do

Health Education team will contact municipalities to assess transportation needs.

Who We Serve

The intent is to improve transportation options for residents needing transportation to health care appointments.

How We Impact

Information collected from municipalities will be shared with county leadership and community partners to address transportation needs in the county.

Percentage of municipalities assessed for transportation needs

2021

100%

SOTCH REPORTS

2020 SOTCH

Progress on CHIPs

Brunswick County Health Services conducted the Community Health Assessment (CHA) in 2018-19 to determine the community’s needs and develop programs to address the health priorities. The CHA was released in March 2019 and the final health priorities were substance misuse, access to health care, and chronic conditions. An overarching theme and focus on the aging population was also identified.

The Community Health Improvement Plan (CHIP) was completed in December 2020. Local health departments are now using Results Based Accountability (RBA) and Clear Impact Scorecard for CHIP documentation instead of the previous paper forms. Health Education staff completed the RBA training and adopted the approach when completing the CHIP.

“Results-Based Accountability™ is a disciplined way of thinking and acting to improve entrenched and complex social problems. Communities use it to improve the lives of children, youth, families, adults. RBA is also used by organizations to improve the effectiveness of their programs.”

Characteristics:

Disciplined Thinking
Data Driven
Transparent Decision-Making
Common Sense
Plain Language
Talk to Action
Ends to Means

The lead health educator formed a CHIP committee consisting of community partners and attended trainings with the NC DHHS Community Health Assessment Director throughout 2020. These trainings enabled health education staff to link Brunswick County’s health priorities to the online Clear Impact Scorecard. Results, indicators, programs, and performance measures for each priority were recorded in the scorecard. This allows us to identify data trends and changes so we know what it will look like when we achieve results. We can also update the scorecard in live-time and share the link on our website and other avenues.

Due to the COVID-19 pandemic, all meetings and outreach have been held virtually since March 2020. Health education staff served in reclassified roles during this time. The health educators supervised and trained COVID call center staff, answered incoming calls, scheduled citizens at vaccine clinics, facilitated ongoing correspondence with local hospitals to communicate citizen concerns, responded to the county’s coronavirus email line, and revised the administration form used at the vaccination sites. We also worked at the vaccination sites as the liaison for the call center and registration. Other duties included participating on conference calls with emergency services staff and other county partners, sending isolation letters to positive cases, and updating the county website and dashboard with the latest case counts.

Morbidity and Mortality Changes Since Last CHA

Brunswick County Health Services has been actively responding to the COVID-19 pandemic since March 2020. The pandemic greatly impacted staff’s duties and job responsibilities over the past year. The latest information about COVID-19, testing, local case counts and vaccines is on the Health Services COVID-19 webpage. Data reflecting our health priorities has also changed due to factors accompanying the pandemic.

2019 Leading Causes of Death

According to the NC Opioid Action Plan Data Dashboard, unintentional opioid-related overdose deaths in Brunswick County have been on the rise. This includes deaths involving all types of opioids: commonly prescribed opioids, heroin, and synthetic narcotics like fentanyl and fentanyl-analogues.

Emerging Issues Since Last CHA

The evolving situation surrounding COVID-19 has triggered overwhelming emotions for a lot of people. These emotions can contribute to higher levels of stress and anxiety.

According to the State Center for Health Statistics, 25 deaths in Brunswick County in 2019 resulted from intentional self-harm.

There are several resources available in Brunswick County for individuals needing to speak with someone anonymously. Resources regarding managing your overall health and mental health and wellness resources are available on Brunswick County’s website: Managing Your Overall Health During the COVID-19 Pandemic

In partnership with Brunswick County Emergency Services, a county website was created to support other emerging issues related to the pandemic. The page is dedicated to community awareness and includes offers of assistance, updates from utility providers, homelessness assistance, food bank notices, and other resources. Emergency Services is also available (M-F 8:30am – 5:00pm) to assist the public with needs not listed on the website. The website and list of resources can be viewed at: COVID-19 Community Assistance

New/Paused/Discontinued Initiatives Since Last CHA

Health education activities reflected in the CHIP were paused in 2020 due to the pandemic. Staff began working on initiatives focused on preventing the spread of COVID. In March 2020, the County began operating a joint information center with a Public Health Call Line and email to answer residents’ coronavirus questions. Educational initiatives were launched on the County website and social media encouraging everyone to practice the Three Ws—wear a mask, wait six feet apart, wash your hands—for the next several months.

Brunswick County Health Services administered its first doses of the Moderna COVID-19 vaccine to Brunswick County Emergency Medical Services (EMS) personnel December 22, 2020. The department also began working with internal and external partners to vaccinate individuals within local law enforcement, fire/rescue teams, Health Services and other medical providers eligible under Phase 1a.

2021 SOTCH

Progress on CHIPs

Brunswick County Health Services conducts the Community Health Assessment (CHA) every three to four years. This assessment is used to understand the overall health of the county and to determine its health priorities. Brunswick County Health Services completed the CHA in 2019 and identified the following health priorities: substance misuse, access to healthcare, and chronic conditions. Next, community partners and stakeholder came together to develop and implement the Community Health Improvement Plan (CHIP). The plan includes strategies, interventions, partnerships, and measures to address the identified health priorities over the next four years. Brunswick County utilizes a Results Based Accountability™ approach and a Clear Impact Scorecard to track this data. This progress is then reported on the State of the County Health Report (SOTCH) which is done every year between the CHA.

The COVID-19 pandemic continues to cause challenges in Brunswick County. Most of the health services staff duties were reassigned to help with the COVID-19 call center or the vaccine clinic. Programs addressing the health priorities were either moved online, paused, or discontinued. In the CHIP data may be skewed due to agencies altering their program delivery method, which in turn changed program efficacy and data collection methods. Despite all these challenges, Brunswick County Health Services continues to strive to improve the health of the county.

Chronic Conditions: Brunswick County chose six programs to target this health priority. The performance measures for each of these programs can be seen in the CHIP above. Brunswick Wellness Coalition, Brunswick County Cooperative Extension, and Brunswick County Health Services were leading these programs. In the CHIP you will be able to see individuals in the diabetes programs had a decrease in their A1C and weight loss changes. Brunswick County Cooperative Extension’s programs, Families Eating Smart and Moving More, Teen Cuisine, SNAP-ED, and 4-H Healthy Habits, showed majority of participants completed the program and had an increase of knowledge on chronic conditions. Brunswick Wellness Coalition programs, Walk with a Doc and Health Hacks, had a reduction in participation due to these valuable in person programs being changed to a virtual format. Many of our citizens continued to stay home to protect themselves.

Substance Misuse: Coastal Horizons, methadone treatment center and the Christian Recovery Center Inc., Rose House continues to support individuals affected by substance misuse. Since the last SOTCH, Coastal Horizons provides medication lock boxes and naloxone kits to multiple businesses and individuals in Brunswick County. These are important indicators to decrease substance misuse. Brunswick County also chose two treatment centers to show our progress. The Methadone Clinic stayed open during the pandemic; however, they did have to change some of the treatments they were providing. Telehealth counseling was given to their patients instead of in person. They also had to send in an exception request to the state that was approved to give patients take home medications. Brunswick County Cooperative Extension implemented the Health Rocks and Empowering Youth & Families Program (EYFP) programs to teach opioid prevention education to youth. Brunswick County Health Services website continues to update their citizens with resources for substance misuse. https://www.brunswickcountync.gov/health/opioideducation/

Access to Healthcare: Individuals already struggling with access to healthcare have been impacted by the COVID-19 pandemic significantly. Many individuals struggled to see healthcare providers due to illness due to COVID-19. However, there has been some positive outlook that has come out of this time. Technology has come a long way during this time. Telehealth has given more opportunities for patients to receive health care. Multiple healthcare facilities are offering telehealth for their patients which is also helping with transportation needs. Brunswick County municipalities were asked how their citizens were impacted through transportation and data was shared with county leaders. The county leaders continue to evaluate and work on transportation needs for the county. Transportation resources are on the Brunswick County Government page. Social media has also been a instrumental in educating the public on healthcare information and transportation resources.

Morbidity and Mortality Changes Since Last CHA

According to the NCDHHS COVID-19 Dashboard there have been 309 COVID-19 deaths in Brunswick County since March 2, 2020. COVID-19 continues to affect many of those dealing with substance misuse which is shown in the data below.

The NC Opioid and Substance Use Data Dashboard shows overdose deaths have increased from past years in Brunswick County. There were 28 unintentional overdose deaths in 2019 and increased to 49 in 2020. However, our Place Rank has gone from high overdose deaths to ranked middle.

Emerging Issues Since Last CHA

COVID-19 remains a barrier
Substance misuse continues to be an ongoing problem in Brunswick County with overdose deaths rising
Mental Health issues are on the rise due to COVID-19 isolations

Brunswick County population continues to grow which is affecting the amount and accessibility of affordable housing and lack of transportation resources

New/Paused/Discontinued Initiatives Since Last CHA

In 2021, the way services and programs were delivered were altered due to COVID-19. The Learn, Grow, Eat, Go program through Brunswick County Cooperative Extension was paused due to lack of participants during this time. The Rose House a new women’s recovery center had some setbacks on their renovations and staffing due to COVID-19. This delayed the opening date for this facility. They plan to open and start helping patients in the next 2-3 months. Brunswick County Health Services also planned and implemented a COVID-19 mass vaccination initiative. The county had pop-up clinics in rural areas to make vaccines easily accessible for at risk populations. Brunswick County Health Services administered over 41,000 vaccinations and the number continues to grow. This involved all staff to help with clinic, call center, outreach, and social media initiatives.