HNC 2030 Scorecard: Union County (2019-2022)

Progress on CHIPs

Progress on CHIPs

The Union County Community Health Improvement Plan (CHIP) identifies two priorities and associated performance metrics. The information below describes the progress made in 2021 towards our CHIP.

Priority 1- Access to Care

Utilize Mobile Units

●        The following mobile units were used over the past year in the community: Atrium Health’s Mobile Lung Cancer Screening Unit, OneBlood’s Bloodmobile, and Charlotte Radiology’s Mobile Mammography Unit. Union County’s Mobile Health Unit was utilized for COVID vaccinations and testing. In 2022, as the COVID-19 response focus decreases, we will explore other opportunities to utilize the Union County’s mobile unit for additional services.

●        The use of mobile units in the community increased by 56% between 2020 and 2021.

●        There was a decrease in the use of mobile units in the last quarter of 2021 due to threats made towards public health.

 Prevention, Education, Awareness Campaign to Underinsured and Underserved Population

●        Union County provided almost two times the number of prevention, education, and awareness campaigns in 2021 than in 2020.

●        Our Health Promotions team promoted COVID Vaccines and pop-up clinics in a variety of settings. The team also set up a table in the lobby of the Human Services building to provide education and information to Union County residents on breast cancer, the flu vaccine, diabetes, tobacco prevention, and Quitline information. Staff collaborated with Wingate University on several awareness and education campaigns.

●       Human Services staff partnered with our Union County Communications Team to develop and provide education, information, and awareness campaigns on the following: Atrium Mobile Pharmacy, Christmas Bureau, COVID-19 vaccine information/ guidelines, Emergency Rental Assistance Program, Low-Income Household Water Assistance Program, Mental Health, National Breastfeeding Month, Opioid Crisis, Ovarian Cancer, Alzheimer’s, Breast Cancer, Domestic Violence, Mammograms, Diabetes, Pneumonia, and AIDS.     

Healthy Union Advisory Coalition

In 2021, the Healthy Union Advisory Coalition developed an infrastructure and subcommittee structure. The subcommittees include the Access to Care Subcommittee, Mental Health Subcommittee, and Substance Use Disorder Subcommittee. Each subcommittee developed work plans and focus areas and met monthly. The Healthy Union Advisory Committee met monthly over the last year and utilizing meetings to review secondary data for the 2022 Community Health Assessment.

Priority 2- Mental Health and Substance Use Disorder

Mental Health Awareness and Education

●        Union County Public Schools (UCPS), Atrium Health, and Partners continued to offer Mental Health First Aid Courses in the community. The number of trainings are at the same level in 2021 as in 2020.

●        Union County Government posted mental health awareness on social media and the community newsletter (Horizon) on the following topics: world suicide prevention day, minority mental health month, and mental health awareness.

●        UCPS launched Start with Hello campaign to bring attention to the growing epidemic of social isolation and to empower young people to create a culture of inclusion and connectedness within their school, youth organization, and community (10 social media posts from 9/18-9/27/22), a bullying prevention campaign (6 media posts), and an anonymous tip line to report crisis.

●        UCPS has four mental health clubs that meet regularly.           

●        Partners Health Management provided classes in QPR Suicide Prevention, Mental Health and Substance Use Disorders, and Mental Health 101.

Behavioral Health Collaborative

The Union County Human Services Behavioral Health Collaborative continued to serve students and families in our schools, despite COVID restrictions. The number of presentations about social and emotional wellness for students, staff, and parents and the number of students served through the collaborative increased over this past year.

Tobacco/Vaping Awareness and Education

One of Union County's Healthy Communities Strategies is to increase compliance of the NC 100% tobacco-free schools’ law by partnering with youth, parents, and school personnel to educate about dangers of tobacco use and new and emerging tobacco products. To address this issue, representatives from Union County Human Services met with Carleen Crawford (Region 4 Tobacco Director), two Union County Public Schools (UCPS) Nurse Supervisors, and UCPS Substance Use Supervisor on met several times at the end of 2019 and the first few months of 2020. Several initiatives were in development phases, including updating the UCPS core curriculum to include e-cigarette education, bringing in a student speaker in the fall to speak at all the county middle schools, implementing several parent forums to provide information about the impact of e-cigarettes on teens, and developing a teen alliance with Wingate University and UCPS. Unfortunately, due to COVID and a lack of resources, these were all put on hold in 2021. In Fall 2021, we reinitiated these efforts and have completed/planned the following:

●        Introduced evidence-based curriculum to UCPS staff. UCPS plans to implement new curriculum in Fall 2022

●        Developed a Parent Education Webinar for Spring 2022.

●        Updated the current UCPS end of year parent and student survey to include more specific questions about  tobacco and substance use survey. UCPS is waiting on approval from the administration.

Over the last six months, Union County posted the following education and awareness campaigns on Union County’s social media: nicotine in e-cigarette, signs of nicotine addiction, help to quit smoking, know the risks of vaping, e-cigarette dangers, and information about Juul users.

Tobacco Ordinance

In January 2020, the Human Services Agency Board approved an updated Tobacco Ordinance, making the use of tobacco products prohibited on County grounds, buildings, and county vehicles. A phased timeline was developed in early March 2020, with the ultimate goal of obtaining approval from the BOCC during a meeting in May 2020 and implementing the policy in January 2021. Unfortunately, due to COVID, the Tobacco Ordinance was put on hold until July 2021. The following were completed between July - December 2021:

●        The Tobacco-Free Ordinance language was updated slightly to clarify tobacco products.

●        Human Services staff presented information to four County Departments and Division Leaders.

●       The  Consolidated Human Services Board approved the proposed Tobacco-Free Ordinance.

The Union County Health Director and Director of Community Support and Outreach plan to present the Tobacco-Free Ordinance at a Board of County Commissioner meeting in January 2022.

Morbidity and Mortality Changes Since Last CHA

COVID-19

There were 289 COVID-19 deaths in 2021, a 175% increase up from 105 deaths in 2020.

Leading Causes of Death

Cancer (all sites) remains the leading cause of death since 2009 and the rate has increased over time. Diseases of the heart and motor vehicle accidents have both seen downward trends in death rates over the last several years and are lower than in NC overall, but some of the other leading causes of death rates in Union County have increased, such as Alzheimer’s Disease and Septicemia, both which has higher rates than NC state overall.

 Cancer

Lung and colon cancer incidence have decreased over time in Union and NC. Prostate cancer rates increased and are higher than the state rates. Overall cancer incidence rates in Union County are slightly lower than the state.

 Infant Mortality

Infant mortality in Union County has trended downward since 2010 and is below both the NC state average and the Healthy North Carolina 2030 (HNC 2030) goal.

Crude Death Rates

Although crude death rates increased slightly for both Union County and NC from 2014 to 2019, Union still remains below the NC average.

HIV

Rates of newly diagnosed HIV cases have trended downwards in Union County since 2016 and remain below the state average.

Life Expectancy

Union County life expectancy is higher than the NC value and has increased since 2013 while the state average has decreased. However, the Union County life expectancy of 80 years is still below the HNC 2030 goal of 82 years.

Emerging Issues Since Last CHA

●        Impact of COVID-19 response on substance use disorders and behavioral health needs in the general community (depression, suicide, etc.).

●        Impact of COVID-19 response on youth educational delays/set-backs and disruption of supportive assistance particularly for high risk population groups.

●        Impact of COVID-19 response on delays in preventive health care that could lead to later diagnosis and effective management of chronic health conditions.

●        Impact of COVID-19 response on possible reduction in health promotive behaviors that reduce the risks contributing to chronic health conditions (physical activity, diet/nutrition, alcohol & substance use, etc.).

●        Impact of Medicaid reform on access to care for underserved population groups.

New/Paused/Discontinued Initiatives Since Last CHA

New Initiatives

Union County Public Health Division FY2021

2022 CHA

In July 2021, in collaboration with Atrium Health and Novant Health, we launched our 2022 Community Health Assessment (CHA). The goal of CHA is to identify factors that affect the health of the population and determine the availability of resources within the County to address these factors.  In 2019, Union County collaborated with Novant Health and Atrium Health to conduct our community health needs assessments together. By doing this, we were able to collect community health data collaboratively and more comprehensively. Union County, Novant Health, and Atrium Health are collaborating again for the 2022 CHA.  Planning meetings for the 2022 CHA started in August 2021 with representatives from Union County Human Services, Novant Health, and Atrium Health (CHA Team).

The following timeline was developed:

●        October 2021- June 2022 – Secondary Data Presentations during our Healthy Union Advisory Coalition meetings

●        Jan 18 2022- March 31, 2022 – CHA Survey Distribution and Focus Groups

●        July or Aug 2022- Coalition determines focus areas

●        March 2023- 2022 CHA Report Due

●        September 2023 – Community Health Improvement Plan (CHIP) Due

Secondary Data Presentations

The first 30-45 minutes of our Healthy Union Advisory Coalition meetings were used to present secondary data in different health areas. Here was our schedule this past fall:

Surveys and Focus Groups

The CHA Team developed adult and teen survey questions and focus group questions. These were finalized in December 2021.

Communication Strategies

The CHA Team developed a comprehensive communication and marketing plan. This was finalized in December 2021.

Community COVID Vaccine Outreach

Union County Public Health will continue to be a COVID vaccine provider and prioritize our vaccine campaign to ensure that the community has equitable access to vaccines and accurate information about vaccines.  As we transitioned from mass vaccination clinics and vaccinating as many people as quickly as possible, our primary focus has shifted to reaching priority populations and providing opportunities for parents to easily access vaccines for their children. Our vaccine team, including community outreach and clinical staff, work in tandem to identify priority sites in the community for vaccine pop-up clinics.  The team communicates regularly with assisted living facilities, group homes, SNFs, the Union County Jail and community homeless shelter to ensure vaccine access to residents and staff.  This includes providing vaccines on site or in some cases assisting the facility to become vaccine providers.   Our vaccine team developed a partnership with the Union County EMS community paramedicine team to vaccinate homebound people.  Union County Public Health will continue to adapt our COVID vaccine outreach, in the form of providing factual and transparent information and equitable access to vaccines, to meet the needs of our community.

Communicable Disease Outreach Campaigns

Union County Public Health offers free screening and treatment of sexually transmitted infections (STI’s), and partners with local providers to ensure adequate treatment of all Union County residents receiving an STI diagnosis. The pandemic negatively affected access to STI care all over the country, due to reduced screening, limited resources, and stay-at-home orders. Reports of STI’s dropped briefly during the early months of the pandemic, but quickly increased and are now higher than in previous years. These include resistant bacterial and viral infections, and congenital syphilis, which can cause permanent defects or death. Broad STI screening and effective treatment are more important than ever.

Our STI clinic is now operating a full schedule and we plan to increase appointment availability over the next year to meet the county’s demand. At the end of 2021 the CDC published updated guidelines for the treatment of STI’s. Some providers who see patients with STI’s may not be familiar with the newest updates and guidance. Our team will be providing outreach to area providers in an attempt to ensure that all Union County residents receive timely, accurate diagnosis and treatment.

Union County is expanding our epidemiology capacity to assess community health data, monitor trends and stimulate focused public health initiatives such as a communicable disease dashboard. Similar to our display of COVID-19 information, residents will access this new dashboard to increase their awareness of communicable disease trends in the community.

Childhood Immunizations

Union County Public Health consistently meets state benchmarks for vaccination rates in our clinic. We are also responsible for childhood vaccine rates throughout the county, and the benchmarks for the county as a whole were not met in 2021. We are employing existing and plans of action to increase Union County vaccine rates. Education efforts targeted to both public health staff and local providers are underway. Additional annual training for Union County staff has been added this year and a newsletter, “Immunization Buzz,” will also be distributed to staff. Local providers will also receive a monthly newsletter, “Immunization Focus,” for their increased awareness of immunization administration. Our team will continue to partner with Union County Public Schools to coordinate vaccine clinics and circulate the message that Union County Public Health is equipped to offer all required school vaccinations. A “Back to School Vaccine Clinic” will be held prior to any exclusion date, to ensure that no students miss school because of delinquent immunizations.  Our team will continue to monitor immunization counts and mail reminder cards to all children in the county who are not up to date on their vaccinations. Social media outlets will also be used to notify a wider audience of opportunities for vaccination, and staff who assisted the county during the pandemic response will be redirected to focus on vaccine education in the community.

Health Equity and HMP Efforts

COVID-19 Education and Vaccination Efforts to Reach Historically Marginalized Populations (HMP)

Since the release of the vaccine, Human Services staff noticed a small number of minority participants vaccinated, as this population tends to be hesitant about the vaccine. At the same time, this population is most adversely affected by the pandemic, especially when one or more chronic health conditions are present. This trend parallels those across our state and nation. To address this concern, staff ramped up intentional marketing, outreach, and education to address these disparities. These efforts included:

●        Weekly emails with testing locations, COVID prevention education, and information on vaccine safety (CDC) and the vaccination phases; fliers that promote our vaccine clinics and hotline to schedule appointments; and vaccination education through FAQs and short videos targeting these populations (NCDHHS’s “Get Your Shot, You Have A Spot”).

●      Intentional outreach efforts through personal phone calls and emails to known community partners and agencies, including pastors of African-American and Hispanic Churches, civic groups, such as the NAACP, City Councilmen, non-profits, and known minority leaders in our community. Staff provided messaging to share on social media pages, in meetings, in church newsletters, and on pulpits.

●        Providing vaccine information materials to our minority staff, who reached out to their families, friends, and neighbors via social media, etc.

●        Creating a PowerPoint presentation with pictures of minority community leaders receiving their vaccines and smiling during the process in order to ease fears of vaccinations. This presentation was shared via email and other sources of media throughout our community.

●         Positive “word-of-mouth” from HMP participants proved to increase our percentage of the minority population seeking the vaccine.

●        Public Communications staff developed a few billboard designs, participated in radio station interviews, and produced a Q & A video with our Medical Director and several minority community and church leaders to promote vaccine safety and outreach to these populations.

●        Concentrating vaccine efforts on the Eastern side of the county here the SVI (Social Vulnerability Index) is the highest. Clinics were hosted in low-income neighborhoods, housing authorities, mobile home communities, Latino and African American churches, Senior Centers and Nutrition sites, shopping center parking lots, large flea market events, restaurant parking lots, local parks, and the Old Armory Community Center (centrally located to one of our highest vulnerable and low-income areas).  We used community volunteers to assist us with event promotion, parking, and greeting.

●       Conducting vaccine efforts on site at small and large businesses throughout our county. This offered a convenient option for employees to access this service without leaving or missing work.

SUD ROOTS Summit Planning

During 2021, the Healthy Union Coalition Substance Use Disorder (SUD) Subcommittee met monthly, however, the subcommittee was ineffective due to difficulties with getting the appropriate representatives together, including SUD providers, legal system, law enforcement, emergency management, and substance users. Programs and services in the SUD arena seem siloed and there appears to be significant gaps and needs in Union County. To address these issues, the Healthy Union Executive Committee suggested having a summit meeting to gather everyone who might touch a person with SUD around the table, including providers, health care, law enforcement, courts, schools, etc. Wingate University’s Collaborative for the Common Good (CCG) and the Healthy Union Advisory Coalition representatives started planning for a ROOTS Summit on April 26, 2022. The overall goal for the summit is the following:

●        Map out current SUD services and partners in Union County

●        Determine gaps and needs in Union County

●        Lay the groundwork and foundation for a community plan/strategic plan to address SUD in the community (including programs and services)

Union County Environmental Health Division FY2021

The Environmental Health Division endeavors to promote and protect public health and preserve the environment by conducting daily activities designed to prevent disease, educate the public and enforce regulations. Environmental Health includes mandated programs administered by the Union County Public Health Division pursuant to Chapters 130A and 87-97 of the General Statutes of North Carolina and/or adopted under Board of Health Authority.  The employees working in these programs must be registered with the state as Environmental Health Specialists.

Three primary programs operate within Environmental Health: The On-site Water Protection Program, the Food, Lodging and Institutions Program and the Children’s Environmental Health Program.

Water Quality Initiatives

Surface and ground water quality concerns continue to drive requests for well water sampling and well (down-hole camera) assessments in Union County. The Environmental Health Division created a framework for a well rehabilitation and repair program using American Rescue Plan Act funds. This program will assist qualifying homeowners with the testing, repair and/or replacement of contaminated wells. Our partnership with the University of North Carolina-Chapel Hill Superfund Research Program and Clean Water for North Carolina on a multi-faceted well water outreach project continues. Environmental justice factors are used to identify focus areas of Union County that may have higher environmental burdens and vulnerable populations. Engineering research to identify improved well construction practices and develop lower-cost treatment options for arsenic and co-contaminants is being conducted. This research will be used to develop tools to improve public health practices and educate decision makers on future land development options.

Lead and Asbestos in Child Care Facilities and Public Schools

North Carolina Session Law 2021-180, Section 9G.8. (a) directed the Commission for Public Health (CPH) to adopt rules as necessary to implement requirements for the testing and remediation of lead in drinking water in public schools and the inspection for and abatement of asbestos and lead-based paint hazards in public schools and child care facilities. Temporary rules to establish these requirements have been proposed and public comments are being sought. American Rescue Plan Act funds are to be used to remediate these environmental health hazards.

On-Site Wastewater Disposal System Repair and Replacement Program

Approximately 35% of Union County residents utilize on-site wastewater (OSWW) disposal systems to treat the wastewater generated in their homes and businesses. System age and limited soil and site conditions have contributed to the increasing number of malfunctioning OSWW disposal systems. This is a serious public health issue. Environmental Health is developing a framework to utilize Community Development Block Grant funding to implement a program to assist qualifying property owners with the maintenance, repair, or replacement of failing systems. The program will focus on areas of our county that may have higher environmental burdens and vulnerable populations or are located in areas of known clusters of malfunctioning OSWW systems.

Environmental Health COVID-19 Response

The Environmental Health Division continues to adapt and support the public health response to the COVID-19 pandemic in Union County. While the rate of community spread of the disease fluctuates, Environmental Health Specialists (EHS) assist with guidance and implementation of the NC DHHS Public Health Tool Kits for child care facilities and schools. We continue to conduct COVID-19 risk assessments at the start of all facility inspections with a focus on minimizing disease spread through preventive measures, identification of symptomatic employees and proper cleaning and disinfecting procedures. Citizen complaints related to COVID-19 in regulated facilities are investigated by the environmental health team. Present trends seem to indicate that our COVID-19 response is moving toward case monitoring and surveillance activities such as wastewater outflow testing.

Description

Progress on CHIPs

We made the following progress on our Community Health Improvement Plan (CHIP) in 2020:

• Adopted Results-Based Accountability
• Transitioned CHIP from paper-based to web-based documents
• Set up results, indicators, programs, and performance measures in Clear Impact Scorecard
• Linked to the HNC 2030 Scorecard to create greater awareness of population accountability
• Created the Union County Healthy Advisory Coalition to utilize the cooperative strength of community partners to identify overall health, quality of life and health equity issues, and support work to address those issues in Union County
• Despite COVID-19 restrictions, the Behavioral Health Collaborative continued to serve students and families in our schools 
• Continued Mental Health and Tobacco prevention and educational messaging via social media platforms

Some of our CHIP programs were paused due to COVID-19 (see below).

Morbidity and Mortality Changes Since Last CHA

There were no updates to the local morbidity and mortality rates since the last CHA report, as the most recent figures were pulled for the CHA. The COVID-19 impacts on deaths in our county can be viewed here: https://ucgov.info/covid19-dashboard-desktop. The % case mortality from COVID-19 in Union County is 0.95 %. This is lower than most counties in our region and the state, which is at 1.32%.

Emerging Issues Since Last CHA

The following are some emerging issues since writing our 2019 CHA report:

• COVID19 related impacts on community mental health
  • School and social structure disruption and impact on social support norms
  • Financial and economic hardship on individuals and families due to workforce closures, layoffs and work reductions
  • Substance use disorder impacts on individuals and families resulting from COVID and related coping & behavioral actions
  • Suicide as a result of the above. (although I’m not sure if data demonstrates an increase in suicide over the pandemic(?))
  • Impact of COVID related stress on tobacco, alcohol use and dietary habits.
  • Physical Activity and nutrition impacts on chronic diseases resulting from less focus on healthy lifestyles and behaviors during the stress and life disruption from COVID.
• Possible increased chronic disease due to delays in routine preventive care
• Possible decrease in dental health due to delays in preventive dental care and treatment
• Access to safe water for homes with poor well water quality
• Continued attention on health disparities and health equity
• Complexity of inmate health care and costs

New/Paused/Discontinued Initiatives Since Last CHA

New Initiatives

Public Health Department COVID-19 Response

Contact Tracing

Beginning in March 2020, Union County Public Health provided lab testing guidance for community providers, COVID-19 case investigation and subsequent contact tracing, issued isolation and quarantine orders and education related to these orders and advised multiple employers in the county on containment and mitigation efforts related to COVID-19.  The Health Director and Communicable Disease team advised first responders, LTC facilities, schools and child care centers on management of COVID-19 occupational and community exposures.  Public Health established an IC structure in March 2020 to ensure that our scope of operations met the needs of the community.  The PH EOC provided operational guidance to the Union County Emergency Operations Center during the pandemic. 

Vaccination Clinic for COVID
Union County Public Health started offering COVID-19 vaccinations to the public on January 7, 2021. There have also been many educational opportunities offered to our community regarding the vaccine to clarify misinformation. Atrium Health Union & Union County Public Schools have been valuable community partners in our vaccination efforts, joining in to assist in Mass Vaccination events and working diligently to provide vaccinations quickly and efficiently. Other local retail pharmacies started providing vaccinations in March to assist vaccinating more Union County citizens. The State of North Carolina, through the Division of Public Health, established the Vaccination Phases and Guidelines, along with the Priority Groups, which we continue to follow.  Our Public Health and Community Support and Outreach Division were also following the State’s recommended guidelines to reach Historically Marginalized Populations (HMP) with additional outreach efforts and off-site clinics. Partnering with local churches, the City of Monroe, local non-profits and civic groups, we continue to be successful in our efforts to reach, educate and assist those minority groups in obtaining vaccinations. Collaboration with local businesses and industry to vaccinate their workforces are on-going and have proven to strengthen partnerships. Group homes, non-profits and many medical facilities across the county have also utilized our agency for their vaccinations.    

Environmental Health COVID-19 Response

In response to the identification of COVID-19 in North Carolina, the Environmental Health Division mobilized and adapted to provide a coordinated response to the pandemic as it impacted Union County. While the community spread of the disease increased, Environmental Health Specialists (EHS) assisted with the implementation of Executive Orders issued by the Governor. This included closure of some facilities or operational changes to others. We conducted outbreak investigations of congregate living facilities with the communicable disease nursing team and provided guidance on disease prevention practices, cleaning and disinfection procedures and building ventilation systems. We continue to conduct COVID-19 risk assessments at the start of all facility inspections with a focus on minimizing disease spread through preventive measures, identification of symptomatic employees and proper quarantine measures. Citizen complaints related to COVID-19 and associated Executive Orders are investigated by the environmental health team.

Clean Water for Carolina Kids Program

This program is led by the nonprofit research institute RTI International, with program partners including: the North Carolina Division of Public Health, the North Carolina Division of Child Development and Early Education, the North Carolina Public Health Laboratory, NC Child, and the Duke Environmental Law and Policy Clinic. Because of the potential for lead in water and the harm lead exposure causes children, program partners advocated for an updated North Carolina rule that requires all licensed child care centers to test for lead at locations where water is used for drinking or food preparation. The rule (15A NCAC 18A .2816 of the North Carolina Rules Governing the Sanitation of Child Care Centers) addresses lead poisoning hazards in child care centers. As part of this preventative program, environmental health staff provide guidance, technical information and follow-up water testing. In cases where high concentrations of lead are found in water taps, corrective action is taken to remediate the hazard.

UNC-Chapel Hill Superfund Research Program

The Environmental Health Division is partnering with the University of North Carolina-Chapel Hill Superfund Research Program and Clean Water for North Carolina on a multi-faceted well water outreach project. Environmental justice factors will be used to identify focus areas of Union County that may have higher environmental burdens and vulnerable populations. Engineering research to identify improved well construction practices and develop lower-cost treatment options for arsenic and co-contaminants is being conducted. This research will be used to develop tools to improve public health practices and educate decision makers on future land development options.

Union County Safe Kids and Communities 

In partnership with the Safe Kids/Safe Communities Organization, Environmental Health and other agencies will work to reduce the number of injuries or deaths resulting from poison-related incidents in children by providing education materials on poison prevention and Operation Medicine Drop to child care facilities, parents or guardians in Union County. In an effort to reduce injuries or deaths related to swimming pool safety, Environmental Health Specialists will distribute pool safety materials at community pools during inspection visits.

Other Initiatives

Food Council

During the onset of COVID-19, the Division Director for Community Support and Outreach (CSO) at Union County Human Services Agency was assigned by the North Carolina Emergency Operation Center (EOC) the responsibility to be the feeding coordinator for the County. One component of this job was to coordinate food resources, determine food needs, and to address gaps. The Division Director for CSO contacted food pantries, nonprofits, churches, schools, and restaurants to obtain this information. During this process, it became apparent that there was a lack of coordination, communication, and collaboration amongst all of these entities. In an effort to address these issues, the Union County Food Council was formed in May 2020. 

Over the last 9 months, the Food Council worked to developed infrastructure, specifically vision, mission, by-laws, website, and logo. The vision for the Food Council of Union County is a thriving food system from the farm to the kitchen table, which encompasses healthy lifestyles, access to nutritious food, and an economically prosperous community for all Union County residents. The mission of the Food Council is to create a healthy and sustainable food community that involves all Union County residents in a collaborative effort by providing educational resources that address wellness and nutrition, developing supportive relationships between agricultural producers, vendors, and consumers, and advocating for all residents of Union County by bringing every voice to the table. The council connects every aspect of Union County's food system; from farmers to producers and all the way to consumers and collaborates with nonprofit organizations, faith based organizations, government agencies, and universities improve the local food system and share resources with the community. Over the next year, the Executive Committee is focused on increasing membership and forming a 501c3.

Healthy Union Advisory Coalition

The Healthy Union Advisory Coalition (HUAC) was created to utilize the cooperative strength of community partners to identify overall health, quality of life and health equity issues, and support work to address those issues in Union County. In addition, the HUAC was created to ensure that the community continues to work on the identified priority areas in the Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP), identify and/or support additional priority areas as they arise, and to provide the ongoing structure to develop future CHA and CHIPs. The infrastructure of the HUAC and Executive Committee were developed in 2020, along with guiding principles, mission, board structure, and HUAC job description for coalition members. The HUAC and the HUAC Executive Committee each met one time in 2020. Over the next year, some of the goals for the HUAC is to to identify all community initiatives, programs, and committees that are currently working on CHIP focus areas, review the CHIP and determine whether there are strategies and measurements that need to be added to the CHIP, and develop subcommittees if needed to work on focus area strategies.

Paused initiatives

Health Equity Committee

During 2019, the Health Equity Committee provided educational workshops during meetings. Due to decreased attendance and interaction during meetings, the leadership committee met during early 2020 and unanimously agreed to refocus the committee focus on access to care issues. The revamped Health Equity Collaboration meeting was scheduled to meet on 3/25/20, but this was cancelled due to COVID-19. Due to limited Health Department resources during COVID, the committee was put on hold. Our goal is to re-evaluate this in the next 3-6 months and determine how this committee fits in with the Healthy Union Adivisory Coalition needs. 

Tobacco Ordinance

In January 2020, the Human Services Agency Board approved an updated Tobacco Ordinance, making the use of tobacco products prohibited on County grounds, buildings and county vehicles. A phased timeline was developed in early March, with the ultimate goal of obtaining approval from the BOCC during a meeting in May and implementing the policy in January 2021. Unfortunately, due to COVID and issues/concerns related to this, the Tobacco Ordinance was put on hold. We hope to revisit this in the Spring/Summer of 2021 with a goal of implementing in July 2022. 

Tobacco Awareness and Partnership with Union County Public Schools

One of Union County's  Healthy Communities Strategies is to increase compliance of the NC 100% tobacco-free schools’ law by partnering with youth, parents and school personnel to educate about dangers of tobacco use and new and emerging tobacco products. To address how we can educate students and parents and be impactful within the schools, representatives from Union County Human Services met with Carleen Crawford (Region 4 Tobacco Director), two Union County Public Schools (UCPS) Nurse Supervisors, andUCPS Substance Use Supervisoron met several times at the end of 2019 and the first few months of 2020. Several initiatives were in development phases, including updating the UCPS core curriculum to include e-cigarette education, bringing in a student speaker in the fall to speak at all the county middle schools, implementing several parents forums to provide information about the impact of e-cigarettes on teens, and developing a teen alliance with Wingate University and UCPS. Unfortunately, due to COVID and lack of resources, these were all put on hold in 2020. Our hope is to implement some of these in 2021-2022 school year. 

Minority Diabetes Initiative

In October 2019, Union County Human Services Agency entered into a MOA with the Cabarrus Health Alliance to bring a new minority diabetes program called Journey to a Healthier Me to Union County. We started our first cohort with employees at Union County Human Services Agency in early Feb 2020, with the goal of launching this into the community in the Spring 2020.  Unfortunately, due to COVID, this program was put on hold. We hope to reinitiate this program during Spring 2021. 

Executive Summary

Public health is the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. One way that local health departments assess their community strengths and resources, needs, health outcomes, emerging issues, and resident concerns is through the Community Health Assessment (CHA). The assessment affords Public Health, county officials, community partners and residents an opportunity to ascertain what is impacting health and wellness in Union County. The process examines primary and secondary evidence to develop a factual reflection of population health resulting from emerging trends and epidemiological statistics. In addition to being best practice, the CHA is also required by the State of North Carolina in order for local health departments to receive funding and accreditation.

The CHA is required to be completed on either a three or four year cycle. Union County completed assessments in 2008, 2012, and 2016. Union County decided to alter its four year CHA schedule cycle in order to align with Novant Health, one of our local hospital systems, as they embarked on conducting their Community Health Needs Assessment (CHNA). By doing this, we were able to collect community health data collaboratively and more comprehensively. Atrium Health, the other local hospital system, collaborated with us as well, despite the fact that they did not need to complete their CHNA this year.

Planning meetings for the 2019 CHA started in March 2019 with representatives from Union County Human Services, Novant Health, and Atrium Health. The work plan and timelines were developed, as well as survey and focus group question drafts for the collection of primary data. Primary data establishes a foundation regarding what county residents are concerned about relating to individual health and population health and open a dialogue about health issues, access to care, chronic disease, health equity, disparities, social determinants of health, and environmental impacts. Surveys (divided by age categories: teens 13 —18, adults 19—61 and seniors 62 and older) and focus group questions were finalized early May 2019 by a CHA Steering Committee, which consisted of representatives from County departments, non-profit organizations, business groups, community committees,  educational institutions, and the faith community.

The CHA survey was open for responses from May 15- June 30, 2019. All surveys were available in both English and Spanish and available electronically and via paper. Surveys were collected by random sampling via the jury pool participants and by convenience sampling at community locations and events. Over 4300 surveys were collected. Specific niche groups were identified to participate in Focus Groups. The niche groups were selected based upon demographics, occupation or elected position. All groups were asked the same questions. Fourteen focus groups were held capturing opinions and discussion of 100 individuals.

Input gathered from the surveys and focus groups data were analyzed. Recurring themes and trends were identified. Following this, secondary data in these areas was utilized. Secondary data is a required component of the CHA. Secondary data is statistical data collected by outside agencies such as the Center for Disease Control, Census Bureau, County Health Rankings and Roadmaps, County Statistics, NC State Center for Health Statistics, etc. This data provides factual information to support primary data, or dispel residents report as impacting health. Input gathered from both the primary and secondary data was combined and analyzed to determine the top focus areas to consider for prioritization.

It should be noted that secondary data was also collected and reviewed for other important areas of public health issues, such as Maternal Health, Communicable Disease, and Infant Mortality. While these are important issues and are addressed daily in our clinics and by Public Health staff, they were not included in the final focus areas. The rise in STD’s, disparities in infant mortality deaths amongst races, and the rise in diabetes, Alzheimer’s Disease, and  cancer rates for breast cancer and prostate cancer will continue to be monitored and addressed in Union County.  Information regarding these areas are included in the report.

The specific top focus areas identified by Union County residents based on both primary and secondary data include: Chronic Disease Prevention, Mental Health, Substance Use Disorder, Environmental Health, and Access to Care. Some of the feedback obtained from community members are as follows:

Community members verbalized repeatedly that the community should address specific health concerns such as cancer, diabetes, obesity, and high blood pressure. Contributors to this problem are the lack of exercise (opportunities for exercise) and the lack of healthy food in diets (lack of access to healthy foods or farmer’s markets, especially in the Eastern part of the County). Many areas of the County do not have easy accessibility to grocery stores or to healthy restaurants.  A few mentioned the need to create larger protected parks and increasing the safety of walking areas so people feel more comfortable exercising outside.

Addressing mental health was another concern which was mentioned by survey and focus group respondents.  Mental health problems, Alzheimer’s, dementia, suicide, and substance abuse disorders were also discussed as common among the adult population. One pediatrician mentioned that ~20% of her daily visits revolved around mental and behavioral health issues such as anxiety, depression, self-harming activities, and ADHD due to a lack of access to mental health providers. Several groups mentioned a lack of bilingual mental health providers. On surveys, Teens were more likely than adults and senior adults to describe their mental health as poor or very poor and identified depression and anxiety as concerns.

The limited ways to treat substance use disorder was identified as a concern by community members. Several Focus Group participants mentioned the need to make Narcan more available. Teens identified that e-Cigarettes, prescription pills, and alcohol abuse have become significant problems in the schools. 

Respondents discussed a need to improve access to preventative healthcare services (such as mammograms), primary care services, mental and behavioral health services and collaboration between both healthcare systems and other community partners. Community members are often unaware of the resources which are available to them, multiple ways to disseminate this information needs to be developed. 

Many focus groups mentioned that there is a lack of access to specialty care (such as infectious disease specialists or fetal medicine specialists) in Union County. The Latino Focus group participants mentioned that many Hispanic residents do not speak English (or in some cases, do not even know how to read), which is a large barrier to accessing care. Lack of affordable countywide public transportation was declared a major barrier to health. Residents without transportation cannot access basic needs such as groceries, medical appointments, or pharmacies. Prevention services are not typically an option, therefore medical needs wait until a situation becomes acute.

Environmental concerns focused on water quality, air quality, access to water, and access to greenspace. The sentiment around water quality was more residents need access to county or municipal water and sewer. Many survey responses indicated concerns about what is in both the County public and private well water due to smell or taste. Outdoor air quality has been an on-going challenge. Residents verbalized that they would like the County to consider infrastructure improvements to the built environment, such as sidewalks, more parks, increased greenspace, and walking trails.

The analysis of the data was presented to the Steering Committee on October 29, 2019 at Union County Human Services (see Appendix A) and this group determined the final priorities for Union County to be considered for action plans by discussion and vote. Magnitude, severity, intervention effectiveness, public concern, urgency, and current resources/efforts were considered during the voting process.    

The 2019 priority areas selected by the Steering Committee included:  

•     Substance Use Disorder (Prescription Drug Misuse, Opioids, and Tobacco Use/Smoking/E-Cigarettes),

•     Environmental Health (Water Quality, Access to Water, Greenspace), and

•     Access to Care (Insurance Coverage, Affordable Mental Health Services, and Transportation)

Two of these priority areas, specifically around the growing needs around substance use disorder treatment for opioids as well as access to healthy water, were identified in the 2016 CHA. Some goals surrounding these priority areas have been accomplished, however, due to reducing the cycle from 3 to 4 years, it has hindered the County from meeting all the goals of the action plans for these priority areas. The goal is to continue work in these areas by coalition building, identifying gaps and needs, and obtaining future funding.

Over the next six months, Union County Human Services, along with Community Partners, will develop action plans associated with the focus area priorities. The Union County Human Services Strategic Plan, 2030 Healthy Communities Plan, SHAC Committee Goals, and Healthy Communities Strategies will be utilized to develop these action plans.

For additional information regarding this 2019 CHA process, final report, or associated action plans, please contact the Human Services Agency Community Support and Outreach or Public Health Division Director: Stephanie.Starr@UnionCountyNC.gov and Dennis.Joyner@UnionCountyNC.gov.

Priorities

The initial 2019 priority areas selected by the Steering Committee included:  

Substance Use Disorder 

Environmental Health 

Access to Care 

COVID-19 shifted the community priorities and needs. In August 2020, the Steering Committtee revoted on the community priorities and needs and agreed on the following priority areas:

Substance Use Disorder 

Mental Health 

Access to Care 

Why Is This Important?

HNC 2030: Access to comprehensive, quality health care services is critical to achieve and maintain health, prevent and manage disease, and achieve health equity. Health insurance is the most common means used to obtain affordable health care services. For those without health insurance, care may be inaccessible and unaffordable, resulting in poor health outcomes. Those without
coverage may not receive important preventive care services, may avoid treatment for acute illness and injury, and may also have poorly managed chronic health conditions. Lack of health insurance coverage can also lead to financial burdens that further negatively impact one’s health. Access to affordable health care positively impacts individuals’ health and well-being and overall
quality of life.

HNC 2030: Primary care providers typically serve as the entry point into the health care system and provide a wide array of services including preventive, diagnostic, chronic disease management, and urgent care. As such, primary care providers play an integral rolein maintaining and improving the  overall health and well-being of communities. Access to primary care is associated with fewer
health care disparities and better health outcomes across socioeconomic circumstances.

What We Do

Who We Serve

How We Impact

What We Do

Who We Serve

How We Impact

What We Do

Who We Serve

How We Impact

Why Is This Important?

HNC 2030: Tobacco use remains the leading preventable cause of early death and disease in North Carolina and the nation. Tobacco use and secondhand smoke exposure are responsible for multiple causes of preventable morbidity and mortality in North Carolina. While combustible cigarette use has decreased among North Carolina’s youth, prevalence among adults has declined only slightly, and there are major disparities of tobacco-attributable disease and death among population groups. E-cigarette use among young people has become epidemic in North Carolina and the nation and poses a public health threat.

HNC 2030: Mental health and access to treatment services are often overlooked in our health care system. One indicator of mental
health outcomes – suicide –has been on the rise for years. Some special populations, such as veterans and LGBTQ youth, have seen
elevated rates of suicide that will require targeted prevention strategies.

What We Do

Who We Serve

How We Impact

What We Do

The Behavioral Health Collaborative program was started in November 2018 to help support the Social and Emotional needs of students who attend Union County Public Schools (UCPS). This program was initiated to build a partnership. Initial staff started in November 2018. Presently, the Collaborative has a total of 40 staff (both social workers and therapists). Since 2018, the collaborative provided over 84,249 students with services in the school. With the support of this collaborative, children who are trying to survive based on their social and emotional circumstances can move toward thriving socially, emotionally and academically.

Who We Serve

Students who attend Union County Public Schools

Families of students who attend Union County Public Schools

How We Impact

School Social Workers:

• Support a student’s social, emotional, and academic success.

• Facilitate engagement as the link between student, family, school, and community.

• Advocate for students to have a voice and promote family involvement.

• Enhance the capacity of school personnel to support student’s social and emotional needs.
• Mobilize resources & promote a continuum of services to meet the needs of the whole student.

• Actively participate in team collaboration and problem-solving.

• Bring a strengths perspective that honors cultural identity and empowers students.

• Voice consideration of barriers and the importance of self-determination for students when appropriate. 

Behavioral Health Therapists:

• Support a student’s mental health and academic success.

• Enhance the capacity of school personnel to support student’s mental health needs.

• Mobilize resources & promote a continuum of services to meet the needs of the whole student.
• Actively participate in team collaboration and problem-solving.

• Bring a strengths perspective that honors cultural identity and empowers students.

• Voice consideration of barriers and the importance of self-determination for students when appropriate. 

Progress in 2023

The Behavioral Health Collaborative provided mental health and social work services to 7,947 students in Union County Public Schools.

What We Do

Who We Serve

How We Impact

What We Do

Who We Serve

How We Impact

Establish a County wide ordinance for tobacco use on County property, with the long-term goal of making the entire County smoke free.