Updated: March 2, 2023
The health priorities identified in the 2019 Catawba County Community Health Assessment (CHA) are:
Chronic Disease
Brain Health
Healthy Foods & Healthy Weight
The following Community Health Improvement Plan (CHIP) Scorecard as approved on December 22, 2020 by the North Carolina Division of Public Health. The CHIP was developed utilizing the results-based accountability (RBA) framework through the health priority work groups. RBA uses a data-driven, decision-making process to help communities and organizations get beyond talking about problems to taking action to solve problems. RBA starts with the end and works backwards towards the means.
Our CHIP is a long-term, systematic effort to address the health priorities identified in our community health assessment. Our CHIP includes our desired results, indiciators, and strategies to address our health priorities. The CHIP guides the work of Catawba County Public Health, LiveWell Catawba, and our community partners. The three work groups addressing each of the current health priorities include, the Chronic Disease Work Group, Brain Health Work Group, and Catawba County Food Council.
The following resources were used and/or reviewed to develop the CHIP:
Results-Based Accountability Handouts & Guides
Common Language Key
Vision Statement:
We collaboratively aim to achieve a healthier community and enhanced quality of life for all people in Catawba County.
Leadership:
Led by Catawba County Public Health and LiveWell Catawba, in partnership with Catawba Valley Health System and Frye Regional Medical Center, a Catawba County CHA Leadership Team was convened to facilitate and inform the 2019 CHA process. In order to address the various health needs of the community, a multi-sectoral approach was utilized with several areas represented.
Partnerships and Collaborations:
PARTNER AGENCIES AND SECTORS:
Regional/Contracted Services:
We contracted creation of the Community Health Opinion Survey and primary data analysis services with a local group, Jackson Creative.
Theoretical Framework/Model:
We used the North Carolina Division of Public Health's eight-phase community health assessment process. 1) Establish CHA Leadership Team: The team comprised of stakeholders from various community sectors, including traditional and non-traditional partners such as the business sector, faith communities, and transportation and housing experts. 2) Collect primary data: Community listening sessions and Community Health Opinion Survey. 3) Collect secondary data: Gathered data from local, state, and national-level sources, along with data surrounding social determinants of health. 4) Analyze and interpret county-level data: Data review sessions with CHA Leadership Team and subject-matter experts. 5) Determine health priorities: Community listening sessions with data review and ranking by community members and stakeholders from key groups. 6) Create the CHA document. 7) Disseminate the CHA document: Distribute throughout the community by reaching out to media outlets, conducting and participating in community meetings, and communicating with key stakeholders. 8) Develop Community Health Improvement Plan: Plan to address health priorities identified in the CHA and how progress will be measured in the short- and long-term.
Key Findings
Drivers of Health, or social determinants of health, help a community understand the root causes of poor health outcomes. The 2019 Community Health Assessment identified the following key social issues that directly impact our health priorities:
Life expectancy is a critical indicator in examining a community's overall health and well-being, but where you live within that community affects your potential outcomes even more. In Catawba County, the highest estimated life expectancy by census tract is 82.6 years, while the lowest is 64.6 years, just minutes away. This is why we try to obtain and use data on the most local level possible while examining health issues and identifying opportunities to improve outcomes.
Infant mortality data highlights a significant inequity in child health outcomes, with Black infants being more than twice as likely to die than White infants.
Health Priorities
Chronic Disease
Brain Health
Healthy Foods & Healthy Weight
Next Steps:
The identification of health priorities is the beginning of a continuing process. Workgroups will be formed to generate action steps with goals for addressing community needs, and a community health improvement plan will be developed to be submitted by September 2020. The results from the CHA will be shared throughout Catawba County via traditional and non-traditional methods, leveraging partnerships through the CHA Leadership Team and other partner organizations.
Tobacco use is the leading cause of preventable disease, disability, and death in the United States. The use of tobacco harms nearly every organ in the body and causes cancer, heart disease, stroke, lung diseases, type 2 diabetes, and other chronic health conditions. The impacts of smoking extend past the smoker through secondhand smoke (CDC, 2020). Using e-cigarettes also causes health risks. E-cigarettes both contain and emit a number of potentially toxic substances (American Lung Association, 2020).
In Catawba County, chronic lung disease is the third leading cause of death. Chronic lung disease has led to 8,371 years of potential life lost by Catawba County residents. Mortality rates for lung cancer and chronic lower respiratory diseases for Catawba County are also higher than the North Carolina rates. In the 2019 Catawba County Community Health Opinion Survey, 15.5% of the respondents reported having smoked cigarettes or other nicotine products, including e-cigarettes, within the past twelve months; compared to 12.0% in 2015 (Catawba County Public Health, 2020).
If all Catawba County community members lived in communities that supported tobacco free and e-cigarette free lifestyles, Catawba County would potentially have:
Lower rates of lung cancer deaths,
Reduced hospital admissions related to lung cancer,
Increases in life expectancy,
Increases in community members receiving lung cancer screenings,
Decreases in the number of community members using tobacco, and
Increases in the number of tobacco free worksite policies.
Connection to COVID-19 complications?
References:
American Lung Association. (2020). The Impact of E-Cigarettes on the Lung. Retrieved on November 30, 2020 from https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung.
Catawba County Public Health. (2020). 2019 Catawba County Community Health Assessment). Retrieved on November 30, 2020 from https://catawbacountync.gov/site/assets/files/2488/2019_catawba_county_cha.pdf.
Centers for Disease Control and Prevention. (2020). Tobacco Use. Retrieved on November 30, 2020 from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/tobacco.htm.
At the Chronic Disease Work Group meeting on January 24, 2022, work group members reviewed and updated their current strategies based on what was working well, what was not working well and/or could be removed or changed, and how these strategies impact health disparities in Catawba County. The work group’s action plan was updated to include the following strategies. Action steps related to the followling strategies are discussed and updated during monthly work group meetings.
Strategies: Tobacco Policy
Workplaces adopt or enhance comprehensive tobacco-free policies.
Indoor and outdoor public places adopt or enhance tobacco policies.
Media education campaign on tobacco policies to educate the public and have workplaces become more involved in setting tobacco policies.
Strategies: Lung Cancer Screening
Screening education for the community and public about why lung cancer screening is a beneficial choice.
Promotion and education of lung cancer screenings for providers.
As of December 2022, nineteen teachers from thirteen schools across all three school districts have implemented CATCH My Breath, impacting 1,775 students in grades 6-9.
CATCH my breath is a Youth Vaping prevention program that was developed at the University of Texas School of Public Health. The program creator, Dr. Steven Kelder, developed the curriculum in response to the spike in youth e-cigarette use.
CATCH my breath is a peer reviewed program, found in the Mar/April 2020 issue of Public Health reports- the official journal of the US Surgeon General. The study found that students in schools that implemented the program were half as likely to experiment with e-cigarettes over the following 16 months, compared with those in schools that did not receive the program. The review also found the program increased student knowledge of vaping dangers and positive perceptions and choosing a vape-free lifestyle.
The program has already served 1.8 million students across all 50 states and is in over 5500 schools. It can be taught to ages 10-18 years/ grades 5-12. There are 4 lessons per version 5, 6th, 7/8th, 9-12th. Sessions are 30-40 minutes each. These are easy to integrate into Health, PE, Science and Advisory classes. The curriculum utilizes peer led teaching approach and meets national and state health education standards. There is no cost to using the curriculum and it is continually updated so that our teachers can have the most up to date information and strategies to use in the classroom.
Equipping our youth with the tools to say “NO” to risky behaviors like vaping and empowering healthy decision making is a must as we look to improve health in our communities. Giving our students strategies to avoid unhealthy behaviors along with helping youth that maybe have already started vaping find the courage and support to quit is essential in addressing this Public Health challenge.
https://letsgo.catch.org/courses/take/ToT-catch-my-breath/pdfs/38588212-create-a-catch-org-account-enroll-in-catch-my-breath
We have worked with School Health Advisory Councils, the Catawba County Public Health School Health team, district staff, and health/physical education teachers to ensure that the CATCH My Breath curriculum is available to all 6th - 9th grade classes across all three school districts.
The Healthy Schools Program Framework of Best Practices identifies specific criteria for a healthy school environment and serves as a guide for policy and practice change. It aligns with the 2017 School Health Index, created by the Centers for Disease Control and Prevention (CDC), which reflects the Whole School, Whole Community, Whole Child model (WSCC). The WSCC model recognizes the connection between health and academic achievement and promotes an inclusive, school-wide approach to student health. The CDC retains the full comprehensive School Health Index at cdc.gov/healthyYouth, addressing seven health topics: physical activity and physical education, nutrition, tobacco use prevention, alcohol and other drug use prevention, chronic health conditions (e.g., asthma and food allergies), unintentional injury and violence prevention (safety), and sexual health.
https://api.healthiergeneration.org/resource/11
This process allows for full participation in school wellness improvements from the classroom all the way up to district administrative staff. This engagement in the planning and prioritization process ensures better representation in decision-making and buy-in across the district as priority strategies are implemented.
We work in collaboration with the School Health Advisory Councils (SHACs) in each of our three school districts: Catawba County Schools, Hickory Public Schools, and Newton-Conover City Schools. In partnership with district staff and community partners serving on the SHAC, we support schools in participating in the Alliance for a Healthier Generations assessment-to-action process, which informs district-level priority setting. During the course of this CHIP, each district and SHAC have identified tobacco prevention policy and education as a top priority.
Behavioral health is an important part of overall health and includes emotional, psychological, and social well-being (CDC, 2020). An individual’s behavioral health can affect many aspects of their life including their ability to cope with stress, resiliency levels, build sustaining relationships, and make healthy choices. Integrated behavioral health care incorporates primary medical care with behavioral healthcare. Integrated behavioral health care includes whole person wellness with the individual as part of the team and care includes both the individual and their support system. The movement towards integrated behavioral health emphasizes the importance of whole person health.
During the community listening sessions for health priority selection in 2019, 34.2% of participating community members identified a need for increased access to behavioral health services, resources, social supports, and behavioral health professionals (Catawba County Public Health, 2020). From 2016 to 2019, 13.2% of all emergency department visits by Catawba County residents were for anxiety, mood, and psychotic disorders (The University of North Carolina at Chapel Hill, 2020). Access to equitable and affordable primary care that incorporates behavioral is both an applicable and realistic need as Catawba County continues to move forward and cope with the unintended consequences of COVID-19.
References:
Catawba County Public Health. (2020). 2019 Catawba County Community Health Assessment. Retrieved on November 30, 2020 from https://catawbacountync.gov/site/assets/files/2488/2019_catawba_county_cha.pdf.
Centers for Disease Control and Prevention. (2020). Learn about Mental Health. Retrieved on November 30, 2020 from https://www.cdc.gov/mentalhealth/learn/index.htm.
The University of North Carolina at Chapel Hill. (2020). NCDETECT- Emergency Department Data for Catawba County for Anxiety, Mood, and Psychotic Disorders from 1/1/2019 to 11/30/2020. Retrieved on December 1, 2020 from https://ncdetect.org/.
At the Behavioral Health Work Group meeting on January 19, 2022, work group members reviewed and updated their current strategies based on what was working well, what was not working well and/or could be removed or changed, and how these strategies impact health disparities in Catawba County. The work group’s action plan was updated to include the following strategies. Action steps related to the followling strategies are discussed and updated during monthly work group meetings.
Strategies: Whole Person Care & Technology Supported Care
Strategies: Community Engagement
A farmers market is a public and recurring assembly of farmers or their representatives selling food that they produced directly to consumers (Farmers Market Coalition, 2020). Catawba County currently has five farmers markets; Catawba County Public Health Farmers Market, Conover Farmers Market, Downtown Hickory Farmers Market, Murray's Mill Farmers Market, and Farmers Market at Center United Methodist Church. Market seasons for all the farmers markets vary slightly year to year.
For SNAP Double Bucks, for every $1.00 spent at the farmers market, $1.00 will be matched from funding. This will allow customers who utilize SNAP (Supplemental Nutrition Assistance Program) to purchase a greater quantity of fresh produce.
Reference:
Farmers Market Coalition. (2020). What is a Farmers Market. Retrieved December 2, 2020 from https://farmersmarketcoalition.org/education/qanda/.
The Catawba County Food Council’s strategies will target the the census tracts of 103.03, 104.2, 106, 107, 109, 110, 112 and 113, which are low-income census tracts where a significant number or share of residents are more than ½ or 1 mile (urban) or 10 miles (rural) from the nearest supermarket. At this time the census tracts targeted are based on the 2015 data from the USDA's Food Access Research Atlas. The Food Council had also planned to target parents and/or caregivers of children ages 2 to middle school within the low income and low access census tracts.
The Catawba County Food Council's action plan includes the following strategies related to farmers markets. The work group recognizes the importance of focusing on evidence-based strategies. Action steps related to the following strategies are discussed and updated during monthly work group meetings.
Strategies: Farmers Markets
Policy Agenda: Equitable Access to Healthy Foods
Despite the challenges due to COVID-19 in 2020, Catawba County Public Health and our partners were able to:
Catawba County declared a state of emergency due to the COVID-19 pandemic on March 18, 2020. Catawba County has had over 19,000 confirmed cases of COVID-19 and 300 deaths. Catawba County Public Health updates our COVID-19 dashboard daily at https://www.catawbacountync.gov/county-services/public-health/coronavirus-19/.
Catawba County COVID-19 Case Update: 5/27/2021
Cases | |
Number of total cases | 19,186 |
Number of deaths | 305 |
Number recovered | 18,712 |
Retrieved on 5/27/2021 from https://covid19.ncdhhs.gov/dashboard/cases-demographics.
Catawba County Vaccination Update: 5/27/2021
Vaccinations | |
People Fully Vaccinated | 56,107 |
Percent of Population Fully Vaccinated | 35.2% |
Retrieved on 5/27/2021 from https://covid19.ncdhhs.gov/dashboard/vaccinations.
Community Health Advocates
Throughout 2020, the Chronic Disease Work Group, Behavioral Health Work Group, and the Catawba County Food Council met monthly to develop Community Health Improvement Plans (CHIPS). The planning process was extended to the end of 2020 and by the end of the year all three work groups had started action planning and preparing for the upcoming year. The work groups anticipate new strategies will begin implementation in 2021.
In January and February 2021, all three work groups paused to allow Catawba County Public Health and our healthcare partners to focus all of their efforts to supporting the COVID-19 vaccine rollout. The work groups picked back up with action planning in March 2021. Action plans for the Chronic Disease Work Group, Behavioral Health Work Group, and Catawba County Food Council are available in the Work Group Action Plan folder. The work groups' action plans are fluid and are being updated monthly as the work group and/or subgroups meet.
Chronic Disease
Behavioral Health
Healthy Foods & Healthy Weight
Morbidity and mortality changes for Catawba County for 2021 are focused on the impact of COVID-19 on the community and the leading causes of death from the 2021 County Health Data Book for 2015 to 2019. Local COVID-19 data is available on the NC DHHS COVID-19 North Carolina Dashboard. COVID-19 surveillance is continuously changing, as key metrics, such as testing positivity rates and total case counts, have become more difficult to quantify due to at-home testing. CCPH has linked to the state dashboard in order to remain consistent with new metrics the state is using to track COVID-19.
In 2021, COVID-19 reports accounted for 92.2% of Catawba County’s Communicable Disease case investigations. This includes a prolonged period of elevated case numbers early in the year, the Delta wave and part of the Omicron wave at the end of the year.
COVID-19 Case Data (March 2020 to March 30, 2022)
While many cases are no longer reported due to at-home testing, the overall trends of cases reported can still be informative. Trends in reported cases help understand the spread of disease in the community and in specific groups and locations over time.
COVID-19 Vaccinations:
2015-2019 Leading Causes of Death
Leading Causes of Death (Unadjusted Death Rates per 100,000 Population, Ranking by Geographic Area) |
Catawba |
North Carolina |
||
Total Deaths- All Causes |
1078.0 |
901.7 |
||
|
|
|
|
|
Cause of Death |
Rate |
Rank |
Rate |
Rank |
Cancer - All Sites |
211.8 |
1 |
190.9 |
1 |
Diseases of the heart |
201.1 |
2 |
184.1 |
2 |
Chronic lower respiratory diseases |
87.4 |
3 |
52.3 |
3 |
Alzheimer's disease |
73.6 |
4 |
41.4 |
5 |
Cerebrovascular disease |
51.0 |
5 |
49.4 |
4 |
Other Unintentional injuries |
40.6 |
6 |
41.1 |
6 |
Diabetes mellitus |
28.9 |
7 |
28.5 |
7 |
Pneumonia & influenza |
27.4 |
8 |
19.3 |
9 |
Nephritis, nephrotic syndrome, & nephrosis |
25.9 |
9 |
19.3 |
8 |
Chronic liver disease & cirrhosis |
18.5 |
10 |
- |
- |
2015-2019 Leading Causes of Death by Age for Catawba County
References:
North Carolina Department of Health and Human Services. (2022). NC COVID-19 Dashboard- Cases and Deaths. Retrieved on March 30, 2022 from https://covid19.ncdhhs.gov/dashboard/cases-and-deaths.
North Carolina State Center for Health Statistics. (2022). County Health Data Book: Death Counts and Crude Death Rates per 100,000 Population for Leading Causes of Death, by Age Groups NC 2015-2019- CD11A. Retrieved on March 29, 2022 from https://schs.dph.ncdhhs.gov/data/databook/.
Catawba County Heptatis Coalition
COVID-19
Equipping Local Health Departments to Build COVID-19 Vaccine Confidence (COVIED) Project
Health Priority Work Groups
2016-2020 Leading Causes of Death and Inequities (rate per 100,000)
Cause of Death |
Overall |
Black |
Latino |
White |
Heart Disease |
157.0 |
186.3 |
382.4 |
159.6 |
Cancer |
156.3 |
169.8 |
64.0 |
160.0 |
Chronic Lower Respiratory Disease |
65.0 |
42.7 |
* |
68.8 |
Alzheimer’s |
54.9 |
58.2 |
* |
56.6 |
Cerebrovascular disease |
40.5 |
51.4 |
* |
40.0 |
All other unintentional injuries (non-motor vehicle) |
39.3 |
33.7 |
* |
43.6 |
Diabetes |
26.5 |
55.7 |
* |
25.1 |
Pneumonia and Influenza |
22.3 |
39.1 |
* |
20.8 |
Kidney disease |
20.9 |
58.3 |
* |
18.9 |
Suicide |
17.5 |
* |
* |
19.1 |
Source: 2022 County Health Data Book, North Carolina State Center for Health Statistics
From 2016 through 2020:
We will be working with community members to understand better the root causes of these inequities in the 2023 Community Health Assessment process.
County Health Rankings and Roadmaps Updates:
Food Insecurity:
Food insecurity has been a growing priority of our CHA/CHIP cycle, but this year we were able to disaggregate data to better understand inequities related to food insecurity in our county. As noted in our updated indicators, there is a significant inequity in food security between White residents and Black and Latino residents. As we enter our next community health assessment process, this clearer understanding of inequities in food access will better inform more specific and equity-oriented strategies.
Drivers of Health:
While they've always impacted health and well-being, there's growing recognition across the community and among partners related to how drivers of health are impacting outcomes, specifically housing and transportation. We are currently reviewing results from the 2020 Census and 2021 American Community Survey to identify potential indicators to inform a shared understanding of these issues as we move into our next community health assessment. For example:
Source: American Communities Survey, 2021
The following are new initiatives:
The following initiatives experienced changes or are paused:
The following are discontinued initiatives in 2022: