HNC 2030 Scorecard: Catawba

Why Is This Important?

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.

Story Behind the Curve

While Catawba County has seen a decrease in age-adjusted death rates for lung cancer since 2015, chronic lung disease remains one of the leading causes of death. Smoking tobacco is the leading risk factor for lung cancer. The risk of lung cancer for smokers is much higher than for non-smokers and the longer an individual smokes and the more packs a day smoked, the greater the risk. Secondhand smoke, breathing in the smoke of others, can also increase the risk of developing lung cancer (American Cancer Society, 2020). In Catawba County, there is an opportunity to push for tobacco policy adoption, enhancement, and implementation to support tobacco and e-cigarette free lifestyles to decrease lung cancer deaths in the long-term. Lung cancer screenings can increase detection before any symptoms appear. Implementing comprehensive policies is an evidence-based strategy used to reduce tobacco use.

References:

American Cancer Society. (2020). Lung Cancer Risk Factors. Retrieved on December 2, 2020 from https://www.cancer.org/cancer/lung-cancer/causes-risks-prevention/risk-factors.html.

Partners

In June 2020, Catawba County Public Health and LiveWell Catawba convened work groups for each of the 2020 to 2023 health priorities: chronic disease, behavioral health, and healthy foods & healthy weight. The Chronic Disease Work Group narrowed their focus from all chronic diseases to lung cancer specifically. As the work group moved through the results-based accountability process to develop the community health improvement plan (CHIP), they discussed on an ongoing basis who are partners and community members that are not involved that should be involved.

The Chronic Disease Work Group is continuously expanding to include a diverse group of community members, agencies, and sectors. A current list of Chronic Disease Work Group members is available here. 

What Works

The Chronic Disease Work Group through the strategy selection process discussed best practices that work to support tobacco and e-cigarette free lifestyles, potential low cost and no cost ideas, and data needed to better inform the work.  

Strategy Selection Process

In 2020, the Chronic Disease Work Group selected the overarching strategies of tobacco policy and lung cancer screening to support tobacco-free lifestyles. The strategy selection process included the work group members rating each strategy idea as high, medium, or low on the criteria of leverage (short-term: 3 years, intermediate: 3 to 5 years, and long-term: 10 years), feasibility, values, and specificity. The work group then reviewed the rating survey results, discussed each strategy, identified the overarching strategies based on related themes of the strategies selected, and determined, based on the criteria and rankings, which strategies should not be included in the community health improvement plan. The work group continued to update their strategies and action steps throughout 2021 and 2022. 

What are the programs and/or interventions recognized as best practices? 

• Comprehensive tobacco-free policies

• Leveraging health insurance for preventive screenings

• Onsite screenings at worksites

What are potential low cost and/or no cost ideas for immediate improvements? 

• Education for worksites

• Media campaigns

• Promoting available resources (American Cancer Society, NC Quitline, Tobacco Support Specialists)

What data is needed to better inform the work? 

The Chronic Disease Work Group has discussed the following data needs and/or additional data to consider if available.

• Age-adjusted lung cancer rates at the census tract level (currently is available at the zip code level)

• Hospital admission data related to lung cancer at the county level

• Number of health professional referrals to tobacco treatment resources

• Number of people receiving lung cancer screenings at the county level

• Number of worksites currently with tobacco-free policies

• Tobacco use (including e-cigarette use) data at the county level collected regularly for adults and children 

Action Plan

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.

What Is It?

Tobacco free policies are public-sector regulations and private-sector rules that prohibit smoking in indoor spaces and designated public areas. State and local ordinances establish smoke-free standards for all, or for designated, indoor workplaces, indoor spaces, and outdoor public places. Private-sector smoke-free policies may ban all tobacco use on private property or restrict smoking to designated outdoor locations. Tobacco free policies are highly effective in decreasing tobacco use and reducing secondhand smoke exposure (The Community Guide, 2020). The Chronic Disease work group has selected to address tobacco policies in indoor public places, worksites, and adoption of tobacco-free/ comprehensive policies.  

A comprehensive tobacco-free policy prohibits smoking and the use of tobacco products in the city, town, or county buildings, grounds (including parks), and in vehicles owned, leased, or occupied by the city or county. A comprehensive tobacco-fee policy also includes all enclosed or indoor areas of public places within the city, town, and/or county, excluding those places identified in NCGS 130A-498(b1) as being exempt from smoking restrictions. Exclusions include certain tobacco shops, premises of tobacco manufacturers and growers, smoking guest rooms in lodging establishments, certain cigar bars, private clubs, and live production sets (North Carolina Department of Health and Human Services, 2020).

A 100% tobacco-free policy for local governments and worksites applies to all of the property under the program's control that is rented or owned and all of that property, including the buildings, grounds, and vehicles, are tobacco-free. Tobacco includes the use of combustible, electronic, heated, and smokeless tobacco products. Under a 100% tobacco-free policy there are no designated areas for tobacco use indoors or outdoors. Programs do not purchase, accept as donations, or distribute any tobacco products. The gold standard is 100% tobacco-free, plus smoke-free and tobacco-free for enclosed or indoor public places for local governments (NCDHHS, 2020). 

References:

The Community Guide. (2020). Tobacco Use: Smoke-Free Policies. Retrieved on November 30, 2020 from https://www.thecommunityguide.org/findings/tobacco-use-smoke-free-policies.

The Community Guide. (2020). Tobacco Use: Comprehensive Tobacco Control Programs. Retrieved on November 30, 2020 from https://www.thecommunityguide.org/findings/tobacco-use-comprehensive-tobacco-control-programs#:~:text=Comprehensive%20tobacco%20control%20programs%20are%20coordinated%20efforts%20to%20implement%20population,tobacco%20use%20among%20young%20people.

North Carolina Department of Health and Human Services- Tobacco Prevention and Control Branch. (2020). North Carolina Gold Standard for Comprehensive Tobacco Policy. Received on December 1, 2020 from Carleen Crawford, Region 4 Tobacco Control Specialist.

Who We Serve

The Chronic Disease Work Group’s strategies for tobacco policy and lung cancer screenings target adults ages 45 to 64 in the 28601 zip code. Community members age 45 to 64 in the 28601 zip code had higher rates of lung cancer deaths, emergency department visits for chronic lower respiratory disease, and tobacco use.

Experience and Importance

The Chronic Disease Work Group’s action plan includes the following strategies related to tobacco policies. The work group recognizes the importance of focusing on evidence-based strategies to lower tobacco use. Action steps related to the following 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. 

Policy Agenda: Tobacco and E-cigarette Free Lifestyles

In the fall of 2021, the Chronic Disease Work Group crafted the following policy statement as part of LiveWell Catawba's overall policy agenda supporting health and wellness in Catawba County. 

1. We support adoption of evidence-based, comprehensive tobacco-free policies to provide the healthiest environment for our community members.
2. We believe lung cancer screening should be accessible to community members that meet the criteria for screening. 

What Is It?

Lung cancer screening is a test used to detect lung cancer before any symptoms appear. People who currently smoke or formerly smoked are at higher risk for lung cancer. The American Cancer Society recommends yearly lung cancer screening with a low-dose CT scan (LDCT) for some of these people (American Lung Association, 2022).

The American Cancer Society advises that health care providers, and people at increased risk for lung cancer, follow the recently updated recommendations for annual lung cancer screening from the US Preventive Services Task Force (USPSTF), the American Academy of Family Physicians (AAFP), or the American College of Chest Physicians.

These organizations recommend yearly lung cancer screening with LDCT scans for people who:

• Are 50 to 80 years old and in fairly good health,
  and
• Currently smoke or have quit in the past 15 years,
  and
• Have at least a 20 pack-year smoking history. (This is the number of packs of cigarettes per day multiplied by the number of years smoked. For example, someone who smoked 2 packs a day for 10 years [2 x 10 = 20] has 20 pack-years of smoking, as does a person who smoked 1 pack a day for 20 years [1 x 20 = 20].)

In addition, it’s important that people who are going to be screened:

• Receive counseling to quit smoking if they currently smoke,
  and
• Have been told by their doctor about the possible benefits, limits, and harms of screening with LDCT scans,
  and
• Can go to a center that has experience in lung cancer screening and treatment.

References:

American Cancer Society. (2022). Lung Cancer Screening Guidelines and Screening Criteria. Retrieved on March 29, 2022 from https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/lung-cancer-screening-guidelines.html. 

Who We Serve

The Chronic Disease Work Group’s strategies for tobacco policy and lung cancer screenings target adults ages 45 to 64 in the 28601 zip code. Community members age 45 to 64 in the 28601 zip code had higher rates of lung cancer deaths, emergency department visits for chronic lower respiratory disease, and tobacco use.

Experience and Importance

The Chronic Disease Work Group’s action plan includes the following strategies related to lung cancer screenings. Action steps related to the following strategies are discussed and updated during monthly work group meetings. 

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.

Policy Agenda: Tobacco and E-cigarette Free Lifestyles

In the fall of 2021, the Chronic Disease Work Group crafted the following policy statement as part of LiveWell Catawba's overall policy agenda supporting health and wellness in Catawba County. 

1. We support adoption of evidence-based, comprehensive tobacco-free policies to provide the healthiest environment for our community members.
2. We believe lung cancer screening should be accessible to community members that meet the criteria for screening. 

Why Is This Important?

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/.

Story Behind the Curve

As Catawba County continues to move forward and cope with the unintended consequences of COVID-19, access to equitable and affordable primary care that incorporates behavioral is both an applicable and realistic need. In 2019, 15.5% of all emergency department visits were for anxiety, mood, and psychotic disorders. From January 1 to November 30, 2020, 15.8% of all emergency department visits have been for anxiety, mood, and psychotic disorders (The University of North Carolina at Chapel Hill, 2020).

Behavioral health conditions, such as anxiety, mood, and psychotic disorders, affect a person’s thinking, feeling, mood, or behavior in a way that influences their ability to relate to others and function each day. These conditions may be situational, short-term, or long-lasting, chronic (Centers for Disease Control and Prevention, 2020). Emergency department visits are categorized by ICD-10-CM codes and anxiety, mood, and psychotic disorders are defined as follows:

• Anxiety disorders are a category of behavioral health disorders characterized by feelings of anxiety and fear, where anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a racing heart and shakiness. There are a number of anxiety disorders including generalized anxiety disorder, a specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, and panic disorder among others. While each has its own characteristics and symptoms, they all include symptoms of anxiety (UNC, 2020).
• Mood Disorders include bipolar disorder, also known as bipolar affective disorder or manic depression, and major depressive disorder. Bipolar disorder is a mental disorder characterized by periods of elevated mood and periods of depression. The elevated mood is significant and is known as mania or hypomania depending on the severity or whether there is psychosis. During mania an individual feels or acts abnormally happy, energetic, or irritable. They often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced. Major depressive disorder, also known as clinical depression, major depression, unipolar depression, or unipolar disorder; or as recurrent depression in the case of repeated episodes, is a mental disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities. The term "depression" is used in a number of different ways. It is often used to mean this syndrome but may refer to other mood disorders or simply to a low mood (UNC, 2020).
• For psychotic disorders, psychosis refers to an abnormal condition of the mind described as involving a "loss of contact with reality". People with psychosis are described as psychotic. People experiencing psychosis may exhibit some personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities (UNC, 2020).

The Behavioral Health Work Group continues to consider if they have a full understanding of root causes and continue to discuss equity, stigma, non-medical drivers/ social determinants of health, case management and lack of wrap around services. 

References:

Centers for Disease Control and Prevention. (2020). Coronavirus Disease 2019: Coping with Stress. Retrieved on December 3, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html. 

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/. 

Partners

In June 2020, Catawba County Public Health and LiveWell Catawba convened work groups for each of the 2020 to 2023 health priorities: chronic disease, behavioral health, and healthy foods & healthy weight. The Behavioral Health Work Group narrowed their focus from behavioral health prevention to the prevention of anxiety, mood, and psychotic disorder relapses. As the work group moved through the results-based accountability process to develop the community health improvement plan (CHIP), they discussed on an ongoing basis who are partners and community members that are not involved that should be involved.

The Behavioral Health Work Group is continuously expanding to include a diverse group of community members, subject matter experts, agencies, and sectors. A current list of Behavioral Health Work Group members is available here.

What Works

The Behavioral Health Work Group through the strategy selection process discussed best practices that work to support access to equitable and affordable primary care that incorporates behavioral health, potential low cost and no cost ideas, and data needed to better inform the work.  

Strategy Selection Process

In 2020, the Behavioral Health Work Group Group selected the overarching strategies of whole person care, technology supported care, and community education to support access to equitable and affordable primary care that incorporates behavioral health. The strategy selection process included the work group members rating each strategy idea as high, medium, or low on the criteria of leverage (short-term: 3 years, intermediate: 3 to 5 years, and long-term: 10 years), feasibility, values, and specificity. The work group then reviewed the rating survey results, discussed each strategy, identified the overarching strategies based on related themes of the strategies selected, and determined, based on the criteria and rankings, which strategies should not be included in the community health improvement plan. The work group continued to update their strategies and action steps throughout 2021 and 2022. In 2021, the Whole Person Care Subgroup and Technology Supported Care Subgroup merged into one subgroup for Whole Person Care & Telehealth. 

What are the programs and/or interventions recognized as best practices? 

• Behavioral health primary care integration, including bringing mental health screenings into primary care settings and Integrative care team approach (holistic)
• Telehealth and virtual health expansion and outreach, including education on community benefits of using these options. [Technology supported care includes telehealth (phone conversations) and virtual health (provider can see the client) for behavioral health care.] 
• Resources on techniques to deal with anxiety and depressive disorders
  • An example: CRM (Community Resiliency Model) 
• Reducing behavioral health stigma
  • Education for the community on anxiety, mood, and psychotic disorders and resources available for behavioral health care
  • Mental health first aid training
  • Working with the businesses/ worksites/ workforce development

What are potential low cost and/or no cost ideas for immediate improvements? 

• Building collaboration with agencies and partners already doing the work
• Educating the community on behavioral health
• Facilitating open community discussions about behavioral health
• Finding out about what is currently working well
• Learning about available resources
• Offering community mental health first aid trainings
• Partnering with municipalities to promote behavioral health resources
• Partnering with the Society for Human Resource Management to promote employee assistance programs (EAPs)
• Sharing available educational tools and resources

What data is needed to better inform the work? 

The Behavioral Health Work Group has discussed the following data needs and/or additional data to consider if available.

• Number of emergency department visits for anxiety, mood, and psychotic disorders by census tract
• Number of emergency department visits for psychotic disorder relapses 
• Number of integrated primary and behavioral health care providers 
• Number of integrated primary and behavioral health care providers and/or behavioral health care providers offering technology supported care

Action Plan

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

• Behavioral health primary care integration, including bringing mental health screenings into primary care settings and Integrative care team approach (holistic)
• Telehealth and virtual health expansion and outreach, including education on community benefits of using these options. [Technology supported care includes telehealth (phone conversations) and virtual health (provider can see the client) for behavioral health care.]

Strategies: Community Engagement 

• Resources on techniques to deal with anxiety and depressive disorders
  • An example: CRM (Community Resiliency Model)
• Reducing behavioral health stigma
• Education for the community on anxiety, mood, and psychotic disorders and resources available for behavioral health care
• Mental health first aid training
• Working with the businesses/ worksites/ workforce development

What Is It?

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. Holistic care refers to caring for the whole person.

Technology supported care includes telehealth (phone conversations) and virtual health (provider can see the client) for behavioral health care. Before the COVID-19 pandemic, trends show some increased interest in use of telehealth services by both health care providers and clients. However, recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth as a way to deliver acute, chronic, primary and specialty care. Telehealth can also improve patient health outcomes (Centers for Disease Control and Prevention, 2020). 

Reference:

Centers for Disease Control and Prevention. (2020). Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic. Retrieved on December 2, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html#:~:text=%2D%20Screen%20patients%20who%20may,%2C%20and%20refer%20as%20appropriate. 

Who We Serve

The Behavioral Health Work Group’s strategies target adults ages 19 to 44 in the 28609 zip code (Town of Catawba) and surrounding area, with focus on the rural community and working with churches. Of emergency department visits for anxiety, mood, and psychotic disorders, 39.7% were for adults ages 19 to 44. Community members age 19 to 44 in the 28609 zip code had a higher number of emergency department visits for anxiety, mood, and psychotic disorders compared to other zip codes and age groups in Catawba County. 

Experience and Importance

The Behavioral Health Work Group's action plan includes the following strategies related to whole person care and telehealth. 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: Whole Person Care & Technology Supported Care

• Behavioral health primary care integration, including bringing mental health screenings into primary care settings and Integrative care team approach (holistic)
• Telehealth and virtual health expansion and outreach, including education on community benefits of using these options. [Technology supported care includes telehealth (phone conversations) and virtual health (provider can see the client) for behavioral health care.]

Policy Agenda: Equitable Access to Whole Person Care

1. We advocate for wellness that incorporates the whole person, mind and body, for all community members.
2. We believe all community members should have equitable and timely access to care which includes medications, medical equipment, and primary care (whether in-person or via telehealth) regardless of ability to pay.

What Is It?

Community engagement may include and is not limited to, education on resources available in the community, reducing stigma, mental health first aid training, community groups, etc. 

Who We Serve

The Behavioral Health Work Group’s strategies will target adults ages 19 to 44 in the 28609 zip code (Town of Catawba), with focus on the rural community and working with churches. Of emergency department visits for anxiety, mood, and psychotic disorders, 39.7% were for adults ages 19 to 44. Community members age 19 to 44 in the 28609 zip code had a higher number of emergency department visits for anxiety, mood, and psychotic disorders compared to other zip codes and age groups in Catawba County. 

Experience and Importance

The Behavioral Health Work Group's action plan includes the following strategies related to community engagement. The work group recognizes the importance of focusing on evidence-based strategies. The following strategies were discussed during the whole distance exercise completed by the Behavioral Health Work Group in December 2021 and January 2022.  Action steps related to the following strategies are discussed and updated during monthly work group meetings.

Strategies: Community Engagement 

• Resources on techniques to deal with anxiety and depressive disorders
  • An example: CRM (Community Resiliency Model)
• Reducing behavioral health stigma
• Education for the community on anxiety, mood, and psychotic disorders and resources available for behavioral health care
• Mental health first aid training
• Working with the businesses/ worksites/ workforce development

Why Is This Important?

Food is a basic building block of health that affects both behavioral and physical health. Where someone lives strongly influences access to healthy foods. Limited access to healthy foods links to obesity, cardiovascular conditions, nutritional deficiencies, diabetes, and chronic kidney disease (North Carolina Institute of Medicine, 2020). Limited access to healthy foods is defined as living more than ½ a mile in urban areas or more than 10 miles in rural areas from the nearest supermarket, supercenter, or large grocery store. Census tracts where a significant number of residents have limited access to healthy foods are considered food deserts (United States Department of Agriculture, 2019). Low-income neighborhoods and those with large minority populations are less likely to have supermarkets and the available stores often have more limited healthy options and may have higher prices than their counterparts in wealthier communities (NCIOM, 2020).

In Catawba County, 8 of 31 census tracts (25.8%) have limited access to healthy foods with 14,151 community members living more than a ½ mile (urban) or 10 miles (rural) from the nearest supermarket. Nearly 1 in 3 adults (31.3%) age 20 and over report a body mass index (BMI) of greater than or equal to 30 (obese). In the 2019 Catawba County Community Health Opinion Survey, 42.6% of the respondents reported eating at least 5 servings of fruits and vegetables a day; compared to 51.6% in 2015 (Catawba County Public Health, 2020). Respondents were asked in follow-up why they felt they were not eating 5 servings of fruits or vegetables a day, 23.5% responded they were too expensive and 7.2% selected it was not convenient for them to buy fruits and vegetables 2015 (Catawba County Public Health, 2020). Improving access to healthy food is a critical component of creating an equitable and sustainable food system and a healthier community. (The Food Trust, 2010).

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.

North Carolina Institute of Medicine. (2020). Healthy North Carolina 2030: A Path Toward Health. Retrieved on December 1, 2020 from https://nciom.org/healthy-north-carolina-2030/.

The Food Trust. (2010). The Grocery Gap: Who Has Access to Healthy Food and Why It Matters. Retrieved on December 1, 2020 from http://thefoodtrust.org/uploads/media_items/grocerygap.original.pdf.

United States Department of Agriculture. (2019). Food Access Research Atlas. Retrieved on December 1, 2020 from https://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas/.

United States Department of Agriculture. (2019). Food Access Research Atlas Definitions. Retrieved on December 1, 2020 from https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation/.

Story Behind the Curve

Food insecurity refers to a lack of access, at times, to enough food for an active, healthy life for all household members and limited or uncertain availability of nutritionally adequate foods. Food-insecure households are not necessarily food insecure all the time. Food security may reflect a household's need to make trade-offs between important basic needs, such as housing or medical bills, and purchasing nutritionally adequate foods (Feeding America, 2020). 

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, also referred to as food deserts, are included in the Food Access Research Atlas map below. 

References:

Feeding America. (2022). 2019 Overall County Food Insecurity In North Carolina, Catawba County. Retrieved on March 30, 2022 from https://map.feedingamerica.org/county/2019/overall/north-carolina/county/catawba. 

United States Department of Agriculture. (2022). Food Access Research Atlas. Retrieved on March 30, 2022 from https://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas/.

Partners

In June 2020, Catawba County Public Health and LiveWell Catawba convened work groups for each of the 2020 to 2023 health priorities: chronic disease, behavioral health, and healthy foods & healthy weight. The Catawba County Food Council, formerly the Healthy Foods & Healthy Weight Work Group, narrowed their focus to reducing food deserts in Catawba County. As the work group moved through the results-based accountability process to develop the community health improvement plan (CHIP), they discussed on an ongoing basis who are partners and community members that are not involved that should be involved.

The Catawba County Food Council is continuously expanding to include a diverse group of community members, agencies, and sectors. A current list of Catawba County Food Council members is available here.

What Works

The Catawba County Food Council through the strategy selection process discussed best practices that work to support equitable access to health foods and culturally appropriate resources, potential low cost and no cost ideas, and data needed to better inform the work.  

Strategy Selection Process

In 2020, the Catawba County Food Council selected the overarching strategies of community gardens and farmers markets to support equitable access to health foods and culturally appropriate resources. The strategy selection process included the work group members rating each strategy idea as high, medium, or low on the criteria of leverage (short-term: 3 years, intermediate: 3 to 5 years, and long-term: 10 years), feasibility, values, and specificity. The work group then reviewed the rating survey results, discussed each strategy, identified the overarching strategies based on related themes of the strategies selected, and determined, based on the criteria and rankings, which strategies should not be included in the community health improvement plan.

In 2021, the Catawba County Food Council updated their overarching strategies to target food pantries and farmers markets. The Food Council had met with volunteers with community gardens and found that the majority of gardens were already donating produce within the community and were accessible to local community members. The Food Council met with the two largest food pantries, Greater Hickory Cooperative Christian Ministry (GHCCM) and Eastern Catawba Cooperative Christian Ministry (ECCCM) to assess culturally appropriate foods and resources and identify education needs for community members. 

What are the programs and/or interventions recognized as best practices? 

• SNAP Double Bucks/ Double Dollars programs
• Education for food pantries to share on how to use frequently received foods and food safety
• Expansion of grocery stores into food deserts

What are potential low cost and/or no cost ideas for immediate improvements? 

• Contacting local volunteers and experts to provide education 
• Convening all partners and community members to discuss food access
• Hosting healthy cooking demonstrations at the farmers markets
• Partnering with the YMCA to use their mobile kitchen for healthy cooking techniques
• Promoting available resources (farmers markets, community gardens, food pantries, etc.)
• Promoting awareness of programs and resources available related to food access 
• Sharing information on healthy eating and resources with the childcare community
• Social media campaigns

What data is needed to better inform the work? 

• Dollar amount of SNAP Double Bucks redeemed
• Number of people receiving SNAP Double Bucks
• Number of adults who eat at least 5 servings of fruit and vegetables daily at the county level
• Number of grocery stores near food deserts and/or number of corner or convenience stores in food deserts

Strategy

At the Catawba County Food Council 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. 

Strategies: Food Pantries

• Develop education for food pantries on:
  • Food safety (thawing, freezing, temperatures, safe storage)
  • Food preservation (freezing)
  • Easy, family friendly recipes using commodity foods 
  • Translate recipes into Spanish and other languages as needed

Strategies: Farmers Markets

• Maintain and sustain farmers market SNAP Double Bucks and WIC Bonus Buck programs
• Find sustainable funding
• Educate community on SNAP/EBT use and Double Bucks programs at farmers markets
• Community health worker position at Hickory Farmers Market
• Expand number of farmers and farmers markets that accept SNAP/EBT
• Educate local farmers at farmers markets and hobby farmers on how to donate their fresh produce to food pantries
• Virtual education on SNAP/EBT

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

What Is It?

A food pantry is a distribution center where hungry families can receive food. Supplied with food from a food bank, pantries feed hundreds of people per week. Because every community is different, there are many different types of pantries (Feeding America, 2022).

The Catawba County Food Council has partnered with Greater Hickory Cooperative Christian Ministry (CCM) and Eastern Catawba Cooperative Christian Ministry (ECCCM) for cooking videos, recipes, accessing culturally appropriate resources, and continues to work directly with both food pantries to provide education on topics they have identified. 

References: 

Feeding America. (2022). What is the difference between a food bank and food pantry. Retrieved on March 30, 2022 from https://www.feedingamerica.org/hunger-blog/what-difference-between-food-bank-and-food-pantry. 

Who We Serve

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.

Experience and Importance

The Catawba County Food Council's action plan includes the following strategies related to food pantries 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: Food Pantries

• Develop education for food pantries on:
  • Food safety (thawing, freezing, temperatures, safe storage)
  • Food preservation (freezing)
  • Easy, family friendly recipes using commodity foods 
  • Translate recipes into Spanish and other languages as needed

Policy Agenda:  Equitable Access to Healthy Foods

1. We support and advocate for sustainable policy, systems, and environmental change strategies that support equitable access to healthy foods for all community members. 
2. We believe equitable access to healthy foods can be achieved through community education, SNAP Double Bucks, and the elimination of food deserts in support of a healthier community.

What Is It?

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/. 

Who We Serve

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.

Experience and Importance

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

• Maintain and sustain farmers market SNAP Double Bucks and WIC Bonus Buck programs
  • Find sustainable funding
• Educate community on SNAP/EBT use and Double Bucks programs at farmers markets
  • Community health worker position at Hickory Farmers Market
• Expand number of farmers and farmers markets that accept SNAP/EBT
• Educate local farmers at farmers markets and hobby farmers on how to donate their fresh produce to food pantries
• Virtual education on SNAP/EBT

Policy Agenda:  Equitable Access to Healthy Foods

1. We support and advocate for sustainable policy, systems, and environmental change strategies that support equitable access to healthy foods for all community members. 
2. We believe equitable access to healthy foods can be achieved through community education, SNAP Double Bucks, and the elimination of food deserts in support of a healthier community.

Progress on CHIPs

Despite the challenges due to COVID-19 in 2020, Catawba County Public Health and our partners were able to: 

• Adopt Results-Based Accountability
• Transition Community Health Improvement Plans (CHIPS) from paper-based to web-based documents
• Set up results, indicators, strategies, and performance measures in Clear Impact Scorecard
• Link to the HNC 2030 Scorecard to create greater awareness of population accountability
• Adapt the CHA, CHIP, and SOTCH process to reflect COVID-19's impact on Catawba County

Morbidity and Mortality Changes Since Last CHA

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 

Retrieved on 5/27/2021 from https://covid19.ncdhhs.gov/dashboard/cases-demographics.  

Catawba County Vaccination Update: 5/27/2021

Retrieved on 5/27/2021 from https://covid19.ncdhhs.gov/dashboard/vaccinations. 

Emerging Issues Since Last CHA

Community Health Advocates

• For some people in Catawba County, the COVID-19 pandemic has exacerbated existing challenges and for others has created new barriers to health and wellbeing. Because of the unique challenges families are facing during the COVID-19 pandemic surrounding housing, nutrition, childcare and more, NCDHHS (North Carolina Department of Health and Human Services) awarded grants to organizations in hopes of rapidly deploying community health workers in communities throughout the state.
• Catawba County Public Health (CCPH) was selected as a recipient of the community health worker grant, which has allowed CCPH to bring six Community Health Advocates to Catawba County. These Community Health Advocates are responsible for connecting people affected by COVID-19 to medical and social support resources, including diagnostic testing, primary care, case management, nutrition assistance, behavioral health services and financial assistance.
• Catawba County’s Community Health Advocates help facilitate telehealth visits, point community members to health and/or social resources and provide advocacy on behalf of individuals and the community.
• The Community Health Advocates are working in coordination with contact tracers and community-based organizations to identify and assist individuals who need help accessing medical or social services, finding a safe location to isolate, or connecting with other COVID-19-related assistance. Because these workers are most successful when they can deliver culturally and linguistically appropriate services, CCPH has ensured that there is a diverse blend of workers who are able to meet these varied needs.

New/Paused/Discontinued Initiatives Since Last CHA

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. 

Progress on CHIPs

Chronic Disease

• During 2021, the Chronic Disease Work Group focused on tobacco policy and lung cancer screenings.
• Work Group members contacted over 100 businesses in 28601 about their tobacco free policies, tobacco quit benefits, and adopting and/or enhancing their tobacco policies. Priority businesses included those in automotive, construction & contractors, entertainment, faith-based organizations, food & dining, manufacturing/ wholesale/ distribution, and real estate. 
• In contacting businesses in 28601, the Chronic Disease Work Group identified the following barriers to worksites enhancing and/or adopting comprehensive tobacco free policies. In 2022, the work group will explore alternatives to engaging worksites and employees. 
  • Labor shortage and need for businesses to focus on hiring more people
  • Concern about putting policies in place that would potentially cause more employees to leave
  • Employees voicing that they would leave if a tobacco policy was enforced where tobacco use was not permitted anywhere onsite
• On November 18, 2021, on the Great American Smokeout, the work group partnered with LiveWell Catawba, Tobacco-Free Alliance Region 4, American Heart Association, and the Catawba County Chamber of Commerce to provide training on pathways to tobacco-free workplace policies. Over 30 businesses and community organizations attended the training.
• Work group members from Catawba Valley Health System and Frye Regional Medical Center provided ongoing presentations to medical providers on lung cancer screenings for those eligible. 
• In 2021, new recommendations for annual screening for lung cancer with low-dose computed tomography (LDCT) were released. In February 2022, Centers for Medicare & Medicaid Services (CMS) announced the expansion of lung cancer screening for at-risk populations that meet the following criteria:
  • Age 50-77 years
  • Asymptomatic (no signs or symptoms of lung cancer)
  • Tobacco smoking history of at least 20 pack-years
  • Current smoker or one who has quit smoking within the last 15 years
  • Receives an order for lung cancer screening with LDCT

Behavioral Health

• During 2021, the Behavioral Health Work Group has three overarching strategies, whole person care, technology supported care, and community engagement.
  • Whole Person Integrated Care is the integration of medical, behavioral, and public health approaches to care for the whole person. The model expands integrated care beyond the health care sector to include the social determinants of health, or the conditions in the places where people live, learn, work, and play. Social determinants of health are factors that can greatly influence the health and quality of life of individuals, populations, and communities (including food, housing, transportation, employment, access to care, medication access, etc.).
  • Technology supported care refers broadly to electronic and telecommunications technologies and services used to provide care and services at-a-distance.
  • Community engagement includes education for the community on anxiety, mood, and psychotic disorders and resources available for behavioral health care.
• The Whole Person Care and Technology Support Care Subgroups did deep dives into emergency room, Medicaid, and uninsured data to identify providers serving community members from the 28609 area. In March 2022, the Subgroups plan to conduct a practice survey to collect information on telehealth and integrated care services practices provide to increase telehealth awareness, access, and consistent engagement with whole person centered care services.
• The Community Engagement Subgroup actively worked with Partners Behavioral Health Management to train work group and Coalition members on the Community Resiliency Model (CRM). The Community Resiliency Model teaches participants about the impact of trauma and chronic stress on the nervous system, behavior, and long-term health. Participants learn how to reset the nervous system with easy to learn, concrete, coping skills. One of the goals of CRM is to create trauma-informed and resilient communities. The Community Engagement Subgroup plans to use CRM during part of the community groups’ education sessions.
• The Community Engagement Subgroup worked to engage community leaders from 28609 and the Town of Catawba in support of a community group. Participants in the community group would learn practical ways to make positive changes and find resources to support mental health. Professional facilitators would lead small peer counseling sessions. The community group plans to tentatively start in 2022. 

Healthy Foods & Healthy Weight

• During 2021, the Catawba County Food Council focused on strategies for food pantries and farmers markets.
• The Food Council partnered with Catawba County Cooperative Extension, Greater Hickory Cooperative Christian Ministry, (GHCCM), and Eastern Catawba Cooperative Christian Ministry (ECCCM) to do cooking videos using recipes with ingredients frequently available in the food pantries. Funding for the videos and recipes was provided by Community Food Strategies.
• Food Council members did tours of the food pantries at CCM and ECCCM and are evaluated the availability of culturally appropriate foods. The Food Council provided WIC cookbooks to both food pantries to distribute to their clients in addition to the cooking video recipes. Recipes and cookbooks were provided in English and Spanish.
• SNAP (Supplemental Nutrition Assistance Program) Double Bucks were piloted at Catawba County Public Health’s Farmers Market for the 2021 market season; $1,447.00 SNAP Double Bucks were redeemed at the market for fresh fruits and vegetables. LiveWell Catawba also supported WIC Bonus Bucks for WIC participants to use to purchase fresh fruits and vegetables; $1,580.00 WIC Bonus Bucks were redeemed.
  • For SNAP Double Bucks, for every $1.00 spent at the farmers market, $1.00 was matched from funding. This allows customers who utilize SNAP (Supplemental Nutrition Assistance Program) to purchase a greater quantity of fresh produce.
  • For WIC Bonus Bucks, each eligible WIC (Women, Infants, and Children) participant could receive $5.00 Bonus Bucks in addition to their WIC vouchers. 
• The Food Council worked with the Hickory Farmers Market in the fall of 2021 to implement a SNAP Double Bucks program starting in January 2022. LiveWell Catawba was able to support this program with funding from Healthy People, Healthy Carolinas and Community Food Strategies. The Food Council is continuing in 2022 to work with the Hickory Farmers Market for sustainable long-term funding.
• The Food Council is currently working with the Hickory Farmers Market to hire a community health worker (CHW) to provide community outreach and education on SNAP and WIC. The CHW would provide outreach and education at farmers markets in Catawba County and within the community, specifically targeting food deserts.
• In 2022, the Food Council plans to begin environmental scans of the 8 food deserts in Catawba County. The Food Council worked with County GIS to map convenience stores and grocery stores within the food deserts.
• LiveWell also provided funding to Morning Star First Baptist Church to support their community garden and snack for seniors program. Funding was also provided to Catawba County Cooperative Extensions Juntos program for healthy meals and snack for their participants.

Morbidity and Mortality Changes Since Last CHA

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

2015-2019 Leading Causes of Death by Age for Catawba County

• Ages 0 to 19
  1. Conditions originating in the perinatal period
  2. Congenital anomalies (birth defects)
  3. Motor vehicle injuries
• Ages 20 to 39
  1. Other Unintentional injuries
  2. Suicide
  3. Motor vehicle injuries
• Ages 40 to 64
  1. Cancer - All Sites
  2. Diseases of the heart
  3. Chronic lower respiratory diseases
• Ages 65 to 84
  1. Cancer - All Sites
  2. Diseases of the heart
  3. Chronic lower respiratory diseases
• Ages 85 and Over
  • Diseases of the heart
  • Alzheimer's disease
  • Cancer - All Sites

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/. 

Emerging Issues Since Last CHA

Catawba County Heptatis Coalition

• In 2021, the Heptatis C Coalition expanded to include hepatitis A, B, and C and is now known as the Catawba County Heptatis Coalition. The Catawba County Hepatitis Coalition continues to focus on providing seamless, coordinated care for those with hepatitis of all types. Because the population most affected by Hepatitis in recent years tends to cross county lines, the coalition is expanding across those lines as well, and has begun collaborating with surrounding counties to ensure continuity of care. This also comes in response to an increase in hepatitis throughout the region. By adopting a regional approach, the Hepatitis Coalition can leverage resources in multiple counties, and address spread across county lines, and have consistent messaging for these individuals, no matter where they live.
• Based on the continued success of Catawba County’s Hepatitis Coalition, Public Health was invited to speak at the NC Viral Hepatitis Task Force meeting and at the United States Conference on HIV/ AIDS to share best practices with other coalitions.
• In response to an outbreak of Hepatitis A that began in 2020 and expanded in 2021, the outreach efforts among people who use drugs and people who are experiencing homelessness have increased, as these two populations have been affected the most by this ongoing outbreak. To do this, partnerships with organizations that serve the homeless population and organizations that provide harm reduction services were strengthened, including ALFA, Olive Branch Ministry, Hickory Soup Kitchen and Open Door Homeless Ministry and have offered Hepatitis A and B vaccinations to at-risk individuals at off-site events sponsored by these trusted organizations.

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. Catawba County Public Health (CCPH) administered more than 64,000 COVID-19 vaccines in 2021, beginning at the Hickory Metro Convention Center, then moving to the Public Health building. At times, CCPH vaccinated more than1,000 people per day.

New/Paused/Discontinued Initiatives Since Last CHA

Equipping Local Health Departments to Build COVID-19 Vaccine Confidence (COVIED) Project

• Catawba County Public Health (CCPH) has been selected to participate in the Equipping Local Health Departments to Build COVID-19 Vaccine Confidence (COVIED) project. Through this grant-funded project, CCPH will partner with NACCHO to address vaccine hesitancy and increase COVID-19 vaccine confidence and uptake among priority populations disproportionately impacted by COVID-19 disease and complications.
• Because Catawba County’s African-American community has the lowest vaccination rate among the county’s major historically marginalized populations, and based on the number of individuals falling into that group, focusing on the African-American community is a priority for this grant.
• CCPH plans to hire a part-time vaccine coordinator who will coordinate vaccine education and outreach events, and who will develop a team of vaccine ambassadors who are well-respected within the African-American community. Those ambassadors will work alongside the vaccine coordinator to share messages about the vaccine’s safety and effectiveness, and address misinformation that has led to a lower vaccination rate among this population.
• CCPH  will couple these efforts with strategic advertising opportunities to amplify the message. CCPH will recieve $75,000 over the grant period, which lasts through December 31, 2022.

Health Priority Work Groups

• In January and February 2021, the Chronic Disease Work Group, Behavioral Health Work Group, and Catawba County Food Council paused to allow Catawba County Public Health and our healthcare partners to focus all of their efforts to supporting the COVID-19 vaccine rollout. All three health priority work groups picked back up with action planning in March 2021. 
• In December 2021 and January 2022, the three health priority work groups completed whole distance exercises to update the community health improvement plan (CHIP). The whole distance exercises included each work group reviewing, discussing, and updating their results statement, indicators, story (why is this important and the story behind the curve), partners involved and/or that should be involved in the work group, and what works, including their strategies and action plans.