Swain County strives to enhance the lives of its citizens through knowledge and better health. In the Swain County Health Department Community Health Assessment process the community has established two health priorities. In collaboration with WNC Healthy Impact and other community partners, Swain County will continue to work together to impact the health of its community with positive action and education.
The 2021 Community Health Assessment priority areas are continuations of the 2018 CHA long-term priorities:
- Chronic Disease
- Substance Use
The following Community Health Improvement Plan (CHIP) Scorecard was created and submitted by September 12th, 2022, to meet the Swain County Long Term Community Health Plan requirements.
A key to navigating this scorecard:
The following resources were used/reviewed to complete this scorecard:
Executive Summary
The executive summary can be found on pp. 4-6 of the CHA Report.
CHA Priorities
The 2021 Community Health Assessment priority areas are continuations of the 2018 CHA long-term priorities:
- Chronic Disease
- Substance Use
HNC2030 Alignment
Chronic Disease and the related result "Residents of Swain County are healthy, active, and thriving" are aligned with the following Healthy NC 2030 health indicators and desired results.
- Access to Exercise Opportunities - Increase physical activity
- Sugar-Sweetened Beverage Consumption - Reduce Overweight and Obesity
Experience & Importance
How would we experience residents of Swain County being healthy, active, and thriving in our community?
Swain County would be healthier and happier by reducing obesity, chronic disease, and food insecurity. According to community key informant sessions, listening sessions, and digital surveys, community members would experience the following if "Residents of Swain County are healthy, active, and thriving" were reached:
- Increased physical activity
- More outdoor activity
- Increased life span
- Increased healthy food options
- Decreased visits to a primary care provider as a result of reduced chronic disease
- Hearing more people communicating about healthy options
What information led to the selection of this health issue and the related results?
The Swain County Health Department, in conjunction with Swain Community Hospital, processed the community health assessment data in August and September of 2021. Information was gathered regarding the relevance, impact of chronic disease, and the feasibility of decreasing chronic disease. Community members unanimously voted to continue with the long-term priority of Chronic Disease.
Known risk factors (Healthy People 2030 website) for this issue are as follows:
- Built-in Environment
- Low Socioeconomic Status
- Low Educational Attainment
Partners with a Role to Play
Partners include:
- Swain County Health Department
- Swain Community Hospital
- Mountain Wise
- Eat Smart, Move More North Carolina
What Works to Do Better and Process
The following actions have been identified as ideas for what can work for our community to make a difference in chronic disease.
Actions and Approaches Identified by Our Partners: Our partners think these actions and approaches can make a difference in chronic disease.
- Worksite Wellness -- Swain Summits
- Eat Smart, Move More, Prevent Diabetes Program
What is currently working in our community: These actions and approaches are now in place in our community to make a difference in chronic disease.
- Worksite wellness programs (i.e., Swain Summits)
- Access to gym facilities
- Increase in health awareness
- Community health assessments
- Mammography Bus
- Dental Grants
Evidence-Based Strategies: These are actions and approaches that have been shown to make a difference in obesity as it relates to chronic disease.
Name of Strategy Reviewed |
Level of Intervention |
---|---|
Worksite Wellness |
Organizational |
Eat Smart, Move More, Prevent Diabetes Program |
Organizational |
Process for Selecting Priority Strategies
The Community Wellness Action Team (C-WAT) reviewed the community health assessment data in September and October 2018. Following those meetings, the whole distance exercise was completed by walking through the results-based accountability format in selecting actionable items. The whole distance exercise was conducted over two meetings. The group worked through the exercise and landed on the "what will work". Each group member in attendance voted on a strategy that met the three identifiable principles -- data power, proxy power, and communication power. In 2021, worksite wellness was voted to be continued as a priority strategy. It was also voted to add promoting Eat Smart, Move More, Prevent Diabetes Online as a new priority strategy.
What Is It?
Many of us in the community are working toward a healthier and happier Swain County. Together, we are trying to reduce chronic disease through health programs, like Swain Summits. Swain Summits is a community and worksite wellness program. Swain County Health Department aims to increase physical activity, nutrition, and mental health through worksite wellness. Why worksite wellness? We spend over 60% of our time at work and we want to help work toward a healthier and happier Swain.
Swain Summits was identified by the Community Wellness Action Team (C-WAT) as an action in 2019, that when combined with other actions in our community, has a reasonable chance of making a difference in chronic disease in our community.
The priority population/customers for Swain Summits are all residents in Swain County over the age of 18 years old, and Swain Summits aims to make a difference at the individual and county level.
This addresses health disparities in the following ways:
- Health assessments aid in connection to healthcare and provide free health screenings to the public that includes cholesterol and A1C
- Physical activity education and challenges will be aimed to help obesity, heart disease, and diabetes
- Nutrition education and challenges will be aimed to decrease obesity, food insecurity, heart disease, diabetes
- Stress management/mental health education and challenges will be aimed to decrease obesity and heart disease
Partners
The partners for Swain Summits include:
Agency |
Role |
Swain County Health Dept | Lead |
Great Smokies Health Foundation | Support |
What Is It?
Eat Smart, Move More, Prevent Diabetes Online Program is a statewide program to prevent obesity and associated chronic illnesses, such as Diabetes. Implementing North Carolina’s Obesity Prevention Plan promotes healthy nutritional choices, increased movement, and obtaining optimal body weight. This organization works to help communities, schools, and businesses have easy access to healthy food and physical activity. They desire to create an environment where nutritious food choices and exercise are easy for all North Carolinians. Their online program contains many resources pertaining to the community, education, and healthcare in relation to fitness and nutritional health—various educational resources regarding food choices, workouts, and other health-related issues.
Eat Smart, Move More, Prevent Diabetes Online Program was identified by the Community Wellness Action Team (C-WAT) as an action in 2021, that when combined with other actions in our community, has a reasonable chance of making a difference in chronic disease in our community.
The priority population/customers for Eat Smart, Move More, Prevent Diabetes Online Program are all residents in Swain County over the age of 18 years old, and Eat Smart, Move More, Prevent Diabetes Online Program aims to make a difference at the individual and county level.
Partners
The partners for this strategy include:
Agency |
Person |
Role |
Swain County Health Department |
Trish Hipgrave |
Lead |
Eat Smart, Move More, Prevent Diabetes Online Program |
State Representative |
Collaborate and Support |
HNC2030 Alignment
Substance Misuse and the related result "Residents of Swain County are healthy, safe, and thriving" are aligned with the following Healthy NC 2030 health indicators and desired results.
- Drug Overdose Deaths - Decrease Drug Overdose Deaths
- Tobacco Use - Decrease Tobacco Use
Experience & Importance
How would we experience residents of Swain County being healthy, safe, and thriving in our community?
Swain County would be healthier and happier by way of deduction of substance abuse/misuse. According to previous years' community listening sessions, community members would experience the following:
- No needles
- More treatment
- More participation in the community
- No cigarette butts
- Fewer funds being used
- Empowered by discussion
- Less smoke pollution
- Not holding breath to go into buildings
- Not hearing about overdoses
- More communication
What information led to the selection of this health issue and related results?
The Community Wellness Action Team and the Coalition for a Safe and Drug Free Swain County processed the community health assessment data. Both groups were provided information about the relevance, impact, and feasibility around substance misuse, specifically looking at opioid, tobacco, and alcohol data. The community members in attendance then unanimously voted to move forward with the substance abuse priority as a result of evaluating the primary and secondary community health data. These being long-term issues they are being continued in 2021.
Known risk factors for this issue are as follows:
- Family
- Social Networks
- Peer Pressure
- Income Level
- Educational Attainment
Partners with a Role to Play
Partners include:
- Swain County Health Department
- Coalition for a Safe and Drug Free Swain County
- Mountain Wise
- Swain Community Hospital
- QuitlineNC
What Works to Do Better and Process
The following actions have been identified as ideas for what can work for our community to make a difference in Substance use.
Actions and Approaches Identified by Our Partners: Our partners think these actions and approaches can make a difference in Substance use.
- Lock Box / DropBox Campaigns
- Quitline
What is currently working in our community: These actions and approaches are now in place in our community to make a difference in Substance use.
- Lox Box Distribution
- Naloxone Distribution
- Medication Drop Boxes
- Syringe Drop Box
- Quitline Promotion
Evidence-Based Strategies: These are actions and approaches that have been shown to make a difference in obesity as it relates to chronic disease.
Name of Strategy Reviewed |
Level of Intervention |
---|---|
Quitline |
Organizational |
Lock Your Meds Campaign |
Organizational |
Process for Selecting Priority Strategies
The Community Wellness Action Team (C-WAT) reviewed the community health assessment data in September and October 2018. Following those meetings, the whole distance exercise was completed by walking through the results-based accountability format in selecting actionable items. The whole distance exercise was conducted over two meetings. The group worked through the exercise and landed on the "what will work". Each group member in attendance voted on a strategy that met the three identifiable principles -- data power, proxy power, and communication power. In 2021, Lock Box / DropBox Campaigns and Quitline were voted to be continued as priority strategies.
What Is It?
LockBox and DropBox Campaigns were identified by the Community Wellness Action Team and the Coalition for a Safe and Drug Free Swain County as an initiative in 2019. It will be continued in 2022 as an action, when combined with other actions in our community, has a reasonable chance of making a difference in substance misuse in our community. This is an ongoing program in our community.
This program is ongoing as it is currently effective in Swain County and needs to be expanded to reach more of the population.
The priority population for these LockBox and DropBox Campaigns are organizations that are willing to establish a DropBox and community members interested in a LockBox. LockBox and DropBox Campaigns aim to make a difference at the community level. Implementation is ongoing in the community.
Misuse often impacts rates of violence, injuries, and certain diseases, so people who are using substances are at a disadvantage when it comes to overall health.
Partners
The partners for this strategy include:
Agency |
Person |
Role |
Coalition for a Safe and Drug Free Swain County |
Beth Young |
Lead |
Swain County Health Department |
Trish Hipgrave |
Collaborate and Support |
What Is It?
Promoting Quitline was identified by the Community Wellness Action Team and the Coalition for Safe and Drug-Free Swain County as an initiative in 2019. It will be continued in 2022 to encourage community members to stop using tobacco products. Quitline provides over-the-phone counseling and education 24 hours a day and Nicotine products to help with side effects associated with the cessation of tobacco use. These services are beneficial for the youth because it gives them support without retribution. This campaign aims to reduce tobacco use and, therefore, reduce the adverse health effects associated with it, including morbidity or mortality.
The priority population/customers for Quitline are individuals who use tobacco products within the community, and Quitline aims to make a difference at the individual at a community level.
Partners
The partners for this strategy include:
Agency |
Person |
Role |
Coalition for a Safe and Drug Free Swain County |
Tobin Lee |
Lead |
Swain County Health Department |
Trish Hipgrave |
Collaborate and Support |
Progress on CHIPs
Swain Summits Health screenings were held in April 2022. The Swain County Health Department provided free wellness panels and A1C bloodwork, as well as a % Body Fat, Blood Pressure, and Health Questionnaire screening. Forty-five community members participated.
Eat Smart, Move More, Prevent Diabetes Online advertising was conducted via Facebook, Med Assist Event, and email listservs and reached 9,699 community members.
Quarterly Eat Smart, Move More Prevent Diabetes Online ads were placed in the Smoky Mountain Times, reaching 3,900 community members each quarter.
Eat Smart, Move More, Prevent Diabetes Online incentives were offered to encourage community members to take and finish the first sixteen weeks of the course. Two community members have completed the course.
QuitlineNC advertising was conducted via Facebook, Med Assist Event, and email list serve, 12,432 community members were reached.
Quarterly Quitline and Live Vape Free ads were placed in the Smoky Mountain Times, reaching 3,900 community members each quarter.
QuitlineNC Billboard was placed in Bryson City for 61 days, reaching an average of 17,000 community members daily.
An Opioid Prevention Grant was received by the Coalition for a Safe and Drug Free Swain County, increasing Swain County's Lock Box distribution with the results as follows:
Morbidity and Mortality Changes Since Last CHA
The leading causes of death in Swain County for 2022 compared to 2021 revealed few changes. Deaths due to cancer remain the number one leading cause of death, with Diseases of the Heart as the second leading cause of death.
New Initiatives and Community Changes
According to the 2019 NC Vital Statistics, Cancer was found to be the leading cause of death in Swain County. Every year in the United States, more than 1.8 million people are diagnosed with cancer, and research shows that over half of those could have been prevented through healthy lifestyle choices, screenings, and vaccinations. In Swain County, we see many opportunities for education, counseling, and screening resources. While cancer incidence rates have continued to increase, the actual number of people dying of cancer is beginning to decrease. Breast cancer is the fourth leading cause of cancer deaths in the United States. The Swain County Health Department hosts Invision Diagnostics, a 3D Mammograms bus, twice a year to help with breast cancer screening and access to care. thirty-two community members have been served in 2022.
The Coalition for a Safe and Drug Free Swain County also received a Consolidated Appropriations Act Grant for Methamphetamine Prevention, with the results as follows:
The Coalition for a Safe and Drug Free Swain County also received a Consolidated Appropriations Act Grant for Alcohol Misuse Prevention, with the results as follows:
New and Emerging Issues
Monkey Pox - Currently, Swain County has had one case; however, investigative services are still ongoing.
Progress on CHIPs
Swain Summits Health screenings were held in Janurary 2022. The Swain County Health Department provided free wellness panels, CRP and A1C bloodwork, as well as a % Body Fat, Blood Pressure, and Health Questionnaire screening. Seventy-seven community members participated.
2024 - Health screenings will be held in Janurary 2024. The Swain County Health Department will
provided free wellness panels, CRP and A1C bloodwork, as well as a % Body Fat, Blood Pressure, and Health Questionnaire screening.
Eat Smart, Move More, Prevent Diabetes Online advertising was conducted via Facebook, and email listservs and reached 6860 community members. Eat Smart, Move More, Prevent Diabetes Online incentives were offered to encourage community members to take and finish the first sixteen weeks of the course. Seventeen community members have registered for the course and two community members have completed the course.
QuitlineNC advertising was conducted via Facebook, Swain Summits Screenings, and email list serve, 4288 community members were reached.
Lock Your Meds advertising was conducted via Facebook, Swain Summits Screenings, and email list serve, 7389 community members were reached. Eight hundred and ninty-six lockboxes were given to community members free of charge.
Morbidity and Mortality Changes Since Last CHA
The leading causes of death in Swain County for 2023 compared to 2022 revealed few changes. Deaths due to cancer remain the number one leading cause of death, with Diseases of the Heart as the second leading cause of death.
New Initiatives and Community Changes
Opioid Settlement grant
Swain County, along with other counties in collaboration with the Southwestern Commission, is actively engaged in addressing the opioid crisis through the utilization of an Opioid Settlement grant. The recent bid for facilitator marks an important step in planning and executing the next phases of work associated with this grant.
The Opioid Settlement grant aims to provide funding and resources to communities affected by the devastating impacts of the opioid epidemic. Swain County, like many other regions, has witnessed the detrimental effects of opioid abuse, including addiction, overdose-related deaths, and strained healthcare systems. In response to this crisis, efforts have been made to secure the Opioid Settlement grant, which serves as a significant opportunity to combat and alleviate the ongoing opioid crisis.
To ensure the effective utilization of the grant, Swain County has collaborated with neighboring counties and the Southwestern Commission, an organization that works towards the economic and social development of communities in Western North Carolina. This collaborative approach enables a coordinated and unified response to the opioid crisis, leveraging the combined expertise and resources of multiple entities to maximize impact.
In order to strategically plan the initiatives associated with the Opioid Settlement grant, a facilitator has been hired. The facilitator plays a crucial role in coordinating efforts, engaging stakeholders, and guiding the decision-making process. Their expertise helps streamline operations, establish priorities, and ensure that the grant's objectives are met effectively.
Considering the history of the Opioid Settlement, it is important to acknowledge that this grant is a result of legal action taken against pharmaceutical companies involved in the production and distribution of opioid medications. These companies were accused of misleading marketing practices and downplaying the addictive nature of their products, leading to widespread opioid misuse and addiction. The resulting settlements are aimed at providing financial support to affected communities, aiding in addiction treatment, prevention programs, and other initiatives to address the opioid crisis.
Swain County's involvement in this grant, alongside other counties and the Southwestern Commission, demonstrates a commitment to combating the opioid crisis through collaborative efforts and utilizing the resources provided by the Opioid Settlement. The hiring of the facilitator further emphasizes the importance of effective planning to ensure the grant's success in making a positive impact on the community.
Produce Prescription Box Program
The Swain County Health Department is committed to bringing food equity to the county and improving access to fresh, healthy food for all residents. Through the MountainWise's Duke Endowment-funded Healthy People, Healthy Carolinas grant for Jackson, Swain, and Macon County, the department chose to invest the majority of their funds toward the Produce Prescription Pilot Program.
Partnering with ASAP (Appalachian Sustainable Ag Project), Darnell Farms, MountainWise's HPHC (Healthy People Healthy Carolinas) program, and EMFS (Emerging Mountain Food Systems), the Swain County Health Department launched the Produce Prescription Pilot Program in Swain County. The program provides weekly fresh produce boxes, along with additional food items from local producers, recipes, and food preparation materials and equipment, to forty-nine households participating in Swain's CHORE or WIC programs. The deliveries began on February 7th and will continue for 12 weeks, with participants gathering monthly for a recipe cooking demonstration and family activities.
ASAP is leading the coordination of this project, bringing GusNIP funds to support the work. The organization also provides monthly cooking demonstrations and sourcing the recipes and materials/equipment add-ons. Darnell Farms is sourcing the food and delivering the boxes to each participant's home. MountainWise is serving in overall project support and organizing role along with the allocated funds directed by the Swain County Health Department from the Duke Endowment-funded Healthy People, Healthy Carolinas grant. EMFS is offering technical assistance and advisement, leveraging its experience in running similar programs in the past.
By bringing together these partners and leveraging funding and resources, the Swain County Health Department is making significant strides toward improving food equity in the county and supporting local food systems. The department is proud to be a part of this important work and looks forward to seeing the positive impact it will have on the community.
"We are thrilled to partner with ASAP, Darnell Farms, MountainWise, and EMFS to bring the Produce Prescription Pilot Program to Swain County," said Trish Hipgrave Public Health Educator "This program is a great example of how local partnerships can strengthen our food systems and support community health and wellbeing."
2024 - A second itteration of the Swain Produce Prescription Program will be serving fifty families for twenty-six weeks.
Narcan - In collaboration with Mountain Projects, State of Opioid Response, Swain Coalition and the Swain County Health Department the highest volume of Narcan distribution in Swain County was achieved to date. Through a strategic campaigns on various social media platforms, a total of 1197 Narcan kits were generously provided to members of the community, completely free of charge, in the year 2023.
New and Emerging Issues
Monkeypox
Potential Threat of Monkeypox outbreak in Swain County. Despite no confirmed cases, the county's characteristics make it susceptible to zoonotic diseases. The need for preparedness and preventive measures is emphasized to mitigate the potential risks associated with a Monkeypox outbreak.
Monkeypox, a rare viral disease transmitted through contact with infected animals, poses a potential risk to Swain County. To combat this threat, proactive measures such as surveillance systems, enhanced diagnostics, and awareness campaigns are essential. By remaining vigilant and prioritizing preparedness, Swain County can effectively minimize the impact of a potential Monkeypox outbreak and safeguard the health of its residents.
Increased Drug Exposer
The Swain County Sheriff's Department and Bryson City Police have jointly reported a concerning surge in drug-related incidents, specifically involving the highly potent synthetic opioid, fentanyl. This emerging issue poses a significant threat to public safety and law enforcement personnel. Fentanyl, known for its potency and association with a rising number of overdose cases nationwide, is now impacting our local community. Collaborative efforts between law enforcement, healthcare professionals, and community stakeholders are essential in developing comprehensive strategies to address this public health crisis.
Increased Gang Activity
The Swain County Sheriff's Department and Bryson City Police have recently observed a concerning uptick in gang activity, particularly among individuals aged 13-18. This troubling trend poses a significant risk to the safety and well-being of our community's youth. Gang involvement among adolescents and young adults demands our collective attention, as it can have far-reaching consequences for the community's overall safety and stability. Efforts to curb the rise in gang activity will require collaboration between law enforcement, educational institutions, and community leaders.
Firearm Safety
Recent incidents have brought attention to an increase in youth-related firearm use, marking an emerging concern in our community. This serves to keep the community informed, emphasizing responsible gun ownership, especially in households with children. It is essential for everyone to stay vigilant, prioritize secure firearm storage, and engage in open conversations within families about firearm safety.
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