HNC 2030 Scorecard: Clay County 2021-2023

Executive Summary

Community Results Statement

Leading the way to a healthier community

Leadership for the Community Health Assessment Process

The leadership for the CHA process included the Clay County Health Department Public Health Educator and the Interim Health Director.

Partnerships

Partnerships during the CHA process were particularly crucial. The main partnership came from Healthy Carolinians, which is comprised of multiple entities from around the county. Healthy Carolinians was developed to enhance the health of Clay County through networking to determine how we can support each other within our county.

Regional/Contracted Services

Our county received support from WNC Healthy Impact, a partnership and coordinated process between hospitals, public health agencies, and key regional partners in western North Carolina working towards a vision of improved community health. We work together locally and regionally to assess health needs, develop collaborative plans, take action, and evaluate progress and impact.  This innovative regional effort is coordinated and supported by WNC Health Network. WNC Health Network is the alliance of stakeholders working together to improve health and healthcare in western North Carolina. Learn more at www.WNCHN.org.

Theoretical Framework/Model

Collaborative Process Summary

Clay County’s collaborative process is supported on a regional level by WNC Healthy Impact.

Locally, our process is to share our Community Health Assessment Primary and Secondary data with our CHA team to identify and prioritize our priorities for the CHA.

Clay County examined the data that was distributed by WNC Healthy Impact, and distributed the information to the CHA team. To determine the key issues for Clay County, the Public Health Educator created a rating and prioritizing worksheet to help determine which issue is the highest priority that can be obtained within Clay County. The results showed that Chronic Disease Prevention and Control, Prevention and Management of Acute Respiratory Infections along with Prevention and Screening for Cancers are three areas of need that are still troubling our county.

Phase 1 of the collaborative process began in January 2021 with the collection of community health data. For more details on this process see Chapter 1 – Community Health Assessment Process.

Key Findings

The data collected for the 2021 Community Health Assessment showed a need for prevention and control on chronic illnesses. According to the data, the leading cause of death included diseases of the heart, chronic lung disease, and diabetes mellitus. Unfortunately, the lifestyle behaviors and health status such as inactivity, obesity, and poor nutrition continues to be a prevalent cause of these chronic diseases. The data also showed the need to prevent and manage acute respiratory infections. In the analysis, it showed that flu, pneumonia, and COVID-19 were a contributing factor in several cases where death had occurred. Thirdly, Cancer seems to play a role in the lives of several Clay County residents, making prevention and proper screening essential for the wellbeing of the community.

Health Priorities

The Following health issues were identified as priorities:

Chronic Disease Control and Prevention

Prevention and Management of Acute Respiratory Infections.

Prevention and Screening for Cancer

Next Steps

The next steps for developing the community health improvement plans include:

• Working with partners and community members to understand the root cause of the problem and determine how to implement changes to improve the overall health of the county
• Using evidence-based strategies when working on health issues within the county.
• Selecting priority strategies and creating performance measures to help us evaluate how people are better off because of the strategies.
• Publish the Community Health Improvement Plan (CHIP) on an electronic Scorecard that anyone can access to monitor progress.
• To access the full data set that was used for the CHA please email Regina Harper at reginaharper@clayhdnc.us

Priorities

Importance

Chronic Disease continues to be prevalent within our county and is causing more premature deaths than overdose and motor vehicle accidents combined. In 2015-2019, Clay County had 163 total deaths pertaining to heart disease, 54 deaths involving Cerebrovascular Disease and 23 deaths pertaining to diabetes. Prevention is imperative because studies have shown that effective prevention can stop or delay many chronic diseases and limit their negative impact. All health is connected, meaning that one chronic disease can contribute to other diseases down the road. Therefore, the best action plan for chronic diseases is to manage the condition at hand and keep it as stable as one can. By remaining stable, other chronic diseases are delayed from occurring.  Our goal is to limit the burden that chronic disease has on not only the individual, but the community as a whole.

Experience

Clay County would experience more individuals having controlled blood pressure and blood glucose levels due to increased monitoring. Physical activity will increase within the community, by the utilization of walking trails and the recreational gym. More community members will buy from local food stands and learn to choose healthier options. The Clay County Health Department will see an increase of clients attending health promotion classes and participation in a wellness program initiative. Clay County will see more clients taking control of their health by becoming more health conscious and monitoring their current disease. Overall, Clay County will observe positive lifestyle changes among the residents of this county and be an inspiration to surrounding counties.

What is it?

Clay County BeFit was identified by Elite Health Team as an action, that when combined with other actions, it has a reasonable chance of making a difference in physical activity, nutrition, and obesity as it relates to chronic diseases in our community. This is a new program in our community and is not an evidence-based strategy.

The clients for this health and fitness program are individuals who are struggling to become healthy or want to continue their journey of being healthy. The health and fitness program aims to make a difference at the individual level. Clients will join the Clay County BeFit page for helpful tips on eating healthy, exercises to do at home, and have an  in-person/virtual lunch and learn about how to improve their health and wellness. Implementation will take place at Clay County Health Department along with virtual classes through media outlets.

Partners

The partners for this health and fitness program include:

Updates

Clay County Health Department decided to post healthy information within their own facebook page instead of creating a new page. The decision to not create a new facebook page was the fact that many individuals would not follow a new page but would prefer to stay on the original one. To determine the performance on this strategy, we will measure how many individuals the healthy information reached. 

What is it?

Worksite Wellness was identified by county leadership as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in a person’s overall health. This is a new program in our community and is not an evidence-based strategy.

The audience for the worksite wellness are individuals within the county who want to become healthier mentally and physically. The worksite wellness program aims to make a difference at the individual and organizational level. County employees will sign up to participate in a 52-week program that will allow them to be coached and encouraged to better health. Participants will receive journals, step counters, and weekly vouchers for nutritional shakes/teas. Implementation will take place at Clay County Health Department in hopes to improve worker retention, less lost work time, increased worker output, economic boost, and healthier families/communities.

Partners

The partners for this health and fitness program include:

Updates

02/15/2023- Unfortunately, Clay County Health Department was not able to be awarded the grant that was applied for to get the worksite wellness program started. In the meantime, we will continue to look for grants to help improve the wellness of our employees.

02/22/2024- Clay County Health Department was unable to receive grant money to implement the worksite wellness program for our county employees, but we were able to help another facility with their worksite program. Clay County Health Department teamed up with the Clay County School System to help them implement a wellness event for all teachers. During our event, we performed blood draws, hearing screengins, blood pressure checks, vision screenings, and weight/BMI checks. In total, we were able to perform 20 blood draws and several other screensings. Since the wellness event was a big success, Clay County Health Department plans to continue to work with Clay COunty School System again this year.  

What is it?

Community Health Project was identified by Elite Health Team as an action, that when combined with other actions, has a reasonable chance of making a difference in management of chronic diseases. This is a new program in our community and is not an evidence-based strategy.

The clients for the Community Health Project are individuals who are struggling with managing their chronic diseases. Unfortunately, management of chronic diseases can become expensive over time. Therefore, this program will help eliminate some of the cost by providing blood pressure machines, glucose monitors, incentive spirometers, and pulse oximetry monitors to clients within our clinic. The Community Health Project aims to make a difference at the individual level and improve health disparities when it comes to socioeconomic status. Implementation will take place at Clay County Health Department.

Partners

The partners for this health and fitness program include:

Updates

The Community Health Project is still providing the community with blood glucose monitors and pulse oximeters. Clay County Health Department is currently writing a grant to purchase more blood pressure cuffs to continue to provide our clients with the resources they need to become healthier. 

Importance

Acute Respiratory Infections can be caused by a great number of etiological agents that within the right climate can become fatal. Because of the many etiological agents, diagnosing and determining the right treatment plans can be challenging. Therefore, early prevention is key when it comes to vaccine mimicked viruses. Early intervention and management can make a big impact on the outcome. Aging adults, pregnant women, and even children under the age of five may develop complications from an Acute Respiratory Infection that could lead to death. During 2015-2019, Clay County had 17 residents die from complications from pneumonia and influenza.  Shortly after in 2020, Clay County expierenced 3,039 cases of Covid-19 and 49 of those cases lead to death. Those numbers alone made a huge impact on our community as a whole. For this very reason, Clay County Health Department believes that the prevention and management of Respiratory Infections is crucial.

Experience

Clay County would experience more individuals becoming less susceptible to contracting Acute Respiratory Infections. Vaccine administrations would increase for all Influenza, Pneumonia, and COVID-19 vaccines. Clay County residents will follow proper guidelines when diagnosed with an Acute Respiratory Infection. Individuals will become more aware of their symptoms and recognize when healthcare should be sought out.  Overall, Clay County wants to see all residents free from Acute Respiratory Infections and live healthier and happier lives. 

What is it?

Immunization program was identified by the Elite Health team as an action, that when combined with other actions can make a difference with the number of individuals suffering from Acute Respiratory Infections in our community. This is an ongoing program in our community. The immunization program helps eliminate vaccine-preventable diseases, especially those that can cause respiratory infections. Our goal is to promote and educate as many individuals that we can on the importance of vaccinations. The immunization program allows individuals to walk in anytime during office hours to receive the vaccine of their choice along with informational sheets about the vaccine.

The immunization program is available for individuals of all ages, which aims to make a difference at the individual level. Implementation will take place at the Clay County Health Department.

Partners

The partners for the immunization program include:

Updates

Clay County Health Department offers an immunization program that encourages patients to receive vaccines to help eliminate vaccine-preventable diseases, especially those that can cause respiratory infections. Through promotions within our media outlets, Clay County Health Department is determined to bring awareness to vaccines and how they can be beneficial. In the year 2023 alone, we have given 313 Influenza vaccines, 93 Pneumonia vaccines, and 212 COVID-19 vaccines. Many of these vaccines were given through off-site outreach clinics and even in-home services. Starting in December 2023, Clay County Health Department will be administering RSV vaccines (Abrysvo) to those who are 60 years of age or who are currently pregnant within their 32 to 36 weeks gestational age. Administration will be provided seasonally with a one-time dose of the vaccine.

What is it?

Monoclonal Antibody treatment Program was identified by Clay County Health Department as an action, that when combined with other actions, has a reasonable chance of making a difference in COVID-19 as it relates to Acute Respiratory Infections in our community. This is a new program in our community.

The customers for the Monoclonal Antibody treatment program are those who have a risk of being hospitalized with COVID-19, and the program aims to make a difference at the individual level. The primary goal was to provide a pro-active treatment for our citizens to minimize the potential seriousness and side effects which can arise from COVID-19. Simultaneously, we want to keep mild and moderately symptomatic patients from being hospitalized which will help relieve some of the stress on our local facilities and emergency services. Implementation took place at the Clay County Senior Center and was moved to Clay County Health Department a few months after implementing the program.

Partners

The partners for this Monoclonal Antibody Treatment Program include:

Updates

The monoclonal antibody therapy was completed in March 2022 and is no longer being done at Clay County Health Department. However, Clay County Health Department is still working with their patients to prescribe antiviral therapy to those who become positive for COVID-19 and would like to receive the antiviral treatment.

Importance

Cancer is known as the second leading cause of death affecting one in three individuals in the United States; in 2015-2019 there were a total of 158 deaths in Clay County from cancer.  Unfortunately, cancer doesn’t just affect one organ, it can affect several. Cancer develops when our body stops removing the old cells and continues to make new ones. Over the years, medical interventions have improved, but the burden cancer causes on a person, their family, and the community is still impactful. To avoid the unnecessary burdens that cancer causes, Clay County has decided to make awareness of preventive measures and early screenings to try to eliminate a devastating diagnosis or prognosis.

Experience

Clay County would experience more individuals having their annual screenings done. There will be a decrease in the use of tobacco, vaping and alcohol. An increase in individuals eating more fiber and less fat within their diet. Increased use of sunscreen and limited time in direct sunlight.  Clay County residents will be more health conscious and more aware of cancer-causing agents. Fewer Clay County residents being diagnosed with cancer or caught in the early stages of diagnosis. Overall, Clay County residents will become healthier in all aspects of life.

What is it?

Breast and Cervical Cancer Control Program (BCCCP) was identified by Clay County Health Department as an action, that when combined with other actions, can have a reasonable chance of making a difference in the prevention and screening of cancer in our community. This is an ongoing program in our community. The current interventions have been effective the last few years. We were able to acquire more targets/money to be used towards screening individuals that are seen within our facility. As the year continues, we hope to continue to receive more money/targets to help reach as many individuals as we can.

The customers for the BCCCP program are those who have no insurance and very little income. By implementing the BCCCP program, Clay County residents are able to receive mammograms and pap smears along with any additional testing, if needed, free of cost. Not having to worry about cost of screenings, lifts a huge burden off an individual with low income and allows them to maintain physical exams. The BCCCP program aims to make a difference at the individual level. Implementation of this program takes place at the Clay County Health Department.

Partners

The partners for this BCCCP program include:

Updates

As of June 2023, Clay County Health Department is assuring BCCCP services through an alternative practice. Therefore, if any clients are in need of these services, they are being referred to Haywood County (Blue Ridge Health). 

What is it?

Promotion and referral to Quitline NC was identified by the Clay County Health Department as an action that, when combined with other actions, can have a reasonable chance of making a difference in lung cancer in our community. This is an ongoing program in our community. Clients that are seen within our clinic are asked about their tobacco status and if there is an interest in quitting. If the client is interested in quitting, the nurse will provide Quitline NC information and help council about the importance of quitting. Many clients are open to discuss it and take the information home with them, but never follow-up on contacting the company for help on quitting. I believe new interventions should be discussed to help improve the number of individuals that follow through.

The customers for the Quitline NC are those who use tobacco products and are willing to quit. Quitline NC aims to make a difference at the individual level. The main goal that Quitline NC is focused on is helping an individual overcome the nicotine addiction by providing counseling and suggesting strategies to place the focus on something different than the cravings. Implementation will take place at Clay County Health Department.

Partners

The partners for the Quitline NC include:

Updates

Quitline NC is a program that helps individuals receive counseling and techniques to stop smoking. Within our clinic, each patient is asked about their smoking status and asked if they desired to stop smoking. Clay County Health Department has had a total of 11 people who were willing to have our clinic fax a referral to the Quitline NC. Even though, many patients do not want to be referred at the time of their visit, we still provide them with the resources to the Quitline in hopes they will decide to call. Clay County Health Department is continuing to figure out a more appealing way to get individuals encouraged to quit and seek out the Quitline NC.

What is it?

Relay for Life- Festival of Hope was identified by the Elite Health team as an action, that when combined with other actions in our community, it has a reasonable chance of making a difference in cancer awareness. This is a new program in our community.

The customers for Relay for Life- Festival of Hope are the Clay County residents and surrounding areas. Relay for Life aims to make a difference at the individual level and the community level. Implementation will take place in Clay County Health Department. The main goal for Relay for Life- Festival of Hope is to bring awareness to cancer, promote our BCCCP program, and supply individuals with the tools and necessary resources if they feel they need to be screened.

Partners

The partners for Relay for Life include:

Updates

Relay for Life is an event that the Clay County Health Department hoped would bring awareness back to the community regarding cancer and the importance of early screenings. The Relay for Life event took place on May 20^th 2023.  Overall, we have raised 700.00 in funds to go towards American Cancer Society.

Snapshot

The 2022 State of the County Health (SOTCH) Report presents an update on the current health status of Clay County residents. The SOTCH provides health information that is intended to augment the 2021 Community Health Assessment (CHA) that is conducted every four years and includes a more comprehensive analysis of the overall health status of the county. The main priorities identified from the 2021 Community Health Assessment were:

1. Chronic Disease Control and Prevention
2. Prevention and Management of Acute Respiratory Infections
3. Prevention and Screening of Cancer

This report demonstrates progress made in the last year as it relates to these health priorities, recent health statistics, new initiatives and emerging issues that may impact the health status of residents in Clay County. The 2021 CHA and previous SOTCH reports may be found at the county library, the health department, or online at https://www.health.claync.us/community-health-assessment                              

(U.S Census Bureau, 2021 Quick Facts; N.C Institute of Medicine)

Progress on CHIPs

Progress on Community Health Improvement PLAn

Priority One: Chronic Disease Control and Prevention

Healthy Initiative-Clay County BeFit

The Clay County Health Department decided to create a program that provided information to the public through lunch and learns along with healthy lifestyle posts on social media. To better understand what our community would like to learn more about, Clay County Health Department decided to create a survey asking clients what they would like to learn about health wise. Unfortunately, the responses have been very minimal and the majority of individuals would prefer to not have an in-class environment but more of a virtual learning. Since the use of social media to educate individuals about healthier lifestyles, we have seen an increase in individuals being reached with this information.

Worksite Wellness

Clay County Health Department found an opportunity to write for a grant to help improve the lives of our county employees. With this grant, our hope was to bring in incentives to motivate individuals in becoming healthier. However, the grant that the Health Department was writing for was not granted to us. Even though, we have encountered this small bump in the road, we are still exploring other avenues to get this program started for a healthier future for our employees.

Community Health Project

The community health project was initiated due to a mini-grant being awarded to the Clay County Health Department. This grant was used to buy blood pressure monitors, incentive spirometers, pulse oximetry monitors, and blood glucose machines. Since this purchase, we have helped several individuals who could not afford these items on their own. We have seen an improvement with patients’ self-care. Patients are taking the initiative to be proactive in their care and learn the importance of proper monitoring when dealing with both acute and chronic conditions. Our goal is to continue to work with these individuals and hopefully see improvements overall within their health.

Priority Two: Prevention and Management of Acute Respiratory Infections

Immunization Program

Clay County Health Department offers an immunization program that encourages patients to receive vaccines to help eliminate vaccine-preventable diseases, especially those that can cause respiratory infections. Through promotions within our media outlets, Clay County Health Department is determined to bring awareness to vaccines and how they can be beneficial. In the year 2022 alone, we have given 434 Influenza vaccines, 75 Pneumonia vaccines, and 1,082 COVID-19 vaccines. Many of these vaccines were given through off-site outreach clinics and even in-home services.

Monoclonal Antibody Therapy Program

Monoclonal Antibody Therapy helps those individuals who are at a greater risk of being hospitalized with COVID-19 build their immune system up to fight off this infection. The program started in September 2021 and was completed in March 2022. During that time, we treated 344 individuals with Monoclonal Antibodies and only 8 reported hospitalizations post treatment. To our knowledge, there were no deaths involving those who were hospitalized after receiving the Monoclonal Antibody treatment. As the year continued and more research was discovered, it was determined that oral antiviral medications were the best practice for patients versus Monoclonal antibody treatment. Sadly, due to this change, Clay County Health Department decided to stop the program until Monoclonal Antibodies were needed again.  

Priority Three: Prevention and Screening of Cancer

Breast and Cervical Cancer Control Program          

Breast and Cervical Cancer Control Program helps screen or identify abnormalities within a patients breast tissue or cervix. This program is aimed to help those individuals who do not have insurance and has very little income. Within 2021-2022, Clay County Health Department has set up 59 individuals with breast and/or cervical screenings, and 9 of those individuals needed to have further testing to help rule out cancer. This current program will continue until June 2023.

Promotion and Referral to Quitline NC

Quitline NC is a program that helps individuals receive counseling and techniques to stop smoking. Within our clinic, each patient is asked about their smoking status and asked if they desired to stop smoking. Unfortunately, we have had only four individuals that requested to be referred to the Quitline NC. Clay County Health Department is continuing to figure out a more appealing way to get individuals encouraged to quit and seek out the Quitline NC.

Relay for Life-Festival of Hope

Relay for Life is an event that the Clay County Health Department hoped would bring awareness back to the community regarding cancer and the importance of early screenings. Overall, we have raised 646.97 in funds to go towards American Cancer Society and continue to find avenues to raise more money.

On December 3, 2022, Clay County Health Department had our very first kick-off for Relay for Life. At this event, we provided individuals with information on what Relay for Life involved and how to become a team member. This outreach helped share the excitement for this event and let them know when the main event would take place.  Monthly meetings are being held to monitor progress and brainstorm more ideas to make our festival of Hope a success.

Morbidity and Mortality Changes Since Last CHA

Morbidity and Mortality Changes

Current reports from the North Carolina State Center for Health Statistics continues to show that Clay County has high rates of chronic diseases, but are showing some mild improvements within the disease process. In 2016-2020, cancer had made a small improvement with 148 total deaths from 158 total deaths in 2015-2019. Unfortunately, in 2016-2020, diseases of the heart increased to 170 deaths from 163 deaths in 2015-2019.  We have also discovered that since COVID-19 erupted in 2020, the number of deaths related to respiratory illnesses has increase to 24 total deaths with 8 of those being COVID-19 related. To show a comparison, Table 1 is the most recent statistical data, and Table 2 is the statistical data that the Community Health Assessment was based off of in 2021. Even though these numbers can be discouraging, Clay County Health Department is determined to continue to improve these numbers and continue to increase our life expectancy. Our progress towards these community improvement activities can be found within this document. One main challenge noted, is making sure that residents understand the importance of assessing their own personal choices and behaviors, and how their decisions may impact their health outcomes.

Table 1 - Leading Causes of Death 2016-2020.

Table 2 - Leading Causes of Death 2015-2019.

 North Carolina State Center for Health Statistics (NC SCHS). (2020). Causes of Death. [Data tables]. Available from https://schs.dph.ncdhhs.gov/data/

Emerging Issues Since Last CHA

Emerging Issues since last community health assessment

• COVID-19 testing, antivirals, and vaccinations have become a new normal within the health department.
• An emerging issue with teenagers vaping within the local school system.
• Mental Health concerns are an ongoing issue within the community and has gotten worse since the start of the pandemic.
• Social determinates of health continue to be a challenge for our residents along with the lack of access to healthcare.
• In 2022, Influenza continues to spread rapidly with more patients ending up at the hospital.
• Within the last six months, Clay County Health Department has seen 5-10 initial Herpes cases throughout the community.
• Within the last year, Clay County Health Department has treated 5-10 cases of Syphilis from individuals within our community or those residing surrounding counties.

New/Paused/Discontinued Initiatives Since Last CHA

New/ Paused/ Discontinued initiatives since last community health assessment

• Clay County Health Department has decided to discontinue the Monoclonal Antibody Therapy due to new research and recommendations involving better treatment for COVID-19.
• The worksite wellness program has been paused until a grant is found to help support program implementation.

Snapshot

The 2023 State of the County Health (SOTCH) Report presents an update on the current health status of Clay County residents. The SOTCH provides health information that is intended to augment the 2021 Community Health Assessment (CHA) that is conducted every four years and includes a more comprehensive analysis of the overall health status of the county. The main priorities identified from the 2021 Community Health Assessment were:

1. Chronic Disease Control and Prevention
2. Prevention and Management of Acute Respiratory Infections
3. Prevention and Screening of Cancer

This report demonstrates progress made in the last year as it relates to these health priorities, recent health statistics, new initiatives and emerging issues that may impact the health status of residents in Clay County. The 2021 CHA and previous SOTCH reports may be found at the county library, the health department, or online at https://www.health.claync.us/community-health-assessment.

Clay County, nORTH cAROLINA

(U.S Census Bureau, 2023 Quick Facts; N.C Institute of Medicine)

Progress on CHIPs

Progress on Community Health Improvement PLAN

Priority One: Chronic Disease Control and Prevention

Healthy Initiative-Clay County BeFit

Unfortunately, the healthy lifestyle in-class environment was not able to be successfully completed. However, we have received several responses to our educational information that is shared through our social media accounts. We will continue to work on different avenues to engage our community towards a healthier lifestyle.

In the meantime, the Clay County Health Department decided to have our Healthcare Providers become educated through lunch and learns regarding new weight loss medications available.

Worksite Wellness

Clay County Health Department was unable to receive grant money to implement the worksite wellness program for our county employees, but we were able to help another facility with their worksite program. Clay County Health Department teamed up with the Clay County School System to help them implement a wellness event for all teachers. During our event, we performed blood draws (CBC, CMP, LIPID, HgbA1C, Thyroid Panel, and Uric Acid), hearing screenings, blood pressure checks, vision screenings, and weight/ BMI checks. In total, we were able to perform 20 blood draws and several other screenings.  Since the wellness event was a big success, Clay County Health Department plans to continue to work with Clay County School System again this year.

Community Health Project

The community health project was initiated due to a mini-grant being awarded to the Clay County Health Department through the WNC Healthy Impact partnership. This grant was used to buy blood pressure monitors, incentive spirometers, pulse oximetry monitors, and blood glucose machines. Since this purchase, we have helped several individuals who could not afford these items on their own.  We have seen an improvement with their willingness to do self-care. Since the beginning of the Community Health Project, Clay County Health Department has given out 63 blood pressure cuffs, 33 incentive spirometers, 18 glucose monitors, and 10 pulse oximeters. Unfortunately, our supplies of blood pressure monitors and incentive spirometers have come to an end. However, our goal is to find another mini-grant to help purchase more blood pressure monitors and incentive spirometers since it made a big impact on managing these chronic and acute conditions.

Priority Two: Prevention and Management of Acute Respiratory Infections

Immunization Program

Clay County Health Department offers an immunization program that encourages patients to receive vaccines to help eliminate vaccine-preventable diseases, especially those that can cause respiratory infections. Through promotions within our media outlets, Clay County Health Department is determined to bring awareness to vaccines and how they can be beneficial. In the year 2023 alone, we have given 313 Influenza vaccines, 93 Pneumonia vaccines, and 212 COVID-19 vaccines. Many of these vaccines were given through off-site outreach clinics and even in-home services. Starting in December 2023, Clay County Health Department will be administering RSV vaccines (Abrysvo) to those who are 60 years of age or who are currently pregnant within their 32 to 36 weeks gestational age. Administration will be provided seasonally with a one-time dose of the vaccine.

 Monoclonal Antibody Therapy Program

The monoclonal antibody therapy was completed in March 2022 and is no longer being done at Clay County Health Department. However, Clay County Health Department is still working with their patients to prescribe antiviral therapy to those who become positive for COVID-19 and would like to receive the antiviral treatment.

Priority Three: Prevention and Screening of Cancer

Breast and Cervical Cancer Control (BCCCP) Program

Breast and Cervical Cancer Control Program helps screen or identify abnormalities within a patient’s breast tissue or cervix. This program is aimed to help those individuals who do not have insurance and has very little income. Within 2022-2023, Clay County Health Department has set up 46 individuals with breast and/or cervical screenings, and 9 of those individuals needed to have further testing to help rule out cancer. Since June 2023, Clay County Health Department is assuring BCCCP services through an alternative practice. Therefore, if any clients are in need of these services, they are being referred to Haywood County (Blue Ridge Health).

Promotion and Referral to Quitline NC

Quitline NC is a program that helps individuals receive counseling and techniques to stop smoking. Within our clinic, each patient is asked about their smoking status and asked if they desired to stop smoking. Clay County Health Department has had a total of 11 people who were willing to have our clinic fax a referral to the Quitline NC. Even though, many patients do not want to be referred at the time of their visit, we still provide them with the resources to the Quitline in hopes they will decide to call. Clay County Health Department is continuing to figure out a more appealing way to get individuals encouraged to quit and seek out the Quitline NC.

Relay for Life- Festival of Hope

Relay for Life is an event that the Clay County Health Department hoped would bring awareness back to the community regarding cancer and the importance of early screenings. The Relay for Life event took place on May 20^th 2023.  Overall, we have raised 700.00 in funds to go towards American Cancer Society.

Morbidity and Mortality Changes Since Last CHA

Morbidity and Mortality Changes

Current reports from the North Carolina State Center for Health Statistics shows that Clay County has high rates of chronic diseases that have increased over the past few years. In 2017-2021, cancer had increased with 151 total deaths from 148 total deaths in 2016-2020. In 2017-2021, diseases of the heart increased to 180 deaths from 170 deaths in 2016-2020.  We have also discovered that since COVID-19 erupted in 2020, the number of deaths related to respiratory illnesses has increase to 67 total deaths with 51 of those being COVID-19 related. To show a comparison, Table 1 is the most recent statistical data, and Table 2 is the statistical data that the State of the County Health Report was based off of in 2022. Even though these numbers can be discouraging, Clay County Health Department is determined to continue to improve these numbers and continue to increase our life expectancy. Our progress towards these community improvement activities can be found within this document. One main challenge noted, is making sure that residents understand the importance of assessing their own personal choices and behaviors, and how their decisions may impact their health outcomes.

Table 1 - Leading Causes of Death 2017-2021.

 Table 2 - Leading Causes of Death 2016-2020.

Emerging Issues Since Last CHA

Emerging Issues since last community health assessment

• An emerging issue with teenagers vaping within the local school system.
• Mental Health continues to be a concern as there are limited providers/resources available.
• Social determinates of health continue to be a challenge for our residents along with the lack of access to healthcare.
• Increase interest in new weight loss medication (Wegovy) but lack of funding for patients to have access to the medication.
• Homeless population has increased.
• Workforce recruitment and retention.
• Substance use disorder continues to be a concern.
• Affordable housing
• Childcare (limited related to closing of southwestern child development centers).

New/Paused/Discontinued Initiatives Since Last CHA

New/ Paused/ Discontinued initiatives since last community health assessment

• Clay County Health Department has decided to discontinue the BCCCP program as of June 2023.
• Relay for Life was completed on March 20^th 2023. The year 2024 has been placed on pause for any future plans of another Relay for Life.
• The administration of the new RSV vaccine to those individuals who are 60 years of age or are 32-36 weeks pregnant started in December 2023.
• Clay County Health Department will continue to work closely with Clay County School System with their staff wellness project.
• Smoky Mountain Pregnancy Center offers services to pregnant woman here at Clay County Health Department with their mobile unit.
• Community Paramedic Increasing opportunities for telehealth.