Executive Summary

Macon County 2021 Community Health Assessment Executive Summary

Community Results Statement

Macon County’s health matters.

Leadership and Partnership for the Community Health Assessment Process

During 2021-2022, Macon County Public Health, Angel Medical Center, and Highlands-Cashiers Hospital have facilitated the development of this comprehensive Community Health Assessment by engaging multiple organizations and community members; by outlining the need for certain decisions and interventions; and by creating a positive environment for discussion and change.

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

WNC Health Network provides local hospitals and public health agencies with tools and support to collect, visualize, and respond to complex community health data through Results-Based Accountability™ (RBA). RBA is a disciplined, common sense approach to thinking and acting with a focus on how people, agencies, and communities are better off for our efforts.

Collaborative Process Summary

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

Locally, the CHA team guides our process. This team reviews the data and provides input into health issues of concern. Data summaries for the identified health issues are then brought forth to the community, where health priorities are confirmed. 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 Community Health Assessment Coordinator with support from WNC Healthy Impact compiled a list of data filters to be used when viewing the data.  While reviewing the data health indicators were scored and ranked based on size and severity while taking into consideration any disparities that might be noted. It was very apparent that the top ten health indicators could be grouped into health issues of concern. Once the top issues of concern were determined a data summary document was created for each. 

The Community Health Assessment (CHA) Team then reviewed each data summary independently and as a group virtually to fill in any information gaps.  The CHA team was also instrumental in helping to shape the community prioritization meeting.

Community members met in May 2022.  During this time background information regarding types of data collected, the review process, the Community Health Assessment Teams role was provided.  Community members were able to review each data summary for the health issues of concern and ask questions or provide input.  Members then ranked the health issues based on impact and feasibility.  The group then discussed benefits and downsides of combining issues into the health priorities, keeping capacity to address each issue in mind.  Then members voted on how to structure the health priorities for the 2021 assessment.

For more details on this process see Chapter 1 – Community Health Assessment Process.

Health Priorities

Health Priority 1: Access to Care

Health Priority 2: Affordable Housing

Health Priority 3: Substance Abuse

Health Priority 4: Obesity

Next Steps

CHA leadership and partners will work with community members to better understand the story and root causes behind our priority health issues. New and existing partners will be engaged to help to do better on these issues.

We will identify what works to do better through research on evidence-based strategies, observing what is working in other communities, and engaging priority populations. Strategies will be selected, as well as performance measures to ensure that residents are better off because of them.

The Community Health Improvement plan will be developed as an electronic scorecard and published so that teams and the community at large can monitor progress.

Priorities

Health Priorities

Health Priority 1: Access to Care

Health Priority 2: Affordable Housing

Health Priority 3: Substance Abuse

Health Priority 4: Obesity

Importance

Why it Matters?

Access to primary care can encourage preventive health care and improve health outcomes. Many rural areas of North Carolina lack adequate access to medical professionals, including those providing primary care.

Receipt of early prenatal care is a protective factor for many negative health outcomes for mothers and their babies. In North Carolina, only 68% of pregnant women receive care within the first trimester. Those who do not receive care are disproportionately women of color and teenage mothers.

The Numbers

What Does This Mean for Macon?

• The percent of adults who were unable to get needed medical care at some point in the past year slightly increased to 17% in 2021.
• The percent of adults without healthcare insurance slightly decreased to 23.2% in 2021.
• Approximately 37% of adults chose to go without needed care during the pandemic.
• This health issue is related to the HNC 2030 desired results and indicators for increase the primary care workforce.

What’s Helping?

• County Health Department
• Local Healthcare Facilities
• Free-clinics
• VA Clinic
• Private practices
• Telehealth

What’s Hurting?

• Transportation
• Education
• Seasonal Residents
• High cost of living
• COVID-19
• Lack of Medicaid Expansion
• Difficult Insurance Requirements
• Aging providers
• Housing costs
• Lack of urgent cares
• Lack of comprehensive care (physical and mental health
• Lack of child/adolescent care
• Labor shortage

Who’s Most Impacted?

• Older adults
• Veterans
• Low income, uninsured and/or underinsured
• Hispanic/Latinx population
• Seasonal residents

What Else Do We Know?

• Access to care typically begins with affordable and comprehensive health insurance.
• Geographic proximity to health care providers is key.
• Quality care means the provision of safe, effective treatment in a timely manner.

What Works to Do Better?

• Examples identified by CHA Prioritization attendees:
• Telemedicine (New NC law requires insurance to cover)
• Remote clinic locations
• Programs that target “whole health’ approach and pair both physical and mental health

What Is It?

Promote the recruitment and retention of additional primary care physicians and dental practitioners serving Macon County was identified by Macon County Public Health as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in access to health care in our community. This is an ongoing program in our community.

Current standards/rates of pay have not been effective in attracting medical professionals to rural areas within Macon County. A new hospital has been completed. Hopefully this, plus increased rates of pay, additional benefits, and better advertising will help in attracting talent to our area.

The customers for this program are local medical practices, and the patients they serve. This recruitment program aims to make a difference at the organizational change level. Implementation will take place in local medical offices.

In turn, once medical staff in the area increases, the community care clinics within Macon County will be better able to serve the uninsured and underinsured. Non-Profit clinics in rural areas tend to use local doctors who are willing to provide services at reduced cost. More doctors equals more availablity to more patients.

Partners

The partners for this program include:

Progress in 2022

• Established data sharing with Community Care Clinic of Franklin, Community Care Clinic of Highlands, and Vecinos Health Hub to share monthly visit data to guage patient access to care for low income patients.
• Established monthly data measure to track Primary Care utilization at Macon County Public Health to guage clinic utilization for low income patients. 

Progress in 2023

• Established School Based Telehealth Program in Macon County Schools.
  • In partnership with Health-e-School, Center for Rural Health Initiative, Macon County Public Health and Macon County Schools established the School-Based Health Center. This program provides access to a licensed medical provider for health care needs directly from each school within the county shools. 
  • Telehealth appointmenst are available each school day, Monday through Friday.

  • Our goal is that ALL children and their parents are connected with a primary care medical home. This program is available to supplement the health care services of students and school staff in Macon County.

  • When appointments with primary care may not be possible; the school-based health program provides access to evaluation by a licensed medical provider during the school day.

  • The school-based health center provides an option to have a child evaluated before leaving school. This saves time from parents having to leaving work. The school nurse determines the student needs to be further evaluated and schedules an appointment with SBHC. 

• ​​​​​​​North Carolina Medicaid Expansion

What Is It?

The Community Care Clinics of Macon County help fill the gaps in healthcare services for low income, uninsured/underinsured Macon County residents. The Community Care Clinic of Highlands-Cashiers, Community Care Clinic of Franklin, and Vecinos help low income residents recieve medical services that they would likely do without without their support. Macon County/Macon County Public Health provides direct support to the Community Care Clinics of Franklin by providing facilities to operate at no cost and in collaboration with LabCorp to provide free laboratory services for CCC of Franklin patients. Macon County/Macon County Public Health provices direct support to the Community Care Clinic of Highlands-Cashiers by providing facilities to operate at no cost. 

Partners

The partners for this [insert program type] include:

What Is It?

Macon County’s School-based Health Center’s primary mission is to provide students and staff of Macon County Schools a convenient and affordable option to access health care. These services will be provided through a telehealth model. This program is designed to serve Macon County’s most vulnerable populations: Low-Income, uninsured and/or underinsured, Hispanics/Latinx population, and those without transportation. 

Eligility: Must be enrolled in Macon County Schools, and enrolled in the school based health center. Adult (School Staff): Must be employed by Macon County Schools, and enrolled in the school based health center.

Finance: Child: Medicaid or private insurance plans will be billed, if available. If non-insured, fees will be based on NC Child Health Program Financial Guidelines. ​​​​​​​Sliding fee scales are used for children whose gross household income is between 101% and 250% of the federal poverty level per current NCDPH sliding fee scales. Adult: Medicaid or private insurance plans will be billed, if available. If non-insured a flat fee, determined by MCPH’s Governing Boards, will be billed to the patient. Currently, the rate for adults is $30.

This program helps address Access to Care by not requiring parents to miss work time to have their school aged children seen by a medical professional. This program allows the school aged children be seen by a medical professional without the need to secure additional transportation. Macon County Public Health added an additional Spanish Interpreter to assist with support to this program and to augment current interpreter services at the Health Department. 

This program is currently in the pilot stage and will be fully implemented at the start of the 23-24 School Year. ​​​​​​​

Partners

The partners for this [insert program type] include:

What Is It?

Macon County Public Health provides primary care services to eligible full time Macon County Residents who do not have a primary care doctor and are between the ages of 21-64 years. MCPH will not accept the following for primary care services: chronic pain management, methadone physicals, disability claims. Patients must complete a medical questionnaire, which is reviewed by the MCPH medical provider; patients can be accepted or denied primary care services based on the medical questionnaire and whether or not Macon County Public Health’s physician can provide the level of care the patient requires.

This program is intended to help low-income, uninsured and/or underinsured residents,  and Hispanics/Latinx populations of Macon County without a primary care provider. 

1. Eligibility:

1. Patient must be a Macon County resident
2. Patient must be between the ages of 21-64 years.

3. Finance:

1. Patients with Medicare, Medicaid, or private insurance, their plans will be billed for services.
2. Patients with insurance are responsible for insurance co-payments or remaining balances after insurance payment.
3. Self-Pay patients are responsible for remaining balances after sliding fee scale has been applied to their services.

D. Sliding Fee:

1. A sliding fee scale is applied to patients without insurance (self-pay) based on provided income, with a maximum discount of 60%.

Partners

The partners for this [insert program type] include:

Importance

Why it Matters?

Exercise is linked to positive physical, psychological, and social outcomes. Communities that create spaces for physical activity have healthier
people with decreased risks of obesity, heart disease, and other chronic conditions that increase morbidity and mortality.

Food is a basic building block of health that affects weight, blood pressure, and countless other health outcomes. Access to healthy
foods is strongly influenced by where someone lives. People in rural or underserved areas of North Carolina are particularly affected by lack of
access to stores where they can purchase ingredients for healthy meal.

Obesity continues to be a concern in North Carolina. Sugar-sweetened beverages (SSB) are the leading source of calories and added sugars in
the American diet.

The Numbers

What Does This Mean for Macon?

• 28.9% of individuals meeting current physical activity recommendations in 2021 (increase).
• Regional data analysis indicates that low income, people who are unable to work and people who live in rural areas were more likely to be obese.
• 66% of key informants selected obesity as a major problem in the community.
• This health issue is related to the HNC 2030 desired results and indicators for increase physical activity and reduce overweight and obesity.

What’s Helping?

• Free physical activities
• Mountain Wise programs
• Minority Diabetes Prevention Programs
• Double Up Food Bucks
• Worksite Wellness programs

What’s Hurting?

• Health habits
• Lack of education and value on cooking and gardening
• Fast food is easy/convenient
• Cost of healthy foods
• Lack of mental health services

Who’s Most Impacted?

• Hispanic/Latinx population
• Children, youth and adolescents
• Low income, uninsured and/or underinsured

What Else Do We Know?

• People who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions.
• Obesity and its associated health problems have a significant economic impact on the US health care system.

What Works to Do Better?

• Examples of Evidence-based Interventions
  • School-based nutrition and physical activity programs
  • Worksite obesity prevention programs
  • Community-wide physical activity campaigns

Progress in 2023

• Almost all Macon County Schools are providing free breakfast and lunch to their students. Frankling High School did not qualify for the grant.
• The Macon/Swain Produce R/X program was developed with the help of community partners and a Duke Endowment. Fifty applicants are currently receiving weekly food boxes to improve healthy eating habits. This program officially began in January 2024 and will last 26 weeks.
• The Macon Food Council was developed in late 2022 in order to study food insecurity within WNC. It was determined that increasing access to healthy foods via SNAP/EBT acceptance was the best way to begin to address food insecurity. A new farmers market for Macon County that will accept SNAP/EBT is set to begin in May 2024.

What Is It?

Chronic Disease Management and other educational classes were identified by MCPH as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in decreasing the high level of Obesity in our community, and subsequently, other health issues that result from being overweight. This is a new program in our community. 

These classes can be held all over the community to accommodate those with disabilities. Currently, our plan is to begin holding these classes in the local library for ease of access and scheduling.

Partners

The partners for this program include:

Progress in 2022

• MountainWise Diabetes Prevention Program
• Living a Healthy Life with Chronic Conditions classes will begin in June 2023. The first class will be an 6 week workshop (meeting once per week for 2 hours) and will be limited to 10 students.
• This class was chosen due to the high rate of people in Macon county living with a chronic condition, which can limit one's activity and increase chances of obesity. Our goal is to educate people on how to manage their chronic conditions and increase their health and wellness.

Progress in 2023

• Living a Healthy Life with Chronic Conditions was a 6 week workshop that met once a week for 2 hours. A commitment for the entire class was required. Only two student signed up for the course and only one actually attended every class. Follow-up with the one student was positive. She continues to use the skills taught in the class to control her chronic conditions at home. Future plans consist of breaking up the course into several mini-workshops offered on different dates and times to encourage better attendance.
• Several health fairs were conducted throughout Macon County inform people of available health services. Lack of information appears to be a factor in rural areas for those who do not have regular health care.
• A permanent display of health related informational brochures was added to the Macon County Public Library. Brochures are changed out monthly to provide a wide variety of information to the public.
• MCPH conducted several events aimed at encouraging better health for families. This included a "Duck Hunt", the Healthy LIttle Learners program (which is still ongoing), and the Mighty Writers Storybook Challenge. All of these events were well attended and we received positive feedback from the community.
• Medicaid expansion was finally approved and began late last year. 
• MCPH and Mountainwise will be participating in a health fair at the Macon Campus of Southwestern Community College in March.
• MCPH and Mountainwise will be participating in a Good Neighbor Clinic in April. This event is sponsored by the Seventh Day Adventist Church.

Importance

Substance misuse and our related results are aligned with the following Healthy NC 2030 Indicators:

• Reduce the suicide rate (per 100,000 population)
• Drug overdose/poisoning deaths

Why it Matters?

As in other states, North Carolina has experienced a sharp increase in the number of drug overdose deaths over the last decade, largely due to the
opioid epidemic. Substance Use Disorder has devastating impacts on the life of the people who experience it, their families, and their communities.

Excessive drinking, a major cause of morbidity and mortality across the United States, has significant impacts on individuals, families, communities,
and state and local economies. Alcohol is the third leading cause of preventable deaths in North Carolina.

The Numbers

What Does This Mean for Macon?

• 9% of child abuse and neglect cases were substantiated in FY19-20.
• The prevalence of individuals whose life has been negatively affected by substance abuse decreased to 50.1% in 2021.
• The rate of hospital discharges with infant drug withdrawal diagnosis decreased from 31.6 to 28.1 per 1000 live births in 2015-2019.
• 66% of key informants selected substance misuse as a major problem in the community.
• This health issue is related to the HNC 2030 desired results and indicators for decrease overdose deaths. The rate of drug overdose deaths was 18.3 in 2019 and is close to meeting the 2030 target of 18.

What’s Helping?

• No wrong door approaches
• Peer support
• Opioid Settlement Funds
• Harm reduction intervention

​​​​​​What’s Hurting?

• Unintended consequences of restriction on prescribing Rx opioids (people turning to illicit substances.
• Lack of mental health resources
• Lack of long term programs
• Access to comprehensive healthcare
• Stigma

Who’s Most Impacted?

• Veterans
• People experiencing mental health issues
• People experiencing chronic pain

What Else Do We Know?

• One in 14 Americans reports experiencing a substance use disorder
• Not one single driving factor that leads to addiction.
• Some people use drugs to cope with stress, trauma, or to help with mental health issues.
• Some may develop opioid use disorder after misusing opioids that were prescribed by doctors.

What Works to Do Better?

• Examples of Evidence-based Interventions
  • Promoting alternative to prescription pain management through advocacy and patient education
  • Public awareness campaign
  • Screening for substance use disorder
• Examples identified by CHA Prioritization attendees:
  • Peer Support (peer support for veterans)
  • Long-term rehabilitation facilities

What Is It?

Supporting aligned activities of community partners and systems was identified by a team of community stakeholders as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in substance use and mental health in our community. This is an ongoing program in our community, building on work that is already happening around substance use and mental health.

The priority population/customers for this strategy are community partners and those most affected. This aims to make a difference at individual and organizational levels. Implementation will take place within community systems whose efforts are concentrated around substance use and mental health.

This strategy will address health disparities by addressing issues of access to available services within the community by connecting community partners to identify aligned activities and to avoid duplication of work, while expanding the network of organizations working together to solve this public health issue.  

Partners

The partners for this program include:

Progress in 2022

• NARCAN is regular being administered throughout the county and helping to save lives.
• Coordination between organizations dealing with behavioral health and substance abuse issues continued to improve.
• Established NARCAN and Overdose EMS Response data measures with Macon County Emergency Management Services to help guage the substance abuse rates in Macon County.

Progress in 2023

• Active participant in the WNC Health Network View From Here Campaign to address the stigma and provide educational support and information about harm reduction, using Vaya's Health Crisis Line and WNCAP as supportive resources. The campaign focused targeted ads and facebook posts on Mental Health, Substance Misuse, and Healthy Eating/Active Living.
  • Substance abuse ads viewed by Macon County Residents times:
    • English- 25,216
    • Spanish- 4,563
• Macon County Behavior Task Force continues to look for transitional housing options for post treatment released patients
  • Old Angel Medical Center
  • Tiny Home Communities

What Is It?

View From Here WNC is the product of a 19 county collaboration spreading from Cherokee to McDowell, including the Eastern Band of Cherokee Indians and community based organization, UNETE. This umbrella social media campaign focuses on improving the lives of WNC residents by addressing the top three shared health priorities in our region, Substance Use, Mental Health, Healthy Eating/ Active Living as well as COVID/Flu Vaccinations.

What Is It?

Harm reduction is an evolving set of practical strategies to meet people where they are in their behaviors to promote safer options. This approach can reduce the risks that may be involved with the behavior and supports healthier practices more long-term.

For overdose prevention, harm reduction recognizes a range of drug use practices and promotes ways for people to manage their drug use with a variety of support options. Syringe services programs, community-based naloxone distribution, and drug-checking are all harm reduction techniques that reduce the risks associated with drug use. Harm reduction is also a philosophy that people who use drugs deserve to protect themselves and their loved ones, regardless of whether they seek additional health services.

Naloxone Access

A standing order is a medical order that authorizes the dispensing or distribution of a medication, like naloxone or the flu vaccine, to any person who meets criteria designated by the prescriber. North Carolina’s statewide standing order for naloxone, signed by the State Health Director, authorizes any pharmacist practicing in the state of North Carolina and licensed by the North Carolina Board of Pharmacy to dispense naloxone to any person who meets set criteria. These criteria include:

• Being at risk of opiate-related overdose due to medical conditions or history;
• Being the friend or family of someone at risk of opiate-related overdose, thus being able to respond in case of overdose; and
• Being in the position to assist another person at risk of opiate-related overdose.

Naloxone is available under the statewide standing order, without a prescription, at the majority of retail pharmacies in North Carolina and is covered under most insurance policies. First signed in June 2016, North Carolina is the third state in the country to adopt a statewide standing order for naloxone. 

Macon County Emergency Services, along with Macon County Sheriff Office, Franklin Police Department, and Highlands Police Department equip their officers with Narcan to aid in responding to drun overdoses. 

Partners

The partners for this [insert program type] include:

What Is It?

Harm reduction is an evolving set of practical strategies to meet people where they are in their behaviors to promote safer options. This approach can reduce the risks that may be involved with the behavior and supports healthier practices more long-term.

For overdose prevention, harm reduction recognizes a range of drug use practices and promotes ways for people to manage their drug use with a variety of support options. Syringe services programs, community-based naloxone distribution, and drug-checking are all harm reduction techniques that reduce the risks associated with drug use. Harm reduction is also a philosophy that people who use drugs deserve to protect themselves and their loved ones, regardless of whether they seek additional health services.

Naloxone Access

A standing order is a medical order that authorizes the dispensing or distribution of a medication, like naloxone or the flu vaccine, to any person who meets criteria designated by the prescriber. North Carolina’s statewide standing order for naloxone, signed by the State Health Director, authorizes any pharmacist practicing in the state of North Carolina and licensed by the North Carolina Board of Pharmacy to dispense naloxone to any person who meets set criteria. These criteria include:

• Being at risk of opiate-related overdose due to medical conditions or history;
• Being the friend or family of someone at risk of opiate-related overdose, thus being able to respond in case of overdose; and
• Being in the position to assist another person at risk of opiate-related overdose.

Naloxone is available under the statewide standing order, without a prescription, at the majority of retail pharmacies in North Carolina and is covered under most insurance policies. First signed in June 2016, North Carolina is the third state in the country to adopt a statewide standing order for naloxone. 

Macon County Public Health, Western North Carolina Aids Project, No Wrong Door assist in the distribution of Narcan/naloxone kits in Macon County. 

Partners

The partners for this [insert program type] include:

Importance

Why it Matters?

People who live in homes that cost a large portion of their income, or where there is overcrowding or poor maintenance, are exposed to a variety of health risk factors. In many areas of North Carolina, there are insufficient affordable, quality housing options for low-income people and their families.

Without access to an affordable, stable housing environment, other issues such as substance abuse, mental health and healthy eating get put on the back burner. The physiological needs of proper housing/shelter must be met before behavior change in higher health needs can occur.

The Numbers

What Does This Mean for Macon?

• 37% of rental units were spending >30% of their household income on housing and 14.3% were spending >50% of their household income on housing.
• 32.4% of adults were worried or stressed about paying rent or mortgage in the past year.
• 4.6% of adults lived on the street, in a care, or in a temporary shelter in the past three years.
• Nearly one in five adults (18%) had a time in the past year when their home was without electricity, water or heating.
• The health issue is related to the HNC 2030 desired results and indicators for improved housing quality.

What’s Helping?

• Subsidized housing/apartment complexes

What’s Hurting?

• High cost of housing
• Lack of affordable housing
• Lack of housing in general
• Long commutes from communities with more affordable housing
• Impact of short-term rentals
• Increased building costs

Who’s Most Impacted?

• Low income
• People experiencing homelessness
• Veteran and veterans with disabilities
• People who access housing through section 8
• People with disabilities

What Else Do We Know?

• Housing quality is an important determinant of overall health and well-being.
• Studies show that there is a direct link between housing quality and physical and mental health.

​​​​​​​What Works to Do Better?

• Examples identified by CHA Prioritization attendees:
  • Government role in affordable housing.

What Is It?

Creating and participating in a committee was identified by the International Friendship Center of Highlands, NC as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in obtaining affordable housing in our community. This is a new program in our community.

The customers for this program are local non-profit organizations that deal with housing issues on a regular basis, and the committee aims to make a difference at the local level. Meetings began in December 2022. MCPH joined for the first time on February 3, 2023.

By increasing affordable housing in Macon County, more people will choose to live and work in the area. Plus, stable affordable housing allows individuals with health isssues to address those issues without worrying whether or not they will have a place to live.

Partners

The partners for this committee include:

Progress in 2022

• Macon County Public Health is not currently actively addressing this issue because it is beyond our area of influence, but we are closely monitoring the progress in addressing this issues by our community partners. 

Progress on CHIPS

Please see the progress on CHIP for 2022 note tabs listed under each program by clicking the links below.

Access to Care

•   Promote recruitment and retention of additional medical personnel

Obesity

•   Chronic Disease Management and other health education classes within Macon County

Substance Abuse

•   Supporting Aligned Activities of Community Partners and Systems

Affordable Housing

•   Committee to Address Affordable Housing Issues

Significant/Notable Changes In Morbitity and Mortality

There have been no significant morbidity and mortality changes in our community.

• RWJF County Health Rankings 2022 

Emerging Changes Impacting Health

These are the new or emerging issues in our community in 2022 that were not identified as priorities in our CHA.

• Cost of healthy food has increased with inflation.

• Increase in property tax assessments at the beginning of 2023, which will make it even more difficult for new buyers to purchase homes and current owners to keep their homes.

• Change in county leadership, transferring the lead on substance abuse and mental health related issues from government to the private sector. 

New/Paused/Discontinued Initiatives or Activities

The following are new initiatives or changes in our community in 2022:

• Mental Health Task Force rebranded as Behavioral Health Task Force to help reduce potential stigma. Leadership of Task Force transitioned from government to the private sector. 

• Grant received from the Duke Endowment to help with better access to healthy foods within the county.

• Amazon announced the opening of a distribution center within the county, which will help with unemployment.

Progress on CHIPS

Please see the progress on CHIP for 2022 and 2023 note tabs listed under each program by clicking the links below.

Access to Care

•   Promote recruitment and retention of additional medical personnel
  •   MCPH Telehealth Visits
  •  Number of Primary Care Visits at MCPH 
  •  Vescinos Mental Health Visits for Macon County Residents
  •  Vescinos OPV Provided to Macon County Residents
  •  CCC Franklin OPV
  •  CCC Highlands OPV

Obesity

•   Chronic Disease Management and other health education classes within Macon County

Substance Abuse

•   Supporting Aligned Activities of Community Partners and Systems
  •  View From Here - Macon County
  •  Narcan on EMS Vehicles
    • Illicit Drug OD EMS Response 
    • Prescription Drug OD EMS Response
    • Number of Overdoses EMS Responded
    • Number of Overdoses Requiring Transport to Hospital
  •  Narcan Distribution Program
    • NARCAN Administered by Non-EMS

Affordable Housing

•   Committee to Address Affordable Housing Issues

Significant/Notable Changes In Morbitity and Mortality

No significant changes in morbitity and mortality in our community.

• RWJF County Health Rankings 2023

Emerging Changes Impacting Health

These are the new or emerging issues in our community in 2023 that were not identified as priorities in our CHA.

• Cost of healthy food continues to increase with inflation.

• Increase in property tax assessments at the beginning of 2023, has made it even more difficult for new buyers to purchase homes and current owners to keep their homes. Home prices have skyrocketed and new building has not kept up with demand.

• Pandemic and Post Pandemic urban to rural migration has caused housing costs to increase for home purchase and rentals. Many homes have been converted to short-term rentals, decreasing housing availablity for local residents. 

• Increased housing costs have decreased available family income for food, utilites and medical care.

• Increase in food insecutity amoung seniors on fixed income due to inflation. 

New/Paused/Discontinued Initiatives or Activities

The following are new initiatives or changes in our community in 2023:

• The first installment of Opiod Settlement Funds was received, but no clear direction has been established on what will be done with the money.

• Grant received from the Duke Endowment was used to establish a produce perscription program for food insecure familie in Macon and Swain Counties. 

• A new farmers market that will accept SNAP and EBT benefits is set to begin in May 2024. This project is a collaborative effort between MountainWise, Macon County Public Health and The Town of Franklin. 

• NC Medicaid Expansion has increased the number of people with health insurance, but many providers are not currently seeing new patients or accepting Medicaid.