HNC 2030 Scorecard: Gaston County 2021-2024

Executive Summary

Introduction & Vision Statement

Gaston County, NC - The Gaston County Community Health Assessment (CHA) findings have been released and highlight the community's top health concerns. The CHA is a collaborative effort between the Gaston County Department of Health & Human Services (DHHS) and CaroMont Regional Medical Center and provides a comprehensive review of the demographic, social, and economic factors influencing the health of Gaston County citizens.  The report presents the notable health outcomes in Gaston County, and includes a survey of over 1,400 individuals who provide their individual experiences and opinions.

When the full report had been compiled, DHHS presented the data to leadership teams from numerous governmental, nonprofit and neighborhood organizations in the county. These community leaders reviewed the data and voted on the priority areas to be addressed in the Community Health Improvement Plan (CHIP). The priority areas selected are:

• Access to Healthcare-Neighborhood Initiative 
• Infant and Maternal Health 
• Substance Use and Misuse 

Leadership

The CHA process was facilitated by public health staff. Staff contributed to the design of the survey as well as provided critical input when determining priorities.

• Steve Eaton, DHHS Director
• Brittain Kenney, Public Health Director
• Carrie Meier, Community Health Education Administrator
• Ellen Wright, Communicable Disease Coordinator
• Cheri Singleton, Community and Support Services Nursing Administrator
• Jacob Smith, CDC Associate
• Diana Willman, Latinx Outreach Coordinator
• Krystle White, Manager of Health Equity Outcomes
• Leigh Yount, Health Education Supervisor
• Marti Morris, Data Analyst
• Jenny Niu, Community Health Strategist
• Abby Newton, Special Projects Manager
• La Verne Partlow, Health Education Coordinator

Partnerships/Collaborations

• CaroMont Regional Medical Center
• City of Gastonia
• Community Foundation of Gaston County
• Gaston Business Association
• Gaston County Government
• Gaston County Schools
• Gaston County YMCA
• Gaston Together
• Highland Neighborhood Association
• Holy Angels
• Kintegra Health
• Partners Behavioral Health
• Phoenix Counseling
• Senior TLC
• United Way of Gaston County

Theoretical Framework and Model

The following frameworks and models were used in conducting the Community Health Assessment:

• County Health Rankings Model
• Healthy North Carolina 2030 Framework
• CDC Assessment and Planning Framework

Collaborative Process Timeline/Summary

2021 Community Health Assessment Key Findings & Health Priorities

Gaston County utilized an in-depth approach in defining the health priorities for the County Health Improvement Plan (CHIP). In partnership with CaroMont Health System, a presentation outlining the primary health indicators of Gaston County was developed. The presentation was viewed by several professional and neighborhood organizations throughout Gaston County. After the presentation and a following discussion, participants were asked to vote on their priorities for the community. Over 75 individuals participated in this priority-setting process.

The following focus areas were chosen during community meetings around Community Health Assessment findings. These will be the key health priorities Gaston County will focus on with the Community Health Improvement Plan.

1. Maternal & Infant Health
   1. Infant mortality remained level between 2016 and 2019 and increased by 83% between 2019 and 2020. This was seen most notably in the African American Community, where the increase between 2019 and 2020 was 115%.
   2. Access to prenatal care in the first trimester is often cited as a primary factor in healthy pregnancies and births. While behaviors for all racial and ethnic groups are increasing between 2016 and 2020, African Americans and Hispanics are still less likely to seek early care.
2. Substance Use & Misuse
   1. Opioid deaths have historically been associated with prescription pain medication, such as oxycodone and hydrocodone; however, deaths due to illicit substances, such as heroin and fentanyl, have increased in North Carolina and constitute the primary cause of opioid-related deaths in Gaston County. In 2021, the percentage of overdose deaths from illicit opioids was 71.7%.
   2. Gaston Emergency Medical Services Response has seen an increase in the number of Narcan doses administered and overall overdose cases. The number of charted opioid overdoses increased by 172% between 2019 and 2021.
3. Access to Healthcare: Neighborhood Initiative 
   1. Affordable and high-quality insurance is a primary determinant of access to healthcare. Gaston county census tracts range from less than 2% uninsured to over 25% uninsured.
   2. Transportation is an essential element in access to healthcare for Gaston County residents. The city of Gastonia has the only bus route in the county with a limited service area. The “Access” program provides transportation in rural parts of the county but is limited to those receiving Medicaid.
   3. Residents ranked in the top 25% of Census tract health risk factors which included high rates of cancer, heart disease, depression, diabetes, poverty, and others. The chart below provides a visual representation.

Next Steps

• Residents can request more information about the CHA/CHIP
• Residents can volunteer with workgroups/collaborations/partnerships for each priority area  (add interest email)
• Be informed about the community health in Gaston County
• Data sharing in the community about health needs
• Continual evaluation of programs and use of best practice interventions in all programming for priority areas
• Program and fund development for all priority areas

Priorities

Gaston County Health Priorities 

1. Access to Healthcare : Neighborhood Initiative 

2. Infant and Maternal Health  

3. Substance Use and Misuse  

Description

Read our 2021 Gaston County Community Health Assessment: here

Why Is This Important?

Access to healthcare is important due to several factors. Affordable and high-quality insurance is a primary determinant of access to healthcare. Gaston county census tracts range from less than 2% uninsured to over 25% uninsured, emphasizing the importance of having insurance coverage to ensure access to healthcare services. Limited transportation options, with only one bus route and restrictions on the "Access" program, further hinder access to healthcare. Furthermore, certain clusters of neighborhoods in Gaston County face significant health risks, as indicated by their ranking in the top 25% of Census tract health risk factors. These risk factors include high rates of cancer, heart disease, depression, diabetes, and poverty.

Map

*The health department identified census tract 332.04 as an area of focus due to its health risk factors being in the worst 25% performance category, as well as having high numbers of these factors.

What We Do

During the evaluation of the 2021 CHA data, we carefully examined the health and socioeconomic factors that could affect the health of the residents in all census tracts in the county. Among them, the census tract closest to the health department stands out with its high poverty level and poor health outcomes. To address this concern, our dedicated staff has taken action by forming a workgroup comprising stakeholders from various county organizations. The primary objective of this workgroup is to promote community engagement and gain a deeper understanding of the needs of the neighborhood residents, and provide the necessary support to improve access to care and resources in the community. We also organize community events to engage residents, create a vibrant environment, and inform them about our health department programs and services.

Current stakeholders include: 

• City of Gastonia 
• Gaston County Public Library 
• Gaston-Cleveland-Lincoln Metropolitan Planning Organization 
• Gaston County Public Schools 
• NC Cooperative Extension 
• Kintegra Health

Who We Serve

We primarily serve the neighborhood community members living in close proximity to the health department. Our goal is to provide accessible and comprehensive healthcare services, resources, and support tailored to the unique needs of this local community. 

How We Impact

Through community engagement and collaboration, we aim to foster a healthier environment and ensure residents have access to the care they need.

Why Is This Important?

Considering the alarming rise in infant mortality rates between 2019 and 2020 as seeing in the CHA, and the disproportionate impact on specific communities, promoting health and well-being in mothers and children become even more critical. Efforts are needed to address barriers and disparities in healthcare access in marginalized communities, to improve infant and maternal health outcomes and also reduce the disparities in seeking prenatal care.

What We Do

The WIC Program in Gaston County provides access to nutritious foods, information on healthy eating, including breastfeeding promotion and support, and referrals to health care and community resources for moms-to-be, new moms, and families with young children.

Who We Serve

The WIC Program in Gaston County serves to safeguard the health of low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk.

How We Impact

WIC provides quality, cost-effective care to thousands of families across North Carolina. Evidence demonstrates that women who participate in WIC have improved pregnancy outcomes, resulting in healthier babies. There are numerous benefits to women, infants and children who participate in WIC. Studies show that: 

• WIC reduces infant mortality: WIC connects pregnant women to prenatal care, provides nutritious foods and encourages health-promoting behaviors. These factors are linked to positive birth outcomes (USDA, 2012). 

• WIC saves public health care dollars: women who participate in WIC are less likely to have pre-term or low-birth weight babies, contributing to healthier babies and reduced medical costs (Institute of Medicine, 2006). 

• WIC improves children’s health: children who participate in WIC are more likely to receive regular preventive health services and are better immunized than other low-income children who do not participate in WIC (USDA, 2012). 

• WIC improves infant feeding practices and diet quality: WIC promotes and supports breastfeeding as the optimal infant feeding choice. In addition, revisions to the WIC Food Package have resulted in increased intake of fruits, vegetables, whole grains and low-fat dairy among WIC participants (USDA, 2012; Center on Budget and Policy Priorities, 2015). 

• WIC supports cognitive development: research shows that WIC services can mitigate the harmful effects of poor nutrition during critical periods of growth and development, leading to lifelong cognitive gains (USDA, 2012). 

• WIC enhances community food environments: revisions to the WIC Food Package, and thus changes in the foods available at WIC-authorized stores, have increased the availability of healthy foods for all individuals living in low-income communities (USDA, 2015). 

Reference: My WIC | NCDHHS ;  Women, Infants, and Children | Gaston County, NC (gastongov.com)

What We Do

The Gaston Healthy Beginnings Program is a free program that was developed for pregnant and post-partum African American women and Latinos between the age of 13 to 22 who live in Gaston County. The program provides case management services, educational group sessions, support services, resource and referrals, and community outreach.

Who We Serve

Gaston County Healthy Beginnings serves unduplicated minority individuals, specifically pregnant and post-partum African American women and Latinos between the age of 13 to 22 who live in Gaston County.

How We Impact

Healthy Beginnings, a minority infant mortality reduction program, that focuses on improving birth outcomes among minority individuals, reducing minority infant morbidity and mortality, and supporting families and communities. The Healthy Beginnings Program provides education to each participant in the following areas:

• Breastfeeding: Provide education, support and referrals to encourage breastfeeding initiation and maintenance for at least the first six months. Provide education and support to partners/support people and family members to support breastfeeding individuals.
• Quitting smoking/tobacco and avoiding secondhand smoke: Provide education and advice to help participants quit using tobacco products (inclusive of electronic nicotine delivery systems). Provide education and advice to help eliminate participants’ and their children’s exposure to secondhand smoke. Offer education and resources to help partners/support people and family members quit using tobacco.
  products and provide education on the risks of secondhand smoke exposure. Refer participants, partners/support people and family members to QuitlineNC for tobacco cessation counseling.
• Safe sleep:  Provide education to participants, partners/support people, and family members on current infant safe sleep practices and conduct monthly assessments on infant safe sleep practices until the child is 12 months of age. Provide resources and referrals for infant items that are approved for safe sleep environments when available.
• Folic acid consumption: Provide education and support to ensure that participants are continuing to consume a multivitamin that contains the recommended daily allowance of folic acid and other nutrients. 
• Reproductive life planning: Conduct reproductive life plan assessments with participants, provide education on the risks of short interpregnancy intervals, and conduct monthly assessments on birth control methods being used. Offer education and resources to partners/support people on reproductive life planning.
• Healthy weight and exercise: Provide education and support on healthy weight and physical activity and conduct assessments on participants’ postpartum body mass index (BMI), no sooner than six weeks after baby’s birth and at program discharge when baby turns two years of age. Offer education and resources to partners/support people and family members on healthy eating and physical activity.
• Well child visits: Provide education and referrals to participants to ensure their children are receiving all the recommended well-childcare and immunizations based on the recommendations for preventive pediatric health care from Bright Futures/American Academy of Pediatrics. 

Why Is This Important?

Gaston County has experienced an increase in drug overdose deaths since 2019. Substance Use Disorder (SUD) put individuals, familes, and communities at health and life risks including injury and death, poor mental health outcomes, imparied ability to attend school or work, and legal issues. The increasing rates over the last three years highlights the need for improved SUD detection and prevention through expanding access to appropriate treatment and recovery programs and services.

What We Do

GEMS' Community Paramedics Program is dedicated to providing crucial follow-up care for individuals who have experienced drug overdoses. Our community paramedics offer essential support by supplying fentanyl and xylazine test strips, distributing naloxone to reverse opiate overdoses, and, for those who qualify, providing suboxone—a medication designed to treat opiate withdrawal. Our program is committed to enhancing the well-being of individuals affected by substance use through comprehensive and compassionate care.

Who We Serve

GEMS'Community Paramedic serves individuals with Substance Use Disorder (SUD) and it plays a crucial role in providing support, follow-up care, and resources to those affected by substance abuse.

How We Impact

Offering a chance to address gap in SUD healthcare services within Gaston County, a Community Paramedic program extend beyond the conventional first responder ambulance model. They integrate elements of public health, primary care, public safety, and prevention within their service odelivery model. The Gaston County Board of Commissioners voted tp expand the program by adding three additional paramedics, making it a 24-hour service.

Reference: Opioid Settlement Funds Dashboard | Gaston County, NC (gastongov.com)

What We Do

The Gaston County Harm Reduction Alliance is planning to combine condom distribution, STI testing awareness, and Narcan distribution into one outreach effort to encourage safer practices and risk reduction in the community. Our mission in creating the Gaston County Harm Reduction Alliance is to bring together multiple departments within Gaston County Public Health (GCDHHS-PH) and community stakeholders to promote harm reduction through education, identification, and prevention strategies. 

Who We Serve

We aim to serve all residents in Gaston County, with particular focus on supporting individuals at risk for STI infection and those dealing with substance use and misuse.

How We Impact

We aim to unite and build on the existing strengths and resources of Gaston County to support the long-term health and wellbeing of our community by promoting harm reduction strategies.

EDUCATION

• We provide up-to-date and reliable information about health threats and training on topics like Narcan administration.

IDENTIFICATION 

• We offer Information on where to receive STD testing, how to recognize an opioid overdose, fentanyl and xylazine test kits.

PREVENTION

• We offer free condoms and condom delivery to the community. We educate how to respond to an opioid overdose, and provide linkage to community services and other resources. 

Progress on CHIP

Gaston County has completed the Community Health Improvement Plan for 2022. After completion of the Community Health Assessment, Gaston County Public Health staff worked in partnership with CaroMont Health system to develop a presentation outlining the primary health indicators of Gaston County.  This presentation was offered to a number of professional, nonprofit, and neighborhood leadership teams throughout the county.  Following the presentation and a subsequent discussion, participants were asked to vote on their priorities for the community.  Over 75 individuals participated in the priority-setting process.

Morbidity and Mortality Changes Since Last CHA

The Gaston County Community Health Assessment was completed in October of 2022, so there have been very few data releases since that time.  Monitoring data for the three areas noted as priorities revealed some changes in that data.  In the Substance Use priority, the only data to be updated for 2021 was "Emergency Visits to the ED as the Result of an Overdose". This measure increased by nearly 44.3% between 2021 and 2022.  It is also notable that this increase took place during the same time period that the state experienced a decrease, whereas, in prior years, Gaston County had paralleled the state rate.

Another significant change that took place was an improvement in Infant Mortality Rates.  Infant Mortality was chosen as a priority area due to a significant rise in infant deaths between 2019 and 2020 that was seen most notably in the African American population.  As can be seen in the charts below, the rates for Gaston county diminished for 2021.  While the rates stratified by race and ethnicity can no longer be compared historically, Gaston County rates by race and ethnicity are now aligned with the rates seen at the state level.  

Another improvement that coorelated to the infant mortality rate was seen in the release of the data for Child Deaths ages 1 - 17.  This rate diminished from 22.9 in 2020 to 16.2 in 2021.

Emerging Issues Since Last CHA

Beginning in the last quarter of 2022, Gaston County has been experiencing a significant increase in Group A Streptococcal Invasive Infections.  While no specific common exposures have been identified at this time, the county Communicable Disease team is monitoring this closely.

New/Paused/Discontinued Initiatives Since Last CHA

Since the 2018 CHA DHHS has discountinued: Integration of Mental Health Resources, Childhoold Obesity, Improved Family Functioning and Senior Livability and Support as priority focus areas. DHHS staff continue to conduct programs focusing on these previous priorities. 

Progress on CHIP

Gaston County completed its most recent Community Health Assessment in 2021 and created the Community Health Improvement Plan immediately following the publication of the Community Health Assessment.  The three priorities chosen for the CHIP at that time:

1. Infant and Maternal Health
2. Substance Use Disorder with an emphasis on opioid use
3. Access to Healthcare – focusing on the Mountainview Neighborhood

Gaston County Public Health is actively addressing each of the priority areas with significant activities and programming in each area.

Access to Healthcare and Neighborhood Health 

Gaston County is a diverse community that shares its eastern border with Mecklenburg County.  This geographic positioning drives many of the socio-economic factors in the community with nearly 30% of Gaston County workers commuting to Mecklenburg County.  This commuting pattern creates a pattern of wealth in the eastern part of the county with large areas of poverty and inadequate access to care predominately in the western part of the county.  There is roughly a 20 difference in life expectancy between the impoverished areas of the county and the areas of high wealth.  The following map illustrates the areas of higher risk in the county.

Access to Care – Activities

After reviewing the pertinent data and working with community partners, Gaston County determined that the best approach to Access to Care was to target a specific census tract / neighborhood to address access to care issues.  The Mountainview neighborhood, which is physically located in the same census tract as the primary location of the health department has high rates of poverty, including a public housing complex, heart disease, diabetes, and uninsured individuals.  Additionally, the FQHC serving Gaston County has identified this neighborhood has an area of high need and is providing targeted services as well.

Gaston County began by convening a workgroup of representatives from various government and nonprofit Initial activities to engage the Mountainview community have included a health fair, a survey of residents and an event that allowed participants to have a conversation about health care with one of the public health providers over dinner.

Infant and Maternal Health

There were several factors that drove the decision to focus on Infant and Maternal Health, but one statistic that created the most impact in the county was the infant mortality rate in the African American population during 2020. 

The chart below shows that the infant mortality rate in Gaston County was 11.4/1,000 live births in 2020, however there was a  rate of 25/1,000 live births in the African American population.  During this same time, the overall rate for North Carolina was 6.9/1,000 live births, and the rate for the African American population was 12.8/1,000 live births.

In 2021, these statistics improved considerably, while racial comparisons are not possible, the overall rate for Infant Mortality in Gaston County dropped 24.6% to 8.6/1,000 live births.  This is still somewhat higher than the 6.8/1,000 live birth rate experienced at the state level, but a significant improvement for Gaston County.  Preliminary data provided by the State Center for Health Statistics shows continued improvement for 2022, however data for North Carolina was not available at this time.

Source: NC State Center for Health Statistics, Rate/1,000 live births

Infant and Maternal Health - Activities

Gaston County Public Health has partnered with the local Perinatal Equity Coalition to examine racial bias in Infant and Maternal Health.  This coalition was developed and supported by a grant from the NC Maternal Health Innovation program in cooperation with Atrium Health.  Working cooperatively with this coalition Gaston County Public Health will be hosting a Health Equity Summit focusing on Black Maternal Health in April of 2024.  CEU’s will be available for nurses, social workers and other professionals.

The Gaston Healthy Beginnings Program is a free program that was developed for pregnant and post-partum African American women and Latinos between the age of 13 to 22 who live in Gaston County. The program provides case management services, educational group sessions, support services, resource and referrals, and community outreach.

The Healthy Beginnings program has served 40 clients with a total of 33 live births.  The program has shown a number of significant outcomes, including improvement in the number of infants sleeping on their backs, and a steady rate of participants who received postpartum care.

Gaston County Public Health also hosts the Women Infants and Children (WIC) Program which provides access to nutritious foods, information on healthy eating, including breastfeeding promotion and support, and referrals to health care and community resources for moms-to-be, new moms, and families with young children.  Like most of the counties in North Carolina the Gaston WIC program remains below it’s baseline participation level, but between August and October of 2023 (most recent data available) the program saw a 7.5% increase in participation rates, and 33.6% of the infants in the programs were fully or partially breastfed.

Substance Use and Misuse 

Gaston County has seen an increase in overdoses including opioid overdoses in recent years.  This issue extends well beyond the effect on the individual experiencing Substance Use Disorder and affects the entire population with its impact on healthcare, the economy, and even foster care.

Gaston County has an active coalition involved in the distribution of the Opioid Settlement Funds.  One of the early projects funded by the coalition was the Community Paramedic program.  This program extends the conventional first responder model and integrates aspects of public health, primary care, public safety, and prevention in its service delivery model. 

The community paramedics in this program offer essential support by supplying fentanyl and xylazine test strips, distributing naloxone to reverse opiate overdoses, and, for those who qualify, providing suboxone—a medication designed to treat opiate withdrawal.

Based upon the early success of this program the Gaston County Board of County Commissioners has recently approved expansion of the Community Paramedic program to a 24-hour service.

Morbidity and Mortality Changes Since Last CHA

This information is pending and will be updated when information is available.

Emerging Issues Since Last CHA

Gaston County, much like the rest of the state, and nation has seen an increase in syphilis cases over the past four years.   The disease is primarily affecting men in the 25 to 49 age group.

New/Paused/Discontinued Initiatives Since Last CHA

Gaston County has been experiencing an influx of patients whose primary language is not English.  Most notably this increase has been seen in both the Spanish-speaking, and Haitian-French Creole languages.  To improve services to these communities Gaston County Public Health has increased the number of Spanish-speaking interpreters and added a Haitian- French Creole interpreter.