HNC 2030 Scorecard Alamance County 2021-2024

Executive Summary

EXECUTIVE SUMMARY

Vision Statement and Purpose

  This document serves as an ongoing commitment to addressing access to resources and health care, the education level achieved, and economic opportunity for residents in Alamance County which were identified by the community in 2015. All three priorities require systemic change to address. Systemic change is guided by an institution’s willingness to rigorous periodic review of policies, procedures, and institutional culture that creates barriers to the priorities a community seeks to address. This 2021 assessment reflects upon both the creation of processes to aid this review and challenges encountered during the last three years that illustrates the development of, and growing shared lens for, the role equity plays in determining the health of an individual and their community.

Leadership

  The theme of leadership for this assessment is the redefining of stakeholders and how residents and institutions work together to assess and address health. The partnerships below reflect an interactive process grounded in values and accountability.

Partnerships 

Parternships include: Public Health Agency, Hospital/Health Care System, Hospital/Public Health Nonprofit Agency, Local Health Foundation, Dental Health Provider, Community Organizations, Businesses, Educational Institutions, Public School System, Media/Communication Outlet, Public Members, Regional/contracted services - Piedmont Triad Regional Council, and Community Food Lab.

Theoretical Framework/Model

  The incorporation of a Community Based Participatory Research (CBPR) approach into the Community Health Assessment process allows partners to engage the community in meaningful conversations about health and better positions partners to address priorities.

Collaborative Process Summary

  Alamance County has a long history of collaboration between the health department and the hospital in developing a community assessment. Over the years, agencies and groups have joined the team, allowing for a cross-sectoral approach. The 2021 assessment process is Alamance County’s most collaborative process to date, building off the focus group findings from community residents in 2018 by conducting charrettes across four locations in Alamance County.

Methodology

A charrette is a tool as part of a community based participatory approach (CBPR) for aiding in the collection of primary data while creating space for mitigating conflict, resolution, and solution generation. To learn more about the charrette process, explore NCTracs.

Key findings

The following themes emerged from the charrettes:

Theme #1: Disconnection from resources

Theme #2: Disconnection among neighbors/Divided communities

Theme #3: Concern for young people

Theme #4: Safety

Theme #5: Infrastructure

Theme #6: Health

Health Priorities

  The 2021 priorities are access to care, education, economic issues

Next steps

  The Health Equity Collective will conduct a series of forums to bring participants together to explore these themes further and begin the process of creating solutions. These forums will focus on identifying who needs to hear this information and be a part of the planning to inform the Community Health Improvement Plan (CHIP). 

Reading Guide

  This assessment is made up of eight chapters with relevant county information. Each chapter begins with a title page that contains an image of an Alamance County mural, key questions, and key words. Our goal as a CHA team is to make the reading experience for the reader as easy and as informative as possible. The murals resemble a small tour through the county, and we encourage you to visit the murals in person (addresses will be below each image). The key questions can help prime the reader to interpret key themes and topics before diving into the details. And the key words offer an insight into the specific content of the chapter. Each key word and definition can be found in the glossary.

Priorities

The three priorities addressed in the Community Health Assessment for Alamance County are:

• Access to care
• Education
• Economy

Story Behind the Curve

The Alamance Partnership for Children is a non-profit, early childhood initiative for young children to be healthy and successful in school. Their literacy programs include Dolly Parton's Imagination Library and Reach Out and Read.  The Dolly Parton Imagination Library provides free books, once a month, to children until they are 5 years old. The Imagination Library serves children from birth to 5 years old. This program allows children to have access to many books despite their family's economic status and provides the chance for children to begin reading at an earlier age. Reach Out and Read is a program where medical providers inform parents on the importance of reading aloud to their children. Providers show parents how to hold the book, engage in the pictures, and help their children follow along. These tips are given during their regular check-up appointments, along with receiving an age appropriate book to take home.  In 2022-2023, over 5,000 children recieved a book through the Dolly Parton's Imagination Library and over 430 children were served through the Reach Out and Read program. 

Why Is This Important?

The skills children gain before kindergarten can have an immense impact on their ability to succeed throughout school. In fact, children who enter school ready to learn are more likely to read on grade level by the third grade, thrive in middle school math, and graduate from high school.

How We Impact

• Alamance Partnership for Children the Alamance Partnership for Children is a non-profit organization serving children and families in Alamance County. The Partnership administers Smart Start and NC Pre-Kindergarten funds, an early childhood initiative designed to ensure that young children enter school healthy and ready to succeed. 
•  Elon Academy the Elon Academy is a non-profit college access and success program for academically promising high school students in Alamance County with a financial need and/or no family history of college. 
• Boys & Girls Club of Alamance County the Salvation Army Boys and Girls Club is dedicated to inspiring youths to meet their true potential through our Afterschool Program and Summer Camp. 
• It Takes a Village Project the It Takes a Village Project is a program that uses a collaborative approach to help children in the community who are struggling to read. Children, Elon students, and trained community volunteers are paired together for weekly tutoring sessions on campus. 
• Positive Attitude Youth Center the Positive Attitude Youth Center is a non-profit organization in the Burlington, North Carolina community that works to reach out to children and young adults to help them mature physically, spiritually, and emotionally by providing a positive learning and social environment through after school programs, day schools, and recreational opportunities. 

Why Is This Important?

Individuals with more education are more likely to have jobs with higher earnings; live in communities with more resources like better schools and access to nutritious food, health services, and transportation; and acquire knowledge and skills to support healthier behaviors.

Description

A partnership between Alamance-Burlington School System (ABSS), Alamance County Health Department, Elon University and Impact Alamance.

As a result of the partnership, a new measurement of kindergarten readiness was launched across all kindergarten classrooms in the ABSS system. The Early Development Instrument (EDI) provides, for the first time, a snapshot of the specific skills that kindergartners from each neighborhood are starting school with, and where there are opportunities to strengthen skills. This data enables community partners to make strategic, aligned decisions about policies and programs that support the specific needs in each neighborhood.

The Kindergarten Readiness Network works to ensure every child in Alamance County has access to strong community and family supports before kindergarten — supports that build a child’s brain architecture and set children on a path to success.

What We Do

Who We Serve

How We Impact

Ready Freddy is an evidence-based program through Alamance Achieves, that aims to improve the transition into kindergarten and takes place the year before the child is to start school.  This program is especially helpful for children who did not attend a formal pre-school and have little to no experience with the structure that being in a classroom brings.  Children who participated in Ready Freddy scored higher, on average, on the ABSS Kindergarten Screener’s measurements of academic, social, emotional, and motor skill readiness than their peers who did not attend the program. In addition, parents reported feeling more confident about supporting their child’s transition into kindergarten and incorporated additional early learning activities at home.  Currently, this program is on pause due to Alamance Achieves going through turnover and trying to reorganize.

Why Is This Important?

Economic inequality influences many aspects of health and well-being, and low socio-economic status puts people at risk for heart disease, mental health problems, chronic disease, and shorter life expectancy. Higher income, in turn, creates more opportunities for a healthy lifestyle, such as being able to afford to live in a safe neighborhood with parks, sidewalks, good services and strong schools.

Why Is This Important?

Equitable and stable communities provide individuals and families with safe and affordable housing, access to quality education, and the support needed to lead a healthy life. 

What We Do

Who We Serve

How We Impact

Why Is This Important?

Increased physical activity is associated with lower risks of type 2 diabetes, cancer, stroke, hypertension, cardiovascular disease, and premature mortality, independent of obesity. The role of the built environment is important for encouraging physical activity. Individuals who live closer to sidewalks, parks, and gyms are more likely to exercise. 

What We Do

The Alamance Wellness Collaborative (AWC) convenes multidisciplinary partners to implement active living and healthy eating strategies throughout the county.  The AWC recognizes the importance of creating environments where current and future residents have access to opportunities to improve their health—including facilities that encourage physical activity, healthy food outlets, healthy school environments, as well as policies and the economic base to support them.

Who We Serve

The community members of Alamance County. 

How We Impact

A greenway that connects the Town of Elon (home to Elon University) to downtown Burlington was funded through collaborative action and planning of members. The connectivity allows Elon students and residents to walk, run, or bike to downtown Burlington. This not only creates another resource for physical activity, but also reduces air pollution by reducing cars on the road and provides a benefit to downtown businesses seeking new patrons.  Over $100,000 dollars has been funded to create Outdoor Learning Environments by Impact Alamance, which provide more opportunity for physical activity and to be outdoors.

Why Is This Important?

Food insecurity is associated with chronic health problems in adults including diabetes, heart disease, high blood pressure, hyperlipidemia, obesity, and mental health issues including major depression.

What We Do

Meals for Alamance County Students (MAC’s Diner) was established to bring hot, nutritious meals to children in areas of high concentration of need.

Who We Serve

The summer feeding program at both sites and food trucks permits the distribution of meals for ANY children 18 and under.

How We Impact

There are approximately 12,000 students in the Alamance-Burlington School System who qualify for free or reduced meals during the school year, which is 52% of the student population. During summer recess, these students do not have access to healthy food for two and a half months. The ABSS Nutrition Services offers meals at various sites throughout the county during the summer. Due to COVID-19 restrictions, the number of children needing food was more than 12,000 children served during the 2019-20 school year alone. The food truck was made possible through concerned community members raising funding and from an Impact Alamance grant.

What We Do

The Alamance Food Collaborative (AFC) represents entrepreneurs from the local restaurant industry, academics from Elon University, health care system partners, non-profit leaders, farmers, and local government. This group is focused on creating infrastructure for Alamance County’s food system that will have a lasting impact and influence the health of the community and economic viability.

Who We Serve

How We Impact

The AFC supports strategies to increase diverse membership by:

• Seeking connections

• Building power among community groups

• Thinking and acting collectively and collaboratively

• Paying members for their time representing the AFC

Why Is This Important?

Medical costs in the United States are extremely high, so people without health insurance may not be able to afford medical treatment or prescription drugs. They are also less likely to get routine checkups and screenings, so if they do become ill, they will not seek treatment until the condition is more advanced and therefore more difficult and costlier to treat. 

Progress on CHIPs

Education

Kindergarten Readiness

The Alamance-Burlington School System Early Learning Community serves over 200 children ages 3 through 5 within Alamance County.  Their programs include NC Pre-K/Title I classrooms, Exceptional Children's classrooms, and itinerant services for students with Individualized Education Programs (IEPs) in the Alamance-Burlington community. ABSS has 13 schools that hosts the NC Pre-K program.

High School Graduation

2021-2022 4-year cohort graduation rate in Alamance-Burlington School System is 86.0%, which is similar to the graduation rate for all NC public schools (86.4%).

Source: North Carolina School Report Cards, https://ncreports.ondemand.sas.com/src/index

Economy

Income & Poverty

According to 2021 Census data, 12.5% of Alamance County residents live in poverty, a decrease from 15.1% in 2020. Families and children in Alamance County living in poverty are more likely to suffer poor nutrition, lower quality educational opportunities, and chronic stress, which are especially harmful at the earliest stages of life (QuickFacts: Alamance County, North Carolina, 2022).

The median household income in Alamance County (2017-2021) is $55,078, which is an increase of approximately $5000 from the median household income of $49,700 reported in 2015-2019.

In Alamance County, 17.6% of children (those under 18 years of age) are living in poverty, which is, unlike previous years, lower than the state percentage of 18.2% (2021).

Source: Kids Count Data Center, Jan 2023 https://datacenter.aecf.org/ 

Access to Health

Health Insurance

Some Alamance County residents continue to report difficulty accessing health care due to cost and/or lack of health insurance. Of adults between the ages of 18-64 years, 17.8% remain uninsured as of 2020, compared to 18.2% in 2019.  Health insurance for children is particularly important. As stated in the 2021 CHA, to stay healthy, children require regular checkups, dental and vision care, and medical attention for illness and injury. Children with health insurance are more likely to have better health throughout their childhood and adolescence. They are more likely to receive required immunizations, fall ill less frequently, obtain necessary treatment when they do get sick, and perform better at school. Having health insurance lowers barriers to accessing care, which is likely to prevent the development of more serious illnesses. With the help of the ACA, 94.4% of children under 19 had access to health insurance in 2020.

Source: Kids Count Data Center, Jan 2023

Morbidity and Mortality Changes Since Last CHA

MORBIDITY AND MORTALITY

Source: NC State Center for Health Statistics https://schs.dph.ncdhhs.gov/data/databook/

*Septicimia death rate for NC came from the CDC https://www.cdc.gov/nchs/pressroom/sosmap/septicemia_mortality/septicemia.htm

2016-2020 trend data shows that cancer remains the leading cause of death among Alamance County residents. The top five causes, following cancer, is diseases of the heart, chronic lower respiratory diseases, cerebrovascular disease, unintentional injuries, and Alzheimer’s disease. When compared to North Carolina, Alamance County has a higher rate among all ten leading causes.  

Mortality rates are higher for Black or African Americans than other races or ethnicities for all leading causes of death in Alamance County, with the greatest disparities in cancer and heart disease. Mortality rates are higher for men than women each of the leading causes of death. Structural and systemic racism can be considered as a root cause of these inequities.

Life expectancy rates are similar to previous years, still showing lower life expectancy for Black residents than white residents. Average life expectancy overall is 76.8 2018 to 2020.

The 2020 infant mortality rate is 8.8, which is higher than the 2019 rate of 6.0.

Emerging Issues Since Last CHA

MPox (Monkeypox)

During the second half of 2022, the United States experienced an outbreak of MPox. North Carolina’s first case was detected on June 23, 2022, and had 697 cases as of December 28, 2022. In North Carolina, 96% of MPox cases were men and 67% were Black/African American. Alamance County Health Department investigated up to 19 possible cases as of January 11, 2023. The most affected group has been men that have sex with other men (MSM). Social and economic conditions, including high poverty rates, unemployment, income inequality, lack of social mobility, and low education access/attainment can make it more difficult for individuals to know about their sexual health.

With MPox considered a probable threat to the MSM community, more efforts are being put towards LGBTQ+ communities by the U.S. Department of Human Health Services (HHS) to slow the spread. To combat the virus, vaccines (Jynneos) are being administered at local health departments, including Alamance County Health Department. The health department has also listed information and resources on their website to spread awareness and is working with the North Carolina Department of Health and Human Services (NCDHHS). Although MPox is not considered an STI, it is spread through bodily fluids including saliva and lesion fluids from the rash; therefore, it is not recommended to engage in sex, or touching of any kind, with someone who has been diagnosed with MPox.

Source: North Carolina Department of Health and Human Services https://www.ncdhhs.gov/divisions/public-health/monkeypox

COVID-19 Variants

COVID-19 has been a pressing issue in all communities for over three years. In 2022, Omicron was identified as the primary COVID-19 variant, and remained so for the majority of the year. According to the NCDHHS, the Omicron variant was two to three times more contagious than the Delta variant. Despite vaccination status, people are still susceptible to the virus and are able to spread it regardless of symptoms, or lack thereof. The Omicron strain, B1.1.529, was extremely prevalent between January and February 2022, making up seventy-six percent (peak) of cases in North Carolina. Between June and November, strain BA.5 made up seventy-nine percent of cases at its peak. Congregate living settings (nursing homes, residential care facilities) are extremely susceptible to virus outbreaks due to the close living quarters. Congregate living facilities are of heightened concern for exposure. Not only are residents at risk, but staff as well. In 2022, Twin Lakes Assisted Living in Alamance County reported 37 total cases of COVID-19; 36 of those cases were among staff. 

Environmental Health/Justice

Renewed conversations around environmental justice have proven to be an emerging issue in North Carolina and Alamance County.  In August 2022, congressional leaders pushed for the continuation of the Mountain Valley Pipeline, which would run through the heart of Alamance County. There were completion delays as courts nullified multiple environmental permits. The continuation of the MVP pipeline has raised concerns among residents regarding safety, water quality, and whether it would further marginalize communities.

The Western Electric site in east Burlington has been and continues to be a concern for the community. As reported in the 2021 CHA, residents reported that the seemingly abandoned plant has caused hazardous chemicals to seep into the ground under homes in the immediate proximity. The Health Department brought forth this concern to the Mebane City Council during the presentation of the CHA on January 9, 2023.

Environmental injustices, as a whole, often disproportionately affect minority communities, including Black/African American and Latinx/Hispanic individuals, and low-income communities where poor Whites are congregated. Children living in these are areas are at a higher risk of developing chronic diseases, with the morbidity rates of asthma, for example, being increased in areas affected by environmental injustice. The Health Department operates the Healthy Homes program where a Registered Environmental Health Specialist will visit a home, assess any triggers for asthma, and give a written action plan to lower the risk of an attack.

Organizations exist both at the state and local levels that work towards environmental justice. The North Carolina Environmental Justice Network works with low income communities and people of color to address social, environmental, racial, and environmental injustices. This organization addresses concerns such as fracking, coal ash, pipelines, and other issues that continue to marginalize the discussed communities. Locally, Alamance County is home to the West End Revitalization Association (WERA), which services homeowners and landowners of five local African American communities in Mebane. Additionally, Elon University has recently pushed for education on this subject by having students read the book Bias by Jennifer L. Eberhardt. This book focuses on bias between races, but touches on the issue of environmental justice as it brings forth stories from those who have lived near landfills and toxic waste. With a more educated local community, issues can be more readily recognized and addressed.

Sources: North Carolina Environmental Justice Network https://ncejn.org/issues/

                West End Revitalization Association https://www.wera-nc.org/

                WFAE 90.7 https://www.wfae.org/energy-environment/2022-12-08/pellet-plant-permit-delayed-amid-environmental-justice-concerns

                Elon University https://www.elon.edu/u/news/2020/09/10/jennifer-l-eberhardt-tackles-bias-in-live-common-reading-conversation/

                News & Record https://greensboro.com/pipeline/article_3e3c3cf8-1713-11ed-8a69-03a3b7e6018c.html

             North Carolina Policy Watch https://ncpolicywatch.com/2021/09/09/former-army-missile-plant-burlington-poses-public-health-risk-eng/

                Alamance County Health Department https://www.alamance-nc.com/environmentalhealth/programs/air-quality-and-asthma/healthy-homes-and-asthma/

New/Paused/Discontinued Initiatives Since Last CHA

SCHOOL RESOURCE OFFICERS

The schools in the Alamance County district a seeing a new change for the 2022-2023 school year as the county places School Resource Offers (SROs) in all 37 schools in the district, including elementary schools. After the constant unrest the nation has experienced in the last few years of kids not being safe in school, the Alamance County Commissioners worked with Alamance-Burlington School Board to provide funding for the new SROs.  All SROs have also currently undergone crisis intervention training and active shooter training, which will be taught again annually at different schools.

These officers recognize that they are not only there to protect the kids in the community, but also to build trusting relationships with students, as they may sit at lunch together or enjoy casual conversations. Master Police Officer and SRO, Dylan Rose, states that he wants to show these kids a different side of law enforcement that they may not know or have seen before. This not only shows the students, but parents and the community as well, that safety comes first.

Reference: WXXI 12 https://www.wxii12.com/article/alamance-burlington-school-system-puts-school-resource-officers-at-every-campus/41032983

Progress on CHIPs

EDUCATION

Kindergarten Readiness

Some grant-funded kindergarten readiness programs, such as Ready Freddy within Alamance-Burlington School System, and the Kindergarten Readiness Network through Alamance Achieves, were temporarily discontinued. However, through NC Pre-K ('21-'22 report) programs such as Alamance Partnership for Children (APC) and Head Start, 433 children were served.  

Early Literacy Programs

One of the key components of education is reading. The Dolly Parton Imagination Library and Reach Out and Read programs continue to be integral in providing access to books for thousands of children in Alamance County. In addition to schools and child care centers, community organizations such as health clinics, churches, the health department, and social services participate in these programs. According to the 2021-22 APC report, 1,611 new children were added to the Dolly Parton Imagination Library and 323 new children were added to Reach Out and Read. 

High School Graduation Rates

The 2023 four-year high school graduation rate in NC was 86.5%, which is slightly higher than the Alamance-Burlington School System (ABSS) rate of 85.3%. ABSS saw a 0.7 point decrease from the 2022 rate, but a 6.3 point increase over the last 10 years. This overall decrease was seen all across gender and racial/ethnic groups, with the exception of Asian, which saw no change (>95%), and White, which saw a 0.8 point increase (89.4%) from 2022. When the 2023 graduation rate among subpopulations were assessed, economically disadvantaged increased by 6.3 points (84.5%), English learners decreased by 2.3 points (64.1%), homeless decreased 8.6 points (61.9%), and students with disabilities decreased by 2.2 points (69.4%).   

ACCESS TO CARE

Inclusive Playgrounds

The first inclusive playground in the Burlington parks system opened in early November 2023  at Burlington City Park.  This project was completed through collaborative efforts of the City of Burlington Recreation and Parks, Blue Cross and Blue Shield of North Carolina, and a nonprofit, KABOOM!, that focuses on building safe, inclusive and secure play spaces.  Community members were able to voice their opinions on what should be featured on the new play space to ensure that needs were met. The playground includes ramp access, grab bars, sway fun glider and two reach panels. 

Health Insurance 

Health insurance can be the determining facotr in if and/or when someone receives healthcare. According to the most recent data, the percentage of uninsured in Alamance County and in NC, in comparison, remained stable between 2020 and 2021.

ECONOMY

Median Household Income- 2021 & 2022

Children 100% Below Poverty

Unemployment

Households Spend >30% of Income on Housing

Morbidity and Mortality Changes Since Last CHA

Top 10 Causes of Death, 2021- NC State Center for Health Statistics, 2024

Alamance County

North Carolina 

Emerging Issues Since Last CHA

ABSS: Mold Found in Schools

A primary health issue that developed in the Alamance County community in 2023 was mold found in 32 of 36 schools in the ABSS system. The initial case was found during summer cleaning duties taking place at Andrews Elementary. Consequently, after inspecting all schools, it was found that most of them did have some form of mold. Through the assistance of the environmental health section of the health department, ABSS facility staff, remediation experts and the State of North Carolina's Occupational and Environmental Epidemiology Branch, it was determined that the mold occurred due to poor HVAC ventilation, structural issues, high humidity levels experienced during the summer, and the age of most of the buildings; some buildings were 50 years old. It was found that 16 of the 32 schools had toxigenic mold and required more intensive cleaning. Because of the number of affected schools, remidiation became a lenghty process. The school district opening was moved from August 28 to September 11 to ensure that staff and students would have a safe return. Approximately $25.8 million was spent on mold remidiation and HVAC cleaning. 

New/Paused/Discontinued Initiatives Since Last CHA

NEW INITIATIVES

Western Electric Cleanup

The 2021 CHA and 2022 SOTCH referenced the history of the Western Electric site, the physical and environmental health concerns of local residents, and the potential plans for cleaning up the site. Phases one and two of the multi-year cleanup began in 2023. This site that the City of Burlington website refers to as, "abandoned, polluted buildings and grounds that blight a major commercial and residential neighborhood of our city" consists of 22 buildings, complete with utilities and parking lots, occupying approximately 22 acres within the city limits of Burlington. Known as the Tarheel Army Missile Plant (TAMP) when it was owned by the US Department of Defense (DoD) between the years of 1942-2004, the Western Electric site has since been in the hands of four different private property owners. The goal is to  get the site cleaned up and eventually redeveloped.              

Refugee Resettlement Program

Agencies across the state are partnering with NCDHHS to offer and administer a wide range of programs that are part of the implementation of the Refugee Resettlement Program funded under Title IV of the Immigration and Nationality Act, which is a federal program of public assistance and services to refugees resettling in the United States. The program consists of three service areas: Refugee Public Assistance, Refugee Service Programs, and Refugee Support Activities.

Alamance County is one of the top fourteen refugee resettlement counties in NC, with the state receiving approximately 7,000 refugee arrivals each year. The county is currently partnering with two resettlement organizations- Church World Services in Durham and NC African Services Coalition in Greensboro. Both agencies are working to house fulltime staff in the Citygate Dream Center, which is in Burlington. To meet the need for refugee resettlement, the health department started a new service line conducting health assessments to introduce new refugee arrivals to the US healthcare system and to guide refugees in establishing a medical home. The assessment is done soon after arrival to identify any communicable diseases of public concern. The health department's focus is to preventing the spread of communicable diseases and referral to a primary medical home, Piedmont Health Services, for further medical evaluation, treatment and follow-up. The local health department refugee health assessment includes: immunization assessment and follow-up, communicable disease screenings (HIV, syphilis, hepatitis B & C), tuberculosis screening and follow-up, sickle cell and other hemoglobinopathy screenings, blood lead screening, and STI screenings, if indicated.

DISCONTINUED INITIATIVES

Healthy Alamance

Healthy Alamance's, a local non-profit, funding was reduced. The Healthy Alamance Board worked with community partners to find ways to keep the organization funded and allow it to continue its mission. Unfortunately, there was no identified way to continue, and its board voted to dissolve the non-profit. For a number of years, Healthy Alamance co-led the CHA process along with the health department, initiated the Alamance Food Collaborative and the Wellness Collaborative, and led the formation of Authentically Alamance, which operated three farmers' markets in the county. As an organization whose mission was to improve access to and increase awareness of preventive health services, as well as eliminate health disparities among the disadvantaged, its dissolution leaves a void in the Alamance County community.