HNC 2030 Scorecard: Madison County 2021-2023

Executive Summary

The executive summary can be found on pp. 4-5 of the 2021 Madison County Community Health Assessment Report.

2021 Madison County Community Health Assessment

CHA Priorities

The 2021 Madison County Community Health Assessment priorities are:

• Healthy Eating/Healthy Weight and Diabetes
• Substance Use/Mental Health

Importance

People who eat too many unhealthy foods — like foods high in saturated fat and added sugars — are at increased risk for obesity, heart disease, type 2 diabetes, and other health problems. Obesity in turn is also linked to many serious health problems, including type 2 diabetes, heart disease, stroke, and some types of cancer (Healthy People 2030).

Individuals with low incomes and long work hours may have less time to prepare meals at home and less time to participate in physical activities. In addition, people in rural areas and low income communities may be far from a grocery store that sells healthy foods. Their communities may lack formal facilities for exercise, or the roads and public spaces may not be safe to move around in (Healthy NC 2030).

During our 2021 Community Health Assessment process obesity and diabetes were found to be issues of high concern in both secondary data and primary data reviewed by our team.

What Is It?

Walk with Ease was identified by the Healthy Eating Active Living (HEAL) Team as an action that - when combined with other actions in our community - has a reasonable chance of making a difference in physical activity in our community. This is an on-going program in our community.

The priority population/customers for Walk with Ease are adults who wish to increase their physical activity, and the program aims to make a difference at the individual/interpersonal/organizational and community change level. Implementation will take place in the community and virtually.

Walk with Ease has been conducted in person (pre-pandemic) and self guided (post-pandemic).  Our goal for ongoing implementation is to find a balance between both delivery styles in an effort to better meet our communities need.  

Partners

The partners for Walk with Ease include:

Progress in 2022

In 2022 the program remained as an online self-led program and there were 2 newly registered participants to the Walk with Ease (WWE) program increasing the total Madison County participation to 11 for 2021 and 2022. In March it was recognized that the online portal for registration was not active and that was corrected. In August due to the lack of new participation there was an advertisement for the program and registration details published in the Madison County Employee Newsletter to try and promote involvement.

In the Fall we contacted the two new participants in an effort to collect feedback on the program and to inquire about completion. One answered, providing limited feedback and they in fact were not able to complete the program. 

Land of Sky Regional Council is attempting to recruit and train leaders for the Walk with Ease program in hopes of restarting an in-person version in the near future.  Furthermore, the HEAL team is looking to local providers for collaboration in regard to promoting participation. 

Progress in 2023

In 2023, the self-led program continued to be offered online and there were 3 newly registered participants to the Walk with Ease (WWE) program increasing the total Madison County participation to 14 for 2021-2023.  None of the 3 participants completed the post program survey/evaluation. 

Land of Sky Regional Council attempted to hold in-person sessions twice during 2023 but did not receive enough registrants to hold the program.  

The HEAL Team has provided resources to help generate more interest among potential participants.  This will help to improve outreach to community with the target of generating more regsistrants and participation. In addition, plans are to partner in the future with a local senior center to eliminate transportation barriers. 

Lastly, a local community health worker has started a "Walk With Me" program.  The group meets on Tuesday's and Thursday's to walk together and has enrolled 6 participants.

What Is It?

Cooking Matters was identified by the Healthy Eating Active Living (HEAL) Team as an action that - when combined with other actions in our community - has a reasonable chance of making a difference in healthy eating in our community. This is an on-going program.

The priority population/customers for Cooking Matters are low income adults and families, and the healthy eating program aims to make a difference at the individual/interpersonal/organizational/community change level. Implementation will take place in the community setting and virtually.

Cooking matters has been very successful in our community.  Our goal is to continue the program either in person or virtually.  We would love if funding and support is available to expand to offering more than twice per year.

Partners

The partners for Cooking Matters include:

Progress in 2022

In 2022 the Cooking Matters program was put on hold by the lead agency and during the summer restructuring of the program began.

As of August, the new plan was to collaborate with care managers to make referrals through NC Care 360 as part of the Healthy Opportunities Pilot.  Qualifying individuals would be admitted to the program for free and would have the necessary ingredients provided for the lessons. However, community members that were interested would be charged a small fee for participation and would be sent an ingredient list they would be responsible for bringing to the class for their own personal use. Due to increased need for food boxes through the Healthy Opportunities Pilot the YMCA did not have the capacity to restart the program as planned.

The HEAL team is collaborating with NC Cooperative Extension Family and Consumer Science Agent in an attempt to partner with the YMCA, local libraries and food pantries in hopes of restarting Cooking Matters or implementing a similar program.

During the pause of the Cooking Matters program the local Family and Consumer Science Agent (FCS) began Dining with Diabetes program. The program was conducted at two area active living centers and a gift card incentive was offered upon completion. In Hot Springs, 16 individuals completed the program and in Laurel there were 13. A future Dining with Diabetes class is scheduled for Mars HIll in March of 2023.  In addition, the FCS agent also created recipe cards and conducted cooking demonstrations and taste testings at the YMCA Mobile Market (a mobile fresh fruit/vegetable delivery program).

Progress in 2023

In Summer of 2023 a virtual Cooking Matters program was held and promoted.  No Madison County residents participated.  Some barriers that were identified that may have attributed to this lack of participation were the time of year the class was held, internet availability, and ingredients were not supplied as they were in the past.  The HEAL team is working with the YMCA to offer this program again in Spring 2024.

Also in 2023 our local Cooperative Extension conducted an in-person Cooking Matters/Let's Get Cooking program with 9 participants. This program featured participants cooking and eating together and in partnership with MANNA provided ingredients to make the meal again at home.

In addition, during 2023 the following programs were offered in collaboration with community partners:

• Three Diabetes 101 classes with 36 participants, and one Spanish class with 12 participants
• Cook Together, Eat Together class with 12 parents and children and Snacks with Friends with 12 parents and children
• One Pan Meals class with 12 participants
• Two Med Instead of Meds classes with 22 participants
• International Cooking class with 12 participants
• Smarter Shopping class with 5 participants
• Batch Making Pesto class with 3 participants
• My Plate Breakfast program at Hot Springs Elementary School with 148 students
• All About Strawberries program with 25 preschool children and their parents

What Is It?

Diabetes educational videos was identified by the Healthy Eating Active Living (HEAL) Team as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in diabetes in our community. This is a new program in our community.

The priority population/customers for this educational program are residents at risk for or currently diagnosed with diabetes, and the educational videos aims to make a difference at the individual/interpersonal behavior level. Implementation will take place in on websites and social media platforms.

Partners

The partners for this Educational program include:

Progress in 2022

During 2022 the Madison County Cooperative Extension Family and Consumer Science Agent in collaboration with the RN Care Manager from Hot Springs Health Program created and posted two videos to YouTube with the focus of healthy recipes and diabetes self-management. Videos were shared on multiple HEAL team members social media platforms.

September 21, 2022, a video titled Better Breakfast with Egg Muffins and October 11, 2022, a video titled Live Longer and Stronger - Reimagining Downhome Country Cooking were posted.  Contact details are tagged at the end of the video in the event viewers would like more information.

More recently a Diabetes Blog has been developed. The plan is to continue to post videos and pair those with blog entries.  In addition, the HEAL team is discussing a way to track effectiveness of the information by way of survey post viewing of the video.  

Progress in 2023

During 2023 the Madison County Cooperative Extension Family and Consumer Science Agent in collaboration with the RN Care Manager from Hot Springs Health Program created and posted four videos to YouTube with the focus of healthy recipes and diabetes self-management. Videos were shared on multiple HEAL team members social media platforms.

The following are the titles/subject of the videos:

• Braised Mustard Greens and Potatoes
• Quick and Hearty Vegetable Soup
• Mashed Cauliflower "Reimagining Downhome Country Cooking"
• Lower Carbohydrate Cornbread "Reimagining Downhome Country Cooking"

Contact details are tagged at the end of the video in the event viewers would like more information.

In addition, a survey has been added to the videos so that increased knowledge can be measured.

The diabetes blog was discontinued due to lack of engagement.

Importance

There is a growing awareness of the connection between mental health and substance use.  Addiction and mental illnesses are dangerous alone; together they can be lethal. 

Substance use and abuse are health issues which often are major contributors to death and disability.  People who suffer from abuse or dependence are at risk for premature death, injuries, and disability.  In addition, substance use and misuse can have adverse consequences for families and communities. Having a substance use disorder affects an individual’s relationships with family and friends, ability to attend school or work, their overall physical and mental health, and may lead to problems with the legal system. 

Mental health and physical health are closely connected.  Mental illnesses such as depression and anxiety, affect people’s ability to participate in health promoting behaviors.  In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person’s ability to participate in treatment and recovery.  Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. 

Rural communities such as Madison often struggle with access to mental health and substance use programs and services.  Lack of providers and transportation in the community are barriers to access for care. People, including children and adolescents, with untreated mental health disorders are at high risk for many unhealthy and unsafe behaviors, including alcohol or drug abuse, violent or self-destructive behavior, and suicide. Mental health disorders also have a serious impact on physical health and are associated with the prevalence, progression, and outcome of some of today’s most pressing chronic diseases, including diabetes, heart disease, and cancer. Mental health disorders can have harmful and long-lasting effects—including high psychosocial and economic costs—not only for people living with the disorder, but also for their families, schools, workplaces, and communities. 

Source: Healthy People 2030 and Healthy NC 2030

What Is It?

Medication Assisted Treatment was identified by Madison Substance Awareness Coalition as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in Substance Use. This is a on-going program in our community.

The MAT program is currently serving 50 clients and is planning to hire another provider to be able to meet the needs of more individuals in the community. The program currently has a waiting list.

The priority population/customers for Medication Assisted Treatment (MAT) are adults and pregnant women with opioid use disorder, MAT aims to make a difference at the individual/interpersonal/organizational and policy level. Implementation will take place in the clinical setting.

Partners

The partners for Medication Assisted Treatment include:

Progress in 2022

Madison County Health Department’s (MCHD) Medication for Opioid Use Disorder (MOUD) program had some struggles and success in 2022. The year started without the capacity to accept new patients which resulted in having nearly 20 people on a waitlist come October when MCHD contracted with a new X-waivered provider. Unfortunately, many of those on the waitlist did not engage in care. A major success for 2022 was securing two different grants to support the MOUD clinic and staff and our client’s treatment and recovery goals.

Progress in 2023

2023 was another successful year for our Medication for Opioid Use Disorder program (MOUD). We were awarded three grants to continue to support our patients with their treatment and recovery goals. We have seen a steady increase in patients resulting in our largest caseload since inception. In addition, we continue to see a majority of our patients thrive.

What Is It?

Teen Intervene was identified by Madison Substance Awareness Coalition (MSAC) as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in substance use in our community. This is a new program in our community.

The priority population/customers for this program are teens, and the Teen Intervene program aims to make a difference at the individual/interpersonal behavior; organizational and policy change level. Implementation will take place in the school setting.

Partners

The partners for this [insert program type] include:

Progress in 2022

Teen Intervene is a new program added to our CHIP in 2022.  The Madison Substance Awareness Coalition (MSAC) hired a Youth Coordinator to lead the program in September. The program received a significant number of referrals and the majority of students completed the program.  The concern is that there was a higher-than-expected rate of repeat referrals. Our focus in 2023 will be to explore the cause of the repeat referrals and attempt to reduce that number.

Progress in 2023

In 2023, Teen Intervene, a program under the Drug Free Community grant, experienced some successes and challenges. Our overall number of referrals for vaping has decreased significantly from the beginning of the calendar year. Additionally, we experienced a decrease in repeat referrals. We continue to see a downward trend, which is a huge success!  In early fall, our Health Education Coordinator, a provider of Teen Intervene, gave her resignation. Fortunately, we were able to hire our Master's level intern as our new Health Education Coordinator. Because of this smooth transition, we did not experience any lag time in serving the youth. 

Communities Served

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.

Progress on CHIPs

All Madison County priorities are addressed in the Community Health Improvement Plan (CHIP). Click on the links below for Progress Made in 2022.

For the priority area Heathy Eating, Healthy Weight and Diabetes see progress tabs for each program below.

HEAL Walk with Ease 

HEAL Cooking Matters 

HEAL Diabetes Education Videos 

For the priority area Substance Use/Mental Health see prograss tabs for each program below. 

Substance Use Medication for Substance Use Disorder (MAT) A 

Substance Use Teen Intervene

Significant or Notable Changes in Morbidity and Mortality

The following represent significant morbidity and mortality changes in our community.

Opioid and Substance Use Action Plan Data Dashboard | NCDHHS

Madison County's rate of overdose deaths in 2020 was at a record high for the county at 46 overdose deaths per 100,000 residents. This rate is significantly higher than the NC rate in the same year, 31.5 overdose deaths per 100,000 residents. However, there were 4 overdose deaths in Madison County in 2021 lowering the rate to 18.4 per 100,000 residents in comparison to the previous year where in Madison County there were 10 overdose deaths. 

Madison, North Carolina | County Health Rankings & Roadmaps

Madison County, according to the 2022 Robert Wood Johnson County Health Rankings, is positioned at 40 out of the 100 counties in North Carolina. Madison County is also represented in the higher middle range of counties (50-75%) in both the health outcomes and health factors measures.

Fifteen Leading Causes of Death

Age-Adjusted Death Rates per 100,000 Population

Standard Year = Year 2000 U.S. Population

Single 5-Year Aggregate, 2016-2020

While there are some minor fluctuations between rankings of the leading causes of death in Madison county there are no sinificant differences when compared to the previous chart covering 2015-2019. One notable difference to note on the current table is the first appearance of COVID-19 as a leading cause of death. 

Emerging Issues Impacting Health

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

• Affordable housing
• Long-term rental availability
• Economic inflation
• Quality childcare
• Food insecurity
• Increase in fentanyl
• Homelessness
• Uncontrolled diabetes
• Vaping, involvement of K-5 population
• Transportation
• Recreation facilities
• Senior Services
• Access to care (extended hours, weekends, and urgent care needs)
• New residential developments 
• Two long term staff members retired from NC Cooperative Extension.
• Loss of two community health workers due to funding.
• The Lords Harvest mobile food delivery restructured/ended partnership with MANNA food bank.
• Covid/Flu/RSV trifecta

New, Paused, or Discontinued Initiatives/Activities

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

• Madison County Cooperative Extension  nutrition education programs
• Overdose 2 Action OD2A program
• Mental Health Awareness and Training Grant (MHAT) -health department next 4 years
• Abiding Hope has a new medical director and nurse on staff 
• Abiding Hope's jail/high school parenting classes were paused due to Covid and have not resumed.
• Healthy Living mobile market paused and upon resuming days of operation were changed- Nutrition Schedules/YMCA of WNC
• Creation of the Madison County Resource Guide with a focus on social determinants of health- Madison County Resource Guide 2022
• Community Health Workers organized multiple health fairs and vaccine clinics in remote areas of Madison County.
• HSHP and La Esperanza  staff completed Community Health Worker certification.
• In Partnership with Land of Sky Regional Council on Aging Civility training was attended by school resource officers and community members.
• In Partnership with YWCA, Racial Justice workshop was attended by community members.
• Madison County Health Department and Madison County dental center brochures now available in Spanish.
• Establishment of Health Department food pantry
• All branches of the MADISON COUNTY PUBLIC LIBRARIES established food pantries-
• Obtained Opioid planning grant
• DFC funding received for an additional five years- Drug-Free Communities Support Program
• Holler Harm Reduction obtained a permanent location
• Madison County Health Department hired a youth coordinator to work with Madison County Schools.
• Madison County Health Department established infant/child supplies and storage facility.
• Madison County Health Department partnered with Healthy Opportunities Pilot- Healthy Opportunities Pilots | NCDHHS

Progress on CHIPs

All Madison County priorities are addressed in the Community Health Improvement Plan (CHIP). Click on the links below for Progress Made in 2023.

For the priority area Heathy Eating, Healthy Weight and Diabetes see Progress in 2023 note tabs for each program below.

• HEAL Walk with Ease 
• HEAL Cooking Matters 
• HEAL Diabetes Education Videos 
• View From Here - Madison County

For the priority area Substance Use/Mental Health see Prograss in 2023 note tabs for each program below. 

• Substance Use Medication for Substance Use Disorder (MAT) A 
• Substance Use Teen Intervene
• View From Here - Madison County

Significant or Notable Changes in Morbidity and Mortality

There are no notable changes in morbidity and mortality to report for 2023.

Emerging Issues Impacting Health

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

• Rapid population growth/Inadequate infrastructure to support growing population
• Increase in development resulting in environmental and economic threat (air pollution, traffic, etc.)
• Environmental concerns related to salt treatment of highways in winter and use of weed killer in summer
• Increasing social/Economic inequality/income gaps
• Low-wage service-industry jobs
• Rising housing costs/Lack of affordable housing options/Cost burdened households
• Aging and substandard housing stock/Overcrowded housing conditions
• Critically low housing vacancy rates/Unused housing vouchers
• Lack of affordable, full time, year round, licensed child care (especially for infants and toddlers)
• Decrease in trust of public health
• Post Covid-19 recovery/continued high school absenteeism rates 
• Increase in seasonal respiratory illness (Covid-19, RSV, Flu)
• Increase in Syphilis and Congenital Syphilis
• Pediatric dental care especially those accepting Medicaid
• Increase in fentanyl overdose deaths
• Potential access to health care issues due to decrease in providers
• More students with mental health challenges in need of therapy and medications
• Students in need of food, clothing, eye exams/glasses, dental and health services

New, Paused, or Discontinued Initiatives/Activities

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

• Family and Consumer Science agent devoted to just Madison County
• Med Instead of Meds classes
• Little Learning Library through Madison County Smart Start for families/community and child care programs
• Two child care expansion grants awarded 
• Mental Health Awareness Training grant and classes
• Teen Intervene expanded to elementary school
• Asheville Area Habitat for Humanity joined forces with Madison County Habitat for Humanity to address housing crisis
• Expansion of water and sewer infrastructure along highway 213
• Pickleball facilities at Mars Hill Town Park
• Improvements/grants/developments at Bailey Mountain Preserve
• View From Here Social Media Campaign