HNC 2030 Scorecard: Hoke County (2021-2024)

Executive Summary

Hoke County Health Department (HCHD) is pleased to present the 2021-2022 Community Health Assessment (CHA). This report guides community members and stakeholders who wish to become involved in or continue to engage in health and wellness improvement. It also provides an opportunity for the local public health sector to evaluate the health of the population and factors that contribute to high health risks and subsequently set goals to address these issues through the Community Health Improvement Plan (CHIP).

The review provides us with a picture of the health status of the residents in our communities. It includes information about social and health-related problems that impact health status. As we embarked on this CHNA process, the country, North Carolina, and our county of Hoke were focused on mitigating the COVID-19 pandemic. The process for this CHNA is affected by the pandemic in several ways. It is less collaborative than other CHNAs because we were mindful that our partners had more than enough to do to manage the care they provide. We needed to find ways to allow respondents to focus on health concerns other than COVID-19 when that was their primary concern, and when we look at the community input, we wonder how much of the response is related to COVID. Most of the "hard" data indicators are from 2019, the newest data available, but also unaffected by COVID-19. COVID has also affected our ability to develop an implementation plan that addresses the participants' concerns in our CHNA process. We have a three-year window to implement strategies and anticipate that sometime in the next year, the issues of COVID contagion will be controlled. Still, plans will focus on large projects in scope in collaboration with community partners, with a longer development process, and that will significantly impact community health.

Our assessment includes a review of population characteristics such as age and racial and ethnic composition because demographic factors are important determinants of health. Socioeconomic factors such as education, employment, and poverty are included because current research suggests that the way a person lives in their community, the challenges they face, and the solutions they find play a substantial role in that person's ability to lead a healthy life. The assessment also looks at risk factors like obesity and smoking and health indicators such as mortality rates and preventable hospitalizations. Community input is vital to the process, and we conducted a community survey, key informant interviews, and solicitation from critical stakeholders. Finally, the assessment presents the health status indicators that depict the medical conditions commonly found in the community. Each data type is essential in developing a comprehensive view of community health.

The needs assessment identifies numerous health issues that our communities face. While there are many significant community health problems, we focus our efforts on the topics listed below. Considering factors such as the size and scope of the health problem, the severity and intensity of the problem, the feasibility and effectiveness of possible interventions, health disparities associated with the need, the importance the community places on addressing the need, and consistency with our mission "to improve health every day," we have identified three priority health problems in our area, all of which have been exacerbated by the COVID-19 pandemic. Because of the high number of deaths due to chronic disease, and the needs indicated by community members through the health opinion surveys, Hoke County has decided to focus on Heart Disease, Diabetes, and Hypertension, enhance efforts to address behavioral health issues related to addiction and suicide and embed health equity across the county of Hoke.  

Priority Area 1:  Heart Disease, Diabetes, and Hypertension 

• We will continue to provide preventative and supportive services to educate citizens on the benefits of participating in regular physical activity and eating a healthy diet. Raising awareness of the importance of maintaining healthy glucose levels will be strongly encouraged to those living with diabetes to prevent complications from the disease. We must educate the public about these health concerns, and proactive efforts must be continued to assist community members in initiating and maintaining healthy, positive lifestyle changes. Efforts will be made to make physical activity opportunities available and increase nutrition education opportunities. Advocacy and consideration of even greater physical activity initiatives and walking trails will continue to be advocated for and established in the county.

Priority Area 2:  Behavioral Health 

• We will aim to address the community's mental health needs by making available a more holistic sense of health within the county by linking health's psychological and physical aspects. We will focus efforts on decreasing the stigma associated with mental health, addressing gaps in mental health care, increasing access to mental health services, and becoming more actively involved in policy and advocacy activities addressing mental health.

Priority Area 3:  Promotion of Health Equity 

• We will advocate for critical partners such as community- and faith-based organizations, employers, health care systems and providers, policymakers, and others to support our efforts in promoting fair access to health. We will keep eliminating socioeconomic and racial/ethnic health disparities as an integral part of our public health chronic disease prevention and health promotion efforts.  Most of these priority health issues are continued from and interrelated with previous CHNAs, and this makes sense because these are complex intractable health conditions. It takes many years and a concerted effort to make positive changes that are significant enough to impact outcomes for the whole community.

In 2019, an implementation strategy was developed to address these problems, and many programs have been designed to improve health for those who face these health challenges. Progress has been tracked on the implementation activities to evaluate the impact of these programs. For the coming three years, we will design our strategies with an awareness of how the needs and interventions impact the vulnerable in our communities, including older adults, children, and people of diverse backgrounds.

The report aims to offer a meaningful understanding of the most pressing health needs across Hoke County and guide planning efforts to address those needs. The team provided special attention to the needs of vulnerable populations, unmet health needs or gaps in services, and input from the community. Findings from this report will assist in identifying, developing, and targeting initiatives to provide and connect patients with resources to improve these health challenges in the community.

Vision Statement

We strive to promote Healthy People and a Healthy Environment for Healthy Communities within and to surround Hoke County through recognizing, valuing, and pursuing health and overall wellness. HCHD values relationships, partnerships, and collaborations that unify and advance our priorities. We believe our unified priorities will infuse a quality output that results in new, creative solutions to our community health challenges. With these new priorities and innovative solutions in mind, we hope to communicate better with each other, instilling the value of good health and how to achieve it as a thriving, connected community.

Leadership

Partnerships/Collaborations

The CHA was completed through a collaborative effort that integrated the Community Health Needs Assessment (CHNA) process with Cape Fear Valley Hospital.

The Community Health Assessment (CHA) is a three-year process required of local health departments in the consolidated agreement between the North Carolina Division of Public Health and individual health departments. It is crucial for planning and implementing projects and programs by public and private healthcare providers, businesses, and community members. It is also required for local health department accreditation through the NC Local Health Department Accreditation Board.

The CHA is part of a collaborative process of collecting and analyzing data, developing priorities, and planning actions to improve Hoke County's health. The results of this CHA will provide the basis for the development of the Hoke County CHIP. This report helps HCHD meet the requirements to complete a community health needs assessment every three years and is part of the essential services of local public health departments based on standards by the Public Health Accreditation Board.

The Community Health Needs Assessment data is reported using the framework for the County Health Rankings from the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. These rankings, released annually, measure the health of a community and rank them against all other counties within a state. In North Carolina, 100 counties are indexed annually. The County Health Rankings for Hoke County for 2021 is in the Lower 25%-50% quartile for "Health Outcomes," which measures morbidity and mortality and how healthy a locality is a today. "Health Factors" represent factors that influence a community's future health.

Priorities

• Heart Disease, Diabetes, Hypertension
• Behavioral Health (Substance Misuse, suicide)
• Promotion of Health Equity

Why Is This Important?

Life expectancy is a measure often used to gauge the overall health of a community. Life expectancy at birth measures health status across all age groups.

Shifts in life expectancy are often used to describe trends in mortality. Predicting how populations will age has enormous implications for planning and providing services and support. Small increases in life expectancy translate into significant increases in the population.  As the life expectancy of a population lengthens, the number of people living with chronic illnesses tends to increase because chronic diseases are more common among older persons.

Therefore, while getting older is inevitable, adopting healthy lifestyle changes can help you age well and add a few extra years to your life.

Why Is This Important?

The DSMP helps participants learn skills to effectively manage diabetes by checking blood sugar, eating healthy, taking prescribed medications, and being active in order to improve quality of life. 

Description

The Diabetes Self-Management Program (DSMP) of the Hoke County Health Department (HCHD) has been serving the residents since August 2011. The program focuses on empowering diabetic patients through education and demonstrations on self-management. Patients receive information on monitoring, meal planning, medications, complications, sick days care, exercising, and stress management.

What Works

Ensuring that those who recieve education and information do so in a judgement free environment with scientifically backed direction.

Why Is This Important?

Tobacco use remains the leading preventable cause of early death and disease in North Carolina and the nation. Tobacco use and secondhand smoke exposure are responsible for multiple causes of preventable morbidity and mortality in North Carolina. While combustible cigarette use has decreased among North Carolina’s youth, prevalence among adults has declined only slightly, and there are major disparities in tobacco-attributable disease and death among population groups. E-cigarette use among young people has become an epidemic in North Carolina and the nation and poses a public health threat.  HNC2030 pg. 68

Description

Provide and conduct presentations to local agencies and county commissioners regarding the benefits of Tobacco Free government buildings, grounds, vehicles, parks/recreation areas, and smoke-free public places. Promote the benefits of cessation and tobacco-free living during events such as the Great American Smokeout, Take Down Tobacco, and Kick Butts Day. Encourage cessation efforts within schools and support school personnel to utilize available evidence-based curriculum and trainings through presentations and handouts for resources on tobacco prevention, suspension, and tobacco/vaping cessation. Spread the message regarding QuitlineNC via social media, mass media campaigns, cards, and brochures, at community events, and through presentations, among area providers.

Why Is This Important?

Improving access to quality behavioral health care is crucial in reducing disparities in mental health and substance use services for marginalized populations and communities.  Those seeking assistance should be ensured a fair and just opportunity to be as healthy as possible.  Social determinants such as employment and housing stability, insurance status, proximity to services, and culturally sensitive care must be considered within behavioral health services.  

Description

Hoke Syringe Service Program began in December 2019 on the brink of the COVID19 outbreak.  The community based harm reduction program provides a range of services, including linkage to substance use and opioid use disorder treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing, and linkage to care and treatment for infectious diseases.  

Description

The Hoke County Health Department participates in getting select employees trained in Applied Suicide Intervention Skills (ASIST) and Counseling on Access to Leathal Means (CALM). As well as providing awareness and education in mental health and suicide prevention and linking residents with any outside resources they may need. 

Why Is This Important?

Medical costs in the United States are extremely high, so people without health insurance may be unable to afford medical treatment or prescription drugs.    For most people, access to affordable healthcare services depends on whether they have health insurance coverage. 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. Although uninsured rates in North Carolina decreased between 2013 and 2016, they have started to rise again. 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. Policy options available to state lawmakers have the potential to greatly reduce the number of people who are uninsured in North Carolina. 

Story Behind the Curve

Hoke County, located in the Sandhills region of southeastern North Carolina, continues growing racially, ethnically, and linguistically. The county’s rapid development over the past 20 years has included dramatic demographic shifts, with the most significant population growth among the military, Latinos, and families with young children. Mental health, infectious disease prevention, health inequities, and addressing the root causes of chronic disease have been identified as the most critical issues affecting the county’s public health. Where we live influences our health, and demographic information helps to understand trends and project potential needs for public health services for the population. Demographic, socioeconomic, and environmental factors contribute to health behaviors, outcomes, healthcare utilization patterns, and community health needs unique to Hoke County. 

According to the 2021 Census, the population demographics include White, at 43.4%, 33.2% Black or African American, 14.3% of the population is Hispanic/Latino, 7.7% identify with two or more races, 7.3% American Indian and Alaska Native, followed by 1.5% Asian, and 0.1% Native Hawaiian and Other Pacific Islander.   

Progress on CHIPs

Chronic diseases are a significant health concern in Hoke County, and several community health improvements have been implemented to address them. Some of the community health improvements for chronic disease in Hoke County include:

Health Education and Outreach Programs: Hoke County Health Department (HCHD) provides health education and outreach programs to residents to increase awareness and promote healthy behaviors. These programs focus on preventing and managing chronic diseases like diabetes, heart disease, and hypertension.  HCHD has a diabetes support group that meets twice monthly, a Registered Dietitian who provides Nutrition therapy, and an Employee Wellness Garden to educate others on small space gardening and the importance of fresh foods and eating healthy.

Chronic Disease Management Programs: The Hoke County Health Department offers several chronic disease management programs to residents, including diabetes self-management programs, hypertension management programs, and heart disease management programs. These programs aim to improve disease management and prevent complications associated with chronic diseases.

Physical Activity Programs: The Hoke County Health Department provides physical activity support programs to residents, including care coordination to fitness classes and walking programs and pedometers to help support the measurement of fitness walking to promote physical activity, an essential component of chronic disease prevention and management.

Access to Healthy Foods: The Hoke County Health Department works to increase access to healthy foods for residents, particularly those in food deserts. The department has implemented an employee wellness garden onsite and a community garden at a local church, providing residents with fresh fruits and vegetables.

Tobacco Cessation Programs: The Hoke County Health Department provides residents referrals to a tobacco cessation program to reduce the incidence of chronic diseases associated with tobacco use, such as lung cancer and heart disease.

Healthcare Provider Education: The Hoke County Health Department provides education and training to healthcare providers to improve chronic disease diagnosis, treatment, and management.

Overall, these community health improvements aim to reduce the incidence and impact of chronic diseases on Hoke County residents by promoting healthy behaviors, improving disease management, and increasing access to healthcare services and healthy foods.

Morbidity and Mortality Changes Since Last CHA

According to the North Carolina State Center for Health Statistics, the leading causes of death in Hoke County in 2019 (the latest year for which data is available) were heart disease, cancer, chronic lower respiratory disease, and stroke. These conditions are also leading causes of death in many other parts of the United States.

Regarding morbidity, the Hoke County Community Health Assessment Report notes that chronic diseases such as diabetes, hypertension, and obesity are prevalent in the county. These conditions can lead to various health problems and complications, including cardiovascular disease, kidney disease, and nerve damage, if not managed properly.

It's important to note that the COVID-19 pandemic has significantly impacted morbidity and mortality rates in many parts of the world, including the United States.

Emerging Issues Since Last CHA

New/Paused/Discontinued Initiatives Since Last CHA