Executive Summary

The Executive Summary can be found on pages 5-11 of the 2021 Avery County Community Health Assessment. 

Avery County 2021 Community Health Assessment Executive Summary

Community Results Statement

Our mission is to partner with local agencies to not only identify health needs of our community, but to also explore and develop possible solutions to address health concerns in order to work toward improving health for all residents.

Leadership for the Community Health Assessment Process

The Community Health Assessment team is comprised of many participants representing area agencies in Avery County, North Carolina. The purpose of this Community Health Assessment is to learn about the health status and quality of life concerns of Avery County residents, collaborate with citizens by soliciting input from the community, and to provide an overview of resources that exist for handling those concerns. This document is the result of collaboration between Toe River Health District, WNC Healthy Impact, and the Healthy Carolinians of Avery County Partnership.

Partnerships

A health department-led comprehensive Community Health Assessment (CHA) provides community insight into the health status of the county. Using surveys, focus groups, interviews, community members, local government and business leaders, and health professionals came together to identify and prioritize health issues.  Participating in the assessment process puts the county in a position to take the next steps in developing policy, environment, and system changes that support their concerns. Currently in Avery County there is a coalition to bring together all the organizations and individuals that are committed to improving health in the county. This group consists of motivated individuals who are advocates on behalf of a broad range of community members and can represent appropriately the concerns of various populations within the county. The limited resources available in the county demonstrates a need for a coalition who will take responsibility and provide leadership for promoting and supporting policy, systems and environmental change that support healthy eating, and increase physical activity and prevent tobacco use throughout the county to combat most chronic disease conditions.

Membership of Healthy Carolinians of Avery County Partnership

Regional/Contracted Services

Our county received support from WNC Healthy Impact, a partnership and coordinated process between hospitals, public health agencies, and key regional partners in western North Carolina working towards a vision of improved community health. We work together locally and regionally to assess health needs, develop collaborative plans, take action, and evaluate progress and impact.  This innovative regional effort is coordinated and supported by WNC Health Network. WNC Health Network is the alliance of stakeholders working together to improve health and healthcare in western North Carolina. Learn more at www.WNCHN.org.

Theoretical Framework/Model

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

Collaborative Process Summary

Avery County’s collaborative process is supported on a regional level by WNC Healthy Impact (WNCHI).  Locally, our process is a community-wide and multi-faceted approach to completing the community health assessment and giving this information to the community.

The collaborative process includes input from the community as an important element of the community health assessment process. Our county included community input and engagement: (1) Through partnerships on conducting the health assessment process; (2) Through primary data collection efforts; (3) In the identification and prioritization of health issues. Community engagement is an ongoing focus for our CHA Leadership Team as we move forward to the collaborative action planning phase of the community health improvement process.  Partners and stakeholders with current efforts or interest related to priority health issues will continue to be engaged. We also plan to work together with our partners to help assure programs and strategies in our community are developed and implemented with community members and partners.

Phase 1 of the collaborative process began in January 2021 with the collection of community health data. For more details on this process see Chapter 1 – Community Health Assessment Process.

Key Findings

A community wide 75-questionnaire was conducted in the spring and summer of 2021 to give residents an opportunity to express concerns and opinions about the quality of life in Avery County. This included questions about the quality of life, economy, education, health, housing, physical activity, social issues, transportation, and COVID. Surveys were conducted by telephone by a trained interviewer and efforts were made to reach a representative sample of the population.   Self-administered surveys were also available online. A total of 225 Avery County surveys were analyzed: 200 via telephone interview and 25 via the publicly available weblink.   

Some of the major findings that the Healthy Carolinians of Avery County discussed in the prioritization process included the large proportion of respondents whose life has been negatively influenced by substance abuse.  Approximately 27% of respondents were classified as excessive drinkers and 12% reported using opioids in the past year, with or without a prescription.  Twenty percent of respondents reported more than seven days of poor mental health in the past month and almost 20% did not get needed mental health care or counseling in the past year. Sixty-five percent of Avery County respondents had calculated BMIs in the overweight or obese range and less than a quarter of respondents got the recommended amount of physical and strengthening activity in an average week.  Twenty percent of respondents reported current smoking, 12% used smokeless tobacco and 7% used vape products.

In additional to secondary data and survey collection, eleven (11) community stakeholders participated in an online key informant survey.  Individuals were asked to consider specific health issues, provide comments about social determinants of health, and evaluate the strengths and opportunities of the Avery County community. The graphic below displays a summary of their ranking of health topics in the community.

During monthly meetings, standards for the Community Health Assessment Process and Accreditation were discussed and reviewed for publication in the 2021 Community Health Assessment. Each member reviewed and approved of the Community Health Assessment Survey and Community Resource Directory included in the assessment. After the analysis was completed, qualitative and quantitative data findings were presented to the CHA team. The team reviewed the data and developed the top ten major health issues based upon statistical data and community survey results.  Based on findings from the community survey combined with secondary health data, in November 2021, Healthy Carolinians of Avery County members identified chief health concerns for the county.

1. Substance Abuse
2. Obesity Issues
3. Mental Health
4. Childhood Trauma
5. Food Insecurity
6. Poverty Issues
7. Housing Expenses
8. Language Barriers
9. Stigma
10. Effects of COVID-19

Health Priorities

In November 2021, Healthy Carolinians of Avery County along with the CHA Team members participated in a prioritization activity to determine the three leading health concerns to be addressed during this cycle. The worksheet asked that each of the ten concerns be ranked, to find the top three concerns for future action. The results from the prioritization process were reviewed and discussed at the meeting. Results of these worksheets were calculated to come up with the top three priorities, which are as follows:

1. Mental Health
2. Substance Abuse
3. Food and Nutrition

Next Steps

The 2021 CHA will be disseminated in a variety of ways. To begin, the document will be made available online at http://www.toeriverhealth.org.  Hard copies will also be available at the Health Department, local library, and printed upon request. The CHA Facilitator will present the CHA data during a Board of Health Meeting, Healthy Carolinians of Avery County steering committee meeting, Avery County Health Department staff meeting, and upon request.

Further steps will be taken including the development of a community health improvement plan based on the findings from the CHA. The CHA Facilitator will convene community members and partners interested in moving forward on the selected health priorities. Action teams will emerge from the selected health priorities and the teams will begin brainstorming evidence-based strategies. While much work has already been done to improve the health of our community’s residents, more work is left to do to ensure that Avery County is the healthiest place to live, learn, work, and play.

Collaborative action planning with hospitals and other community partners will result in the creation of a community-wide plan that outlines what will be aligned, supported and/or implemented to address the priority health issues identified through this assessment process. 

A key step in action plans will be to determine what is currently going on regarding the top health concerns, and what we would like to see going on regarding these health concerns.

The health partnership will create subcommittees for each health concern and these committees will work on creating collaborative action planning and implementation efforts. Upcoming meetings will be scheduled, and partners will be notified.  We will conduct a root cause analyzes and identify possible evidence-based strategies to tackle the health concerns during the action planning process. 

While much work has already been done to improve the health of our community’s residents, more work is left to do to ensure that Avery County is the healthiest place to live, learn, work, and play.

CHA Priorities

The 2021 Avery County Community Health Priorities are: 

1. Mental Health

2. Substance Abuse

3. Food and Nutrition

Experience and Importance

If we are successful in fully achieving this result, we envision Avery County where….

• All people are happy and healthy.
• People are thriving in a healthy environment all day long.
• People have access to mental health care, for themselves and family members.

Why is this important?

• 20% of survey respondents reported 7+ days of poor mental health in the past month
• The county suicide mortality rate is 28% higher than NC and rose 3% since 2012-2016.
• 16% of survey respondents were currently taking medications or receiving treatment for mental health issues.
• 20% of respondents indicated a time in the past year when they needed mental health care or counseling but could not get it.
• The domestic violence shelter in Avery County served 124 clients in the FY2019-2020 and the shelter was full on 250 days out of the year. 

Good mental health is more than just the absence of individual mental illness or distress.  The social, environmental, systemic, and economic factors of the community we live in and interact with significantly contribute to mental well-being and resilience.   Evidence also provides a strong cause and effect relationship between mental health and physical health, and the relationship between mental health and community factors goes beyond individuals. When a community fosters good mental health, it is rewarded with healthy youth, families, schools, workforce, and economy.

Experience and Importance

If we are successful in fully achieving this result, we envision Avery County where….

• All people are happy and healthy.
• People are thriving in a healthy environment all day long.
• People have access to mental health care, for themselves and family members.

Why is this important?

• 20% of survey respondents reported 7+ days of poor mental health in the past month
• The county suicide mortality rate is 28% higher than NC and rose 3% since 2012-2016.
• 16% of survey respondents were currently taking medications or receiving treatment for mental health issues.
• 20% of respondents indicated a time in the past year when they needed mental health care or counseling but could not get it.
• The domestic violence shelter in Avery County served 124 clients in the FY2019-2020 and the shelter was full on 250 days out of the year.

Good mental health is more than just the absence of individual mental illness or distress.  The social, environmental, systemic, and economic factors of the community we live in and interact with significantly contribute to mental well-being and resilience.   Evidence also provides a strong cause and effect relationship between mental health and physical health, and the relationship between mental health and community factors goes beyond individuals. When a community fosters good mental health, it is rewarded with healthy youth, families, schools, workforce, and economy.

What Is It?

Freedom Life Program helps individuals who have a criminal record and may have faced incarceration encounter a wide range of spiritual, mental, medical, relational, and practical needs as they seek to transition back into the community. There are people in our neighborhoods who are struggling to overcome their past. Many do not have the support they need to gain new footing and break through unhealthy life cycles that impact themselves, their families, and the community. They need our help. Freedom Life collaborates with our community in providing aid and support that will help our justice involved neighbors turn the cycles of their past into opportunity for a new life filled with hope. 

Partners

The partners for this program include:

What Is It?

Avery Youth Initiative, an empowerment and leadership program which centers the voices of youth in Avery County and provides a space for youth to take action on the issues most important to them. The participants seeks to engage young people through meaningful discussions, activities, and experiences, developing their ideas and capacities to implement positive change in their communities and schools.

Partners

The partners for this program include:

Experience and Importance

If we are successful in fully achieving this result, we envision Avery County where….

• All people are living as healthy as they can by having all their basic daily needs met.
• All children in Avery County are clean, fed, and clothed ready to learn at school.
• People in Avery County are obtaining a healthy diet to support normal growth, maintaining a healthy body weight, and reducing the risk of chronic disease leading to overall health and well-being.

Why is this important?

Reliable and sufficient nutrition is necessary order to have a healthy, active life.  Many rural communities, including Avery County, were already struggling with low grocery store access, availability, low wages, and poverty.  The inflating cost of food, supply chain disruptions, and employment impacts resulting from the COIVD Pandemic have complicated the food environment in Avery County.  

• Feeding America projects, that 17% of adults and 21% of children are food insecure in 2021.
• Only 7% of Avery County survey respondents consume the recommended servings of fruits and vegetables daily.
• 24% of survey respondents reported running out of food at least once in the past year or worries about running out of food in the past year.
• The number of individuals receiving Food and Nutrition Services (food stamps) in Avery County rose from 1,815 in Nov. 2,020 to 2,056 in Nov. 2021, indicating an increasing need for food-related assistance.
• There are only four grocery stores in Avery County and all are located in close proximity in the central part of the county; additional grocery shopping options require traveling out of the county.  There are convenience stores and small stores that might sell shelf-stable items. 

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).

What Is It?

Food Distribution Center Friday markets

Partners

The partners for this program include:

What Is It?

Implement a program to help Avery Seniors stay in their own homes and live independently. Outreach volunteers help with home visits, general home assessments, meal deliveries, transportation to and from medical appointments, etc.

Partners

The partners for this program include:

What Is It?

Healthy Opportunities Pilot, delivering whole-person care through coordinated physical health, behavioral health, intellectual/developmental disability, and pharmacy products and care models. It addresses the full set of factors that impact health (both medical and non-medical) and performs localized care management at the site of care, in the home or community.

Partners

The partners for this program include:

What Is It?

Avery Mentoring Program, a program assigning a compassionate adult role model and advocate who helps a youth in need or caring guidance grow up to be their best; commits to spending about two hours per week for one year with a specially-matched mentee. Go fishing together, take a walk, make a meal, or do whatever everyday fun things you both enjoy doing, and just listen to each other.

Partners

The partners for this [insert program type] include:

Progress on CHIPs

Click on each program/ strategy below to find and review updates in the "Story Behind the Measure" note tabs. 

Mental Health and Substance Abuse Priorities

•   New Freedom Life: Reentry Intensive Program (Mental Health and Substance Use)

•     Youth to Youth Group (Avery Youth Coalition) (Mental Health and Substance Use)

Food and Nutrition Priority

•  Food Distribution Center Friday Markets

• New Program to help Avery seniors stay in their homes

• Healthy Opportunities Pilot   

• Avery Mentoring Program 

Significant/ Notable Changes in Morbidity and Mortality

The following represent significant morbidity and mortality changes in our community.
[Guidance: Keep this section brief! Here are some examples provided by WNCHI partners.]

• Drug Abuse and Overdoses rising and need education on Narcan use
  • NC Opioid Dashboard
• Child Adverse Effects are showing more than ever
• Severe Housing Problems getting worse

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.

• Animal Cruelty
• Lack of childcare and daycare options

New/ Paused/ Discontinued Initiatives/ Activities

The following is information on new/ paused/ discontinued initiatives or activities in our community in 2022:

• Community Paramedic Program
• New part of the high school opened and is being enjoyed by students
• Feeding Avery Families purchased a new lot of land and has a brand new facility to serve people free food in a grocery store type environment