Executive Summary

The Executive Summary can be found on pages 6-10 of the 2021 Mitchell County Community Health Assessment. 

Mitchell 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

Many local organizations assisted the local health department with the creation of this document. Among those were community leaders, public health agencies, businesses, medical community, school systems, and local faith-based organizations and churches. This team worked to identify, collect, analyze, and disseminate information on community assets, strengths, resources, and needs.  This document is the result of collaboration between Toe River Health District, WNC Healthy Impact, and the Mitchell County Health Partnership.

Partnerships

A health department-led comprehensive Community Health Assessment (CHA) provides community insight into the health status of the county. Through the use of 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 put the county in a position to take the next steps in developing policy, environment, and system changes that support their concerns. Currently in Mitchell 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 Mitchell County Health 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

Collaborative Process Summary

Mitchell County’s collaborative process is supported on a regional level by WNC Healthy Impact (WNCHI).  The Community Health Assessment outlines the community’s current health status.   Based upon findings, steps have been developed to implement interventions, as well as community resources to address these health issues.

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 in a number of ways: (1) Partnership 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 76-questionnaire was conducted to give residents an opportunity to express concerns and opinions about the quality of life in Mitchell 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 244 Mitchell County surveys were analyzed: 200 via telephone interview and 44 via the publicly available weblink.   

Some of the major findings that the Mitchell Community Health Partnership discussed in the prioritization process included that 54% of respondents stated that their life has been negatively influenced by substance abuse. An increasing proportion of participants have had more than seven days or poor mental health in the past year and 15% of respondents did not get needed mental health care or counseling in the past year.  Three quarters of Mitchell County survey respondents had a Body Mass Index in the overweight or obese range; 39% had been diagnosed with high blood pressure. 

In additional to secondary data and survey collection, nine (9) 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 Mitchell County community. The graphic 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 Community Health Assessment 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, Mitchell County Health Partnership members identified ten (10) chief health concerns for the county.

Health Priorities

In November 2021, 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, as to find a top three concerns to take action. The results from the prioritization process are reviewed and discussed at the meeting. The final health concerns are named as the focus for the next four-year cycle. Results of these worksheets were calculated to come up with the top three priorities, which are as follows:

1. Mental Health/ Substance Abuse/Domestic Violence 
2. Access to Care/ Use of Services 
3. Chronic Disease/Obesity/Healthy Lifestyles

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, Health Partnership meetings, Mitchell 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.

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.  The next steps will be to formulate action plans regarding these three prioritized health concerns, starting with determining 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 Mitchell County is the healthiest place to live, learn, work, and play.

CHA Priorities

The 2021 Mitchell County Community Health Priorities are: 

1. Mental Health/ Substance Abuse/ Domestic Violence

2. Access to Care/ Use of Services

3. Chronic Disease/ Obesity/ Healthy Lifestyles

Experience and Importance

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

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

Why is this important?

• Although the rate has decreased over time, a higher percentage of Mitchell County residents were dispensed opioids compared to NC and WNC.
• 54% of survey respondents had been negatively affected by substance abuse.
• The Mitchell County unintentional poisoning mortality rate was higher compared to NC and WNC in 2014-2018.
• 20% of survey respondents reported 7+ days of poor mental health in the past month, a higher proportion compared to previous surveys.
• The county suicide mortality rate is 81% higher than NC and rose 8% since 2012-2016.
• The DV shelter in Mitchell County served 293 clients in FY19-20 and the shelter was full on 26 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?

Exploration of 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?

Re-start the Appalachian Youth to Youth Network, an empowerment and leadership program that centers the voices of youth in Mitchell 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:

What Is It?

Conduct a media campaign on public awareness of mental health issues and effects of substance abuse among local officials, Mitchell County residents, and local healthcare providers. 

Partners

The partners for this program include:

Experience and Importance

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

• Peaceful, with more time and energy to engage with community
• More relationship driven
• People listening to each other & respecting each other
• Healthcare with no stigma
• Less stress
• Families can earn a real living wage to live with benefits
• No drugs, alcohol, vandalism
• Respect, honoring each other
• Emotional and physical safety
• Less fear
• Children can safely play outside with their friends
• More connection with nature

 Why is this important?

• While the uninsured population decreased since 2009 in Mitchell cOunty, the percentage remained higher than NC.
• 21% of Mitchell County survey respondents did not have health insurance in 2021. 
• The percentage of the population eligible for Medicaid has increased steadily.
• Nearly 12% of survey respondents reported a time in the past year when they were unable to get medical care.  20% of respondents reported a time in the past year when they needed mental health care or counseling and could not get it.
• As of 2019, Mitchell County had higher provider to population ratios compared to WNC and NC, meaning that there were more providers available to serve the population.8

Our CHA Team, with representation from roughly 20 community organizations, working to broadly address health, social and economic needs, were actively engaged in 3 2-hour work sessions to identify which community health conditions to prioritize.  Using a tool to prioritize conditions based on relevance, impact and feasibility, Access to Care and Use of Services emerged as one of the three areas to focus on for CHIP moving forward.

What Is It?

• Reduce poverty among families
  • Learn, collaborate, and partner with organizations that focus on poverty reduction
  • Collect and report data on how living in lower wealth communities impacts health
  • Recommend and support legislation of a livable wage and pay equity
  • Standardize poverty reduction strategies in systems, services, and programs

Partners

The partners for this program include:

What Is It?

• Increase access to and use of quality, team-based, comprehensive, compassionate primary health care (including preventive, physical, and behavioral/mental health care services)
  • Provide affordable, comprehensive insurance coverage
  • Promote access to and use of immunizations
  • Provide evidence-based culturally responsive patient education and guidance

Partners

The partners for this program include:

What Is It?

Develop a plan to increase community awareness on resources and demonstrate the value of the work to the public and stakeholders.

Partners

Experience and Importance

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

• All people are living as healthy as they can by having all their basic daily needs met.
• All children in Mitchell County are clean, fed, and clothed ready to learn at school.
• People in Mitchell 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.
• Everyone has access to a quality education, safe and healthy homes, recommended amounts of physical activity and nutrition, regular health care appointments and check ups

Why is this important?

• Historically, heart disease mortality rates have been higher in Mitchell County compared to WNC and NC and they have recently risen.  The same pattern is seen among Mitchell County survey respondents: higher and rising rates of heart disease.
• The diabetes mortality rate is also climbing in Mitchell County and was 21% higher than NC in 2015-2019.
• Compared to NC and WNC, a higher proportion of survey respondents were overweight or obese: 75% in 2021.  An increasing percentage of respondents would be categorized as obese: 41% in 2021, higher compared to WNC, NC and the US. 
• 25% of survey respondents reported no leisure-time physical activity; 18% meet the physical activity recommendations.

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?

New recreation center in Bakersville

Partners

The partners for this program include:

What Is It?

Support and assist in planning for new YMCA in Spruce Pine

Partners

The partners for this program include:

What Is It?

Physical Activity Campaign where creative events are hosted throughout the summer, such as Latino Soccer Day (with resource booths) and coordinated dance classes weekly in the park, etc.  Creative ideas to get people of all ages out, active, and social.

Partners

The partners for this program include:

What Is It?

Assist with food drives/food distribution at local food pantries/backpack programs and help meet the basic needs of those in need; media campaign, volunteering at events, help manage referrals, evaluate needs/resources, etc.

Partners

The partners for this program include:

What Is It?

Start a Walk with Ease Program, encouraging others as they put together your own walking plan and set your own goals.

Partners

The partners for this program 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/Substance Abuse/Domestic Violence

•   New Freedom Life

•   Restart Appalachian Youth to Youth (PATH)

•   New Media Campaign

Some projects that we have started and continue currently are:

• Drug take-back days: During these scheduled events, community members have voluntarily turned in more than 500,000 unused prescription medications and another 425 lbs. of illegal drugs, all of which were appropriately disposed of by law enforcement.
• Physician trainings: MYSATF members have drawn upon a national model to train local physicians in the use of the Controlled Substance Registry. Additionally, MYSATF has facilitated roundtable discussions with health care providers about the risk of treating youth and adolescent sports injuries with opioids.
• Free after-school programs: At-risk youth have access to positive role models and community activities through STAR (Students Taking Active Roles) in Mitchell County, the Cougar Fit Club in Yancey County, and the Youth to Youth Initiative in both counties.
• Dissemination of materials: MYSATF is responsible for distributing Substance Use and Mental Health Resource Guides and safe drug disposal guidelines appropriate for community members in both counties.
• Drug Lock Boxes: To date, MYSATF has distributed over 200 FREE medication lock boxes to to individuals, physicians, senior centers, and churches.
• Drug Drop Boxes: Safely dispose of unused medication at one of 4 permanent drug drop boxes. We encourage you to leave medication in the original prescription bottle for the purpose of identifying the type of medication (please MARK OUT personal information on the label).
  • Yancy County Sheriff’s Office
  • Burnsville Town Hall
  • Mitchell County Sheriff’s Office
  • Spruce Pine Police Department

Access to Care/ Use of Services

• New Leadership Conference for Mitchell County Resources 

• New Comprehensive Community Media Campaign

• New Utilization of 211 Resources 

Chronic Disease, Obesity, & Healthy Lifestyles   

• New New recreation center in Bakersville  
• New New YMCA in Spruce Pine
• New Physical Activity Campaign 
• New MANNA Backpack Programs 
• Walk with Ease Program

Here are some examples of organizations and programs we currently host to keep families healthy, especially kids and teens in underinvested communities:

• Offer healthier food and beverage choices overall. Schools can reduce or eliminate sugary beverage options and instead offer a variety of drinking water choices. They can also ensure that the food available on campus (in the cafeteria, snack machines, etc.) more closely matches US nutrition standards.
• Educate students about healthy diets. Schools are arguably the best place for teaching kids about the many benefits of a whole food plant-based diet. Education centered around eating fewer processed foods and more produce can reduce inflammation, strengthen the immune system, provide fiber, reduce the risk of cancer—and help kids maintain a healthy weight.
• Promote wellness and physical activity. In addition to offering high-quality physical education programs, schools can encourage wellness through PSA-style messaging and by designing school contests and challenges around exercise.
• Encourage participation among low-income children and teens. After-school programs through the YMCA actively recruit students for participation, and may be able to waive fees for low-income students. This can help to keep students engaged, help them build new skills, increase their self-esteem, and live healthier lives.
• Find creative ways to promote good health. After-school sports naturally encourage healthy physical activity, but can also teach athletes about how a healthy diet improves individual and team performance. Even non-sports-related activities and clubs can find creative ways to promote good eating habits and fun forms of exercise.

Significant/ Notable Changes in Morbidity and Mortality

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

• Substance Abuse and Mental Health Issues still on the rise
  • NC Opioid Dashboard
• Child Adverse Experiences are showing more than ever
• Severe Housing Problems getting worse
• Uninsured Rate of people in county rising

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.

• Lack of recreational facilities to accommodate youth league numbers
• 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:

• New middle school coming in 2025
• Existing parks being enhanced with new playground equipment, splash pads, Skate Park, and basketball goals.
• New afterschool program for grades K-5th grade provides an opportunity to continue learning after school with homework help from staff and tutors, targeted reading and math activities, social-emotional learning, art projects, guest speakers, and other enrichment activities. The program provides physical activity daily to ensure your child is staying active, as well as a nutritious snack.