HNC 2030 Scorecard: Alexander County (2022-2025)
Every four years the Alexander County Health Department completes a comprehensive Community Health Assessment as required by the North Carolina Department of Health and Human Services. This assessment allows us to gather information used to better understand the community’s health concerns, document health status trends and catalyze developing strategies to assess the community health problems.
Community Health Assessments are the foundation for improving and promoting the health of community members. The role of the Community Health Assessment is to identify factors that affect the health of a population and to determine the availability of resources within the community to adequately address these factors. In 2022 the process consisted of three primary steps: survey the community, analyze the data collected, and select health priorities. While the Health Department is the lead agency in conducting the assessment, existing community partnerships are utilized throughout the process to ensure the evaluation truly reflects the community’s needs. The Healthy Alexandrians Task Force is commissioned with analyzing and determining health priorities for Alexander County. Healthy Alexandrians is comprised of a mixture of government agencies, private industry leaders, the non-profit community, and interested community members who are concerned with the ongoing health needs of our community. These individuals, along with the Alexander County Board of Health, examined the survey results and health data to make a final determination of health priorities for the next four years.
Statistical data presented in the report represents the most recent information available at the time the assessment was completed. Health survey results vary and represent the opinion of the person completing the survey.
This Scorecard is being used to illustrate the priority health needs in Alexander County as identified through our Community Health Assessment process and the efforts to address them. Scorecard utilizes the Results-Based Accountability/Scorecard processes through the North Carolina Division of Public Health and Clear Impact. More information is available at:
- Alexander County State of the County Health (SOTCH) Report 2023
- Alexander County Community Health Assessment 2022
- Healthy North Carolina 2030
- North Carolina State Health Improvement Plan
Executive Summary
VISION STATEMENT
The mission for the Alexander County Health Department is to promote, protect and ensure the health and well-being of all citizens of Alexander County. In the practice of public health, the health of the population is monitored and evaluated by examining key indicators such as leading causes of death, access to health care, and health trends such as physical activity. Every four years, the Alexander County Health Department conducts a state-developed process known as the community health assessment (CHA). Findings from the CHA are used by the Health Department to lead strategic planning and to guide collaborative community action addressing identified priority issues. The CHA is also used to meet the requirements for state accreditation of local health departments.
The Alexander County 2022 Community Health Assessment is designed to:
- show the systematic collection, assembly, analysis, and dissemination of information about health in Alexander County
- evaluate the quality of life in Alexander County with an emphasis on health care
- identify trends in chronic diseases, causes of death, and high-risk behaviors; and
- define Alexander County’s health assets, needs, and priorities
LEADERSHIP AND PARTNERSHIP
The Alexander County Health Department guided this process using the Population Health Model. Alexander County Public Health is not the only party responsible for improved health outcomes in this community. Improving health is a collaborative process. With no hospital within Alexander County, the CHA is conducted by the Alexander County Health Department. However, the Health Department works in tangent with a variety of community agencies in providing care and services to residents of Alexander County. The Alexander County Health Department did not receive support from a regional community health initiative or privately contracted vendor to conduct the 2022 CHA.
| Partnerships | Number of Partners |
| Public Health Agency | 1 |
| Hospital/Health Care System | 0 |
| Healthcare Provider(s) - other than behavioral health | 9 |
| Behavioral Healthcare Provider(s) | 4 |
| Dental Health Provider(s) | 5 |
| EMS Provider | 1 |
| Pharmacies | 5 |
| Community Organizations - advocacy, charitable, NGO | 10 |
| Business(es) - employers, not organizations | 657 |
| Educational Institutions - colleges, universities | 1 |
| Public School System | 1 |
| Media/Communication Outlets | 3 |
| Public Member(s) | 18 |
| Others - specify: | 4 Chiropractors 6 Veterinarians |
To prepare this Community Health Assessment, the Alexander County Health Department collaborated with representatives from Alexander County DSS, Alexander County School System, Alexander County Cooperative Extension, Alexander County Emergency Management, and citizens from the community. Once the Healthy Alexandrians Committee Members chose the focus areas, the Board of Health approved them.
2022 Healthy Alexandrians Committee Members
Alexander County Health Department: Billie Walker, Mallory Chapman, Dorian Maltba, Kimberly Edmisten
Alexander County DSS: Thomas Mitchell
Emergency Management: Daniel Fox
Guardian Ad Litum: Cassie T Hileman
Alexander County Schools: Donna Mayberry, Jessica Anderson
Alexander County Government: David Moose
Alexander Partnership for Children: Paula Cline
Alexander County Early Head Start: Cathy Knepp, Angela Revell
ICGH Treatment Centers: Stacie Parson
NC Cooperative Extension Alexander County: Der Holcomb
Citizens: Pedro Renteria, Mike Richmond
Board of Health Members
Dr. Thomas Rider
Dr. Richard Williams
Dr. Jennifer Hull
Hazel Yoder
Betty Long
Scott Westmoreland
Macy Jones
DATA COLLECTION
To build a comprehensive assessment, the Health Department utilized both primary (collected directly) and secondary (provided by other identified organizations) data sources to compile data.
- Primary data collection tool-the 2022 Alexander Community Health Assessment Survey distributedto the public in both paper and web-based formats from September 2022 until Februrary 2023.
- Electronic and paper versions in both English and Spanish were used to facilitate broad participation.
- A link to the 2022 Alexander County CHA Survey was posted on the Alexander County Health Department website, Facebook page, and sent via email to all county employees and ocmmunity partners. Paper versions were distributed at the Health Department and local community events and health fairs. Five hundred twenty five responses were collected through these formats.
- Secondary data gathered from local, state, and national sources were also collected from outside organizations and were used in assessing the severity of the health issues in the county.
KEY FINDINGS
In February 2023, members of the Healthy Alexandrians Task force reviewed indicators specific to the following areas:
- Mental Health
- Substance Use
- Healthy Living (exercise/fitness, managing weight)
- Child Care/Parenting
- Elder Care
Members next reviewed the data obtained from the 2022 Alexander County Community Health Assessment Survey and anked them using the following criteria: severity, magnitude, urgency, and intervention effectiveness. Survey respondents made recommendations for the top 10 areas of concern: Affordability of care, Access to Care, Depression/Mental Health, Overweight/obesity, Availibility/Affordability of healthy foods, Dental Health, Lack of Physical Activity, Cancer, Heart Disease, and Diabetes
HEALTH PRIORITIES
Participants of the final Priority Setting meeting in February 2022 made recommendations for the top 4 health concerns to address in the next four years: Mental Health, Healthy Living, Child Care/Parenting, Elder Care. The 2022 CHA Priorities were similar to the priorities in 2018. The Healthy Alexandria Task Force decided that these were the most important areas to focus on over the next four years. The next steps for each focus area are as follows:
Mental Health
- Build behavioral health program at the Alexander County Health Department by hiring an LCSW available to the community and any county employees
- Create public awareness/educational campaigns centered around Substance Abuse
- Work with the Substance Use Disorder Coalition to use Opioid Settlement Funding to bring implementation programs to Alexander County within the community around Mental Health and Substance Use
- Increase public awareness of existing counseling resources for mental health/substance use within Alexander County
Healthy Living
- Investigate areas within the community (churches, parks, schools, etc.) that already have existing available space for the public to use at little to no costs within each community in Alexander County so that individuals have easy access to areas to exercise.
- Create educational campaigns/advertisements for the community to promote local and safe areas to exercise
Child Care/Parenting
- Participate in the Child Collaborative Meetings to bring improvements to child care and parenting issues within Alexander County
- Work with Child Collaborative on a strategic plan for improvements in these areas within the county
Elder Care
- Work with the senior center to survey specific needs within this population
- Work with the Board of Health to see what future plans we can put into place to improve access to elder care within our community
2023-2026 ALEXANDER COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP)/STRATEGIC PLAN
Utilizing the data from the Community Health Improvement Process, a CHIP was developed in order to address the priority areas of concern.
This Scorecard is being used to illustrate the priority health needs and efforts to address them utilizing the Results-Based Accountability/Scorecard process through the North Carolina Division on Public Health and Clear Impact. More information available at:
- Healthy North Carolina 2030
- Healthy North Carolina 2030 Scorecard
- North Carolina State Health Improvement Plan
- Clear Impact's Results-Based Accountability Resource Library
- Clear Impact: The Results-Based Accountability Guide
Priorities
For the 2022 Community Health Assessment, the focus group chose Mental Health, Healthy Living, Child Care/Parenting, and Elder Care (includes substance use, obesity, heart disease, access to care, etc.) as the health priorities for the next four years. Very similar priorities were chosen for the 2018 CHA. Below is the work Alexander County Health Department has done in collaboration with other community agencies to address these needs: Mental Health, Healthy Living, Child Care/Parenting & Elder Care.
Mental Health
One of the priority areas chosen for this Community Health Assessment was Mental Health. Mental Health has been a priority since the 2014 CHA and has consecutively been the topic of conversation in meetings and around the community. This year the Healthy Alexandrian Task Force felt that Mental Health and Substance Use go hand in hand. The Alexander County Substance Use Disorder Coalition, Child Collaborative and Healthy Alexandrian Task Force are working closely together to address these priorities of mental health and substance use together as a whole since each group has access to different valuable information. When this information is brought together and each group brings different knowledge and expertise to the table, we can accomplish more together. Currently, Alexander County has RHA Behavioral Health Serv
Healthy Living
Living a healthy life is key to better health outcomes, quality of life, and the health of the overall community. Healthy living was the second priority selected by the Task Force. The topic was selected to improve the overall health and wellbeing of the community. Alexander County Health Department plans to collaborate with the Child Collaborative, Substance Use Prevention Coalition, and Healthy Alexandrian Task Force to investigate areas within the community like churches, parks, schools, etc. that already have existing space available for the public to use at little to no cost. This will be used to advertise local and safe areas within each community so that it may be more accessible to residents who do not want to pay or drive very far in order to maintain their health and physical activity. Farmers markets will continue to be promoted in the county offering fresh fruits and vegetables to the community. Currently, the Alexander County Health Department has a Health Educator position and that individual goes around the community to educate and teach individuals about health, what services the health department offers and who those services are available to, and is able to into schools to teach children in classrooms on various health outcomes. Rocky Face park in Alexander County is open to the public and provides a variety of outdoor physical activity opportunity like the vertical mile challenge. Alexander County has various food pantries and a soup kitchen that offers healthy meals to the public and a WIC program serving the health department for women, infants, and children so that they have access to healthier food options. WIC also offers breastfeeding support and education for mothers and expectant mothers.
Child Care/Parenting
Currently, Alexander County has twenty-one childcare programs within the county and there are eight hundred twelve children birth through school aged children enrolled in these programs. Some families with low income or more than one child in the childcare programs struggle to afford the cost of childcare, which can lead to children being left unattended, a parent having to quit a job and losing part of an income, or leaving the child with someone untrustworthy because parents feel as if they have no other option. Subsidy funds are available, however the parent has to make less than $34,836 in order to qualify and receive that. There are issues with staffing childcare centers due to daycare teachers being underpaid. On top of that, there is currently no Pediatrician in the county; however, other providers such as family practitioners if needed can still see children. The Alexander County Health Department and Child Collaborative along with DSS and other agencies are currently meeting every month to develop a strategic plan in order to improve the childcare and parenting in the county. There some parenting classes offered within the county to the community through various agencies to provide extra education to parents. Also, Alexander County received a childcare stabilization grant to supplement childcare workers income in order to prevent them from leaving the workforce to lower turnover in childcare facilities through the American Rescue Plan Act. It was stated during a report provided by the Alexander County Schools that 55.75% of students in the school system qualified for free and reduced lunch, the highest in over fifteen years.
Elder Care
Alexander County Alexandrian Task Force viewed 2022 CHA results and felt that Elder Care is a priority in the county due to lack of access, transportation issues, and no hospital within the county. The Alexander County Health Department held a focus group meeting with the senior center to understand some of their concerns regarding elder care within the county. We have one home health care agency in the county, however most of the residents seek healthcare outside of the county. Our goal is to continue to work closely with the senior center in order to hear their needs to be able to advocate for them in meetings and be able to relay that valuable information to providers in our community.
Progress on CHIPs
Based on the 2022 Community Health Assessment, Alexander County's Community Health Improvement Plan focus areas for 2023 remained as Mental Health, Substance Use, Elder Care, Childcare & Parenting, and Healthy Lifestyles. In 2023, Mental Health and Substance Use Disorder were slpit into two seperate priorities. The State of Emergency for the Covid-19 pandemic ended on May 11, 2023. In May of 2023 the Alexander County Health Department discontinued the tracking of COVID-19 numbers apart from deaths.
The Alexander County Health Department provided the community with messaging to support good mental health, promote Lock Your Meds and give away medication lockboxes at approved outdoor events and individually by request, as well as messaging about tobacco/vaping cessation and chronic disease screenings through its Facebook page https://www.facebook.com/alexandercountyhealth and through traditional media such as WBTV and Taylorsville Times. The Alexander County Health Department was able to hire a Licensed Clinical Social Worker in April of 2023 and partner with Alexander County EMS to utilize Opioid Settlement Funds to begin a PORT porgram in Alexander County. Most partner relationships including those with Vaya Health, Alexander County Senior Center, Alexander County Department of Social Services, North Carolina Department of Health and Human Services, and North Carolina Emergency Management were maintained through telecommunications and web-based programs such as Zoom and Microsoft Teams, as well as through in-person meetings and coalitions.
Additionally, members of our staff trained in Results-Based Accountability (RBA) in 2021 and, as a result, Alexander County Public Health has utilized RBA for its 2021 State of the County Report, 2022 Community Health Assessment, 2023 State of the County Health Report, as well as its Healthy Communities grant activities. This moves Alexander County's community health initiatives to web-based documents that are easily understood and utilized by our stakeholders and audiences, simplifying work with partner agencies and helping us to better track results of implemented programs. The priorities and programs are available on our Clear Impact Scorecard and linked with the Healthy North Carolinians 2030 Scorecard for better transparency and to provide our citizens clearer understanding of population accountability.
Mental Health Needs: Hiring a Licensed Clinical Social Worker to serve as a full time Behavioral Health Specialist at the Alexander County Health Department; Applying for the Rural Health Grant to assist with the provision of primary health care to low-income patients
Substance Use Disorder Needs: Distributing 152 medication lock boxes to community members through a grant partnership with RHA Prevention Resource Center, and 20 medication lock boxes at community outreach events and free pickup at the Health Department Clinic; Development and implementation of substance use disorder prevention materials to three local churches, Alexander Central High School health classes, and the Alexander County Senior Center; Partnering with AC EMS Community Paramedic to distribute overdose kits which include Narcan, test strips, information on overdose and rehabilitation services, and local resources; Training in Catch My Breath program to Alexander Central High School, West Alexander Middle School, and East Alexander Middle School teachers to implement to all student body; Promoting the campaign which includes, in part, recognition of overdose signs and symptoms, introduction to NC Good Samaritan and Naloxone Access Laws, and resources for additional information, alongside Lock Your Meds & #naloxonesaveslives in our social media, on our website, and Health Department electronic sign
Healthy Living Needs: Promoting nutrient-dense foods, physical activity and tobacco cessation messaging and opportunities via our website and social media; Certifying our health educator as a trainer for CATCH® My Breath and training nine new community leaders in the program; Improving access to care by providing drive-thru flu vaccinations at the Health Department every Friday the month of October; Collaborating with Cooperative Extension to promote and provide wellness and nutrition classes to the underserved population of the county
Child Care Needs: Partnering with the Child Collaborative to utilize Systems of Care Grant funds for childcare and wellbeing programs; Promoting local child care services and partnering with Early Head Start to campaign for parents’ education and rights through social media and promoting an in-person class for the Spanish community
Elder Care Needs: Developing and implementing health education presentations to be displayed at the senior center during Monthly Birthday Lunches
Morbidity and Mortality Changes Since Last CHA
In 2023 in Alexander County, the most significant change in morbidity and mortality shifted from the results of the COVID-19 pandemic back to chronic diseases. In 2023 diseases of the heart was the leading cause of death, closely followed by cancer. Compared to updated data reflecting the number of positive tests and deaths per week for 2021 and 2022, 2023 showed a significant decline in deaths from coronavirus. The Alexander County Health Department stopped tracking coronavirus apart from deaths in May of 2023 as the Federal government ended the state of emergency.
Emerging Issues Since Last CHA
The impact of climate change on health, specifically vector-borne infectious disease has presented itself as a major issue with pathogens being spread to people from insects like ticks and mosquitos. The warming planet is expanding the range of mosquitos which carry dangerous pathogens like dengue, chikungunya, Zika, and yellow fever.
Mental Health and substance use/abuse issues continue to rise across the nation, and with this the rates of vaping and e-cigarettes in the youth population have drastically increased. The long-term health consequences of e-cigarette usage is still unknown.
In 2023 there was a significant rise in syphilis cases, especially congenital syphilis in North Carolina with a shortage of the antibiotic recommended for treatment.
New/Paused/Discontinued Initiatives Since Last CHA
The State of Emergency for coronavirus ended on May 11, 2023. In May of 2023 the Alexander County Health Department discontinued the tracking of COVID-19 numbers apart from deaths. The calendar year of 2022 saw 26 deaths in Alexander County from COVID-19, and calendar year 2023 saw a total of 7 deaths from the respiratory virus. COVID-19 positive cases listed in the chart run from January of 2022-May of 2023.
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