HNC 2030 Scorecard: Harnett County 2022-2025

Executive Summary

Executive Summary

Every three years, Harnett County Department of Public Health is required to conduct a Community Health Assessment (CHA). Through this assessment process, the local public health department works with other crucial partners and stakeholders in comprehensively reviewing the health status of the community as well as collecting information about perceptions of health and quality of life in the county. The Community Health Assessment document summarizes these assessment efforts and provides the foundation for community health improvement planning over the next three years.
The vision for the community health assessment process is “synthesizing health data with the voices in our community to chart a course toward a health community for all in Harnett County.”
Leadership for the community health assessment process is largely a bi-sectoral process—between Harnett Health (the hospital and related clinical care system) and the local health department. The process was facilitated by the academic public health department at Campbell University, including more than a dozen graduate students and the primary authorship and direction of Dr. David Tillman. The full leadership team details are below.

Community Health Assessment Team (CHAT)
Harnett County Assessment Leadership Team:
• John Rouse, Director, Harnett County Health Department
• Sandy Godwin, Vice President for Planning, Cape Fear Valley Health
• David Tillman, Chair, Campbell University Department of Public Health

Harnett County Public Health Advisory Group (Healthy Harnett Coalition):
• Georgia Anthony, Project Access
• Terri Farmer, Project Access
• Debra Hawkins, Harnett County Health Department
• Belinda Rayner, Harnett County Health Department
• Kayla Shamaly, Harnett County Health Department
• Melinda McDonald, Alcohol and Drug Services
• Debra Vaughn, Harnett County Division on Aging
• Frances Harrington, Lillington Star Church
• Kittrane Sanders, Cooperative Extension
• Natalia Solera, Poe Center
• Katie Trotta, Campbell University

Community Health Assessment Components
The 2023 Harnett County Community Health Assessment includes the following components:
• A community profile providing overall information on community demographics and socioeconomic factors, including context regarding social determinants of health.
• An analysis of leading causes of death in Harnett County and other secondary health outcomes data
• An overview of the survey data collection process and results
• A description of the health priority determination process, including summaries of important data related to key community health concerns which were presented to stakeholders in multiple community meetings
• Information regarding county demographics, health behaviors & outcomes, and the results from the Community Health Survey
 

The Community Health Assessment Process
The CHA process began in January 2022 with the initial meeting of the Community Health Assessment Team (CHAT). Once again, under the direction of the team from Campbell University, the theoretical fraemwork for the community health assessment process is a local adaptation of the features from the MAPP process. In February, the CHAT met with stakeholders to revise and approve the survey to be used in primary data collection. In March survey data collection began and preliminary reports were shared with stakeholders throughout the summer. Concurrently, members of the CHAT began aggregating and analyzing secondary data. A full version of the report was first made available in the CHNA submitted by Harnett Health in September 2022. Draft versions of the complete CHA document were circulated to key stakeholders—including members of the Healthy Harnett partnership, members of the Harnett County Board of Health, and staff members through Harnett County Department of Public Health. In January 2023 through a series of meetings, highlights from the report were shared with specific stakeholders and three specific health priorities were identified. In these meetings, stakeholder groups were able to contribute assessment of the “Forces of Change” in conjunction with the analysis of the public health system assets and the community health indicators. The drafts of the summary CHA document were finalized for approval in February 2023 and submitted to conclude the community health assessment process in March 2023.

Community Health Assessment Partnerships
 

Harnett County Health Priorities
Through the community health assessment process, the team identified six potential priority areas. These areas are listed in the table below.

Potential Priority Areas

Behavioral Health
Chronic Disease
Motor Vehicle Injuries
Pandemic Response
Physical Activity
Economic Opportunity

Harnett County’s CHA health priorities are (1) Behavioral Health (including substance use disorder and overdose prevention), (2) Chronic Disease and (3) Motor Vehicle Injuries. Community members have rated these concerns as significant with regard to the urgency, severity, and feasibility of improvement efforts.
 

Next Steps
As this report is now completed, several next steps are needed to move the CHA from assessment to action:
1. Results from the 2023 Community Health Assessment will be disseminated to the community via online access, community organizations, media, and promotion through partnerships.
2. Action plans outlining evidence-based strategies to address the county’s health priorities will be developed and submitted to the state.
3. An annual State of the County’s Health (SOTCH) Report will be compiled and released to provide timely updates on health indicators related to our community and the work surrounding our health priorities.

Priorities

Harnett County’s CHA health priorities are (1) Behavioral Health (including substance use disorder and overdose prevention), (2) Chronic Disease and (3) Motor Vehicle Injuries. Community members have rated these concerns as significant with regard to the urgency, severity, and feasibility of improvement efforts.

Why Is This Important?

The leading cause of death in Harnett County is cancer. The total cancer (all cancers) age-adjusted mortality rate for Harnett County is 10% higher than the comparable rate for the state. Specific cancers have mortality rates in which Harnett County is even more disparate. While heart disease is the second leading cause of death in all counties in NC and across the nation, the age-adjusted mortality rates for heart disease in Harnett County is 17% higher than the state average and the highest among the peer counties. The age-adjusted diabetes mortality rate for Harnett County is 37% higher than the state average and is the highest among peer counties. Leading causes of death—including diabetes, cancer, and heart disease—result from community health challenges in managing chronic disease. Chronic disease is relevant for all populations in the county, however, for many chronic diseases, racial/ethnic minority communities bear a disproportionate burden of disability and death.

What We Do

The PreventT2 lifestyle change program, offered by Harnett County Health Department, helps participants make lasting changes to prevent or delay type 2 diabetes. Participants work in a group with a trained coach to learn how to eat healthy, add physical activity to their lives, manage stress, stay motivated, and solve problems that can get in the way of healthy changes. The PreventT2 program offers a chance to prevent or delay the onset of type 2 diabetes by adopting a healthier lifestyle. PreventT2 is part of the National Diabetes Prevention Program, led by the Centers for Disease Control and Prevention (CDC), and is proven to prevent or delay type 2
diabetes. PreventT2 groups meet for a year — weekly for the first 4 months, every other week for 2 months, then once a month for the second 6 months to maintain healthy lifestyle changes. The program is based on research that found people with prediabetes can cut their risk of developing type 2 diabetes in half by losing 5 to 7 percent of their body weight. That is about 10 to 14 pounds for a person weighing 200 pounds. This program is offered in partnership with FirstHealth as part of the NC Minority Diabetes Prevention Program (NC MDPP).

Who We Serve

This program is offered for all residents of Harnett County with an emphasis on the minority population. Racial and ethnic minorities have a higher burden of diabetes, worse diabetes control and are more likely to  experience complications. The North Carolina Minority Diabetes Prevention Program (NC MDPP) is a statewide collaborative effort between local health departments, local health care providers, and community organizations across North Carolina to keep people with prediabetes from developing type 2 diabetes and other health problems, such as stroke and heart disease. The goal of the program is to increase minority access to and participation in diabetes prevention programs in North Carolina.

How We Impact

The goal of the class is to reduce participants' risk of developing type 2 diabetes. Participants set goals to lose 5-7% of their weight and reach at least 150 minutes of moderate intensity physical activity.  We plan to offer one Prevent T2 Program per year.  There will be a minimum of 10 participants per class.  We propose that 80% of class participants will report an improvement in their weight.  In addition, 80% of class participants will report increased physical activity levels.  

What We Do

The mobile mammography screening program at the HCHD provides access to screening mammograms to women through a partnership with Rex Mobile Mammography. The goal is to provide access to 3D screening mammograms to women who have difficulties accessing healthcare due to socio-economic obstacles. The Health Department holds 14 screenings a year with the capacity to screen 280 patients. Screenings are held each month for women age 35 and older with a priority population of uninsured, and women from historically marginalized populations.

Who We Serve

Women from racial and ethnic minority groups and who are uninsured are screened at a disproportionally low rate. We serve women age 35 and older through the mobile mammography screening program with an emphasis on uninsured and women of marginalized communities. The goal is to provide access to underserved community members. Funding assistance is available for women who meet program specific criteria.

How We Impact

Despite strong scientific evidence indicating the effectiveness of breast cancer screening and universal recommendation of expert groups, surveys routinely show underutilization of mammography among eligible women. The goal of the mobile mammography screening program is to increasing utilization of women obtaining screenings. The priority population we serve is minority women, and women who are uninsured. We will provide access to screening mammograms for women age 35 and older. Screening for breast cancer with a mammogram reduces death rates. The Rex Mammography Assistance Program is designed to help uninsured
women, Rex Healthcare Foundation provides funding assistance for women that are uninsured and in need of a screening mammogram, eligibility is based on income and household size.
 

Why Is This Important?

Respondents to the Community Health Survey named Substance Abuse Prevention and Mental/Behavioral Health as the top two “health behaviors that the community needs more information about. Misuse of prescription painkillers along with illicit opioid use (e.g. heroin, fentanyl) are driving the overdose crisis. Substance Use Disorder services help to prevent misuse of alcohol and other drugs and to help people with substance use disorders in obtaining the appropriate services and supports they need to live a life in recovery.

What We Do

Harnett County Health Department’s (HCHD) Narcan Distribution Program began in September 2023. Naloxone can quickly restore normal breathing and save the life of a person who is overdosing on opioids. Naloxone is a safe medication that is widely used by emergency medical personnel and other first responders to prevent opioid overdose deaths. Unfortunately, by the time a person having an overdose is reached, it is often too late. Friends, family, and other bystanders can save lives with naloxone. Naloxone distribution programs give naloxone kits to opioid users, their friends and families, and others who may find themselves in a position to save the life of someone at risk of an opioid overdose. Free Narcan kits are available for pick up at HCHD Monday-Friday between the hours of 8:00am-11:30am and 1:00pm-4:30pm. HCHD is also partnering with local pharmacies, Harnett County Schools, and Harnett County Detention Center to establish Narcan distribution plans for the community.

Who We Serve

Individuals that have friends or family who are at risk of an opioid overdose or individuals who want to help if they see someone having an opioid overdose.

How We Impact

The HCHD NARCAN Distribution Program promotes accessibility to NARCAN through free kits and education.

Progress on CHIPs

Priority: Chronic Disease Prevention

PreventT2 Lifestyle Change Program

Diabetes is the 7th leading cause of death (age-adjusted) in Harnett County. Lifestyle changes can help prevent the onset of type 2 diabetes, the most common form of the disease. Prevention is especially important in individuals currently at an increased risk of type 2 diabetes because of excess weight or obesity, high cholesterol, or a family history of diabetes.

The Harnett County Health Department (HCHD) provides the PreventT2 (Type 2 Diabetes) Lifestyle Change Program. This program is offered in partnership with FirstHealth as part of the NC Minority Diabetes Prevention Program (NC MDPP).  Participants work in a group with a trained coach to learn how to eat healthy, add physical activity to their lives, manage stress, stay motivated, and solve problems that can get in the way of healthy changes. This year long program offers a chance to prevent or delay the onset of type 2 diabetes by adopting a healthier lifestyle. PreventT2 is part of the National Diabetes Prevention Program, led by the Centers for Disease Control and Prevention (CDC), and is proven to prevent or delay type 2.

Outcome: HCHD conducted a PreventT2 Program February 2022-March 2023.  Approximately 88% of class participants were ethnic and racial minorities. Six of the 7 (85%) participants lost weight by the conclusion of the program. Another PreventT2 program began in April 2023 and will conclude in March 2024 with 8 participants.

Mobile Mammography Screening Program

Cancer ranks as the second leading cause of death in Harnett County and North Carolina. The mortality rate for breast cancer in Harnett County has decreased in recent years.  Harnett’s mortality rate for breast cancer decreased since 2014 by 7.3%, while the North Carolina rate has only decreased by 4.6% over the same time frame.

When breast cancer is detected early, and is in the localized stage, the 5-year relative survival rate is 99%. Disparities in screening mammography and barriers to accessing breast cancer screening are most prevalent among racial/ethnic minority and low-income women. These barriers include access to care, language barriers, and lack of medical insurance. The HCHD mobile mammography program provides access to mammography screenings, in partnership with Rex Mobile Mammography.

Outcome: In 2023, the HCHD provided access to 12 mobile mammography screenings with the capacity to screen 240 women. Approximately, 183 women were scheduled and 165 were screened. Overall, 90% of the women scheduled kept their screening appointment.

Approximately 64% of the women screened were ethnic and racial minorities. The percent of women screened by race/ethnicity includes 32% White, 42% African American, 23% Hispanic, and 3% other. Approximately 35% of the women screened were uninsured. Funding assistance is provided for women who meet program criteria through Rex Mammography Assistance program.

Priority: Overdose Prevention

Narcan Distribution Program:  Opioid overdose deaths have been increasing in the United States in North Carolina and Harnett County. Harnett County Health Department’s (HCHD) Narcan distribution program began in September 2023, to prevent opioid overdose deaths. Distribution of naloxone to lay persons, particularly those at high-risk for overdose and their family members, has shown to be a safe and cost-efficient way to reduce overdose deaths (Tobin, Sherman, Beilenson, Welsh, & Latkin, 2009) (Wagner et al., 2010) (Wheeler, Jones, Gilbert, & Davidson, 2014).

HCHD has worked to identify and recruit additional distribution partners which have included  Harnett County Sheriff’s Office, Harnett County Schools, and three pharmacy sites- Angier/Coats Family Pharmacy, Thomas Drug, and Hogan’s Pharmacy as part of our efforts to increase the availability of naloxone sites across the county. We have worked to increase community awareness and knowledge about naloxone through a series of ongoing posts on the HCHD social media sites.

Outcome: HCHD has distributed 146 free naloxone kits to individuals since September 2023. In addition, 219 kits were provided to community organizations. Four community outreach events were conducted in which Narcan was distributed. 

Morbidity and Mortality Changes Since Last CHA

2017-2021

Leading Causes of Death

There were some changes in Harnett County’s Leading causes of death since the 2022 Community Health Assessment.  Based on data from the NC State Center for Health Statistics, from 2017-2021, diseases of the heart surpassed cancer – all sites as the number one leading cause of death among Harnett County residents. COVID-19 moved from the 9^th leading cause of death to the 6^th leading cause of death during this time period.

Emerging Issues Since Last CHA

Hospital discontinued labor and delivery, creating 'maternity desert'. Betsy Johnson Hospital located in Dunn announced September 2023 it will stop providing labor and delivery services in October 2023. The hospital is operated by Cape Fear Valley Health System in Fayetteville, and the news impacts hundreds of expectant mothers. This also impacts the HCHD prenatal clinic.

Congenital Syphilis:  Congenital syphilis is on the rise in North Carolina. Early detection and rapid treatment are key. A NCDHHS public health alert regarding the increase in syphilis in women of reproductive age and in congenital syphilis. In 2023, there were seven neonatal and stillbirth deaths due to congenital syphilis in North Carolina. Congenital syphilis is preventable. All pregnant women should be screened at least three times during pregnancy. Many mothers of infants with congenital syphilis had little or no prenatal care according to NCDHHS report. In Harnett County, from January 2023-February 2024 there were 7 probable cases of congenital syphilis.  HCHD staff continues to work closely with disease intervention specialists (DIS) and prenatal providers to ensure adequate early treatment. Every person deserves to have a healthy pregnancy and baby, and women should be tested throughout their pregnancy to address sexually transmitted infections. HCHD will continue efforts to raise awareness and address this issue with educational campaigns; to increase awareness of syphilis and the importance of testing.  The HCHD follows the recommended testing schedule for screening of syphilis during pregnancy: initial exam appointment, between 28-30 weeks of gestation, and when symptomatic.

COVID-19 Public Health Emergency Ended:  The Department of Health and Human Services (HHS) announced the expiration date for the Public Health Emergency (PHE) for COVID-19 as May 11, 2023.

While cases are down, COVID-19 is still a threat, and the virus remains a leading cause of death in the United States. In Harnett County COVID-19 moved from the 9^th leading cause of death to the 6^th leading cause of death. The HCHD continues to administer the COVID-19 vaccine booster.   The Health Department participates in the Bridge access program. This program provides COVID-19 vaccines to uninsured or underinsured adults (19 years and older) or adults whose health insurance does not cover all COVID-19 vaccine costs. Testing helps prevent and contain the spread of COVID-19. The Health Department continues to provide free at-home COVID-19 test kits. 

New/Paused/Discontinued Initiatives Since Last CHA

Mobile Health Program:  Harnett County Health Department implemented a Mobile Health Program in 2023. The goal of this program is to provide preventative health care to underserved communities in the County. This program utilizes a mobile health clinic vehicle. The mobile health clinic includes a fully functional clinical exam room, triage station and immunization storage units. HCHD has provided outreach efforts which includes Kindergarten vaccinations at five summer reading camps at Harnett County elementary schools, education outreach at local community events, Flu and COVID-19 vaccinations and access to WIC services at local food pantries, and a Potassium Iodide Distribution at Northwest Harnett Fire Department.

2023 Child Safety-Reducing Access (Gun locks and Medication Lock Bag Distribution programs).  Children, particularly preschoolers, spend a significant part of their time at home, where risk exposure is associated with the access to poisonous substances and medicines. Opioids were the most common substance contributing to death, followed by over-the-counter medications for pain, colds, and allergies. Unintentional shootings happen to children of all ages. In homes with guns, the likelihood of accidental death by shooting is four times higher. Everyone is at risk of a potentially harmful gun encounter, but children are especially at risk of accidental shootings. Our goal is to educate parents and guardians about firearm and medication safety.  Our plan is to provide access to gun locks and medicine lock bags to help prevent accidental child deaths in Harnett County. HCHD received an Ann Wolfe Mini Grant in September of 2023 to implement an injury prevention program regarding child safety. Our goal is to implement an injury prevention program by increasing access to gun locks and medication lock bags.  Utilizing grant funds 375 cable gun locks and 268 medication safe lock bags along with educational materials were purchased. The free gun and medication safe lock bags are available at the HCHD for residents. Safety devices are provided during child health and care management visits as indicated.