HNC2030 Scorecard: Mecklenburg County (2022-2025)

Executive Summary

PURPOSE
The Community Health Assessment (CHA) process periodically assesses local data to understand the strengths and needs of our diverse and changing community to inform community health improvement planning, programmatic decision-making, policy development, and financial investments to improve community health outcomes. 

VISION
The Mecklenburg County Community Health Assessment aims to place data in the hands of residents, community-based organizations, and other partners, empowering them to work collectively and build on existing assets to improve structures, overcome barriers, and increase opportunities to be the healthiest community in which to live, work,
and play for all.

LEADERSHIP
Historically, every four years, Mecklenburg County Public Health (MCPH) and a steering committee of community partners led the CHA. In 2022, MCPH joined Novant Health, Atrium Health, and One Charlotte Health Alliance to conduct a single assessment every three years. The newly implemented approach avoids duplication while satisfying all reporting and regulatory requirements for public health via the North Carolina Department of Health and Human Services, and health care systems through the Affordable Care Act.

2022 Mecklenburg CHA Advisory Committee
The CHA Advisory Committee informed all phases of the CHA process including assessment design,
survey recruitment, community engagement activities, and data analysis. The team included representation from public health, healthcare systems, and the nonprofit sector.

• Atrium Health, Kristen Soni Manager, Department Strategy and Programs
• Atrium Health, Jennifer Snow, Associate Vice President of Community Health Strategy
• Novant Health, Lila Riley Compliance Lead, Community Engagement
• Novant Health, Ylida Roberson, Director Program Management-Population Health
• Novant Health, Robbie Doran Manager, Community Engagement
• Novant Health, Kimberly Dull Director of Performance, Community Engagement and Social Determinants of Health
• Novant Health Keiley Como Manager, Community Health Worker Program
• One Charlotte Health Alliance, Rodney Gaddy, Executive Director
• One Charlotte Health Alliance, Emily Lancucki, Operations Director
• Mecklenburg Co Public Health, Paige Bennett, Deputy Health Director
• Mecklenburg Co Public Health, Kimberly Scott Assistant Health Director, Population Health
• Mecklenburg Co Public Health, Susan Long-Marin, Epidemiology Manager
• Mecklenburg Co Public Health, Donna Smith, Epidemiologist

KEY FINDINGS

• Mecklenburg County is an area of continued growth and increasing diversity. Between 2010 and 2021, the population grew by 22%. In 2021, Non-Hispanic White residents made up 46% of the population compared to 50% in 2010. Between 2010 and 2021, the Hispanic/Latinx population had one of the largest growth rates, increasing by 30% to represent 13% of the population. Youth outnumber seniors with those under 18 years of age representing 24% of the population and those 65 years and above half that number at 11%.
• The mortality rate has increased over the past decade. COVID-19 caused a dramatic increase in 2020 and 2021 mortality rates.
• Chronic diseases account for seven of the ten leading causes of death. Heart disease and cancer are the first and second leading causes of death. Chronic conditions are associated with a higher risk of severe illness and death from COVID-19. In 2020 and 2021, COVID-19 became the third leading cause of death.
• Injury is the leading cause of death for persons ages 1-44 years. Unintentional injury is the fourth leading cause of death. The unintentional injury mortality rate has steadily risen over the past decade, partially due to an increase in motor vehicle crashes, but mainly because of an increase in drug overdose deaths; 80% of overdose deaths are due to opioids.
• Homicide rates have risen for the past decade. Homicide is the second leading cause of death for persons ages 15-24 in 2021. Between 2015 and 2020, 50% 0f homicides in Charlotte occurred in five zip codes (28205,28206, 28208, 28215, and 28216).
• Black infants are more likely to die before their first birthday than White infants. Similar to national rates, the county’s overall infant mortality rate has decreased over the past decade. However, the Black infant mortality rate is almost three times the White infant mortality rate.
• Healthy behaviors and access to care can help prevent premature death and onset of disabilities. Over 105,000 adults had no access to health insurance in 2021. The rate of uninsured children has risen since 2016.
• Behavioral health is a growing priority for youth and adults. One in five Mecklenburg adults report being diagnosed with depression; one in five Charlotte-Mecklenburg high school students reports seriously considering suicide in the past year.
• Affordable Housing was the most frequently reported Quality of Life concern among residents surveyed. Thirteen percent of households experience severe housing burden, spending greater than 50% of their income on housing.

NEXT STEPS
Findings from the CHA inform strategic planning and collaborative community action to address priority issues. The next step in the CHA process is the development of Community Health Improvement Plans (CHIPs). CHIPs identify existing assets to inform local solutions to priority issues.

The Mecklenburg County CHIP process begins with Meck Design in June 2023. Meck Design is an interactive day of learning, sharing, and planning to strengthen partnerships and enhance local synergy surrounding community health improvement goals. Completed plans will be submitted to the North Carolina Department of Health and Human Services Division of Public Health for review with plans to launch implementation September 2023.
 

Priorities

Priorities 

Consideration of community input and health indicator data resulted in the top four Mecklenburg County priority health issues:

Access to Care

Access to care refers to an individual’s ability to access and respond appropriately to health care services.

Chronic Disease Prevention

Nationally and locally, chronic conditions, such as heart disease, cancer, and stroke, are leading causes of premature death and disability.

Mental Health

Mental health includes an individual’s emotional, psychological, and social well-being. At every stage of life, from childhood through adulthood, mental health plays an important role in our overall health.

Violence Prevention

Violence is a serious problem affecting all age ranges, and types of people causing death, injury, disability, and emotional health problems that devastate our community. Across the nation, US cities and towns are witnessing increases in violent acts, particularly those perpetuated by firearms.

Why Is This Important?

What We Do

Who We Serve

How We Impact

Why Is This Important?

Multiple forms of violence have caused significant injury and trauma for individuals, families, and neighborhoods within Mecklenburg County. The experiences of victims and survivors impacted by violence weigh heavily on the community and provide a rallying cry for immediate and sustained leadership and action.

A recent uptick in local gun related assaults and homicides have led to a call for solutions to prevent and reduce community violence from wide-ranging stakeholders. The Mecklenburg County Office of Violence Prevention (OVP) was launched in response. OVP coordinates countywide violence prevention efforts to ensure all residents live, learn, work, and play in safe, healthy, thriving communities. The Way Forward strategic plan outlines a community approach to violence prevention. 

What We Do

The Way Forward is a comprehensive five-year community violence prevention plan that aims to reduce overall community violence in
Mecklenburg County through two long-term goals. The plan was developed with wide representation from residents, community based organizations, and other stakeholders. The plan was visited during the Meck Design Community Health Improvement Planning event to determine best strategies for implementation to address community violence.

The plan ultimately aims to see a reduction in the rates (per 100,000 residents) of both homicides and gun-related assaults at the end of the
implementation period of this plan (2028) compared to the baseline year (2022).

Who We Serve

They Way Forward serves all Meckleburg County residents. The impacts of community violence influence the entire county. The outlined strategies recognize that Black and African American residents of Mecklenburg County are disproportionately impacted by community violence and center interventions and prevention initiatives relevant to this audience. The leading age groups of individuals involved in homicides— for both victims and suspects— were between the ages of 18-34. Combined, these groups made up over 50% of homicide victims and over 70% of known suspects in 2015-2020.

How We Impact

What We Do

Cure Violence applies an evidence-based strategy that uses data and evaluated methodology to interrupt violence on the ground. Cure Violence’s methodology includes resourcing community members to work with people who are at the most risk for perpetrating violence. Interrupters are community members and trusted messengers who use their credibility and relationships to mediate conflict and stop violence before it happens. Interrupters work in their neighborhoods, talking to people on the street, during the times that violence is known to happen. Outreach specialists maintain a caseload of persons they support in receiving services and resources to prevent future violence. This program in Charlotte has been named Alternatives to Violence. It is funded by the city and the county and is being launched in July 2021 in the Beatties Ford Road-LaSalle Street corridor.

Who We Serve

Areas of the city and individuals that are most likely to be affected by violence, as identified by data.

How We Impact

Violence interruption stops violence before it happens and prevents future violence. Per the CDC, experiencing violence has a profound impact on lifelong health, opportunity, and well-being. Individuals exposed to violence are often at higher risk of developing physical and mental health conditions, experiencing other forms of violence, and experiencing educational or job challenges. Preventing violence can prevent these significant consequences which jeopardize the health and well-being of families and communities and cost society hundreds of billions of dollars in medical care and lost productivity. 

What We Do

Who We Serve

How We Impact

Why Is This Important?

Mental health includes an individual’s emotional, psychological, and social well-being. At every stage of life, from childhood through adulthood, mental health plays an important role in our overall health.

Description

Why Is This Important?

What We Do

Who We Serve

How We Impact

What We Do

Who We Serve

How We Impact

What We Do

Who We Serve

How We Impact

What We Do

Who We Serve

How We Impact

What We Do

Who We Serve

How We Impact

What We Do

Who We Serve

How We Impact

Description

An overarching CHIP strategy centering coordination and alignment is included to ensure a strengthened stakeholder network. Coordination and alignment includes but is not limited to people, resources, policies, strategies, and funding. 

Progress on CHIPs

Acccess to Care

• Enhance the community’s capacity to provide primary care to uninsured and underinsured individuals and families
  • North Carolina Medicaid expansion launched December 1, 2023 XX Mecklenburg county residents enrolled through February 28, 2024
  • New primary care access points through 8 county-funded partnerships and health systems for uninsured and underinsured residents
  • Mecklenburg County Public Health launched new Colposcopy Clinic
• Strengthen and sustain expanded access to care partnerships
  • Mecklenburg County provided funding to 8 organizations including federally qualified health centers and charitable clinics expanding access to primary care services
  • Mecklenburg County and access to care partners established a core set of core performance indicators rooted in research to ensure quality and evidence-based best practices
• Strengthen coordination among programs focused on alternative pathways to accessing care (e.g. mobile units, Community Health Workers (CHW), telemedicine, etc.)
  • Mecklenburg County Public Health acquired new Medical (2) and Dental (1) Mobile Health Units; internal infrastructure was established to coordinate deployment logistics and maintenance
  • Community partner MedLink formed a committee to strengthen the coordination of alternative pathways to accessing care
  • Mecklenburg County Public Health expanded two local Community Health Workers (CHW) networks, including the 1) CHW Stakeholder Advisory Collaborative, a convening of organizations that employ and support CHWs; 2) Queen City Community Coalition Connect, a coalition led by local CHWs that aims to unify, equip, and empower CHWs to serve the community
  • CHWs convened for a countywide summit to strengthen coordination and collaboration 
  • Mecklenburg County secured funding to launch a pilot Promotora CHW program in partnership with the Latino Faith Coalition; the program slated to launch in Spring 2024 will expand the promotora workforce to include 10 additional Latino bilingual CHWs  

Pictured Below: Meck Health In Action (MHIA) Mobile Unit

Chronic Disease Prevention

• Implement Making Healthy Choices Easier Chronic Disease Prevention Plan
  • Subawarded CDC REACH grant funds to support tobacco prevention, physical activity, and healthy eating policy, systems, and environmental changes
  • Funded 20 grassroots organizations, nonprofits, and faith-based organizations to implement chronic disease prevention programs via Mecklenburg County Public Health, Health Equity Grant Program
• Increase and improve opportunities for physical activity with a focus on bicycle and pedestrian safety
  • Increased Safe Routes to School (SRS) partnership programs across Mecklenburg County
  • Initiated Health in All Policies(HIAP) Economic Development plan
• Increase and improve healthy food environments and strengthen healthy food access
  • Expanded access to healthy food via mobile markets, food distribution, and healthy corner store initiatives and new infrastructure investments in the Charlotte Mecklenburg Food Policy Council, West Blvd Neighborhood Coalition (Three Sisters Market Co-op), and Carolina Farm Trust Food Distribution Center
  • Expanded access to SNAP Double Bucks and SNAP EBT through 75% of Mecklenburg County Farmers Markets
• Increase and improve the number of tobacco-free environments and prevent youth tobacco use
  • Launched nationally recognized menthol focused education and awareness campaign
  • Promoted QuitlineNC services to residents, health care professionals, and community engagement partners through awareness campaign (quitline data and comparison of baseline, previous fiscal year, to be provided July 2024)

Pictured Below: Mecklenburg County Office of Chronic Disease Policy and Prevention Traffic Garden Demo

Maternal and Child Health

• Implement strategies outlined in the Mecklenburg County Prenatal-to-Three Strategic Plan
  • Began implementation of the Mecklenburg County PN-3 Strategic Plan
  • Local health systems expanded maternity care initiatives
• Support community-based supportive and wrap-around services for pregnant and postpartum women
  • Expanded community-based supportive programs for pregnant/postpartum women, including Nurse-Family Partnership
  • Implemented year two of A Guided Journey perinatal community health worker program
  • First-ever Healthy Start Initiative launched by Care Ring, with MCPH support
• Expand awareness and opportunities for breastfeeding and safe sleep
  • Conducted safe sleep and breastfeeding education campaigns
• Enhance data systems and data integration to ensure inform maternal and child health strategies and monitor impact
• Provide high-quality prenatal and postpartum health care
• Continue efforts to improve coordination among county services that serve women and infants
  • Developed new Community Pregnancy Resource Guide

Pictured Below: A Guided Journey COmmunity Health Workers

Mental Health

• Support implementation of the Mecklenburg County Behavioral Health Strategic Plan
  • Convened stakeholders to develop Behavioral Health Strategic Plan
  • Opened Behavioral Health Urgent Care facility
  • Established and implementing initiatives funded by Opioid Settlement Fund
  • Launched CDC Overdose Data to Action
  • Implemented Year One of SAMSHA ReCAST II to address community resilience and trauma informed capacity

Pictured Below: The Smith Family Behavioral Health Urgent Care

Violence Prevention

• Launch and sustain The Way Forward (TWF) community violence plan implementation coalition
  • Awarded SAMSHA ReCAST II funding to support trauma-informed approach to community violence prevention
  • Fully staffed Mecklenburg County Public Health Office of Violence Prevention serving as coordinating agency for countywide community violence prevention efforts
  • Launched The Way Forward Advisory Group including more than 50 diverse advisors
• Implement multi-media violence prevention (VP) campaigns with community partners
  • Implemented Clean Graffiti Campaign promoting violence prevention message in areas at increased risk of community violence
  • Launched Not Another Media Campaign 
  • Hosted more than 10 gun lock distribution and awareness events in partnership with local grassroots organizations
• Collaborate with local schools to reduce youth violence by implementing the 100 Youth Advisory Council
  • Launched 1oo Youth Advisory Council engaging more than 100 youth advisors in violence prevention work
  • Expanded Charlotte Mecklenburg Schools partnership to launch Handle with Care
• Provide performance-based funding and technical support for community partners to implement evidence-based strategies that reduce violence
  • Established infrastructure for performance based funding to launch Summer 2024
• Provide technical assistance and training to community-based organizations implementing violence prevention initiatives through the Peacekeepers Academy
  • Launched inaugural Peacekeepers Academy Cohort of ten grassroots organizations
• Implement and expand community violence interruption and hospital-based violence intervention initiatives
  • Expanded Alternatives to Violence (ATV) program to two new sites, totaling three community violence interruption sites
  • Expanded Hospital-Based Violence Intervention Program to two local healthcare systems

Pictured below: Peacekeepers Inagural Cohort

Morbidity and Mortality Changes Since Last CHA

Emerging Issues Since Last CHA

Declining immunization Rates

Since 2020, after 10 years of near 95% nationwide coverage, the CDC reports that kindergarten-entry vaccine rates have fallen to 93%. Declining immunization rates leave us vulnerable to outbreaks from diseases of childhood that due to vaccination are no longer frequently seen in this country. Measles, considered eliminated from the United States, is one example. An extremely contagious disease that requires a high coverage rate to maintain herd immunity, measles has caused more cases of disease in the US during the first quarter of 2024 than it did in all of 2023. Most index cases are imported from other countries but may spread to the unvaccinated and immune compromised. Declining vaccine uptake mixed with the ease and speed of international travel creates a situation requiring enhanced surveillance, an increased index of suspicion, and a rapid response to control and prevent further cases.

Congenital Syphilis

Once nearly eliminated in the United States, syphilis and congenital syphilis cases have risen rapidly in nearly every region of the Nation.  Reported congenital syphilis cases more than doubled within a five-year period in Mecklenburg making it a re-emerging public health concern. Rising syphilis cases among women of reproductive age, barriers to receiving high-quality prenatal care and ongoing declines in prevention infrastructure and resources are contributors to this increase.  Strategies to improve outcomes include access to innovative testing and treatment options as well as improved access to quality care during all stages of pregnancy.

Tension between Data Privacy and the Data-Driven Health Department

While there is a move toward and a demand for decisions made based on data in the Public Health arena, there is at the same time a cry for protecting individual privacy. Technology has made available more opportunities for understanding data at a small geographic level, but data privacy protection may oppose the release of such information. Attention must be paid by parties on all sides to intentionally developing guidelines that allow for sharing and using data to better inform community health concerns without compromising individual privacy.

New/Paused/Discontinued Initiatives Since Last CHA

A new organizing framework, Live Well Meck, was established to support the network of partners supporting the CHA, CHIP, and SOTCH implementation. The framework includes four core principles:

• Vision: Live Well is not only the brand used to communicate the local CHA, but a vision for a Healthy Mecklenburg County. It aligns the efforts of individuals, organizations, and government to help all Mecklenburg County residents live healthy lives.
• Priorities: Core areas of focus as identified through CHA primary and secondary data analysis and community input.
• MECKtrics: MECKtrics are core population health indicators used to assess the health status of Mecklenburg County. Each MECKtrick includes an established baseline, trend data, and goals associated with Community Health Assessment (CHA) priority areas of focus. MECKtrics are monitored and reported on annually via the State of the County Health (SOTCH) report to determine progress towards identified goals
• Community/Partners: Includes a network of county partners committed to implementing related CHIP strategies.

Additional New Initiatives 

• Health Equity Grants: The Mecklenburg County Health Equity Grants program provides grassroots, community, and faith-based organizations with funding, capacity-building resources, and technical support to implement programs or initiatives aligned with identified CHIP strategies.

• Community Health Worker Initiative: The CHWI envisions a sustainable infrastructure that supports and values CHWs in Mecklenburg County. It works internally and externally to support CHW programming by 1)Leading and Coordinating Collaborative Groups; 2) Facilitating and Coordinating Trainings and Technical Assistance; 3) Participating in Policy Development and System Change Management; 4)Implementing and Directing Programs and Strategies using the CHW Model.

• A Guided Journey: A Guided Journey is a Mecklenburg County Public Health maternal child health program delivered through a partnership with CareRing which aims to support pregnant women and women at least three months postpartum with linkage to care via NCCARE360 with support from Community Health Workers.

• ReCAST Cycle II: Resiliency in Communities After Stress and Trauma (ReCAST) is a grant-funded program through Mecklenburg County Public Health, running from December 2022 to December 2026. The program, which is currently in Cycle II, is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). The ReCAST II mission is to support community resilience by fostering evidence-based trauma-informed practices such as educational opportunities for the community, improving access to high-quality mental health services, and supporting efforts to curb community violence. The vision is to create a safer and more supportive environment for youth and families in Mecklenburg County.

• Overdose Data to Action: Overdose Data to Action is a Centers for Disease Control (CDC) funded program supporting Mecklenburg County in implementing prevention activities and collecting accurate, comprehensive, and timely data on nonfatal and fatal overdoses and in using those data to enhance programmatic and surveillance efforts.

• Peacekeepers Academy: Peacekeepers Academy is an interactive, eight-session learning series designed to build resiliency for community-based organizations working to address community violence in Mecklenburg County. Participant organizations receive 1) Education/technical assistance from experts focused on violence prevention; 2) Best practices on organizational efficiency; 3) Lessons on how to measure and track success; 4) Lessons on how to increase scalability of services; 5) Holistic public health approaches to prevent and interrupt the cycle of violence; 6) Financial grant to support efforts to learn, implement and achieve resiliency which may include dedicated computers to track an organization’s work

• Prenatal to Three Strategic Plan (PN3): The Mecklenburg County Manager’s Office assembled an Early Childhood Executive Committee to develop a strategic plan to identify policy recommendations to improve the trajectory of child and family wellbeing in the earliest years. Policy priority areas include 1)Healthy and Equitable Births; 2) Optimal Child Health and Development; 3) Parental Health and Emotional Wellbeing. A newly created Senior Public Health Manager was hired to led public health strategies associated with the plan.

Description

The Community Health Improvement Plan (CHIP) outlines priority-centered strategic actions identified by a diverse network of Mecklenburg County residents, grassroots leaders, community partners, and other core stakeholders to improve the population's health. The inaugural Meck Design event catalyzed the CHIP process. The day-long event focused on collaborative learning, sharing, and community health improvement planning with nearly 200 people in attendance. Participants identified successes, challenges, gaps, and opportunities to advance population health improvement through engaging sessions that encouraged trust building, strengthened partnerships, buy-in, and shared visioning and implementation models.

A PDF for the CHIP is enclosed to highlight additional narrative and information as a supplmental tool for partners, residents, and others to view and understand local priorites and strategies. 

View a Meck Design recap video below!