Vision
The shared vision of the Montgomery County Department of Health (MCDH) and its Community Partners is to improve the quality of life of Montgomery County citizens by enhancing their capacity to be healthy. MCDH and its Community Partners conducted the Community Health Assessment (CHA) with several end goals in mind:

• Understand the status of health in the County – what are the Leading Causes of Death, what diseases and conditions are prevalent and where do people get their health care.
• Understand the health and wellness obstacles and needs of the citizens. Calculate their perception of current services.
• Assess the effectiveness of communication between individuals and the health and wellness providers.
• Compare the current status to that of the past with an eye toward altering processes and improving communication in order to affect real change.
• Measure the equity of services and processes.
• Evaluate the position and strength of the County, MCDH and the Community Partners to obtain the necessary funding to make the changes and additions that will improve the capacity of its citizens to be healthy.

Leadership and Partnerships
The historic and ongoing affiliation of the Montgomery County Department of Health and its Community Partners, including FirstHealth, creates a core group of leaders that continually work to improve the health and quality of life of Montgomery County citizens. This core group has stepped-up to lead past CHAs and other efforts to evaluate, modify and improve health and wellness in the County. The core group again provided the leadership, and the muscle, to execute the 2020 CHA. The fact that a full CHA with appropriate documentation was accomplished during an unprecedented pandemic that drastically altered the day-to-day functionality and substantially increased the workload of all the partners is a testament to the fact that the core leadership is committed and the partnership is strong. Some of the challenges of the pandemic and resulting staff changes/losses is reflected in the Process included in this report. The CHA Work Group which represents most of the Community Partners is also provided in the following table:

Work Group Member Organization
Craig Jones - Town of Troy Mayor
Bridgette V. Bennett - Better Together Montgomery
Tawanda Bennett - Why Not Me Services
Kimberly Burger - Department of Health, Public Health Educator
Deandra Chambers - Purpose By Design
Annie Dara - FirstHealth School Health Centers
Roxanne Elliott - FirstHealth Community Health
Chrissy Haynes - Cooperative Extension
Pamela Munger - Sandhills Center
Debbi Musika - Montgomery County Partnership for Children
Rhonda Peters - Cooperative Extension
Dottie Robinson - Board of County Commissioner
Amy Santos - FirstHealth Community Health
Karina Sedano - Esther House

Regional/Contracted Services
Montgomery County Department of Health (MCDH) contracted with the consulting firm Leverage & Development, LLC to assist in the analysis of the data and in the development of the CHA report and appendices. The contractor worked under the direction of MCDH. The contractor has worked with several other counties in North and South Carolina on CHAs or CHNAs including: Anson County, NC (2012, 2016, 2020), Rowan County, NC, Union County, NC, Spartanburg County, SC and Cherokee County, SC.

Theoretical Framework/Model
The 2020 CHA was performed in accordance with the guidelines and recommendations from the NC Division of Public Health. The MAPP (Mobilizing for Action through Planning and Partnerships) was used in a modified form. Modifications were done to comply with Covid-19 guidelines from the CDC and the NC Division of Public Health. Modifications primarily impacted the collection of public input because survey solicitation, focus groups and meetings could not be done in person.

Collaborative Process Summary
May 2021: Prepared CHA Report and had it reviewed by CHA Work Group
March - April 2021:
Hired Consultant to do analysis and prepare CHA documents
Gathered Secondary Data
Analyzed Primary & Secondary Data with virtual input from CHA Work Group
August 2020
Modified Plan for Survey Solicitation
Solicited Survey Participation
Received deadline extension from NC Division of Public Health
Summer 2020
Modified CHA Plan because of Covid-19 Pandemic
February/March 2020
Established Work Group & held Initial Meeting
Developed Public Survey & Solicitation Plan
December 2019/January 2020
Determined CHA Work Group Goals
Developed Framework and Methodology

Key Findings

• Diseases of the Heart is the Leading Cause of Death in the County at a Rate that is 108.1 points higher than the #3 Cause of Death. It is 7.9 points higher than Cancer the #2 Leading Cause of Death.
• Several prevalent health conditions & behaviors contribute to Diseases of the Heart including:
  • Hypertension
  • Obesity
  • Diabetes
  • Nutrition
  • Cardiovascular Disease
  • Lack of Physical Activity
• Mental Health / Substance Abuse was seen as a major health problem and unhealthy behavior by the Public Survey participants.
• Rate of Opioid Emergency Department visits has increased by 110.8 points since 2010.
• Life Expectancy of minorities has consistently been lower than whites since 2012.
• Percentage of deaths in several "Leading Causes" is extremely dispproportionate to the percentage of Race/Ethnic population:
  • Kidney Disease
  • Diabetes
  • Cancer
  • Homicides
  • Unintentional Injuries

Health Priorities
Three priorities were selected based on the data collected through the CHA and considering the Healthy North Carolina 2030 Health Indicators/Targets. Care was made to be certain the priorities not only matched the data findings and the priorities of the State, but also position Montgomery County to capitalize on State and local funding and resources.

• Diseases of the Heart
• Mental Health / Substance Abuse
• Minority Health Equity

Diseases of the Heart – Priority
Diseases of the Heart were chosen as a priority not only because it is the Leading Cause of Death in the County, but also because of the following:

• It moved from the second Leading Cause of Death in the 2016 CHA to the first in 2020.
•  It has increased in females.
• It impacts Blacks/African Americans by a greater percentage than whites even though it is the #2 Leading Cause in Blacks/African Americans.
• It is caused or worsened by other health factors and unhealthy behaviors that can be changed/improved/treated.
• It not only has the potential to shorten life, it also diminishes Quality of Life.
• It is related to (affects/causes or is impacted by) several of the Healthy NC 2030 Health Indicators and the Desired Results:
  • Increase physical activity
  •  Improve access to healthy food
  • oReduce overweight and obesity
  • oIncrease life expectancy

Mental Health / Substance Abuse – Priority
Mental Health and Substance Abuse as a combination were chosen as a priority because of the following factors:

• Both of these impact many other health and quality of life issues such as:
  • Employment barrier
  • Maternity complications and Infant health/mortality
  • Traffic accidents and fatalities
  • Violent Crime increase
• Both have consistently been an issue for many years.
• They are often intertwined and must be addressed simultaneously.
• Mental Health was chosen as the 3rd most important Health Problem in the County. (#1 Obesity/Overweight and #2 Diabetes are addressed in the previous priority – Diseases of the Heart)
• Since 2010 there have been significant increases in the Rate of Unintentional Opioid Overdose Deaths and the Rate of Opioid Overdose Emergency Department/Room Visits. The Rate of Emergency Department/Room visits has increased 110.8 points since 2010.
• Participants in the CHA Public Survey said that 3 of the top 4 Unhealthy Behaviors listed in the survey are related to Substance Abuse:
  • #1 Illicit Drug Abuse
  • #3 Prescription Drug Abuse
  • #4 Drunk Driving
• They are related to (affects/causes or is impacted by) several of the Health NC 2030 Health Indicators and the Desired Results:
  • Improve child well-being
  • Decrease drug overdose deaths
  • Decrease excessive drinking
  • Improve birth outcomes
  • Improve access and treatment for mental health needs

Minority Health Equity – Priority
One of the chosen priorities to be addressed during the following three years is Minority Health Equity. This issue was chosen as a priority in part because of the statistical data collected during the CHA process. Another factor in choosing this as a priority was the input and insight from a group of Key Informants that due to their professional positions and involvement with minorities in the County are aware of factors that cause or perpetuate inequities.
Following are the primary factors influencing the choosing of this issue as a priority:

• The high percentage of minority deaths in several Leading Causes of Death compared to the percentage of minority population percentages.
• The high percentage of incident rate for minorities in some diseases and health conditions compared to the percentage of minority population percentages.
• Cultural norms that hamper access to and use of health care, as shared by Key Informants.
• They are related to (affects/causes or is impacted by) several of the Health NC 2030 Health Indicators and the Desired Results:
  • Improve child well-being
  • Reduce overweight and obesity
  • Improve birth outcomes
  • Decrease infant mortality
  • Increase life expectancy

Next Steps

• Share CHA report and appendices with appropriate boards, organizations and agencies.
• Publish CHA online and make printed copies available as directed by State Guidelines.
• Publicize link to online version of complete CHA report and appendices.
• Develop CHIPs that include strategies, tactics and measurements to address the chosen Health Priorities. Engage appropriate community partners. CHIPs to be completed and submitted to the NC Department of Public Health by September 1, 2021.
• Execute CHIPs during 2021 -2023. Use e-CHIPs system to measure progress and rprovide reports to the NC Department of Public Health.

Diseases of the Heart

Mental Health/Subtance Abuse

Minority Health Equity