HNC 2030 Scorecard: Catawba 2019-2023

Executive Summary

Vision Statement:

We collaboratively aim to achieve a healthier community and enhanced quality of life for all people in Catawba County.

Leadership:

Led by Catawba County Public Health and LiveWell Catawba, in partnership with Catawba Valley Health System and Frye Regional Medical Center, a Catawba County CHA Leadership Team was convened to facilitate and inform the 2019 CHA process. In order to address the various health needs of the community, a multi-sectoral approach was utilized with several areas represented.  

Partnerships and Collaborations:

PARTNER AGENCIES AND SECTORS: 

Regional/Contracted Services:

We contracted creation of the Community Health Opinion Survey and primary data analysis services with a local group, Jackson Creative.

Theoretical Framework/Model:

We used the North Carolina Division of Public Health's eight-phase community health assessment process. 1) Establish CHA Leadership Team: The team comprised of stakeholders from various community sectors, including traditional and non-traditional partners such as the business sector, faith communities, and transportation and housing experts. 2) Collect primary data: Community listening sessions and Community Health Opinion Survey. 3) Collect secondary data: Gathered data from local, state, and national-level sources, along with data surrounding social determinants of health. 4) Analyze and interpret county-level data: Data review sessions with CHA Leadership Team and subject-matter experts. 5) Determine health priorities: Community listening sessions with data review and ranking by community members and stakeholders from key groups. 6) Create the CHA document. 7) Disseminate the CHA document: Distribute throughout the community by reaching out to media outlets, conducting and participating in community meetings, and communicating with key stakeholders. 8) Develop Community Health Improvement Plan: Plan to address health priorities identified in the CHA and how progress will be measured in the short- and long-term.

Key Findings

Drivers of Health, or social determinants of health, help a community understand the root causes of poor health outcomes. The 2019 Community Health Assessment identified the following key social issues that directly impact our health priorities:

• 55% of Catawba County public school students are enrolled in the National School Lunch Program
• 14.2% of the total population and 20.5% of children are living in poverty
• 43.8% of renters are spending over a third of their household income on housing
• 21.9% of residents have a bachelor's degree or higher
• 12.3% of residents are experiencing food insecurity

Life expectancy is a critical indicator in examining a community's overall health and well-being, but where you live within that community affects your potential outcomes even more. In Catawba County, the highest estimated life expectancy by census tract is 82.6 years, while the lowest is 64.6 years, just minutes away. This is why we try to obtain and use data on the most local level possible while examining health issues and identifying opportunities to improve outcomes. 

Infant mortality data highlights a significant inequity in child health outcomes, with Black infants being more than twice as likely to die than White infants. 

Health Priorities

• Chronic Disease

• Brain Health

• Healthy Foods & Healthy Weight

Next Steps:

The identification of health priorities is the beginning of a continuing process. Workgroups will be formed to generate action steps with goals for addressing community needs, and a community health improvement plan will be developed to be submitted by September 2020. The results from the CHA will be shared throughout Catawba County via traditional and non-traditional methods, leveraging partnerships through the CHA Leadership Team and other partner organizations.

Why Is This Important?

Tobacco use is the leading cause of preventable disease, disability, and death in the United States. The use of tobacco harms nearly every organ in the body and causes cancer, heart disease, stroke, lung diseases, type 2 diabetes, and other chronic health conditions. The impacts of smoking extend past the smoker through secondhand smoke (CDC, 2020). Using e-cigarettes also causes health risks. E-cigarettes both contain and emit a number of potentially toxic substances (American Lung Association, 2020).

In Catawba County, chronic lung disease is the third leading cause of death. Chronic lung disease has led to 8,371 years of potential life lost by Catawba County residents. Mortality rates for lung cancer and chronic lower respiratory diseases for Catawba County are also higher than the North Carolina rates. In the 2019 Catawba County Community Health Opinion Survey, 15.5% of the respondents reported having smoked cigarettes or other nicotine products, including e-cigarettes, within the past twelve months; compared to 12.0% in 2015 (Catawba County Public Health, 2020).

If all Catawba County community members lived in communities that supported tobacco free and e-cigarette free lifestyles, Catawba County would potentially have:

• Lower rates of lung cancer deaths,

• Reduced hospital admissions related to lung cancer,

• Increases in life expectancy,

• Increases in community members receiving lung cancer screenings,

• Decreases in the number of community members using tobacco, and

• Increases in the number of tobacco free worksite policies.

• Connection to COVID-19 complications?

References:

American Lung Association. (2020). The Impact of E-Cigarettes on the Lung. Retrieved on November 30, 2020 from https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung.

Catawba County Public Health. (2020). 2019 Catawba County Community Health Assessment). Retrieved on November 30, 2020 from https://catawbacountync.gov/site/assets/files/2488/2019_catawba_county_cha.pdf.

Centers for Disease Control and Prevention. (2020). Tobacco Use. Retrieved on November 30, 2020 from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/tobacco.htm.

Action Plan

At the Chronic Disease Work Group meeting on January 24, 2022, work group members reviewed and updated their current strategies based on what was working well, what was not working well and/or could be removed or changed, and how these strategies impact health disparities in Catawba County. The work group’s action plan was updated to include the following strategies. Action steps related to the followling strategies are discussed and updated during monthly work group meetings. 

Strategies: Tobacco Policy

• Workplaces adopt or enhance comprehensive tobacco-free policies.

• Indoor and outdoor public places adopt or enhance tobacco policies. 

• Media education campaign on tobacco policies to educate the public and have workplaces become more involved in setting tobacco policies. 

Strategies: Lung Cancer Screening

• Screening education for the community and public about why lung cancer screening is a beneficial choice. 

• Promotion and education of lung cancer screenings for providers.

How We Impact

As of December 2022, nineteen teachers from thirteen schools across all three school districts have implemented CATCH My Breath, impacting 1,775 students in grades 6-9.

What Is It?

CATCH my breath is a Youth Vaping prevention program that was developed at the University of Texas School of Public Health.   The program creator, Dr. Steven Kelder, developed the curriculum in response to the spike in youth e-cigarette use.

CATCH my breath is a peer reviewed program, found in the Mar/April 2020 issue of Public Health reports- the official journal of the US Surgeon General.  The study found that students in schools that implemented the program were half as likely to experiment with e-cigarettes over the following 16 months, compared with those in schools that did not receive the program.  The review also found the program increased student knowledge of vaping dangers and positive perceptions and choosing a vape-free lifestyle.

The program has already served 1.8 million students across all 50 states and is in over 5500 schools.  It can be taught to ages 10-18 years/ grades 5-12.  There are 4 lessons per version 5, 6^th, 7/8^th, 9-12^th. Sessions are 30-40 minutes each.  These are easy to integrate into Health, PE, Science and Advisory classes.  The curriculum utilizes peer led teaching approach and meets national and state health education standards.  There is no cost to using the curriculum and it is continually updated so that our teachers can have the most up to date information and strategies to use in the classroom.

Equipping our youth with the tools to say “NO” to risky behaviors like vaping and empowering healthy decision making is a must as we look to improve health in our communities.  Giving our students strategies to avoid unhealthy behaviors along with helping youth that maybe have already started vaping find the courage and support to quit is essential in addressing this Public Health challenge.

https://letsgo.catch.org/courses/take/ToT-catch-my-breath/pdfs/38588212-create-a-catch-org-account-enroll-in-catch-my-breath

Who We Serve

We have worked with School Health Advisory Councils, the Catawba County Public Health School Health team, district staff, and health/physical education teachers to ensure that the CATCH My Breath curriculum is available to all 6th - 9th grade classes across all three school districts. 

What We Do

The Healthy Schools Program Framework of Best Practices identifies specific criteria for a healthy school environment and serves as a guide for policy and practice change. It aligns with the 2017 School Health Index, created by the Centers for Disease Control and Prevention (CDC), which reflects the Whole School, Whole Community, Whole Child model (WSCC). The WSCC model recognizes the connection between health and academic achievement and promotes an inclusive, school-wide approach to student health. The CDC retains the full comprehensive School Health Index at cdc.gov/healthyYouth, addressing seven health topics: physical activity and physical education, nutrition, tobacco use prevention, alcohol and other drug use prevention, chronic health conditions (e.g., asthma and food allergies), unintentional injury and violence prevention (safety), and sexual health.

https://api.healthiergeneration.org/resource/11

How We Impact

This process allows for full participation in school wellness improvements from the classroom all the way up to district administrative staff. This engagement in the planning and prioritization process ensures better representation in decision-making and buy-in across the district as priority strategies are implemented. 

Who We Serve

We work in collaboration with the School Health Advisory Councils (SHACs) in each of our three school districts: Catawba County Schools, Hickory Public Schools, and Newton-Conover City Schools. In partnership with district staff and community partners serving on the SHAC, we support schools in participating in the Alliance for a Healthier Generations assessment-to-action process, which informs district-level priority setting. During the course of this CHIP, each district and SHAC have identified tobacco prevention policy and education as a top priority. 

Why Is This Important?

Behavioral health is an important part of overall health and includes emotional, psychological, and social well-being (CDC, 2020). An individual’s behavioral health can affect many aspects of their life including their ability to cope with stress, resiliency levels, build sustaining relationships, and make healthy choices. Integrated behavioral health care incorporates primary medical care with behavioral healthcare. Integrated behavioral health care includes whole person wellness with the individual as part of the team and care includes both the individual and their support system. The movement towards integrated behavioral health emphasizes the importance of whole person health.

During the community listening sessions for health priority selection in 2019, 34.2% of participating community members identified a need for increased access to behavioral health services, resources, social supports, and behavioral health professionals (Catawba County Public Health, 2020). From 2016 to 2019, 13.2% of all emergency department visits by Catawba County residents were for anxiety, mood, and psychotic disorders (The University of North Carolina at Chapel Hill, 2020). Access to equitable and affordable primary care that incorporates behavioral is both an applicable and realistic need as Catawba County continues to move forward and cope with the unintended consequences of COVID-19.

References:

Catawba County Public Health. (2020). 2019 Catawba County Community Health Assessment. Retrieved on November 30, 2020 from https://catawbacountync.gov/site/assets/files/2488/2019_catawba_county_cha.pdf.

Centers for Disease Control and Prevention. (2020). Learn about Mental Health. Retrieved on November 30, 2020 from https://www.cdc.gov/mentalhealth/learn/index.htm.

The University of North Carolina at Chapel Hill. (2020). NCDETECT- Emergency Department Data for Catawba County for Anxiety, Mood, and Psychotic Disorders from 1/1/2019 to 11/30/2020. Retrieved on December 1, 2020 from https://ncdetect.org/.

Action Plan

At the Behavioral Health Work Group meeting on January 19, 2022, work group members reviewed and updated their current strategies based on what was working well, what was not working well and/or could be removed or changed, and how these strategies impact health disparities in Catawba County. The work group’s action plan was updated to include the following strategies. Action steps related to the followling strategies are discussed and updated during monthly work group meetings. 

Strategies: Whole Person Care & Technology Supported Care

• Behavioral health primary care integration, including bringing mental health screenings into primary care settings and Integrative care team approach (holistic)
• Telehealth and virtual health expansion and outreach, including education on community benefits of using these options. [Technology supported care includes telehealth (phone conversations) and virtual health (provider can see the client) for behavioral health care.]

Strategies: Community Engagement 

• Resources on techniques to deal with anxiety and depressive disorders
  • An example: CRM (Community Resiliency Model)
• Reducing behavioral health stigma
• Education for the community on anxiety, mood, and psychotic disorders and resources available for behavioral health care
• Mental health first aid training
• Working with the businesses/ worksites/ workforce development

What Is It?

A farmers market is a public and recurring assembly of farmers or their representatives selling food that they produced directly to consumers (Farmers Market Coalition, 2020). Catawba County currently has five farmers markets; Catawba County Public Health Farmers Market, Conover Farmers Market, Downtown Hickory Farmers Market, Murray's Mill Farmers Market, and Farmers Market at Center United Methodist Church. Market seasons for all the farmers markets vary slightly year to year.  

For SNAP Double Bucks, for every $1.00 spent at the farmers market, $1.00 will be matched from funding. This will allow customers who utilize SNAP (Supplemental Nutrition Assistance Program) to purchase a greater quantity of fresh produce.

Reference: 

Farmers Market Coalition. (2020). What is a Farmers Market. Retrieved December 2, 2020 from https://farmersmarketcoalition.org/education/qanda/. 

Who We Serve

The Catawba County Food Council’s strategies will target the the census tracts of 103.03, 104.2, 106, 107, 109, 110, 112 and 113, which are low-income census tracts where a significant number or share of residents are more than ½ or 1 mile (urban) or 10 miles (rural) from the nearest supermarket. At this time the census tracts targeted are based on the 2015 data from the USDA's Food Access Research Atlas. The Food Council had also planned to target parents and/or caregivers of children ages 2 to middle school within the low income and low access census tracts.

Experience and Importance

The Catawba County Food Council's action plan includes the following strategies related to farmers markets. The work group recognizes the importance of focusing on evidence-based strategies. Action steps related to the following strategies are discussed and updated during monthly work group meetings. 

Strategies: Farmers Markets

• Maintain and sustain farmers market SNAP Double Bucks and WIC Bonus Buck programs
  • Find sustainable funding
• Educate community on SNAP/EBT use and Double Bucks programs at farmers markets
  • Community health worker position at Hickory Farmers Market
• Expand number of farmers and farmers markets that accept SNAP/EBT
• Educate local farmers at farmers markets and hobby farmers on how to donate their fresh produce to food pantries
• Virtual education on SNAP/EBT

Policy Agenda:  Equitable Access to Healthy Foods

1. We support and advocate for sustainable policy, systems, and environmental change strategies that support equitable access to healthy foods for all community members. 
2. We believe equitable access to healthy foods can be achieved through community education, SNAP Double Bucks, and the elimination of food deserts in support of a healthier community.

Progress on CHIPs

Despite the challenges due to COVID-19 in 2020, Catawba County Public Health and our partners were able to: 

• Adopt Results-Based Accountability
• Transition Community Health Improvement Plans (CHIPS) from paper-based to web-based documents
• Set up results, indicators, strategies, and performance measures in Clear Impact Scorecard
• Link to the HNC 2030 Scorecard to create greater awareness of population accountability
• Adapt the CHA, CHIP, and SOTCH process to reflect COVID-19's impact on Catawba County

Morbidity and Mortality Changes Since Last CHA

Catawba County declared a state of emergency due to the COVID-19 pandemic on March 18, 2020. Catawba County has had over 19,000 confirmed cases of COVID-19 and 300 deaths. Catawba County Public Health updates our COVID-19 dashboard daily at https://www.catawbacountync.gov/county-services/public-health/coronavirus-19/. 

Catawba County COVID-19 Case Update: 5/27/2021 

Retrieved on 5/27/2021 from https://covid19.ncdhhs.gov/dashboard/cases-demographics.  

Catawba County Vaccination Update: 5/27/2021

Retrieved on 5/27/2021 from https://covid19.ncdhhs.gov/dashboard/vaccinations. 

Emerging Issues Since Last CHA

Community Health Advocates

• For some people in Catawba County, the COVID-19 pandemic has exacerbated existing challenges and for others has created new barriers to health and wellbeing. Because of the unique challenges families are facing during the COVID-19 pandemic surrounding housing, nutrition, childcare and more, NCDHHS (North Carolina Department of Health and Human Services) awarded grants to organizations in hopes of rapidly deploying community health workers in communities throughout the state.
• Catawba County Public Health (CCPH) was selected as a recipient of the community health worker grant, which has allowed CCPH to bring six Community Health Advocates to Catawba County. These Community Health Advocates are responsible for connecting people affected by COVID-19 to medical and social support resources, including diagnostic testing, primary care, case management, nutrition assistance, behavioral health services and financial assistance.
• Catawba County’s Community Health Advocates help facilitate telehealth visits, point community members to health and/or social resources and provide advocacy on behalf of individuals and the community.
• The Community Health Advocates are working in coordination with contact tracers and community-based organizations to identify and assist individuals who need help accessing medical or social services, finding a safe location to isolate, or connecting with other COVID-19-related assistance. Because these workers are most successful when they can deliver culturally and linguistically appropriate services, CCPH has ensured that there is a diverse blend of workers who are able to meet these varied needs.

New/Paused/Discontinued Initiatives Since Last CHA

Throughout 2020, the Chronic Disease Work Group, Behavioral Health Work Group, and the Catawba County Food Council met monthly to develop Community Health Improvement Plans (CHIPS). The planning process was extended to the end of 2020 and by the end of the year all three work groups had started action planning and preparing for the upcoming year. The work groups anticipate new strategies will begin implementation in 2021. 

In January and February 2021, all three work groups paused to allow Catawba County Public Health and our healthcare partners to focus all of their efforts to supporting the COVID-19 vaccine rollout. The work groups picked back up with action planning in March 2021. Action plans for the Chronic Disease Work Group, Behavioral Health Work Group, and Catawba County Food Council are available in the Work Group Action Plan folder. The work groups' action plans are fluid and are being updated monthly as the work group and/or subgroups meet. 

Progress on CHIPs

Chronic Disease

• During 2021, the Chronic Disease Work Group focused on tobacco policy and lung cancer screenings.
• Work Group members contacted over 100 businesses in 28601 about their tobacco free policies, tobacco quit benefits, and adopting and/or enhancing their tobacco policies. Priority businesses included those in automotive, construction & contractors, entertainment, faith-based organizations, food & dining, manufacturing/ wholesale/ distribution, and real estate. 
• In contacting businesses in 28601, the Chronic Disease Work Group identified the following barriers to worksites enhancing and/or adopting comprehensive tobacco free policies. In 2022, the work group will explore alternatives to engaging worksites and employees. 
  • Labor shortage and need for businesses to focus on hiring more people
  • Concern about putting policies in place that would potentially cause more employees to leave
  • Employees voicing that they would leave if a tobacco policy was enforced where tobacco use was not permitted anywhere onsite
• On November 18, 2021, on the Great American Smokeout, the work group partnered with LiveWell Catawba, Tobacco-Free Alliance Region 4, American Heart Association, and the Catawba County Chamber of Commerce to provide training on pathways to tobacco-free workplace policies. Over 30 businesses and community organizations attended the training.
• Work group members from Catawba Valley Health System and Frye Regional Medical Center provided ongoing presentations to medical providers on lung cancer screenings for those eligible. 
• In 2021, new recommendations for annual screening for lung cancer with low-dose computed tomography (LDCT) were released. In February 2022, Centers for Medicare & Medicaid Services (CMS) announced the expansion of lung cancer screening for at-risk populations that meet the following criteria:
  • Age 50-77 years
  • Asymptomatic (no signs or symptoms of lung cancer)
  • Tobacco smoking history of at least 20 pack-years
  • Current smoker or one who has quit smoking within the last 15 years
  • Receives an order for lung cancer screening with LDCT

Behavioral Health

• During 2021, the Behavioral Health Work Group has three overarching strategies, whole person care, technology supported care, and community engagement.
  • Whole Person Integrated Care is the integration of medical, behavioral, and public health approaches to care for the whole person. The model expands integrated care beyond the health care sector to include the social determinants of health, or the conditions in the places where people live, learn, work, and play. Social determinants of health are factors that can greatly influence the health and quality of life of individuals, populations, and communities (including food, housing, transportation, employment, access to care, medication access, etc.).
  • Technology supported care refers broadly to electronic and telecommunications technologies and services used to provide care and services at-a-distance.
  • Community engagement includes education for the community on anxiety, mood, and psychotic disorders and resources available for behavioral health care.
• The Whole Person Care and Technology Support Care Subgroups did deep dives into emergency room, Medicaid, and uninsured data to identify providers serving community members from the 28609 area. In March 2022, the Subgroups plan to conduct a practice survey to collect information on telehealth and integrated care services practices provide to increase telehealth awareness, access, and consistent engagement with whole person centered care services.
• The Community Engagement Subgroup actively worked with Partners Behavioral Health Management to train work group and Coalition members on the Community Resiliency Model (CRM). The Community Resiliency Model teaches participants about the impact of trauma and chronic stress on the nervous system, behavior, and long-term health. Participants learn how to reset the nervous system with easy to learn, concrete, coping skills. One of the goals of CRM is to create trauma-informed and resilient communities. The Community Engagement Subgroup plans to use CRM during part of the community groups’ education sessions.
• The Community Engagement Subgroup worked to engage community leaders from 28609 and the Town of Catawba in support of a community group. Participants in the community group would learn practical ways to make positive changes and find resources to support mental health. Professional facilitators would lead small peer counseling sessions. The community group plans to tentatively start in 2022. 

Healthy Foods & Healthy Weight

• During 2021, the Catawba County Food Council focused on strategies for food pantries and farmers markets.
• The Food Council partnered with Catawba County Cooperative Extension, Greater Hickory Cooperative Christian Ministry, (GHCCM), and Eastern Catawba Cooperative Christian Ministry (ECCCM) to do cooking videos using recipes with ingredients frequently available in the food pantries. Funding for the videos and recipes was provided by Community Food Strategies.
• Food Council members did tours of the food pantries at CCM and ECCCM and are evaluated the availability of culturally appropriate foods. The Food Council provided WIC cookbooks to both food pantries to distribute to their clients in addition to the cooking video recipes. Recipes and cookbooks were provided in English and Spanish.
• SNAP (Supplemental Nutrition Assistance Program) Double Bucks were piloted at Catawba County Public Health’s Farmers Market for the 2021 market season; $1,447.00 SNAP Double Bucks were redeemed at the market for fresh fruits and vegetables. LiveWell Catawba also supported WIC Bonus Bucks for WIC participants to use to purchase fresh fruits and vegetables; $1,580.00 WIC Bonus Bucks were redeemed.
  • For SNAP Double Bucks, for every $1.00 spent at the farmers market, $1.00 was matched from funding. This allows customers who utilize SNAP (Supplemental Nutrition Assistance Program) to purchase a greater quantity of fresh produce.
  • For WIC Bonus Bucks, each eligible WIC (Women, Infants, and Children) participant could receive $5.00 Bonus Bucks in addition to their WIC vouchers. 
• The Food Council worked with the Hickory Farmers Market in the fall of 2021 to implement a SNAP Double Bucks program starting in January 2022. LiveWell Catawba was able to support this program with funding from Healthy People, Healthy Carolinas and Community Food Strategies. The Food Council is continuing in 2022 to work with the Hickory Farmers Market for sustainable long-term funding.
• The Food Council is currently working with the Hickory Farmers Market to hire a community health worker (CHW) to provide community outreach and education on SNAP and WIC. The CHW would provide outreach and education at farmers markets in Catawba County and within the community, specifically targeting food deserts.
• In 2022, the Food Council plans to begin environmental scans of the 8 food deserts in Catawba County. The Food Council worked with County GIS to map convenience stores and grocery stores within the food deserts.
• LiveWell also provided funding to Morning Star First Baptist Church to support their community garden and snack for seniors program. Funding was also provided to Catawba County Cooperative Extensions Juntos program for healthy meals and snack for their participants.

Morbidity and Mortality Changes Since Last CHA

Morbidity and mortality changes for Catawba County for 2021 are focused on the impact of COVID-19 on the community and the leading causes of death from the 2021 County Health Data Book for 2015 to 2019. Local COVID-19 data is available on the NC DHHS COVID-19 North Carolina Dashboard. COVID-19 surveillance is continuously changing, as key metrics, such as testing positivity rates and total case counts, have become more difficult to quantify due to at-home testing. CCPH has linked to the state dashboard in order to remain consistent with new metrics the state is using to track COVID-19.

In 2021, COVID-19 reports accounted for 92.2% of Catawba County’s Communicable Disease case investigations. This includes a prolonged period of elevated case numbers early in the year, the Delta wave and part of the Omicron wave at the end of the year.

COVID-19 Case Data (March 2020 to March 30, 2022)

While many cases are no longer reported due to at-home testing, the overall trends of cases reported can still be informative. Trends in reported cases help understand the spread of disease in the community and in specific groups and locations over time.

 COVID-19 Vaccinations:

2015-2019 Leading Causes of Death

2015-2019 Leading Causes of Death by Age for Catawba County

• Ages 0 to 19
  1. Conditions originating in the perinatal period
  2. Congenital anomalies (birth defects)
  3. Motor vehicle injuries
• Ages 20 to 39
  1. Other Unintentional injuries
  2. Suicide
  3. Motor vehicle injuries
• Ages 40 to 64
  1. Cancer - All Sites
  2. Diseases of the heart
  3. Chronic lower respiratory diseases
• Ages 65 to 84
  1. Cancer - All Sites
  2. Diseases of the heart
  3. Chronic lower respiratory diseases
• Ages 85 and Over
  • Diseases of the heart
  • Alzheimer's disease
  • Cancer - All Sites

References: 

North Carolina Department of Health and Human Services. (2022). NC COVID-19 Dashboard- Cases and Deaths. Retrieved on March 30, 2022 from https://covid19.ncdhhs.gov/dashboard/cases-and-deaths.  

North Carolina State Center for Health Statistics. (2022). County Health Data Book: Death Counts and Crude Death Rates per 100,000 Population for Leading Causes of Death, by Age Groups NC 2015-2019- CD11A. Retrieved on March 29, 2022 from https://schs.dph.ncdhhs.gov/data/databook/. 

Emerging Issues Since Last CHA

Catawba County Heptatis Coalition

• In 2021, the Heptatis C Coalition expanded to include hepatitis A, B, and C and is now known as the Catawba County Heptatis Coalition. The Catawba County Hepatitis Coalition continues to focus on providing seamless, coordinated care for those with hepatitis of all types. Because the population most affected by Hepatitis in recent years tends to cross county lines, the coalition is expanding across those lines as well, and has begun collaborating with surrounding counties to ensure continuity of care. This also comes in response to an increase in hepatitis throughout the region. By adopting a regional approach, the Hepatitis Coalition can leverage resources in multiple counties, and address spread across county lines, and have consistent messaging for these individuals, no matter where they live.
• Based on the continued success of Catawba County’s Hepatitis Coalition, Public Health was invited to speak at the NC Viral Hepatitis Task Force meeting and at the United States Conference on HIV/ AIDS to share best practices with other coalitions.
• In response to an outbreak of Hepatitis A that began in 2020 and expanded in 2021, the outreach efforts among people who use drugs and people who are experiencing homelessness have increased, as these two populations have been affected the most by this ongoing outbreak. To do this, partnerships with organizations that serve the homeless population and organizations that provide harm reduction services were strengthened, including ALFA, Olive Branch Ministry, Hickory Soup Kitchen and Open Door Homeless Ministry and have offered Hepatitis A and B vaccinations to at-risk individuals at off-site events sponsored by these trusted organizations.

COVID-19

• In 2021, COVID-19 reports accounted for 92.2% of Catawba County’s Communicable Disease case investigations. This includes a prolonged period of elevated case numbers early in the year, the Delta wave and part of the Omicron wave at the end of the year. Catawba County Public Health (CCPH) administered more than 64,000 COVID-19 vaccines in 2021, beginning at the Hickory Metro Convention Center, then moving to the Public Health building. At times, CCPH vaccinated more than1,000 people per day.

New/Paused/Discontinued Initiatives Since Last CHA

Equipping Local Health Departments to Build COVID-19 Vaccine Confidence (COVIED) Project

• Catawba County Public Health (CCPH) has been selected to participate in the Equipping Local Health Departments to Build COVID-19 Vaccine Confidence (COVIED) project. Through this grant-funded project, CCPH will partner with NACCHO to address vaccine hesitancy and increase COVID-19 vaccine confidence and uptake among priority populations disproportionately impacted by COVID-19 disease and complications.
• Because Catawba County’s African-American community has the lowest vaccination rate among the county’s major historically marginalized populations, and based on the number of individuals falling into that group, focusing on the African-American community is a priority for this grant.
• CCPH plans to hire a part-time vaccine coordinator who will coordinate vaccine education and outreach events, and who will develop a team of vaccine ambassadors who are well-respected within the African-American community. Those ambassadors will work alongside the vaccine coordinator to share messages about the vaccine’s safety and effectiveness, and address misinformation that has led to a lower vaccination rate among this population.
• CCPH  will couple these efforts with strategic advertising opportunities to amplify the message. CCPH will recieve $75,000 over the grant period, which lasts through December 31, 2022.

Health Priority Work Groups

• In January and February 2021, the Chronic Disease Work Group, Behavioral Health Work Group, and Catawba County Food Council paused to allow Catawba County Public Health and our healthcare partners to focus all of their efforts to supporting the COVID-19 vaccine rollout. All three health priority work groups picked back up with action planning in March 2021. 
• In December 2021 and January 2022, the three health priority work groups completed whole distance exercises to update the community health improvement plan (CHIP). The whole distance exercises included each work group reviewing, discussing, and updating their results statement, indicators, story (why is this important and the story behind the curve), partners involved and/or that should be involved in the work group, and what works, including their strategies and action plans. 

Morbidity and Mortality Changes Since Last CHA

2016-2020 Leading Causes of Death and Inequities (rate per 100,000)

Source: 2022 County Health Data Book, North Carolina State Center for Health Statistics

From 2016 through 2020:

• Chronic diseases, like heart disease and cancer, remain the leading causes of mortality for Catawba County. 
• There are significant inequities related to recent local mortality data:
  • The mortality rate related to heart disease among Latino residents was more than double that of both White and Black residents. Black residents also experience a higher mortality rate related to heart disease than White residents. 
  • The mortality rates related to diabetes and kidney disease among Black residents were more than double that of White residents.
  • The mortality rates related to non-motor vehicle unintentional injuries and chronic lower respiratory disease were higher among White residents than Black residents.
  • The mortality rate related to cancer was highest among Black residents, with both Black and White residents having a cancer mortality rate 2.5x higher than Latino residents.

We will be working with community members to understand better the root causes of these inequities in the 2023 Community Health Assessment process.

County Health Rankings and Roadmaps Updates:

• Catawba County ranks 30th overall
• According to 2019 data used for the most recent rankings:
  • 13% of adult residents reported poor physical health for 14 or more days in the past month
  • 15% of adult residents reported poor mental health for 14 or more days in the past month
  • Adult diabetes prevalence is estimated at 11%
  • Adult smoking prevalence is estimated at 20% 

Emerging Issues Since Last CHA

Food Insecurity:

Food insecurity has been a growing priority of our CHA/CHIP cycle, but this year we were able to disaggregate data to better understand inequities related to food insecurity in our county. As noted in our updated indicators, there is a significant inequity in food security between White residents and Black and Latino residents. As we enter our next community health assessment process, this clearer understanding of inequities in food access will better inform more specific and equity-oriented strategies. 

Drivers of Health:

While they've always impacted health and well-being, there's growing recognition across the community and among partners related to how drivers of health are impacting outcomes, specifically housing and transportation. We are currently reviewing results from the 2020 Census and 2021 American Community Survey to identify potential indicators to inform a shared understanding of these issues as we move into our next community health assessment. For example:

• 35.1% of renters in Catawba County are spending 30% or more of their gross monthly income on housing costs
• Approximately 4.6% of households have less vehicles available than workers over the age of sixteen in their home

    Source: American Communities Survey, 2021

New/Paused/Discontinued Initiatives Since Last CHA

The following are new initiatives:

• A Community Food System assessment through NC Division of Public Health's Advancing Equity support
• A new Community Health Worker (CHW) initiative, coupled with a refreshed emphasis on utilizing NCCARE 360
• The launch of our 2023 Community Health Assessment
• Messaging to providers regarding whole-person care and brain health
• A community workshop on brain health and reducing stigma

The following initiatives experienced changes or are paused:

• We renamed our Behavioral Health workgroup and priority area to Brain Health based on workgroup and community feedback and updated equity-oriented language emerging in the field

The following are discontinued initiatives in 2022:

• Healthy People, Healthy Carolinas Duke Endowment Grant came to an end December 31, 2022
• Food Pantry Nutrition Education
• Implementing training and education plans related to brain health as outlined in the CHIP