Haywood County 2015 Community Health Assessment

Acknowledgements

This document was developed by Haywood County Health and Human Services Agency, in partnership with HaywoodRegionalMedicalCenter and the Healthy Haywood Partnership as part of a local community health (needs) assessment process. We would like to thank and acknowledge several agencies and individuals for their contributions and support in conducting this health assessment:

Healthy Haywood Steering Committee

  • Chair- Nancy Bauman

Healthy Haywood Partnership

  • Member Organizations

HaywoodRegionalMedicalCenter

  • Philip Wright, CEO
  • Susan Schneider, Director of Rehab Services and Cardio Pulmonary Rehab

HaywoodCounty Health and Human Services Agency

  • Patrick Johnson- Public Health Director
  • Lisa Davis- Nursing Director/Child Health Nursing Supervisor
  • Megan Hauser- Health Educator
  • Anita Wilkins- Health Educator/Preparedness Coordinator

Our community health (needs) assessment process and product were also supported by technical assistance, financial support, and collaboration as part of WNC Healthy Impact, a partnership between hospitals, health departments and their partners in western North Carolina to improve community health.
Table of Contents

Haywood County 2015 CHA Executive Summary

Purpose and Process

Data Summary

Community

Health Outcomes

Populations at risk

Health Priorities

Health Priority 1- Substance Abuse......

Health Priority 2- Mental Health......

Health Priority 3- Physical Activity and Nutrition......

Next Steps

Chapter 1 – Community Health Assessment Process

Purpose

Definition of Community

WNC Healthy Impact

Data Collection

Core Dataset Collection

Additional Community-Level Data

Health Resources Inventory

Community Input & Engagement

At-Risk & Vulnerable Populations

Chapter 2 – Haywood County

Location and Geography

History5

Population

Chapter 3 – A Healthy Haywood County

Elements of a Healthy Community

Community Assets7

Chapter 4 – Social & Economic Factors

Income

Employment

Education9

Community Safety

Housing...... 20

Family & Social Support

Chapter 5 – Health Data Findings Summary

Mortality

Health Status & Behaviors

Clinical Care & Access

At Risk Populations

Chapter 6 – Physical Environment

Air Quality

Water

Access to Healthy Food & Places

Chapter 7- Health Resources

Health Resources

Process

Findings

Resource Gaps

Chapter 8 – Identification of Health Priorities

Health Issue Identification

Process

Identified Issues

Priority Health Issue Identification

Process

Identified Priorities

Priority Issue #1- Substance Abuse

Data Highlights

Health Indicators

Specific Populations At-Risk

Health Resources available/needed

Priority Issue #2- Mental Health

Data Highlights

Health Indicators

Specific Populations At-Risk

Health Resources available/needed

Priority Issue #3- Physical Activity and Nutrition

Data Highlights

Health Indicators

Specific Populations At-Risk

Health Resources available/needed

Chapter 9 - Next Steps

Sharing Findings

Collaborative Action Planning

Works Cited

Appendices

Appendix A - Data Collection Methods & Limitations

Secondary Data from Regional Core

Secondary Data Methodology

Data limitations

Gaps in Available Information

WNC Healthy Impact Survey (Primary Data)

Survey Methodology

Benchmark Data

Survey Administration

Information Gaps

Online Key Informant Survey (Primary Data)

Online Survey Methodology

Haywood County 2015 CHA Executive Summary

Purpose and Process

Community health assessment (CHA) is the foundation for improving and promoting the health of county residents. Community health assessment is a key step in the continuous community health improvement process. The role of CHA is to identify factors that affect the health of a population and determine the availability of resources within the county to adequately address these factors.

Data Summary

Community

Haywood County is home to 59,471 residents, both full-time and seasonal. It has four incorporated towns and several unincorporated communities. Waynesville has 9,761 residents, Canton has 4,159, Maggie Valley has 1,247 and Clyde has 1,235 (US Census Bureau, 2014).

Demographics:

  • White- 96.5%
  • Hispanic- 3.7%
  • Black- 1.2%
  • American Indian/Alaskan Native- 0.6%
  • Asian- 0.5%
  • Adults 65 and older- 23.7%

(US Census Bureau, 2014)

Health Outcomes

2012 Health Priorities

1)Substance abuse

  • Progress:
  • Trainings have been held for the ‘’Be a Responsible Seller and Server’’ program.
  • In 2015, Haywood County’s tobacco-free property policy became an ordinance, allowing for stronger enforcement.
  • The Town of Waynesville adopted a tobacco-free ordinance in 2015.
  • In 2015, Haywood Regional Medical Center began offering ‘’Freedom From Smoking’’ classes.
  • All five law enforcement agencies carry Narcan, a reversal medication for opioid overdoses. This project is overseen by Haywood County EMS.
  • A diverse group, ‘’Pain Changers,’’ has formed to address opioid overprescribing.
  • Challenges:
  • Adult tobacco use rates have increased by over 4% (WNC Healthy Impact, 2015).
  • State allocation for tobacco use prevention has significantly declined. No funds are dedicated for youth tobacco use prevention.
  • The opioid overdose death rate remains high (Haywood County Medical Examiner).
  • Many people perceive opioids to be the best option. Research from the National Safety Council shows that an acetaminophen and ibuprofen combination is often more effective.
  • Underage drinking is sometimes seen as a rite of passage.
  • Binge drinking by adults has increased by 4% (WNCHI, 2015).

2)Physical activity and nutrition

  • Progress:
  • Five schools have Girls on the Run (GOTR) teams. GOTR is an effective curriculum that combines running and important life lessons.
  • Several schools participate in Active Routes to School (ARTS) activities. ARTS funding is available through 2019.
  • Two local farmer’s markets now accept SNAP/EBT benefits. One market also offered bonus dollars to SNAP users in 2015.
  • Challenges:
  • Adult obesity rates have increased by over 3% (WNC Healthy Impact, 2015).
  • Fewer adults are eating the recommended servings of fruits and vegetables (WNCHI, 2015).
  • Over 16% of adults say it is difficult or very difficult to access fresh produce at an affordable price (WNCHI, 2015).

3)Chronic disease

  • Progress:
  • Diabetes rates among adults have decreased by 5% (WNC Healthy Impact, 2015).
  • Staff at the Haywood Senior Resource Center and Haywood County Health and Human Services Agency have been trained to lead the Diabetes Prevention Program. Both agencies will begin leading this evidence-based program in spring 2016.
  • The rate of high blood cholesterol has declined among adults (WNCHI, 2015).
  • Challenges:
  • The rate of pre-diabetes rate among adults has increased by nearly 3% (WNCHI, 2015).
  • The rate of adults with high blood pressure has increased. Over 43% of adults experience this condition (WNCHI, 2015).

4)Social Determinants of Health/Access to Care

  • Progress:
  • Haywood County funds a part-time Physician’s Assistant at the Good Samaritan Clinic.
  • Blue Ridge Health Center and the Good Samaritan Clinic are merging. Blue Ridge is a federally qualified health center.
  • Health insurance enrollment events were held in February 2015 and January 2016. Health care navigators also assist consumers outside of these events.
  • Challenges:
  • Many people do not qualify for Medicaid and are unable to afford private insurance.

5)Mental health

  • Progress:
  • Smoky Mountain Center will develop suicide prevention plans for each county in their service area. This organization will begin the process by surveying each county served.
  • Over 75% of adults reported that they always or usually get needed social and emotional support (WNC Healthy Impact, 2015).
  • Challenges:
  • More adults reported having greater than seven days of poor mental health within the past month (WNCHI, 2015).
  • Haywood County averages one suicide per month (Haywood County Health and Human Services Agency).

6)Unintentional injury and maternal/infant health/unintended pregnancy tied for priority six.

  • Progress:
  • The infant death rate has decreased (State Center for Health Statistics, 2009-2013).
  • The rate of unintentional motor vehicle injury mortality has decreased (SCHS, 2009-2013).
  • Challenges
  • Haywood County has a higher teen birth rate than North Carolina (County Health Rankings, 2015).
  • The county rate of low birth weight is higher than the state (CHR, 2015).

7)Dental health

  • Progress
  • Among 1-5 year olds with Medicaid, Haywood County has a higher average than the state of receiving dental services within the past year (State Center for Health Statistics, 2011).
  • Challenges:
  • The number of adults who visited a dentist in the past year has declined by 20% (WNC Healthy Impact, 2015).

8)Communicable disease

  • Progress
  • North Carolina’s rate of childhood immunizations is higher than the national average (2013, ages 19-35 months, Centers for Disease Control and Prevention).
  • Challenges
  • Norovirus outbreaks have occurred in several locations in the county (Haywood County Health and Human Services Agency).

9)Environmental health

  • Progress
  • Haywood County Health and Human Services Agency (HCHHSA) received grant funds to assist with septic repairs.
  • No rabies cases were reported in 2013 or 2014 (HCHHSA).
  • Challenges
  • In 2015, harmful algae blooms were discovered in Waterville Lake (HCHHSA, The Mountaineer)
  • From 2013-2014, over 300 animal bites were reported (HCHHSA).

Populations at risk

  • Individuals in poverty
  • Over 21,000 individuals fall below 200% of the federal poverty level (2009-2013, US Census Bureau).
  • Victims of domestic violence
  • From 2012-2014, over 1100 clients experiencing domestic violence were served (2013-2014, Council for Women).
  • Uninsured
  • Over 1/5 of 18-65 year olds are uninsured (2013, US Census Bureau)

Health Priorities

In November 2015, the Healthy Haywood Partnership held a prioritization meeting. Local data from a telephone survey was reviewed. Information was also shared from an electronic stakeholder survey. A diverse group of individuals was present, including substance abuse and mental health providers, business, government, faith and community or non-profit. Attendees were presented with a list of 11 health priorities. These priorities were taken from the report ‘’Healthy North Carolina 2020: A Better State of Health.’’ Participants ranked each health priority based on five areas:

Magnitude: number of people who suffer from this problem

Consequences: seriousness to health if not addressed

Feasibility: probability of success in addressing this problem

Needs: needs to be addressed more thoroughly than it currently is

Interest: I am personally interested in helping with this issue

These areas were ranked as high, medium or low importance.

Each person’s totals were added together. As a result, a new list of health priorities was determined.

2015 Health Priorities

1)Substance abuse (alcohol, tobacco and other drugs)

2)Mental health

3)Physical activity and nutrition

4)Chronic disease

5)Maternal and infant health

6)Sexually transmitted disease and unintended pregnancy

7)Injury and violence

8)Oral health

9)Social determinants of health

10)Infectious diseases and food borne illnesses

Next Steps

  • Findings will be shared through the following methods:
  • Healthy Haywood website
  • Haywood County website
  • Presentations to stakeholders, including the board of the Haywood County Health and Human Services Agency.
  • Copies will be made available at the following locations: all Haywood County libraries and the public health services desk of the Haywood County Health and Human Services Agency.
  • Plans for collaborative implementation/action planning and related development of strategies to improve top three health priorities.
  • Three work groups will form through the Healthy Haywood Partnership. Each work group will develop an action plan for one of the top three priorities.

Chapter 1 – Community Health Assessment Process

Purpose

Community health assessment (CHA) is an important part of improving and promoting the health of county residents. Community-health assessment is a key step in theongoing community health improvement process.

A community health assessment (CHA), which is both a process and a product, investigates and describes the current health indicators and status of the community, what has changed, and what still needs to change to reach a community’s desired health-related results.

Definition of Community

Community is defined as "county" for the purposes of the North Carolina Community Health Assessment Process. Haywood County is included the Haywood Regional Medical Center community for the purposes of community health improvement and as such,they were a key partner in this local level assessment.

WNC Healthy Impact

WNC Healthy Impact is a partnership between hospitals and health departments in western North Carolina to improve community health. As part of a larger, and continuous, community health improvement process, these partners are collaborating to conduct community health (needs) assessments across western North Carolina Our county and partner hospitals are involved in this regional/local vision and collaboration. Participating counties include: Buncombe, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania and Yancey.

Data Collection

The set of data reviewed for our community health assessment process is comprehensive, though not all of it is presented in this document. Within this community health assessment product, we share a general overview of health and influencing factors then focus more on priority health issues identified through this collaborative process. Our assessment also highlights some of our community strengths and resources available to help address our most pressing issues.

Core Dataset Collection

The data reviewed as part of our community’s health assessment came from the WNC Healthy Impact regional core set of data and additional local data compiled and reviewed by our local CHA team. WNC Healthy Impact’s core regional dataset includes secondary (existing) and primary (newly collected) data compiled to reflect a comprehensive look at health. The following data set elements and collection are supported by WNC Healthy Impact data consulting team, a survey vendor, and partner data needs and input:

  • A comprehensive set of publically available secondary data metrics with our county compared to the sixteen county WNC region as a “peer”
  • Set of maps accessed from Community Commons and NC Center for Health Statistics
  • Telephone survey of a random sample of adults in the county
  • Email key-informant survey

See AppendixA for details on the regional data collection methodology.

Additional Community-Level Data

Data from the State Center for Health Statistics, County Health Rankings and State of the County Health reports and the local media was reviewed. Data was also obtained from public health department staff.

Health Resources Inventory

An inventory of available resources of our community was conducted through reviewing a subset of existing resources currently listed in the 2-1-1 database for our county as well as working with partners to fill in additional information. Where gaps were identified, we partnered with 2-1-1 to fill in or update this information when applicable. See Chapter 7 for more details related to this process.

Community Input & Engagement

Including input from the community is an important element of the community health assessment process. Our county included community input and engagement in a number of ways:

  • Partnership on conducting the health assessment process
  • Through primary data collection efforts (survey and key informant interviews)
  • In the identification and prioritization of health issues

In addition, community engagement is an ongoing focus for our community and partners as we move forward to the collaborative action planning phase of the community health improvement process. Partners and stakeholders with current efforts or interest related to priority health issues will continue to be engaged. We also plan to work together with our partners to help assure programs and strategies in our community are developed and implemented with community members and partners.

At-Risk & Vulnerable Populations

Throughout our community health assessment process and product, our team was focused on understanding general health status and related factors for the entire population of our county as well as the groups particularly at risk for health disparities or adverse health outcomes. In particular, for the purposes of the overall community health assessment, we aimed to understand variability in health outcomes and access of medically underserved, low-income, minority, and others experiencing health disparities. These populations include:

  • Individuals who are uninsured or underinsured
  • Individuals experiencing poverty
  • Victims of domestic violence
  • Pregnant women who smoke
  • Individuals who have trouble accessing fresh produce

Chapter 2–Haywood County

Location and Geography

Haywood County covers 546 square miles. Waynesville covers 6.9 square miles, Clyde covers 0.8, Maggie Valley covers 1.6 and Canton covers 1.8. Haywood County includes parts of four nationally protected areas: the Blue Ridge Parkway, the Great Smoky Mountains National Park, the Pisgah National Forest and the Cherokee Indian Reservation/ Qualla Boundary. There are 13 peaks above 6,000 feet. All water in Haywood County originates here. Two lakes exist in Haywood County: Lake Logan and Lake Junaluska. Haywood County has 13 peaks with an elevation of over 6,000 feet (haywoodnc.net). Due to many high mountain ranges, travel can take a great deal of time. To drive from the northwestern most part of the county to the southeastern most part of the county is only 62 miles, but the travel time is over an hour and fifty minutes (Healthy Haywood).

History, Tradition and Industry

Haywood County was founded in1808 and was named after John Haywood. The railroad came to Canton in 1881 and Waynesville in 1882 (haywoodnc.net). The area is a Blue Ridge Hertiage Area and is well-known for arts and crafts. Haywood Regional Arts Theater is an award-winning establishment. The county annually hosts Folkmoot, North Carolina’s International Festival. Public street dances are a regular occurrence in the summer months. The population changes significantly depending on the season, as Haywood County has many part-time residents.

The area is home to Haywood Community College (HCC), an institution with over 50 programs. HCC has the only fish and game wildlife program in North Carolina.

Haywood County’s largest employer is Evergreen Packaging Group. Other large employers are Haywood Regional Medical Center (a Duke LifePoint Hospital), Haywood County Schools and Haywood County Government.

Haywood County is also home to Lake Junaluska Assembly. Lake Junaluska is the headquarters for the Southeastern Juristiction of the United Methodist Church and the World Methodist Council. The Lake Logan Episcopal Center is located in the Canton area.