2019 Transylvania County eCHIP

Transylvania Public Health is committed to protecting and improving the health of all people in Transylvania County. One way we do this is through identifying and working to address important health needs in the community. (Watch this video or click here to learn more about this process.)

The 2018 Community Health Assessment priority areas are:

  • Mental Health & Substance Use
  • Healthy Lifestyle

We then work to bring community members together to develop action plans that will address these top health priorities. Together, these action plans form a Community Health Improvement Plan (or CHIP), which is a strategic plan for the entire community designed to encourage cross-sector collaboration.

This "e-CHIP" scorecard is a low-cost, easy-to-use tool that helps us track and display data related to these health priorities and organize community improvement efforts to improve health in Transylvania County.

The following CHIP Scorecard was created and submitted by September 9, 2019 to meet the requirements for the Transylvania County Long and/ or Short Term Community Health Improvement Plans. This Scorecard is a low-cost, easy-to-use tool that helps us track and display data related to these health priorities and organize community improvement efforts to improve health in Transylvania County.

Clear Impact Scorecard™ is a strategy and performance management software that is accessible through a web browser and designed to support collaboration both inside and outside organizations. WNC Healthy Impact is using Clear Impact Scorecard™ to support the development of electronic CHIPs, SOTCH Reports and Hospital Implementation Strategy scorecards in communities across the region.

Scorecard helps communities organize their community health improvement efforts:

  • Develop and communicate shared vision
  • Define clear measures of progress
  • Share data internally or with partners
  • Simplify the way you collect, monitor and report data on your results

The following resources were used/reviewed in order to complete the CHIP:

Mental Health and Substance Use
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Why It Matters?

Mental health and substance use are interconnected to each other and to issues that include suicide deaths, overdose deaths, adverse childhood experiences, depression, anxiety, liver disease, alcohol-related motor vehicle crashes, lung cancer, COPD, and employment. However, residents have limited options for treatment and counseling options, especially for those who have lower incomes, no insurance, or transportation issues. Despite promising community efforts to address substance use and suicide, there is still much work to be done in this area.

Alignment

Mental Health and Substance Use and the related conditions of well-being are aligned with the following Healthy NC 2020 Focus Areas

  • Mental Health: "Mental health, an integral component of individual health, is important throughout the lifespan. Individuals with poor mental health may have difficulties with interpersonal relationships, productivity in school or the workplace, and their overall sense of well-being. Depression is linked to lower productivity in the workplace, is a leading cause of suicide, and has been associated with increased use of health care services." (North Carolina Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: North Carolina Institute of Medicine; 2011.)
    • Objective 1. Reduce the suicide rate (per 100,000 population)
    • Objective 2. Decrease the average number of poor mental health days among adults in the past 30 days
    • Objective 3. Reduce the rate of mental health-related visits to emergency departments (per 10,000 population)
  • Substance Use: "Substance use and abuse are major contributors to death and disability in North Carolina. Addiction to drugs or alcohol is a chronic health problem, and people who suffer from abuse or dependence are at risk for premature death, comorbid health conditions, injuries, and disability. Therefore, prevention of misuse and abuse of substances is critical. Furthermore, substance abuse has adverse consequences for families, communities, and society, contributing to family upheaval, the state’s crime rate, and motor vehicle fatalities." (North Carolina Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: North Carolina Institute of Medicine; 2011.)
    • Objective 1. Reduce the percentage of high school students who had alcohol on one or more of the past 30 days
    • Objective 2. Reduce the percentage of traffic crashes that are alcohol-related 5.7%
    • Objective 3. Reduce the percentage of individuals aged 12 years and older reporting any illicit drug use in the past 30 days
Experience & Importance

How would we experience lifelong physical, emotional, and social well-being of all residents in Transylvania County?

Community members said that we could experience the following conditions:

  • People getting the help they need
  • Abundant resources
  • Kids in the “best place” to learn (mentally, physically, socially)
  • Education and awareness about mental health and substance use
  • Less stigma, more acceptance and understanding
  • Programs across the lifespan
  • Engagement and connectivity
  • People supporting each other
  • Proactive efforts, with a focus on wellness
  • Building on kinship and friendship relationships
  • Expertise from a variety of lived perspectives
  • Less homelessness
  • Lower suicide rate
  • Less crime
  • Fewer involuntary committals
  • Stable families
  • Less truancy
  • More high school graduations
  • Emergency department only being used for medical emergencies
  • Higher employment
  • Fewer overdoses
  • More healthy births
  • Less poverty
  • Less hunger
  • Fewer medical crises
  • Fewer shut-ins, more “getting out”
  • More social infrastructure
  • More people using parks, libraries, etc.
  • People able to get to places they want to go
  • Transportation for students
  • More affordable housing
  • More quality affordable childcare
  • More accessibility of healthcare
  • More civic engagement

What information led to the selection of this health issue and related result?

Transylvania County residents reported more “poor” mental health days; some said they were unable to get the care they need. Suicide rates are higher than the state rates and residents are being treated for mental health symptoms through emergency department visits and hospitalization. Mental health concerns are linked to substance use and ACEs. Key informants named both general mental health and depression/anxiety/stress as top concerns and said that additional treatment resources were needed. Mental health was a priority health issue in 2015.

Substance use is related to overdose deaths, liver disease mortality, and motor vehicle crashes. Smoking rates among pregnant women and breathing someone else’s cigarette smoke at work are concerns. Substance use is connected to mental health and ACEs. Many residents reported their lives being affected by substance use and it was the #2 top community concern named by key informants. It was the top priority health issue in 2015.

In the 2019 Community Health Assessment process, community members identified many connections between mental health and substance use, and determined that they should be addressed as a single priority in Transylvania County.

According to the US Office of Disease Prevention and Health Promotion, "Several factors have been linked to mental health, including race and ethnicity, gender, age, income level, education level, sexual orientation, and geographic location. Other social conditions—such as interpersonal, family, and community dynamics, housing quality, social support, employment opportunities, and work and school conditions—can also influence mental health risk and outcomes, both positively and negatively."1 In addition, "Several biological, social, environmental, psychological, and genetic factors are associated with substance abuse. These factors can include gender, race and ethnicity, age, income level, educational attainment, and sexual orientation. Substance abuse is also strongly influenced by interpersonal, household, and community dynamics. Family, social networks, and peer pressure are key influencers of substance abuse among adolescents."2 Within Transylvania County, individuals with low incomes; those without stable, adequate, and affordable housing; those who may be socially isolated due to geography and lack of transportation; and those with a family history of mental health or substance use issues are at higher risk for poor outcomes in the areas of mental health and substance use. Individuals with high ACE scores are more likely to experience negative health behaviors such as substance use and suicide. In addition, those without access to health insurance are less likely to be able to access care when needed, and resources are limited for mental health and substance use treatment within Transylvania County.

Healthy Lifestyle
HealthyWeight
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Why It Matters?

Transylvania County’s top two causes of death and many of our morbidity statistics of concern including obesity, type 2 diabetes, high blood pressure, heart disease, certain cancers, and stroke are directly affected by nutrition and physical activity. Residents report having trouble accessing healthy food and getting the recommended amount of physical activity.

Alignment

Healthy Lifestyle and the related conditions of well-being are aligned with the following Healthy NC 2020 Focus Areas

  • Physical Activity and Nutrition: "Overweight and obesity pose significant health concerns for both children and adults. Excess weight increases an individual’s risk of developing type 2 diabetes, high blood pressure, heart disease, certain cancers, and stroke.39 For the first time in two centuries, the life expectancy of children in the United States is predicted to be lower than that of their parents. The root cause of this phenomenon is the increase in obesity.40 Increased physical activity and improved nutrition are among the many factors that can help individuals reach and maintain a healthy weight." (North Carolina Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: North Carolina Institute of Medicine; 2011.)
    • Objective 1. Increase the percentage of high school students who are neither overweight nor obese.
    • Objective 2. Increase the percentage of adults getting the recommended amount of physical activity.
    • Objective 3. Increase the percentage of adults who consume five or more servings of fruits and vegetables per day.
Experience & Importance

How would we experience lifelong physical, emotional, and social well-being of all residents in Transylvania County?

Community members said that we could experience the following conditions:

  • Access to natural world
  • Less chronic disease
  • Less substance use
  • Access to affordable healthy food
  • Active lifestyles
  • Systems that support physical activity e.g. infrastructure, sidewalks, paths
  • Sense of community engagement
  • Less social isolation
  • Healthy social experiences
  • Education and ability to make good choices
  • Fewer unintentional deaths
  • Supports to age in place e.g. fall prevention
  • Transportation / better public transit
  • Participation in youth sports
  • Protected natural resources
  • Employer support for healthy lifestyle
  • Promoted resiliency
  • Importance of vaccines understood
  • Education in schools
  • Experiential education and opportunities across the lifespan
  • Year-round options for physical activity
  • Affordable options / sliding scales
  • More pools
  • Life skills training
  • People know how to access information
  • Living wage jobs
  • Access to basic healthcare
  • Alternative treatments
  • Prevention options
  • Celebration of diversity in race, ethnicity, religion, etc.
  • Intentional and collaborative efforts

What information led to the selection of this health issue and related result?

Many county residents are overweight or obese, which is connected to multiple poor health outcomes including diabetes. Residents are not meeting recommendations for nutrition and physical activity, and many residents experience regular stress and other barriers, all of which contribute to obesity. It was the #1 top concern among key informants and was selected as a health priority in 2015.

Diabetes is related to obesity, physical activity, and nutrition, and rates are increasing. It was named as a top community concern by key informants. Key informants also identified heart disease/stroke as a top community concern, and it, too, is closely related to body weight and physical activity. A large proportion of Transylvania County’s population is affected by high blood pressure and stroke, and cardiovascular disease is a leading cause of death and hospitalization. Cancer was the leading cause of death in Transylvania County. Incidence can be related to ACEs, behaviors like alcohol and tobacco use, and environmental causes like radon, but cancer is also linked to overweight and obesity. 

According to the US Office of Disease Prevention and Health Promotion, "Good nutrition, physical activity, and a healthy body weight are essential parts of a person’s overall health and well-being. Together, these can help decrease a person’s risk of developing serious health conditions, such as high blood pressure, high cholesterol, diabetes, heart disease, stroke, and cancer. A healthful diet, regular physical activity, and achieving and maintaining a healthy weight also are paramount to managing health conditions so they do not worsen over time."1 Within Transylvania County, individuals with low incomes or who work long hours; those without stable, adequate, and affordable housing with adequate kitchen facilities; those who may be far from grocery stores and infrastructure for physical activity due to geography and lack of transportation; and those who must travel long distances to and from work are less likely to have the time, desire, and opportunity to prepare and cook nutritious meals and spend leisure time being physically active. In addition, people who are overweight or obese, those who do not eat the recommended amount of fruits and vegetables, and those who do not participate in the recommended amount of physical activity are at-risk for poor health outcomes including diabetes, stroke, high blood pressure, and high blood cholesterol.

Scorecard Result Program Indicator Performance Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy