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HomeMy WebLinkAboutBOH Agenda 052720 ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: May 27, 2020 TIME: 7:00 P.M. PLACE: Go to Meeting Please join my meeting from your computer,tablet or smartphone. https://qlobal.gotomeeting.com/moin/299879645 You can also dial in using your phone. United States: +1 (872) 240-3212 Access Code: 299-879-645 New to GoToMeeting? Get the app now and be ready when your first meeting starts: https://qlobal.gotomeeting.com/install/299879645 TIME ITEM 7:00 p.m. I. Public Comment for Items NOT on Printed Agenda public Comment for Items ON Printed Agenda will be handled during that agenda item (Please sign up for both on the chat section of the screen.) Please limit your comments to 3 minutes. 7:00—7:05 II. Approval of May 27, 2020 Agenda 7:05—7:10 III. Action Items (Consent) A. Minutes of April 22, 2020 7:05—8:05 IV. Educational Sessions A. 474 CLAS Standards Advancing Health Equity AA Beverly Scurry (15 minutes)(relative to BOH Strategic Plan Priority: Engagement) B. 2019 Community Health Assessment Presentation Ashley Rawlinson (20 minutes)(relative to BOH Strategic Plan Priority:ALL) C. BOH Strategic Plan Discussion Quintana Stewart/Beverly Scurry (25 minutes)(relative to BOH Strategic Plan Priority:ALL) 8:15—8:45 V. Reports and Discussion with Possible Action A. BOH Vice-Chair Discussion Jessica Frega B. Health Director Report Quintana Stewart C. Mask/Cloth Facial Covering Jessica Frega D. COVID-19 Update Quintana Stewart E. Media Items Kristin Prelipp 8:45—8:50 VI. Board Comments 8:50 VII. Adjournment BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to 1stran_ge(@oranpecountVnc._gov advising her of your attendance at this meeting OR CALL 919-245-2411. Compliance with the"Americans with Disabilities Act'and Title VI-Interpreter services and/or special sound equipment are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation. Conforme a la"Ley sobre Estadounidenses con Discapacidades"(ADA)y el Titulo VI—los servicios de interprete y/o equipo de sonido especial estan disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919-245-2387 para solicitar un interprete u otros arreglos o adaptaciones. MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH April 22, 2020 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality (of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON April 22, 2020 virtually via Go To Meeting. BOARD OF HEALTH MEMBERS PRESENT: Jessica Frega, Chair, Jennifer Deyo, Vice-Chair, Keith Bagby, Bruce Baldwin, Liska Lackey, Sam Lasris, Commissioner Earl McKee, Lee Pickett, and Alison Stuebe. BOARD OF HEALTH MEMBERS ABSENT: Aparna Jonnal and Timothy Smith. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Victoria Hudson, Environmental Health Director; Donna King, Health Promotion & Education Services Director; Pamela McCall, Public Health Nursing Director; Kristin Prelipp, Communications Manager; Ashley Rawlinson, Healthy Carolinians Coordinator; Beverly Scurry, BOH Strategic Plan Manager; and La Toya Strange, Administrative Support I. GUESTS PRESENT: Cayman Seider. Jessica Frega, Chair, called the meeting to order at 7:05pm. I. Public Comment for Items NOT on Printed Agenda: None. II. Approval of the April 22, 2020 Agenda Motion was made by Alison Stuebe to approve the agenda, seconded by Liska Lackey and carried without dissent. III. Action Items (Consent) A. Minutes of March 25, 2020 Meeting Motion was made by Alison Stuebe to approve the minutes of March 2020, seconded by Liska Lackey and carried without dissent. IV. Educational Sessions A. Cardinal Annual Update Lynn Inman, Community Engagement, along with Ric Bruton, Senior Community Executive, Cardinal Innovations, presented on how county funds are used to support Cardinal Innovations programming in Orange County (OC). Below are some highlights. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ April Page 1 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH April 22, 2020 • Cardinal Innovations manages Medicaid State money; it does not perform any of the services. It aids in determining how much and to where the funds should be dispersed. • Children services usually drop during the summer as the problems caused in a school setting aren't occurring outside of school; while, the number of adults that receive services remains stable during the year with an average of 650-780 seen any given month. Those receiving services are only counted once even if they have multiple diagnoses. • Mr. Inman presented graphs that displayed Medicaid and State data pertaining to the: o Number of members served by age and diagnosis o Members served and expenses by service category o Members served and expenses amounts — crisis services • Local Maintenance of Effort (MOE) Funding o The counties will give monies to support programs per part B of statute § 122C- 115. Part D stipulates that counties aren't allowed to reduce the amount they contributed from the previous year; however, they're always able to increase the amount. o OC contributes $1.3 million annually which is divided amongst many line items and entities. • There are various programs that receive funding. Services that these programs provide include services to undocumented people, assisting DSS with placements and trauma focused therapy, crisis and language resource center. The biggest providers are Freedom House Recovery and UNC Department of Psychiatry. The BOH members had questions that were addressed by Mr. Inman and Mr. Bruton. B. 3rd Quarter Financial & Billing Dashboard Reports Rebecca Crawford, Financial &Administrative Services Director, gave a report on the 3rd quarter revenue and billing accuracy. Her report is as follows: • Total Health Department Budget vs. Actuals: Average YTD monthly revenue in FY19-20 after the third quarter is $220k/month or $2.OM YTD, representing 56.3% of our overall budgeted revenue for the year. As usual though, the total third quarter revenue is skewed down due to the majority of state funds not eligible to be drawn in July (this is typical) and allocations of Medicaid Max funds will not be transferred into our budget until the end of the fiscal year. Expenses are above revenues, at 62.7% of the overall budget but on trend with prior fiscal years. • Total Billing Accuracy: The medical and dental billing accuracy measure continues to be a challenge as we work with UNC and the Dental EHR, Eaglesoft, to improve the accuracy of the reporting system for Health Department revenue and is not included in this quarter's dashboard. • Dental Earned Revenue by Source: The FY 19-20 average monthly revenue ($49.4k/month) for the third quarter is above our budget projection ($45k/month) and our FY 18-19 average of$46.6k/month. We are seeing the direct impact of adding the additional Dental Hygienist in FY 18-19 and will potentially exceed our projected annual revenue related to this position ($72,157) since the dental clinic is fully staffed. The dental clinic will most likely see a more immediate, negative impact on revenues than the medical clinics as a result of the severely S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ April Page 2 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH April 22, 2020 decreased operations and very limited appointments. FY 19-20 dental earned revenue totaled $445k at the end of the third quarter compared to $393k at the end of the FY 18- 19 third quarter. • Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 19-20 ($57k/month) at $42k/month due to provider turnover and as clinic staff continue to work through issues with the billing in the Epic EMR. Most appointments returned to 30- minute lengths in January as the medical clinic is almost fully staffed. Our EMIR Quality Improvement team called the "Epic Optimization Team" along with clinic staff have made a large amount of progress in improving revenue from medical clinic services from the Epic system and the monthly average revenue of$42k/month is already higher than it was in FY 18-19 at $35.5k/month. This improvement in billing processing will most likely help insulate the medical clinic from experiencing large revenue deficits until early FY 20-21. Medical clinic revenue totals $378k after the third quarter FY 19-20 compared to $320k after third quarter FY 18-19. • Environmental Health Earned Revenue by Source: Environmental Health earned revenue is currently below the budgeted projection for FY 19-20 ($54k/month) at $44.6k/month. It is a seasonal trend to see lower revenue in the first half of the year than in later quarters due to spring pool inspections; however, the decreased revenue is directly related to the limited number of temporary staff available to complete WTMP inspections. EH had 7 temporary Environmental Health Specialists (EHS) working regularly to complete the inspections at this time last year and now have only 3 temporary EHS working irregularly. We found it difficult to recruit and retain the temporary EHS this summer given the heat. As a result, permanent staff in EH are adding WTMP inspections to their current workloads in order to complete them as required by the end of the fiscal year. EH staff continue to inspect where able during the Stay at Home Order, which will result in only a slight decrease in projected revenue for the remainder of the FY. FY 19-20 YTD revenue totals $401 k compared to FY 18-19 YTD revenue of$404k. • Grants Fund Revenue: FSA has drawn $200k of the multi-year Kenan grant. Expenditures are tracking as anticipated and will continue to increase since we filled the vacant Navigator position in November. This position was dependent upon additional United Way funds in order to hire at the full time equivalent level, which were approved by the BOCC in September. The BOH members had questions that were addressed by Ms. Crawford. C. Accreditation Review/Update Co-Accreditation Coordinators, Ashley Rawlinson and Rebecca Crawford, provided the Board with an overview of the accreditation process. Highlights of their presentation are below. • The purpose of accreditation is to ensure that all NC health departments are meeting the 10 essential services. One of the benefits is that it assures a minimum standard for all health departments and to ensure the same level of service is provided at all local health departments (LHDs) across the state. • As of May 2018, all LHDs in NC have been accredited at least once. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ April Page 3 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH April 22, 2020 • The basic components of the process are: o Self-Assessment by the Agency ➢ Health Department Self-Assessment Instrument (HDSAI) is completed by all health departments and submitted with all accreditation evidence. o Site Visit ➢ A team of multidisciplinary team consisting of local public health professionals familiar with health departments, Environmental Health and the Board of Health will conduct a site visit and interviews. o Board Adjudication ➢ After the visit, the OCHD will receive notification from the Accreditation Board that will state whether accreditation was granted. • Activities and Scoring Requirements o Agency Core Functions and Essential Services ➢ Assessment— OCHD must meet 26 of 29 activities ➢ Policy Development— OCHD must meet 23 of 26 activities ➢ Assurance - OCHD must meet 34 of 38 activities o Facilities and Administrative Services - OCHD must meet 24 of 27 activities o Governance - OCHD must meet 24 of 27 activities ➢ Most of the activities that affect the Board of Health are in the Governance standard. If an agency is assessed 4 or more "Not Mets" under Governance, they will not be recommended for reaccreditation —what the Board of Health does for local public health is very important, and the accreditation standards reflect this importance. ■ The Board of Health-related activities are placed into the following 5 categories: finance, community health, health director/staff, Board function and rules and ordinances. The Board's requirements of tasks for each category was conveyed to them during the presentation. • The Law o NC health departments are required by General Statute to be accredited and maintain accreditation status. Additionally, G.S. 130A-34.4 states that by July 1, 2014, in order for a local health department to be eligible to receive state and federal public health funding from the Division of Public Health, they must obtain and maintain accreditation pursuant to G.S. 130A-34.1. • The "Roles and Responsibilities of Boards of Health Related to N.C. Local Health Department Accreditation (NCLHDA)" guide was reviewed with the Board. The NCLDHA is a general overview and tool that can be used by any Board of Health governance structure. There are also a number of activities for which the Health Director may serve as the designee for the BOH and there must be a link between the Board and Health Director demonstrating that the Board was updated, involved and engaged in the particular activity. o The guide breaks down the Board role into 5 types of involvement. ➢ Ensure you have required policies, procedures or materials. ➢ Hear or review LHD reports. ➢ Discuss service costs, need for new/amended rules or ordinances. Documentation of this must be reflected in the minutes. ➢ Approve fees and budgets. ➢ Take other actions or be involved with efforts to assure the health department has what it needs to do its job. • What can you do to be a "good" BOH member? o Attend meetings regularly, so quorums are reached and, thus, required items can be approved on schedule. S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ April Page 4 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH April 22, 2020 o Document your activities regarding community health and contribute to discussion during Board meetings. ➢ Carefully review meeting minutes to make sure your comments were captured. o Complete required trainings promptly. The BOH members had questions that were addressed by Ms. Rawlinson and Ms. Crawford. D. Advisory Board Report The Board accepted the information as presented in the Board of Health agenda packet. Beverly Scurry was unable to present due to technical difficulties. Jessica Frega asked the Board if there were any questions. There were none. V. Action Items (Non Consent) A. Physical Activity and Nutrition Grant Award Jessica Frega, Chair, reminded all that the Physical Activity and Nutrition (PAN) subcommittee annually provides community support grant funds to both county school systems. The schools have an opportunity to apply for funds up to $1,000 for projects that address physical activity and nutrition. The Board announced that Orange County Schools would be the recipients of two PAN grants of$1,000 each. Motion to award the amount of$1,000 to the Orange County Schools to implement afterschool programs was made by Liska Lackey, seconded by Earl McKee, and carried without dissent. Motion to fund the amount of$1,000 to the Orange County Schools to implement functional wellness programs was made by Jennifer Deyo, seconded by Earl McKee, and carried without dissent. VI. Reports and Discussion with Possible Action A. Health Director Report Highlights of Quintana Stewart's Health Director Report are below. • New information was received at the FY 20-21 budget meeting with the County Manager regarding supporting the economic contingency plan for the remainder of this fiscal due to COVID-19 in which the following was requested: o Reduce spending, closely monitor revenue and expenditures, and implement a hiring freeze for non-mandatory/non-essential positions. • The OCHD will still be able to hire for critical positions such as a dentist and nurses. • The OCHD will be updating their budget and looking to make a few changes in response to the county's contingency plan. Revisions/reductions will not impact staff or any of our essential services. • Board activities will not be affected at this time.* S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ April Page 5 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH April 22, 2020 • On April 9, 2020, Secretary Mandy Cohen waived accreditation and granted a 12 month extension for all fully accreditated local health departments (LHDs) in NC. • On April 15, 2020, Secretary Mandy Cohen issued a public health waiver to all LHDs in which they received six waivers that will not endanger public health and will provide necessary relief to allow us to focus efforts on responding to the COVID-19 pandemic. (See Health Director's report a for list of specific activities waived.) • Orange County is currently ranked number 1 out of 100 counties in the state for its response rate to the Census. • Jessica Frega, Chair, asked if it would be helpful not taking the BOH per diem to which Ms. Stewart replied it's up to the Board. Ms. Frega proposed to the Board the option of not accepting the per diem so that it can be used at the OCHD. Many Board members voiced their eagerness to do so. Board members that wished to do so were directed to send an email to La Toya Strange, specifying whether they wanted to forego their per diem for remainder of FY 19-20 and if they wanted their per diem to be used in a particular department. The BOH members had questions that were addressed by Ms. Stewart. B. COVID-19 Q &A Quintana Stewart, Health Director, gave an update on the COVID-19 status in Orange County as well as took questions from the Board. Some highlights are below. • As of today at 11 am, ➢ in NC, there are: 0 7,220 confirmed lab cases 0 242 deaths 0 434 hospitalizations o UNC-Chapel Hill is at 63% capacity o UNC-Hillsborough is at 91% capacity ➢ in OC, there are: 0 195 confirmed lab cases 0 7 deaths 0 23 hospitalizations 0 57 of the positive cases are being monitored; 21 of those cases will soon come off of isolation/monitoring which will leave 36 actively being monitored • Governor Cooper shared the 3 T's in which he's looking for before lifting the executive orders. o Robust Testing o Aggressive contact Tracing in the state (OC never relaxed contact tracing.) o Trend - decrease in deaths, positive cases and hospitalizations • There isn't an infinite number of tests. The guidance on testing has changed —testing anyone based on their symptoms. Asymptomatic and those with mild symptoms that are able to recover at home may not need to be tested. The state is not accepting asymptomatic cases to test. These cases may be tested thru a private lab. • OCHD Environmental Health have been quite busy conducting routine checks and have been talking with retail and grocery stores to ensure they're following executive orders. • Kristin Prelipp, Communication Manager, sent a press release on yesterday about the public health strike team created by the OCHD and Orange County Emergency Services in early April. The team has worked closely with representatives from UNC and Duke S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ April Page 6 MINUTES - Draft ORANGE COUNTY BOARD OF HEALTH April 22, 2020 University Hospitals. To get ahead of outbreaks, the strike team will provide ongoing education and guidance to those who work at high-risk facilities such as residential facilities as well as conduct swab testing, when required. • Another communication tool headed by Ms. Prelipp is the Joint Information Center (JIC). The JIC's activites includes sending weekly press releases, responding to media inquiries, attending the Call Center which handles all non-medical calls, updating the dashboard on the OCHD website every Tuesday and Thursday to share demographic information mirroring what the state has. • In response to a BOH member's question regarding extending current restrictions, Ms. Stewart stated that everyone is waiting on the Governor's response while also acknowledging that the OC COVID-19 policy group is having this discussion as well, that small businesses are suffering and schools are closed until May 15t". Commissioner Earl McKee added that he would support a gradual reopening. C. Media Items Kristin Prelipp, Communications Manager, briefly mentioned that all of the articles were COVID- 19 related. Media items were in the packet which focused on Orange County's events and our involvement in various efforts. Vill. Board Comments. Jessica Frega congratulated Co-chair,Jennifer Deyo, on the birth of her baby. Ms. Frega also suggested that the Board think about NALBOH in light of COVID-19 in case the conference takes place this year. Lee Pickett thanked the OCHD for doing their regular work in addition to performing COVID-19 related tasks. Lastly, Ms. Frega mentioned that notification of when the BOH Nursing representative recommendation would be added to the BOCC's agenda hasn't yet been received. IV. Adjournment Alison Stuebe moved to adjourn the meeting at 9:08pm and Liska Lackey seconded. The next Board of Health Meeting will be held May 27, 2020 at 7:00pm with location TBD. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\BOH\Agenda &Abstracts\2020 Agenda &Abstracts/ April Page 7 Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 27, 2020 Agenda Item Subject: 474 CLAS AA Update Attachment(s): PowerPoint Presentation Staff or Board Member Reporting: Beverly Scurry Purpose: Action X Information only Information with possible action Summary Information: The Orange County Health Department (OCHD) received an Agreement Addendum (AA) from the North Carolina Office of Minority Health and Health Disparities (NC OMHHD) in December 2018 to address the health status gap between racial/ethnic minorities and the general population. The goal of the AA is to provide training for agencies and communities to increase cultural and linguistic competence through adoption of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. OCHD is now in the second and last year of this pilot project. While COVID-19 interrupted a lot of our plans in year 2, there were many great outcomes from for our staff and community partners. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to _X_Accept as information Revise & schedule for future action Other (detail): 474 1 AA Advancing Health Equity Wednesday, May 27, 2020 Beverly Scurry Service Period June 1, 2019- May 31, 2020 Purpose To address the health status gap between racial/ethnic Overview minorities and the general population. The goal is to provide training for agencies and communities to increase cultural and linguistic competence through adoption of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. Award $28,000 X Health Department Staff Leading the Agreement Addendum (AA) Efforts: + Beverly Scurry + Susan Clifford + Donna King Health Equity Council X 35 individuals representing 23 community Yorganizations and county departments. An increase of 13 individuals and 9 organizations from Year One. X HEC meets monthly X Trainings provided by the Office of Minority Health Disparities and attended by approximately 60 staff and community partners XHosted the Achieving Equitable Outcomes through Results Based Year One Highlights Accountability Training which was attended by approximately 70 staff and partners X25 staff and partners attended the 40th Annual Minority Health Conference XSupported 3 staff members in attending the Racial Equity Institute's Phase 1 Training X Conducted a Community Forum that featured a Gallery Walk and was attended by approximately 60 staff and partners X Offered four Walking the Talk:Diversity, Equity, and Inclusion Webinars from NC Nonprofit with about 20 staff and partners in attendance. X One year membership to Government Alliance on Race and Equity 4o' c VID-19 Deliverable + 8 Hours of training with the Office of Year Two Highlights Minority Health and Health Disparities X In lieu of face-to-face meetings, OMHHD have sent us 10 webinars to attend including topics such as: Soul Food Junkie: Bryon Hurt + Perinatal Health Equity + NC Cares360 XWt,\N'FR) 'eN1h!KR-jj + Health Equity and Food Security ® + Community Health Workers + Health Equity and Inclusion of People with Disabilities i + Why and How Amidst COVID-19 + Building Communities through Faith Partnerships :- IiINEMDE c V, 19 T Deliverable Year Two Highlights + Complete Diversity, Equity, and Inclusion training provided by VISIONS and hosted by Orange County Government DEI ` Leadership Team + Thus far, 498 Orange County Government w -- _ staff have completed the DEI training. + OCHD has had 67 individuals go through the training + Incentivizing staff with lots of swag to attend the three hour training Deliverable + Attend Minority Health Conference Year Two Highlights + 41"Annual Conference held February 28, 2020 was attended by about 15 staff and HEC members + Three OCHD staff were session speakers Zin Lyons—Language Access in Our Health Systems, Grassroots Organizing for Language TRU Justice TO Tommy Green—Successful Transitions Back to WE the Community and Healthcare after Release 0 5ir from Incarceration Krishnaveni Balakrishnan—Asthma and Healthy Homes a 4CVID-�9 , Deliverable T� Year Two Highlights + Management Team, Frontline Staff, HEC members, and BOH members attend Racial Equity Institute (REI) Phase 1 Training + At the beginning of the AA we had 6 members of our 20+ member Management Team who had not undergone training — Currently at least 3 have attended + At least 3 out of 5 BOH members have attended + At least 5 frontline staff attended — many were from Environmental Health Division + One HEC member was able to attend Deliverable Year Two Highlights + Walking the Talk: Equity, Diversity, and Inclusion Webinars (sponsored by the OCHD Immigrant and Refugee Health Program) + 5 webinars from October — December open to OCHD staff and our community partners + Attended by approximately 20 individuals + Topics included: CERTIFICATE ■ Women in the Nonprofit Sector OF PARTICIPATION �� �� .nm ■ White Supremacy Culture ■ What's White Got to Do With it f�a.rwingd.W.Md gtn.Twrev.kW.W.,•Di..—I.n..d.. }+tm Otwb.r id—DOD.MW 11.7D19 ■ Including People with Disabilities $y..n p'rffp.WK..Mpg Or(.nlaer r Deliverable Year Two Highlights + Racial Equity Institute's Groundwater training + Training hosted by HEC on October 10, 2019 + This training featured the regular 3 hour Groundwater training in the morning and an extended version in the afternoon to take a deeper dive with a smaller audience + The event was free and open to the public There were over 100 OCHD staff and community �I partners in attendance. 1 Deliverable Year Two Highlights + Cultural Considerations when working with Muslim Clients + Hosted by the Orange County Immigrant/Refugee Health Coalition on March 6, 2020 + Featured Speakers and Topics: Samy Abdelbaky—Intro to Islam Djaouida Siaci—Challenges of Refugee t; Settlement .t it ' Arshiya Siddiquid—Spirituality and Healthcare 4 � Andy Al Wazni—Muslim Culture and A Islamophobia,Trauma,and Microagression + Over 60 in attendance Deliverable Year Two Highlights + Racial Equity Workshop conducted by Equity Paradigm + Two workshops conducted in Partnership with HEC partners — Refugee Community Partnership and Community Worx + First workshop held Sunday, November 3rd and second held on Saturday, February 8th + Intended for frontline staff and community health The workers who have found it hard to take off work to attend other workshops + 10 — 1$ individuals in attendance at each Equl* ty workshop Paradeigm `r. C VID-19 + Exploration and research of an Equity Data Index Year Two Highlights + Subcommittee of HEC members and other interested community partners gathered to discuss, research, and find funding for an countywide Equity Data Index + Researched examples in Tacoma City, Washington, Durham, NC,Asheville, NC and ® is more + Created a proposal to present to Orange County El I Health and Human Services Leadership Team — ;' 209.3� 2"9% this was done in January and received support and 4 g fundin for a summer intern .. + This project will be underway again in the fall 41 �78°1,�• ��B% cal r 01-1 ;,C VID-19 �. Deliverable Year Two Highlights + Support HEC partners with interpretation/translation and COVID-19 relief Funding support was provided to HEC partners for translation/interpretation services or COVID-19 relief efforts through gift cards Organizations that received funding include: Compass Center for domestic violence clients C40 EmPOWERment Inc for community members in low-income housing COMPASS PASS Refugee Community Partnership for immigrant CENTER a��G o and refugee clients for Women and Families Church World Service for immigrant and refugee clients ,INC—EmPOWERmmt community partnership Deliverable Year Two Highlights + The following were cancelled due to COVID-19: X Community Forum X Language Justice Summit X Health Equity Impact Assessment X Gender Identity Panel ? X GARE Annual Meeting — Portland, OR Facilitator Training for Social Determinants of Health Workshop COV'D_1 ! X CLAS-related data on OCHD clients X CLAS Assessment • 6yy.X •A� v µ� �M1 �OVID-19 -AWNext Steps w. Year Three X The Health Equity Council will be creating an Action Plan to address the Health Equity top priority identified in the CHA OOt. OF GLag,4L X OCHD will have a fall UNC Capstone Team from the Health G� p�� Behavior and Health Equity, Social Justice and Human Rights MPH concentrations at the UNC Gillings School of Global 0 y Public Health that will focus on the Equity Data Index as well as other items from OCHD's Racial Equity Strategic Plan rX We hope to hold a Community Forum much like we planned U this year X We hope to stay connected to ongoing County equity efforts [y with GARS and DEI r 'LTLL TO Year Three Join Today X The Health Equity Council is open to anyone in the community who wants to join — Spread the word • • Social Contact Beverly Scurry — i , bscurry(&orangecount, ov or 919-245- 2405 ( J el I _ II I I _ I L f 4 4 , REALITY EQUALITY EQUITY SOCIAL JUSTICE �UUU1� lfU�l GIUUJ . `J H � J `� "i ORANGF- COUNTY ,y-�.,f D„r., .,cif E Improving health.lnsprrirtg change. 2019 Community Health Assessment Asian-All Other Multiracial Burmese/Karen 3% I ° American Indian or 3% Native Hawaiin o% Black or 'can Ameri 13% Hispanic or Latino/a/x White zo% 6o% Foreign-born population 13.30% Speak a language other than English at home 18.7% - Majority Spanish Speak English less than very well (LEP - Limited English Proficient) 6.45% (8,523) Spanish (4,838) Chinese (1,432) Top languages spoken by LEP population Other Asian (628) Korean (620) Japanese (132) 8mPhase , ccAmcc anent Process Establish CHA Team , Collect Primary Develop Data Community \ Action Plans i Collect& The Analyze Health Disseminate Assessment Statistics CHA Document Process Analyze Primary& Create I Secondary CHA Solicit Data Document Community • Input & Select Health Priorities Commun *K ,, Or 'a Collectr ' 1. Community Opinion Youth Surveys Spanish speakers In-person Online Community Input Sessions 2. Focus Groups Cedar Grove Community Homeless Population Center Karen Speaking SHSC Burmese Speaking CH Public Library Kinyarwanda Speaking Tr% ,r) Issues Access to Care High Cost and Lack of Affordability Lack of Insurance Coverage Inconvenient Hours and Lack of Availability of Care Mental Health Substance Abuse Alcohol Abuse Drug Abuse (ex. opioids) Tobacco Use (e-cig, vaping, smoking) Physical Activity & Nutrition Lack of Safe Places to Exercise Limited Access to Healthy Foods Overweight and Obesity Hunger Issue ,-. County Government and Infrastructure Over-Development Tax Burden Increased Population Density Transportation and Traffic Issues Income & Employment Poverty and Economic Disparities Lack of Job Opportunities and Training Social Justice Health Inequity Discrimination and Racism Fear and Stress Associated with Immigration � r% Ro) Issues Housing Limited Affordable Housing Eviction Homelessness Environmental Health Waste and Pollution Poor Water Quality Health Promotion Need for Chronic Disease Management Need for Health Education • • HCOC "s Chosen Priority Areas 1. Access to Care Health care Dental Care Health Insurance Transportation 2. Health Behaviors Substance Use (Alcohol, Opioids, Tobacco) Exposure to Trauma Physical Activity Food Accessibility 3. Health Equity Environmental Justice Criminal Justice Social Determinants of Health (Employment and Income, Poverty, Education, Housing and Homelessness) Uninsured by Age and Income Status All Income ■<a00%Poverty Level Number of people who are food insecure 18,o3o 2r7.8o% 23•90/o ° Percentage of people who are food insecure 12.70% Children under 18 who are food insecure 4,420 la% iz.5o% l0.50% Percentage of children under 18 who are food 15.50% insecure 5% —M Individuals over 65 who are living below the 0-18 18-64 0-65 poverty level 914 2010 2011 2012 201 201 2015 2o16 201 2o18 Total Alcohol Related 27 23 28 22 26 33 38 39 37 278 Deaths h Orange County,NC Year Iota Vamp 20.6`4 c1 M 10"tLLE- InN croanvilie• — // � l ; Antlirsun• sxnen[, COLUMB V+' ore ,NTA. SOUTH EMc—ive Drinking Prevalence 1d-19 -70-30 81%-1❑49A■104%-15%■1345-147%■4d.7%-164%0 16.d%-189% �wre nq cakuiMee.<5 aeanz 018.9%-274%0274%-264% r mm,geo xe.rtn.,wo�.ia.��mmr:ls-vdeam:l 2014 7015 2015 201] 2018 Community & Partner Involvement/Recruitment Community Health Improvement Plans (CHIP) Access to Care Health Behaviors Health Equity Results Qnced Accountability We are planning to create all CHIP's around RBA — at the population level by determining who will be responsible for what. Population Measures Working with partners to promote community well-being. Not allowing one person, organization, or agency to be held responsible for the well-being of entire communities. Performance Measures Organizes the work to have the greatest impact on the people we serve through programming ' stateIon ^ t � f `a cti o n Activity 38.2 The local BOH (or the advisory committee on health) shall review community health assessment data and citizen input used to plan and monitor progress toward health-related goals. Evidence/minutes should reflect that the BOH review specific aspects of the CHA data. Any Questions ? )oh6- ')r ORANGE COUNTY HEALTH DEPARTMENT Improving health. Inspiring change. 2019 2019 ■ Community Health Assessment Orange County, NC Submitted to the North Carolina Department of Health and Human Services Division of Public Health By the Orange County Health Department And Healthy Carolinians of Orange County Healthy ORANGE COUNTY Carolinians of Orange ORANGE COUNTY NORTH CAROLINA County HEALTH DEPARTMENT Table of Contents -d-A List of Charts and Figures . . . . . . . . . . . . . . . . . . . . . . .v Death and Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi Leading Causes of Death . . . . . . . . . . . . . . . . . . . . 31 Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Background and Introduction . . . . . . . . . . . . . . . . . . . . 1 Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . .32 County Description . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Cerebrovascular Disease (Stroke) . . . . . . . . .32 2020-2024 Community Priorities . . . . . . . . . . . . . . . .7 Chronic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Access to Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Communicable Disease . . . . . . . . . . . . . . . . . . . . . . .33 Access to Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . 7 COVID-19 (Coronavirus) . . . . . . . . . . . . . . . . . . . .33 Access to Dental Care . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Influenza (flu) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Access to Health Insurance . . . . . . . . . . . . . . . . . . . . . 8 Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Access to Transportation . . . . . . . . . . . . . . . . . . . . . . . 9 Vaccine Preventable Diseases . . . . . . . . . . . . . . .35 Health Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Sexually Transmitted Diseases . . . . . . . . . . . . . . . . .35 Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Injury and Violence . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Maternal and Infant Health . . . . . . . . . . . . . . . . . . . . . . 37 Substance Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Maternal Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Opioids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Teenage Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 37 Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Infant Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Infant& Child Health . . . . . . . . . . . . . . . . . . . . . . . .38 Physical Activity& Obesity . . . . . . . . . . . . . . . . . . . . 17 Environmental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Water Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Overweight and Obesity . . . . . . . . . . . . . . . . . . . . 17 Drinking Water Quality . . . . . . . . . . . . . . . . . . . . . . 41 Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Onsite Wastewater . . . . . . . . . . . . . . . . . . . . . . . . .42 Food Insecurity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Water Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Health Equity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Inspections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Equity and Equality . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Retail Food, Lodging and Institutions . . . . . . . .42 Environmental Justice . . . . . . . . . . . . . . . . . . . . . . . .22 Childhood Environmental Health . . . . . . . . . . . . . .43 Criminal Justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Lead Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Formally Incarcerated Transition Program . . . .24 Environmental Health Activities (2015-2019) . . . .43 Social Determinants of Health . . . . . . . . . . . . . . . . .25 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Employment and Income . . . . . . . . . . . . . . . . . . .25 Poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Childhood Poverty . . . . . . . . . . . . . . . . . . . . . . . . . .26 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Homelessness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 List of Figures • Tables Table 1: Orange County General Population Compared to Figure 16: Math Performance Rates. . . . . . . . . . . . . . . . . . 28 Peer Counties and NC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Figure 17: Reading Performance Rates. . . . . . . . . . . . . . . 28 Figure 1: Orange County Race & Ethnicity. . . . . . . . . . . . . 3 Figure 18: Individuals Experiencing Homelessness Table 2: Orange County Population Demographics. . . . . 4 in Orange County. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 3: Direct Refugee Arrivals in Orange County . . . . . 4 Figure 19: Special Populations Experiencing Homelessness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 4: OCHD Interpretation Services. . . . . . . . . . . . . . . . 5 Table 5: OCHD Translation Services . . . . . . . . . . . . . . . . . . 5 Figure 20: People Experiencing Homelessness byRace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 6: Orange County Political Profile. . . . . . . . . . . . . . . 6 Figure 21: Orange County Leading Causes of Deaths, 2014 Table 7: OCHD Patient Encounters . . . . . . . . . . . . . . . . . . . 8 - 2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Figure 2: % Uninsured by Age and Income Status . . . . . . 8 Table 13: Leading Causes of Deaths by Age. . . . . . . . . . . 32 Figure 3: Where Survey Responders Would Refer Figure 22: 1 have been told that I have. . . . . . . . . . . . . . . 33 Someone for Counseling. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure 23: Confirmed Flu Associated Deaths by Figure 4: Methods of Death: NC-VDRS, 2007 - 2016 . . . .12 Age in NC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Figure 5: Rate of Unintentional Opioid Table 14: Reported Communicable Diseases and Overdose Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Conditions in Orange County. . . . . . . . . . . . . . . . . . . . . . . 34 Figure 6: Number of Deaths Caused by Table 15: Sexually Transmitted Reported Cases in Drug Overdose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Orange County and NC. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Figure 7: Current Smokers by Age - Region 5 . . . . . . . . .15 Figure 24: Injury and Violence Rate by Gender andRace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 8: Orange County Alcohol Related Deaths . . . . . . .16 Table 16: 2017 Reported Crime Rates in Orange County Figure 8: Excessive Drinking Rate. . . . . . . . . . . . . . . . . . . .16 and NC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Figure 9: Reasons why survey responders Table 17: Teen Pregnancies in Orange County don't exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 and NC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Figure 10: Obesity Rate by Age, Race and Gender. . . . . 10 Figure 25: 2018 Orange County Infant Death Rate. . . . . 38 Table 9: Food Insecurity in Orange County . . . . . . . . . . . . 9 Figure 26: Children living in Poverty Concentrated Figure 12: Social Factors and Health Risk. . . . . . . . . . . . . .21 Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 10: Orange County Solid Waste Exposure. . . . . . . 22 Figure 27: OWASA Rate Comparison . . . . . . . . . . . . . . . . .41 Table 11: Orange County Detention Center Table 18: Onsite Water Protection Services Program. . . 42 Bookings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 19: Food, Lodging, Institutions, Childcare, Pool, Figure 13: Household Income. . . . . . . . . . . . . . . . . . . . . . . 25 Tattoos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Figure 14: Poverty by Race/Ethnicity . . . . . . . . . . . . . . . . 26 Table 20: Childhood Lead Poisoning Prevention program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Figure 15: Education Attainment in Orange County. . . . 27 Figure 28: Percent of NC Children tested for Lead Table 12: Racial Demographics in Orange County School Poisoning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Districts (2020) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 V 2019 COMMUNITY HEALTH ASSESSMENT The Orange County Health Department (OCHD) and Special thanks to: Healthy Carolinians of Orange County (HCOC) would like to acknowledge and say thank you to the many indi- Ashley Heger, Orange County Food Council victuals, groups and community members who assisted Beverly Scurry, Orange County Health Department in the preparation and development of the 2019 Com- munity Health Assessment (CHA) process. Caitlin Fenhagen, Criminal Justice Resource Whether you answered a survey, volunteered to admin- Department ister door-to-door surveys, were a participant in a focus Cecilia Payne,North Carolina Central University group, attended a community input session, helped spread the word of the assessment in your community Corey Root, Orange County Partnership to or workplace, or responded to a CHA request, this as- End Homelessness sessment could not have been successful if it were not Dana Crews, Orange County Health Department for this collaborative effort. The goal of this document is to publish a report that is Donna King, Orange County Health Department easy to navigate and enables the reader to quickly lo- Elinor Landess, Campus& Community Coalition cate information on a topic of interest. In the electronic version, internal and external links are identified to ease Gayane Chambless, Orange Partnership for Alcohol movement through and beyond the document. Internal and Drug Free Youth links are underlined in green font and external links are Jen Costello, Piedmont Health Services underlined in font. Thank you to the volunteers who conducted the door- Juliet Sheridan, Orange County Health Department to-door surveys, community partners for hosting focus Kristin Prelipp, Orange County Health Department groups and community input sessions, and multilingual interpreters who provided translation and interpreta- LaToya Strange, Orange County Health Department tion services during the data collection process. With Latonya Brown, Orange County Department on Aging the help of these individuals, the voices of community members were heard throughout this process. Liska Lackey, Orange County Board of Health The 2019 CHA process and report was coordinated and Krishnaveni Balakrishnan, Orange County Health compiled by Ashley Rawlinson, MPH, Program Manager Department and Healthy Carolinians Coordinator with the Orange County Health Department. A number of committee Margaret Nemitz, UNC Gillings School of Public Health members, partners and public health professionals re- viewed and/or provided information to the CHA. Megan Clawar, Refugee Community Partnership Melissa Blackburn, Orange County Community Relations Quintana Stewart, Orange County Health Department Rita Krosner, Orange County Health Department Sherry Hay, UNC Family Medicine Susan Clifford, Orange County Health Department Victoria Hudson, Orange County Health Department 2019 COMMUNITY HEALTH ASSESSMENT VI Executive Summary Introduction Health Behaviors Every four years, the Orange County Health Depart- Health behaviors are not always determined by a choice ment (OCHD) and Healthy Carolinians of Orange Coun- to be healthy or unhealthy but rather the influence from ty (HCOC) conduct a Community Health Assessment one's community, systemic racism, exposure to trauma, (CHA). Regular assessment of Orange County's health physical activity, food accessibility, substance use, sexu- enables public health officials to monitor trends in al health and one's social and economic status. health status, determine priorities among health is- sues, and determine the availability of resources within Health Equity Orange County to help best protect and promote the Health equity is achieved when every person has the public's health. opportunity to attain their full health potential and no The overall goal of the community health opinion survey one is disadvantaged from achieving this potential is to address health disparities and identify needs of because of social position or other socially determined populations who are most disadvantaged. 240 house- circumstances. Areas included under health equity are: holds were randomly selected from 40 census blocks environmental justice, criminal justice, and social deter- using the Center for Disease Control and Prevention minants of health to include employment and income, (CDC's) CASPER survey methodology, with emphasis on poverty, education, housing and homelessness. low-income and predominantly minority communities. Surveyors visited close to 800 households and received Next Steps 197 door-to-door survey responses. A duplicated health Findings from this CHA report will help influence stra- opinion survey was placed online and was completed by tegic planning around the three priority health issues. 147 community residents, using a non-random snowball HCOC will disseminate the full report broadly so that approach of sharing the link with partner organizations entities contributing to the health of Orange County and mailing lists. This created 355 total surveys com- residents can develop new or modify existing programs, pleted, which were complemented with data from six services, and resources to address the community focus groups and three community input sessions. health needs relevant to their stated missions. Selected Priorities It is the intended purpose that this 2019 CHA report, and its follow up activities, will be of use to community Results from secondary data, opinion surveys, and members and service providers alike, for all are working community input sessions resulted in the identification towards the common goal of making Orange County a of the three priority areas that will be addressed over healthy place to live, work, play and pray. To get in- the next four years (2020-2024). Those priority areas volved in community efforts targeting the three prior- are 1) Access to Care, 2) Health Behaviors, and 3) Health ity areas, visit https://www.orangecountync.gov/346/ Equity. Healthy-Carolinians. Access to Care Access to comprehensive, quality health care services is important for promoting and maintaining health, pre- venting and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all. Areas included under access to care are: health care, dental care, health insurance, and transpor- tation. VII 2019 COMMUNITY HEALTH ASSESSMENT Background & Introduction Introduction Engagement Team -those responsible for ensuring that the voices of the community are heard as well as Every three-to-four years, Local Health Departments in engaging the community in every step of the process, North Carolina (NC) are required by the NC Department (3) a Volunteer Recruitment Team - those responsible of Health and Human Services to conduct a Community for recruiting volunteers to assist with data collection Health Assessment (CHA). Regular assessment of a and community events, and (4) a Data Team - those community's health enables local public health officials responsible for the format and analysis of the collected to monitor trends in health status, determine priorities data. Community partners served on committees, went among health issues and determine the availability of door-to-door to collect survey responses, and coordinat- resources within the community to best protect and ed and implemented community efforts such as focus promote the public's health. A primary goal of the as- groups and community input sessions (see Appendix A sessment process is to involve the community in every - Committee Members and Appendix B - Survey Volun- phase of the process including planning, data collection, teers). evaluation, identification of health issues and communi- ty strengths, and the development of strategies to ad- Data Collection and Analysis dress identified problems. The information in this 2019 CHA will be compared to information and data from 2019 Community Health Assessment Sampled Blocks previous years, peer counties and NC. You can access _ the 2015 CHA here. The Assessment Process / Establish CHA Team Collect Primary Develop Data Community j Action Plans — - a.ma . Collect& l Du­ Co Analyze Health / Disseminate Assessment Statistics / CHA Process Document rr ' Create CHA Solicit .. ,. Document Community Input& - ----- Select l Ch.- w Health Priorities a."w:ie:a°em«c u,•a>�a em%a aew CMnMI�.'�m::w".°m°.me r - � m.nh°�n°a°im m°VV'in9 mpawxau.me no�ie9afieee0�+diM,ioron enrormev nan mpcm°p• Orange County Tax Administration/Land Records Date:5/16/20791 inch=16,667 feet The completion and success of the CHA is not possible This report was created using both primary (community without input, support, and participation from our com- input) and secondary (previously collected) data sourc- munity and our partners. Collaboration was essential es. Primary data was collected through community in order to effectively identify and assess the health of health opinion surveys (door-to-door and online), focus Orange County. As a result, four teams were created to groups, and community input sessions. Using both assist in the 2019 process. Those teams were made up primary and secondary data yields a more in-depth and of: (1) a CHA Leadership Team (CHALT) - the govern- reliable assessment of the specific factors that affect our ing body and final decision makers, (2) a Community community's health. 2019 COMMUNITY HEALTH ASSESSMENT 1 With the overall goal to address health disparities and Focus Groups identify needs of populations who are most disadvan- taged, 240 households were randomly selected from 40 Six focus groups (47 voices) were conducted among census blocks using the CDC's CASPER survey meth- under-represented populations to gain an in-depth odoloay, with the goal to over sample low-income and understanding of the health concerns, strengths, and predominantly minority communities. Surveyors visited challenges that are experienced in Orange County. close to 800 households and received 197 door-to-door Focus group questions explored important aspects survey responses, compared to 166 door-to-door survey of good health, community strengths and barriers to responses in 2015. A duplicated health opinion survey overall well-being, with additional questions tailored to was placed online and was completed by 147 communi- specific groups. Focus groups were held in partnership ty residents, using a non-random, snowball approach of with Refugee Community Partnership, Orange County sharing the link with partner organizations and mailing Public Library, Inter-Faith Council (IFC) and Family Suc- lists. Combined, this created 355 total survey responses. cess Alliance. Focus groups were successfully facilitated among youth, individuals experiencing homelessness, Over a two month period, survey collection was carried Spanish speakers, Kinyarwanda speakers, Karen speak- out by a team of 85 volunteers. Prior to surveying, all ers, and Burmese speakers. volunteers participated in a mandatory training which covered safety plans and procedures for conduct- Recruitment for focus group participation was done ing surveys (e.g. techniques for conducting unbiased through existing networks and relationships with com- surveys, what to do if someone was not home or chose munity partners. Each focus group was led by a facilita- not to participate, procedures for non-English speaking for and all feedback was captured by a note-taker and residents, etc.). Volunteers conducted surveys in teams was digitally recorded and transcribed to help ensure of two and each team was assigned a specific list of that participants' thoughts, concerns, expressed barri- addresses grouped by proximity. Households who were ers, and recommended methods for improvement were unable to participate in person were given the option to thoroughly captured. Community findings and respons- either complete the survey over the phone or online, via es are presented throughout the document under the a personalized link, to complete at a later date. All sur- Focus Group headings. vey respondents who completed a door-to-door survey Community Input Sessions were given a small incentive for their participation. A 53-question door-to-door survey was administered Three community input sessions were held where com- by hand (pen and paper) and entered into data ana- munity members had a chance to learn and hear the re- lyzing software. Online health opinion surveys were sults from the data collection process; discuss concerns administered and analyzed through Survey Monkey. All with elected officials, people who work in government, data was combined and analyzed, by the Health Depart- and the health department; and help prioritize and de- ment's Informatics Manager, through custom formulas cide what health issues will be selected for 2020-2024. and reports, comparing all question responses against Each community input session had representation from multiple categories of age, race/ethnicity, and gen- an Orange County Board of Health member, where der. Community findings and responses are presented Board members encouraged community members to throughout the document under Survey Data headings. share their honest opinions and feedback on the health Promotion of both online and door-to-door surveying of Orange County. Sessions were held at Cedar Grove was created through: electronic emailing, postal mail, Community Center, Southern Human Services Center local media outlets (newspapers, radio), social media, and Chapel Hill Public Library, where input was received community partners, various community coalitions and from 55 community residents. partnerships, HCOC member listserv, Orange County 2020-2024 Priority Areas Government, community and neighborhood newsletters and listservs, county agencies and organizations, HCOC Results from secondary data, opinion surveys, and committees, Orange County Board of Health, and the community input sessions resulted in the identification Orange County Board of County Commissioners. of the three priority areas that will be addressed over the next four years. Those priority areas are 1) Access to Care, 2) Health Behaviors, and 3) Health Equity. 2 2019 COMMUNITY HEALTH ASSESSMENT CountyDescription Orange County covers approximately 400 square miles, In 2010, there were about 336 people per square mile or 254,720 acres, and is centrally located between Re- compared to 366 people per square mile in 2018. The search Triangle Park(RTP) and the Triad (Greensboro, effects of a high population density could include: high Winston-Salem, and High Point) with Interstates 85 and cost of living, overcrowding and traffic congestion, high 40 providing primary transit avenues. Orange County land prices and reduced affordability due to restricted is an attractive place with mild winters and blue skies land supply, higher crime levels, less green spaces and and is known for the University of North Carolina (UNC) trees, and air and noise pollution. at Chapel Hill (the oldest state-supported university in the United States). Its diverse population includes dairy Orange County Race & Ethnicity farmers, professors, small business owners, corporate The largest racial and ethnic minorities differ in the executives, newly settled refugees, and students from three municipalities. all over the world. The diversity of the population and workforce make Orange County a lively and vibrant African American residents are the largest group of place to work, live, and play. minorities in Hillsborough making up 23%; and Asian residents are the largest groups in Carrboro (10.6%) and General Population Chapel Hill (12.5%).1 With a population of approximately 146,027, Orange Figure 1: Orange County Race & Ethnicity County includes historic Hillsborough, the county seat, with a population of 7,239; Chapel Hill, with a population Burmese/Karen Asian-All Other Multiracial American Indian of 60,988; Carrboro, with a population of 21,314; and 3% 3, 1r° or Native Hawaiian parts of Mebane, (which is mostly in Alamance County), Black or African 0% American with a population of 2,000.1 Below are in-depth de- 13% tails about the population, compared to peer counties - counties that are similar based on key demographic, social, and economic indicators. ispanic or In terms of where people reside, 71.5% of Orange Hatino/a/x White County residents live in the southern "urban" areas of ' Chapel Hill and Carrboro, while the remaining 28.5% live throughout the rural areas of the County.2 L_ aj Table 1: Orange County General Population Compared to Peer Counties and NC r New PEOPLE Orange Brunswick Hano er Buncombe County County V County I County Population, 2018 146,027 136,744 232,274 259,103 Population, % change (April 2010 to July 2018) 9.2% 27.3% 14.6% 8.7% Persons under 5 (2018) 4.5% 3.9% 4.9% 5.0% Persons under 18 (2018) 19.7% 15.3% 18.4% 18.5% Persons 65 and over(2018) 14.0% 31.5% 17.7% 20.0% Female Persons (2018) 52.2% 52.2% 52.3% 52.1% 2019 COMMUNITY HEALTH ASSESSMENT 3 Immigrant and Refugee Populations Refugees in Orange County Orange County has a growing immigrant and refugee Nationwide, refugee arrivals have significantly de- population - 13.3% of the population is foreign-born creased annually since 2016-2017, after the change in - mostly comprised of Hispanic/Latinx immigrants of federal administration. In 2017, the Trump Administra- Latin American origin, and Asian immigrants from vari- tion used an Executive Order to reduce the number ous locations, including China, Burma/Myanmar, Korea, of refugee admissions previously set by the Obama and Japan. Administration. Since then the number of refugee admissions has been reduced even further. In addition, In addition to its diversity in countries of origin, Orange in March 2020, the International Office of Migration and County is home to a linguistically-diverse population. United Nations High Commissioner for Refugees an- With 18.7%of the population speaking a language other nounced a temporary suspension of travel for refugees than English, there are a substantial number of house- during the COVID-19 (coronavirus) pandemic. holds that require language access for county services. The Limited English Proficient (LEP) population, which OCHD Language Services: is measured by those who speak English "less than very When looking at the OCHD language services provision well" is 6.45% (or 8,523 people) according to the 2018 American Community Survey 5-year estimates. Among over the last several years, this increase in the linguis- thatgroup, the top languages spoken are: 1) Spanish, 2) tic needs of the Orange County population is evident. Chinese, 3) Other Asian, 4) Korean, and 5) Japanese. Staff and on-site contract interpreters have annually increased the number of interpretation encounters cov- Several languages and dialect subsets are spoken by ered at OCHD. These include medical and dental clinical refugees from Burma including: Burmese, Karen- Sgaw appointments and a range of interpretation services and Pwo/Poe, Chin -Falam, Hakha, Tedim, and Rohing- for other OCHD programs such as: the Home Visiting ya. Additional languages spoken by refugee neighbors Program, Family Success Alliance Navigator appoint- include: Kinyarwanda and Swahili, spoken by refugees ments and parent meetings, Diabetes Self-Management from DRC (Democratic Republic of Congo) and Ara- Education (DSME) classes for the Nutrition Services bic, spoken by refugees from Syria. Due to in-and-out program, and Healthy Homes appointments. Patients migration, available data are limited for the refugee speaking over 20 languages (including American Sign populations; nevertheless, tracking of direct arrivals to Language) were served using these services. Orange County, for those served by the Refugee Health Program, provides a glimpse into a basic number of the population living in the county. Table 2: Orange County Population Demographics4 Table 3: Direct Refugee Arrivals in Orange County' New Foreign-born population 13.3% COUNTY Direct Countries Origin FISCAL YEAR I.efugee 2015-2016 83 DRC, Burma, Iraq, Speak a language other 18.7% - Majority Russia than English at home Spanish 2016-2017 102 Burma, Syria, DRC, El Salvador Speak English less than 6.45% (8,523) 2017-2018 22 Burma, DRC, very well (LEP - Limited Spanish (4,838) Nepal English Proficient) Chinese (1,432) 2018-2019 34 Burma, DRC, Syria, El Salvador Top languages spoken Other Asian (628)Korean (620) 2019-2020 Burma, DRC, by LEP population Japanese (132) (YTD as of 9 Ethiopia 4/1/2020) 4 2019 COMMUNITY HEALTH ASSESSMENT Table 4: OCHD Interpretation Services •n-Site Telephonic Video COUNTY FISCAL YEAR Interpretation Interpretation - - • Encounters* Calls" Calls*** 2015-2016 4,732 1,528 N/A 2016-2017 5,195 1,910 393 2017-2018 5,362 1,816 230 2018-2019 5,651 2,749 305 2019-2020 (YTD as of 4/1/2020) 4,350 (9 months) 1,582 (7 months) 273 (8 months) *On-site interpretation encounters include appointments covered by an in-person interpreter,across all programs and divisions of the department. This number does not include no-shows or cancellations with less than 24-hour notice. **Telephonic interpretation calls include patient encounters and patient calls across the department for a wide variety of languages. ***Video interpretation calls during this time only include medical and dental clinic appointments. Table 5: OCHD Translation Services COUNTY rTranslations FISCAL YEAR ' 2015-2016 171 Spanish, Karen, Burmese, Chinese, Arabic 2016-2017 173 Spanish, Karen, Burmese, Chinese, Arabic, Kinyarwanda 2017-2018 142 Spanish, Karen, Burmese, Chinese, Arabic, Kinyarwanda, Vietnamese 2018-2019 228 Spanish, Karen, Burmese, Chinese, Arabic, Kinyarwanda 2019-2020 240+ Spanish, Karen, Burmese, Chinese, Arabic, Kinyarwanda (YTD as of 4/1/2020) In addition to interpretation services, the demand for cally. In March 2020, community members asked for translation service continues to increase. Translations the inclusion of Swahili as well as Kinyarwanda, as there were produced by multiple services and divisions rang- are some Congolese members of the community who ing from Medical and Dental clinical services to Family do not speak both, and communication with all in the Success Alliance and Family Home Visiting, Emergen- community is even more critical during this public health cy Preparedness, Environmental Health, Finance, and emergency. It is expected that the multilingual needs Vital Records. As part of the COVID-19 (coronavirus) will continue to grow as we continue to work closely pandemic, the need for translations and multilingual with immigrant and refugee partners in ensuring inclu- audio/visual communications has increased dramati- sion and language justice for all. 2019 COMMUNITY HEALTH ASSESSMENT 5 Political Profile County commissioners are responsible for establish- ing the annual property tax rate. Property taxes are Orange County is considered a progressive county, charged to residential and commercial entities (or voting primarily Democratic. In the 2016 presidential persons)that own land in the county. The median prop- election, 72.8%voted for Hillary Clinton, the Democratic erty tax in Orange County is $2,829 for a home worth candidate, as opposed to 22.5% who voted for Donald a median value of$258,000. This is compared to $933 Trump, the Republican candidate. According to the NC in Brunswick County, $1,257 in Buncombe County, and State Board of Elections, as of November 30, 2019, there $1,394 in New Hanover County, Orange County's peer were 108,426 registered voters in Orange County. The counties. This puts Orange County as having the high- party affiliations and racial/ethnic demographics, of est median property tax in the U.S. The average yearly those registered, are listed below.6 property tax paid by Orange County resident's totals about 3.31%of their yearly income.? Property taxes are Table 6: Orange County Political Profile used to fund county and municipality infrastructure and operations, including public schools. AFFILIATION • History Democratic 50,282 r'— On September 9, 1752, Republican 14,817 Orange County was founded and named after Green 36 William V of Orange. Hillsborough, the county PA, Constitution 26 seat, was founded in 1754 Libertarian 693 and had several names over the years. Its first name was Corbin Town, then Unaffiliated 42,572 Childsburgh, and in 1766 the town's final name became Hillsborough. Hillsborough is an old and interesting Demographic Count town located on land where the Great Indian Trading White 77,494 Path crossed the Eno River and was the center of much colonial activity. The county is divided into the seven African American 12,006 townships of Bingham, Cedar Grove, Chapel Hill, Cheeks, Eno, Hillsborough, and Little River' American Indian 258 Originally home to a succession of Native American Other 18,668 tribes that included the Haw, Eno, Occaneechi, and others, the area including what is now Orange County Hispanic 3,670 covered 3,500 square miles. This large area also in- Male 45,988 cluded all of present day Alamance, Caswell, Person, Durham and Chatham counties as well as parts of Wake, Female 55,191 Lee, Randolph, Guilford and Rockingham counties. County Infrastructure Faith and Spirituality There are hundreds of places to worship in Orange Similar to other NC counties, Orange County is gov- County, including churches, mosques, synagogues and erned by aseven-member board of commissioners who other faith organizations. These institutions provide a are elected to four-year terms by district and at-large source of spiritual nourishment, community support partisan elections. The results of the 2019 CHA found and resources to the residents of Orange County. As that county residents had varying concerns related to residents face the challenge of trying to stay connect- county government and infrastructure including: tax ed to their community in an area where the population burden, transportation and traffic issues, over-develop- is growing and changing quickly, their spiritual homes ment, and increased population density. become sources of social interaction, information ex- change, and health care. 6 2019 COMMUNITY HEALTH ASSESSMENT Community2020-2024 Priorities The results from secondary data, opinion surveys, and insurance, additional barriers include: 1)the concen- the community input sessions allowed the identification tration of health care resources in the southern part of of three priorities that will be addressed over the next the county, 2) inadequate transportation systems in the four years. Those priority areas are 1) Access to Care, 2) central and northern part of the county, 3) language Health Behaviors, and 3) Health Equity all of which are barriers, and 4) perceived discrimination (or racism) detailed below. within health care facilities. Access to Care Among survey responders: Access to comprehensive, quality health care services • Over the past 12 months, 15% reported having a is important for promoting and maintaining health, pre- problem getting needed health care for themselves venting and managing disease, reducing unnecessary or a family member. disability and premature death, and achieving health • 25%expressed having issues accessing health care, equity for all. Health inequities are systemic differences including dental care. in the health status of different populations and of- ten exist due to cost and income status, access to the • 10% reported problems accessing health care be- healthcare system and primary care physicians, employ- cause their deductible/co-pay was too high. ment status, ethnicity, transportation, and preventative health services. • 9% reported problems accessing health care because their insurance did not cover what they (or their Among survey responders: family member) needed. • 28%of responders felt that access to care was an • 9% reported problems accessing health care because issue, with concerns around cost and affordability, the wait (at health care facilities) was too long. insurance coverage and hours of availability of care. Among Focus Group responders: Access to Health Care • Karen and Burmese speaking focus group partici- Access to health care means "the timely use of personal pants shared the lack of language services and inter- health services to achieve the best health outcomes." preters that are available, in their language, when it An individual's ability to access health care, including comes to health care facilities. dental care, can be impacted by a variety of factors such as; availability of services, high cost of care, lack of • Spanish speaking focus group participants shared health coverage, and lack of culturally competent care. the lack of health information that is available in The inequities around accessing care are often based on Spanish. race, ethnicity, socioeconomic status, age, sex, disability Access to Dental Care status, sexual orientation, gender identity, and residen- tial location. Individuals facing inequities often expe- Dental care is one of the nation's greatest unmet health rience unmet health needs, delays in receiving appro- needs. Issues in oral health include availability of afford- priate care, inability to get preventive services, financial able dental insurance, access to regular and preventive burdens, and preventable hospitalizations.9 care, and population specific issues like children's dental Orange County has a strong health care community that heath, increasing refugee population needs, and lan- includes a nationally-ranked hospital system, an accred- guage barriers. According to the NC Department of ited School of Public Health, a federally qualified health Health and Human Services, poor oral health can lead to center, a local public health department, a medical and diseases and injuries of the skull and face. As a result, dental school, and various private medical practices. public health has been focusing on improving oral Even though Orange County has a physician rate of health by reducing disparities and expanding access to 119.62 per 10,000 population, compared to the state rate effective preventative programs. Such efforts include work around community water fluoridation, school of 24, residents continue to report problems accessing dental sealant programs, baby and prenatal oral health health care services. In addition to not having medical programs, and incorporating oral health programs into 2019 COMMUNITY HEALTH ASSESSMENT 7 chronic disease prevention and medical care. Research OCHD Medical and Dental Patients& Encounters: from the East Carolina University School of Dental Med- icine found that community water fluoridation (CWF) With an increase in linguistic diversity and numbers in and telehealth services are two examples of cost-effec- Orange County, the patients served by OCHD have also tive and equitable public health services that can help increased. In fiscal year(FY) 2018-2019, which occurs reduce dental decay.'o July to June, 42% of dental encounters and 36%of medical encounters required an interpreter or bilingual Communities of color have much higher rates of tooth staff for language access. OCHD served these Limited decay, tooth loss, fewer dental visits and preventive English Proficient (LEP) clinical patients using interpret- treatments than White populations. Economic hardship er services (on site, telephonic and video) in the top lan- negatively affects access to dental care for many people guages of 1) Spanish, 2) Karen, 3) Chinese, 4) Burmese of color." In INC, children of minority backgrounds have and 5) Arabic. high rates of tooth decay. 55% of American Indian children and 52%of Hispanic/Latinx children experience Table 7: OCHD Patient Encounters tooth decay, compared to 30% of White children. How- ever, 29% of American Indian and 23% of Asian Ameri % of Patients % of Encounters - can children have untreated tooth decay, compared to that were that were with 13%of White children. When it comes to adults, 32% r LEP LEP Patients of White adults in NC did not visit a dentist in 2016 and that percentage was significantly higher among African MEDICAL 32% 36% Americans (44.5%) and Hispanic/Latinx (51.2%)'. DENTAL 41% 42% According to the CDC, fluoridated water reduces tooth decay by 25%among children and adults. Fluoride also Access to Health Insurance helps with reducing cavities, less severe cavities, less need for fillings and removing teeth, and less pain and According to small areas health insurance estimates, suffering because of tooth decay. As of March 2020, 10.5% of Orange County residents, between 0-65 years the Orange County Board of Health recently approved of age, are currently uninsured, compared to the INC continued fluoridation of Orange Water and Sewer Au- rate of 12.6%, and the U.S. rate of 10.2%.13 NC children thority's (OWASA) water supply, at the current levels, as and seniors enjoy higher rates of coverage due largely deemed effective for prevention of tooth decay and for to Medicaid and Medicare. Approximately 28%of those promotion of good oral health.12 uninsured in Orange County are adults 18-64. Orange County has a dentist rate of 18 per 10,000 Among survey respondents: population compared to NC (5.08), with OCHD Dental Clinic and Carrboro Community Health Center listed as • 17% reported not having any health insurance. Orange County's oral health safety net providers. Figure 2: % Uninsured by Age and Income Status Among survey responders: -All Income ■<200%Poverty Level • 6% expressed having issues accessing dental ser- 27.8% 23.9% vices. • 72%support local fluoridation of water from OWA- 12% 12.5% las% SA. 5% • 68%support fluoridation of water because in the right amounts, it helps prevent dental decay, fluo- 0-18 18-64 0-65 ridation is a social justice issue for those who have trouble paying for dental care, and it's equitable and Having health insurance provides individuals access into reaches all citizens. the health care system. Lack of coverage creates barri- ers that can limit or prohibit individuals from receiving the health care that they need and can cause an indi- vidual to have poor health status, late diagnoses, and/or premature death. 8 2019 COMMUNITY HEALTH ASSESSMENT The Affordable Care Act (ACA), the largest health care 5%walk, and 3% utilize other means21. Orange County legislation since the enactment of Medicaid and Medi- Commuter Options (OCCO) is an available program that care, helped to reduce racial and ethnic disparities in helps one get to work without having to drive alone. access and extended care to millions of Americans14. Data from the Kaiser Family Foundation also points to Orange County's three transit providers operate in and improvements in health care access, coverage, and utili- through the county to connect people to both rural and zation by race and ethnicity as compared to the ACA15 urban destinations. Orange County Public Transpor- tation (OCPT) connects Hillsborough to other regional Out of more than 10 million NC residents, approximately towns, and provides service for the rural areas of the 30%are either uninsured, on Medicaid, or are dually eli- county and into Chapel Hill, as well as regional con- gible for Medicare and Medicaid". Between 2010-2016, nections to Durham and Mebane. Chapel Hill Transit the number of uninsured in INC and Orange County de- provides mobility needs to the residents of Chapel Hill clined with the passage of the ACA; however, in 2017 the and Carrboro, UNC students, employees and visitors. uninsured rate began to rise". Approximately 100,000 Go Triangle connects Orange County to neighboring Medicaid eligible and non-elderly uninsured individu- Durham and Wake Counties, including express service als live within a four-county radius of Orange County18. to Duke University, INC State University and frequent While a single disease does not dominate within these service to RTP. subgroups, the work through Carolina Health Net (the local system of care for the uninsured) and Community Among survey responders: Care of North Carolina (the local system of care for Med- . 17% reported that bus routes do not go where they icaid) indicates that approximately 82%of patients often need them to go. have multiple health and psychosocial needs". • 15% reported that public transportation doesn't op- While the ACA called for Medicaid expansion in every erate in the hours/times they need them. state, which would cover all legally-present residents with income up to 133%of poverty, INC rejected Medicaid • 15% reported that public transportation takes too expansion. Due to the non-expansion, INC is missing out long. on billions of federal dollars, and is causing NC hospitals to provide approximately$1 billion in uncompensat- Among focus group responders: ed care each year- an amount that would drastically . Karen and Burmese speaking participants shared the decline if Medicaid were expanded. Expanding Medic- lack of language services and interpreters that are aid could have created 40,000 jobs, which could have available, in their language, when it comes to public assisted with rural hospitals being able to remain open20. transportation. Access to Transportation In 2020, there are a number of new transportation projects aimed at providing increased service to in- dividuals in Orange County. A few of those projects ,meU,e,yo.rideor tpuhhotrampar�anis include: 1) Americans with Disabilities Act (ADA) com- ouadle m yom C rn mrnrty by us IV yfRd11•� &ton Board Bay onbpn1252019ID show your support /* b pliant improvements at bus stops for Chapel Hill Transit, M puWr transportauen 2) construction of the Hillsborough train station, 3) a park-and-ride lot in north Hillsborough, and 4) bus stop improvements throughout Orange County, as well as in 'R Mebane. OCPT will add a new service on two routes; A Hillsborough-Mebane on the Alamance Health Connec- p.Irpa.A.«a tor, and a new Cedar Grove-Durham Express. The Hill- sborough Circulator will be expanded and counter-cir- w *� cular service will be provided and OCPT will increase service for mobility on-demand. _ p 8� � � � •awrw p� �� RawaMNe Get p1199�9rnn„sos,�•`O$� eeparui � rQ aaaxswn`O Transportation infrastructure in Orange County has Board �� improved over the years. The 2030 Comprehensive In 2017, there were 70,923 Orange County residents, 16 Plan outlines future efforts of the Transit Department. years and over, commuting to Orange County for work, Those efforts even include alternative transportation compared to 66,130 in 2014. 68% of the population efforts such as interconnected pedestrian and bicycle drive alone, 8% utilize public transportation, 9% carpool, trail, transit lanes along major thorough fares, and the 2019 COMMUNITY HEALTH ASSESSMENT 9 development of park-and-ride lots that would encour- age use of public transportation to travel to and from work. While the Comprehensive Plan outlines future efforts to improve connectivity throughout the county, those efforts will be met with funding constraints, fre- quency of users, and the rural nature of certain areas in the county. To aid in access and utilization of transpor- tation services, transit academies and ride-a-longs have been introduced to health and human service providers, older adults, and non-profit agencies to help educate and provide awareness of available local, regional and state transportation resources. For more information on current transportation routes, fees, and ridership criteria visit the Transportation Services website. Below is a non-inclusive list of local and state programs and initiatives to help address Access to Care. Affordable Care Act Cardinal Innovations Healthcare Carolina Health Net Carrboro Community Health Center Chapel Hill Transit Community Care of North Carolina Go Triangle Piedmont Health Orange County Health Department Dental Clinic Orange County Public Transportation 10 2019 COMMUNITY HEALTH ASSESSMENT Health Behaviors • 11%felt that mental health was an issue. Health behaviors are not always determined by a choice • 52%said they would refer a family member/friend to to be healthy or unhealthy but rather the influence from a private counselor/therapist if they needed counsel- one's community, systemic racism, exposure to trauma, ing. physical activity, food accessibility, substance use, sexu- . 14% did not know who to refer a family member or al health and one's social and economic status. friend to for counseling. Mental Health Suicide Mental health is defined as an individual's emotional, The rate of suicide (2014- psychological and social well-being22. Mental health 2018) in Orange County is 9.8 J the 70 suicideess w were shapes and helps to determine how individuals relate per 100,000, accounting for to themselves and others, how to deal with stress and 70 deaths, compared to 66 how to make choices, and handle everyday life activities. SUICIDE Mental health problems are common, and it is estimated deaths from 66 of P R E V E N T 10 N that 21% of adults in Orange County and 19% of adults in were a among NC live with depression23. White, non-Hispanic individ- LIFELINE uals and 55 of the 70 deaths 1-800-273-TALK(8255) Although rates of depression are lower among African were completed by men. •_• _ • • Americans and Hispanic/Latinx than in Whites, depres- Suicide is the 9tn leading cause sion among African Americans and Hispanic/Latinx are of death for all ages in Orange likely to occur more often. LGBTQ+ individuals are 2.5 County, the 711 leading cause of death among those 0 times more likely to experience depression, anxiety and - 19 years of age, the 2nd leading cause of death among substance misuse compared to heterosexual individu- those 20-39 years of age, and the 511 leading cause of als. Twice as many women will experience depression, death among those 40 - 64 years of age. While sui- generalized anxiety disorder or PTSD (post-traumatic cide in Orange County is higher among White males, stress disorder) in their lifetime, versus men 24. About 1 the data also shows that the suicide rate is significantly in 5 American adults have a mental health condition, yet lower among African Americans, American Indians and about 56% of mentally ill adults lack treatment. Barri- Hispanic/Latinx to the point where the numbers are ers to care include a chronically underfunded mental too low (or non-existent)to produce a rate. Racial and healthcare system, the social stigma of mental health ethnic differences in suicide and suicidal behaviors are conditions, high costs of care, lack of mental health pro- often related to underreporting and limitations among fessionals, and a scarce number of community-based data collection systems. resourceS25. Suicide is preventable and there are a number of signs Among survey responders: and symptoms to be aware of that can ultimately save a life. Warning signs of suicide ideation include26: • Mental health concerns were one of the most com- mon issues, being more prevalent than high blood • Talking about wanting to kill oneself pressure, diabetes, or high cholesterol. • Sleeping more or less than usual Figure 3: Where Survey Responders Would Refer Someone for Counseling Don't Know/Not Sure 13.7�W Minister/religious official School Staff Support Group(i.e.AA,NA,etc.) Doctor Private Counselor/Therapist 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 2019 COMMUNITY HEALTH ASSESSMENT 11 • Indicating feeling hopeless, isolated and extremely Cardinal Innovations Healthcare lonely El Futuro • Withdrawal from family, friends or activities Faith Connections on Mental Illness • Extreme mood swings Freedom House Recovery Center • Acting recklessly National Alliance on Mental Illness (NAMI) • High anxiety or agitation National Suicide Prevention Lifeline • Increased alcohol or drug use NC Injury and Violence Prevention Branch From 2007 to 2016, 3,157 NC youth, ages 10 to 24, died as a result of violence. Of these violent deaths, 1,505 Orange County Behavioral Health Systems Analysis (47.7%) were suicides. Regardless of age, males consis- UNC Center for Excellence in Community Mental Health tently had a higher number of deaths by suicide than females. The number of NC suicides peaked for males Substance Use at age 22 with 171 suicides, and for females at age 23 with 38 suicides. 73%of all youth suicide victims were Substance abuse is generally defined as a harmful pat- identified as non-Hispanic White, 16.3% were identified tern of use of any mood-altering substance. Substances as non-Hispanic African American, 6.2% identified as include alcohol and other drugs, whether legal or illegal. Hispanic/Latinx, and 4.5% identified as belonging to Included in this section will be information on the use, another racial/ethnic group. Overall, the most common misuse and/or abuse of the top three most misused/ method of suicide among youth is firearms27. abused substances - opioids, tobacco and alcohol. Figure 4: Method of Death: NC-VDRS, 2007-2016 Among survey responders: -N.L owi of Public fth N.L.vlale Dt hRep­g SysKVP— • 8%stated that substance use was an issue with con- Firearm 53% cerns around alcohol, drugs and tobacco. Hanging 35% opioids Poisoning . [% America's opioid and heroin epidemic claimed nearly 64,000 lives in 2016 - more than guns, car accidents, Dine,. , 6% homicides, or HIV/AIDS. Opiate-related overdoses are now the leading cause of death for Americans under the 0% 25% 50% 75% 100% age of 5029. Percerd of SukWa Opioids are a large cause of unintentional drug over- Healthy Carolinians of Orange County (HCOC) adopted dose deaths. When it comes to opioid overdose, the#BeTheOneTo campaign with hopes that together Orange County has a rate of 6.6 per 100,000 (shown lives can be changed. There are five evidence support- below). In 2015, over 1,100 North Carolinians died due ed steps for communicating with someone who may be to opioid-related causes, which was a 73% increase over suicidal. Those steps are: 1)Ask, 2) Keep Them Safe, the past 10 years3o 3) Be There, 4) Help Them Connect, and 5) Follow Up. Though rarely talked about or reported, suicides out- Among survey responders.- number homicides two-to-one, resulting in nearly 1,200 suicides in NC each year28. Preparing communities, ' 89%said they would refer their friend or family organizations, and individuals to skillfully reach out to member to a doctor or private counselor for coun- help others in need is an important responsibility, and seling. one that Orange County and NC takes seriously. To help A 2016 report found that people who use opioids are do this, NC has the 2015 Suicide Prevention Plan . more likely to live in the rural south than anywhere else Below is a non-inclusive list of local and state programs in America. Of the 25 most addicted American cities, and initiatives to help address mental health. four are located in NC. Fayetteville ranked 1811 (79%) Jacksonville ranked 121h (8.2%), Hickory ranked 51h (9.9%) and Wilmington is at the very top with more than 11.6% of its population abusing opiates31. 12 2019 COMMUNITY HEALTH ASSESSMENT Historically, prescription drugs—often painkillers—were in Orange County over the past ten years, with a sig- the major contributor to this epidemic, and today opi- nificant increase occurring among heroin and/or other oids are a class of drug that include, but are not limited synthetic narcotics. to: "heroin, fentanyl, oxycodone, hydrocodone, codeine and morphine". Below, is a graph of substances that Due to the consistent increase in opioid overdoses, contribute to the unintentional overdose deaths here Governor Roy Cooper declared NC as having an opioid epidemic. To help combat this crisis at the state level, Figure 5: Rate of Unintentional Opioid Overdose Deaths OpioidRate of Unintentional Overdose Dea • • • • • North Carolina 2014-2018 0 3-g Orange 6.6 9-13 14-19 20 30 Statewide 13.6w Rate not calculated,c5 deaths # Interpret rate with caution,low numbers(5-9 deaths) Figure 6: Number of Deaths Caused by Drug Overdose 20 Commonly Prescribed Opioid Medications —�IFHeroin and/or Other Synthetic Narcotics f Cocai ne 18 fit—Psychostimulants —.—Benzodizepines —.&—Antiepileptic 16 --*--Alcohol 14 N m 12 d a 0 d 10 n E z 8 6 4 2 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 COMMUNITY HEALTH ASSESSMENT 13 state and local partners created and updated the Opioid Tobacco Action Plan 2.0. Tobacco use and smoking remains the leading cause of In 2013, the OCHD became the first in the state to preventable death in the U.S., NC, and Orange County. pursue a standing order to allow public health nurses to Smoking and tobacco use can cause cardiovascular dis- dispense the drug naloxone to its clinic patients. Nalox- ease, cancer, stroke and upper respiratory infections32. one, also known as Narcan, is an antidote that reverses Tobacco products include cigarettes, cigars, chew opiate overdoses within minutes of being administered tobacco, hookah, and electronic cigarettes. via intramuscular injection or intranasal spray. OCHD's naloxone kit distribution is one innovative and replicable Over the past 60 years, tobacco companies have been way to help tackle NC's opioid-related deaths. In 2019, known to spend billions of dollars each year in market- the Orange County Board of County Commissioners ing that disproportionately impacts low-income and supported the formation of the Orange County Opioid people of color communities. Targeting has been seen Taskforce. This group will work together to address through distributing free cigarettes to children in hous- education around opioids, reducing the oversupply of ing projects, dispensing tobacco coupons with food prescription opioids by prescribers, and expand treat- stamps, discounting tobacco products, and increasing ment and recovery oriented systems of care. the number of retailers selling tobacco products in cer- tain communities33 Below is a non-inclusive list of local and state programs and initiatives to help address and combat the opioid Here's how tobacco impacts different segments of the epidemic. population: COORE (Coordinated Opioid Overdose Reduction • Tobacco use varies among racial, income, geographic Effort) and other demographic groups. Drug Treatment Courts • Low-income persons, those with lower levels of education, persons with mental illness and substance NC Safe Syringe Initiative disorders, and those who are unemployed smoke at Orange County Health Department Syringe Exchange higher rates than other groups. • American Indians have a higher prevalence of smok- ing than any other racial or ethnic group. Prescription Drug Drop Boxes • African American tobacco users die from tobac- co-related causes at higher rates than any other racial or ethnic group. • LGBTQ+ individuals are more likely to be smokers than their heterosexual counterparts. • Infants and children exposed to second-hand smoke are more likely to experience asthma attacks, ear in- fections, and sudden infant death syndrome (SIDS). • Adolescents who use nicotine become addicted more quickly than adults. • Educational level and household income are key indicators of smoking status. In 2018, cigarette smoking among Orange County adults holds steady at approximately 14.2%, compared to NC (17.6%) and the Region 5 (combined) surrounding counties (17.4%). Alamance, Wake, Durham, Chatham, Orange, Rockingham, Guilford and Caswell counties all make up Region 5. Of the current smokers with- in Region 5, 18.2% are non-Hispanic Whites, 17.2% are non-Hispanic other, 12.2% are non-Hispanic African 14 2019 COMMUNITY HEALTH ASSESSMENT Americans, and 10.8%are Hispanic/Latinx. Current Orange County middle school students' use of tradition- smokers by age, within Region 5, are shown below, with al cigarettes follows the statewide NC declining trend; the highest percentage of smokers occurring among however, the increasing trend of e-cigarette use by mid- those aged 45-54. Individuals with a college degree or dle schoolers both statewide and in Orange County is higher and a household income of more than $75,000 alarming. The use of traditional cigarettes fell from 15% per year were less likely to smoke34. in 1999, to 10% in 2013, to 2.5% in 2017 among NC mid- dle school students. Meanwhile, in 2011, approximately The emergence of new tobacco products such as 1%of NC middle school students used e-cigarettes, electronic cigarettes and the dramatic rise in their use, and in 2017 this percentage increased to approximate- especially by adolescents and young adults, are a signif- icant public health concern. The 2017 percentage of NC vaping associated lung injury (Vaping/EVALI) has been students using e-cigarettes or vaping is 17%, compared reported in 73 individuals in NC and in one individual in to 16.8% in 2015, and 1.7% in 2011. Electronic cigarettes Orange County. have become the most popular tobacco product for youth and adolescents in the U.S. and are attracting OCHD has taken a three pronged approach to help curb youth to new avenues for nicotine addiction. While the local use and addiction of tobacco and nicotine. electronic cigarettes have been known to help some This approach includes: 1) educating Orange County smokers quit, the long-term health effects of these youth, among both school systems, on electronic ciga- products, and the net public health effect associated rette use and its dangers, 2) offering tobacco cessation with their use, remain unclear. through Nicotine Replacement Therapy (NRT) patches, gum or lozenges to those who live or work in Orange Among students in Orange County. County, and 3) continued implementation and educa- • 29% of high school students in Orange County tion around the Smoke-Free Public Places Rule, that Schools (OCS) reported having not smoked tradi- was adopted in October of 2012 by the Orange County tional cigarettes within the past 30 days. Board of Health to ban smoking in public places includ- ing bars and restaurants. • 1 in 5 OCS students reported using an electronic vapor product or vaping within the past 30 days. Below is anon-inclusive list of local and state programs and initiatives to help address and combat tobacco use • Approximately 56%of OCS high school students did and prevention. not think electronic-cigarettes or vaping products posed a risk to their health. Freedom House Recovery Center • In 2017,13% of high school students in Chapel Hill NC QuitLine Carrboro City Schools (CHCCS) reported using an NC Tobacco Prevention and Control Branch e-cigarette within the past 30 days. • In 2017, 29%of CHCCS high school students reported Orange County Health Department ever having used an e-cigarette. UNC Horizons Program UNC Nicotine Tobacco Treatment Center You Quit Two Quit Figure 7: Current Smokers by Age - Region 5 0 5• ° 20.90% 21.20% 20.00% 18.40% o 14.60 15.00% 10.00% ° 5.00% 0.00% 18-34 years of 35-44 years of 45-54 years of 55-64 years of 65-74 years of 75+years of age age age age age age 2019 COMMUNITY HEALTH ASSESSMENT 15 Alcohol fetal alcohol syndrome (FAS), which is caused by heavy drinking during pregnancyd6 Excessive use of alcohol is considered to be four or more drinks/day for women and five or more drinks/ In 2017, over 33,000 NC Emergency Department (ED) day for men. Alcoholism is the dependence on alcohol visits were due to acute alcohol intoxication, 477 oc- that results in preoccupation with alcohol, frequent curred in Orange County, and from 2010 - 2018, close to impaired control over drinking alcohol, use and abuse of 300 Orange County individuals lost their life due to an alcohol despite negative or adverse consequence, and alcohol-related death37. One of the single largest issues the inability to recognize one's dependence on alcohol negatively impacting colleges, universities and their or distorted thinking (denial) about alcohol use. Alco- surrounding communities is high-risk excessive drinking. holism comes from a variety of factors including family Orange County, particularly in the Town of Chapel Hill history of alcoholism, environmental stressors, and where the University of North Carolina is located, is no psychosocial and mental health factors. exception. Data from 2013-2017 indicates that Orange County had 13,217 car crashes, and of the 13,217 crashes, Regardless of the intake amount, alcohol has been 27% (52) resulted in an alcohol related death. known to increase one's risk for mouth, throat, voice box, esophagus, female breast, liver, and colorectal In 2018, Orange County had the second highest preva- cancer. Alcohol use has a greater effect on one's cancer lence of excessive drinking (20.6%), followed by Wake risk than occupational hazards, UV radiation or protec- County (20%), and led by Onslow County (22.6%)38. tive behaviors like physical exercise and breastfeeding. Excessive drinking is defined as binge drinking, heavy In the U.S., alcohol use contributes to approximately drinking and/or any drinking by pregnant women or 3.5% of all cancers and 15% of breast cancer deaths35. people younger than age 21. Alcohol intake while pregnant can result in a woman's baby being born with birth defects and developmental There are 270 alcohol outlets (retailers where alcohol disabilities. Babies exposed to alcohol in the womb can be purchased) in Orange County and 17,782 outlets can develop fetal alcohol spectrum disorders (FASDs) in NC. African American, Hispanic/Latinx, and Native that include a wide range of physical, behavioral, and American communities are more likely to have a higher learning problems. The most severe type of FASD is prevalence of alcohol retailers than White communities. Table 8: Orange County Alcohol Related Deaths MWOOMWMMMMMMMM Alcohol Related 27 23 28 22 26 33 38 39 37 278 Deaths Figure 8: Excessive Drinking Rate orange County,NC Year 20F& y01ue 20.6%u ;4KVILLE• -- ,r 4 xlrnn- F lon.nci r.i•len s• C04VMgla' a• SOUTH Myr[Ir Brach• Excessive Drinking Prevalence 6.1%-10.4% 10.4%-13% 0 13%-14.T% 0 14.7%-16.4% 16.4%-18.9% 1$.9%•27.4%0 27 4%_28.4% 2014 2015 2016 2017 2018 16 2019 COMMUNITY HEALTH ASSESSMENT In most NC counties, African American and Hispanic/ physical activity that is planned, structured, repetitive, Latinx neighborhoods are exposed to greater alcohol and purposeful in the sense that maintenance of one or retailers than White non-Hispanic neighborhoods39. more components of physical fitness is the objective. Physical activity includes exercise as well as playing, Below is anon-inclusive list of local and state programs working, active transportation, house chores, and recre- and initiatives to help address and combat alcohol use ational activities. Many American communities are dis- couraged from participating in physical activity due to Freedom House Recovery Center reasons such as violence, increased traffic, pollution, and a lack of sidewalks, parks and recreational facilities42. Orange Partnership for Alcohol and Drug Free Youth Among survey responders: The Campus and Community Coalition to Reduce the Negative Impacts of High Risk Drinking • 16% stated that physical activity was an issue with concerns around safe places to exercise, access to UNC Healthcare Alcohol and Substance Abuse Treat- healthy food, overweight and obesity and hunger. ment Program (ASAP) • 31%stated that they engage in physical activity or Physical Activity& Obesity exercise three to four(3-4) days a week. Physical Activity • 32% stated that they do not engage in physical activ- ity because they do not have time. According to the World Health Organization, physical activity is any bodily movement that requires using en- Overweight and Obesity ergy. Physical activity is important for both children and adults of all ages. It is recommended that adults receive Overweight and obesity are defined as abnormal or 150 minutes a week of physical activity and children excessive fat accumulation that presents a risk to health. receive 60 minutes a day40. According to the Behavioral Overweight and obesity serve as risk factors fora num- ber of chronic diseases, including diabetes, cardiovas- Risk Factor Surveillance System (BRFSS), adults who cular (heart) diseases, stroke, and cancer 43. The study are physically inactive are those who did not engage in physical activity or exercise during the previous 30 days of obesity varies based on the cause of weight gain. other than for their regular job. 23.7% of NC adults are There is not one single type or cause for obesity. Com- other than inactive tive41. ponents of obesity include genetic, stress-induced, and physimenopause-related, to name a few. Obesity is related Physical inactivity is estimated to be the main cause for to genetic, psychological, physical, metabolic, neurolog- approximately 21-25% of breast and colon cancers, 27% ical, and hormonal impairments. It is intimately linked of type two diabetes, and approximately 30% of acute to heart disease, sleep apnea, and certain cancers. As a heart disease burden. Physical activity is often con- result of stigma, obesity is one of the few diseases that fused with exercise; however, exercise is a component of can negatively influence social and interpersonal rela- tionships44 Figure 9: Reasons why survey responders don't exercise Exercise is not important to me. 0.50% No safe place to exercise. 2.260 Don't know 3. 1% Physically disabled. 3 76% My job is physical or hard labor. 5.26% It costs too much 5.51% 1 have no one to exercise with. 5.51% No convenient exercise facilities 6.52% No childcare I don't like to exercise. .02% Too tired to exercise. 1 .80% 1 don't have time i 32.3 0 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 2019 COMMUNITY HEALTH ASSESSMENT 17 Among survey responders: Poor diet is often the cause of adults living with one or more chronic disease. In order to start and maintain a • 32%stated that they have been told by a doctor, healthy lifestyle, it is recommended that individuals 1) nurse or healthcare professional that they are obese. focus on variety, amount and nutrition of foods, 2) eat As of 2018, 23%of Orange County and 30% of NC adults the right amount of calories - based on age, sex, height, are obese. The highest obesity rates are seen among weight, and physical activity, 3) choose foods with less NC residents aged 45-64 (42.4%) and among African saturated fat and low sodium and beverages with no Americans (42.7%). added sugars, 4) make half the plate fruits and vegeta- bles, 5) make half the grains whole grains, and 6) vary Figure 10: Obesity Rate by Age, Race and Gender (2018) your protein routine. Orange County is the home to five local Farmers' Markets - Carrboro, Chapel Hill, Southern OBESITY RATE BY AGE(2018) Village, Eno River and Hillsborough Farmers Markets, and a number of farms and Community Supported Ag- riculture (CSA) outlets. 26 44 Among survey responders: • 73%stated that at the store where they typically buy 45-64 food, there is a good selection of fruits and vegeta- bles available. 65+ . , Food Insecurity Food insecurity refers to the uncertainty, lack of, or OBESITY RATE BY RACE(2018) inability to obtain nutritious food in a safe and social- ly acceptable manner. Food insecurity refers to the White percentage of households unable to provide adequate food for one or more household members due to lack Black of resources. Approximately 18,030 residents are food insecure, which gives Orange County a food insecuri- ty rate of 12.7%, compared to NC (16.5%) and the U.S. Latino ' (11.1%)47 Table 9: Food Insecurity in Orange County OBESITY RATE BY GENDER(2018) Number of people who are food insecure 18,030 Men ' Percentage of people who are food inse- 12 7% cure Women •' Children under 18 who are food insecure 4,420 Percentage of children under 18 who are 15.5% Nutrition food insecure Nutrition is about eating a healthy and balanced diet, Individuals over 65 who are living below 914 where energy and nutrients are obtained through food the poverty level and beverage. Understanding these nutrition terms may make it easier to make healthy and necessary food Among survey responders: choices. Foods eaten provide energy (calories) and nutrients such as protein, fat, carbohydrate, vitamins, • 14% shared that in the past month, they had to cut minerals, and water. Eating healthy foods, in the right the size of meals, or skip meals, because there wasn't amounts, gives the body energy to perform daily activ- enough money for food. ities, helps to maintain a healthy body weight, and can lower the risk of chronic diseases45 18 2019 COMMUNITY HEALTH ASSESSMENT • When asked if they, or a family member they lived In 2017, SNAP lifted 3.4 million people out of pover- with, were unable to access a service when it was ty. Despite this success, it is estimated that 27% of really needed, 15.9%shared that they had trouble food-insecure individuals live in a household that does accessing food. not qualify for assistance31. In Orange County, SNAP or Federal Nutrition Service (FNS) program enrollment Food inequalities are experienced most among racial decreased by 6.5% between 2017-2018 and 2018-2019. and ethnic minorities, low-income families, and single 14,478 Orange County residents were enrolled in SNAP/ parent households. Among women, food insecurity EBT from June 2018 - July 2019, compared to the re- is associated with obesity, anxiety and depressive symp- toms, corded 15,499 participants in 2017- 2018. A number of risky sexual behavior, and negative pregnancy issues may have impacted enrollment during this time outcomes such as low birthweight and gestational including new USDA rules that increased work require- diabetes. When we consider children, food insecurity ments for SNAP participants, the spread of misinforma- is associated with anemia, asthma, depression and anx- iety, cognitive and behavioral problems, and higher risk immi- gration status by participating in FNS programs. of being hospitalized". As of December 2019, the percentage of CHCCS stu- Additional definitions of food security and insecurity by dents enrolled in free and reduced lunch was 26.2%. the USDA are explained as41: Over the past few years, enrollment in the free and • High food security - no reported indications of reduced lunch program in OCS has remained between food-access problems or limitations, 39-42%. The current enrollment for the 2019-2020 school year is 41%. OCS offers a universal free breakfast • Marginal food security - one or two reported indica- program and served 89,350 during the 2017-2018 school tions—typically of anxiety over food sufficiency or year. As of December 2019, the total number of break- shortage of food in the house. Little-or-no indication fasts served had already reached 101,153. Unlike the free of changes in diets or food intake, and reduced lunch program, the universal free breakfast • Low food security (food insecurity without hunger) program requires no enrollment process or eligibility i - reports of reduced quality, variety, or desirability of requrements . diet. Little or no indication of reduced food intake, The Orange County Food Council_(OCFC) plans to ad- and dress food insecurity and food access by coordinating a gap analysis, to include food access and insecurity for • Very low food security (food insecurity with hunger) the Orange County Food System. The gap analysis will - Reports of multiple indications of disrupted eating serve as the initial phase in developing a Food Policy patterns and reduced food intake. Agenda (FPA). The Orange County Food Council's There is limited data on food insecurity for older adults FPA will serve as a tool for each jurisdiction in Orange in the county; however, most food insecure seniors are County to implement practices and policies to address living in the rural parts of the county. It is estimated issues of food insecurity and food access, the local food that between 900-1,000 seniors over the age of 65 are economy, agriculture, and food waste using a systems living below the poverty level50. The Orange County change approach that is grounded in racial equity prin- Master Aging Plan identifies food insecurity of older ciples. adults as a primary issue - especially for those living in Below is a non-inclusive list of local and state programs the northern or rural areas of the county. Objective 7.4 and initiatives to help address and food insecurity and in the aging plan outlines a number of strategies for hunger: addressing the issue of food access for older adults. There are local, state and national programs that have Anathoth Community Garden been known to assist with reducing food insecurity Carrboro Farmers Market by providing either cash or food assistance to those in need. Such programs are: Supplemental Nutrition Chapel Hill Farmers Market Assistance Program (SNAP), special supplemental nu- Community Food Resource Guide{English}{Spanish} trition program for Women, Infants and Children (WIC), National School Lunch Program (NSLP) and local food Department of Social Services banks. Eno River Farmers Market 2019 COMMUNITY HEALTH ASSESSMENT 19 Freedom House Recovery Center Hillsborough Church of God Inter-Faith Council Orange Congregations in Mission Orange County Cooperative Extension Orange County Food Council Transplanting Traditions Community Farm 20 2019 COMMUNITY HEALTH ASSESSMENT Health Equity Despite the many strides that have been made to improve health in the U.S., racial and ethnic disparities According to the CDC, health equity is achieved when are the most unyielding inequities experienced54. While every person has the opportunity to attain their full progress has been made around extending the length health potential and no one is "disadvantaged from and quality of life for everyone, there is clear evidence achieving this potential because of social position or that certain racial and ethnic groups—African American, other socially determined circumstances." Health ineq- Hispanic/Latinx, American Indian, Asian and Pacific uities are reflected in differences in length of life; quality Islander—suffer a disproportionate burden of premature of life; rates of disease, disability and death; severity of illness and preventable death compared to Whites" disease; and access to treatment52. Below are social and health disparities that affect Af- rican Americans in the U.S. compared to non-Hispanic Equity and Equality Whites56 Equity involves trying to understand and give peo- Among Focus Group responders: ple what they need to enjoy full, healthy lives. Equality helps to ensure that everyone gets the same things in • Hispanic/Latinx participants stated that they notice order to enjoy full, healthy lives. Like equity, equality hate from workers when they go to certain offices promotes fairness and justice but can only work if ev- and agencies. eryone starts from the same place and needs the same things. Equality ignores factors such as language, place • Hispanic/Latinx participants stated that they feel un- of residence, sexual orientation and gender, race, socio- safe in the community due to being left uneasy after economic status, etc. -that can act as barriers. Under- certain marches (i.e. KKK march in Hillsborough). standing the differences between equity and equality is . Hispanic/Latinx participants stated that they have important to be able to recognize and respond to differ- gone to local agencies where no one looks at or ences in health and well-being that are unfair, avoidable addresses them at the check-in windows. and changeable53 Figure 12: Social Factors and Health Risks Some socil factors �� UnemploymentaLiving poverty 13m= health risks 25%1 9% 100% affect African 69% youngerages.Americans13% 25% Jt34 57% 45�a UP% 194(t 20% /° African American . 4% 5% U16% 9% 22%White18-34 35-49 50-64 18-34 35-49 50-64 18-34 35-49 50 64 AGES AGES AGES Im 25%1 19% 19% 16% z5% 50% � 20?0 20% 20% 43°I° 43% 199�0 18�a 35°Io 2694r 30% 29% id 12, 19�10 ° y 18-34 35-49 50-64 18-34 35-49 50 64 10-34 M9 50-64 18-34 35-49 56-64 AGES AGES AGES AGES 2019 COMMUNITY HEALTH ASSESSMENT 21 Below is a non-inclusive list of local and state programs According to the Orange County State of Exclusion and initiatives to help address health and race equity. Report, the Rogers Eubanks neighborhood Associa- tion (RENA), between Carrboro and Chapel Hill, is well NC Office of Minority Health and Health Disparities known locally for its 40-year struggle against the land- North Carolina Health Equity Report 2018 fills and a proposed waste transfer station sited in the community by Chapel Hill, Carrboro and Orange County. Orange County Health Department As one of only a handful of African American neigh- borhoods in southern Orange County, Rogers Eubanks Orange County Health Equity Report Card served as a host to the county's only solid waste facility Organizing Against Racism from the 1970's until 2013. The county's recycling facility and a solid waste "convenience center" remain in the Racial Equity Institute neighborhood, which still lacks sewer service despite promises made when the landfill opened. As a result, The State of Exclusion: Orange County, NC the rate of exposure to solid waste facilities for residents Environmental Justice of census blocks that are 75% or more non-White is 17%, as opposed to only 3%for the county as a whole. The Environmental Protection Agency (EPA) defines Compared to other wealthy counties, or to the state, environmental justice as "the fair treatment and mean- Orange County has a smaller overall rate of exposure to ingful involvement of all people regardless of race, color, solid waste facilities, but a higher exposure rate for ma- national origin, or income with respect to the develop- ment, implementation, and enforcement of environmen- jority non-White census blocks. Unfortunately, issues of tal laws, regulations, and policies." Because historically environmental racism in Orange County are not limited to the Rogers Eubanks neighborhood. underdeveloped communities have lower property values and less political power, they can be targets for Fairview, a historically African-American neighborhood unwanted facilities. Placing and permitting potentially in Hillsborough, did not gain access to city water until polluting facilities ignores race results in environmental 1988, after it was annexed into the Town of Hillsborough. justice. In 1999, the "Field of Dreams" baseball field was built Table 10: Orange County Solid Waste Exposure Aesidents Of ,J&En E Are 75% Or r �� POPULATION EXPOSURE RATE POPULATION EXPOSURE RATE Orange county residents exposed to a solid waste 6,315 16.72% 133,80 3.20% facilities Tier 3 county residents ex- 732,614 16.72% 4 ° posed to a solid waste facility ,823,641 6.21/North Carolina residents ex- 1,309,105 9.37% ° posed to a solid waste facility 9,535,483 5.34/Tier 3 county residents ex- posed to an EPA monitored 6,315 46.57% 133,80 28.27% pollution source North Carolina residents exposed to an EPA monitored 732,614 51.06% 4,823,641 29.77% pollution source North Carolina residents exposed to an EPA monitored 1,309,105 41.82% 9,535,483 24.25% pollution source 22 2019 COMMUNITY HEALTH ASSESSMENT atop of the Hillsborough Landfill site that closed in 1975. opportunities for diversion from the criminal justice This baseball field served as a place for neighborhood system, and provide treatment needs assessment and children to gather and play. Shortly after the Field of programming for justice-involved individuals. CJRD's Dreams was built, contamination problems were dis- primary objective is to reduce the number of individ- covered. The community continued using the field until uals diagnosed with mental illness and substance use debris from the old landfill began to surface. Eventually, issues, safely and successfully reduce the overall rates it became too hazardous for use and closed. of justice involvement and pretrial incarceration, reduce repetition, and address racial and economic dispari- In 2001, Orange County voters approved a Parks and ties. CJRD seeks to ensure a productive collaboration Open Space Bond that secured $850,000 for the de- between county and court system stakeholders that velopment of a park in Fairview. These funds were not promotes sharing of information and implementation invested until 2008, and by then, were not enough to of evidence-based and equitable best practices and cover the cost of the originally planned improvements; programs. however, additional funding was added in 2009. By 2011, Fairview Park was completed and features a 0.25 Some quick 2019-2020 facts: mile paved walking trail, basketball courts, picnic shelter, playground, tennis courts, and of course, a baseball • Approximately 800 individuals will be screened by field51. Pretrial Services and 375 individuals will be released to Pretrial Services for supervision. Criminal Justice • The Criminal Case Assessment Specialist will assist Criminal justice is the act of delivering justice to those 140 justice-involved and/or incarcerated adults to who have committed crimes. The criminal justice help them receive direct CJRD mental health or sub- system is made up of government agencies and insti- stance use services. tutions, law enforcement, lawyers, courts and prisons that offer rehabilitation to offenders and provides moral ' The Youth Mental Liaison will assist over 40 jus- support to victims. tice-involved youth and their families to help them receive CJRD mental health and/or substance use The inequities around the cash bail system are some- services. thing Orange County officials have long understood. The county is one of dozens across the state that • Close to 100 individuals will be diverted from arrest support pretrial services — a jail alternative system that or charge to the Misdemeanor Diversion Program or identifies poor people who are low risks for violence and Orange County Pre-Arrest Diversion. likely to show up for their court dates and allows them • An estimated 50 individuals will be served by Recov- to be released on very low or no bail. Below are local ery Court and Family Treatment Court. Detention Center numbers over the past two years. • 56 individuals will be enrolled in and will receive The mission of the Criminal Justice Resource Depart- reentry case management and support. ment (CJRD) is to support and increase jail alternatives, Table 11: Orange County Detention Center Bookings Cost per day to house an individual at the Detention Center $110 2019 Total Pretrial Detention Center Bookings 1,918 2018 Total Pretrial Detention Center Bookings 2,031 2019 Average Daily Population at Detention Center 124 (72 Pretrial; 42 Federal; 10 State serving) 2018 Average Daily Population at Detention Center 125 (77 Pretrial; 35 Fed; 13 State serving) 2019 Average length of stay for Pretrial inmates 14 days (felonies and misdemeanors) 2019 COMMUNITY HEALTH ASSESSMENT 23 • Since its October 2019 inception, the Restoration The top five priority gaps identified in Orange County Legal Counsel Program handles approximately 35 in- were: takes per month which has resulted in approximately 40%of individuals proving to be eligible for relief 1. Crisis Diversion Center and Day Center from traffic debt. 2.Increased Access to Case Management • 19 individuals in the Jail have received suboxone 3.Affordable and Accessible Housing since the Medication-Assisted Treatment pilot began. 4.Data Collection Each year, approximately 2 million people, with serious mental illnesses, are admitted to jails across the U.S., 5.Addressing Social Determinants of Health where approximately 15% are men and 30% are women. Almost three-quarters of these adults also have drug Formally Incarcerated Transition (FIT) Program and alcohol use problems. In counties across the nation, The FIT Program is designed to connect formerly jails house more people with mental illnesses than incarcerated people with chronic illness to health care psychiatric hospitals. Once incarcerated, individuals services. Community Health Workers from the FIT pro- with mental illnesses tend to stay longer in jail and upon gram work closely with Piedmont Medical Health Cen- release, are at a higher risk of returning to incarceration ter, OCHD, UNC Family Medicine, and NC Department of than those without a mental illness. Public Safety to connect participants to appropriate and In 2015, the Orange County Board of County Commis- necessary health services, as well as community reen- sioners adopted the Stepping Up Initiative, a national try resources to help them develop a comprehensive initiative whose goal is to achieve a measurable reduc- reentry plan. tion in the number of people in jails who have mental Over 20,000 people are released annually from NC pris- illnesses. The CJRD has two clinical positions dedicat- ons without a link to primary health care services so the ed to providing support to individuals in the Orange FIT Program is in place to assist people who suffer from County Detention Center who have mental health and chronic diseases during their reentry process (while still substance use diagnoses through: incarcerated), after release, and up to two years lat- • Assessment er. FIT participants receive assistance with issues that include, but are not limited to, diabetes, hypertension, • Crisis support and counseling congestive heart failure, COPD or emphysema, kidney • Referrals to treatment failure, liver disease, mental illness, and substance use disorders. • Court advocacy Below is a non-inclusive list of local and state programs • Linkage to other community supports and initiatives to help address environmental and crimi- nal justice. • Follow up and support during the transition back to the community Carrboro Police Department • Psychiatric referral Chapel Hill Police Department Although jail-based mental health and substance use Criminal Justice Resource Department services are helpful to those in need, the Detention Cen- FIT Program of Orange County ter is not designed to serve as a treatment facility. In April of 2019, Orange County stakeholders participated Hillsborough Police Department in a 2-day Sequential Intercept Mapping Workshop to help advance community-based solutions for justice-in- Orange County Sheriff Department volved people with mental health and substance use RENA Community Center disorders. 24 2019 COMMUNITY HEALTH ASSESSMENT Social Determinants of Health is one thing that they will need in order to survive if they left the shelter tomorrow. Many factors can create or limit opportunities for good health. Some communities are rich in resources while Karen speaking participants shared that "money/ others lack the social, economic and environmental income is an issue that keeps us from having the investments that are needed to support good health. best quality of life. We don't make enough money to One's socioeconomic status including education, support our families because when income is calcu- employment, income and housing are all factors that lated, they only take into account the rent. Nothing influence health. else is factored". Employment and Income • Karen speaking participants shared that "there is not enough money to support health issues due to all Orange County's unemployment rate (5.2%), among the co-pays. My husband works but I don't". individuals 16 and over, is lower than NC (7.2%), Bruns- wick County (7.8%) and New Hanover County (7.0%)58. Karen speaking participants shared that "no one can When we look at race, in NC, the highest unemployment support a family by working in housekeeping or in rates are experienced by African Americans, American the cafeteria". Indians and Hispanic/Latinx populations59. Karen speaking participants shared that "money According to income inequality measures, wealth in is enough but not enough to obtain food stamps Orange County is not evenly distributed across resident and Medicaid because they say our spouse makes populations. Orange County has an income inequality too much. So it looks like we have too much Gini coefficient of 0.51 and is the second highest in NC. money when we don't because we are living pay- This coefficient is also higher among Buncombe County check-to-paycheck, day-by-day, with 5-6 kids". (0.429), Brunswick County (0.478), and New Hanover County (0.475), Orange County's peer counties. The Poverty Gini coefficient ranges between zero and one, where The U.S. measures poverty by the federal poverty zero represents perfect wealth equality and everyone level (FPL). The FPL uses food costs to estimate ba- has the same level or share of wealth and one rep- sic income levels for families. Research suggests that resents total inequality and only one person has all the most families need an approximate income of twice the wealth and everyone else has nothing60. FPL to meet their basic needs. Children living in fami- The county's median household income ($65,522) is lies with incomes below the FPL are referred to as low above both NC ($50,320) and the U.S. ($57,652), but income. In 2018, twice the FPL was $50,200 for a family hides various pockets of poverty. The chart below of four with two children. More than 1 million children in shows household income among survey respondents NC live in poor or low-income households61. compared to Orange County residents, with the highest 14% of Orange County residents live in poverty. Poverty percentage of individuals making $100,000 - $249,999. is experienced the highest among individuals 18 to 64 Among Focus Group participants: years of age (17.3%), followed by those 18 and younger (9.3%) and then those 65 years and older(5.3%). The • Homeless participants shared that sufficient income most common racial or ethnic group living below the Figure 13: Household Income 25.00% 20.00% 15.00% OC Residents 10.00% (2018) 5.00% Survey 0.00% Respondents Less than $10,000- $15,000- $25,000- $35,000- $50,000- $75,000- $100,000 $250,000 (2019 CHA) $10,000 $14,999 $24,999 $34,999 $49,999 $74,999 $99,999 - or more $249,999 2019 COMMUNITY HEALTH ASSESSMENT 25 poverty line in Orange County is White, followed by gap and end generational poverty in Orange County. African American and Hispanic/Latinx62. FSA was designed to reduce the effects of poverty on Poverty guidelines are identified based on family size development and academic achievement by fulfilling practices that are responsive to the priorities and needs and income to determine financial eligibility for federal of children and their families, and by affecting larger programs. Programs using the guidelines (or percent- systems and policy change. FSA works to address the age multiples of the guidelines —for instance, 125% or needs of the community through individual-level and 185%of the guidelines) in determining eligibility include system-level strategies that are implemented via various Head Start, SNAP, the National School Lunch Program, FSA programs and partnerships. FSA's programs are: the Low-Income Home Energy Assistance Program, and the Navigator Program - a peer support program for the Children's Health Insurance Proaram63, low-income, at-risk families; the Connections Program Among survey responders: - support that allows FSA to maintain contact with families formerly assigned to a navigator and provides • 8.16% of participants shared that they do not have services to families on the Family Navigator waitlist to enough financial resources to meet basic needs, ensure that needs are addressed pending a navigator including food, shelter, clothing, utilities, etc. assignment; the Community Council - a collaborative partnership between local community leaders and FSA Childhood Poverty family navigators to create positive change on individ- Young children are more likely than older children to live ual, institutional, and systemic levels; and the Partner below the poverty line. In 2016, in NC, approximately Network- a collaboration with cross-sector agencies to one in four children ages 0-5 lived in poverty, compared center parent expertise and priorities to problem solve to one in five older children, with American Indian, Afri- and work towards positive and sustaining outcomes for can American, and Hispanic/Latinx children being more families. likely to live in low-income families. Despite making For several years, FSA has sponsored a four-week Kin- up only 41% of the child population, African American dergarten Readiness camp in the two zones of Orange and Hispanic/Latinx children account for 63% of NC's County where FSA was being piloted, to include four children in poverty. Among all 100 counties in 2014, the elementary schools. To date, 378 rising kindergarteners 20 highest poverty rates in the state were all in rural have participated in the program. The Kindergarten counties49. Readiness camps have shown to have a great impact The Family Success Alliance (FSA) is a collective impact on children in attendance over the years. To measure initiative with the explicit goal to close the achievement the success of the program, UNC conducted evalua- tions that suggested that children who engaged in the program gained increased attentional, basic reading, Figure 14: Poverty by Race/Ethnicity 50% 40% 30% 20% 10% 0% � White Black Hispanic Asian Two Or More Other Native American Pacific Islander 11 Asian [] Black []Hispanic © Native American 11 Other © Pacific Islander 11 Two Or Mare []White 2013 2014 2015 2016 2017 26 2019 COMMUNITY HEALTH ASSESSMENT literacy, and classroom behavior skills. Of the children Figure 15: Education Attainment in Orange County who entered the program, those who entered at lower skill levels made the largest gains. When compared to a comparison group during the school year, FSA chll- Education Attainment in Orange County,North Carolina dren were healthier according to their teachers, and High School or equivalent degree-14.8% had higher levels of attention, math, and social skills. Of equal importance was that the gains made during the Some college,no degree-13.7% summer program were not lost during the school year. After multiple years of FSA sub-granting funds to the Pssocia=a-6.6% CHCCS system for summer programming, CHCCS will Bachelor's degree-24.8% now provide funding to serve an additional 80 children at seven elementary schools. Graduate or professional degree-32.7% Education D 5 1D 1s 20 25 3n 35 Education is defined as the act or process of inform- ing or obtaining knowledge; developing the powers of spending nearly three-times as much money per stu- reasoning and judgment; and intellectually preparing dent than the average county in the state. oneself(or others) for life. In NC, 87%of adults have a Beyond the county appropriation, a special tax district high school diploma or GED. 84.7% of African Ameri- brings CHCCS an additional 20.84 cents per$100 of as- cans, 75.7%of American Indians and 59.5% Hispanic/ sessed property value. During the 2015-2016 fiscal year, Latinx have lower proportions of adults with a high the special tax district brought CHCCS more than $22 school diploma or GED than Whites 6as million, bumping CHCCS's local per-pupil funding up Among Orange County residents, 7.28% of individuals, to $5,503, while OCS' local per-pupil funding is $3,697. aged 25 and older, do not have a high school diploma Further comparison of the two school districts reflects (or equivalent)615. the high concentration of wealth that exists in the towns of Chapel Hill and Carrboro. CHCCS has a larger stu- Among survey responders: dent population, fewer students who are eligible for • 7%of resp stated that they have a 9th - 12th grade free or reduced lunch, and better overall performance education with no diploma. on standardized tests than OCS. With a student pop- ulation of over 12,000, CHCCS serves a higher percent- Orange County is divided into two school districts, the age of non-White students because of its high Asian Chapel Hill-Carrboro City School District, that serves student population. However, OCS has a total student the southeastern corner of the county, and the Orange population of 7,630 and has higher percentages of both County School District, that serves the remainder. Both African American and Hispanic/Latinx students. CHCCS and OCS receive significant local financial sup- Student test performance levels vary among the two port for education. Orange County has the highest local school districts. Data shows that 32% of students in per-pupil education expenditure of any county in NC, Table 12: Racial Demographics in Orange County School Districts (2020) SCHOOL Student Non-Hispanic American %Of Latinx %Of Asian Population Chapel Hill Carrboro 12,115 52% 11% 16% 15% City District Orange County District 7,630 54% 14% 25% 1% Orange Charter 304 84% 4% 6% 1% The Expedition School 336 84% 1% 5% 1% 2019 COMMUNITY HEALTH ASSESSMENT 27 Figure 16: Math Performance Rates Figure 17: Reading Performance Rates ■CHCCSArlath Performance■005 Arlath Perform an re ■CHCCSReading Fefformance■005 Reading Performance ■NC Math Performance ■NC Reading Performance 41%41% 39% 3196 32iS h43 29 2$ 26% 27% 23% 19%19% 1 1 " 13% 12351335 11% inp%" i 1% N -111 oil l [Ii Not Proficient Level 3 Leve14 Level 5 Level 1 Level 2 Leve13 Leve14 Level 5 CHCCS scored a level five in math, compared to 12% of If Orange County continues to grow without adding students in OCS. When we look at students who scored sufficient affordable housing, lower wealth residents, `not proficient' in math, 41%of students are from OCS predominantly African Americans, will be pushed out. compared to 25% of students in CHCCS. 27% of stu- Orange County's high property tax rates, water and dents in CHCCS scored a level five in reading compared sewer bills, and housing costs all likely contribute to the to 12% of OCS students. Test performance is reported push out of lower wealth residents67. as one of five achievement levels. Levels one and two are below grade level, level three is grade level profi- Among survey responders: cient, and levels four and five indicate students are on • 15% indicated that they would have to move within track for career and college readiness66. the next year, from Orange County, due to housing Housing costs. Orange County has a positive reputation in NC as it is Among Focus Group participants: considered one of the healthiest counties in the state. • Karen and Burmese speaking participants shared Despite this accolade, Orange County has the second that there is a lack of interpreters present at public highest measure of income inequality in NC. Communi- housing complexes. ties of color throughout the county are burdened with inequities, including substandard housing, less income, • Karen and Burmese speaking participants shared the and lack of access to healthcare. Families with children intense need for more affordable housing, including are also more likely to bear the burden of higher costs, Habitat homes. especially in regards to housing. • Formerly incarcerated and homeless individuals Approximately 48% of Orange County families who rent described their constant engagement with local gov- their home are cost burdened, paying over 30% of their ernment and feel that there isn't enough being done income on housing expenses. In order for a family to be to address the affordable housing crisis in Orange able to afford to live in Orange County, they would need County. to have an annual income of$37,980, or$18.25 per hour, to cover rental costs for atwo-bedroom apartment. The Orange County Housing and Community Devel- 2020 Fair Market Rent in Orange County averages opment Department's primary mission is to promote around $1,055. Additionally, renters who have afull- adequate and affordable housing, economic opportuni- timejob that pays the mean renter wage would still only opportuni- ty and a suitable living environment free from discrimi- be able to afford $711, or less, per month in rent. Due to nation. The department's strategic goals include: the lack of affordable housing and rising housing costs, • Expand the supply of assisted housing many families are forced to relocate and tend to move to neighboring counties, including Alamance, Durham, • Improve the quality of assisted housing Chatham and Person. • Increase assisted housing choices 28 2019 COMMUNITY HEALTH ASSESSMENT Homelessness Through this process, and by concentrating funding efforts, Orange County has seen a 37%decrease in peo- On any given night in Orange County, between 130 and ple experiencing chronic homelessness. 150 people experience homelessness. Among those individuals, 30-40 are living unsheltered and the rest are The OCPEH is aligned with federal goals working to in shelters and transitional housing. 68% of the individ- make homelessness rare, brief, and one time. Currently uals are male, 86% are adults age 25 or older, and 90% people are experiencing homelessness an average of of the sheltered households are adults only. 340 days, an increase from 272 days reported in 2018. The HMIS (homeless management information system) In 2019, Orange County community members count- database recorded 298 de-duplicated people served ed 131 people experiencing homelessness, 29 of whom in the homeless service system over 12 months, 197 of were unsheltered 61. Homelessness in Orange County whom were experiencing homelessness for the first has remained virtually flat since 2010, with a 15% decline time. 33% (73 people) are exiting to permanent housing in the U.S. and 24% decline statewide. and 18% of people who are exiting to permanent hous- The Orange County Partnership to End Homelessness ing return to homelessness. (OCPEH) works with service providers to secure federal As a result of both historical and current housing dis- funding for homeless programs and incorporate best crimination practices, as well systemic racism, Orange practices and data-driven decision making into the work County has similar racial disparities in the number of to end homelessness. In 2019, service providers came people experiencing homelessness compared to NC and together to house 78 extremely vulnerable households. the U.S. 12% of Orange County's overall population is Clients gave their consent to be part of a case confer- African-American, however, 51% of African Americans encing list, either with their name or anonymously, and experience homelessness. service providers worked together to provide house- holds with permanent housing quickly and effectively. Figure 18: Individuals Experiencing Homelessness in Orange County 0% 0% 1% 0% GENDER 4Gi HOUSEHOLD , TYPE ■Male ■25 and Older ■Adults Only ■Female ■17 and Younger ■Families ■Transgender , ■18-24 , ■Unaccompanied Youth ■Gender 0 (17 and Younger) Oi Non-Conforming Figure 19: Special Populations Experiencing Homelessness SPECIAL POPULATIONS 50 f Chronically Homeless Families 40 Homeless Veterans 30 20 10 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2019 COMMUNITY HEALTH ASSESSMENT 29 Figure 20: People Experiencing Homeless by Race RACE o°i° z°r° %of People Experiencing Homelessness in Orange County o% 6% %of People in Orange County Overall 2.6%. •1% ■Black or African-American White ■Multiple Races ■American Indian or Alaska Native ■Asian ■Native Hawaiian or Other Pacific Islander Starting in 2017, the OCPEH issued a gap analysis for the homeless service system. The most recent update to this came in June 2019 where ten gaps were recognized. As of February 2020, $512,613 has been secured for gap funding with $1.4 million remaining. Six of the ten gaps have funding estimates identified and four are still under discussion. It is thought that by filling these gaps, homelessness can be eliminated in Orange County69. Below is a non-inclusive list of local and state programs and initiatives to help address social determinant of health. Chapel Hill Carrboro City Schools Chapel Hill Carrboro NCAACP Family Success Alliance Housing for New Hone Orange County Habitat for Humanity Orange County Housing and Community Develonment Orange County Partnership to End Homelessness Orange County Schools 30 2019 COMMUNITY HEALTH ASSESSMENT Death and Disease cancer(55 lives lost), and breast cancer(59 lives lost). Majority of cancers are related to personal lifestyle or Life expectancy is a measure for the total health of a environmental factors, such as smoking and diet and are population. Chronic diseases and injuries are responsi- therefore preventable. Prevention and early detection ble for approximately two-thirds of all deaths in INC, or has successfully helped with the control of the disease about 50,000 deaths each year. When we look at life and ultimately deaths. Less preventable factors include expectancy in Orange County, we see that the overall age, gender, and family history. For some cancers, pre- average life expectancy is 82 years old. Male life ex- vention is more valuable than early detection. For exam- pectancy (80 years) is slightly lower than the county's ple, lung cancer takes many years to develop and often average, female life expectancy (84 years) is slightly spreads to other parts of the body before it is detected; higher, White individuals life expectancy (83 years) is because of this, lung cancer is better prevented74. almost equal, and African Americans life expectancy (75 years) is significantly lower 70. The disparities for African Among survey responders: Americans, compared to Whites, are highly associated 6% have been told by a doctor, nurse or health profes- with limited health care access, lack of trust in medical sional that they have cancer. providers, social racism, unemployment, and firearm deaths among young African American men71. Cancer, 40% of female responders have had a mammogram. heart disease, stroke, chronic lower respiratory diseases, and unintentional injuries make up the top five causes of 13% of male responders have been screened for prostate death in in Orange County72. cancer. Leading Causes of Death In the U.S., African Americans experience a higher burden of cancer having the highest death rate, and the The top leading causes of death vary by age group and lowest survival rate than any racial or ethnic group. This the top three leading causes of death by age are shown is often due to the lower socioeconomic status and less on page 3273. access to medical care. Among cancers, prostate cancer is the most commonly diagnosed cancer among African Cancer American men and breast cancer is the most commonly Cancer is the number one disease killer among Orange diagnosed among African American women75. County residents, with trachea, bronchus and lung cancer being the most common cancers experienced. From 2014-2018, Orange County lost 247 lives to tra- chea, bronchus and/or lung cancer, followed by prostate Figure 21: Orange County Leading Causes of Death, 2014-2018, Age-Adjusted Mortality Rates per 100,000 Suicide 9.4 Nephritis, Nephronic Syndrome,and Nephrosis 10.3 Septicemia 10.6 Diabetes Mellitus 15.5 Alzheimer's Disease 23.5 Unintentional Injuries 25.5 Chronic Lower Respiratory Diseases 27.1 Cerebrovascular Disease 28.8 Diseases of the Heart 111.9 Cancer (All Causes) 137.7 0 20 40 60 80 100 120 140 160 2019 COMMUNITY HEALTH ASSESSMENT 31 Heart Disease affected by bleeding or the lack of blood (ischemia) to the brain. Cerebrovascular disease includes stroke, ca- rotid stenosis, vertebral and intracranial stenosis, aneu- of aheart attack, and is caused by the narrowing of rysms, and vascular malformations". blood vessels used to supply blood to the heart. High blood pressure, high cholesterol, and smoking are the Chronic Disease main risk factors for heart disease. Close to one-third of heart disease deaths are caused by smoking and Chronic diseases are defined as conditions that last one secondhand smoke exposure. Other risk factors include year or more and require ongoing medical attention, family history, physical inactivity, obesity, diabetes, poor limits activities of daily living, or both. Chronic diseases diet, and excessive alcohol use76. and injuries are responsible for approximately two-thirds of all deaths or about 50,000 deaths in NC each year. Among survey responders: Many deaths in the state are preventable and involve risky behaviors or lifestyles such as tobacco use, un- 6.6% have been told by a doctor, nurse or health profes- healthy diet, physical inactivity, alcohol and drug use, sional that they have heart disease. and motor vehicle crashes78. Cerebrovascular Disease Among survey responders, below are the percent of res- Cerebrovascular disease consists of all disorders in idents who have been told by a healthcare professional which an area of the brain is temporarily or permanently that they have a chronic disease. Table 13: Leading Causes of Death by Age AGE GROUP —Cause of Death I 1 All Cancers 972 136.0 All Ages 2 Heart Disease 752 105.2 3 Cerebrovascular 187 26.2 1 Perinatal 11 6.0 0-19 1 Birth Defects 11 6.0 3 Homicide 7 3.8 1 Unintentional Injuries 33 15.1 20-39 2 Suicide 19 8.7 3 Motor Vehicle Injuries 16 7.3 1 All Cancers 267 120.0 40-64 2 Heart Disease 136 61.1 3 Unintentional Injuries 56 25.2 1 All Cancers 512 624.3 65-84 2 Heart Disease 304 370.7 3 Chronic Lower Respiratory Diseases 100 121.9 1 Heart Disease 299 3071.7 85+ 2 All Cancers 178 1828.6 3 Alzheimer's Disease 93 955.4 32 2019 COMMUNITY HEALTH ASSESSMENT Figure 22: 1 have been told that I have... 62.68% 0 32.21 0 27.37% 22.21% 16.77% 12.62% - 6.61% 5.56% Any Chronic Obesity High Blood High Asthma Diabetes Heart Disease Osteoporosis Condition Pressure Cholesterol Communicable Disease Influenza (flu) Communicable diseases spread from one person to The flu (influenza) is a contagious respiratory illness another or from an animal to a person. The spread caused by flu viruses and can spread from person to often happens via airborne viruses or bacteria, through person through droplets such as coughing, talking and blood, or other bodily fluids. The terms infectious and sneezing. Adults age 65+ are at a greater risk of flu than contagious are often used interchangeably to describe the rest of the population, as are those with chronic communicable diseases79. lung disease, heart disease, and compromised immune systems. Healthcare workers and residents of nursing COVID-19 (Coronavirus) homes and long-term care facilities are also at a greater Coronaviruses are a large family of viruses that can risk. Symptoms of the flu include fever, cough, runny/ cause illness in animals and humans. COVID-19 is a dis- stuffy nose, headache and fatigue (tiredness). Season- ease that was identified in late 2019 and was declared a al flu vaccines change annually as the virus naturally pandemic in March 2020. COVID-19 is the name given changes over time. Flu season typically occurs during to the specific coronavirus that originated in Wuhan, the winter and fall months, with a peak between De- China. The most common symptoms of COVID-19 are cember and February. similar to the flu and include fever, cough and shortness There were 203 flu deaths reported in INC during the of breath and can take two to 14 days to appear from 2018-2019 flu season, with 128 deaths occurring among the time of exposure. Older adults and people with people 65 years of age and older severe chronic conditions are at a higher risk for a more serious COVID-19 illness, if affected80. Figure 23: Confirmed Flu Associated Deaths by Age in NC Laboratory Confirmed Influenza-Associated deaths Reported in North Carohna by Age Group' 12$ 120 112 104 96 $$ ${} 7Z 2L 64 m 56 4$ C 40 Z 32 - 24- 16- 8- 0- ado 0-4 5-17 18-24 25-49 50-64 65+ Age Group(Years) 2019 COMMUNITY HEALTH ASSESSMENT 33 Table 14: Reported Communicable Diseases and Conditions in Orange County (by Year)81 DISEASE/CONDITION M W Campylobacter Infection 19 29 32 CJ D 0 0 1 Cyclosporiasis 0 0 0 Dengue 1 0 1 E.coli (Shiga-toxin producing) 5 9 1 Ehrlichiosos (granulocytic) 4 2 1 Ehrlichiosos (monocytic) 5 5 14 Foodborne Other/unknown 0 0 0 Haemophilus influenza, invasive 5 4 2 Hepatitis A 0 0 2 Hepatitis B (Acute) 0 2 1 Hepatitis C (Acute) 0 3 1 Influenza Death (< 18 yo) 1 4 1 Leptosporiasis 0 0 0 Lyme 3 6 5 Malaria 1 0 0 Measles 0 0 0 Meningococcal Disease 0 0 0 Meningitis (Pneumococcal) 0 0 0 Mumps 0 4 0 Pertussis 14 10 25 RMSF (Rocky Mountain Spotted Fever) 12 8 14 Rabies (Animal) 7 9 7 Salmonellosis 46 31 33 Shigellosis 5 5 5 Tuberculosis 0 1 2 Vibrio 1 1 0 34 2019 COMMUNITY HEALTH ASSESSMENT Pneumonia • Meningococcal Infections Pneumonia is an infection of the lungs causing inflam- • Pertussis (whooping cough) mation of the air sacs. Pneumonia can be caused by in- fluenza and respiratory syncytial virus. People that are ' Polio at risk for pneumonia include elderly, young children, • Rotavirus smokers, and those with pre-existing health conditions. In 2017, influenza and pneumonia ranked 11t" in leading • Tetanus causes of death in NC, with a total of 2,076 deaths com- • Varicella (chicken pox) pared to 1,886 deaths the previous year. Sexually Transmitted Infections (STI) Vaccine Preventable Diseases Sexually Transmitted Infections are diseases that are Vaccine preventable diseases are diseases that can spread from one person to another, typically during typically be prevented by obtaining required or recom- vaginal, anal, and oral sex. STI's are common and the mended vaccinations prior to exposure to the illness. majority of people who have them don't experience Vaccinations are widely recognized as one of the most symptoms. Without treatment, STIs can lead to serious important public health strategies ever created. New health problems, however, the good news is that getting immigrants are at greater risks of vaccine preventable tested is effortless and most STIs are treatable. The diseases, specifically if they have not received vaccina- table below shows the number of reported cases of STIs tions in their home countries. The use of vaccines has for Orange County and NC from 2016 - 2018. led to major improvements in child health. Many of the infectious illnesses that were previously experienced by While anyone can become infected with an STI, older generations, from chickenpox to polio to measles, • Young people and gay and bisexual men are at no longer affect most children today. Following the rec- greatest risk. ommended immunization guidelines, by the American Academy of Pediatrics, can help make children healthier. • Individuals 15-24 years of age account for 50% of all Vaccine preventable diseases include81: new STIs, although they represent just 25% of the • Diphtheria sexually experienced population. • Haemophilus Influenza Type B (Hib) • Young women face the most serious long-term health consequences of STIs. It is estimated that • Hepatitis A undiagnosed STIs cause 24,000 women to become infertile each year. • Hepatitis B • Compared to older adults, sexually active adoles- • Human Papillomavirus (HPV) cents 15-19 years of age, and young adults 20-24 • Influenza years of age are at higher risk for acquiring STIs for a combination of behavioral, biological, and cultural • Measles, Mumps, Rubella (MMR) reasons. Table 15: Sexually Transmitted Reported Cases in Orange County and NC STI REPORTED CASES • • • • • • = • AIDS 4 593 2 582 3 509 Chlamydia 692 58,078 779 62,988 690 66,763 Gonorrhea 175 19,599 229 22,736 189 23,593 HIV 11 1,365 5 1,287 10 1,204 Syphilis (late syphilis) 7 758 15 1,009 14 1,201 2019 COMMUNITY HEALTH ASSESSMENT 35 There are multiple barriers that prevent individuals, spe- Figure 24: Injury and Violence Rate by Gender and Race cifically adolescents, from accessing quality STI preven- RAteper tion services. Those barriers include the inability to pay 100.000 or lack of insurance, lack of transportation, discomfort 400 35.5 with facilities and services, and concerns with confiden- 3a.0 27.7 26.0 23.4 tiality84. 20.0 11.2 Injury and Violence 10.0 � ■ Unintentional injuries and injuries caused by acts of 0.0 violence are the leading cause of death for Americans Male Female American Black' White' Asian,, Hispa«niC Indian under age 44, and are the leading cause of disability Norr-Hispanlc for all ages, regardless of sex, race/ethnicity or socio- economic status. Many unintentional injuries are often referred to as accidents, acts of fate, or as a part of life; Table 16: 2017 Reported Crime Rates in Orange Coun- however, most occurrences that result in injury, disability ty and NC87 or death are preventabless. 2017 Murder In 2017, 2,300 NC residents died as a result of violence, REPORTED Rate Rate Rate Rate Robbery Burglary with the leading cause of violent death being suicide CRIME (65.4%) and homicide (29.8%). Of those 2,300 deaths, the leading methods were firearm (61%), hanging, stran- Orange 2.8 57.9 103.2 485.2 gulation or suffocation (17.1%), and poisoning (11.4%). County Violent deaths were highest among males and non-His- North panic American Indians86. Carolina 6.5 95.8 260.8 673.5 • Orange County averages 210 violent crimes a year. • In 2017 there were 273 injury deaths in Orange Coun- ty. • In 2018, Orange County had a violent crime rate of 172.8, compared to the NC rate of 374.9 and the U.S. rate of 386.3 • In 2018, Orange County had rape rate of 21.2, com- pared to the NC rate of 21.1, and the U.S. rate of 36.7. 36 2019 COMMUNITY HEALTH ASSESSMENT Maternal and Infant Health Significant racial and ethnic disparities in maternal dis- ease and death exist in the U.S. Non-Hispanic African Maternal Health American women are three-to-four times more likely to die from a pregnancy related death compared to White The health of women and children is vital to creating a women. Growing research shows that quality health- healthy world. Despite great progress, approximately care, from preconception through postpartum care, may 800 women die every day from preventable pregnancy be a critical component for improving outcomes for and childbirth related causes88. racial and ethnic minority women90. There are a number of factors, including preconception Teenage Pregnancy health status, age, access to appropriate preconcep- tion and prenatal health care, and poverty that can Teen pregnancy is defined as any woman who con- affect pregnancy and childbirth. Infant and child health ceives between the ages of 15 and 19 years of age. outcomes are similarly influenced by factors such as While many believe that teen pregnancy is a growing education, family income, breastfeeding, and physical problem, NC's teen pregnancy rate (24.6) is at an all- and mental health of parents and caregivers. time low, with Orange County's rate at 6.2. Between 2016 and 2017, NC's teen pregnancy rate declined by 5%. Maternal health factors are a leading contributor to While significant racial/ethnic disparities still exist, the certain birth outcomes such as preterm birth, low birth- gaps between White teens and their African American weight, birth defects, and infant mortality. Unfortunate- and Hispanic/Latinx counterparts are narrowing. 71% ly in NC, barriers to affordable and consistent healthcare of pregnancies occur among 18 and 19 year olds, while for women pre- and post-conception contribute to pregnancies to minors are increasingly rare. Fewer alarmingly high rates of fetal and infant death each year, teen parents are having subsequent teen pregnancies despite advances in clinical care. INC had the llt" highest and the decline in teen pregnancy is due mainly to an single-year infant mortality rate in the country in 2017 increase in contraceptive use".at a rate of 7.1 per 1,000 live births, compared to the U.S. rate of 5.8 per 1,00089. Table 17: 2018 Teen Pregnancies in Orange County and NC ORANGE COUNTY NORTH CAROLINA Number of pregnancies among 15-19 year old girls 43 8,255 Teen pregnancy rate per 1,00015-19 year old girls 6.2 24.6 TEEN PREGNANCY RATES BY RACE/ETHNICITY African American 33.7 Hispanic/Latinx 41.4 White 16.1 TEEN PREGNANCY RATES BY AGE 15-17 year olds 10.6 18-19 year olds 8.1 44.0 Number of pregnancies among 15-17 year old girls 8 2,075 Number of pregnancies among 18-19 year old girls 35 6,180 Syphilis (late syphilis) 7 758 *Rates based on small numbers(<20 pregnancies)are unstable and not provided. 2019 COMMUNITY HEALTH ASSESSMENT 37 Infant Mortality education in the prenatal period. Disparities in infant mortality also exist for babies born to women in poverty Infant mortality refers to the death of a baby in its first and those who are uninsured. Women in poverty expe- year of life. NC has an infant mortality rate of 7.2 and rience more challenging life circumstances, have lower Orange County has an infant mortality rate of 4.8, per educational attainment, are more likely to have limited 1,000 births. Leading causes of infant death are birth access to adequate food, transportation and housing, defects, low birth weight and preterm birth, maternal and are more likely to have limited access to health care pregnancy complications, sudden infant death syn- services. Furthermore, in NC, women who are undoc- drome (SIDS) and injuries92. Risk factors that attribute umented immigrants are ineligible for Medicaid during to infant death include: smoking or alcohol consumption pregnancy, severely restricting their access to care ".during pregnancy, maternal age - younger than age 20 and older than age 40, maternal obesity, intimate part- Infant&Child Health ner violence, food insecurity, and maternal educational status - less than a high school degree. Proper access to healthcare services, education, and healthy housing are just a few essentials that are critical Non-Hispanic African American mothers have an infant to a child's development. Environmental health, lack of mortality rate more than two times higher than White access to healthy food, and not having insurance cov- mothers. Women of color are more likely to live in erage can have long lasting effects on a child's health. communities that have fewer educational resources and Health disparities in children are linked to inequities employment opportunities due to historical segregation involving race, ethnicity, and immigrant status. During through housing and education policies. Women of 2013-2017, when we look at both Orange County and color also experience added stress due to discrimination NC, the highest percentage of children living in poverty regardless of socioeconomic status, while socioeconom- concentrated areas were African Americans (24.3%). is factors are often linked to birth outcomes and infant mortality. Within the medical system, unequal treat- A healthy home has long lasting impacts on a child's ment of mothers of color may contribute to worse birth health, particularly in children. A child's health can be outcomes; and implicit bias in health care delivery may influenced in a positive manner by having access to prevent women of color from receiving sufficient patient clean water, active spaces that promote physical ac- Figure 25: 2018 Orange County Infant Death Rate (per 1,000 live births) ■Orange County ■ NC 22.7 6.2 5 12.2 9.3 6.8 4.4 0 0 5 5.2 4.8 Total Death Rate Non-Hispanic White Non-Hispanic Black Non-Hispanic Non-Hispanic Other Hispanic Infant Death Infant Death Rate Infant Death Rate American Indian Infant Infant Death Rate Rate Death Rate Figure 26: Children living in Poverty Concentrated Areas (2013-2017) Orange County NC 24.30% 17.50% 11.30% 11.60% 14% 5.30% 2.40% 4.90% 5% 4% Total Population African American Hispanic or Latino Some other race White non- Hispanic 38 2019 COMMUNITY HEALTH ASSESSMENT tivity, and no physical hazards in the home. On the flip side, poor quality sub-standard housing can negatively affect a child's health and development. Environmental triggers such as lead paint, poor indoor air quality, mold, pest issues, and safety hazards in the home can put a child's health at risk. While children (birth through age 12) are typically healthy, it is during this time when chil- dren are most at risk for developmental and behavioral disorders, child maltreatment, asthma and other chronic conditions, obesity, dental cavities, and unintentional injuries94. Below is a non-inclusive list of local and state programs and initiatives to help support maternal and child health. Adolescent Parenting Program Compass Center for Women and Children Head Start/Early Head Start Family Success Alliance KidSCope Orange County Department of Social Services Orange County Health Department Orange County Healthy Homes Program Orange County Partnership for Young Children Orange County Rape Crisis Center Orange County Safe Kids Planned Parenthood UNC Horizons Women's Birth and Wellness Center 2019 COMMUNITY HEALTH ASSESSMENT 39 Environmental Health Public water supplies, whether a municipal system or public water supply well, are regulated by the North The World Health Organization defines environment, as Carolina Department of Environmental Quality (DEG). it relates to health, as "all the physical, chemical, and bi- Approximately 78% of Orange County populations, ological factors external to a person, and all the related served by community water systems, are served by the behaviors." Environmental health consists of preventing Orange Water and Sewer Authority (OWASA), and ap- or controlling disease, injury, and disability related to the proximately 40%of Orange County community mem- interactions between people and their environment9S. bers are served by private water wells. Private drinking water wells, well siting, permitting, inspections, and Orange County Environmental Health includes: l) onsite water sampling are regulated by the OCHD and carried water protection (subsurface wastewater and private out by the Environmental Health staff. wells), 2) retail food, lodging, and institution inspection, 3) children's environmental health (childcare sanitation The vulnerability of the community was exposed during and lead prevention), 4) public swimming pool sanita- the February 2017 and October 2018 OWASA water cri- tion, and 5)tattoo artist permitting. In addition, Orange ses. Water customers, as well as visitors to Chapel Hill County Environmental Health works closely with part- and Carrboro, were placed under an advisory as a result ner agencies to assist in matters of public sewerage, of a water line break. The break resulted in restaurants public water supply, and indoor air quality. and hotels closing, schools in Chapel Hill and Carrboro Water Protection releasing early, and operations at UNC shutting down. To help support continued delivery of high quality water Drinking Water Quality and infrastructure improvements, a budget increase was The safety of drinking water can be measured in terms approved and adopted by OWASA's Board of Directors of whether Maximum Contaminant Levels (MCL) is met for the July 2018 through June 2019 year. The new bud- for various pollutants present in water that could affect get includes a 2% increase in monthly water and sewer health. MCL standards for drinking water quality are set (wastewater) rates, effective October 2018. A monthly by Environmental Protection Agency (EPA). An MCL is water and wastewater bill for a single-family residence the legal threshold limit on the amount of a substance (using 4,000 gallons each month) will increase $1.41 per that is allowed in public water systems under the Safe month. This is the first monthly rate change at OWASA Drinking Water Act. in over six years. Effective July 2018, system develop- ment fees (one-time fees charged for new connections Figure 27: OWASA Rate Comparison Comparison1� OWASA Rate Residential Monthly Water& Sewer Bills for 4,000 Gal Ions (as of January 2019) 5146 Sim 5100 5W 5 zor sao Sm �` 011 ,,y��' 41 641 ��e 2019 COMMUNITY HEALTH ASSESSMENT 41 to OWASA's system), have been reduced between 10% Inspections and 40%, depending on meter size and property type. Retail Food, Lodging,and Institutions Onsite Wastewater Community members and visitors, including those at- Most every dwelling and place of business or assembly tending athletic events and visiting the medical center, outside the limits of the Townships in Orange County deserve food safety and general sanitation at the places is served by the onsite disposal of wastewater. Septic where they frequent as customers. Orange County system permitting, inspection, monitoring, and enforce- Environmental Health provides food safety classroom/ ment are major services of Orange County Environ- exam and one-on-one instruction for operators. Orange mental Health. Each year, this program offers an annual County will provide courtesy inspections for operators training meeting for septic system installers. The repair and establishments that are not permitted by the local of existing systems and an existing system inspection health department but must have a sanitation inspec- program, known as the Wastewater Treatment Monitor- tion to maintain licensure or status with another state ing Program (WTMP), are critically important functions agency. Such establishments include jail, residential of this program for the protection of public health. cares, adult care facilities, and adult day facilities. Water Supplies In relation to services for children's environmental health, Orange County Environmental Health inspects Community members living in the municipal areas of facilities licensed by the NC Division of Child Develop- Orange County and in some limited unincorporated ar- ment and Early Education, no less than twice per year, systems:are served by the following community public water and yearly inspections of public/private school build- ings. Orange County Environmental Health provides City of Durham an annual meeting for childcare center operators and keeps a seat at the table of the NC Healthy Homes Task- Orange-Alamance Water(OAW) force to stay current with the other parts of children's Orange Water and Sewer Authority (OWASA) environmental health and childhood lead poisoning prevention. Town of Hillsborough Town of Mebane Table 18: Onsite Water Protection Services Program New Wells Completed 195 208 200 263 New Wells Permitted 285 312 334 323 Water Samples Analyzed 1308 1004 934 986 Existing Septic System &WTMP Inspections (monitoring) 915 1881 945 938 Failing Systems Permitted and Repaired 88 98 62 108 Table 19: Food, Lodging, Institutions, Childcare, Pools, Tattoos Number of establishments 754 770 791 810 Total number of activities 2,294 2,269 2,592 2,599 Inspections 1,697 1,648 1,602 1,777 42 2019 COMMUNITY HEALTH ASSESSMENT Childhood Environmental Health Figure 28: Percent of NC Children tested for Lead Poisoning Lead Hazards Assessment for Risk of Exposure Lead poisoning re- PerCentofNC Children Tested for Lead POlsordng,Iard2Year-olds mains a principle environmental concern for young chil- 55 dren. Universal blood lead testing is strongly encour- aged at 12 months and again at 24 months of age, and 45 testing for all immigrant children is recommended at the 40 time of arrival to the U.S. While exposure to lead was 35 once thought to be related to paint and older housing, %30 25 lead exposure through behaviors must also be assessed. �Perm � u 1 Tested --Percent ug/d L,unmOrmed 20 L,unwnfirme A case is confirmed when two consecutive blood lead 15 Percent>=5 ugld d test results, within a 12-month period are: <5 pg/dL = 10 below the reference value, 5-9 pg/dL = elevated blood s lead (EBL), >_10 pg/dL = confirmed lead poisoning. 0 �{ p 1e 101* 4,le'L _llp41ti le'L�'t'l� �l'Lo.O'L 'L�.1't.vo.Y','Lo.YP'Lo�ti'Loyb 4_1 Lead exposure is especially harmful to children under Y rrarTesne six years of age due to their constant hand-to-mouth activity. Lead exposure of women of child-bearing age Environmental Health Activities (2015-2019) can also adversely affect developing fetuses during pregnancy, which has resulted in the emphasis on test- • Radon testing kits are provided during Radon Month ing pregnant women. awareness campaigns. The Childhood Lead Poisoning Prevention Program • Trainings with housing, inspection, and healthy home tracks the number and rate of children in the target community partners and advocates on mold identifi- populations who are required to be screened for blood cation and mold remediation lead levels. Orange County Environmental Health con- ducts lead investigation on all child-occupied facilities • Consistent monitoring of environmental trends in the (schools and childcare centers) that were constructed media to anticipate the public's demands for infor- prior to 1978 and averages 4 -5 lead investigations in the mation, referrals, or sampling. homes and secondary premises of lead poisoned chil- dren identified through lead screening. Orange County • Consistent work with the Rogers Road Community Environmental Health has a certified Lead Assessor on to resolve well and water quality issues. Three wells staff as well as a bilingual staff person authorized to that needed replacement were investigated, permit- conduct lead investigations. ted, inspected, and sampled. • Received grant funds to implement a vector control program that allowed staff to receive training, licen- sure, and supplies to respond to mosquito related public health emergencies. Table 20: Childhood Lead Poisoning Prevention Program16 .1M=== Number of Children Tested (age Birth - 6yo) 1,263 1,291 1,448 1,228 5-9 Ng/dL 4 3 3 3 10-19 fag/dL 1 2 2 1 >20 Ng/dL 1 0 0 0 2019 COMMUNITY HEALTH ASSESSMENT 43 Appendices Appendix A: Community Health Assessment Team Members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Appendix B: Survey Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 Appendix C: Map of Surveyed Sampled Blocks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Appendix D: Notification Postcard Sent to Randomly Selected Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 Appendix E: Community Health Opinion Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Appendix F: Focus Group Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 Appendix G: Community Input Session Flyer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Appendix H: Diversity, Equity & Inclusion Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Appendix I: References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 2019 COMMUNITY HEALTH ASSESSMENT 45 Appendix A; Community Health Assessment Team Members CHA Leadership Team (CHALT) Community Engagement Team The governing body and final decision makers. Those responsible for ensuring that the voices of the community are heard as well as engaging the communi- ty in every step of the process. • Ashley Rawlinson, Orange County Health Depart- . Allyson Coltrane, Orange County Public Transporta- ment tion • Charles Blackwood, Orange County Sheriff Depart- . Carolyn Hall, Chapel Hill Carrboro City Schools ment • Chris Atack, Carrboro Police Department • Elinor Landess, Campus and Community Coalition • Corey Root, Orange County Partnership to End • Erin Sapienza, Orange County Public Library Homelessness • Gayane Chambless, Orange Partnership for Alcohol • Dominika Gazdzinska, Orange County Health De- and Drug Free Youth partment • Kristin Prelipp, Orange County Health Department • Donna King, Orange County Health Department • LaDean Jones, Head Start/Early Head Start • Jacqueline Wilson, Orange County Head Start/Early • Liska Lackey, Orange County Board of Health Head Start • Meagan Clawer, Refugee Community Partnership • Janet Cherry, Chapel Hill Carrboro City Schools • Natasha Snipes, Inter-Faith Council • Jen Castello, Piedmont Health Services • Ramon Negron, El Centro Hispano • Juliet Sheridan, Orange County Health Department • Richard Lewis, Orange County Schools • Latonya Brown, Orange County Department on Aging • Sharquilla Howard, Insight Human Services • Liska Lackey, Orange County Board of Health • Sherry Hay, UNC Family Medicine • Margaret Nemitz, UNC School of Public Health • Stephani Kilpatrick, Inter-Faith Council • Mark Dorosin, Orange County Board of County • Susan Clifford, Orange County Health Department Commissioners • Meagan Clawer, Refugee Community Partnership Volunteer Recruitment Team • Quintana Stewart, Orange County Health Depart- Those responsible for recruiting volunteers to assist ment with data collection and community events. • Ramon Negron, El Centro Hispano • Kim Lamon-Loperfido, Orange County Department • Robin Pulver, Orange Partnership for Young Children on Aging • Krishnaveni Balakrishnan, Orange County Health • Sherita Cobb, Orange County Schools Department • Sherry Hay, UNC Family Medicine • Margaret Nemitz, UNC Gillings School of Public Health • Rebecca Crawford, Orange County Health Depart- ment 2019 COMMUNITY HEALTH ASSESSMENT 47 Data Team Those responsible for the format and analysis of the collected data. • Allison Young, Duke University • Allyson Coltrane, Orange County Public Transporta- tion • Brandy Keys, Orange County Resident • Christy Stanley, Chapel Hill Carrboro City Schools • Coby Austin, Orange County Health Department • Jen Costello, Piedmont Health Services • Juliet Sheridan, Orange County Health Department • Marybeth Grewe, UNC Chapel Hill • Mike Fliss, Orange County Resident • Richard Lewis, Orange County Schools • Sarah Dumas, NC Birth Center • Zin Lyons, Orange County Health Department 48 2019 COMMUNITY HEALTH ASSESSMENT Appendix B; Survey Volunteers • Angela Sowers • Ling Oy • Anna-Lisa Johanson • Lundan Winchester • Ayah Isleem • Margaret Nemitz • Barbara Hawksworth • Mel Ceasar • Beverly Scurry • Moira Beck • Bruce Baldwin • Pam McCall • Caroline Hall • Phil Vilaro • Cheryl Bono-Zehia • Rani Richardson • Cierra Hoover • Rebecca Bloch • Dana Crews • Rebecca Crawford • Dominika Gazdzinska • Rhea Colmer • Donna King • Roberto Diaz • Gayane Chambless • Sarah Nahum • Grant Berry • Savannah McCall • Jada Rogers • Shade Little • Joan Melton • Sherry Hay • Joe McLean • Sonia Desai • John Davis • Steven Campbell • Kathryn Hobby • Tameiah Ross • Katie Comanici • Thais Ramirez • Kaylin Cooley • Tim Smith • Kenneth Taylor • Kristin Prelipp • Krishnaveni Balakrishnan • Julie Johnson • Lauren Frey 2019 COMMUNITY HEALTH ASSESSMENT 49 Appendix C; Map of Surveyed Sampled Blocks 2019 Community Health Assessment Sampled Blocks f f r r r aaarrMenee EUMarn i � r h 4 � L fJri _ _ F Chatham Wax Thin m paonrai%paraah prspered for Han irwan"of real props wthin Orange County and in co-mpbsd horn naoord*d dead,plain,end other pubic rstords en6 derv. Usm of tha ramp ere hsrabi nafitisd Ihal dw sforernwiwad �,.�, pAW Prmmfr wli mVtioa corms shc4ld be EGSgvij*d rer a;nr4dren or Os iniprw"CoaSFwttl On rhM1 nup The '. cwnty and AF r^lWg cvm0 n asuene no rygsl respon44i V W the in%wmryL*R ca twit map Orange County Tax Administration/Land Records DaEe' l1&20i9 1 inCh- 16,667 feet .,� 50 2019 COMMUNITY HEALTH ASSESSMENT Appendix D; Notification Postcard Sent to Randomly Selected Households \�,pRS pf Oq Place • stamp % c Healthy Carolinians here rib �e 300 W.Tryon St. y k� Hillsborough,NC 27278 ppppp"— You,opinion matters! v To: For more information: Para mas informaci6n: 41 is x : 919-245-2440 www.orangecountync.gov/cha Volunteers will be visiting your neighborhood in May and June 2019 to get your opinions about the HEALTH of Orange County, NC.They will collect your feedback through an anonymous survey.The information collected will determine the health priorities for the next four years.So,when you see volunteers with orange t-shirts with the Healthy Carolinians logo,please take 30 minutes to tell us what you think. Habra voluntarios visitando su vecindario en mayo y junio del 2019 para obtener sus opiniones sobre la 5ALUD del Condado de Orange,Carolina del Norte(NC).Las voluntarios recopilaran sus comentarios a traves de una encuesta an6n1ma. La informaci6n recopilada determinare las prioridades de salud Para los pr6ximos cuatro anos.Por to tanto, cuando vea a los voluntarios de camiseta naranja con el logotipo de Healthy Carolinians,por favor,t6mese unos 30 minutos para decirnos to que piensa. 2019*4)1 5Ala�4f$ � �1 #t� .PA 5--8111 h4 1lC*VAJb+*I Orange Countyl[1t 2 1:- tM ]SPL;111&0. &*141 @QAMAV`.A.01-4*fEPfi Healthy Carolinians N491LkTVrh 1 #�L305t4Kafla�gft 4ljUA irf lf]VN*V, 2019 COMMUNITY HEALTH ASSESSMENT 51 Appendix E; Community Health Opinion Survey (Also printed in Chinese, Burmese, Spanish, and Karen) OF o � � 9 U • m ORANGE COUNTY y W HEALTH DEPARTMENT �ja, �� Improving health.Inspiring change. 2019 Orange County Community Health Opinion Survey I Date COMMENTS I I I ❑ No One Home ADMIN ONLY Language Barrier(Interpreter not available) ❑ Spanish Follow Up? ❑ Karen ❑ Burmese Phone Number: ❑ Mandarin ❑ Other: (Call back to complete? Provide phone Address: number) ❑ Ended Before Survey Completed (Call back to complete? Provide phone number) ❑ No one in home eligible Email: ■ Under 18 years of age ■ Non-resident of Orange County Household Refusal ❑ Unoccupied/Vacant/Demolished House/Condemned House ❑ Selected Address Not a Household ❑ Survey Completed ❑ Yes ❑ No 52 2019 COMMUNITY HEALTH ASSESSMENT o U • mlp ORANGE COUNTY HEALTH DEPARTMENT Improving health.Inspiring change. 2019 Orange County Community Health Opinion Survey READ THE FOLLOWING SECTION TO EACH POTENTIAL PARTICIPANT WITH BADGE/TSHIRT/VEST CLEARLY VISIBLE: Hello, I am and this is representing Healthy Carolinians of Orange County. The Orange County Health Department is conducting a community survey to learn more about the health and quality of life in Orange County. Your responses will help determine the direction of future programs for the health department and other agencies across the county. Maybe you remember receiving a postcard in the mail recently that described the survey? [SHOW LAMINATED POSTCARD] Your address, and/or neighborhood, was randomly selected to answer our community opinion survey. The survey is completely voluntary, and it should only take about 30 minutes to complete. There is no right or wrong answer and you may refuse to answer any question. Your responses will be visible only to our Data Team and will not be linked to you in any way. All reports, presentations and publications of the data will be shared as de-identified, comprehensive data only. 2019 COMMUNITY HEALTH ASSESSMENT 53 NON-ENGLISH LANGUAGE RESPONDENTS ONLY IF RESPONDENT DOES NOT SPEAK ENGLISH OR SPANISH GIVE RESPONDENTA COPY OF THE LANGUAGE POSTCARD FOR THEM TO IDENTIFY THEIR LANGUAGE AND RECORD BELOW. Language: CALL TELE-LANGUAGE, REQUEST THE DESIRED LANGUAGE (RECORDED ABOVE) AND READ THE FOLLOWING TO THE INTERPRETER We are conducting a community health survey. We are sorry that we do not have an interpreter present with us right now who speaks (insert language), however, we have an on-call interpreter who can be here shortly, if you're willing to participate? 54 2019 COMMUNITY HEALTH ASSESSMENT Would you be willing to participate? ❑YES ❑NO (If NO, stop the survey here and thank him/her for his/her time.) ELIGIBILITY Do you live in Orange County? ❑ YES ❑NO (If NO, stop the survey here and thank him/her for his/her time.) BEGIN SURVEY Read: I will now begin asking questions. If at any time you realize that you have already participated in this survey let me know, and I can stop. In this survey,there is no right or wrong answer. We are just interested in your honest opinion, based on what you have seen or experienced. Remember your individual responses will be kept anonymous and will not be linked to you in anyway. Emergency Preparedness 1. What would be your main way of getting information in a large-scale disaster or emergency?(Choose only one.) ❑ Social media (i.e.Twitter, Facebook, ❑ Text message/cell phone alert etc.) (emergency alert system) ❑ Internet ❑ Other: ❑ Television ❑ Don't know/not sure ❑ Radio ❑ Prefer not to say ❑ Neighbors/neighborhood watch/community apps 2. Does your household have working smoke and carbon monoxide detectors? (Choose only one.) ❑ Yes, smoke detectors only ❑ No ❑ Yes, carbon monoxide detectors only ❑ Don't know/not sure ❑ Yes, both ❑ Prefer not to say Creating a Healthy Community 3. How do you usually get around town to go to work,school, run errands,shop,etc.? (Choose all that apply) ❑ 1 drive ❑ I bike/walk ❑ I get rides from family members or ❑ I use a transportation service friends (i.e. Uber, Lyft,Taxi, etc.) ❑ I take public transportation ❑ Other: 2019 COMMUNITY HEALTH ASSESSMENT 55 ❑ Prefer not to say 4. In the past year,which of the following transportation concerns have you experienced? (Choose all that apply) ❑ Can't afford gas J I don't know how to use public ❑ Can't afford car repairs transportation (i.e. bus Bus routes don't go where I need transfers, bus routes, etc.) them to Uber/Lyft/Taxi are not ❑ Public transportation doesn't operate available where I live in the hours/times I need them to Other: ❑ Public transportation takes too long U None of these ❑ Prefer not to say S. Do you have access to the Internet? LJ Yes ❑ Prefer not to say ❑ No 6. What ways do you access the internet? (Choose all that apply) I don't have access F Public computers (i.e. library) At home (i.e. computer,tablet, C Other: watch, etc.) ❑ Prefer not to say ❑ Smart phone data ❑ Public Wi-Fi (i.e. coffee shop, restaurant, government building, etc.) Access to Care 7. Do you have a regular medical home, somewhere you go regularly for your medical care? Yes ❑ Prefer not to say No 8. Where do you go most often when you are sick? (Choose only one.) ❑ My regular doctor F Chapel Hill Community Health ❑ Hospital emergency room Center ❑ Urgent Care ❑ Specialist ❑ Health Department ❑ Other: ❑ Carrboro Community Health Center ❑ Prefer not to say 56 2019 COMMUNITY HEALTH ASSESSMENT 9. The current hours of the Health Department's Medical Clinic are Monday through Friday 8:00am to 5:00pm with extended hours on Tuesday and Thursday until 6:3013M. If you or your family were in need of services,would these hours be convenient for you? J Yes L Don't know/not sure J No ❑ Prefer not to say 10.The current hours of the Health Department's Dental Clinic are Monday through Thursday 8:00am to 5:00pm,and Fridays 8:00 am to noon. If you or your family were in need of services,would these hours be convenient for you? J Yes L Don't know/not sure J No ❑ Prefer not to say 11. If you have received services at the Orange County Health Department in the last year, how satisfied were you with your service? (Including medical, dental,and/or environmental health services) ❑ Very satisfied ❑ Very dissatisfied ❑ Satisfied ❑ Don't know/not applicable ❑ Dissatisfied ❑ Prefer not to say 12.What is your primary health insurance plan?This is the plan which pays your medical bills first or pays most of your medical bills. (Choose only one.) ❑ No health insurance ❑ Medicare ❑ The State Employee Health Plan ❑ Medicaid ❑ Blue Cross and Blue Shield of North ❑ The Military,Tricare, CHAMPUS, or Carolina the VA ❑ Other private health insurance plan ❑ Other: purchased from employer or ❑ Don't know/not sure workplace ❑ Prefer not to say ❑ Other private health insurance plan purchased directly from an insurance company or through the Affordable Care Act 13. In the past 12 months, did you have a problem getting the health care you needed for you personally or for an adult family member from any type of health care provider,dentist, pharmacy, or other facility? ❑ Yes ❑ Don't know/not sure ❑ No ❑ Prefer not to say 2019 COMMUNITY HEALTH ASSESSMENT 57 14. If you said "yes,"what type of provider or facility did you or your family member have trouble getting health care from? (Choose all that apply). N/A; does not apply ❑ Health Department J Dentist ❑ Hospital General practitioner/primary care ❑ Urgent Care Eye ❑ Medical Clinic care/optometrist/ophthalmologist ❑ Specialist: Pharmacy/prescriptions ❑ Other: J Pediatrician ❑ Prefer not to say ❑ OB/GYN 15. Do you have children under the age of 19 for whom you are the caretaker? (Includes step-children,grandchildren, or other relatives). ❑ Yes ❑ Prefer not to say ❑ No 16. If you answered "yes", have you ever had trouble getting medical care for the child(ren) you care for? ❑ N/A; does not apply ❑ No Yes ❑ Prefer not to say 17. Concerning access, have any of the below problems prevented you or your family member(s)from getting necessary health care? (Choose all that apply). J N/A; does not apply ❑ Pharmacy would not take No health insurance my/our insurance or Medicaid ❑ Insurance didn't cover what I/we ❑ Didn't know where to go needed ❑ Couldn't get an appointment Deductible/co-pay was too high ❑ The wait was too long J Doctor would not take my/our ❑ The hours and days they are insurance or Medicaid open is not convenient J Hospital would not take my/our ❑ There was no one who spoke insurance my preferred language and no J No transportation to get there interpreter available ❑ Dentist would not take my/our ❑ Other: insurance or Medicaid ❑ Prefer not to say 58 2019 COMMUNITY HEALTH ASSESSMENT 18. If a friend or family member needed counseling for a mental health or a drug/alcohol abuse problem,who would you tell them to talk to? (Choose all that apply). ❑ Private counselor or therapist J Doctor ❑ Support group (e.g.,AA, NA., etc.) ❑ Don't know/not sure ❑ School staff(i.e. counselor, coach, ❑ Other: teacher, bus driver, custodian, etc.) ❑ Prefer not to say ❑ Minister/religious official 19. Have you ever heard of NC 2-1-1? ❑ Yes ❑ Don't know/not sure ❑ No ❑ Prefer not to say Community Improvement 20. When you think about the health of our community,what issues do you think affect the overall health of the county? 21. If you had to pick one issue from your previous list that is most important to the health of the community,which would it be? 22.Thinking about teenagers in our community,what would you say are the top three problems that they face? READ:The next group of questions will ask about your personal health. Remember you can skip any question that you are uncomfortable answering. Personal Health 23.Would you say that, in general,your health is...(Choose only one ❑ Excellent ❑ Fair ❑ Very good ❑ Poor 2019 COMMUNITY HEALTH ASSESSMENT 59 ❑ Good ❑ Prefer not to say 24. Have you ever been told by a doctor, nurse,or other health professional that you have any of the following health conditions? (DK=Don't know/not sure;P=Prefer not to say) a. Asthma ❑ Yes ❑ No ❑ DK ❑ P b. Depression, anxiety or ❑ Yes ❑ No ❑ DK ❑ P other mental health concern c. High Blood Pressure ❑ Yes ❑ No ❑ DK ❑ P d. High Cholesterol ❑ Yes ❑ No ❑ DK ❑ P e. Diabetes (not during ❑ Yes ❑ No ❑ DK ❑ P pregnancy or Type 1) f. Osteoporosis ❑ Yes ❑ No ❑ DK ❑ P g. Overweight/obesity ❑ Yes ❑ No ❑ DK ❑ P h. Heart Disease ❑ Yes ❑ No ❑ DK ❑ P i. Cancer ❑ Yes ❑ No ❑ DK ❑ P 25. How do you identify? (Choose all that apply) ❑ Male ❑ Prefer to self-describe: ❑ Female ❑ Transgender ❑ Prefer not to say ❑ Gender Queer, Gender Non- Conforming, Non-Binary,Third Gender 26.When it comes to Cancer screenings, have you ever had a.....(DK=Don't know/not sure; P= Prefer not to say, NA= Not applicable/does not apply) Mammogram(Female)?—An x- ❑ Yes ❑ No ❑ DK ❑ P ❑ NA ray taken only of the breast by a machine that presses against the breast. Prostate Exam—PSA or DIRE ❑ Yes ❑ No ❑ DK ❑ P ❑ NA (Male)?—The prostate-specific antigen (PSA)test and digital rectal exam (DRE) are tests used to check men for prostate cancer. Blood Stool Test ❑ Yes ❑ No ❑ DK ❑ P ❑ NA (Male/Female)?—A test that may use a special kit at home to determine whether the stool contains blood. 60 2019 COMMUNITY HEALTH ASSESSMENT 27. In the past 30 days, have there been any days when you felt down, depressed or hopeless, and it made it difficult for you to do your work,take care of things at home or get along with other people? Yes ❑ Don't know/not sure No ❑ Prefer not to say 28. During a normal week,other than your regular job, how many days do you engage in physical activity or exercise for at least a half an hour? ❑ Zero (0) days ❑ Five (5) or more days ❑ One to two (1-2) days ❑ Prefer not to say ❑ Three to four(3-4) days 29. Over the past month,were there any times when you wanted to engage in physical activity but couldn't or found it difficult because of the following reasons? (Choose all that apply) I don't have time. L I don't like to exercise. It costs too much. ❑ I'm too tired to exercise. I don't have convenient exercise ❑ I'm physically disabled. facilities. ❑ Exercise is not important to I don't have child care. me. There is no safe place to exercise. ❑ Other: I have no one to exercise with. ❑ Don't know/not sure My job is physical or hard labor. ❑ Prefer not to say 30. During a normal week, how often do you eat fruits and vegetables? Everyday ❑ Never Five to six (5-6) days ❑ Don't know/not sure Three to four(3-4) days Prefer not to say One to two (1-2) days 31. During the past 12 months, have you had a flu vaccine? Yes, flu shot ❑ No ❑ Yes, flu spray ❑ Don't know/not sure ❑ Yes, both ❑ Prefer not to say 32.About how much do you weigh without shoes? Weight: pounds ❑ Don't know/not sure ❑ Prefer not to say 2019 COMMUNITY HEALTH ASSESSMENT 61 33.About how tall are you without shoes? Height: feet inches ❑ Don't know/not sure ❑ Prefer not to say READ:We are now about to ask questions regarding your experience with some of the issues facing people who live in Orange County. Remember that you always have the option to skip any question that you are uncomfortable with,and your answers will not linked to you in any way. 34.At the store where you typically buy food,is there a good selection of fruits and vegetables available? ❑ Always ❑ Don't know/not sure ❑ Sometimes ❑ Prefer not to say ❑ Never 35. In the past month,could you afford to eat fresh fruits and vegetables? ❑ Yes ❑ Prefer not to say ❑ No 36. In the past month, did you ever cut the size of your meals,or skip meals,because there wasn't enough money for food? ❑ Yes ❑ Prefer not to say ❑ No READ:Please state how strongly you agree,or disagree,with the next few following statements. 37. In my community, people of all races,ethnicities, backgrounds,and beliefs are treated fairly. Strongly agree ❑ Strongly disagree ❑ Agree ❑ Don't know/not sure ❑ Disagree ❑ Prefer not to say 38. Orange County offers you all of the necessary resources to build a good life for you and/or your family. ❑ Strongly agree ❑ Strongly disagree ❑ Agree ❑ Don't know/not sure ❑ Disagree ❑ Prefer not to say 39. 1 have enough financial resources to meet my basic needs(i.e.food,clothing,shelter,and utilities,etc.) 62 2019 COMMUNITY HEALTH ASSESSMENT ❑ Strongly agree ❑ Strongly disagree ❑ Agree ❑ Don't know/not sure ❑ Disagree ❑ Prefer not to say 40. How likely is it that you'll be able to afford to live in Orange County in a year? ❑ Highly likely ❑ Highly unlikely ❑ Likely ❑ Don't know/not sure ❑ Unlikely ❑ Prefer not to say 41. In the past year, did you ever experience homelessness,whether temporarily or permanently? (Including staying with others, in a hotel, in a shelter, living outside on the street, in a car, in a park, etc.) ❑ Yes, 1 time ❑ No ❑ Yes, multiple times ❑ Prefer not to say 42. In the past year, have you or any family members you live with been unable to get any of the following when it was really needed? (Choose all that apply.) ❑ Food ❑ Phone ❑ Utilities ❑ Clothing ❑ Medicine ❑ Child care ❑ Health care (medical, dental, mental ❑ Other: health,vision care) ❑ Prefer not to say 43. Are you able to access services and receive information in your preferred language? ❑ Yes, always ❑ Don't know/not sure ❑ Yes, sometimes ❑ Prefer not to Say ❑ No 2019 COMMUNITY HEALTH ASSESSMENT 63 Demographic Questions 44. How old are you? 45. What is your race/ethnicity?(Choose all that apply.) ❑ American Indian or Alaska Native ❑ Hispanic or Latino/a/x ❑ Black or African American ❑ Middle Eastern or North ❑ East Asian including Japanese, African Chinese, Korean, Vietnamese, etc. ❑ Native Hawaiian or Pacific ❑ South Asian including Indian, Sri Islander Lankan, Pakistani, Nepalese, etc. ❑ White ❑ Southeast Asian, including Karen, ❑ Other: Burmese, Filipino/a, Indonesian, etc. ❑ Prefer not to say 46. Do you regularly speak a language other than English? ❑ Yes ❑ Prefer not to say ❑ No 47. If yes,what language do you regularly speak? 48.What is your marital status? ❑ Never married/single ❑ Widowed ❑ Married ❑ Separated ❑ Divorced ❑ Other: ❑ Unmarried partner ❑ Prefer not to say 49. What is the highest level of school,college or vocational training that you received?(Choose only one.) ❑ Less than 9th grade ❑ Some college (no degree) ❑ 9-12th grade, no diploma ❑ Bachelor's degree ❑ High school graduate (or GED/ ❑ Graduate or professional degree equivalent) ❑ Other: ❑ Associate's degree or vocational ❑ Prefer not to say training 64 2019 COMMUNITY HEALTH ASSESSMENT 50.What was your total household income last year,before taxes? Let me know which category you fall into. (Choose only one. ❑ Less than $10,000 ❑ $50,000 to$74,999 ❑ $10,000 to$14,999 ❑ $75,000 to$99,999 ❑ $15,000 to$24,999 ❑ $100,000 to$249,999 ❑ $25,000 to$34,999 ❑ 250,000 or more ❑ $35,000 to$49,999 ❑ Prefer not to say 51. How many people does this income support?(If you are paying child support but your child is not living with you,this still counts as someone living on your income.) 52.What is your employment current status?(Choose all that apply) ❑ Employed full-time ❑ Disabled ❑ Employed part-time ❑ Student ❑ Retired ❑ Stay-at-home parent/spouse ❑ Armed forces ❑ Self-employed ❑ Unemployed for more than 1 year ❑ Prefer not to say ❑ Unemployed for 1 year or less READ:Thank you for your time answering these questions about health. The Orange County Health Department and Healthy Carolinians of Orange County will use the results of this survey to help identify and address the major health and community issues in our county. After these results are ready,we will host community workshops,which you are invited to,to prioritize and decide on the most important county issues. 53.Would you like to be contacted when this happens? ❑ Yes ❑ Prefer not to say ❑ No ADMIN ONLY F0110W Up (in response to question 53) Phone Number: Email: 2019 COMMUNITY HEALTH ASSESSMENT 65 Appendix F; Focus Group Template (Conducted among the Homeless population, youth, Spanish speakers, Burmese speakers, Karen speakers, and Kinyarwanda speakers) OPENING Let us start with introductions. One at a time, please introduce yourself and tell us how long you have lived in Orange County. CORE QUESTIONS IF PROBING IS NEEDED, FOLLOW ANSWERS WITH PHRASES LIKE, "TELL ME MORE ABOUT..."OR "COULD YOU GIVE ME AN EXAMPLE..."OR "IN WHAT WAYS..."PROBING IS TO HELP EXPLAIN THE QUESTION AND HELP PARTICIPANTS THINK OUTSIDE THEIR INITIAL THOUGHTS. 1. How do you define health? ■ PROBE: Think about physical health. Mental health. Environmental health. 2. Describe what healthy looks like to you. ■ PROBE: What would be involved in a person being healthy? Think about physical, mental and environmental. 3. Describe what a healthy community looks like to you. ■ PROBE: By community, that could be your neighborhood, your surroundings, or Orange County as a whole, not just you individually. What would make where you live a healthy (or healthier) community? o Safety o Access o Transportation/travel time o Housing o Employment o Recreation activities o Healthcare o Religion o Schools 4. What are the strengths of your community? ■ PROBE: This could be your neighborhood, your surroundings or Orange County as a whole. o Parks/trails o Recreation activities o Numerous medical facilities o Farmer's markets o Schools o Support for your culture/religion/ethnicity o Job opportunities o Cost of living o High graduation rates o Low/no crime 5. Is there anything Orange County can do more of to support your community better? ■ PROBE: What can help your community be better? 66 2019 COMMUNITY HEALTH ASSESSMENT o More funding o More concern for your religion/culture%thnicity o Police presence o Cleaner water o More medical facilities o More transportation options 2019 COMMUNITY HEALTH ASSESSMENT 67 GROUP SPECIFIC QUESTIONS BASED ON THE POPULATION, ASK ANY ADDITIONAL QUESTIONS, IF NECESSARY, TO GET A BETTER IDEA OF THEIR CONCERNS/ISSUES AS IT SPECIFICALLY RELATES TO THEM. HISPANIC/LATINX THE NEXT FEW QUESTIONS IS TO GET A BETTER IDEA OF THE CONCERNS/ISSUES AS IT SPECIFICALLY RELATES TO INDIVIDUALS WHO IDENTIFY AS HISPANIC/LATINX. 6. Thinking about the people in your community, both where you live and those who are Latinx, what are your main health or safety concerns? ■ PROBE: What concerns you most? o Crime o Law Enforcement o Access to services o Medical Care o Language Barriers 7. Tell us about your experience(s) getting healthcare in Orange County. • PROBE: What is going well and what makes it difficult? o Interpretation/translation/communication issues o Proper help at appointments o Transportation issues o Route times and frequency o Insurance/payment o Referrals to other agencies/facilities 8. Do you feel you are well informed on the county's resources and services that would be helpful to you? If not, do you feel comfortable enough to ask questions and get more information about resources/services? 9. Do you feel that you have a way, or connection, to share your opinions, feedback and perspectives with decision makers? 10. The last couple of years have been challenging for some immigrants and refugees across the US, due to changes in policies, unwelcoming language, ICE arrests, and increases in immigrant detention. Has this been a challenge for you or for others you know here in Orange County? ■ PROBE: Have those stressors affected the health and well-being for you or those you know? 11. Are there any specific things that Orange County can do to support the well-being of the Hispanic/Latinx community? • PROBE: Increase transportation options o More outreach to neighborhoods o Clear messages about program eligibility 68 2019 COMMUNITY HEALTH ASSESSMENT o Hire more Dreamers o More funding o More concern for your religion/culture%thnicity o Police presence o Cleaner water o More medical facilities o More transportation options o Affordable housing o Affordable healthcare o Sharing of information HOMELESS POPULATION THE NEXT FEW QUESTIONS IS TO GET A BETTER IDEA OF THE CONCERNS/ISSUES AS IT SPECIFICALLY RELATES TO THOSE INDIVIDUALS EXPERIENCING HOMELESSNESS. 12. Do you feel you are well informed on the county's resources and services that would be helpful to you? If not, do you feel comfortable enough to ask questions and get more information about resources/services? 13. Do you feel that you have a way, or connection, to share your opinions, feedback and perspectives with decision makers? REFUGEE POPULATION THE NEXT FEW QUESTIONS IS TO GET A BETTER IDEA OF THE CONCERNS/ISSUES AS IT SPECIFICALLY RELATES TO REFUGEES. 14. Are there any specific places/locations that are hard to access because they do not speak your language or because they have limited-to-no interpreters? ■ PROBE: transportation/public transit o Doctor offices o Hospitals o Dental agencies o Food pantries o Religious services o County agencies o Schools 15. In addition to language barriers, what else keeps you from getting the services that you need/want? ■ PROBE: Public transportation doesn't run where I need o Hours of operation, at agencies, are inconvenient o Places do not accept my insurance o My culture is not respected o Fear 16. Do you feel you are well informed on the county's resources and services that would be helpful to you? If not, do you feel comfortable enough to ask questions and get more information about resources/services? 2019 COMMUNITY HEALTH ASSESSMENT 69 17. Do you feel that you have a way, or connection, to share your opinions, feedback and perspectives with decision makers? 18.What health/social issues is a priority to you that is preventing you from having the best quality of life that you deserve? ■ PROBE: Well-paying job o Adequate housing o Affordable healthcare o Higher education o Access to interpreters/translators o Transportation (personal or public) 19.Do you partake in preventative health care or do you only visit clinics when you are sick or during emergencies? ■ PROBE: Do you get checkups once a year,just to make sure you're in good health? o How often do your children visit the doctor? o Do you feel it's more expensive to visit yearly, or on occasion? YOUTH POPULATION THE NEXT FEW QUESTIONS IS TO GET A BETTER IDEA OF THE CONCERNS/ISSUES AS IT SPECIFICALLY RELATES TO YOUTH. 20. Do you see a lot of"unhealthy behaviors" among people your age? ■ PROBE: Unhealthy behaviors can be anything from sexual activities, bullying, drug use, alcohol, skipping school, cheating, drunk driving, etc. 21. What "unhealthy behavior" do you see the most? 22. Do you, or any students you know, vape? ■ PROBE: What do they vape? o What is the culture at your school around vaping? o Is it acceptable? o Do students feel that it is harmful? 23. Have you ever been tested for HIV(the virus that causes AIDS, not counting blood transfusions)? ■ PROBE: Is there a fear with teens/youth to get tested? 24. Do students your age care about being physically active? ■ PROBE: What type of activities do you/they engage in? o Traditional sports (football, basketball, cheerleading, track, baseball, soccer, swimming, etc.) 70 2019 COMMUNITY HEALTH ASSESSMENT o Non-traditional sports (hockey, cricket, bowling, martial arts, Polo, etc.) 25. Do you feel like students your age have access to the help they need? ■ PROBE: Think about the support for students dealing with alcohol or drug use, bullying, suicide thoughts or attempts, stress, anxiety, depression, school/grades, etc. 26. How prepared was your community in dealing with your release from incarceration? • PROBE: By prepared, 1 mean, was there a plan set in place by Prison Case Managers, Probation Staff and/or Community Agencies to ensure you had adequate access to essentials like food and shelter? 27. After being released from prison/Jail, were you given an adequate supply of medication? How soon were you able to be seen by another doctor? 28. How did your time in prison/jail affect your overall mental health? ■ PROBE: Thinking both positive and negative 29. How has your re-entry affected your overall mental health? • PROBE: What changes have you noticed, positive or negative, since being released from prison/jail?Are you able to access the help that you need? ENDING QUESTIONS 30. We want to make sure that the health programs in this community will help you and your community. With that in mind, is there anything that we have not asked or that you would like to add? 31. Do you have any questions about the community health assessment process? CLOSING Are there any questions from the notetaker(s)? *Thank all guests and provide any incentive that is intended for participation* 2019 COMMUNITY HEALTH ASSESSMENT 71 Appendix G; Community Input Session Flyer 2019 Orange County Community Health Assessment COMMUNITY INPUT �F,5�ION,5 Dates/l ocatlons/trmes Cedar Grove Community Center Date:Tuesday October 29th Address:5800 INC Highway B6 N.Hillsborough,NC 27278 Time:12:00pm-2:00pm Whitted Human Services Center, Room 230 Date:Tuesday November 12th Address:300 W_Tryon St-Hillsborough,NC 27278 ilk Time:5:30pm-7:30pm Chapel Hill Public Library, Meeting Room B Date:Friday November 15th Address:100 Library Dr,Chapel Hill.NC 27514 0 Time:12:00pm-2:00pm Southern Human Services Center, Room AB Date:Thursday November 21st Add res&2501 Homestead Rd-Chapel Hill,NC 27514 Time:5:30pm-7:30pm FREE MEAL SERVED[ Wi HE THY CAROWNIAN5 ANP THE BOARD OF HEALTH INVITe YOU TO- Learn about what was found in conversations with neighbors during the 2019 Community Health Assessment data collection process. • Discuss your concerns with elected officials, people who work in government,and the health department. • Help prioritize and decide what health issues will be selected for 2020-2024. • Map out next steps toward a plan that improves the health of Orange County, e-mail hcoc@omngecountync.gov or cal To aftend a Community Input Session: Interpretvaarvkm angfar apwal sound equipment are freeardavalloae an request Call In aVance tic maka a••angemerts:919-243-2W or 919-24&-24C4 Los aarrlc=deMthrpreteyJaequrMCeaanldo esperaalam gratll=y eVAndoxnIWE por petl-.Idn.Uame por awlErtado para avlaamos: 919-245-2397 Q 919-2452400. �� J'J� 1�'9}y� 2 �F9sJQ�,� I ) 3dlii : i#9192A�2334192d2400, 72 2019 COMMUNITY HEALTH ASSESSMENT Appendix H; Diversity, Equity and Inclusion Glossary DIVERISITY, EQUITY • • - POLITICS, POWER & PRIVILEGE • Politics— 1)The struggle for or over power. 2)The struggle to attain, maintain, build or take power. Power- 1)The ability to name or define. 2)The ability to decide. 3)The ability the set the rule, standard, or policy. 4)The ability to change the rule, standard, or policy to serve your needs, wants or desires. 5)The ability to influence decisions makers to make choices in favor of your cause, issue or concern. • Types of Power Each of these definitions of power can manifest on personal, social, institutional, or structural levels. a. Personal Power— 1)Self-determination. 2) Power that an individual possesses or builds in their personal life and interpersonal relationships. Example: When a person chooses a new name for themselves rather than the one given to them, this is an act of personal power. b. Social Power — 1) Communal self-determination. 2) A grassroots collective organization of personal power. 3) Power that social groups possess or build among themselves to determine and shape their collective lives. Example: Over the last few years individuals who identify as multiracial or multiethnic have used their social power to name themselves into existence and build a community around the shared experience of being multiracial or multiethnic. The growing social power of the multiracial/multiethnic community is a direct challenge to institutions premised on a binary understanding of race (i.e., you are either this or that.) c. Institutional Power— 1) Power to create and shape the rules, policies and actions of an institution. 2)To have institutional power is to be a decision maker or to have great influence upon a decision maker of an institution. Example: A school principal or the PTO of a local school have institutional power at that school. d. Structural Power-To have structural power is to create and shape the rules, policies, and actions that govern multiple and intersecting institutions or an industry. Example: The city school board, mayor, and the Secretary of Education have structural power in the educational industry. 2019 COMMUNITY HEALTH ASSESSMENT 73 • Minoritized Population— 1)A community of people whose access to institutional and structural power has been severely limited regardless of the size of the population. As a result, the community is constantly being disenfranchised and disempowered by the majoritized population. 2)Also referred to as a subordinated population. • Cultural Default- 1) The status quo; a category or reality specific to one group of people that is used as a rule or standard for all people and groups. 2)Taking the preferences, practices, and policies of a ruling elite and universalizing them so that they feel "natural" or function as social norms. 3) Often referred to in academic circles as hegemony. Examples: Racial justice movements address the cultural default of Whiteness:beauty standards; definitions of culture, civility and humanity; what counts as knowledge; etc. • Eurocentrism - 1)The process and product of the cultural default of Whiteness. 2) The utilization of European cultural standards as universal standards that all should be judged by. 3)To orient to European people and cultures as the benchmark of: humanity, culture, truth, virtue, style, beauty, civility, knowledge, and ethics; a deification of European people and their cultures. • White Privilege- 1)The unearned privileges associated with identifying as or appearing White in a racist society. 2) Living and existing as a White (appearing) person in a world that operates on the cultural default of Whiteness. 3)A tool that a White ally can use to challenge racist oppression in the spaces and places they have access to. Privilege- 1) The unearned social, political, economic, and psychological benefits of membership in a group that has institutional and structural power. 2) Living and existing in a world where standards and rules are premised upon your needs wants and desires. 3. To identify with or be identified as a member of a dominant social group (as opposed to a minoritized group). • Oppression — 1)A system for gaining, abusing and maintaining structural and institutional power for the benefit of a limited dominant class. 2) The inequitable distribution of structural and institutional power. 3) A system where a select few horde power, wealth and resources at the detriment of the many. 4) The lack of access, opportunity, safety, security and resources that minoritized populations experience; a direct result of a vacuum created by privilege. 5)A state of being that is the opposite of social justice. • Community Organizing— 1)The art and science of social movements. 2)The theories, practices and skills that people use to create movements for social transformation. 3) A communal process of using, building and demonstrating power in order to influence decision makers to get things the community needs or wants. 4) The ultimate response on the continuum of responses to social injustice. It is a communal process of building power (often by developing a broad coalition of 74 2019 COMMUNITY HEALTH ASSESSMENT stakeholders) to put an extraordinary amount of pressure on a person that has institutional or structural power to change a policy or practice that negatively impacts the stakeholder communities. Example: The famous Montgomery Bus boycott is a primary example of community organizing. Unfortunately, rather than focusing on all the work the locals did to build power in their community, we instead tell a depoliticized story about Rosa Parks as an elder with tired feet. The truth of the situation is that she was a trained community organizer; she was a member of the local NAACP and a primary organizer of the Boycott movement; and that what she did that day in refusing to yield her seat was a deliberate and planned direct action (tactic) of the Boycott Movement. • Ally— 1) One who is not (most) directly impacted by an issue but works in solidarity with those who are most directly impacted by the issue; 2) One who understands that their primary role is to: a) educate themselves; b) educate their community, and c) lend their support to the leadership of those most directly impacted by the issue. Example: A White racial justice ally would be someone who has educated themselves on the issue of racial justice, seeks to be anti-racist in their everyday life, participates in the education of other White people about racial justice, actively works to use their White Privilege to support the cause of racial justice, seeks to transform spaces where they have power or influence, and supports people of color leadership on racial justice issues and in racial justice movements. There is a difference between being an ally and being an advocate; allies work closely with and in support of those most impacted by an issue. However, one can be an advocate and not work with or know any of the people or groups that you are advocating for. • Theory of Change -A system of beliefs about how change and transformation happen. Our current theory of change revolves around five basic assumptions: (a) a social justice orientation demands that we actively seek to transform unjust social policies and practices in our present world; (b) democratic practice and plurality are key to social transformation; (c) people working together across lines of difference can transform and improve life for all people; (d)social problems must be addressed on multiple levels (direct service, issue education, policy advocacy) to end social inequities; (e) all people cannot be empowered if we do not address issues of race and racism. • People of Color— 1) Political (not biological) identity of solidarity among and across minoritized ethnic communities historically referred to as ethnic minorities or non- White people. 2)A term used to disrupt the Black/White racial binary in the U.S. 3)A linguistic tool of inclusion and reminder that people of the African diaspora are not the only people who have been racialized or have been impacted by institutional and structural racism; common variations include: people of color, youth of color, students of color, queer or LGBTQ people of color. Note: The use of this term is not to suggest that all People of Color are the same, or that the term is accepted and used by all. The creation of the People of Color framing came out of political discussions among social activists about how to represent the common needs of various people from minoritized racial/ethnic communities. 2019 COMMUNITY HEALTH ASSESSMENT 75 • Xenophobia - Fear and/or loathing of people who have social group identities or memberships that are different from your own; the "other" or"those people." Example: Since Sept. 11, 2001 and the attacks on the World Trade Center and the Pentagon, American people and policy have become explicitly xenophobic. This xenophobia is directed at people who identify as or"appear"to be Muslim. This specific xenophobia is also known as Islamophobia. SPECTRUM OF VIOLENCE Spectrum of Violence- See figure below. A model or understanding of violence built upon the assumptions that not all violence is: physical, visible, and/or valued equally. 2)An acknowledgement that there are many types of violence in the world and not all of these types of violence are acknowledged or responded to equally. 3) Beginning with Community Violence, the spectrum, goes clockwise, ordering types of violence from the most"visible" to the least"visible" (noticed in the mainstream). However, each point on the spectrum has "visible" and invisible aspects. Example: violence against women and girls of color (sex trafficking, murder, sexual assault domestic violence or police brutality receives less attention (invisible) than police violence against men and boys of color (visible). • Violence- 1)A primary tool of oppression.2) A coercive spectrum of tools used to acquire, build and/or maintain power. 3)A continuum COMMUNITY of economic, political, cultural, religious, VIOLENCE psychological, and physical resources, behaviors and practices used as vehicles of hL violence. VIOLENCE AGAINST ■ VIOLENCEWOMEN OF I • Community Violence - A combination of COLOR rp!� - violence directed at communities, such as OF police violence,war, and colonialism, and VIOLENCE violence within communities,such as sexual and domestic violence. • Political Violence—1)A tool in the spectrum F ■NO POLITICAL of violence used to exploit the most VIOLE VIOLENCE vulnerable people and communities in our society.2)The targeted coercive or abusive use of political systems, policies and/or practices in the service of acquiring, maintaining, and/or building power(institutional or structural)for a majoritized community. • Economic Violence — 1)A tool in the spectrum of violence used to exploit the most vulnerable people and communities in our society.2)The targeted coercive or abusive use of economic systems, policies and/or practices in the service of acquiring, maintaining, and/or building power(institutional or structural)for a majoritized community. 76 2019 COMMUNITY HEALTH ASSESSMENT • Violence against women of color - A combination of violence directed at women of col-or and their communities,such as police violence,war, and colonialism, and violence used within communities against women of color, such as sexual and domestic violence. • Hate Crimes — 1)A form of community violence that targets the most vulnerable populations. 2)Committed when a perpetrator intentionally selects and commits a crime toward someone based on actual or perceived membership in a particular group, usually defined by race, religion,ability, ethnic origin,gender identity or sexual orientation. Current federal laws make it a crime to commit bias-motivated acts against individuals or property. Hate crimes not only cause direct harm to the victim, but have an intimidating and isolating impact on the larger community than targeted originally. Racial ized V i o I e n ee - 1)A tool in the spectrum of violence used to exploit the most vulnerable people and communities in our society. 2)A form of racialized community violence. 3)Tool of oppression directed against communities of color, such as economic policies, cultural practices, political maneuvers, police brutality, war, criminal justice systems, hate crimes, genocide, and colonialism used in the service of acquiring, building, or maintaining institutional and structural power at the expense of people of color. • Microaggressions- 1)Racial microaggressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, which communicate hostile, derogatory, or negative racial slights and insults toward people of color. 2)The "normalized" (verbal and non-verbal) violent behaviors that daily challenge the full humanity and dignity of people who are or appear to be members of a minoritized population. Due to their frequency, microaggressions have a cumulative (negative) impact on the psychological, emotional, and/or physical well- being of the recipients of these assaults. fines that _ "Toll Cant bB "I don't meanpeunaN'c ��� � see me?' r at His pani€.You're gel ha ppened, �� ton white." color." "That is "Do you guys "You are so So really pray five beautiful far retarded." times a day?"' a trans girl." 2019 COMMUNITY HEALTH ASSESSMENT 77 Ar7 "Just eat less "Is your hair "Are you and your real? Can I a boy or }pack will be touch it?" fine.' 7 girl?" P "B ut you ALL "Are you going to "You people have an arranged always do so look alike. marriage?" well in school." "Are you the "That's "You don't talk new diversity -- Thlt� O like you are hire?" gay! black No where .'But "SD wha is the " � � ou]f man in the are you speak so relationship?" really from?" well." "You are so lucky to _ "oid You transition "Wow,I could a be black.So easy to because you thought never deal get:into college." you were an ugly with that.You girl?"11 are so brave." • Racial Profiling—1)A form of racialized community violence. 2)Structural and institution al racial xenophobia. 3)Refers to the practice of a law enforcement agent or agency relying,to any degree, on race, ethnicity, religion, national origin in selecting which individuals to subject to routine or investigatory activities such as traffic stops,searches, and seizures. 4)A manifestation of racial prejudice that materializes on institutional and structural levels. 5)The systemic targeting, surveillance, policing, and harassment of people of color that begins with the assumption that people of color are more likely to be criminals.At the community level, the discriminatory practice of racial profiling has emerged as a national concern.African- Americans, Native Americans, Latinos,Asian Americans, and Arab Americans, have reported being unfairly targeted by police who use race, ethnicity, national origin, religion and even gender when choosing which individuals should be subjected to stops, searches, 78 2019 COMMUNITY HEALTH ASSESSMENT seizures, and frisks on the streets, during routine traffic stops, at national borders and in airports. Example: In the aftermath of Sept. 11, law enforcement agents at the federal, state and local levels are permitted to engage in racial profiling to prevent terrorist related activities. Arabs and Muslims, and in many cases, any individual who "appears"to be Arab, Muslim, South Asian or Sikh are vulnerable to unfair treatment at the hands law enforcement who have the dual responsibility to protect communities they work in, while respecting the civil liberties of all those they serve. • Human Trafficking— 1)A form of(targeted)community violence involving kidnapping, forced relocation, and forced labor. 2)The illegal and/or immoral forced relocation of people, typically for the purposes of forced labor and/or commercial sexual exploitation. Example: a) The kidnapping, transport and selling of African people across the Atlantic Ocean (Trans-Atlantic Slave Trade) to be used as free labor in the "New World."b) The kidnaping, transport and selling of women and girls across state lines and international borders (often to be used as sex workers); also referred to as sex trafficking. BIAS, PREJUDICE, STEREOTYPE AND RACISM • Bias-An orientation toward something or someone, this orientation can be positive, negative or neutral; a bias can be informed by a previous experience. In other words, biases can be rational. Example: Any distrust of the U.S. Government that Native American communities have could be considered a rational bias rather than prejudice because there are actual historical and contemporary reasons for indigenous people not to trust the government: desecration of sacred land, genocide, forced relocation, biological warfare, and broken treaties to name a few. • Prejudice-An assumption of knowledge about something or someone not rooted in personal experiences with the particular something or someone in question; prejudice is informed by stereotype rather than experience. Example: A White woman clutching her purse when a person of color gets on the elevator with her could be bias but given the prevalence of racism in US culture is more than likely prejudice. • Stereotype— 1)A trait and/or characteristic assumed to be true of all members of a particular social group. Many American cultural practices and public policies are rooted in racial, gendered and class based stereotypes such as Asians are the model minority; meaning submissive, assimilating, and accommodating (e.g., honorary White people). 2) Stereotypes focus on one aspect of a person's identity to the exclusion of their full humanity. 2019 COMMUNITY HEALTH ASSESSMENT 79 Racism - 1)A form of racialized community violence (economic, political, cultural, and/or physical) that targets or has disproportionate negative impact upon people of color(POC). 2) When ones use of institutional or structural power is premised upon racial stereotype/prejudice or when ones use of institutional/structural power creates, maintains or reinforces policies and practices that further racial inequity. 3. Racial prejudice/stereotypes are symptoms of racism, not racism itself. 4) "Not liking" someone because of their race is a form of bias or prejudice which can exist solely on an individual basis but racism exists on institutional and structural levels. 5) Institutional/ structural power+ racial bias/prejudice/stereotype = Racism; 6) Institutional/structural policies and practices + disproportionate negative impact on POC = Racism. • Reverse Racism- If we apply a power analysis,then reverse racism is not possible be- cause people of color do not have enough institutional and structural power to be racist; though they can be biased or prejudiced.The same is true of"reverse sexism." Despite any bias or prejudices that women may have,they do not have enough institutional/structural power to"oppress" men. • Islamophobia-A form of racism rooted in stereotypes that label all Muslim or Muslim "appearing"people as"terrorist."This form of racism manifests itself in hate crimes, federal actions such as the"Patriot Act'and increased surveillance or racial profiling of Muslims,Arab-Americans or anyone who"appears"to be either. Example: Post- Sept. 11, islamophobia has been linked to an increase in targeted violence (hate crimes) against Sikhs, who many mistakenly interpret to be Muslim due to their traditional religious garb. DIVERSITY, EQUITY & INCLUSION • Diversity-A variety of things. Recognition of difference alone does not equal justice or inclusion.A diversity focus emphasizes"how many of these"we have in the room, organization, etc. Diversity programs and cultural celebrations/education programs are not equivalent to doing racial justice. It is possible to name, acknowledge, and celebrate di-verse cultures without doing anything to transform the institutional or structural systems that produce, and maintain racialized injustices in our communities. • Equality-To treat everyone exactly the same.An equality emphasis often ignores historical and structural factors that benefit some social groups/communities and harms other social groups/communities. Often as a response to racism, people will claim a "colorblind"orientation or seek to create"colorblind'policies that will treat all people equally. However, "colorblindness"often leads to inequity because it does not acknowledge the historical and contemporary systemic forces of oppression that do not allow all of us to be our full selves equally. • Equity-To treat everyone fairly.An equity emphasis seeks to render justice by deeply considering structural factors that benefit some social groups/communities and harms other social groups/communities. Sometimes justice demands,for the purpose of equity, an unequal response. 80 2019 COMMUNITY HEALTH ASSESSMENT r EQUALITY: The assumption that equal EQUITY: All three can see the game with- treatment benefits everyone equally. In this out supports or accommodations because case the fence only allows one spectator to the cause of the inequity was addressed. clearly see the game_ The systemic barrier has been removed_ • Inclusion— 1)An intentional effort to transform the status quo by creating opportunity for those who have been historically marginalized. 2)An inclusion focus emphasizes outcomes of diversity rather than assuming that increasing the amount of explicit diversity of people automatically creates equity in access/opportunity, or an enhanced organizational climate. 3) Begins with the needs,wants, and quality of life of the historically Minoritized population rather than the historically privileged. • Social Justice— 1)An anti-oppression orientation to social and political organization. 2) The process and goal of addressing the root causes of institutional and structural"isms." 3)A vision of the world where all groups of people can live(and be perceived)as fully human on all levels (personal, social, institutional, and structural).4.A vision of the world not rooted in the dominance of any one group over all others. Such a vision would include recognizing the inherent worth and connectedness of all people, animals, plants, and all other resources of our planet and universe.Additionally,this vision of the world would not be rooted in a scarcity model that devalues things that are abundant(many can have access to or can acquire)and highly values that which is scarce or rare(very few can have access to or acquire). Inclusive Organization - An organization that proactively enlists intentional strategies to remove barriers to access, participation and success of those who were historically or are currently systematically excluded by or marginalized within the organization. 2) An organization that actively seeks the transformation of its organizational policies and practices, to foster the involvement and success of those who have been excluded or marginalized. • Continuum of Response to Social Injustice— 1)A multipronged or holistic response to addressing social injustices. 2)A belief that social transformation requires a spectrum of responses from meeting immediate needs(via direct service provision)to transforming institutional and structural policies and practices(via public policy advocacy). 3)The Orange County Government continuum of response includes: direct services, issue education and advocacy. 2019 COMMUNITY HEALTH ASSESSMENT 81 a. Direct Service-The highest priority in the continuum where you help individuals navigate a current crisis situation. This is the most immediate form of response to a social injustice. Direct service may also include skill or capacity development opportunities that are longer term rather than immediate such as leadership development or enhanced vocational skills. b. Issue Education-To supply people with information or educational materials or other opportunities to learn more about a social justice topic or issue. c. Advocacy-To work on behalf of those most negatively affected by a specific policy or practice. Those who are being advocated for may not have any idea that this action is taking place. CULTURE, ETHNICITY & RACE • Culture-A shared way of life among a social group. This shared way of life includes commonalities in: geography, language, history,traditions, rituals, belief systems, etc. • Ethnicity- 1) Membership in a particular cultural group. 2)Often confused with race; ethnic groups are self-formed and identified whereas racial groupings were created by a single group and imposed on everyone else. Example: U.S. indigenous people are often referred to collectively as Indians, American Indians or Native Americans, however, the indigenous people of North America exist as many separate nations and ethnic groups that have different languages, histories and cultural practices. • Social Construction-An unreal "real'thing. Social constructions are not"natural';they do not exist outside of language and human imagination; in this sense they are unreal. However, our way of life is built upon the belief in or dedication to socially constructed categories such as"race."As such,though "unreal'social constructions have real world consequences for all of us. The movie"The Matrix" is often used to teach people how social constructions work. VARIATIONS ON RACE & RACISM • Racialization— 1)The ongoing process by which we all are shaped by racial grouping or "racialized" by structural policies/practices, institutional/organizational cultures, and interpersonal interactions. 2)Our daily experiences of being"raced"or"racialized."3)An acknowledgment that these daily experiences look and are experienced differently across various communities and category of identity. • Post- Racial— 1)A belief that we as a society have moved beyond race;that race and racism are no longer relevant because as a society we have addressed all of the racialized barriers to full and equal participation in American society. 2)The election of 82 2019 COMMUNITY HEALTH ASSESSMENT Barack Obama as President of the United States marks for many the moment America became a post-racial society. • Racial Justice—1)A social justice orientation with a focus on dismantling the root causes of racism (institutional and structural policies and practices) rather than merely the symptoms of racism (racial bias, racial prejudice, racial stereotypes). 2) Requires a focus on and commitment to the communities most directly negatively impacted by racism. • Racial Binary-The Western/U.S.tendency to only think and talk about race and racism in terms of Black and White people;thus making invisible the racialization of other people of color including bi/multiracial and bi/multiethnic people. • Multiracial/Multiethnic—1)Of or pertaining to two or more racial/ethnic identities. 2)An identity category growing in usage and popularity by those who understand their racial/ ethnic identity and heritage to be rooted in more than one racial/ethnic tradition. 3. Made up of, involving or acting in the interest of more than one racial/ethnic group. Race — 1)A social rather than biological construction. 2)A theoretical invention of a European scientist used to separate and rank human beings into three distinct biological categories: Caucasoid (European), Negroid (African) and Mongoloid (Asian). According to this "science" these three species of humans evolved completely separate from one another with no common ancestors. The science of race proclaimed that White/ Europeans (Caucasoid) are the most evolved of the three human species and Black/Africans are the least evolved. 3) The term race as applied to humans was invented as equivalent to the term species used to reference (non-human) animals and plants. 4) An umbrella term used to minimize ethnic variety and emphasize broader group identity markers most often rooted in appearance, skin tone, and ancestral homelands or origins. Example: The racialized term Asian includes numerous ethnic groups and nationalities such as Hmong, Korean, Pilipino, Taiwanese, Laotian, Vietnamese, Chinese and Japanese. Despite the fact that some of these nations and people were colonizers and other were colonized, the concept of"race"draws our focus to similarities of these diverse groups of people rather than the many ethnic%ultural differences among the group. 2019 COMMUNITY HEALTH ASSESSMENT 83 Appendix i; References ' U.S. Census Bureau QuickFacts: Carrboro town, North 13 Small Area Health Insurance Estimates. (2020). Re- Carolina; Chapel Hill town, North Carolina; Hillsborough trieved from https://www.census.aov/data-tools/demo/ town, North Carolina. (2020). Retrieved from htt s: sahie/#/?s_statefips=37&s_stcou=37135 www.census.goy/guickfacts/fact/table/carrborotown- northcarolina,chapelhilltownnorthcarolina,hillsborough- 14 Chen, Jie PhD*; Vargas-Bustamante, Arturo PhDt; town north carol ina/PST045219. Mortensen, Karoline PhD1; Ortega, Alexander N. PhD§ Racial and Ethnic Disparities in Health Care Access and 2 httr)://accessnc.commerce.state.nc.us/docs/countyPro- Utilization Under the Affordable Care Act, Medical Care: file/NC/37135.pdf February 2016 - Volume 54 - Issue 2 - p 140-146 3 State and County Quick Facts: Orange County, NC.U.S. 15 Artiga, S., &Orgera, K. (2019, November 13). Key Census Bureau (2020). Retrieved from https://www. Facts on Health and Health Care by Race and Ethnicity. census.aov/guickfacts/orangecountvnorthcarolina Retrieved from https://www.kff.org/disparities-policy/ report/key-facts-on-health-and-health-care-by-race- 4 American Community Survey 2018 5 year estimates and-ethnicity/ (2020). Retrieved from https://data.census.aov/cedsci/ table?q=B16001&q=1600000US2486475 0400000US2 16 Costway, R., Glrod, C., &Abbott, B. (2011). Milliman 4&tid=ACSDT5Y2018.B16001 Report for the North Carolina Division of Medical Assistance. Retrieved from httr)s://www.ncleg.gov/doc- Orange County Health Department (2020). Refugee umentsites/Committees/HouseAppropriationsHHS Screening Logs. Interim Meetings/2012/1) Jan 3 2012/Presentations and 6 Voter Registration Statistics. (2019, December 28). Handouts/Milliman - CCNC Evaluation/Milliman Analysis Retrieved 2020 from httr)s://vt.ncsbe.gov/PegStat/ of CCNC Cost Savings 12-15-2011 (2).pdf Stats?Date=12/28/2019&CountyName=ORANGE 11 Kaiser Family Foundation, Key Facts about the Orange County, North Carolina Property Tax 2020 uninsured population (December 2018) Retrieved Rate. (2020) Retrieved from http://www.tax-rates.org/ from https://www.kff.org/uninsured/issue-brief/ north carolina/orange county property tax key-facts-about-the-uninsured-population/ 8 Orange County NC Genealogy. (2020) Retrieved from 18 US Census, Division of Medical Assistance (2013) Wral https://ncgenweb.us/orange/ Report, and NC Rural Health Research Program Brief, Rutledge, Holmes, Silberman, October 2015. Retrieved 9 Access to Health Services. (2020). Retrieved from from httr)://www.census.gov/did/www/sah/data/inter- https://www.healthypeor)le.gov/2020/topics-obiec- active , tives/topic/Access-to-Health-Services 'g Kaiser Family Foundation, (2009). Foundation Analy- 10 The Road to Oral Health Equity in North Carolina. sis Medicaid expenditure data. (2020). Retrieved from httr)s://r)ublichealth.nc.gov/oral- health/dots/OralHealthNewsletter-Issue2-WEB-v2.pdf 20 Norris, L. (2020, March 28). North Carolina and the ACA's Medicaid expansion: eligibility, enrollment and " Dental Health Is Worse in Communities of Color. benefits. 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Retrieved data from https://www.cdc.goy/vitalsigns/aahealth/info- araphic.html#infographic 69 Cost Associated with First-Time Homelessness for Families and Individuals. (2010). Retrieved from htt s: www.huduser.gov/publications/ndf/costs homeless.ndf 86 2019 COMMUNITY HEALTH ASSESSMENT 70 2018 State of North Carolina and 2016-2018 Coun- NCD3NorthCarolinaDiseaseDataDashboard/Disease- ty Life Expectancy at Birth. (2020). Retrieved from MansanclTrends httr)s://r)ublic.tableau.com/profile/ httr)s://schs.dr)h.ncdhhs.gov/data/databook/CD8A%20 nc.cdb#!/vizhome/NCD3NorthCarolinaDiseaseData- State%20and%20County%20Life%20Expectancies%20 Dash boa rd/DiseaseMansandTrends at%20birth.html httr)s://schs.dr)h.ncdhhs.gov/data/data- book/CD8A%20State%20and%20County%20Life%20 82 NORTH CAROLINA WEEKLY INFLUENZA SURVEIL- Expectancies%20at%20birth.html LANCE SUMMARY. (2019). Retrieved from htt s: e i. dph.ncdhhs.goy/cd/flu/figures/f1u1819.pdf " Healthy North Carolina 2030: A Path Toward Health. (2020). Retrieved from http://nciom.org/wp-content/ 83 Vaccine Preventable Diseases. Retrieved 2020, from uploads/2020/Ol/HNC-REPORT-FINAL-Spread2.pdf https://www.healthychildren.ora/English/health-issues/ vaccine-preventable-diseases/Pages/default.aspx 72 NC State Center for Health Statistics (2020). 2020 County Health Data Book. 2014-2018 NC Resident Race/ 84 Resource Center for Adolescent Pregnancy Preven- Ethnicity-Specific and Sex-Specific Age-Adjusted Death tion. Statistics: Sexually Transmitted Infections (STIs). Rates. Retrieved from http://www.schs.state.nc.us/ (2020). Retrieved from http://recapp.etr.ora/recapp/in- data/databook/ dex.cfm?fuseaction=pages.StatisticsDetail&PagelD=558 73 NC State Center for Health Statistics (2020). 2020 85 Office of Disease Promotion and Prevention. Injury County Health Data Book. Death County and Crude and Violence Prevention. (2020). 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(2020). Re- Retrieved from http://www.globalhealth.gov/glob- trieved from httip://www.shiftnc.org/data p://www.shiftnc.ora/data 80 North Carolina Department of Health and Human 92 Infant Mortality Rate. (2019). North Carolina Violent Services. Frequently Asked Questions about COVID-19. Death Reporting System. (2019, October). Retrieved (2020). Retrieved from httr)s://www.ncdhhs.gov/ from https://www.inouryfreenc.ncdhhs.gov/DataSur- covid-19/fag# veillance/VDRS/FINAL-2017-NCVDRS-AnnualRe- port-5NOV2019.pdf $'NCD3: North Carolina Disease Data Dashboard. Com- municable Disease Statistics. (2020) Retrieved from httr)s://public.tableau.com/profile/nc.cdb#!/vizhome/ 2019 COMMUNITY HEALTH ASSESSMENT 87 93 Healthy North Carolina 2030: A Path Toward Health. (2020). Retrieved from htto://nciom.org/wp-content/ uploads/2020/01/HNC-REPORT-FINAL-Spread2.pdf 94 Office of Disease Prevention. Early and Middle Child- hood. (2020). Retrieved from httr)s://www.healthypeo- r)le.gov/2020/topics-objectives/topic/early-and-mid- dle-childhood 91 Office of Disease Prevention. Environmental Health. (2020). Retrieved from https://www.healthvpeor)le. gov/2020/topics-objectives/topic/environmental-health 96 NCDHHS, Children's Environmental Health Branch, Data https://ehs.ncr)ublichealth.com/hhccehb/cehu/ lead/data.htm 88 2019 COMMUNITY HEALTH ASSESSMENT Healthy • Carolinians ORANGE COUNTY of Orange ORANGE COUNTY NORTH CAROLINA County HEALTH DEPARTMENT Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 27, 2020 Agenda Item Subject: BOH Strategic Plan Discussion Attachment(s): Top Ten Priorities Handout Staff or Board Member Reporting: Beverly Scurry Purpose: X Action Information only Information with possible action Summary Information: The 2019 Community Health Assessment has been completed and the community has identified its top three priorities. The Board of Health will now undergo a process of also reviewing the top ten priorities according to the community, discuss, and choose which of the top three would be good for the BOH to address for the next four years. Please review the handout; Ashley Rawlinson will review the CHA process and outcomes beforehand, and then board members will discuss the following questions to determine their own top three priorities. 1. What do you see as the top priority? 2. Which is the most serious and why? i.e. has the biggest consequences if not addressed? 3. Which topic(s) can we reasonably affect in the next four years? 4. What does the data tell you about Equity? a. Who is at a disadvantage? b. Who benefits the most? As board members decide on which concerns will be top priorities, we encourage you all to think about how you will address the top concerns. The BOH Strategic Plan should address top priorities on a macro level of community and institutional change — public health policy, population health, advocacy, marketing and media, cultural and societal norms, and other systemic level change. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to —X—Accept as information Revise & schedule for future action Other (detail): Top Ten Community Concerns and Related Data Access to Care (28%) Physical Activity and Nutrition (16%) Food Insecurity(lack of access,at times,to enough food for an active, healthy life for Licensed Physicians per 10,000 population all household members and limited or uncertain availability of nutritionally adequate foods) • Orange County-120 • Orange County-12.7% • North Carolina-24 • North Carolina-14.6% Children Uninsured residents under age 65 • Orange County-15.5% • North Carolina-20.1% • Orange County-15.6% Recipients of SNAP Benefits • North Carolina-23% • Orange County-7.3% • North Carolina-13.7% Mental Health (11%) County Growth and Infrastructure (10%) Population Density (Although spread across the county it's not a huge increase, much of this growth has occurred in urban areas, which only represents about 13% of the land in Orange County) Older Adults on Medicaid Who Are Depressed • 2000-296 per square mile • Orange County-21.5% • 2010-336 • North Carolina-19.0% 2017-361 In the past 19 years, Orange County has grown by almost 30,000 peo- ple. Substance Abuse (8%) Health Promotion (7%) All Medication and Drug Poisoning Death Rate per 100,000 Rank Leading Cause of Death Rate per 100,000 people • Orange County-9.0 • North Carolina-24.1 Cancer—All Site 136.0 Alcohol Related Crashes 2 Diseases of the Heart 105.2 • Orange County-4.8% F'3 Cerebrovascular Disease 26.2 • North Carolina-4.0% Chronic Lower Respiratory Diseases 25.3 High School Vaping in the Last 30 Days • Orange County-13% Other Unintentional Injuries 24.1 Income and Employment (5%) Social Justice (4%) "In my community, people of all races,ethnicities, backgrounds, and beliefs are treat- Orange County Population That Lives in Poverty ed fairly." • Agreed-51% • Orange County-14.0% • Disagree-49% • North Carolina-16.1% Under Age 18 Equality:To treat everyone exactly the same.An equality emphasis often ignores historical and structural factors that benefit some social groups/communities and • Orange County-9.3% harms other social groups/communities. • North Carolina-22.9% Racial Equity:To treat everyone fairly.An equity emphasis seeks to render justice by Unem deeply considering structural factors that benefit some social groups/communities and harms other social groups/communities.Sometimes justice demands,for the pur- • Orange County-5.2% pose of equity,an unequal response. • North Carolina-7.2% Racism: Racism is different from racial prejudice, hatred,or discrimination. Racism involves one group having the power to carry out systematic discrimination through the major institutions of society. Racism is a system. Housing (4%) Environmental Health (4%) Of the residents in Orange County who rent,48.4%pay more than 30%of their in- come on towards rent. A family would need to make$18.26 per hour or an annual salary of$37,980 in order to afford Fair Market Rent for a 2 bedroom apartment that costs$1,055 per month. Some of the concerns brought up regarding environmental health were • Climate change This is considered rent burdened. For low-income families(family income under 200 percent of federal poverty threshold),who are more likely than more affluent fami- • Waste and pollution,especially in neighborhoods lies to rent than own housing and have fewer resources available to devote to rent, the experience of rent burden is particularly acute. Renters may have to make deci- sions about how to manage the rest of their money once the rent is paid and some- . Air quality times things like food, medication,and healthcare is comprised in order to keep a roof over your head. Rent-burdened households have higher eviction rates, increased financial fragility,and wider use of social safety net programs,compared with other renters and homeowners. * The percentage by the headings indicate the percentage of survey respondents who indicated the topic in their top three concerns* Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 27, 2020 Agenda Item Subject: BOH Vice-Chair Discussion election Attachment(s): Staff or Board Member Reporting: Jessica Frega Purpose: Action Information only _XInformation with possible action Summary Information: The Board of Health will discuss finding a Pharmacist representative for appointment by the Board of County Commissioners and appointing a replacement Vice-Chair. Background: The new representative will fill the seat vacated by Jennifer Deyo. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to _X_Accept as information Revise & schedule for future action Other (detail): Health Director's Report May 2020 • April 29th and May 15th—Meeting with the Courthouse to discuss safe re-open of Courts on June 1st. Deputy County Manager, Travis Myren, AMS Director, Steve Arndt and myself discussed physical distancing, needed PPE and cleaning needs for the Courthouse during the COVID-19 Pandemic. • May I"—Jill Moore, MPH, JD at UNC School of Government hosted a very informative session for local health departments, "Disclosing COVID-19 Information to the Public."This answered many of our questions in the department. • May 141h—I attended the State Health Coordinating Council, Long-term Behavioral Health Committee Meeting (Virtual). • May 181h—Meeting with UNC Mobile Testing Unit to discuss a testing event in Northern Orange. • May 201h—Victoria Hudson, EH Director and I spoke to the Chapel Hill Chamber on "Safe Operation, Regulation and Health Inspections during COVID-19. • May 2 1"—NC Association of Local Health Directors Meeting (Virtual) • The Department continues to host weekly meetings (each Tuesday) with congregate living facilities facilitated by our Medical Director, Dr. Pettigrew. • I continue to participate in weekly MAC/Policy Group calls to give updates on COVID-19 and discuss potential policy needs. • OCHD will partner with OWASA and NC State to participate in a study to test wastewater samples for COVID-19. NC DHHS is also involved with this study via the NC Policy Collaboratory. OWASA will provide NC State wastewater samples twice a week. For more information about this important work,please see "An Exercise in Tracking Coronavirus in Wastewater..."here: https:Hcollaboratory.unc.edu/current-projects/covid-19-research/ Upcoming Events • Dr. Michael Day is retiring as the OCHD Dental Clinic Director, effective June 1, 2020. Dr. Day has been a true public health advocate for dental for many years in multiple counties in NC. His commitment to dental health and his passion for public health will be missed. Please join me in wishing Dr. Day well in Retirement! Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 27, 2020 Agenda Item Subject: Mask/Cloth Facial Coverings Attachment(s): Staff or Board Member Reporting: Jessica Frega Purpose: Action X Information only Information with possible action Summary Information: Jessica Frega will lead a discussion on mask/cloth facial coverings as a result of responding to a community member's concern. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to _X_Accept as information Revise & schedule for future action Other (detail): Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 27, 2020 Agenda Item Subject: COVID-19 Update Attachment(s): Staff or Board Member Reporting: Quintana Stewart Purpose: Action X Information only Information with possible action Summary Information: Quintana Stewart will give an update on COVID-19 status in Orange County. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to _X_Accept as information Revise & schedule for future action Other (detail): Data shows African Americans might be more affected by COVID-19 than other groups-The Daily Tar Heel 41 020,9.07PM ata shows African America[Asd%& o might be more affected by COVID- 1 than other groups North Ca roiina 4 o of Confimed CQ ID-19 °lo Of N.C. Population Cases in N.C. No, thank you RawEt wotyr i Black or African Arne. 20 Other white Race/EthrncKy.. Black or African American %Of Confvny@d COVIp-19 NC Cusp,- 39.10 - 720 55 DD 70 j50 5 94 Close SHARE BY AMINA 1AA11 AND BRITTANY MCGEE Orange County government officials requested demographic data analyzing SHARE COVID-19 patients in the county after data was released at the state and national level showing African Americans may be disproportionately affected TWEET by COVID-19. MLAIL The U.S. Centers for Disease Control and Prevention released a report on April 8 that found 89.3 percent of the hospitalized patients included in the PRINT study had underlying conditions, and the most common conditions included high blood pressure, obesity, diabetes and heart disease.Approximately 33 percent of the hospitalized patients included in the study were African American. https://www.dailytarheel.com/article/2020/04/covid-racial-impact[5/15/20, 11:04:53 AM] Data shows African Americans might be more affected by COVID-19 than other groups-The Daily Tar Heel "We do know that communities of color will bear a disproportionate burden of this virus in the long term," said Kristin Prelipp, communications manager at the Orange County Health Department. We've talked a lot about COVID-19, and now we want to hear from you. If you have a tip, question or just want to share your experience, leave us a voicemail at (919) 391-4895. Prelipp said minorities are more likely to be employed as essential employees, which would leave them more open to exposure to coronavirus. She said these communities experience disproportionate rates of chronic disease like high blood pressure, diabetes and asthma that puts individuals at high risk of severe illness after developing COVID-19. "We cannot refer to these high rates of chronic disease without mentioning that African American communities also typically experience poverty, food deserts, gentrification, red-lining and environmental and systemic institutional racism at higher rates as well," Prelipp said. EDITORS PICKS 'Like a superhero': UNC System interim Farewell column: Here's to Remembering UNC student president expects campuses the unexpected Patrick Luc Nixon to reopen in the fall Data released by the N.C. Department of Health and Human Services shows African Americans make up 38 percent of both the number of cases and deaths from COVID-19 in the state. Comparatively, African Americans make up about 22 percent of the population in North Carolina, according to data from the United States Census Bureau. Renee Price, vice-chairperson of the Orange County Board of Commissioners, said she had a conversation with Carrboro Town Council Member Barbara Foushee about how COVID-19 has affected African Americans nationwide. Price said during the conversation, they realized they did not have any information about what was happening locally in Orange County. "After that phone call, I drafted a letter and sent it to our elected officials here in Orange County that are African American or Asian American," Price said. https://www.dailytarheel.com/article/2020/04/covid-racial-impact[5/15/20, 11:04:53 AM] Data shows African Americans might be more affected by COVID-19 than other groups-The Daily Tar Heel She said the other officials signed on to the letter, and she was pleased to receive a quick response from Quintana Stewart, the Orange County health director. The Orange County Health Department released demographic information on April 13, but said 30-40 percent of confirmed cases in the county are missing demographic information, and the data should not be used at this time to make any generalizations about who may or may not have higher rates of infection. Prelipp said testing capability has been limited, so the confirmed cases referenced in the study represent only part of all cases in the community. Thirty-seven percent of COVID-19 cases in the county were African Americans and 54 percent were white, according to the data released by the health department. Prelipp said the total number of cases in Orange County is small compared to other counties, such as Wake or Durham. However, she said the discrepancy in the data means they cannot definitively say one racial group fares worse than the other. Allison De Marco, advanced research scientist at Frank Porter Graham Child Development Institute whose research focuses in part on poverty and racial equity, said in an email that systems in the United States have resulted in long-term inequities for populations of color. "Orange County is just a microcosm of what we see everywhere in terms of lack of or disinvestment in communities of color, like the lack of sewer and water in the historically Black community of Rogers Road, siting of environmental hazards, like the long-time landfill in Rogers Road and the industrial land uses near the Lincoln Park neighborhood in Carrboro," De Marco said. De Marco said community engagement on behalf of leadership is critical and involves making sure all voices can be heard and prioritizing those closest to an issue. She said the long-term efforts needed would be to take the fight to the root causes of racial inequities. At the local level Carrboro, Chapel Hill and the Orange County Health Department have all become members of the Government Alliance on Race and Equity. De Marco said this provides them with an organizational assessment, ongoing training and an action plan to work from. Prelipp said the Orange County Health Department is working with several community partners to get a better sense of what is being said and done in the African American community and other communities of color related to COVID-19. "In this time, we want to lean on those working and living in the community to help push out messages, to help share information on social media, to call up people they know, etc," she said. https://www.dailytarheel.com/article/2020/04/covid-racial-impact[5/15/20, 11:04:53 AM] YOUR DAILY LOCAL NEWS SOURCE CHAPELBOROXOM _.maRll 97.9 THE HILL luuu-- Coronavirus Deaths Continue in Orange County Long- term Care Facilities; State Reports 28 Posted by Brighton McConnell I May 6,2020 1 COVID-19,Health From:https://chapelboro.com/news/coronavirus-covid-19/coronavirus-deaths-continue-in-orange-county-long-term-care-facilities- state-reports-28 f' SUMMER C MPS 252 bO CLICK HERE FOR LIST OF FEATURED CHAPEL HILL AREA / 4 The PruittHEALTH D Carolina Point and Signature HealthCARE nursing homes,two of the largest outbreak locations of COVID-19 in Orange County,continue to see more deaths from the virus. Updated coronavirus case counts from the North Carolina Department of Health and Human Services show the two congregate living facilities report 165 total cases among residents and staff,with 28 total deaths.As of Friday, May 1,PruittHEALTH is reporting the cases are largely among residents of the facility,with a total of 84 compared to 25 staff cases.Signature HealthCARE is reporting a similar ratio,with 48 resident cases compared to eight staff cases. Neither nursing home is reporting any deaths to be from staff members:PruittHEALTH reports 16 residents have died from the virus and Signature HealthCARE is reporting 12. These numbers show a slight increase in cases since the state began reporting individual case numbers for long- term care facilities on April 28.At that time,the facilities were reporting 160 combined cases,with 108 coming from PruittHEALTH and 52 coming from Signature HealthCARE. Residents may noticed an difference in deaths reported at these facilities compared to reported deaths in the county.On Tuesday,Orange County reported only 18 deaths of county residents. According to Orange County Health Department Communications Manager Kristen Prelipp,thatbs because not all residents of the nursing homes are residents of Orange County. OThis was set up before the pandemic,itbs just how we track diseases in our state,b she told 97.9 The HillOs Aaron Keck.Off someone happened to be staying at a long-term care facility and unfortunately passed away but are actually a resident of another county in North Carolina,the death is counted toward the tally for their county.0 PruittHEALTH D Carolina Point is located on Mt.Sinai Road on the Durham-Orange county line,while Signature HealthCARE is located off East Franklin Street in Chapel Hill. To view the full list of congregate living facilities experiencing COVID-19 cases,visit the NCDHHS website. Chopelboro.com does not charge subscription fees.You can support local journalism and our mission to serve the community.Contribute today D every single dollar matters. Related Alamance County reports three COVID-19 deaths-News-The Times-News-Burlington,NC ObItuares e-Edfion . ••s Homes Gassifleds • •' thetimesnewsjo Times-Newu From: https://www.thetimesnews.com/news/20200506/alamance-county-reports-three- covid-19-deaths Alamance County reports three COVID-19 deaths +i P https://www.thetimesnews.com/news/20200506/alamance-county-reports-three-covid-l9-deaths[5/13/20,5:37:58 PM] Alamance County reports three COVID-19 deaths-News-The Times-News-Burlington,NC r 1 r 1 _ 1 1 Elizabeth Pattman @EPattmanTN Alamance County has reported three COVID-19 related deaths as case counts continue to climb in the triple digits. The first COVID-19 death was reported by the county Health Department on April 23, with the second and third deaths following on May 1 and 5. Public Health Director Stacie Saunders said all three deaths have been in individuals older than 65 with underlying health conditions.All three were receiving care at the hospital at the time of death. No further information can be released about the individuals because of privacy laws. As of Wednesday, May 6, the county had 134 positive cases of COVID-19, with 71 of those individuals recovered and released from isolation. Sixty people — about 44 percent of the total case count — https://www.thetimesnews.com/news/20200506/alamance-county-reports-three-covid-l9-deaths[5/13/20,5:37:58 PM] Alamance County reports three COVID-19 deaths-News-The Times-News-Burlington,NC remained actively sick Wednesday, with five people receiving care at the hospital. The county topped ioo cases one week ago, April 3o, and the case count has continued growing. Last weekend, May 1 through 3, saw the highest numbers of actively sick individuals thus far, with 62 people sick Friday and Saturday, and 64 sick Sunday. Neighboring counties are also seeing increasing case counts. Guilford County reported 507 cases Wednesday with 35 deaths. Orange County reported 230 cases with 20 deaths. Chatham County reported 412 cases with 11 deaths. Caswell County reported 36 cases and no deaths. Statewide, 12,758 people have tested positive for the virus, with 477 deaths reported. As of Wednesday, 164,482 tests had been completed in North Carolina. The state will begin to gradually reopen beginning this Friday, May 8 at 5 p.m. Governor Roy Cooper has laid out a three-phase plan to slowly reopen, but it will take at least six to nine weeks, and plans are subject to change based on public health and safety needs. storyNever miss a Choose the pan that's right for you. Digital access or•• . and • dekery, Sign up for daily https://www.thetimesnews.com/news/20200506/alamance-county-reports-three-covid-l9-deaths[5/13/20,5:37:58 PM] reportsAlamance County 1 ' Burlington, KtHUtK JtKVIGtJ HuvtKi i�ING Support focal Businesses Advertise Wlth Us My Prof le Place an Ad Subscribe legal Notices Subscriber Services Pay Your Ad Bill Contact Us Mobile-Friendly Account Management NEWS NIE ePaper Contests ©Gannett Co., Inc, 2020, All rights reserved, Original content available for non-commercial use under a Creative Commons license, except where noted,❑ The Tmes-News � 707 S Main St, Buriington, NC 27215 � Privacy Policy �Terms Of Service �Your California Privacy Rights/Privacy Policy Gannett USA TODAY NETWORK WRALIMNews Coronavirus WeadwWrts Business Opinion AOL Local State NCCapitol Politifact Education Traffic Investigations Nation world k i-mi I1LUL& bdJU it I d MAd LU1 I it 11U W VU J�dl 1 LUI i i LI 1i� ad -LrUI IU J<U 11 is Pu jur i iC U 1 Lilt;: Vt:b Y best memories ever." A From: https://www.wral.com/coronavirus/coronavirus-in-nc-live-updates-for-may-6-2020-north-carolina-reaches-500- dead-from-covid-19/19086377/ The group will live-stream "The Pi lgri m's Progress," with showings starting at 8:45 p.m. in ea ch time zo ne and has set up an on I i n e po rta I fo r fa mil ies to sha re their pictures and campfire video clips in real-time with other families in isolation across America. 7 p.m.. Orange County's stay-at-home order will end on Friday, meaning the county will follow the first stage of Goer. Roy Cooper's three-phase plan to relax restrictions to start resuming business and social activities during the pandemic, officials said. The state of emergency for Orange Cau nty, Ca rrbaro, Chapel H ill, a nd Hillsborough will be extended. "Strict measures have been In place over the last sIxweeks to slow the spread of the virus COVID-19 and to protect the public. We will continue to make decisions based on science and recommendations from the state, as well as the Orange County health director, county Beard of Commissioners Chairwoman Ferny Rich said in a statement. County and municipal offices won't reopen to the public in the first phase, officials said. Timelines for reo pen i ng wi I I be announced at a later date. 12:50 p.rrr.. Durham Mayor Steve Schewel and Were dy ja co bs, chairwoman of the Durham County Board of Commissioners, have created the Durham Recovery and Renewal Task Force to advise them over the nest 100 days on how to reprise emergency declarations and stay-at-home orders during the COVID-19 crisis. "Durham has done a great job reducing the spread of the virus," Schewel said in a statement. ''We must continue to do that even as we plan for how Durham will recover, renew a nd re-emerge. The task force will tel I us how to kee p ou r community safe as we gradually and carefully reopen." Katie Galbraith, president of Duke Regional Hospital, and Maticia Sims, vice president and corporate controller for Blue Cross Blue Shield of North Carolina, will co-chair the task force. „The task force will engage our community broadly in this important planning effort. This will include a strong commitment to racial equity and to culturally responsive fra mewo rk,s that seek to add ress widen i ng d is parities caused by COD-1 9+"Ja co bs said in a statement. 72:05 p.m.: Bla den Cou my has re parted its f rst coronavi rus-related death. The individual died Tuesday while hospitalized, officials said. 72 p.m.: An employee at Harris Teeter in the North Pointe shopping center its Durham has tested positive for the coronavirus. A spokesperson from, the location � .;�, ��. . �.�n�� r� ■�, ,n� n■■ ,_.�;�s�:s� s�� ,is_.�;�� �..s,s�....s, _ems.. Is���..�� s��„� CORONAVI RUS Coronavirus cases climb, but some enjoy NC's looser resarictions at stores and parks BY JOSH SHAFFER AND VIRGINIA BRIDGES MAY O� 20201124AM. UPDATED MAY 09 2020 06_34 PM 411 1 FEWER GRAVES IF Z REOPEN IN WAVE . iqiiiq Protesters with ReOpenNC marched through downtown Raleigh, N.C. again on Tuesday, May 12, 2020, in opposition to Gov. Roy Cooper and the COVID-99stay a th a me orders. BYJULIAWALL 0 Listen to this article now From: https:llwww.heraldsun.com/news/coronavirus/ 04:57 Powered by Trinity Audio articIe242619276.htmI RALEI GH Coronavirus cases in North Carolina rose by nearly Soo cases Saturday,adding another 17 deaths to the state's fatality count on the first full day of gradual reopening. The state also reported.deaths at nursing homes had climbed to 277 people, more than half of total deaths. The highest number of fatalities as of Friday evening came from Pruitt Health Carolina Point in Orange County, which has now recorded zo deaths. Gov. Roy Cooper relaxed his stayat-home order starting Friday evening, opening state parks and allowing more businesses to take customers. Some shoppers were taking advantage of having more choice in retail destinations. At Vaguely Reminiscent, which sells women's clothing, jewelry and quirky gifts in a boo-square- foot store on Durham's Ninth Street, the sign in front said "Yes, We are Openl" The sign also said that only four customers would be allowed in the stare a atime, and that masks and social distancing are required. As customers walked in, they were asked to use the hand sanitizer in a bottle by the door. Around ss a.m. the store was empty except for the owner and an employee. The store had closed the moment Durham's separate stay-at-home order went into effect, at 6 p.m. on March 26. It metered to the public from P.m to 7pIn. on Friday and resumed regular hours on Saturday. "It was busier thanI thought it would be," said owner Carol Anderson about the traffic Friday night. People followed the rules, she said. "Everybody was in a good mood," she said. "Everybody seemed delighted to be out" A few miles away, at the multi-level and spacious Morgan Imports, which sells clothing, famiture, gifts and more, about in customers and employees wandered in the stare on Saturday around noun. Morgan Imports also had signs asking customers to wear masks, social distance and use hand sanitizer before entering. Customers and employees remained at least in feet apart as they shopped and waited to check out. All wore masks. In Raleigh, the parking lot at Logan's Garden Shop was full, even though the store had been open under the state's Previous, stricter stay-at-home order. Most employees and shoppers had their faces covered. Checkout went smoothly even in the packed store. Hikers and bikers returned to Wiliam B. Dmstead State Park for the first time in more than a month, most keeping 6 feet apart. "Everything has been closed, so it's been frustrating finding things to do," said Neil Demme of Cary, who rode in miles. "It's just good to be out. Last week I was seeing if Phase One was going to happen. I just kept going to the Dmstead website just making sure they would be on track to open. Got up here around 9:7o a.m." FORMER INMATES PROTEST Statewide, 7h9 of the deaths from COVID-h9 come from nursing homes or residential health centers while another hq have struck prisons. About 20former inmates protested Saturday outside the NC Correctional Institution for Women, where Faye Brown, a 67-year-old inmate died Wednesday dcomolications fmm COVID-ro Many ware shirts in support of Brown, their friend: "Faye Finally Free." . l I rp r, A small group af farmer inmates and supporters from the N.C. Correctional Insdtudan for Women gathered across the street from the facility to protest prison conditions on Saturday,May 9,2020. Theirfnend,67 yearald Faye Brown,died there Wednesday, MW6af COVID-19 complications. They have argued for early release of mnvident offeMers and those within two years of finishing their sameness to prevent the spread &the virus citing personal knowledge of the conditions that make social distancing impossibk. Julia Wall iwnuaaNEWvWs[xv[a.cau They argued for early release for nonviolent offenders and those within two years of the end of their sentences to keep the virus from spreading, and they cited personal knowledge ofconditions inside that make social distance impossible. "We used to sleep a to 3 feet apart from each other, and in the day mom," said Imam Sudderth. "If one person coughs in dorm E, everybody has it." The protesters said they are in centact with current inmates who say they continue to work in unsafo conditions and comply out of far of reprisal. They cited shortages of PPE, mr personal protective equipment, among staff. "We know they don't have any kind of health care," said Christy Wells. "It don't matter if they have a temperature of soo degrees. They have to go to work mr they're going to get written up. This is so they know we haven't forgotten them." COUNT OF CASES, DEATHS The state Department of Health and Human Services reportedr ,36o confirmed cases ofCOV[D- r9, 1117492 from Friday's total. Fatalities jumped to 5 statewide, 86% of them among patients olderthan65. Officials have warned that higher daily case totals could be coming in part from an increase in testing. But the state has also cautioned that the real total is likely higher because noteveryone with the virus has been tested. So far, North Carolina has conducted 186,362tests, up more than 7,000 from Friday. Of infected patients, 513 were hospitalized statewide, down two from Friday. Nearly all of North Carolina's roo counties have daemon positive test Results fir COWD-r9. Only sparsely populated Avery County on the Tennessee border remains without any reported cases. More than two-thirds of the state's roo counties nmv have a death from mmnavims. DHHS updated that total to 71 Saturday. The News & Observer is keeping aseparate count ofCOWD-r9 cases based on reports from DHHS and county health departments, which tends to be higher because the state updates its total once a day.As of Saturday, that tally stood at 4,479 cases and 551 deaths. H writers Jrmarhon M.A/erandev an0 Brwke Can confribrted NC CONONAVINUS GASES Numaper of oriental comnervir es by county in reported by NC number of people who have masevensal aftertesting ixartive am net available. N a all careves of COVID-19 are done net repervivermthetiotal number of Remedial havat or had the virus. 47 31 5' is m Q. 914 at In : ioo �1 in 3 r19 IRS as Its 11K IQ � Me rzss Is :, 77 MM9 � m9es 1 S9 too 117 0 zanmrsv s000rmo,e Small Business Spotlght:MealSmith I Business I mebaneenterprise.com From:http://www.mebaneenterprise.com/business/article_cb4e6686-93b0-1 1 ea-9e83-c76eeb3eca91.html Small Business Spotlght: MealSmith By Adam Powell Enterprise Editor May 11, 2020 Updated May 11, 2020 r � f r V ` The coronavirus pandemic has been an extraordinarily difficult time for people worldwide throughout recent months, and particularly local business and food service providers. For the husband and wife team of Jessica Smith and Tyceson Mills of MealSmith, providers of locally-sourced meals based in Alamance, Orange, and Chatham Counties,the situation has required them, like most local food service professionals,to make numerous transitions. http://www.mebaneenterprise.com/business/article_cb4e6686-93b0-Ilea-9e83-c76eeb3eca9l.html[5/13/20, 1:16:54 PM] Small Business Spotlght:MealSmith I Business I mebaneenterprise.com The coronavirus pandemic has been an extraordinarily difficult time for people worldwide throughout recent months, and particularly local business and food service providers. For the husband and wife team of Jessica Smith and Tyceson Mills of MealSmith, providers of locally-sourced meals based in Alamance, Orange, and Chatham Counties, the situation has required them, like most local food service professionals, to make numerous transitions. We learned to pivot, said Smith in an interview with the Enterprise. Initially, we had great plans for April and May that we had to cancel, revise, or move around. Starting in March we have been in nearly daily contact with our suppliers while making changes to our website and our business model. Happily, we are learning we can do it - one day, one week, or one month at a time. We also are continuing with a pick-up option both in Mebane and Hillsborough and have reverted back to our delivery model offering a contactless option. Fortunately for MealSmith - as has been the case with many local restaurants and food-related businesses - they have managed to stay in good shape as far as supplies. MealSmith sources much of its food from local vendors, who have worked together in an effort to mutually sustain. Even before this crisis, we passionately practiced sourcing locally, hence the majority of our ingredients are from local vendors,0 Smith explained. OWe purchase our meats, our farm fresh eggs, and our dairy products from Kenyon's Market in Mebane. In addition, within the past year, we have become guest vendors with the Eno River Farmer's Market because many of the farmer-members are our vendors. We have come to know each of them as close associates and friends. They know we respect the care they put into their product and in turn, they respect us and our business.O The frustrating thing for a relatively new and growing business like MealSmith is that they were ready to take off, having been booked through the spring for the wide range of events that take place in normal times in April and May. But although things have come to a brief halt, they have still found ways to service their customers by innovating and staying active. Although referrals were fl and still are fl a mainstay, tough times call for pulling out all the stops,0 Smith said. OLuckily, last fall we added catering, and in no time, we were fully booked through April and May with graduations, birthdays, receptions, and conferences, Then came Coronavirus-19 and we were back to pivoting. Smith added that they have included Family Size Meals, which has been very well received. http://www.mebaneenterprise.com/business/article_cb4e6686-93b0-Ilea-9e83-c76eeb3eca9l.html[5/13/20, 1:16:54 PM] Small Business Spotlght:MealSmith I Business I mebaneenterprise.com We had excellent results with a special Easter Menu, serving up well over 150 dinners,0 she said. OWe are projecting similar success for Mother0s Day. We are also onboard with social media fl specifically Facebook and Instagram, where our followers find plenty of appetizing information on a daily basis. We also just started publishing an online monthly newsletter which always contains a coupon code.0 Throughout May, MealSmith is offering its Family Size Meals, along with smaller types of meals for gatherings. Catering will continue to play an important role in what we offer our customers. But even catering will take on a new look with Osmall biteO offerings at least for the remainder of the month. As this crisis subsides, we realize people will opt for smaller Oat homeO gatherings. We deliver to all of Orange County, Mebane and have recently addedJess0s hometown of Pittsboro. As with most all local businesses, MealSmith has received a wide range of assistance from various sources as they0ve been managing through these unprecedented times. In turn, they have been trying to pay at forward as much as possible themselves, assisting with a local emergency shelter and providing meals to essential workers. We believe success needs to be shared, probably now more than ever. Mebane and Orange County continue to lend support to us, making it easy for us to provide exquisite meals to frontline/essential workers, small businesses (still operational), families in need, and out of work food service workers. Partnering with a local Ofoodie0 group, we are able to donate to the InterFaith Council Family House, an emergency shelter for women and children. Downtown businesses rally support, purchasing from each other, helping with marketing, and even providing cooler space when needed. There is virtually no area that our local businesses have not stepped up and assisted, helping each other every day. The business owners in this area are a blessing.0 Kenyon's Meat Market is a new pickup location in Mebane for MealSmith, conveniently off of Interstate 85/40 and N.C. Highway 119. Pickups are available Fridays and Saturdays 12:00 p.m. to 6:00 p.m.. In addition to deliveries in Orange County, (including Hurdle Mills, Efland, and Cedar Grove) and all of Mebane. We are happy to announce that we are offering delivery in Pittsboro, on Friday evenings from 3:00 p.m. to 7:00 p.m.. Our products are designed and prepared in a state-of-the-art Commissary Kitchen in Hillsborough. We are immensely proud of continually maintaining our 100.00 (A) sanitation score with the North Carolina/Orange County Department of Health and Human Services,0 Smith stated. http://www.mebaneenterprise.com/business/article_cb4e6686-93bO-Ilea-9e83-c76eeb3eca9l.html[5/13/20, 1:16:54 PM] Small Business Spotlght:MealSmith I Business I mebaneenterprise.com OWe hope our customers realize every single order means the world to us. We believe we are part of the American Dream, giving us the chance to take our passion for fine locally sourced food and our travels to inspire global food trends and bring it to the marketplace. We have also added Kenyon0s Market as a second pick up location. Look for us soon, we hope, at the Eno River Market in Downtown Hillsborough. We plan to be there once a month starting in June for pickups.0 CLICK HERE! Keeping , Our Reader 6 Yo& Nmd M Most Popular Articles • Mebane Police,Alamance Sheriffs in officer-involved shooting • Mebane Man Charged With Three Felony Counts Sexual Exploitation of a Minor • Local money dispute leads to firearms charges • Woodlawn students earn honors in statewide history competition • ABBOs Mebane expansion continues to progress • ON THE FRONT LINES:ACC Nursing Alumna Says OItOs What We Do0 • Small Business Spotlght: MealSmith • Felony Charges Against local Man After Non-Fatal Overdose • On the Front Lines:ACC Alumnus Manages 25 Biomedical Technicians • Op-Ed: Loss is Gain for North Carolina0s High School Seniors http://www.mebaneenterprise.com/business/article_cb4e6686-93bO-Ilea-9e83-c76eeb3eca9l.html[5/13/20, 1:16:54 PM] Small Business •1tlght:MealSmith I Business I mebaneenterprise.com Lit AS StocksON HGTV Market Data by TradingMew Sections Services ■ ■ About Us ■ News Contact Us ■ Sports Personnel ■ Education Rack Locations ■ Business ■ Advertise ■ Opinion ■ Subscriber Services ■ Obituaries ■ Submission Forms ■ Videos mebaneenterprise.com ■ Photos 106 N. 4th St. Mebane, NC 27302 Phone: (919) 563-3555 Email: mebaneenterpriseeditor@yahoo.com ■ ©Copyright 2020 mebaneenterprise.com,106 N.4th St.Mebane,NC � Terms of Use � Privacy Policy Powered by BLOX Content Management System from TownNews.ci Coronavirus NC:North Carolina's COVID-19 data impressive,but still incomplete compared to other states-ABC I Raleigh-Durham of menu 11C WATCH VIDEOS CORONAVIRUS North Carolina's COVID- 19 data impressive, but incomplete compared to other states By Jonah Kaplan and Samantha Kummerer SHARE TWEET EMAIL From: hops://abcll.com/health/nc-lawmakers-push-for-more-covid-19-data-from-dhhs/6176342/ RALEIGH, N.C. (WTVD) -- North Carolina's COVID- 19 Dashboard is a lesson in real-life arithmetic, but some lawmakers and us journalists continue to push state officials to release more data related to the pandemic. "The more information out there the better," House Speaker Tim Moore (R-Cleveland County) said. "If you just keep that data stored away on some shelf in some office at Health and Human Services in Raleigh, and you 're not getting it out to the media or out to the citizens, then it's not doing anybody any good." Indeed, tackling the COVID-19 pandemic has varied across state lines, including decisions on the extent of Stay-At-Home orders, how to expand testing and when https://abcI I.com/health/nc-lawmakers-push-for-more-covid-I9-data-from-dhhs/6176342/[5/13/20, 1:03:42 PM] Coronavirus NC:North Carolina's COVID-19 data impressive,but still incomplete compared to other states-ABC I Raleigh-Durham to ease restrictions and reignite the economy. It should be little surprise, then, that an ABC11 I-Team investigation finds variances in the information states are either unable or unwilling to share regarding the novel coronavirus. "We have been frustrated that we haven't seen as much robust and deep data when it comes to a county-by- county,basis," Moore said. "Getting that information out there I think is very, very helpful because there is a lot of fear out there, there is a lot of uncertainty about what this means." COVID-19 demographic information, cases by zip codes and names of congregate care facilities have been the top requests sought by states across the country. CORONAVIRUS MAP: Tracking COVID-ig across North Carolina In recent weeks, North Carolina has started releasing zip code data, naming affected nursing homes and releasing statistics on recovered cases. The Tar Heel State, however, still lags behind in transparency for some data, including cumulative hospitalization numbers, testing data by county, demographic of cases at the county level, the number of pending tests and the name of meat-processing plants with COVID-19 outbreaks. Virginia, by contrast, breaks down hospitalizations by race and by zip code and also tracks outbreaks connected to educational settings. Georgia, meanwhile, tracks correctional facility cases by staff versus inmates and also reports hospitalizations at the county level. https://abcI I.com/health/nc-lawmakers-push-for-more-covid-I9-data-from-dhhs/6176342/[5/13/20, 1:03:42 PM] Coronavirus NC:North Carolina's COVID-19 data impressive,but still incomplete compared to other states-ABC11 Raleigh-Durham "Each state has its own data infrastructure which includes both state as well as local data and pre- existing surveillance systems," a spokesperson for NCDHHS said. "NCDHHS is also posting data which many of our neighboring states aren't posting, including information about current PPE, proportion of North Carolinians who have a risk factor for a serious illness from COVID by age and race/ethnicity, and COVID cases and deaths with underlying health conditions by age." While the state does update its dashboard daily, individual county health departments are also releasing county-specific information every day and meeting different standards of transparency. Counties like Cumberland, Orange and Johnston do report demographics of their reported cases--localized data the state does not report--but there isn't any consistency or law that mandates county health departments disclose this information and many don't. ABCii filed official public information requests with Wake and Durham counties for racial data on COVID-19 cases, but the counties have yet to respond. RELATED: The Racial Divide: How minorities are disproportionately affected by the COVID- i9 pandemic in NC Lenoir, Sampson and Cherokee counties, moreover, include how many total residents have been tested in their daily press releases, but Hoke and Lee counties said to find the number you would need to contact every test provider since private providers only are required to report positive numbers to the local health department. https:HabcI I.com/health/nc-lawmakers-push-for-more-covid-I9-data-from-dhhs/6176342/[5/13/20, 1:03:42 PM] Coronavirus NC:North Carolina's COVID-19 data impressive,but still incomplete compared to other states-ABC I Raleigh-Durham "Because negative test reporting is not mandatory, testing is often reported in batches or in aggregate," the NCDHHS spokesperson said. "Further, most demographics are not part of a lab order form. Therefore, we do not currently report testing by demographics or the number of residents tested by county. We continue to assess how to best provide accurate data, balancing public health and patient privacy while responding to the pandemic." What can we help you with? View our COVID-ig information and resources page here Report a correction or typo RELATED TOPICS: health&fitness nc raleigh data journalism coronavirus testing coronavirus i team covid 19 pandemic SHARE TWEET EMAIL Copyright©2020 WTVD-TV. All Rights Reserved. Home Raleigh U.S. &World About ABC1 1 EYEWITNESS Weather Durham North Carolina hotvideos • • NEWS Traffic Fayetteville I-Team Watch Surrounding Area Troubleshooter CalendarPhotos Entertainment Influencers Apps Events TV Listings Jobs Follow Us: https://abcI I.com/health/nc-lawmakers-push-for-more-covid-I9-data-from-dhhs/6176342/[5/13/20, 1:03:42 PM] Coronavirus NC:North Carolina's COVID-19 data impressive,but still incomplete compared to other states-ABC I Raleigh-Durham Privacy Policy Do Not Sell My Info Children's Privacy Policy Your California Privacy Rights Terms of Use Interest-Based Ads Public Inspection File Copyright o Raleigh-Durham. Rights Reserved. https://abcl I.com/health/nc-lawmakers-push-for-more-covid-19-data-from-dhhs/6176342/[5/13/20, 1:03:42 PM] COVID Today-May 12 Pandemic politics-North Carolina Health News fly' on PruittHealth CarolinaPoint s..k'. k. A PruittHealth skilled-nursing facility in Orange County is dealing with a COVID-19 outbreak that has killed two.Photo credit: Rose Hoban From:https://www.northcaro[inahea[thnews.org/2020/05/12/covid-today-may-12/ New count shows that nearly 60 percent of NC COVID-19 fatalities are in long-term care As a state and nation focused on COVID-19 continue to argue the pros and cons of testing, mask- wearing and social distancing, older people and those with disabilities keep dying in North Carolina's long-term care centers. The state Department of Health and Human Services identified four additional skilled nursing facilities as having outbreaks of the virus since Thursday. They are Genesis Healthcare, Chatham County, four cases; Harmony Hall Nursing and Rehabilitation, Lenoir County, two cases; Wilkesboro) Health and Rehabilitation, Wilkes County, four cases; and Oak Forest Health and Rehabilitation, Forsyth County, one case. Newly reported deaths of people in nursing homes since last week, with county location, include six at Treyburn Rehab and Nursing, Durham County; six at Brian Center, Henderson County; five at https://www.northcarolinahealthnews.org/2020/05/12/covid-today-may-12/[5/13/20, 1:08:47 PM] COVID Today-May 12 Pandemic politics-North Carolina Health News Autumn Care of Cornelius, Mecklenburg County; four at Pruitt Health, Orange County; three at Five Oaks Manor, Cabarrus County; three at Springbrook Nursing and Rehab, Johnston County; and three at Rich Square Nursing and Rehabilitation, Northampton County. Licensing more -than 7,00 n In more typical times, we'd likely see headline news and detailed accounts about the presence of a new, deadly virus in four North Carolina nursing homes, let alone more than 30 deaths of older and vulnerable people in these centers in less than a week. Tuesday's release brings to 297 the total of COVID-19 deaths in state nursing homes during the pandemic, with another 46 noted as dying in adult care homes or assisted living facilities. The 343 deaths in long-term care represent nearly 60 percent of North Carolina's total death count of 577 during the pandemic. — Thomas Goldsmith Tend to your mental health, too Given that May is Mental Health Awareness Month, Mandy Cohen, secretary of the state Department of Health and Human Services, encouraged North Carolinians to take care of their minds as well as their bodies during the pandemic. "We've all done a greatjob protecting our families and neighbors and slowing the spread of COVID- 19," Cohen said. "But in taking those important steps, we've had to change the way we live significantly in ways that were just hard to imagine even just a few months ago. We've had to stay physically apart from one another, stop many of the activities that may have brought usjoy. Some of us are newly out of work and others of us have lost family members or friends to this virus." The pandemic itself, Cohen acknowledged, can prompt fear, depression and anxiety. "One way to navigate this challenging time is to find new — or in some cases — old ways to connect with other people," Cohen recommended. "Call or use video chats to connect with your friends and https://www.northcarolinahealthnews.org/2020/05/12/covid-today-may-12/[5/13/20, 1:08:47 PM] COVID Today-May 12 Pandemic politics-North Carolina Health News loved ones. Get outside. Exercise if you can." During this phase of the social distance restrictions, parks have opened again. For people who need help managing their mental health during this unprecedented time, Cohen suggested reaching out to mental health care providers, primary care physicians who might be able to offer care guidance or looking at the department's website for resources. The National Child Traumatic Stress Network offers advice for talking with children of all ages about the virus and the pandemic. Additionally, the state has helplines, such as Hope4NC at 1-855-587-3463, where around the clock call-takers can connect people to resources for mental health and resilience support. Help is also available for people and loved ones experiencing severe distress at the National Suicide Prevention Hotline at 1-800-273-8255. —Anne Blythe NC manufactures changing gears As North Carolina ramps up its testing to an average of 6,000 per day, the state also will need to keep a strong supply of personal protective equipment, or PPE. Gov. Roy Cooper praised several manufacturers in North Carolina for shifting production lines to help with that supply chain. "We've been fighting for more PPE and our manufacturing task force has identified North Carolina businesses that can help us," Cooper said. "North Carolina has a rich history of being a leader in manufacturing and in innovation." Saab Barracuda, based in Lillington, typically produces camouflage netting for the military. Apple Rock in Greensboro specializes in trade show displays. Both companies have agreed to make isolation gowns. https://www.northcarolinahealthnews.org/2020/05/12/covid-today-may-12/[5/13/20, 1:08:47 PM] COVID Today-May 12 Pandemic politics-North Carolina Health News "This is a critical piece of medical equipment that has been in short supply," Cooper said. ASI Sign age of Holly Springs, Gilero of Pittsboro and Bright View Technologies of Durham are producing face shields. "This is exactly what I mean when I say North Carolina will get through this pandemic by working together," Cooper said. "I look forward to more innovation, creativity and team spirit that has always defined our state." —Anne Blythe Coronavirus by the numbers According to NCDHHS data, as of Tuesday morning: • 577 people total in North Carolina have died of COVID-19. • 15,346 have been diagnosed with the disease. Of those, 475 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with coronavirus on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic. • 9,115 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious. • More than 202,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed COVID-19 tests is likely higher. • Most of the cases (42 percent) were in people ages 25-49. While 21 percent of the positive diagnoses were in people ages 65 and older, seniors make up 85 percent of coronavirus deaths in the state. • 110 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities. • There are 3,224 ventilators in hospitals across the state and 734 ventilators in use, notjust for coronavirus cases but also for patients with other reasons for being in the hospital. https://www.northcarolinahealthnews.org/2020/05/12/covid-today-may-12/[5/13/20, 1:08:47 PM] COVID Today-May 12 Pandemic politics-North Carolina Health News Mental health moment Museum curators around the world have been challenging each other to a #curatorbattle on Twitter during the COVID-19 pandemic. They have posted the creepiest objects in their collections with the hashtag#creepiestobjects. Warning. Many could bring on an overwhelming case of the creeps. They also have challenged each other to post#besthats, #SassiestObject and the recent#bestbird challenge from Yorkshire Museum. Yorkshire Museum @YorkshireMuseum • Apr 17, 2020 MUSEUMS ASSEMBLE! It's time for#CURATORBATTLE! Today's theme, chosen by you, is#CreepiestObject! We're kicking things off with this 3rd/4th century hair bun from the burial of a#Roman lady, still with the jet pins in place... CAN YOU BEAT IT? A Norwich Castle @ NorwichCastle @RedHeadedAli how can we ignore such a call to arms? This particular item has caused a few nightmares for our followers this week. Our #CreepiestObject is...this pincushion! Complete with tiny children's heads. You're welcome, Twitter.#CURATORBATTLE https://www.northcarolinahealthnews.org/2020/05/12/covid-today-may-12/[5/13/20, 1:08:47 PM] State WCapitol Politifact Education Traffic Investigations Nation World from: https://www.wral.com/coronavirus/coronavirus-in-nc-live-updates-for-may-12-2020/19094390/ 145 p.m.: Cumberland County Schools plans to provide the opportunity for A principals to invite graduating seniors to "walk across the stage" to receive their ............... diploma h i le following social dIstancing restrictions. The pandemic forced the cancellation of traditional graduation ceremonies this spring. "The seniors expressed how strongly they Felt about being able to walk across the stage to receive their diploma," Superintendent Marvin Connelly said in a statement. "We want to honer our seniors' request and are preparing for this opportunity." Plans' for now, call for seniors to receive their diplomas bet eenjuly 15 and July 23 at the Crown Complex. It's unclear whether family members will be a[lowed to attend or will have to watch the event streamed online. Seniors also will wear a special cord for the event. "The cord will represent the resiliency shown by our 2020 graduates as they have endured modified instruction, the loss of their senior prom and other special senior events, and now, a modified graduation ceremony," Connelly said. 3:40 p.m.: The Fayetteville Comic Con Sp ri rig Shove, scheduled for J un a 7-28r has been canceled. All tickets holders are encouraged to retain their tickets, as all tickets will be valid and honored for Fayetteville Comic Cori in the fall at the Crown Expo Center. 3 p.m.: The Orange County Health Department and the Orange County Sherriff's Office have produced a video in English and seven other languages commonly spoken In the county - Ara bic, Burmese, Ida ren, lingo ra ndar Ma nda rin, Span ish and Swahili - to educate and reassure the public during the pandemic. "Coping with the COVID-19 pa ndemic is obvi ously a n ew experience for eve ryoner and it raises anxiety," health department spokeswoman Kristin Prelipp said, "Some people express that anxiety by blaming the people they feel are responsible. Others become so anxious they hesitate to go out at all. We granted to male a short message to educate and reassure people no matter what experience they were having." 2:50 p.m.: An employee at the Whole Foods store at 5055 Arco St. in Carr has tested positive fo r the coronavi rus. Whole Foods off icia I s d i dn't say wh en th a worke r was last in the store or whether any extensive cleaning has been done since the d iagn psis,