Executive Summary
Mecklenburg County Health Department
Acting Health Director, Michelle Lancaster-Sandlin
Prepared by: Epidemiology Program
December 2013
Executive Summary
2013 Mecklenburg Community Health Assessment
INTRODUCTION
In the practice of public health practice, the community is the patient and the health of the community is
monitored and evaluated on a regular basis by examining key indicators such as infant mortality,
communicable disease rates and leading causes of death. Every four years, the Mecklenburg County Health
Department conducts a more extensive examination of community health indicators through a state developed
process known as a community health assessment (CHA). In addition to providing a picture of the community’s
health, the CHA meets requirements for state accreditation and funding. Findings from the CHA are used by
the Health Department for strategic planning and to develop or support collaborative community action
addressing identified priority issues. The Community Health Assessment includes a review of community
health indicators, a community opinion survey, a community priority setting activity and action planning on
leading priorities.
HIGHLIGHTS: MECKLENBURG COUNTY COMMUNITY DATA OVERVIEW
Leading Causes of Death
•
Cancer and cardiovascular disease are the leading causes of mortality, resulting in over 50% of deaths
in Mecklenburg County each year. However, mortality rates from cancer, heart disease and stroke have
declined steadily over the past five years. This decline may be partially due to prevention efforts but can
also be largely attributed to improved treatment.
•
As the mortality rates for cancer, heart disease and stroke have declined, death rates from Alzheimer’s
disease have remained steady, moving it ahead of stroke as the third leading cause of death during
2008-2012.
•
The 5th leading cause of death is chronic lower respiratory disease (chronic obstructive pulmonary
disease, chronic lower bronchitis and emphysema).
•
Unintentional injury is the 6th leading cause of death for the total population, the leading cause of death
for those 1-44 years of age and is among the top leading causes of death for Hispanics.
•
Diabetes is the 7th leading cause of death and a major contributor to the development of heart disease,
blindness, kidney disease and amputation. Approximately 9.5% of Mecklenburg residents report having
diabetes.
(NC SCHS Vital Records, 2014, County Data Book and BRFSS)
Health Disparities
•
Mortality rates in Mecklenburg County compare favorably with the state and the nation, especially the
rate of death from heart disease which is well below that of the US. However, while rates of death are
decreasing for most groups, not all residents experience positive outcomes equally.
•
African Americans have higher mortality rates than Whites for nearly every type of cancer. Between
2008 and 2012 in Mecklenburg County, black men died from prostate cancer at a rate 3.4 times that of
white men. African Americans also die at higher rates than Whites from heart disease, stroke and
diabetes. Between 2008 and 2012, African Americans died from diabetes at a rate 3.1 times that of
Whites.
Prepared by: Mecklenburg County Health Department (MCHD), Epidemiology Program
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Executive Summary
•
2013 Mecklenburg Community Health Assessment
Mortality rates from chronic diseases for Hispanics are lower than other groups because this population
group as a whole tends to be younger than other race and ethnic groups in Mecklenburg County.
However, nationally, data show that changes in health behaviors such as diet and exercise in some
Hispanic immigrants to the US are resulting in rising rates of chronic disease in this population.
(NC SCHS 2014 County Data Book).
Maternal, Child and Infant Health
•
In 2012, there were 13,848 births in Mecklenburg County; one out of every five babies born was to a
Hispanic mother.
•
Almost 33% of births from 2008 through 2012 were delivered by Caesarean section.
•
The infant mortality rate in Mecklenburg County has declined for the past 10 years; in 2012, it was 5.3
infant deaths per 1,000 live births, better than the state and the nation. However, between 2008 and
2012, African American infants died at a rate almost four times that of White infants.
•
Since 2000, the pregnancy rate in Mecklenburg teens ages 15-19 has decreased by 51% from 72.8 per
1,000 girls15-19 years of age to 35.9 in 2012. However, there are still more than 1,100 teen
pregnancies a year.
(NC SCHS 2014 County Data Book).
Access to Care
•
In 2012, approximately16.5% or 160,000 Mecklenburg residents were uninsured, more than the
combined populations of Cornelius, Davidson, Huntersville, Matthews, Mint Hill and Pineville; 23% of
the non-senior adult population, ages 18-64 years, in the county and 6% of the children were
uninsured.
•
Per the US Census, an estimated 37% (54,300) of uninsured Mecklenburg residents, ages 16-64 years,
work full-time jobs.
•
The number of uninsured is expected to change with implementation of the Affordable Care Act.
(US Census, American Communities Survey 2012).
Sexual Behavior
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In 2011, 50% of Mecklenburg high school students reported every having sex and 35% reported having
sexual intercourse with one or more partners in the past three months. Among those who had sex in
the past three months about 61% reported using condoms and 26% reported drinking alcohol or using
drugs before last sexual intercourse (MCHD YRBS 2011).
•
In 2011, Mecklenburg County reported 246.7 cases of Gonorrhea per 100,000 population compared to
179.9 for North Carolina (NC DPH Epidemiology STD/HIV Surveillance 2012).
Physical Activity, Nutrition and Tobacco Use
•
In 2012, approximately 20% of adults reported no physical exercise in the past month, 20% current
smoking and 81% eating less than five servings of fruits and vegetables per day; 33% of adults
reported elevated cholesterol; 28% high blood pressure and 62% overweight or obesity (NC SCHS BRFSS
2012).
Prepared by: Mecklenburg County Health Department (MCHD), Epidemiology Program
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Executive Summary
2013 Mecklenburg Community Health Assessment
Substance Abuse
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In 2011, nearly 34% of Mecklenburg high school students reported having had at least one drink of
alcohol and 16% reported binge drinking (5 or more than drinks in several hours) within the past month;
8% reported driving a car after they had been drinking. Almost 28% reported using marijuana one or
more times during their life, up from 21% reported in 2009, an increase of 33% (MCHD YRBS 2011).
Environmental Health
•
From 2002 to 2012 the Air Quality Index has fallen from 59 to 45, a 23.7% improvement in air quality.
•
As of 2011, there are 37 miles of developed greenways in Mecklenburg, up from 20 miles that were
under construction in 2007.
(MC LUESA State of the Environment Report 2012)
Violence
•
In 2011, 12% of homicides were the result of Domestic Violence. From 2005 to 2011, the percentage of
students participating in the local Youth Risk Behavior Survey (YRBS) reporting teen dating violence
increased 37% (MC CSS, Domestic Violence Statistics; MCHD YRBS 2011).
•
In 2011, 18% of high school students reported having been the victim of teasing or name calling
because of their race or ethnic background in the past month; 16% reported been electronically bullied
via methods such as email, chat rooms, instant messaging, web sites or text messaging (MCHD YRBS
2011).
Mental Health
•
In 2011, 30% of high school students surveyed reported feeling sad or hopeless almost every day for
two weeks or more in a row to the extent they stopped doing some usual activities; 15% reported
actually attempting suicide one or more times (MCHD YRBS 2011).
•
In 2012, when asked about mental health—stress, depression and problems with emotions—almost
13.7% of adults said their mental health had not been good for 8-29 days in the past month and 4.6%
for 30 days or more; 14.1% said they had been told by a healthcare provider that they had a depressive
disorder (SCHS BRFSS 2012).
RANKING PRIORITY FOCUS AREAS
In 2013, the CHA Advisory Committee reviewed the nine priority focus areas from the 2010 CHA. Examination
of the community data overview suggested that these focus areas remained of current concern and interest.
Health Disparities was retained as an element of every focus area rather than as a separate area.
During the spring of 2013, Mecklenburg County residents were encouraged to participate in a Community
Opinion Survey, either online or in hard copy, to gauge community beliefs and attitudes towards health as well
as prioritize the nine focus areas. In response, 1,888 people returned survey information. On October 25,
2013, 117 individuals representing a variety of community agencies and groups attended a formal CHA Priority
Setting meeting. Participants were asked to view a presentation on data specific to each of the nine priority
areas, discuss the issues following each presentation and then score the area from 1 (least weight) to 10 (most
weight) using the following five criteria: magnitude, severity, intervention effectiveness, public concern and
Prepared by: Mecklenburg County Health Department (MCHD), Epidemiology Program
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Executive Summary
2013 Mecklenburg Community Health Assessment
urgency. Calculated scores were then used to rank the focus areas. Weighted rankings from the two activities
were combined with the following results:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Chronic Disease and Disability
Mental Health
Access to Care
Violence
Substance Abuse
Environmental Health
Maternal Child Health
Responsible Sexual Behavior
Injury
A brief video showcasing the event is available on line at http://www.youtube.com/watch?v=xH6tXeK79vA.
RECOMMENDATIONS
As part of the process, participants of the October 25, 2013 Priority Setting meeting made recommendations
for the top four prioritized health issues. These recommendations will serve as the foundation for community
action planning that will be completed in the spring of 2014. A summary of the recommendations appears
below. A complete list of recommendations can be found in the appendices.
Preventing Chronic Disease and Disability
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Increase opportunities for physical activity through safe communities, greenways, parks and
playgrounds, physical education and recess, sidewalks and bike lanes and community connectivity.
•
Improve access to healthy foods and food choices through community and school gardens, SNAP
benefits accepted by farmer’s markets, attracting full-service grocery stores to food deserts and healthy
school lunch and vending machine choices.
•
Policies to support increased physical activity, healthy food choices and tobacco free environments in
workplaces, schools, daycare facilities and places of worship.
•
Healthcare providers focus on prevention and healthy lifestyle choices.
•
Evidence-based interventions, health education and promotion and health communication that is
age-group specific, culturally and linguistically specific and is delivered in the community.
•
Innovative partnerships between communities and schools, business and healthcare related
organizations.
•
Promote civic pride in and commitment to building a community that values health.
Mental Health
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Increase Funding/Providers/Services
o
Increase funding for mental health programs and services, numbers of beds for acute and
residential care and number of providers.
o
Increase number of providers representing varied ethnic and cultural backgrounds through
scholarships/incentives.
o
Promote school-based programs.
Prepared by: Mecklenburg County Health Department (MCHD), Epidemiology Program
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Executive Summary
2013 Mecklenburg Community Health Assessment
o
Make available free or low-cost counseling.
o
Increase education and prevention services.
•
Ensure comprehensive care including physical and mental health.
•
Work to decrease stigma associated with seeking mental health care.
•
Promote Mental Health First Aid training for mental health professionals.
•
Promote communication and collaboration among mental health providers and other
disciplines/systems such as substance abuse, the criminal justice and education systems, hospitals
and DSS.
•
Increase Awareness/Education/Information
o
Raise awareness of infant mental health, dual diagnosis and the idea that with appropriate
treatment, people can get better.
o
Develop a central repository/hub for mental health resources including more materials in
languages other than English.
•
Extend mental health training to non-mental health professionals and workplaces including law
enforcement, the school system, hospitals and DSS; consider non-traditional partners such as frontline
workers and transit staff.
•
Limit access to firearms.
Access to Care
•
Address barriers to access other than funding such as transportation, non-traditional hours,
culturally competent providers and health literacy awareness and training; improve/develop reliable
funding for free or low-cost health services; and improve communication and awareness of services
and how to access them.
Violence Prevention
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Community/Neighborhood
o
•
Schools and Other Social Service Agencies
o
•
Change norms regarding violence, it is not acceptable; develop a comprehensive plan to
address access to firearms; promote efforts that help create community bonds/help
individuals to get to know their neighbors; encourage a call to action from community and faith
groups with suggestions for what might work with their particular population; expand
community partnerships with business, police, faith community, Park and Recreation facilities
and libraries, provide culturally appropriate monitoring in unsafe areas; and increase youth
involvement by offering additional community activities and providing opportunities for
leadership
Begin violence prevention education at the pre-K level, increase after school activities to keep
kids active and engaged, expand evidence-based interventions already in place in some
schools and expand violence prevention into other social service agencies.
Professionals
o
Use violence assessment tools to ensure consistent messages and encourage healthcare
professionals to ask about safety at every encounter.
Prepared by: Mecklenburg County Health Department (MCHD), Epidemiology Program
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Executive Summary
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Child Abuse
o
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2013 Mecklenburg Community Health Assessment
Increase awareness of the importance of reporting child abuse, offer safe child care options to
parents in need and develop models for parenting education and support.
Domestic Violence (DV)
o
Increase efforts to address domestic violence (DV) including support for the DV Review
Committee, increase awareness of the Women’s Commission and their services, address
language barriers in the DV prevention field and distribute DV educational/support information in
public places.
SOURCES
Mecklenburg County (MC)
MC Community Support Services, Domestic Violence Statistics
http://charmeck.org/mecklenburg/county/CommunitySupportServices/WomensCommission/InfoEdu/Statistics/Pages/Local
Homicides.aspx [accessed November 8, 2013]
MC Health Department/Charlotte Mecklenburg Schools, YRBS Youth Risk Behavior Survey, Charlotte Mecklenburg Youth
Risk Behavior Survey 2011
http://www.cms.k12.nc.us/cmsdepartments/csh/Documents/High%20School%20Highlights%20-%202011.pdf [accessed
November 8, 2013]
MC LUESA Land Use and Environmental Services Agency, State of the Environment Report
http://charmeck.org/mecklenburg/county/LUESA/SOER/Pages/default.aspx [accessed November 8, 2013]
North Carolina State Center for Health Statistics (NC SCHS)
NC SCHS, Behavioral Risk Factor Surveillance System (BRFSS), Mecklenburg Data 2012
http://www.schs.state.nc.us/schs/brfss/2012/nc/nccr/topics.html [accessed November 8, 2013]
NC SCHS, Age-Adjusted, Race-Specific, Sex-Specific Five-Year Death Rates 2008-2012, County Data Book
http://www.schs.state.nc.us/schs/data/databook/ [accessed November 8, 2013]
NC SCHS, Cancer Incidence Rates by County and Selected Sites 2006-2010, County Data Book
http://www.schs.state.nc.us/schs/data/databook/ [accessed November 8, 2013]
NC SCHS, Pregnancy and Live Births, County Data Book http://www.schs.state.nc.us/schs/data/databook/ [accessed
November 8, 2013]
NC SCHS, Infant Mortality Racial Disparities 2008-2012 http://www.schs.state.nc.us/schs/deaths/ims/2012/table3b.html
[accessed November 8, 2013]
NC SCHS, Final Infant Death Statistics 2012 http://www.schs.state.nc.us/schs/deaths/ims/2012/2012rpt.html [accessed
November 8, 2013]
NC SCHS, Vital Records Volume 2: Leading Causes of Death 2007-2011
http://www.schs.state.nc.us/schs/deaths/lcd/2011/ [accessed November 8, 2013]
North Carolina Division of Public Health (NC DPH)
NC DPH Epidemiology, NC HIV/STD Surveillance Report 2012 http://epi.publichealth.nc.gov/cd/stds/figures/std12rpt.pdf
[accessed November 8, 2013]
Prepared by: Mecklenburg County Health Department (MCHD), Epidemiology Program
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