H E A LT H Y C A R O L I N I A N S O F O R A N G E C O U N T Y 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 2 HEALTHY CAROLINIANS OF ORANGE COUNTY • A network of community members and service providers partnering to promote health and wellness in Orange County • Members are representatives from schools, human service agencies, churches, civic groups, businesses, local government, UNC Chapel Hill, health care organizations including UNC Healthcare, and concerned citizens. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 3 HEALTHY CAROLINIANS OF ORANGE COUNTY • Mission is to advocate, guide and assist Orange County in planning and implementing health care strategies to promote healthy lifestyles, improve health status and prevent premature death and injury for ALL residents in the county regardless of age, race, income, or educational level. • Overall goal of the partnership is to reduce health disparities 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 4 HEALTHY CAROLINIANS OF ORANGE COUNTY • What We Do Build and promote collaborative partnerships Guide local planning efforts to improve health Support innovative health programs Advocate for health-promoting policies Identify critical health needs in the community 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 5 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 6 ACKNOWLEDGMENTS • Thanks to the residents of Orange County, Community Health Assessment Team members, and all Healthy Carolinians partners and member agencies who helped to guide and make the assessment a true community process. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 7 COMMUNITY HEALTH ASSESSMENT: OVERVIEW • Required of all NC Health Departments every 4 years • Collaborative process with multiple stages Over 50 Leadership Team members Nearly 150 community survey volunteers 30+ document writers Close to 200 forum participants 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 8 COMMUNITY HEALTH ASSESSMENT: GOALS • Enable local public health officials/community groups to Monitor trends in health status Identify priorities among health issues Determine the availability of resources • Document Useful, relevant, actionable, reflective, forward-looking • Information gathered lays the foundation for effective, strategic community health planning 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 9 HEALTH ASSESSMENT PROCESS: PHASES Phase 1: Establish Community Assessment Team Phase 2: Collect Community Data Phase 3: Collect and Analyze Community Health Statistics Phase 4: Combine County Statistics and Community Data Phase 5: Solicit Community Input to Select Health Priorities Phase 6: Create Community Health Assessment Document Phase 7: Disseminate CHA Document to the Community Phase 8: Develop the Community Health Action Plans 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 10 DATA SOURCES AND COMMUNITY INVOLVEMENT • Both primary and secondary data sources • Community Involvement Various roles Involvement at every stage Planning Data collection Identification of health issues, community strengths Development of strategies to address problems 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 11 QUANTITATIVE: HEALTH OPINION SURVEY • • • • Community Health Opinion Survey Survey households sampled from census blocks with high poverty percentage Administered in multiple languages Covered various topics 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 12 QUALITATIVE: FOCUS GROUPS AND FORUMS • Nine focus groups Gain well-rounded understanding of health concerns Nearly 70 community voices • Five community forums Almost 200 participants Presented and discussed main data findings Selected initial priorities 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 13 COMMUNITY HEALTH ASSESSMENT: FULL REPORT • Available online www.orangecountync.gov /healthycarolinians 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 14 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 15 COMMUNITY PROFILE: DEMOGRAPHICS • Population has more than doubled in past four decades Total: 57,567 (1970) to 133,801 (2010) About a 5.8% rate of increase every ten years • Age Median: 33 years old Age and Percent of Total Population (2010) Age Group Percent Under 5 years 5.1% Under 18 years 20.9% Under 25 years 39.1% Between 25-65 years 51.3% 65 years or older 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 9.6% 16 COMMUNITY PROFILE: DEMOGRAPHICS • Gender 52.2% female / 47.8% male • Rural/Urban 57% of residents live in southern “urban” areas of Chapel Hill and Carrboro 43% live throughout rural areas • Diversity Race and ethnicity Country of origin Languages 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 17 COMMUNITY PROFILE: DEMOGRAPHICS Race and Ethnicity Demographics, Percent of Total Population NC Orange County Carrboro Chapel Hill Hillsborough White 68.5 74.4 70.9 72.8 62.9 Black Hispanic or Latino of any race Asian American Indian and Alaska Native 21.5 11.9 10.1 9.7 29.5 8.4 8.2 13.8 6.4 6.6 2.2 6.7 8.2 11.9 1.7 1.3 0.4 0.4 0.3 0.6 0.1 0.0 0.0 0.0 0.0 4.3 4.0 7.5 2.7 3.3 2.2 2.5 2.9 2.7 2.1 Native Hawaiian and Other Pacific Islander Some other race Two or more races 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 18 PROFILE: LEADING CAUSES OF DEATH Leading Causes of Death in Orange County, % and Number, 2005-2009 OC Rank Cause of Death OC % NC % OC # NC # 1 Cancer 24.6 22.8 859 86,246 2 Diseases of heart 21.2 23.0 742 86,920 3 Cerebrovascular diseases 5.5 6.0 191 22,600 4 Chronic lower respiratory diseases 4.4 5.6 155 21,228 5 All other unintentional injuries 2.9 3.4 100 12,896 6 Influenza and pneumonia 2.7 2.3 96 7 Alzheimer's disease 2.2 3.3 78 12,386 8 Motor vehicle injuries 2.1 2.1 74 9 Diabetes mellitus 2.0 2.9 69 10,906 1.5 NA 51 10 Intentional self-harm (suicide) 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 8,632 8,027 NA 19 PROFILE: DEATH RATES, AGE ADJUSTED Age-adjusted death rates (per 100,000 population) OC Rank Orange County and NC, 2005-2009 Cause of Death OC Rate NC Rate 1 Cancer 158.4 185.6 2 Diseases of Heart 141.8 191.7 3 Cerebrovascular Disease Chronic Lower Respiratory 4 Diseases 5 Pneumonia and Influenza 37.2 50.5 30.7 47.0 18.6 19.4 6 Alzheimer's disease 17.5 28.3 7 All Other Unintentional Injuries 17.2 28.6 8 Diabetes Mellitus 14.5 23.6 12.8 12.0 12.1 18.7 9 Suicide Nephritis, Nephrotic Syndrome, 10 and Nephrosis 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 20 PROFILE: LEADING CAUSES OF DEATH Top-5 Leading Causes of Death Orange County, %, by Year, 2005-2009 Percent of Total Deaths 30 Cancer 25 20 Diseases of heart 15 Cerebrovascular diseases Chronic lower respiratory diseases All other unintentional injuries 10 5 0 2005 2006 2007 2008 2009 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 21 PROFILE: LEADING CAUSES OF HOSPITALIZATION Leading Causes of Hospitalization Orange County and North Carolina, 2009 Cause Other diagnoses (incl. mental disorders) Cardio-vascular and circulatory diseases Pregnancy and childbirth Digestive system diseases Injuries and poisoning Respiratory diseases Musculo-skeletal system diseases Genito-urinary diseases OC % 16.6 16.4 16.1 11.3 10.7 8.2 7.7 4.6 NC % 10.1 19.3 15.7 11 9.4 11.8 6.9 5.4 Endocrine, metabolic and nutritional diseases 4.2 4.7 Malignant neoplasms 4.2 NA Symptoms, signs and ill-defined conditions NA 5.7 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 22 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 23 HEALTH DISPARITIES • Health depends largely on Economic status, income Race/ethnicity Where someone lives (Place, geography) • Rates of disease and health outcomes significantly worse among economically disadvantaged, particular racial and ethnic minorities, and rural populations. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 24 DETERMINANTS OF HEALTH • • • • • • • • • • Built Environment Child Care Crime and Safety Education Housing and Homelessness Hunger and Food Insecurity Income and Poverty* Labor and Employment* Parks and Recreation Transportation 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 25 DETERMINANTS OF HEALTH: INCOME, POVERTY • Median household income: $51,944 (2009) Percentage below the Poverty Level by Age and Gender % Below Poverty Level NC Orange County Population for whom poverty status is determined Age Under 18 years 18 to 64 years 65 years and over Gender Male Female 17.5 20.1 24.9 16.2 9.9 22.2 20.8 11.3 16.2 18.7 18.4 21.6 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 26 DETERMINANTS OF HEALTH: POVERTY Percentage below the Poverty Level by Race and Hispanic or Latino Origin One Race White Black or African American American Indian and Alaska Native Asian Native Hawaiian and Other Pacific Some other race Two or other races Hispanic or Latino origin (of any race) White alone, not Hispanic or Latino % Below Poverty Level NC Orange County 17.3 NA 13.2 20.2 27.7 23.0 31.2 NA 14.1 14.1 26.8 NA 36.7 NA 24.3 33.9 49.8 11.8 16.8 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 27 DETERMINANTS OF HEALTH: LABOR, EMPLOYMENT Unemployment Rate (%) by Gender, Poverty Status, and Disability Status Unemployment Rate (%) NC Orange County Gender Male Female With own children under 6 years Poverty status in the past 12 months Below poverty level Disability status With any disability 12.3 11.4 14.7 10.1 9 6.7 36.2 22 23.2 41.1 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 28 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 29 • Includes the availability and affordability of health care services and insurance, ability to navigate and understand the health system, access and transportation to services, and information about health care. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 30 • Includes human-made structures such as sidewalks, streets, housing, businesses, schools, parks, and, more broadly, land use patterns. The built environment impacts safety and the ability to get exercise, to access good nutrition, and health care services. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 31 • The leading cause of death in Orange County in 2010 and has been ranked as #1 in 9 of the past 10 years. It is estimated that nearly 80% of cancers are due to factors that can be prevented: tobacco use, poor nutrition, lack of physical activity, and exposure to radiation. Many cancers are highly treatable with advanced screening. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 32 • Regular exercise and proper nutrition significantly contribute to physical and mental health; and can help prevent chronic diseases like diabetes, heart disease, stroke and cancer. Physical activity and good nutrition are important in maintaining a healthy body weight. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 33 • Includes air quality; drinking, and ground water quality; and lead hazards. Environmental health issues local to neighborhoods may exist in addition to these key factors. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 34 • Addresses unintentional injuries like motor vehicle crashes, falls, poisonings, drowning, etc., and intentional injuries, or violence, which includes sexual assault, child abuse, domestic violence, homicide, and suicide. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 35 • Refers to a wide range of conditions that affect one’s mood, thinking and behavior. Broad classes of illness include mood disorders (depression, bipolar disorder), anxiety disorders, psychotic disorders (schizophrenia), eating disorders, personality adaptations or disorders, and addictive behaviors/substance abuse disorders. Many factors contribute to its onset, including genetics, biological factors, life experiences, and brain chemistry, though everyday stress. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 36 • Not only includes tooth and gum health, but also has overall health impacts (gum disease contributes to heart disease; tobacco use contributes to tooth decay). Issues in oral health include availability of affordable dental insurance, access to regular and preventative care, and population specific issues. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 37 • Includes alcohol abuse and illegal drug use, but also includes underage drinking, traffic accidents, prescription drug abuse/misuse, and injury related to alcohol and drugs. It often connects with mental health needs. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 38 • Transportation systems impact quality of life and health. Expanding active transportation (walking and biking) options and safety can prevent disease, reduce and prevent motorvehicle-related injury and deaths, improve environmental health, stimulate the economy and improve equal access to resources. Accessible and affordable transportation is particularly an issue in rural areas, for those with disabilities, older citizens and lower-income people. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 39 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 40 RANKED TOP 10 ORANGE COUNTY PRIORITIES 1. Access to Health Care, Insurance, and Information 2. Chronic Disease: Exercise, and Nutrition 3. Mental Health 4. Transportation 5. Built Environment 6. Cancer 7. Substance Abuse 8. Environmental Health 9. Oral Health 10. Injury Write-ins: Teen Pregnancy/Youth Health, Sexual health, Socio-economic Development 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 41 TOP 5 HEALTHY CAROLINIANS PRIORITIES 1. Access to Health Care, Insurance, and Information 2. Chronic Disease: Exercise and Nutrition 3. Mental Health 4. Substance Abuse 5. Injury Current Healthy Carolinians of Orange County Focus Areas 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 42 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 43 ACCESS TO HEALTH CARE • Orange County has highest per capita number of physicians and dentists in NC 88.9 physicians, 10.4 dentists per 10,000 population • 18.3% of Orange County residents do not have one or more persons that they considered a doctor or health care provider • Close to 28% of residents did not visit a doctor for a routine (general physical exam) checkup within the past year • 14.8% of county residents could not see a doctor due to cost 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 44 ACCESS TO HEALTH CARE • In addition to medical insurance, factors contributing to a resident’s inability to access health care services include Concentration of health care resources in the southern part of county Inadequate transportation systems in the central and northern parts of Orange County Language barriers; Recent relocation to the county from another country Perceived disparities (or racism) within health care facilities 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 45 ACCESS: ORANGE COUNTY MEDICAL FACILITIES • Medical facilities (hospitals, urgent care facilities, and health departments) in the county are all within city limits of Chapel Hill, Carrboro, or Hillsborough. • This map does not include private physician or dentist offices. 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 46 ACCESS TO HEALTH INSURANCE • 2008-2009 county-level estimates of uninsured 18.9% (21,854) of Orange County residents, 0-64 years of age • Due to economic recession, rise in unemployment rates consistent with rise in uninsured residents 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 47 ACCESS TO HEALTH INFORMATION • Health Literacy “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Extends beyond a person’s reading and writing skills Ability to comprehend spoken words Use numeracy and math skills for calculations Navigate the health care system Transcends income and education levels 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 48 CHRONIC DISEASE: CANCER • Cancer Leading cause of death in Orange County (2010) Ranked as leading cause of death in 9 of past 10 years Among all cancers, death rate per 100,000 population was 163.3 (2008) Lower cancer death rates than NC (2008) Responsible for 859 deaths (2005-2009) Total number of cancer deaths decreased slightly in comparison with previous time periods Difference in cancer deaths between racial groups is dramatic For all common cancers, African Americans had higher death rate than whites 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 49 CHRONIC DISEASE: DIABETES • Diabetes 2001-2005, age-adjusted diabetes death rates for Orange County was 17.8 per 100,000 (NC rate was 27.6 per 100,000) Percentage county residents with diabetes varied in recent years Disparities in Diabetes Orange County NC Residents Male Female White Race Other 18-44 Age 45+ Education High school or less Some college Gender % with Diabetes 2005 2010 4.2 4.1 6.1 7.1 3.5 3.8 11.6 10.5 2.3 1.5 10.8 8.1 6.5 8.0 5.3 4.5 % without Diabetes 2005 2010 95.4 94.5 91.7 90.0 95.2 95.0 87.9 82.8 96.9 96.4 87.0 90.0 90.4 91.3 92.9 94.0 % Borderline Diabetes 2005 1.4 1.6 0.8 3.9 0.9 2.2 1.7 1.4 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 2010 0.4 1.1 1.0 0.0 0.0 1.6 0.7 0.8 50 CHRONIC DISEASE: HEART DISEASE AND STROKE • Heart Disease and Stroke Second leading cause of death 137 deaths due to heart disease; 29 due to cerebrovascular disease (2009) Heart disease and cerebrovascular disease leading causes of hospitalizations, hospital expenses Heart disease: $31,730,269 Cerebrovascular disease: $7,290,187 Age-adjusted death rate for heart disease decreasing 2001-2005: 165.3 per 100,000 2009: 148.4 per 100,000 Age-adjusted death rate for cerebrovascular disease is 39.0 per 100,000 (2009) 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 51 CHRONIC DISEASE: OBESITY, OVERWEIGHT • Obesity and Overweight Contributes to the burden of cancer, heart disease, stroke Rate of overweight or obese among residents 18 and older Overall rate dropped from 56% to 48.1% (2007-2009) However, recent increase to 53.2% (2010) Rate of overweight among 2-4 year olds has decreased 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 52 CHRONIC DISEASE: EXERCISE AND NUTRITION • Physical activity and proper nutrition Important to reach a healthy body weight Meeting recommendations can help prevent cardiometabolic conditions Healthy eating in childhood and adolescence important for proper growth and development • 31.1% of residents consume five or more servings of fruits or vegetables per day (2009) 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 53 MENTAL HEALTH AND SUBSTANCE ABUSE • Suicide Among top 10 leading causes of death Rates fluctuated (2000-2009), ranging from a low of 5.8/100,000 to a high of 18.5/100,000 • High stress/Poor mental health • Substance abuse Increasing prevalence of prescription drug abuse/misuse Underage drinking Driving under the influence 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 54 MENTAL HEALTH AND SUBSTANCE ABUSE • Contributing factors System instability Family and community violence Barriers to access Stigma Lack of knowledge about existing services Lack of adequate insurance or co-pays Lack of specific service/needing more options 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 55 TOBACCO • Tobacco use remains leading preventable cause of death • 11.5% of county residents report smoking some days or every day, compared to 20.3% in NC (2009) • 14.5% of high school students report using tobacco (cigarettes, cigars, smokeless tobacco) in the past 30 days (2011) • 8.1% of people exposed to secondhand smoke in workplace (2008) • Educational attainment, employment correlated with secondhand smoke exposure • Percentage of mothers who smoked during pregnancy has been decreasing since 1994 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 56 INJURY AND VIOLENCE • Broad topic: Injury-related health issues including Unintentional injuries: Motor vehicle crashes, falls, poisonings, drowning, etc. Intentional injuries/violence: Sexual assault, child abuse, domestic violence, suicide, human trafficking, etc. • Unintentional injuries a leading cause of death for ages 1-44 • Intentional injuries (or violence) likewise pervasive and a leading cause of death/hospitalization, especially for ages 15-35 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 57 TAKING ACTION, TOGETHER • Many efforts underway to address priority areas; new initiatives needed to respond to identified gaps • Progress requires total community involvement to improve the quality of life for people living in Orange County 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 58 TAKING ACTION, TOGETHER • Join the more than 125 other individuals and 80 county agencies and organizations who are partnering with Healthy Carolinians of Orange County to find creative solutions so that all Orange County residents can choose health as their first priority • To find out how to become involved with work groups addressing the top health concerns in the county, please contact the Healthy Carolinians Coordinator 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 59 CONTACT INFORMATION Nidhi Sachdeva MPH, CHES • • • • • • Healthy Carolinians Coordinator Orange County Health Department 300 West Tryon Street | Hillsborough, NC 27278 Phone: 919.245.2440 Email: nsachdeva@co.orange.nc.us Website, Full Report, Membership Information: http://www.co.orange.nc.us/healthycarolinians 2011 COMMUNITY HEALTH ASSESSMENT HEALTHY CAROLINIANS OF ORANGE COUNTY 60