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WAKE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT

Challenges and Opportunities

Wake County, North Carolina

2013 Wake County Community Health Needs Assessment

Page 1

2013 WAKE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT

“CHALLENGES AND OPPORTUNITIES”

This report is available at the Wake County Government website at:

www.wakegov.com/humanservices/data

2013 Wake County Community Health Needs Assessment

Page 2

June 2013 Dear Wake County Citizens, In March 2013, Wake County was ranked as the healthiest county in North Carolina for the fourth consecutive year. This is due to the work and partnership of public health, the community, government, hospital partners and most importantly our Wake County citizens. This accomplishment underscores the importance of our Community Health Assessment, because it helps us identify and address factors that affect the health of our community. As our County continues to evolve and grow we must make sure that we take the necessary steps to ensure that the needs of all our citizens are being addressed. We realize that when it comes to public health, the community itself is the patient and the health of the community must be assessed by focusing on key areas such as behavioral and social health, the economy, education, environmental health, physical health and safety. Every three - four years, Wake County conducts a comprehensive community examination through a process known as the Community Health Needs Assessment (CHNA). This year, the assessment process was a collaborative effort between WakeMed Health and Hospitals, Duke Raleigh Hospital, Rex UNC Health care, Wake County Human Services, Wake Health Services, United Way of the Greater Triangle, Wake County Medical Society Community Health Foundation and Urban Ministries. Additionally, guidance was provided through a Steering Committee of more than 60 non-profit, government, faith-based, education, media, and business organizations. The many hours volunteered by the Steering Committee and the input provided by Wake County residents has be invaluable to this process. Working with the UNC Gillings School of Global Public Health, the assessment included collecting information from citizen opinion surveys, focus groups, and statistical data to identify community health needs and resources. We hope the findings of this CHNA will be used to develop strategies that address our community’s priorities and promote the health of residents across Wake County. We know that with all of us working together, we can create a healthier, safer community while having a better idea of where we need to focus our resources over the next few years. Warm Regards,

Susan Davis Joe Bryan Executive Director, Chairman, Wake County Medical Society-Community Health Foundation Wake County Board of Commissioners

Co-Chairs of the Wake County CHNA Steering Committee

2013 Wake County Community Health Needs Assessment

Page 3

TABLE OF CONTENTS

ACKNOWLEDGEMENTS ............................................................................................................. 6

EXECUTIVE SUMMARY ............................................................................................................ 10

CHAPTER 1 | INTRODUCTION ................................................................................................ 17

Project Purpose and Background ............................................................................................................... 17

Community Health Needs Assessment Team............................................................................................. 18

Community Health Needs Assessment Steering Committee ................................................................... 18

Community Engagement ............................................................................................................................... 19

Methods ........................................................................................................................................................... 19

Existing Statistics ......................................................................................................................................... 19

Health Opinion Survey .............................................................................................................................. 19

Focus Groups ............................................................................................................................................... 20

Comparisons, Targets, and Benchmarks ................................................................................................. 21

Prioritization of Health Issues ................................................................................................................... 21

Report Organization ..................................................................................................................................... 22

CHAPTER 2 | COMMUNITY PROFILES ..................................................................................... 24

Wake County History ................................................................................................................................... 24

Wake County Geography .......................................................................................................................... 24

Wake County Demographics ...................................................................................................................... 25

Population .................................................................................................................................................... 25

Diversity ........................................................................................................................................................ 27

Community Profiles ........................................................................................................................................ 29

Wake County, NC ......................................................................................................................................... 30

Apex, NC......................................................................................................................................................... 31

Cary, NC ......................................................................................................................................................... 32

Fuquay-Varina, NC ....................................................................................................................................... 33

Garner, NC ..................................................................................................................................................... 34

Holly Springs, NC .......................................................................................................................................... 35

Knightdale, NC ............................................................................................................................................... 36

Morrisville, NC ................................................................................................................................................ 37

Raleigh, NC ..................................................................................................................................................... 38

Rolesville, NC .................................................................................................................................................. 39

Wake Forest, NC ........................................................................................................................................... 40

Wendell, NC ................................................................................................................................................... 41

Zebulon, NC .................................................................................................................................................... 42

CHAPTER 3 | SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH ................................... 44

Education and Lifelong Learning ................................................................................................................ 45

Housing and Homelessness ........................................................................................................................... 50

Income and Poverty ....................................................................................................................................... 54

2013 Wake County Community Health Needs Assessment

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Employment ..................................................................................................................................................... 57

Child Welfare and Financial Assistance ................................................................................................... 59

Transportation ................................................................................................................................................ 63

Crime and Safety .......................................................................................................................................... 65

Government and Civic Participation .......................................................................................................... 73

Faith and Spirituality .................................................................................................................................... 75

CHAPTER 4 | HEALTH STATUS ................................................................................................ 77

Rankings ........................................................................................................................................................... 78

Self-Reported Health Status ........................................................................................................................ 81

Maternal and Infant Health ......................................................................................................................... 82

Life Expectancy, Leading Causes of Death, and Chronic Disease ....................................................... 90

Communicable Diseases and Immunization ............................................................................................. 101

Disability and Care-giving ........................................................................................................................ 109

CHAPTER 5 | MENTAL HEALTH AND SUBSTANCE USE ......................................................... 112

Mental Health ............................................................................................................................................... 112

Substance Use .............................................................................................................................................. 117

CHAPTER 6 | MODIFIABLE HEALTH RISKS ............................................................................ 120

Nutrition ......................................................................................................................................................... 120

Physical Activity............................................................................................................................................ 122

Overweight and Obesity ........................................................................................................................... 124

Tobacco ......................................................................................................................................................... 126

Injury and Violence ...................................................................................................................................... 127

Oral Health ................................................................................................................................................... 131

CHAPTER 7 | ACCESS TO HEALTH SERVICES ........................................................................ 134

Health Professionals, Hospitals, and Health Care Facilities ................................................................ 135

Health Insurance Coverage and Access .................................................................................................. 150

CHAPTER 8 | HEALTH OF THE ENVIRONMENT ..................................................................... 157

Environmental Rankings .............................................................................................................................. 157

Environmental Health .................................................................................................................................. 158

Built Environment .......................................................................................................................................... 164

CHAPTER 9 | PARTNERSHIPS AND RESOURCES FOR COMMUNITY HEALTH IMPROVEMENT169

Community Support for Health Improvement ......................................................................................... 170

Resources, Initiatives, and Collaboratives ............................................................................................... 171

CHAPTER 10 | COMMUNITY PRIORITIES .............................................................................. 180

Community Forum ......................................................................................................................................... 180

Forum Demographics................................................................................................................................ 180

Forum Overview ........................................................................................................................................ 182

Prioritization Method ............................................................................................................................... 182

Community Priorities ................................................................................................................................. 183

Next Steps ................................................................................................................................................. 184

INDEX .................................................................................................................................... 185

2013 Wake County Community Health Needs Assessment

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APPENDICES .......................................................................................................................... 187

APPENDIX A: GLOSSARY AND TERMS .................................................................................. 188

APPENDIX B: LOW COST PRIMARY CARE SERVICES IN WAKE COUNTY .............................. 190

APPENDIX C: EXISTING DATA SOURCES .............................................................................. 196

APPENDIX D: COMMUNITY HEALTH OPINION SURVEY METHODS ...................................... 213

APPENDIX E: COMMUNITY HEALTH OPINION SURVEY ........................................................ 218

APPENDIX F: COMMUNITY HEALTH OPINION SURVEY RESULTS ......................................... 235

APPENDIX G: FOCUS GROUP METHODS .............................................................................. 255

APPENDIX H: FOCUS GROUP QUESTIONS AND DEMOGRAPHIC FORM .............................. 258

APPENDIX I: FOCUS GROUP SUMMARIES ............................................................................ 260

APPENDIX J: COMMUNITY FORUM FLYER ............................................................................ 275

APPENDIX K: COMMUNITY FORUM FACILITATOR GUIDE AND DEMOGRAPHIC FORM ...... 276

APPENDIX L: REPORT LINKS ................................................................................................. 280

2013 Wake County Community Health Needs Assessment

Acknowledgements Page 6

ACKNOWLEDGEMENTS We would like to thank all of the community members who agreed to participate in the community

health needs assessment process and help prioritize issues that are most important to us.

COMMUNITY HEALTH NEEDS ASSESSMENT TEAM

 Edie Alfano-Sobsey, Wake County Human

Services

 Michele Crenshaw, Wake County Human

Services

 Andi Curtis, WakeMed Health & Hospitals

 Susan Davis, Community Care of Wake &

Johnston Counties

 Petra Hager, Wake County Human Services

 Kerry Grace Heckle, Rex Healthcare

 Ted Kunstling, Duke Raleigh Hospital

 Sue Lynn Ledford, Wake County Human

Services

 Peter Morris, Urban Ministries

 Regina Petteway, Wake County Human

Services

 Stan Taylor, WakeMed Health & Hospitals

 Lechelle Wardell, Wake County Human

Services

 Penny Washington, Wake Health Services

 Kristina Wharton, Wake Health Services

 Laurie Williamson, United Way of the Greater

Triangle

COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE

Commissioner Joe Bryan, Co-Chair, Wake County Board of Commissioners

Susan Davis, Co-Chair, Wake County Medical Society-Community Health Foundations

 Craig Barfield, Meredith College

 Charlotte Blackwell, Wake Technical

Community College

 Dianne Boardley Suber, St. Augustine

University

 Roland Bullard, St. Augustine University

 Irene Caicedo Gonzales, Univision Local Media

 Kevin Cain, John Rex Endowment

 Leonor Clavigo, Hispanic Chamber of

Commerce

 Tad Clodfelter, SouthLight

 Kenneth Cooper, Christian Faith Baptist Church

 David Cottengim, Gold Coalition-Resources for

Seniors

 Kelly Creech, Wake County Public Schools

 Andi Curtis, WakeMed Health & Hospitals

 Sandra Dietrich, Wake Technical Community

College

 Pam Dowdy, Wake County Smart Start

 Frank Eagles, Town of Rolesville

 Gwen Ferrone, State Employees Credit Union

 Albert Fisher, Community Partnership Inc.

 Joselito Garcia Ruiz, American Red Cross

 Julie Garza, La Ley Radio Station

 Scoop Green, Holly Springs Chamber of

Commerce

 John Guenther, Wake County Smart Start

 Mary Graff, Duke Raleigh Hospital

 Brian Gunter, Wake County Human Services

 Hope Hancock, SPCA of Wake County

 Alicia Hardy, Wake Technical Community

College

 Tara Heasley, Alliance Behavioral Health

Organization

 Sue Lynn Ledford, Wake County Human

Services

 Howard Manning, Dorcas Ministries

 Robert Matheny, Town of Zebulon

 James Miller, LGBT Center of Raleigh

 Dave Olsen, PNC Arena

 Dennis Parnell, The Healing Place

2013 Wake County Community Health Needs Assessment

Acknowledgements Page 7

 Dwayne Patterson, City of Raleigh Community

Service Department

 Joan Pellettier, Triangle Agency on Aging

 Christine Peterson, Risk Management

Association

 Sharon Peterson, Wake County Government

 Regina Petteway, Wake County Human

Services

 Andre Pierce, Wake County Department of

Environmental Services

 Teresa Piner, Town of Wendell

 Barry Porter, American Red Cross

 Megg Rader, Alliance Medical Ministry

 Gary Raiford, Wake County Human Services

 Sonya Reid, Wake County Human Services

 Ramon Rojano, Wake County Human Services

 Ann Rollins, Alice Aycock Poe Center for Health

Education

 Justin G. Roy, William Peace University

 Harvey Schmitt, Greater Raleigh Chamber of

Commerce

 Tamara Smith, Alliance Behavioral Health

Organization

 Jill Staton-Bullard, Interfaith Food Shuttle

 Stan Taylor, WakeMed Health & Hospitals

 Sarah Tencer, United Way of the Greater

Triangle

 Sheree Thaxton-Vodica, NC State Alliance of

YMCAs

 John Thoma, Hospice of Wake County

 Joseph Threadcraft, Wake County Department

of Environmental Services

 Aracelys Torrez, City of Raleigh

 Kristina Wharton, Wake Health Services

 Penny Washington, Wake Health Services

 Mike Williams, Wake County Emergency

Medical Service

 Jean Williams, Women's Center for Wake

County

 Graham Wilson, Apex Chamber of Commerce

 Michelle Zechmann, Haven House Services

CO MM UN I T Y HE A L T H O PIN I ON S U R VE Y DA T A COL L E CT ION T E A MS

 Tanya Beale, Hospice of Wake County

 Meagan Brown, UNC

 Evan Busch, UNC

 Michele Crenshaw, Wake County Human

Services

 Susan Davis, Community Care of Wake &

Johnston Counties

 Scott Elliot, United Way of the Greater

Triangle

 Rachel Frantz, UNC

 Nancy Garcia

 Amber Gautam, UNC

 Shannon Grabich, UNC

 Petra Hager, Wake County Human Services

 Elizabeth Hayward, UNC

 Sydney Jones, UNC

 Katie Lesko, UNC

 Xinxin Li, UNC

 William Miller, UNC

 James Noel

 Megg Rader, Alliance Medical Ministry

 Kristen Ricchetti-Masterson, UNC

 Rich Rosselli

 Mandy Seyerle, UNC

 Sarah Tencer, United Way of the Greater

Triangle

 Asia-La’Rae Walker, UNC

 Elizabeth Watson, UNC

 Kristina Wharton, Wake Health Services

 Dwight Yin, UNC

L OCA L S E CON DA R Y DA T A COL L E CT ION

 Matt Avery, North Carolina State Center for

Health Statistics

 Craig Burrus, Wake County Human Services

 Donna Daughtry, Wake County Human

Services

 Roxanne Deter, Wake County Human Services

 Sharon Gardei, Wake County Human Services

 Eric Green, Wake County Department of

Environmental Services

 Tina Howard, Alliance Behavioral Healthcare

 Tina Hudson, Wake County Child Welfare

 Marcus Kincaid, Wake County Revenue

Department

 Andre Pierce, Wake County Department of

Environmental Services

2013 Wake County Community Health Needs Assessment

Acknowledgements Page 8

 Dianne Smail, Wake County Human Services

 Stan Taylor, WakeMed Health & Hospitals

 John Thoma, Hospice of Wake County

 Penella Washington, Wake Health Services

 Kristina Wharton, Wake Health Services

 Joseph Zalkin, Wake County Emergency

Management Services

F OC US G RO UP CO O RD IN A T ION

 Tad Clodfelter, Southlight

 David Cottengim, Resources for Seniors

 Susan Davis, Community Care of Wake &

Johnston Counties

 Albert Fisher, Community Partnerships

 Petra Hager, Wake County Human Services

 Hugh Hollowell, Love Wins Ministries

 Barbara James, Community Care of Wake &

Johnston Counties

 Fred Johnson, Alliance of Disability Advocates

 Alyssa Kalata, Southlight

 Dave Mullins, CapitalCare Collaborative

 Megg Rader, Alliance Medical Ministry

 Parrish Ravelli, Youth Empowered Solutions

(YES!)

 Dave Richard, Arc of North Carolina

 Lisa Rowe, CapitalCare Collaborative

 Cynthia Smith, Resources for Seniors

 Miranda Strider Allen, Resources for Seniors

G RA P HI C DE S IG N C ON S UL T A N T S

 Petra Hager, Wake County Human Services

 Kerry Grace Heckle, Rex Healthcare

 Debbie Laughery, WakeMed Health & Hospitals

 Lechelle Wardell, Wake County Human Services

CO MM UN I T Y F OR U M T E A MS

 Edie Alfano-Sobsey, Wake County Human

Services

 Cindy Barnier, Wake County Human Services

 Derek Byrd, Wake County Human Services

 Michele Crenshaw, Wake County Human

Services

 Susan Davis, Community Care of Wake & Johnston Counties

 Kasey Decosimo, UNC

 Debbie Earp, Community Care of North

Carolina

 Lue Geddis, Wake County Human Services

Eastern Regional Center Community Advisory

Council

 Shannon Grabich, UNC

 Brian Gunter, Wake County Human Services

 Petra Hager, Wake County Human Services

 CJ Harper, Wake County Human Services

 Kerry Grace Heckle, Rex Healthcare

 Nicole Hill, Wake County Human Services

 Jonica Hinton, Wake County Human Services

 Tangela Keaton, Wake County Cooperative

Extension

 Denise Kissel, Wake County Human Services

 Paula Lindsey, Wake County Human Services

 Lydia Loyd, Wake County Human Services

 Kristen McHugh, Wake County Human Services

 Debbie McLean, Southern Regional Center

Community Advisory Council

 Sharon McMillan, Western Regional Center

Community Advisory Council

 Yolanda McMillan, Wake County Human

Services

 Andrew Meyer, Wake County Cooperative

Extension

 Letty Mendez, Wake County Human Services

 Karen Morant, Wake County Human Services

 Jennifer Morrison, Southern Regional Center

Community Advisory Council

 Annette Newsom

 Joan Pellettier, Triangle J Area Agency on

Aging

 Sharon Peterson, Western Regional Center

Community Advisory Council

 Regina Petteway, Wake County Human

Services

 Carla Piedrahita, Wake County Human

Services

2013 Wake County Community Health Needs Assessment

Acknowledgements Page 9

 Eugenia Pleasant, Restoration Community

Development Corporation

 Karee Redmond, Wake County Cooperative

Extension

 Sonya Reid, Wake County Human Services

 Lucinda Rice, Wake County Human Services

 Maria Robayo, Wake County Human Services

 Ann Rollins, Alice Aycock Poe Center for Health

Education

 Rich Rosselli

 Ginny Satterfield, Wake County Human

Services

 Abigail Shapiro, UNC

 Adonna Simpson-Lewis, Wake County Human

Services

 John Thoma, Hospice of Wake County

 Rosa Vazquez-Cherry, Wake County Human

Services

 Katie Volger, Wake Health Services

 Cheng Wang, Western Regional Center

Community Advisory Council

 Penella Washington, Wake Health Services

 Lechelle Wardell, Wake County Human

Services

 Rosena West, Wake County Human Services

 Kristina Wharton, Wake Health Services

 Becky White, Wake County Human Services

 Rachel Wilfert, UNC

 Laurie Williamson, United Way of the Greater

Triangle

 Joyce Wood, Wake County Human Services

 Ross Yeager, Wake County Human Services

N ORT H CA ROL IN A I N S T IT UT E F OR P UBL I C H E A L T H S T A F F

 Kasey Decosimo

 Jennifer Horney

 Tanya Montoya

 Matt Simon

 Rachel Wilfert

Data Analysts

 Shannon Grabich

 Annika Pfaender

Focus Group Facilitators

 Rocio Anderson  Abigail Shapiro

WA K E C OU N T Y H U M A N S E R VI CE S P ROJ E CT M A N A G E ME N T T E A M

 Edie Alfano-Sobsey

 Michele Crenshaw

 Petra Hager

 Sue Lynn Ledford

 Regina Petteway

 Lechelle Wardell

2013 Wake County Community Health Needs Assessment

Page 10

EXECUTIVE SUMMARY

2013 Wake County Community Health Needs Assessment

Executive Summary Page 11

2013 Wake County Community Health Needs Assessment

Executive Summary Page 12

2013 Wake County Community Health Needs Assessment

Executive Summary Page 13

2013 Wake County Community Health Needs Assessment

Executive Summary Page 14

2013 Wake County Community Health Needs Assessment

Executive Summary Page 15

2013 Wake County Community Health Needs Assessment

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CHAPTER 1:

INTRODUCTION

2013 Wake County Community Health Needs Assessment

Chapter 1| Introduction Page 17

CHAPTER 1 | INTRODUCTION Health is affected by where and how we live, work, play, and learn. To improve the health of our community, it is important that we understand how different factors can influence our health. Part of a larger health planning process is to identify the health status, disparities, gaps and unmet needs of the community in balance with community resources, strengths and perceptions. Understanding the factors that affect our health in a larger context helps us develop action plans to address those needs.

To accomplish this planning process, Wake County Human Services in collaboration with WakeMed Health and Hospitals, Duke Raleigh Hospital, Rex Healthcare, Wake Health Services, and the United Way of the Greater Triangle are leading a comprehensive community health planning effort to measurably improve the health of Wake County, NC residents.

This report discusses the findings from the Community Health Needs Assessment process which was conducted January – June 2013, in collaboration with over 60 agency and community partners.

Project Purpose and Background

Understanding health as physical, mental, economic, and environmental well-being, the overarching goals of the 2013 Wake County Community Health Needs Assessment (CHNA) are to:

 Identify health status, concerns and resources in Wake County.

 Report findings to residents, hospitals, community agencies, and the North Carolina Department of Health and Human Services.

 Work with the community to determine the priority issues to be addressed.

 Develop a community-based action plan to address identified concerns.

Although community needs are identified in a Community Health Needs Assessment, community strengths and resources are also identified as assets that can help address factors that influence Wake County’s health. Starting in March 2012, the Affordable Care Act (ACA) requires tax exempt hospitals to conduct a Community Health Needs Assessment at least every 3 years. Along with hospitals, CHNAs are required by local health departments every 3-4 years for the public health accreditation process.

Image Source: Wake County Government

What is a Community Health Needs

Assessment?

A community health needs assessment is a process that helps to identify factors affecting our county, determine resources needed to address these factors, and develop a plan of action to address community needs. This is done by identifying and collecting information that identifies the community's strengths, resources, and needs.

2013 Wake County Community Health Needs Assessment

Chapter 1| Introduction Page 18

Additionally, the Federally Qualified Healthcare Center (Wake Health Services) and the United Way of the Greater Triangle need a community assessment to document population needs for service and grant provision. All of these assessments require partnerships among hospitals, public health, and the community with the intention of collecting information to inform community health improvement. To avoid multiple community health needs assessments in Wake County and the duplication of efforts among agencies, Wake County Human Services established a partnership with three local hospitals (WakeMed Health and Hospitals, Duke Raleigh, and Rex Healthcare), Wake Health Services, United Way of the Greater Triangle, and the Community Care Collaborative of Wake and Johnston Counties to complete its first joint Community Health Needs Assessment.

Community Health Needs Assessment Team

The Community Health Needs Assessment Team consisted of Wake County staff, representatives from the three local hospitals, Wake Health Services, United Way of the Greater Triangle, the Community Care Collaborative of Wake and Johnston Counties, and other community partners. During CHNA project, the CHNA Team met monthly to provide feedback to the CHNA process, ensure the CHNA was completed, and provide support for data collection and community engagement. There are 8 phases in the CHNA process. The CHNA Team provided oversight throughout the process to ensure timeliness and completion:

1. Establish a community health needs assessment team 2. Collect primary data 3. Collect secondary data 4. Analyze and interpret county data 5. Determine health priorities 6. Create the CHNA document 7. Disseminate CHNA document 8. Develop community health action plans

Community Health Needs Assessment Steering Committee

The Community Health Needs Assessment Steering Committee consisted of more than 60 dedicated community members and representatives from various agencies throughout Wake County, including the following groups:

 Non-profit organizations  Media  County and town government  Institutes of higher education  Faith-based organizations  Providers  Public - private partnerships

The Steering Committee met monthly to serve as a positive voice to:

 Represent various community stakeholders.

 Educate the community about the CHNA process to help increase community engagement and participation.

 Provide feedback on the CHNA process.

2013 Wake County Community Health Needs Assessment

Chapter 1| Introduction Page 19

Community Engagement

Throughout the CHNA process, Wake County community members provided input on the community’s strengths, resources, and needs by participating in data collection and prioritization efforts, including:

 Community Health Opinion Survey: 281  Focus groups: 76  Community forum: 95

A total of 452 community members were engaged in the 2013 CHNA process.

Methods

The community health needs assessment was created using both existing data and data that was collected directly from the community.

Existing Statistics

The health of a community depends on many different factors, including the environment, education and jobs, access to quality health care, and individual behavior. Thus, data from a variety of sources needed to be collected to get an overall picture of Wake County’s health.

The assessment process included collecting existing statistics from state, county, and local sources. The collection of data from existing sources helped create a snapshot of the social, economic, and health status of Wake County residents. Sources of statistical data included, but were not limited to:

 Behavioral Risk Factor Surveillance System (BRFSS)

 County Health Rankings

 Healthy NC 2020

 NC Department of Health and Human Services

 NC State Center for Health Statistics

 U.S. Census Bureau

 Wake County Government

 Local service providers

Health Opinion Survey

Data was also collected directly from the community through surveys and focus groups. The 2013 Community Health Opinion Survey consisted of 59 questions about various community and health topics, including issues that concern residents the most, services needing improvement, topics the community needs more information about, and health care access. A two-stage cluster sampling method was used to randomly select 5 census blocks within each of the eight Wake County Health Service Zones for a total of 40 census blocks, shown outlined in red. In March 2013, the NC Institute of Health, in collaboration with volunteers, completed 281 door-to-door household surveys in each of the 40 randomly selected census blocks.

2013 Wake County Community Health Needs Assessment

Chapter 1| Introduction Page 20

Map of Selected Census Blocks for the 2013 Community Health Opinion Survey

Source: NC Institute for Public Health

Focus Groups

Focus groups explored participants’ perceptions of their communities, key health concerns, health care services, and suggestions for improving services.

The Community Health Needs Assessment Steering Committee selected the focus group populations, which included:

 Youth  Seniors  Homeless  Hispanics/Latinos  Service providers in Wake

County

 Persons living with mental health or substance abuse illness and parents of children with intellectual/developmental disabilities

 Persons living with chronic health conditions

 Persons living with physical disabilities

2013 Wake County Community Health Needs Assessment

Chapter 1| Introduction Page 21

Nine focus groups (including 2 in Spanish) were conducted in March and April 2013, reaching 76 participants. On average, the focus group sessions lasted one hour and included 5-12 participants. Participants were recruited by community and social service agencies located throughout Wake County and received a small gift incentive for participation. The focus group sessions were recorded and transcribed for analyzing and coding into major themes.

Comparisons, Targets, and Benchmarks

Throughout this report, Wake County data is compared to two peer jurisdictions: Mecklenburg County, NC and the state of North Carolina. Mecklenburg County was chosen because of its similar population size to Wake County. Data that was collected was also compared to Healthy NC 2020 which serves as the state’s health improvement plan. Healthy NC 2020 encompasses 13 focus areas with 40 measurable objectives developed by the Governor’s Task Force for Healthy Carolinians.

In addition, Wake County data was compared to the national benchmarks from the University of Wisconsin Population Health Institute’s County Health Rankings and Roadmap. National benchmarks are the 90th percentile or 10th percentile of all counties in the country, depending on whether the measure is framed positively.

Prioritization of Health Issues

Five community forums were held throughout Wake County where residents were invited to hear the main findings from the assessment, which included nine focus areas identified by looking at the intersection of the Community Health Opinion Survey results, focus group themes, and existing health statistics:

 Mental health and substance use  Disability and care-giving  Education and lifelong learning  Health care access and utilization  Housing and homelessness  Nutrition, physical activity, and obesity prevention  Population growth  Poverty and unemployment  Risky youth behavior

Ninety-five residents voted on the priority areas that will be addressed over the next 3 years:

 Poverty and unemployment  Health care access and utilization  Mental health and substance use

More detailed information about the community prioritization process can be found in Chapter 10. More detailed information about the data collection methodology and limitations can be found in Appendix D: Community Health Opinion Survey Data Methodology and Appendix G: Focus Group Methodology.

Image Source: Healthy NC 2020

2013 Wake County Community Health Needs Assessment

Chapter 1| Introduction Page 22

Report Organization

This assessment examines the major health outcomes of Wake County residents, but also the factors that influence health, such as health behavior, access to health care, social and economic influences, and the physical environment.

Within each chapter statistics, trends, and disparities are presented for the various health outcomes or factors. This information is then balanced by equally important community perceptions to gain an overall sense of which outcomes and factors are affecting the community and what resources are needed to address community health improvement.

Throughout this report, some existing community resources and initiatives are highlighted, although programs and services listed are not comprehensive.

2013 Wake County Community Health Needs Assessment

Page 23

CHAPTER 2:

COMMUNITY PROFILES

2013 Wake County Community Health Needs Assessment

Chapter 2| Community Profiles Page 24

CHAPTER 2 | COMMUNITY PROFILES Wake County consists of 12 municipalities, including Raleigh,

which is the county seat and also the state capital. Wake

County is also home to NC State University, Shaw University,

Meredith College, Saint Augustine’s College, William Peace

University, and the Research Triangle Park.

A unique mix of urban and rural small towns distinguishes

Wake County from other counties. Wake County is the

second-most populous County in North Carolina. In 2012,

Wake County was home to an estimated 952,151 residents,

an increase of approximately 50,000 since the 2010 Census.

Sources:

 Wake County Government. Retrieved from http://www.wakegov.com/about/facts.

 U.S. Census Bureau: State and County QuickFacts.

 NCpedia. Government and Heritage Library, State Library of North Carolina.

Wake County History

Early inhabitants of the Wake County area included the Sissipahaw and Occaneechi Indians with English and Scots-Irish settlers later populating the region. Wake County was formed in 1771 from Johnston, Cumberland, and Orange counties and was named after Margaret Wake Tryon, wife of the royal governor William Tyron. In 1792 the city of Raleigh, named in honor of Sir Walter Raleigh, became the capital of North Carolina.

Wake County Geography

Located in the Piedmont region of North Carolina, Wake County is approximately 549,000 acres or 860 square miles.

The geographic center of Wake County is Raleigh. The highest point in the County is 540 feet above sea level, which is one-quarter of a mile north of Leesville. The lowest point in the County is 160 feet above sea level and is one- half mile southeast of Shotwell.

The bodies of water in Wake County include Crabtree Creek, the Neuse River, Lake Crabtree, Lake Johnson, and portions of Falls Lake and Jordan Lake.

Quick Facts

 Wake County’s population: 952,151.

 Wake County is the 2nd most populous County in NC.

 Wake County’s population has increased by more than 40% each decade since 1980.

Image Source: Digital NC http://digitalnc.org.

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Wake County Demographics

Population

In 2011, Wake County was home to an estimated 929,780 residents, an increase of approximately 30,000 since the 2010 Census. Wake County is almost seven times as densely populated as NC as a whole. The population growth seen in Wake County is dramatic, increasing by more than 40% each decade since 1980. This population growth is predicted to slow down over the next two decades.

Sources: Log into North Carolina (LINC) Database. ^North Carolina Office of State Budget and Management . Projected Annual County Population Totals, 2030-2033. April 18,2013.

On the whole, Wake County is a young county, with three-quarters of the county under the age of 50 (75%). In 2010, the population over the age of 65 represented 8.6% of the total population of Wake County. The age group 35-39 year olds represented 8.2% of the population. The overall median age of Wake County residents is 34.4 years.

1980 1990 2000 2010 2020^ 2030^

Number of Persons

Wake County 301,429 426,301 627,846 900,993 1,114,464 1,325,950

Mecklenburg County 404,270 511,481 695,370 919,628 1,138,356 1,355,271

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

P o p u la

ti o n

Population Growth Wake and Mecklenburg Counties

1980-2030

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Below is a map of the percent of population change in Wake County from 2000 to 2010 by census tract. Areas that experienced large increases in population include the far western part of the county near Morrisville, the central northern part of the county near Wake Forest and Rolesville, and the southern part of the county near Holly Springs.

Map of Wake County Percent Population Change, 2000-2010

Note: In 2000 Wake County had 105 census tracts. In 2010, primarily due to population growth, several large 2000 census tracts were subdivided to conform to 2010 Census Bureau defined tract maximum population thresholds, totaling to 187. In addition, some 2000 tracts were reconfigured to follow natural or major transportation features.

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General Demographic Characteristics

Location

Total Population

(2011 estimate)

Total Population

(2010)

Percent Male

Percent Female

Overall Median

Age

Wake County 929,780 900,993 48.7% 51.3% 34.4

Mecklenburg County

944,373 919,628 48.4% 51.6% 33.9

State of NC 9,656,401 9,535,483 48.7% 51.3% 37.4

Source: US Census Bureau, American Fact Finder, 2010 Census, Summary File DP-1, 2010 Demographic Profile Data, Profile of General Population and Housing Characteristics: 2010.

Diversity

According to the 2010 U.S. Census Bureau, Wake County is 66.3% White or Caucasian, 20.7% Black or African American, and 5.4% Asian. A larger percentage of the Wake County population identifies as Asian, Native Hawaiian, and Other Pacific Islander compared with Mecklenburg County or NC as a whole.

Population Distribution by Race

Location Total

Population White

Black or African-

American

American Indian and Alaskan Native

Asian, Native

Hawaiian, Other Pacific

Islander

Some Other Race

Two or

More Races

Wake County 900,993 66.3% 20.7% 0.5% 5.4% 4.5% 2.5%

Mecklenburg County

919,628 55.3% 30.8% 0.5% 4.7% 6.2% 2.6%

State of NC 9,535,483 68.5% 21.5% 1.3% 2.3% 4.3% 2.2%

Source: US Census Bureau, American Fact Finder, 2010 Census, Summary File DP-1, 2010 Demographic Profile Data, Profile of General Population and Housing Characteristics: 2010. Notes: Percentages were calculated.

According to the 2010 U.S. Census Bureau, 9.8% of Wake County residents are Hispanic or Latino, compared to 12.2% in Mecklenburg County and 8.4% statewide.

Population Distribution by Ethnicity

Location Total

Population Hispanic or Latino of Any Race

Wake County 900,993 9.8%

Mecklenburg County 919,628 12.2%

State of NC 9,535,483 8.4%

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According to the U.S. Census Bureau, 64,743 foreign-born persons came to Wake County between 2000 and 2010. In 2010, of the 51,973 non-English speaking households in Wake County, 12,686 were linguistically isolated (24%). A greater number of Spanish-speaking households were linguistically isolated than households speaking other languages.

Household Language by Linguistic Isolation 2010 American Community Survey (5 Year Estimate)

Location Total

Households

Number of Households

English- Speaking

Spanish-Speaking Other Indo- European

Languages

Asian or Pacific Island Languages

Other Languages

Isolated Not

isolated Isolated

Not isolated

Isolated Not

isolated Isolated

Not isolated

Wake County

325,486 273,513 8,523 15,923 1,353 12,02 2,192 7,730 618 3,613

Mecklenburg County

350,392 293,769 11,558 18,516 2,019 11,578 2,541 6,885 530 2,996

State of NC 3,262,179 3,253,431 77,558 150,348 7,770 69,662 11,304 39,025 2,449 14,632

Source: US Census Bureau, American Fact Finder, Table B16002: Household Language by Linguistic Isolation, 2006-2010 American Community Survey 5-Year Estimates. Note: A linguistically isolated household is one in which no member 14 years and over (1) speaks only English, or (2) speaks a non-English language and speaks English "very well". In other words, all members 14 years old and over have at least some difficulty with English.

 Hispanics accounted for 20% of the county’s growth in the last decade.  The Hispanic population in Wake County grew by 53,937 from 2000 to 2010. In 2010 the

areas of Wake County where the Hispanic population is more than 15% includes the eastern part of the county, North Raleigh, and southeast Raleigh near Garner.

Map of Percent of Hispanic or Latino Population by Census Tract, Wake County, 2010

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Community Profiles

This section contains profiles on population, household, and economic characteristics for Wake County and each of Wake County’s 12 core municipalities. To develop each jurisdiction’s profile, socio- economic data was used from the 2000 and 2010 U.S. Census, including the 10 year percent change to compare growth for each town. Additional estimates about each town’s median age, educational attainment, and median household income were sourced from the 2007-2011 U.S. Census Bureau American Community Survey (ACS). ACS estimates are also published annually for single year and three year average releases for geographies with minimum population of 65,000 and 20,000 residents respectively. Several of the smaller towns in Wake County do not meet the 20,000 population threshold; therefore, five year average estimates were used.

Map of Core Municipalities in Wake County

Source: Wake County Community Services Department. Note: Map also displays 3 municipalities from adjacent counties that have annexed into Wake County: Angier, Clayton, and Durham.

GARNER

MORRISVILLE

APEX

ZEBULON

ROLESVILLE

WAKE FOREST

WENDELL KNIGHTDALE

RALEIGH

CARY

HOLLY SPRINGS

FUQUAY- VARINA

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Image: Wake County

Wake County was formed in 1771 from Johnston, Cumberland, and Orange counties and was named after Margaret Wake Tryon, wife of the royal governor William Tyron. 2012, Wake County was home to an estimated 929,780 residents, an increase of approximately 30,000 since the 2010 Census. Wake County is almost seven times as densely populated as NC as a whole.

Con ta ct I nf or ma t ion

Town Hall: P.O. Box 550

Raleigh, NC 27602

Phone: (919) 856-6160

Website: http://www.wakegov.com

De mog ra p hi c P ro fi le : Wa k e Co un ty, N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 900,993 100% 627,846 100% 273,147 44% Population by Race American Indian/Alaska native 4,503 1% 2,152 0% 2,351 109%

Asian 48,553 5% 21,249 3% 27,304 129%

Black or African American 186,510 21% 123,820 20% 62,690 51%

Native Hawaiian/Other Pacific native

387 0% 212 0% 175 83%

Some other race 40,928 5% 15,548 2% 25,380 163%

Two or more races 22,566 3% 10,321 2% 12,245 119%

White 597,546 66% 454,544 72% 143,002 31%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 87,922 10% 33,985 5% 53,937 159%

Population by Gender

Male 438,792 49% 311,436 50% 127,356 41%

Female 462,201 51% 316,410 50% 145,791 46%

Population by Age

Persons 0 to 4 years 65,495 7% 45,142 7% 20,353 45%

Persons 5 to 17 years 169,118 19% 112,455 18% 56,663 50%

Persons 18 to 64 years 589,831 65% 423,877 68% 165,954 39%

Persons 65 years and over 76,549 9% 46,372 7% 30,177 65%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 929,780  Median age2: 34.4  Percent high school graduate or

higher2: 91.8%

 Median household income (dollars)2: $65,929

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

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Image: Town of Apex website

Apex is located in the southwestern part of Wake County, approximately 20 minutes from Raleigh. Incorporated in 1873, Apex was named for its location as the highest point on the Chatham Railroad that extended between Richmond, Virginia and Jacksonville, Florida. In 1911, a fire destroyed a large portion of the downtown buisness district; however, the town rebuilt and restored its railroad heritage, maintaining over 60 buildings on the National Register of Historic Places.

Con ta ct I nf or ma t ion

Town Hall: 73 Hunter Street

Apex, NC 27502

Phone: (919) 249-3400

Website: http://www.apexnc.org

De mog ra p hi c P ro fi le : A pe x , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 37,476 100% 20,212 100% 17,264 85% Population by Race American Indian/Alaska native 106 0% 58 0% 48 83%

Asian 2,652 7% 863 4% 1,789 207%

Black or African American 2,862 8% 1,526 8% 1,336 88%

Native Hawaiian/Other Pacific native

31 0% 12 0% 19 158%

Some other race 1,075 3% 224 1% 851 380%

Two or more races 954 3% 337 2% 617 183%

White 29,796 80% 17,192 85% 12,604 73%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 2,655 7% 648 3% 2,007 310%

Population by Gender

Male 18,232 49% 9,993 49% 8,239 82%

Female 19,244 51% 10,219 51% 9,025 88%

Population by Age

Persons 0 to 4 years 3,191 9% 2,104 10% 1,087 52%

Persons 5 to 17 years 9,168 24% 4,126 20% 5,042 122%

Persons 18 to 64 years 22,997 61% 13,174 65% 9,823 75%

Persons 65 years and over 2,120 6% 808 4% 1,312 162%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 38,702  Median age2: 34.1  Percent high school graduate or

higher2: 96.6%

 Median household income (dollars)2: $86,782

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

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Image: Town of Cary website

Incorporated in 1871, Cary is located west of Raleigh and is named after Samuel Fenton Cary, former Ohio Senator and temperance movement leader. Settlers of English decent lived in the area now known as Cary since the 1750s. Cary is the fastest growing city in North Carolina and the 12th fastest growing city in the nation (U.S. Census Bureau, Annual Estimates of Resident Population for Cities over 50,000, April 1, 2010 to July 1, 2012). The population of Cary has continued to grow due to its proximity to the Research Triangle Park, home to more than 170 global companies and research and development organizations.

Con ta ct I nf or ma t ion

Town Hall: 316 North Academy Street

Cary, NC 27513

Phone: (919) 469-4000

Website: http://www.townofcary.org

De mog ra p hi c P ro fi le : Ca ry , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 135,234 100% 94,536 100% 40,698 43% Population by Race American Indian/Alaska native 559 0% 251 0% 308 123%

Asian 17,668 13% 7,643 8% 10,025 131%

Black or African American 10,787 8% 5,813 6% 4,974 86%

Native Hawaiian/Other Pacific native

46 0% 28 0% 18 64%

Some other race 3,760 3% 1,392 1% 2,368 170%

Two or more races 3,507 3% 1,726 2% 1,781 103%

White 98,907 73% 77,683 82% 21,224 27%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 10,364 8% 4,047 4% 6,317 156%

Population by Gender

Male 65,819 49% 47,075 50% 18,744 40%

Female 69,415 51% 47,461 50% 21,954 46%

Population by Age

Persons 0 to 4 years 9,444 7% 7,619 8% 1,825 24%

Persons 5 to 17 years 28,066 21% 19,855 21% 8,211 41%

Persons 18 to 64 years 86,040 64% 61,993 66% 24,047 39%

Persons 65 years and over 11,684 9% 5,069 5% 6,615 131%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 139,633  Median age2: 36.4  Percent high school graduate or

higher2: 95.1%

 Median household income (dollars)2: $91,997

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

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Image: Town of Fuquay-Varina website

In the early 1900’s tobacco farmers, fleeing the tobacco blight in Granville County, began migrating into Southern Wake County. Their “golden weed” fostered a large commercial tobacco market. Railroads flourished and traffic flowed along Main Street in Fuquay Springs and around the Broad Street station, now known simply as Varina. Fuquay Springs, incorporated in 1909, joined the neighboring community of Varina in 1964 as one municipality.

Con ta ct I nf or ma t ion

Town Hall: 410 Honeycutt Road

Fuquay-Varina, NC 27526

Phone: (919) 552-1400

Website: http://www.fuquay-varina.org

De mog ra p hi c P ro fi le : F uq u a y -V a r ina , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 17,937 100% 7,898 100% 10,039 127%

Population by Race American Indian/Alaska native 110 1% 32 0% 78 244%

Asian 361 2% 38 0% 323 850%

Black or African American 3,527 20% 1,927 24% 1,600 83%

Native Hawaiian/Other Pacific native

5 0% 0 0% 5 0%

Some other race 475 3% 232 3% 243 105%

Two or more races 492 3% 91 1% 401 441%

White 12,967 72% 5,578 71% 7,389 132%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 1,738 10% 583 7% 1,155 198%

Population by Gender

Male 8,486 47% 3,719 47% 4,767 128%

Female 9,451 53% 4,179 53% 5,272 126%

Population by Age

Persons 0 to 4 years 1,698 9% 694 9% 1,004 145%

Persons 5 to 17 years 3,687 21% 1,460 18% 2,227 153%

Persons 18 to 64 years 10,545 59% 4,717 60% 5,828 124%

Persons 65 years and over 2,007 11% 1,027 13% 980 95%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 18,528  Median age2: 34.1  Percent high school graduate or

higher2: 92.3%

 Median household income (dollars)2: $70,744

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

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Image: Town of Garner website

Located at the intersection of U.S. 70 and I-40, Garner is approximately 8 miles south of Raleigh. Incorporated in 1883, Garner began as the location of the North Carolina railroad station between Goldsboro and Charlotte. With the increased population and residential growth, Garner has burgeoned in business and service establishments, both within the corporation limits and the extraterritorial jurisdiction of the town. Town officials predict the town will continue to grow at a rapid rate.

Con ta ct I nf or ma t ion

Town Hall: 900 7th Avenue

Garner, NC 27529

Phone: (919) 773-4407

Website: http://www.garnernc.gov

De mog ra p hi c P ro fi le : G a r ne r , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 25,745 100% 17,757 100% 7,988 45% Population by Race American Indian/Alaska native 140 1% 73 0% 67 92%

Asian 474 2% 197 1% 277 141%

Black or African American 8,468 33% 4,817 27% 3,651 76%

Native Hawaiian/Other Pacific native

12 0% 4 0% 8 200%

Some other race 1,173 5% 492 3% 681 138%

Two or more races 590 2% 273 2% 317 116%

White 14,888 58% 11,901 67% 2,987 25%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 2,561 10% 843 5% 1,718 204%

Population by Gender

Male 12,231 48% 8,581 48% 3,650 43%

Female 13,514 52% 9,176 52% 4,338 47%

Population by Age

Persons 0 to 4 years 1,819 7% 1,198 7% 621 52%

Persons 5 to 17 years 4,458 17% 3,244 18% 1,214 37%

Persons 18 to 64 years 16,440 64% 11,381 64% 5,059 44%

Persons 65 years and over 3,028 12% 1,934 11% 1,094 57%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 26,589  Median age2: 35.9  Percent high school graduate or

higher2: 90.9%

 Median household income (dollars)2: $60,894

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

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Image: Town of Holly Springs website

Holly Springs is located in the southwest corner of Wake County. In colonial times, a small cluster of homes and businesses formed in Tuscarora Indian hunting around near a freshwater springs surrounded by 40-foot holly trees. Incorporated in 1877, the Town of less than 1,000 in 1990 has grown to more than 25,000.

Con ta ct I nf or ma t ion

Town Hall: 128 South Main Street

Holly Springs, NC 27540

Phone: (919) 552-6221

Website: http://www.hollyspringsnc.us

De mog ra p hi c P ro fi le : Ho ll y S pr ing s , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 24,661 100% 9,192 100% 15,469 168% Population by Race American Indian/Alaska native 103 0% 39 0% 64 164%

Asian 724 3% 113 1% 611 541%

Black or African American 3,101 13% 1,714 19% 1,387 81%

Native Hawaiian/Other Pacific native

13 0% 1 0% 12 1200%

Some other race 432 2% 103 1% 329 319%

Two or more races 614 2% 131 1% 483 369%

White 19,674 80% 7,091 77% 12,583 177%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 1,544 6% 278 3% 1,266 455%

Population by Gender

Male 11,996 49% 4,533 49% 7,463 165%

Female 12,665 51% 4,659 51% 8,006 172%

Population by Age

Persons 0 to 4 years 2,507 10% 1,058 12% 1,449 137%

Persons 5 to 17 years 6,206 25% 1,822 20% 4,384 241%

Persons 18 to 64 years 14,742 60% 6,053 66% 8,689 144%

Persons 65 years and over 1,206 5% 259 3% 947 366%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 25,468  Median age2: 33.2  Percent high school graduate or

higher2: 96.3%

 Median household income (dollars)2: $89,421

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

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Image: Town of Knightdale website

Located along US 64, Knightdale was incorporated in 1927 and borders east of Raleigh at the Neuse River. Early inhabitants of Knightdale included the Tuscarora Indians. In 1730, John Hinton settled in the Knightdale area and established seven planations, including The Oaks, Midway, and Beaver Dam. For many years the Knightdale area was a crossroads served only by a post office. By the end of the 19th century, locals decided there was a need to establish a town. Knightdale is named after Henry Haywood Knight, who donated land holdings to the Nortfolk and Southern Railroad Company in order to entice the company to build a railroad that would provide freight and passenger service.

Con ta ct I nf or ma t ion

Town Hall: 950 Steeple Square Court

Knightdale, NC 27545

Phone: (919) 217-2220

Website: http://www.knightdalenc.gov

De mog ra p hi c P ro fi le : Kn ig h tda le , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 11,401 100% 5,958 100% 5,443 91% Population by Race American Indian/Alaska native 66 1% 21 0% 45 214%

Asian 193 2% 87 1% 106 122%

Black or African American 4,368 38% 1,599 27% 2,769 173%

Native Hawaiian/Other Pacific native

6 0% 2 0% 4 200%

Some other race 670 6% 121 2% 549 454%

Two or more races 400 4% 85 1% 315 371%

White 5,698 50% 4,043 68% 1,655 41%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 1,299 11% 220 4% 1,079 490%

Population by Gender

Male 5,315 47% 2,783 47% 2,532 91%

Female 6,086 53% 3,175 53% 2,911 92%

Population by Age

Persons 0 to 4 years 891 8% 561 9% 330 59%

Persons 5 to 17 years 2,458 22% 1,327 22% 1,131 85%

Persons 18 to 64 years 7,321 64% 3,767 63% 3,554 94%

Persons 65 years and over 731 6% 303 5% 428 141%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 11,776  Median age2: 31.6  Percent high school graduate or

higher2: 93%

 Median household income (dollars)2: $75,285

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

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Image: Town of Morrisville website

Morrisville is equal distance from Raleigh and Durham and is located in western Wake County near the Research Triangle Park and Raleigh-Durham International Aiport. Morrisville was named for Jeremiah Morris who donated three acres of land to the North Carolina Railroad in 1852 for a water station, woodshed, and other buildings in support of the railroad. The deed transaction is believed to be on November 30, 1852, which references Crabtree Creek. The town was officially chartered in 1875 but was disincorporated in 1933. Eventually the town charter was restored in 1947.

Con ta ct I nf or ma t ion

Town Hall: 100 Town Hall Drive

Morrisville, NC 27560

Phone: (919) 463-6200

Website: http://www.ci.morrisville.nc.us

De mog ra p hi c P ro fi le : Mo rr is v ille , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 18,576 100% 5,208 100% 13,368 257% Population by Race American Indian/Alaska native 75 0% 23 0% 52 226%

Asian 5,058 27% 472 9% 4,586 972%

Black or African American 2,402 13% 573 11% 1,829 319%

Native Hawaiian/Other Pacific native

12 0% 0 0% 12 0%

Some other race 375 2% 61 1% 314 515%

Two or more races 624 3% 97 2% 527 543%

White 10,030 54% 3,982 76% 6,048 152%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 1,092 6% 170 3% 922 542%

Population by Gender

Male 9,132 49% 2,686 52% 6,446 240%

Female 9,444 51% 2,522 48% 6,922 274%

Population by Age

Persons 0 to 4 years 1,669 9% 379 7% 1,290 340%

Persons 5 to 17 years 3,338 18% 696 13% 2,642 380%

Persons 18 to 64 years 12,766 69% 3,924 75% 8,842 225%

Persons 65 years and over 803 4% 209 4% 594 284%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 19,184  Median age2: 33.5  Percent high school graduate or

higher2: 97.9%

 Median household income (dollars)2: $78,088

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

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Image: Town of Raleigh website

Raleigh is second largest city in North Carolina. Within North Carolina, Raleigh is the 4th fastest growing city, following Cary, Charlotte, and Durham (U.S. Census Bureau, Annual Estimates of Resident Population for Cities over 50,000, April 1, 2010 to July 1, 2012). In 1792 the City of Raleigh, named in honor of Sir Walter Raleigh, became the capital of North Carolina. Raleigh is known as the "City of Oaks" for its many oak trees, which line the streets in the heart of the city.

Con ta ct I nf or ma t ion

Town Hall: 222 West Hargett Street

Raleigh, NC 27601

Phone: (919) 996-3000

Website: http://www.raleighnc.gov

De mog ra p hi c P ro fi le : Ra l e ig h , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 403,892 100% 276,093 100% 127,799 46%

Population by Race American Indian/Alaska native 1,963 0% 981 0% 982 100%

Asian 17,434 4% 9,327 3% 8,107 87%

Black or African American 118,471 29% 76,756 28% 41,715 54%

Native Hawaiian/Other Pacific native

173 0% 118 0% 55 47%

Some other race 22,942 6% 8,946 3% 13,996 156%

Two or more races 10,532 3% 5,179 2% 5,353 103%

White 232,377 58% 174,786 63% 57,591 33%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 45,868 11% 19,308 7% 26,560 138%

Population by Gender

Male 195,143 48% 136,648 49% 58,495 43%

Female 208,749 52% 139,445 51% 69,304 50%

Population by Age

Persons 0 to 4 years 29,027 7% 17,461 6% 11,566 66%

Persons 5 to 17 years 64,209 16% 40,145 15% 24,064 60%

Persons 18 to 64 years 277,518 69% 195,492 71% 82,026 42%

Persons 65 years and over 33,138 8% 22,995 8% 10,143 44%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 416,468  Median age2: 31.8  Percent high school graduate or

higher2: 90.7%

 Median household income (dollars)2: $52,819

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

2013 Wake County Community Health Needs Assessment

Chapter 2| Community Profiles Page 39

Image: Town of Rolesville website

Rolesville is located in northeastern Wake County and is the second oldest town in Wake County. Incorporated in 1837, thet town began as a farming community and was named after William H. Roles, who was a local land owner, merchant, cotton broker, cotton gin owner, and postmaster.

Con ta ct I nf or ma t ion

Town Hall: 502 Southtown Circle

Rolesville, NC 27571

Phone: (919) 556-3506

Website: http://rolesvillenc.gov

De mog ra p hi c P ro fi le : Ro le s v ille , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 3,786 100% 907 100% 2,879 317%

Population by Race American Indian/Alaska native 15 0% 2 0% 13 650%

Asian 119 3% 4 0% 115 2875%

Black or African American 673 18% 77 8% 596 774%

Native Hawaiian/Other Pacific native

0 0% 0 0% 0 0%

Some other race 94 2% 52 6% 42 81%

Two or more races 79 2% 10 1% 69 690%

White 2,806 74% 762 84% 2,044 268%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 233 6% 63 7% 170 270%

Population by Gender

Male 1,911 50% 466 51% 1,445 310%

Female 1,875 50% 441 49% 1,434 325%

Population by Age

Persons 0 to 4 years 331 9% 56 6% 275 491%

Persons 5 to 17 years 929 25% 174 19% 755 434%

Persons 18 to 64 years 2,254 60% 574 63% 1,680 293%

Persons 65 years and over 272 7% 103 11% 169 164%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 3,911  Median age2: 34.2 years  Percent high school graduate or

higher2: 83.8%

 Median household income (dollars)2: $67,273

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

2013 Wake County Community Health Needs Assessment

Chapter 2| Community Profiles Page 40

Image: Town of Wake Forest website

Located north of Raleigh, Wake Forest was originally incorporated as the “Town of Wake Forest College” in 1880. The college, now known as Wake Forest University, moved to Winston-Salem in 1956. Wake Forest is now home to the Southeastern Baptist Theological Seminary. Falls Lake State Recreation Area is also located in Wake Forest.

Con ta ct I nf or ma t ion

Town Hall: 301 S. Brooks Street

Wake Forest, NC 27587

Phone: (919) 435-9400

Website: http://www.wakeforestnc.gov

De mog ra p hi c P ro fi le : Wa k e F o re s t , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 30,117 100% 12,588 100% 17,529 139%

Population by Race American Indian/Alaska native 125 0% 26 0% 99 381%

Asian 887 3% 256 2% 631 246%

Black or African American 4,594 15% 1,987 16% 2,607 131%

Native Hawaiian/Other Pacific native

12 0% 1 0% 11 1100%

Some other race 471 2% 98 1% 373 381%

Two or more races 737 2% 196 2% 541 276%

White 23,291 77% 10,024 80% 13,267 132%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 1,681 6% 262 2% 1,419 542%

Population by Gender

Male 14,484 48% 6,024 48% 8,460 140%

Female 15,633 52% 6,564 52% 9,069 138%

Population by Age

Persons 0 to 4 years 2,756 9% 1,229 10% 1,527 124%

Persons 5 to 17 years 7,008 23% 2,507 20% 4,501 180%

Persons 18 to 64 years 17,901 59% 7,858 62% 10,043 128%

Persons 65 years and over 2,452 8% 994 8% 1,458 147%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 31,073  Median age2: 33.4 years  Percent high school graduate or

higher2: 94.8%

 Median household income (dollars)2: $72,155

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

2013 Wake County Community Health Needs Assessment

Chapter 2| Community Profiles Page 41

Image: Town of Wendell website

Wendell, incorporated in 1903, is located in eastern Wake County, approximately 12 miles from Raleigh. Wendell started in the 1850s when tobacco farmers in Granville County were victims of a blight (known as the Granville County wilt), where farmers chose to move to a new location after their crops failed. Wendell started to experience increased growth and expansion due to the town’s close proximity to Raleigh via Highway US 64.

Con ta ct I nf or ma t ion

Town Hall: 15 E. Fourth Street

Wendell, NC 27591

Phone: (919) 365-4450

Website: www.townofwendell.com

De mog ra p hi c P ro fi le : We n de l l , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 5,845 100% 4,247 100% 1,598 38%

Population by Race American Indian/Alaska native 46 1% 18 0.4% 28 156%

Asian 52 1% 17 0.4% 35 206%

Black or African American 1,768 30% 1,022 24% 746 73%

Native Hawaiian/Other Pacific native 0 0% 2 0.1% -2 -100%

Some other race 395 7% 140 3% 255 182%

Two or more races 189 3% 57 1% 132 232%

White 3,395 58% 2,991 70% 404 14%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 673 12% 251 6% 422 168%

Population by Gender

Male 2,690 46% 1,934 46% 756 39%

Female 3,155 54% 2,313 55% 842 36%

Population by Age

Persons 0 to 4 years 468 8% 339 8% 129 38%

Persons 5 to 17 years 1,258 22% 908 21% 350 39%

Persons 18 to 64 years 3,443 59% 2,470 58% 973 39%

Persons 65 years and over 676 12% 530 13% 146 28%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 6,035  Median age2: 38.1 years  Percent high school graduate or

higher2: 84.8%

 Median household income (dollars)2: $35,864

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

2013 Wake County Community Health Needs Assessment

Chapter 2| Community Profiles Page 42

Image: Town of Zebulon website

Zebulon, located along US Highways 64 and 264, is the easternmost municipality in Wake County and is approximately 20 miles from Raleigh. Zebulon was incorporated in 1907 and was named after Governor Zebulon B. Vance. Zebulon is known as the site of the Five Counties Stadium, a regional attraction that is the home to the Carolina Mudcats (a minor baseball league affiliate of the Cincinnati Reds).

Con ta ct I nf or ma t ion

Town Hall: 1003 N. Arendell Avenue

Zebulon, NC 27597

Phone: (919) 269-7455 Website: www.townofzebulon.org

De mog ra p hi c P ro fi le : Ze bul on , N C

2010 Census 2000 Census 2000-2010 Change Counts Percent Counts Percent Counts Percent

Total Population 4,433 100% 4,046 100% 387 10%

Population by Race American Indian/Alaska native 22 1% 23 1% -1 -4%

Asian 46 1% 41 1% 5 12%

Black or African American 1,713 39% 1,608 40% 105 7%

Native Hawaiian/Other Pacific native 1 0% 0 0% 1 0%

Some other race 393 9% 162 4% 231 143%

Two or more races 159 4% 41 1% 118 288%

White 2,099 47% 2,171 54% -72 -3%

Population by Hispanic or Latino Origin (of any race)

Hispanic or Latino Origin 706 16% 348 9% 358 103%

Population by Gender

Male 2,032 46% 1,860 46% 172 9%

Female 2,401 54% 2,186 54% 215 10%

Population by Age

Persons 0 to 4 years 346 8% 342 9% 4 1%

Persons 5 to 17 years 904 20% 803 20% 101 13%

Persons 18 to 64 years 2,603 59% 2,400 59% 203 9%

Persons 65 years and over 580 13% 501 12% 79 16%

Sources: U.S. Census Bureau, American Fact Finder, 2010 and 2000 Census. Note: Percentages were rounded.

Quick Facts

 Total population1: 4,574  Median age2: 39.4 years  Percent high school graduate or

higher2: 70.6%

 Median household income (dollars)2: $45,625

Sources: 1 U.S. Census Bureau: Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2011. 2U.S. Census Bureau, 2007-2011 American Community Survey.

2013 Wake County Community Health Needs Assessment

Page 43

CHAPTER 3:

SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 44

CHAPTER 3 | SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH Health starts in our homes, schools, workplaces, neighborhoods, and communities. Health is influenced by behavior and access to care, but health can also be determined by social and economic characteristics (Healthy People 2020). These characteristics are defined as social determinants of health; and are the circumstances in which people are born, grow up, live, work, and age; as well as the systems put into place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics (World Health Organization, Social Determinants of Health). Social determinants of health can explain in part why some residents are healthier than others and why some residents are more generally not as healthy as they could be. Poverty, education level, and housing are three important social determinants of health. These factors are strongly tied to individual health. Residents with higher incomes, more years of education, and a healthy and safe environment to live in have better health outcomes and generally have longer life expectancies (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Quick Facts

Positive Trends:

 The high school drop-out rate in Wake County has been on a general decline since the 2006-07 school year. In 2011-12, the rate dropped to 2.83% reached—the lowest point since the 2004-05 school year.

 In 2012, the Raleigh-Durham area was ranked the #1 least congested metro city with a population of 1-3 million in the U.S.

 The Index, Violent, and Property crime rates in Wake County have been below the comparable rates in Mecklenburg County and NC since 2006.

Areas for Improvement:

 Wake County graduation rates among students classified as economically disadvantaged and those with

limited English proficiency are lower compared to both Mecklenburg County and North Carolina.

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 45

Education and Lifelong Learning

Adults who did not graduate from high school are more likely to suffer from health conditions such as heart disease, high blood pressure, stroke, high cholesterol, and diabetes. Additionally, individuals with less education are also more likely to engage in risky health behaviors, such as smoking and being physically inactive (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Statistics, Targets, and Disparities

EDUCATION ATTAINMENT

According to 2011 U.S. Census estimates, 91.8% of residents in Wake County are high school graduates or higher. Approximately 48% of residents in Wake County has earned a bachelor’s degree or higher, compared to approximately 40% in Mecklenburg County and 27% statewide.

Source: US Census Bureau, American Fact Finder, American Community Survey, 2005-2009 American Community Survey (ACS) 5-Year Estimates.

During the 2011-2012 school year, Wake County schools graduated 80.6% of the freshman class who entered high school four years prior.

 The Healthy NC 2020 target is to increase the four-year high school graduation rate to 94.6%.

Female students demonstrated a higher graduation rate compared to males. Among students classified as economically disadvantaged and those with limited English proficiency, Wake County graduation rates are lower compared to both Mecklenburg County and North Carolina. While they represent a small number of students throughout the school districts presented, fewer than half of the students with limited English proficiency graduate from high school within four years.

91.8 47.9

88.6

40.4

84.1

26.5

Population High School Graduate or Higher Population Bachelor's Degree or Higher

P e rc

e n t

Educational Attainment, Adults Aged 25 and Older, 2011

Wake County Mecklenburg County State of NC

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 46

Percent of Students Graduating by School System by Cohort, 2011-2012

School System All

Students Male Female

Economically Disadvantaged

Limited English

Proficiency

Wake County Schools

80.6% 76.8% 84.7% 65.1% 34.6%

Charlotte- Mecklenburg Schools

76.4% 70.8% 82.1% 69.7% 46.1%

State of NC 80.4% 76.5% 84.6% 74.7% 50%

Source: Public Schools of North Carolina, Cohort Graduation Rate. 4-Year Cohort Graduation Rate Report, 2008-09 Entering 9th Graders Graduating in 2011-12 or Earlier.

The high school drop-out rate has been on a general decline since the 2006-2007 school year in Wake County and in 2011-2012 was at the lowest point since 2004-05, at 2.83%.

Source: NC Dept of Public Instruction, Research and Evaluation, Dropout Data and Collection Process, Annual Dropout Reports. Note: A "dropout" is any student who leaves school for any reason before graduation or completion of a program of studies without transferring to another elementary or secondary school. For reporting purposes, a dropout is a student who was enrolled at some time during the previous school year, but who was not enrolled (and who does not meet reporting exclusions) on day 20 of the current school year.

In the 2011-2012 school year, there were 1,236 high school dropout events. Of those events, 44% are among African American students, compared to 26% among white students and 23% among Hispanic students.

R a te

High School Dropout Rates, 2004-05 through 2011-12 Rate per 1,000 students

Wake County Schools

Charlotte-Mecklenburg Schools

State of NC

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 47

Source: NC Dept of Public Instruction, Consolidated Data Report, 2011-2012. Note: Race and ethnicity are considered exclusive categories.

CURRENT TRENDS AND S TUDENT ACHIEVEMENT

In Wake County there are 173 public schools with approximately 151,000 students enrolled in the 2011-2012 school year; the largest public school system in the state, Wake County represents 10% of all public school students in North Carolina. The number of students enrolled in Wake County Schools in the 2011-12 school year has increased 27.6% since 2004-05 (NC Department of Public Instruction, Data and Statistics, Education Data: NC Statistical Profile).

For the 2011-2012 school year, the per pupil expenditure for Wake County students from state, federal and local funds was $7,880, the lowest compared with Mecklenburg and North Carolina overall.

Source: NC Department of Public Instruction, Data and Statistics, Education Data, NC School Report Cards.

For the 2011-2012 school year, a higher percentage of 3rd graders in Wake County were performing at or above grade level in both reading and math compared to Mecklenburg County and North Carolina. A higher percentage of Wake County 8th graders performed at or above grade

0% 1% 2% 4%

23%

26%

44%

High School Dropouts Events by Race or Ethnicity, Wake County, 2011-12 School Year

Pacific Islander

American Indian

Asian

Multiracial

Hispanic

White

African American

$7,880

$8,121

$8,417

Wake County Mecklenburg County State of NC

D o ll a rs

Per Pupil Expenditure State, Federal and Local, 2011-2012 School Year

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 48

level in reading, while Mecklenburg County 8th graders performed slightly higher on the math End of Grade (EOG) test.

Source: NC Department of Public Instruction, Data and Statistics, Education Data, NC School Report Cards. District Profile.

There are currently 72 private schools in Wake County with 16,135 students. Forty of the private schools are categorized as religiously affiliated and 32 are independent schools (NC Department of Administration, Conventional Non-Public Schools, 2011-2012 Directory).

COMMUNITY ENRICHMENT AND EDUCATION

Wake County Public Libraries is a division of Wake County Government’s Community Services Department. The library provides services to children, promotes recreational reading, encourages lifelong learning, serves as a community center, and works to bridge the technology gap.

With 210 staff members, the system operates 6 regional libraries, 13 community libraries, and the Olivia Raney Local History Library. In 2011-2012, Wake County Public Libraries renovated and reopened three libraries.

Wake County Public Libraries provided the following services in 2011-2012:

 Circulated more than 12 million books in both traditional and electronic format.  Hosted more than one million public computer sessions.  Provided more than 9,000 programs that educated 285,000 individuals.  Answered more than two million reference questions.

In addition, 8 million people visited the library and another four million utilized the library remotely through the library website.

Source: Wake County Public Libraries. Explore the possibilities: 2011-2012 report.

75.3

87.2

76.6

85.6

69.2

81.5

70.7

86.4

68.8

82.8

71.1

85.2

3rd Graders At/Above Grade Level, ABCs EOG

Reading Test

3rd Graders At/Above Grade Level, ABCs EOG

Math Test

8th Graders At/Above Grade Level, ABCs EOG

Reading Test

8th Graders At/Above Grade Level, ABCs EOG

Math Test

P e rc

e n t

End-of-Grade (EOG) Test Results, 2011-12 School Year

Wake County Mecklenburg County State of NC

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Chapter 3| Social and Economic Determinants of Health Page 49

Community Perceptions

According to the 2013 Community Health Opinion Survey, residents identified school reassignment as the #2 community concern.

Source: 2013 Wake County Community Health Opinion Survey.

The Wake County education system was identified as a community asset according to two focus groups.

Heritage High holds first graduation in 2013. Image Source: Wake County Public School System.

Unemployment Employment

Opportunities

School Reassignment

Traffic Congestion

Low Income, Poverty

Drug and Alcohol Abuse

Violent Crimes Homelessness

Issues 11.52 10.48 8.47 8.37 5.76 5.18 4.91

P e rc

e n t

Issues that Affect the Quality of Life in Wake County (Wake CHOS, 2013) 95% Confidence Limits

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 50

Resources

Lifelong Learning

with Community

Schools offer

enrichment classes

to adults in the

evenings in

community schools,

usually located in

public high schools

around the county.

The Online

Learning with

Community Schools

program offers

online courses for

those with a

computer and

internet connection.

To promote the love of reading and to foster the

pursuit of knowledge for the residents of Wake County, the Wake

County Public Library system

provides services to children, offers

recreational reading, acts as a community center,

and works to bridge the

technology gap.

However, the youth focus group voiced concern over school crowding and the distance to school from their home.

“There’s so many people that are going to school and it’s hard to - I

mean, where are you going to put everyone? You can’t have classes

that are 50, 60 people…teachers can’t manage that.”

- Community member

Additionally, the Hispanic focus group noted that a major change in Wake County in the past 5 years has been the overburdening of the school bus system.

Housing and Homelessness

Families with difficulties paying rent and utilities are more likely to report barriers to accessing health care, higher use of the emergency department, and more hospitalizations (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Statistics, Targets, and Disparities

HOUSING

According to the U.S. Census Bureau, housing units in Wake County increased by 112,883 from 2000 to 2010. The percent of the all housing units classified as vacant increased slightly, while the percent of owner occupied units decreased slightly. The percent of housing units occupied by renters increased between 2000 and 2010, despite the higher median gross rental costs in Wake County, where the median monthly rent is 18% higher in Wake County compared with the state.

Source: US Census Bureau, American FactFinder, 2000 US Census, Summary File 1 (SF-1).

http://cs.wcpss.net/index.php?route=lllcontroller

http://www.wakegov.com/libraries/Pages/default.aspx

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 51

In 2010, the median monthly housing cost for homes with mortgages in Wake County at $1,580 was 27% higher than the state at $1,244.

In both 2010 and 2011, approximately 46% of the housing units that were rented in Wake County used more than 30% of the householder’s income, a lower percentage than in Mecklenburg County and a higher percentage than North Carolina as a whole. However, the Healthy NC 2020 target is to decrease the percentage to 36.1%.

HOMELESSNESS

Homelessness is defined by the U.S. Department of Housing and Urban Development, as persons living in emergency shelters (including domestic violence shelters), transitional housing for the homeless, or persons living in places not meant for human habitation, such as cars, parks, sidewalks, abandoned buildings, or on the street.

According to the N.C. Interagency Council for Coordinating Homeless Program, an organization that sponsors annual point-in-time surveys each January, there were 1,150 homeless persons living in shelters or going unsheltered in Wake County in 2011. Among homeless persons in Wake County (sheltered or unsheltered), those with a substance use disorder, the mentally ills, veterans, and victims of domestic violence were the leading subpopulations.

Source: North Carolina Coalition to End Homelessness. North Carolina Point-in-Time Count Reporting Form, January 26, 2011.

Additionally, 8% of household residents in Wake County reported in the 2013 Community Health Opinion Survey that they had someone living with them in the past year due to homelessness.

From 2007 to 2011, the Wake County rates of homelessness have been consistent with the overall state rates, and significantly lower than rates in Mecklenburg County.

176

494

Unaccompanied children (under 18)

Persons with HIV/AIDS

Victims of Domestic Violence

Veterans

Mentally Ill

Substance Use Disorder

Number of Homeless Persons in Wake County by Subpopulation, 2011

Housing Costs

 Median monthly housing cost: o Wake County: $1,580 o NC: $1,244

 Median monthly rent: o Wake County: $845 o NC: $715

Source: U.S. Census Bureau, American Fact Finder, 2010 ACS 5- Year Estimates.

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 52

Source: North Carolina Coalition to End Homelessness. North Carolina Point-in-Time Count Totals 2007 through 2012. Note: Rates per 10,000 population were calculated using population estimates from the NC State Center for Health Statistics, NCHS Bridged Population Data.

Community Perceptions

According to the 2013 Community Health Opinion Survey, residents identified homelessness as the #7 community concern.

In the focus groups among homeless residents, one concern was the need for places for the homeless to go during the day to avoid getting citations for loitering in public areas. Another concern identified from this focus group was the mental health needs for the homeless, who often do not get treated and end up being incarcerated. Focus group participants also identified the need for a mobile health clinic to reach homeless camps.

“For about three months in a row I was getting citations for being homeless. And the last two times

I got tickets for being homeless, my caseworker went with me to court and she told the DA, she

said, ‘The reason why she homeless is because she don't have nowhere to go’. And so they asked

me where I was living and I said, ‘I'm living in the woods’.”

- Community member

“I saw a homeless girl yesterday. I can tell she has some mental issues and she's pregnant. And

she's still homeless. And probably because of whatever her dysfunctional habit she has, she might

not never go and see a doctor. Somebody should be giving her prenatal advice or things like that.

There has to be some [mobile health clinic] service to go into the woods and talk to people and

see if they have any health problems. That is necessary because some of these people are so

addicted to whatever they are addicted to. If it doesn't hurt, they're not going to go check it.”

- Community member

2007 2008 2009 2010 2011

R a te

Rate of Homelessness per 10,000 population, 2007-2011

Wake County Mecklenburg County NC

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 53

Resources

Affordable housing is a priority and the county is working with community partners to bring more low-cost options to Wake County. In 2012, Commissioners approved loans for 271 units in Raleigh, Cary, Rolesville, Holly Springs, Garner and Wendell. Several of the projects are designed for tenants who frequently have trouble finding housing including senior citizens, disabled veterans and handicapped adults. The Commissioners also approved funding for 15 single family homes in Apex, to be built by Habitat for Humanity for low income, first time home buyers.

Image Source: 2012 Wake County Annual Report

County financing in prior years helped to support several rental communities that opened in the last year, including:

 Meadow Creek Commons Apartments: 48 -units for seniors in Raleigh, completed in April 2012

 Highland Terrace Apartments: 80 -units for seniors in Cary, completed in March 2011

 Sandy Ridge Apartments: 45-units for families in Wendell, completed in May 2011

 Mingo Creek Apartments: 76-units for families in Knightdale, completed in December 2011

Project Homeless Connect , an annual event that helps homeless people with basic needs, was streamlined in 2012 to better meet the needs of the community. The event provides haircuts, coats and blankets, hygiene kits and ID cards; services like behavioral health care, employment, housing and legal assistance; and access to benefits including Medicaid, WIC and food stamps.

The Second Chance Housing program at Brookridge Apartments received a National Association of Counties Achievement Award. The program provides housing to people who are working to move beyond problems including bad credit, a history of evictions, criminal history or disability. In 2011, half of the tenants in the apartment complex were Second Chance tenants, with 65% reporting to have been formerly homeless.

https://www.facebook.com/phcraleigh

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 54

Income and Poverty

In general, increasing income levels correspond with gains in health outcomes. People in poverty have the worst health, compared to people at higher income levels (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Statistics, Targets, and Disparities

In 2011, the personal per capita income for a Wake County resident was $34,965. The median household income in Wake County was $62,020, which is more than $20,000 higher than the average North Carolina household income.

Source: NC Dept of Commerce, AccessNC, Community Demographics, County Report, County Profile. Notes: Per capita personal income is the income earned per person 15 years of age or older in the reference population Median household income pertains to the incomes of all the people 15 years of age or older living in the same household (i.e., occupying the same housing unit) regardless of relationship. For example, two roommates sharing an apartment would be a household, but not a family. Median family income pertains to the income of all the people 15 years of age or older living in the same household who are related either through marriage or bloodline. For example, in the case of a married couple who rent out a room in their house to a non-relative, the household would include all three people, but the family would be just the couple.

Since 1980, the percent of all people living in poverty in Wake County has been consistently lower than Mecklenburg County or North Carolina as a whole. In 2011, the percent of people living in poverty in Wake County was 37% lower than North Carolina.

$31,965

$62,020

$83,107

$31,184

$57,716

$68,218

$23,955

$42,941

$56,153

Per Capita Personal Income Median Household Income Median Family Income

Income Comparison, 2011

Wake County Mecklenburg County State of NC

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 55

Sources: Log Into North Carolina (LINC) Database, Topic Group Employment and Income (Data Item 6094); U.S. Census Bureau, American Fact Finder, American Community Survey, 2010 American Community Survey 5-Year Estimates; U.S. Census Bureau, American Fact Finder, American Community Survey, 2011 American Community Survey 5-Year Estimates. Note: The poverty rate is the percent of the population (individuals and families) whose money income (including job earnings, unemployment compensation, social security income, public assistance, pension/retirement, royalties, child support, etc.) is below the threshold established by the Census Bureau.

In Wake County, the percent of African-American residents in 2011 who live in poverty (17.4 %) is 2.4 times higher than their white peers (7.2%).

1970 1980 1990 2000 2010 2011

P e rc

e n t o f

a ll p

e o p le

i n p

o v e rt

Decadal Annual Poverty Rate, 1970-2011

Wake County Mecklenburg County State of NC

1980 1990 2000 2010 2011

P e rc

e n t o

f a ll p

e o p le

i n p

o v e rt

Racial Disparities in Poverty, Wake County, Decadal Annual Poverty, 1980-2011

African Americans in Poverty Whites in Poverty

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 56

Although it has increased since a low point in 2000, the percent of children under the age of 18 in Wake County living in poverty has remained below the comparable proportions in both Mecklenburg County and North Carolina. In 2011, the percent of children living in poverty (12.6%) was 1.8 times lower than the state (22.3%).

Sources: Log Into North Carolina (LINC) Database, Topic Group Employment and Income (Data Items 6094, 6100, 6102, 6104); U.S.

Census Bureau, American Fact Finder, American Community Survey, 2010 American Community Survey 5-Year Estimates; U.S. Census

Bureau, American Fact Finder, American Community Survey, 2011 American Community Survey 5-Year Estimates.

Community Perceptions

According to the 2013 Community Health Opinion Survey, residents identified poverty as the #4 community concern.

Additionally, residents identified “higher paying employment” as the #3 service in need of improvement in Wake County.

Source: 2013 Wake County Community Health Opinion Survey

1980 1990 2000 2010 2011

P e rc

e n t

Children Under Age of 18 in Poverty, by Decade (1980-2010) and 2011 Estimate

Wake County Mecklenburg County State of NC

Positive Teen Activities

Availability of Employment

Higher Paying Employment

Mental Health Services

Road Safety, Maintenance

Support to Help Manage Health

Conditions

More Affordable,

Better Housing

Services 9.28 7.82 7.55 7.36 6.49 5.9 5.72

P e rc

e n t

Services Identified as in Need of Improvement 95% Confidence Limits

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 57

Resources

 The Warmth for Wake heating assistance program raised more than $34,000 in 2012 and delivered 153 loads of firewood and 52 space heaters to families who were in danger of being without heat during the winter.

 United Way 2-1-1 is a single source for information about community services and for referrals to health and human service programs. Call 2 -1-1 throughout most of the counties in North Carolina, 24 hours a day, 365 days a year to get connected. Bilingual caseworkers are available during regular business hours.

In the focus groups, the ability to pay increasing medications and co-pays was identified as barriers to receiving health care. In addition to affordability of health care, focus group participants were concerned about the accessibility of recreation and youth activities because of cost.

Employment

The 2007-2009 U.S. economic recession was the longest and deepest recession since the Great Depression, and the economy is still recovering. Health insurance is a major determinant of access to both preventive and acute health care. Most Americans rely on employer-provided insurance, and unemployment affects their access to health services, due to both loss of employer-sponsored health insurance and reduced income. According to the 2009 and 2010 National Health Interview Survey (NHIS), unemployed adults aged 18-64 years had poorer mental and physical health than employed adults and were less likely to receive needed medical care and prescriptions due to cost than those who were employed (Centers for Disease Control and Prevention, health and access to care among employed and unemployed adults: U.S., 2009-2010).

Statistics, Targets, and Disparities

Nearly 360,000 workers, or around 81% of the available workforce, worked in Wake County in 2011. In 2011, approximately 19% of Wake County workers traveled out of the county for work, higher than Mecklenburg (12%) and lower than statewide (28%) (U.S. Census Bureau, American Fact Finder, 2011 ACS 5-Year Estimate).

Since 2000, the percent of the civilian labor force in Wake County that was unemployed has been consistently lower than Mecklenburg County and North Carolina. While the percent of unemployed has increased in all locations since 2007, the percent in Wake County has declined since 2010.

http://www.wakegov.com/humanservices/social/energy/Pages/warmthforwake.aspx

http://www.unitedwaytriangle.org/211/

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 58

Source: NC Employment Security Commission, Labor Market Information, Workforce Information, Employed, Unemployed and Unemployment Rates, Labor Force Statistics. Notes: The unemployment rate is calculated by dividing the number of unemployed by the civilian labor force. The civilian labor force is the total employed plus the unemployed. 2012 figures represent the average monthly rate from January through September.

Between January 2010 and January 2011, the number of active job applicants in Wake County remained relatively stable, with the numbers decreasing in the last months of 2010. Compared to Mecklenburg County, Wake County had fewer job applicants, which supports the lower prevalence of the unemployed Wake County.

Source: NC Employment Security Commission, Labor Market Information, Workforce Information, Job Applicants Registered for Work with ESC Offices.

0.0

2.0

4.0

6.0

8.0

10.0

12.0

P e rc

e n t

Percent of Civilian Labor Force Unemployed, 2000-2012

Wake County Mecklenburg County State of NC

15,000

20,000

25,000

30,000

35,000

40,000

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan

N u m

b e r

Number of Active Job Applicants, January 2010-January 2011

Wake County Mecklenburg County

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 59

Resources

The JobLink Career Center at the Millbrook Human Services Center was honored in 2012 at

the Enable America's Governor's Reception for improving employment opportunities for

persons living with disabilities. JobLink Career Centers served 70,000 job seeking customers

workforce related support and services across Wake County.

Community Perceptions

According to the 2013 Community Health Opinion Survey, 72% of residents thought there is enough economic opportunity in Wake County (compared to 53.7% in 2010). However, residents identified unemployment as the #1 community concern. Additionally, residents identified availability of employment as the #2 service in need of improvement in Wake County.

In two focus groups, there was discussion about the need for increasing employment in Wake County, including job assistance for persons with felonies and providing more opportunities for young people to get jobs.

“It's hard for them [felons] to get a job. There's jobs out here but they can't get it because they

have a criminal record. And I don't think that's fair.

- Community member

“There’s a lot of teenagers who want a job but they can’t get one because adults, and it’s not their

fault, got laid off at their job. We’re not getting opportunities for jobs; it’s just in the way its set

up.”

- Community member

Child Welfare and Financial Assistance

Statistics, Targets, and Disparities

CHILD PROTECTIVE SERVICES

The Wake County Child Protective Services program receives reports from the community of suspected child abuse, neglect, and dependence. In fiscal year 2011-2012, there were 339 children entering child welfare custody in Wake County, where 65.2% of the children remained in their initial placement after 540 days, compared to 48% at the state level. In addition, 8.3% of children were placed in non-family settings including emergency shelters, hospitals, or jail or detention centers, compared to 14% statewide.

http://www.joblinkcc.com/centers/centerInfo.asp?ctrID=51

http://www.wakegov.com/services

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 60

Children Entering Child Welfare Custody, 2007-2012

FY2007-08 FY2008-09 FY2009-10 FY2010-11 FY2011-12

Wake County

Number of Children 218 233 267 307 339

Median # of Days in Custody 217 662 577 593 n/a

% Initially Placed with a relative 32.1 25.3 35.2 41.7 31.0

% Initially placed in a Foster Home 44.5 51.1 44.2 33.9 45.7

State of NC

Number of Children 5,048 4,707 4,574 4,700 4,535

Median # of Days in Custody 417 454 452.5 434.5 n/a

% Initially Placed with a relative 25.0 27.0 29.0 32.0 30.0

% Initially placed in a Foster Home 44.0 43.0 43.0 43.0 43.0

Source: Wake County Child Welfare, February 20, 2013.

WORK FIRST

North Carolina’s Temporary Assistance for Needy Families (TANF) program, called Work First, provides parents short-term training, child care assistance, and other services to help them become employed and self-sufficient.

The total number of Work First Family Assistance (WFFA) cases served by the Wake County Department of Social Services has declined, by about 12%, from 1,680 cases in 2009 to 1,472 cases to 2012. The vast majority of households receiving WFFA has decreased overall, from 3,536 in 2009 to 3,130 in 2012. In 2012, the average WFFA grant amount was $201 per month.

Wake County Work First Family Assistance, 2009-2012

2009 2010 2011 2012

Total Number of WFFA Cases at end of year 1,680 1,531 1,547 1,472

Avg. Monthly Number of Households Receiving WFFA

One-parent household 571 451 490 558

Two-parent household 5 15 17 19

Avg. Monthly Number of Individuals Receiving WFFA 3,536 3,167 3,056 3,130

Avg. Monthly WFFA Grant $233 $185 $184 $201

Source: ¹Duncan, D.F., Kum, H.C., Flair, K.A., Stewart, C.J., Vaughn, J., Bauer, R., and You, A. (2012). Management Assistance for Child Welfare, Work First, and Food & Nutrition Services in North Carolina. Retrieved February 20, 2013, from University of North Carolina at Chapel Hill Jordan Institute for Families website.

In 2010, child care assistance from the WFFA program was provided to less than half as many Wake County children (2,398) compared to Mecklenburg County (6,425) (Annie E. Casey Foundation, Kids Count Data Center).

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Chapter 3| Social and Economic Determinants of Health Page 61

FOOD AND NUTRITION S ERVICES

Food and Nutrition Services (FNS) is a federal food assistance program for low-income families with the goal to increase food security and reduce hunger. The program assists eligible low-income households buy food needed for a nutritionally adequate diet. The number of FNS applications in Wake County has increased each year since 2007. Nearly twice as many applications were received in 2012 compared to 2007. The median monthly FNS benefits issued fluctuates yearly, with the most recent amount being around $120 a month.

Wake County Food and Nutrition Services (FNS), 2007-2012

2007 2008 2009 2010 2011 2012

Total Number of FNS Applications²

1,687 2,015 2,392 2,678 2,861 3,032

Avg. Monthly Number of Households Receiving FNS¹

1,263 1,668 2,182 2,779 3,295 1,783

Avg. Monthly Number of Individuals Receiving FNS¹

4,704 4,626 3,637 2,744 2,783 3,010

Number of Household Receiving benefits

18,872 19,539 22,237 28,697 34,334 37,720

Number of Individuals receiving benefits

43,580 45,177 51,966 65,101 77,068 83,256

Median Monthly Total FNS Benefits Issued (end of year)¹

$118 $123 $140 $113 $120 $119.50

Sources: ¹Duncan, D.F., Kum, H.C., Flair, K.A., Stewart, C.J., Vaughn, J., Bauer, R., and You, A. (2012). Management Assistance for Child Welfare, Work First, and Food & Nutrition Services in North Carolina. Retrieved February 20, 2013, from University of North Carolina at Chapel Hill Jordan Institute for Families website. ² Workload Report by Worker/County/State, Report Number SLEM910-01.

FREE OR REDUCED-PRICE LUNCH

To be eligible for free or reduced-price lunch in Wake County, students must live in households earning at or below 185 percent of the Federal poverty guidelines. In Wake County, the number of children who receive free or reduced-price lunch in the Wake County public school system has increased 31% since the 2006-2007 school year. However, the percentage of Wake County students receiving free or reduced-price lunches has been consistently lower than Mecklenburg County and North Carolina, where more than half of all students receive free or reduced-price lunch.

Reduced priced meals are $.40 at lunch and “no cost” at breakfast.

Source: Wake County Public School System, Free and Reduced Meal Benefit Application, 2012- 2013.

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 62

Resources

 There are a large number of nonprofit and faith -based organizations that provide food, clothing and financial assistance to eligible residents. More information can be found in the 2012 Wake County Human Resources Guide .

 If you suspect a child has been abu sed, neglected or become dependent, please call the Wake County Child Protective Services Report Line at 919 -212-7990 (English) or 919- 212-7963 (Spanish).

Source: Annie E. Casey Foundation, Kids Count Data Center, Data by State, North Carolina.

P e rc

e n t

Percent of Students Enrolled in Free/Reduced Lunch, School Years, 2003-2011

Wake County Mecklenburg County State of NC

http://www.wakegov.com/humanservices/social/senior_adult/documents/resguide2012.pdf

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Transportation

Transportation in Wake County includes many local and state options such as state and federal highways, local bus transit systems, and air travel from the Raleigh- Durham International airport. Transportation reaches beyond the boundaries of traditional health care and public health sectors, but can be an important factor in improving population health. Access to affordable transportation can affect the ability of residents to access health care, as well as employment, schools, recreation, and food options.

Statistics, Targets, and Disparities

The growing population of Wake County has, naturally, increased the number of individuals driving to work. In 2011, 81% of workers over the age of 16 in Wake County drive alone, while 9% carpooled. In 2011, approximately 6% of the workforce in Wake County was able to work from home. According to the Texas A & M Transportation Institute’s 2012 Urban Mobility Report, the Raleigh- Durham area was ranked the #1 least congested metro city with a population of 1-3 million in the U.S.

Community Perceptions

According to the 2013 Community Health Opinion Survey, traffic congestion was rated as the #3 community concern. Of the 13% residents who reported that they had trouble getting the health care they needed, less than 1% said transportation was the main barrier. However, transportation was identified as one barrier for residents having trouble getting care for disabled friends or family and for residents unable to evacuate during a mandatory evacuation in Wake County.

Within all focus groups, accessible, reliable, and affordable transportation emerged as one of the common cross-cutting themes affecting the health of a community. Many residents felt that Wake County’s public transportation options were a key asset to the community and indicated that transportation access was not an issue in their community. However, other residents described transportation in Wake County as car-dependent and voiced concern about accessing transportation options for seniors, youth, persons living with disabilities, Hispanics, and those with little or no financial resources. Two focus groups were concerned about the limited options of the transit systems, including the share-ride van for seniors, and an overall reduction in public transit routes. In addition, some residents linked traffic in Wake County to the overall growth and development of Wake County.

Source: U.S. Census Bureau, American Fact Finder, 2011

Estimates.

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Chapter 3| Social and Economic Determinants of Health Page 64

Resources

Compared to other counties in North Carolina, Wake County is fortunate to have several transportation service providers available. The transit systems in Wake County include:

 Capital Area Transit (CAT): provides bus service throughout Raleigh as well as R-LINE service in Downtown Raleigh

 Triangle Transit Authority (TTA): operates regional bus and shuttle service, paratransit services, ridematching, vanpools, provides commuter resources, and an emergency ride home program for the Raleigh-Durham-Chapel Hill area.

 CTRAN (Town of Cary transit service): offers inexpensive and reliable transportation around Cary for anyone any day except Sunday. The Town of Cary provides two types of service: fixed route and door-to-door service.

 Wake Coordinated Transportation Service (WCTS): a county agency which coordinates transportation services for a variety of Wake County agencies. MV Transit is the private transportation company which is their primary transportation provider. WCTS, using MV Transit, provides medical transportation for Medicaid, Resources for Seniors' medical/ grocery/ nutrition transportation, and dialysis transportation.

 Wolfline (NCSU Campus Bus Service): NC State University's bus service which is tailored to student class schedules, but also serves the general public fare-free. Wolfline buses operate every day classes are in session, serving all three campuses, two park & ride lots, official NC State University housing and privately-owned apartment complexes located on city streets traveled by Wolfline buses on the way to or from these areas.

 Amtrak: offers two train routes for travelers in North Carolina. The Piedmont travels between the commercial center of Charlotte and the state capital of Raleigh. The Carolinian covers the same route, with service extending up the East Coast to New York City.

 Greyhound: largest provider of intercity bus transportation, serving more than 3,800 destinations with 13,000 daily departures across North America.

Wake County Human Services Transportation Services provides a variety of transportation for agency-eligible participants. Eligibility is based on sponsorship by participating agencies/programs such as Medicaid, Public Health, Mental Health, Work First and other programs. In 2012, Wake County leaders were joined by the U.S. Department of Transportation secretary to announce a $600,000 grant to expand the Wake Coordinated Transportation Service call center. The Veterans Transportation and Community Living Initiative grant will provide a 24/7 telephone system to:

 Access automated transportation, Veterans Services, and Human Services information.  Retrieve real-time "where is my ride?" customer ride status information.  Schedule trip reservation requests.  Speak with a live Wake County Human Services Transportation Services customer service agent

during business hours.

“This place has really evolved. I think they have to accommodate the new people who come here

because it wasn’t like this when I came here. There are a lot of new things, new roads, that’s been

added. I’ve seen even where I live the road has been expanded because there’s more traffic. The

traffic is amazing. I mean, it’s truly amazing. When I first came here, you just went through and

okay. Now, no matter what time you go out there, it reminds me of New York, Manhattan.”

- Community member

http://www.raleighnc.gov/services/content/PWksTransit/Articles/CapitalAreaTransit.html

http://www.triangletransit.org/

http://www.townofcary.org/Departments/Planning_Department/Transportation/C-Tran.htm

http://www.resourcesforseniors.com/iris/rfs11798ab.html

http://www2.acs.ncsu.edu/trans/transportation/wolfline/

http://www.amtrak.com/servlet/ContentServer?pagename=am/am2Station/Station_Page&code=RGH

http://www.greyhound.com/en/locations/terminal.aspx?city=340660

http://www.wakegov.com/humanservices/social/transportation/Pages/default.aspx.

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Crime and Safety

The safety of a community has both direct and indirect effects on health. Victims of violent crimes can experience post-traumatic stress disorder and psychological distress felt by those who are routinely exposed to unsafe communities. Other health factors and outcomes that are affected by community safety include birth weight, nutrition, physical activity, and family and social support (County Health Rankings and Roadmaps, 2012. Community Safety, University of Wisconsin Population Health Institute).

Statistics, Targets, and Disparities

INDEX CRIMES

Index crimes include the total number of murders, rapes, robberies, aggravated assaults, burglaries, larcenies, and motor vehicle thefts. A total of 25,939 index crimes were committed in Wake County in 2011. Of those, 91% were property crimes and 9% were violent crimes. The index crime rates in Wake County have been below the comparable rates in Mecklenburg County and in North Carolina since 2006. Over the past 6 years, overall crime has been on the decline in all three jurisdictions.

Source: NC Department of Justice, State Bureau of Investigation, Crime, View Crime Statistics, Crime Statistics. Note: Index crimes include the total number of murders, rapes, robberies, aggravated assaults, burglaries, larcenies, and motor vehicle thefts. While arson is considered an Index Crime, the number of arsons is not included in the Crime Index.

JUNVENILE JUSTICE

A juvenile justice complaint is a formal allegation that a juvenile committed an offense. It is reviewed by a counselor who decides whether to approve or not approve the complaint. If the complaint is approved, it is then heard in juvenile court. In 2011, the rate of juvenile complaints (for both undisciplined and delinquent complaints) in Wake County was lower than both the rates in Mecklenburg County and North Carolina as a whole.

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

2006 2007 2008 2009 2010 2011 N u m

b e r

p e r

1 0 0 ,0

0 0 p

o p u la

ti o n

Number of Crimes, 2006-2011 per 100,000 Population

Wake County Mecklenburg County State of NC

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Juvenile Justice Complaints and Outcomes in Wake County, 2010 and 2011

Ninety-four percent of court-involved youth in Wake County were age 12 or older at the time their first delinquent offense was alleged. Additionally, 61% of juvenile offenders in Wake County have moderate to serious school behavior problems defined by unexcused absences and short or long-term suspensions (Wake County Juvenile Crime Prevention Council, Juvenile Crime Prevention Council Annual Plan, 2012-2013).

GANG ACTIVITY

In 2010, it was reported that there are 97 validated gangs in Wake County, compared to 160 gangs in Mecklenburg County (NC Department of Crime Control and Public Safety, Governor’s Crime Commission, March 2010). In 2010-2011, approximately 9% of juvenile offenders in Wake County assessed at intake were identified as gang members or having some gang association (Wake County Juvenile Crime Prevention Council, Juvenile Crime Prevention Council Annual Plan, 2012-2013). In 2010, the Wake County School Resource Officer program (covering 22 middle schools, 2 ninth-grade centers, and 1 high school in Wake County), responded to 192 gang-related incidents on school campuses (2010 Wake County Sheriff’s Office Annual Report).

SEXUAL ASSAULT

In 2010-2011, there were 309 individuals who filed sexual assault complaints in Wake County. While the number of individuals in Wake County filing sexual assault complaints has declined overall since 2005-2006, there has been an increase in complaints since 2008-2009 (NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, 2010-2011).

Location Complaints Outcomes

Rate Undisciplined (Complaints per 1,000

Ages 6 to 17)

Rate Delinquent (Complaints

per 1,000 Age 6 to 15)

No. Sent to Secure

Detention

No. Sent to Youth

Development Center

No. Transferred to Superior Court

2010 2011 2010 2011 2010 2011 201

0 2011 2010 2011

Wake County 2.22 0.35 18.76 15.53 359 286 14 14 6 5

Mecklenburg County

1.43 1.12 25.19 29.72 401 403 33 33 3 1

State of NC 2.94 2.34 27.55 26.08 4,297 3,558 357 307 30 28

Source: NC Department of Juvenile Justice and Delinquency Prevention, Statistics and Legislative Reports, County Databooks. Notes: Undisciplined :Juvenile between 6 and 16, who is unlawfully absent from school, or regularly disobedient and beyond disciplinary control of parent/guardian, or is regularly found where it is unlawful for juveniles to be, or has run away from home for more than 24 hours. It also includes 16-17 year olds who have done any of the above except being absent from school. Delinquent: Any juvenile between 6 and not yet 16 who commits an offense that would be a crime under state or local law if committed by an adult. Transfer to Superior Court: A juvenile who is 13, 14 or 15 who is alleged to have committed a felony may be transferred to Superior Court and tried and sentenced as an adult. If a juvenile is over 13 and charged with first degree murder, the judge must transfer the case to Superior Court if probably cause is found.

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Chapter 3| Social and Economic Determinants of Health Page 67

Source: NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, County Statistics.

The most common type of sexual assault reported in Wake County in 2010-2011 was adult rape (distinct from date rape, marital rape, or rape with a minor), which accounted for approximately 60% of the sexual assault reports.

Source: NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, 2010-2011.

DOMESTIC VIOLENCE

Compared to Mecklenburg County, Wake County has seen a consistently higher number of individuals filing domestic violence complaints. In 2010-2011, Wake County received 36% more domestic violence complaints filed by individuals than Mecklenburg County.

0 100 200 300 400 500 600 700 800

N u m

b e r

Number of Individuals Filing Sexual Assult Complaints

Wake County Mecklenburg County

60% 14%

12%

4% 1%

Reported Sexual Assaults FY2010-11

Adult Rape

Other

Child Sexual Offense

Marital Rape

Adult Survivor of Child Sexual Assault

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Chapter 3| Social and Economic Determinants of Health Page 68

Source: NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, 2010-2011.

In 2010-2011, there were 3,720 domestic violence victims in Wake County who received almost 14,000 services. Compared to Mecklenburg County, Wake County domestic violence victims received 3.5 times more services (NC Department of Administration, Council for Women, Domestic Violence Commission, Statistics, 2010-2011). The most common domestic violence service received was advocacy, followed by counseling.

CHILD ABUSE AND NEGLECT

In 2011-2012, there were 4,387 reports of child abuse, neglect, and dependency in Wake County. Of those reports, 6% were substantiated to be neglect, 0.8% were substantiated as abuse, and 1.3% were substantiated to be both abuse and neglect. Approximately 12% of those reports were unsubstantiated. Child protective services were recommended in 40% of the cases, needed in 13% of the cases, and not recommended for 25 of the total cases.

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

FY2004-05 FY2005-06 FY2006-07 FY2007-08 FY2008-09 FY2009-10 FY2010-11

N u m

b e r

Number of Individuals Filing Domestic Violence Complaints, 2004-2011

Wake County Mecklenburg County

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Wake County Reports of Child Abuse and Neglect, 2007-2012

Category 2007-08 2008-09 2009-10 2010-11 2011-12

Total No. of Reports of Abuse, Neglect, Dependency

5,398 4,883 4,806 4,504 4,387

No. Substantiated1 Findings of Abuse and Neglect

47 24 22 39 57

No. Substantiated Findings of Abuse 49 39 47 39 35

No. Substantiated Findings of Neglect 338 268 280 267 266

No. Substantiated Findings of Dependency 5 2 4 9 2

Services Needed 736 690 675 589 573

Services Provided, No Longer Needed 131 118 93 98 113

Services Recommended 1,851 1,749 1,784 1,926 1,756

No. Unsubstantiated Findings 780 735 638 579 507

Services Not Recommended 1,483 1,268 1,268 963 1,102

Source: Duncan, D.F., Kum, H.C., Flair, K.A., Stewart, C.J., Vaughn, J., Bauer, R, and Reese, J. Management Assistance for Child Welfare, Work First,

and Food & Nutrition Services in North Carolina, 2013. Note: Under the investigative track, findings for abuse, neglect, or dependency are classified as either substantiated or unsubstantiated.1A report is considered substantiated if it has a finding of abuse, neglect, abuse and neglect, dependency, or services needed. It does not include instances where the finding was services provided, child protective services no longer needed. For reports handled through the family assessment track, the findings can be services needed; services recommended; services provided, protective services no longer needed; and services not recommended. The finding of services needed is made when there are questions about the frequency and severity of maltreatment, current safety issues, if there is a risk of harm in the future, or if the child is in need of protective services. The finding of services provided, protective services no longer needed is used if, during the assessment, a determination was made that the threat to the child’s safety or the risk of future harm were great enough to require the provision of involuntary services, but the problems were addressed and services no longer required at the end of the assessment period. Reports are not based on a unique count of children per year.

According to Point-in-Time findings of child abuse and neglect:

 White children under the age of 5 were the most common victims of neglect in Wake County in

2011-2012.

 A higher number of female children in Wake County (for all races) were victims of child abuse and

neglect.

Source: Duncan, D.F., Kum, H.C., Flair, K.A., Stewart, C.J., Vaughn, J., Bauer, R, and Reese, J. Management Assistance for Child Welfare, Work First,

and Food & Nutrition Services in North Carolina, 2013.

FIRST AID AND EMERGENCY PREPAREDNESS

Like other communities, Wake County is exposed to many hazards, all of which have the potential to disrupt local communities, cause damage, create casualties, and impact communication and electrical networks.

According to 2009 the Wake County Hazard Mitigation plan, natural threats that are moderate to high-hazard in Wake County include:

 Floods (often associated with hurricanes and coastal storms)

 High winds (severe storms/tornados and hurricanes/coastal storms)

 Wildfires

 Droughts and heat waves

 Winter storms and freezes

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Chapter 3| Social and Economic Determinants of Health Page 70

Other potential hazards in Wake County (man-made, technological, and national security) identified in the 2006 Wake County Emergency Operations Plan include:

 Nuclear threat/attack

 Fixed/licensed nuclear facilities (including Shearon Harris Nuclear Power Plant, research reactors

at local universities, and medical and business facilities licensed to use various radioactive

isotopes)

 Hazardous materials (chemicals used to manufacture textiles, petroleum products, pesticides,

paints, dyes, metal plating, electrical components, fertilizers, and some pharmaceuticals)

 Transportation accidents

 Dam failures

 Civil disorders

 Large scale gatherings

 Terrorism

In the 2013 Community Health Opinion Survey, 45% of residents reported that someone in their household was certified in CPR (Cardiopulmonary Resuscitation). If a large-scale disaster were to occur in Wake County, 88% of residents felt that “preparation, planning, and emergency supplies will help me handle the situation”, while 7% reported that they can handle a large-scale disaster situation without any preparation.

Source: 2013 Wake County Community Health Opinion Survey.

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Chapter 3| Social and Economic Determinants of Health Page 71

Resources

ReadyWake! is a

joint information

project of Wake

County, city and

town municipalities,

and community

partners. The

ReadyWake!

website contains

information on

potential hazards,

instructions on how

to make a family

preparedness kit,

and list of valuable

phone numbers.

Assisted by the NC Division of Health

and Human Services, local

health departments in the Shearon Harris Nuclear Power Plant10- mile Emergency

Planning Zone for ensure the

availability of free potassium iodide (KI) tablets for

people within 10 miles of a nuclear facility, including public and private schools, residents,

workers, and

businesses.

If a mandatory evacuation order was issued for a large-scale disaster, 86.6% of residents surveyed in the 2013 Community Health Opinion Survey would evacuate, 5.9% would not evacuate, and 7.5% did not know if they would or would not evacuate. Approximately 8% of respondents reported that they have someone in their household with a disability that would make it more difficult to deal with an emergency like a hurricane or power outage. Of those who responded that they would not evacuate during a mandatory evacuation, the primary reason for not evacuating was concern about leaving property, followed by lack of trust in public officials, concern about family safety, and concern about leaving pets.

Source: 2013 Wake County Community Health Opinion Survey. Note: Includes responses from only the respondents who said they would not evacuate during a mandatory evacuation.

0 10 20 30 40 50 60 70 80

Health Problems

Lack of Transportation

Concern About Personal Safety

No Response

Concern About Leaving Pets

Concern About Family Safety

Lack of Trust In Public Officials

Concern About Leaving Property

Percent

Reason for Not Evacuating in Mandatory Evacuation (Wake CHOS, 2013)

http://www.readywake.com/

http://epi.publichealth.nc.gov/phpr/ki/ki.html

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Chapter 3| Social and Economic Determinants of Health Page 72

Wake County Youth Service Providers Map

Youth Thrive is a collaborative partnership in Wake County working together to support

all youth in becoming productive adults by focusing on strengthening the positive

attributes that enable youth to be fully prepared for succe ss in school, work, and life.

In 2012, youth from Youth Thrive collected basic information for youth service providers throughout the Wake county community, called the Wake County Youth Service Providers Map. Users can search by type of program or search by address to see what the closest available service providers are.

Community Perceptions

In the 2013 Community Health Opinion Survey, 84.3% of residents agreed that Wake County is a safe place to live, compared to 85.7% in 2010. Additionally, 82.8% of surveyed parents reported that they talk to their children about criminal activity, gangs, guns, and drug use. Approximately 7% of those same parents think their child or their child’s friends are actually engaging in those activities.

In several focus groups, the importance of feeling safe and having a low crime was discussed as a key element for making a community healthy. Two groups identified the need for more after school and gang prevention activities with youth. However, crime and safety were not identified as cross-cutting themes.

“The youth also need good programs for them for after school and about gang prevention. They don’t have any programs at the schools.”

- Community member

http://youth-thrive.org/?page_id=154

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 73

Government and Civic Participation

Based on social networks and civic engagement, a community’s norms of reciprocity, interpersonal trust, solidarity, and cooperation are considered dimensions of social capital. Several research studies have shown the protective effects of social capital on health, including reducing stressful conditions, risky behaviors, mortality, and psychological distress (Viswanath K, Randolph Steele W, Finnegan JR. 2006. Social capital and health: civic engagement, community size, and recall of health messages. American Journal of Public Health, 96(8): 1456-1461).

Statistics, Targets, and Disparities

VOTER REGISTRATION A ND TURNOUT

In 2012, a total of 92.3% of the estimated voting age population in Wake County was registered to vote, a percentage higher than North Carolina as a whole (90.1%) and lower than Mecklenburg County (97.2%). The percentage of registered voters by race and ethnicity closely follows the general racial composition of Wake County, with the exception of Hispanic residents. In Wake County, only 2.3% of Hispanics are registered to vote even though Hispanics represent 9.8% of Wake County’s population.

Number and Percent of Voting Age Population Registered to Vote, 2012

In the 2012 election, almost 75% of registered voters actually voted in Wake County (3rd highest in the state), compared to approximately 67% in Mecklenburg County and 69% in North Carolina.

Percent of Registered Voters Who Voted, 2004-2012

Location

Estimated

Voting Age

Population

(2012)

White Black or African

American American

Indian Hispanic Other

No. % No. % No. % No. % No. %

Wake County

689,782 437,428 68.7 130,937 20.6 1,512 0.2 14,626 2.3 66,997 10.5

Mecklenburg County

699,885 401,889 59.1 217,921 32.0 1,923 0.3 18,819 2.8 58,520 8.6

State of NC 7,351,323 4,698,878 70.9 1,489,770 22.5 53,833 0.8 114,149 1.7 381,654 5.8

Sources: Log Into North Carolina (LINC) Database, Topic Group Government, Voters and Elections, Voting Age Population; NC State Board of Elections, Voter Registration, Voter Statistics, Voter Registration Statistics, By County. Note: The total number of registered voters reported by the NC State Board of Elections is based on the sum of registrations by party affiliation, and does not necessarily equal the sum of registrations by race. Therefore, the sum of the percentages does not equal 100%.

Location 2004 2006 2008 2010 2012

Wake County 74% 41% 75% 48% 75%

Mecklenburg County

65% 30% 66% 38% 67%

State of NC 64% 37% 70% 44% 68%

Source: NC State Board of Elections, Elections Central, Elections Results Data, General Elections.

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 74

VOLUNTEERING

According to the 2013 Community Health Opinion Survey, over half of all respondents (52%) reported participating in volunteer activities (formal or informal) in the past year. Of those who volunteer, the majority reported that they volunteer with a religious or spiritual organization (22%), followed by non-profit (16%), community-based organization (13%), and school (10%).

Source: 2013 Wake County Community Health Opinion Survey.

Note: Includes responses from only the respondents who said they volunteered in the past year.

10%

13%

16%

22%

0 5 10 15 20 25

Sports

Civic

Other

Health

School

Community

Non-profit

Religious/Spiritual

Percent

Reported Organizations Residents Volunteer With (Wake CHOS, 2013)

2013 Wake County Community Health Needs Assessment

Chapter 3| Social and Economic Determinants of Health Page 75

Faith and Spirituality

Faith-based organizations in Wake play a critical role in areas such as health promotion and disease prevention programs (such as cardiovascular health, diabetes, substance abuse, HIV/AIDS, Sexually Transmitted Infections, health screenings, health fairs, and environmental and policy changes) in the areas of nutrition and physical activity, counseling/mental health, housing, unemployment, and many other social issues. In addition to playing a role in health promotion and disease prevention programs, the faith community in Wake County provides a great deal of assistance and services to the community, including food banks, soup kitchens, clothing and linen closets, financial assistance, counseling, mentoring, exercise classes and walking programs, camps, and after school programs. Faith-based organizations also provide health care, housing/shelter for the homeless and seniors, substance abuse prevention counseling, and resources related to faith and meditation. In Wake County, there are a variety of religions and religious institutions that mirror the County’s diversity. According to the 2010 U.S. Religion Census conducted by the Association of Statisticians of American Religious Bodies, there are 712 religious congregations in Wake County with approximately 418,000 members and others who regularly attend services. The following are estimates of congregations by tradition/religion:

Source: 2010 U.S. Religion Census: Religious Congregations & Membership Study. Collected by the Association of Statisticians of American Religious Bodies and distributed by the Association of Religion Data Archives.

Community Perceptions

According to the 2013 Community Health Opinion Survey, the faith community was considered a resource for Wake County residents to go for mental health, drug, or alcohol abuse counseling (12%) as well as a resource for current smokers to go to quit smoking (2.5% of current smokers).

 Protestant: 638

 Catholic: 17

 Orthodox: 5

 Church of Jesus Christ of Latter-day

Saints: 22

 Hindu: 9

 Jehovah Witnesses: 9

 Buddhism: 7

 Judaism: 7

 Islam: 7

 Baha’i: 3

 Association of Unity Churches: 2

 Church of Christ Scientist: 2

 Unitarian Universalist: 2

 New Apostolic Church of North

America: 1

 Jain: 1

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 76

CHAPTER 4:

HEALTH STATUS

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 77

CHAPTER 4 | HEALTH STATUS Measures of general health status provide key information about the health of a population. These measures can be used to monitor progress toward promoting health, preventing disease and disability, eliminating disparities, and improving quality of life. This chapter provides an overview of the health status of Wake County residents, including the following:

 Self-reported health status  Maternal and infant health  Life expectancy  Leading causes of death

o Cancer o Heart disease o Stroke o Chronic lower respiratory disease o Asthma o Diabetes

 Communicable diseases and immunization  Disability and care-giving

In the past four years, Wake County was ranked as the #1 healthiest county in North Carolina, leading the state with healthy behaviors and low disease mortality and morbidity rates. However, there are still opportunities to improve health outcomes. Even though Wake County is the #1 healthiest county in the state, North Carolina was ranked 33 out of 50 states in health according to the 2012 America’s Health Rankings. Additionally in Wake County, as in other parts of the state and country, there are significant racial, ethnic, and socioeconomic disparities, where African Americans, Hispanics, and residents with lower income or education experience disproportionately higher disease mortality and morbidity rates. Home to 3 major hospital systems, an established public health structure, a large health care provider community, multiple health clinics, and a strong network of community-based and non-profit organizations, Wake County is equipped with the assets and resources needed to improve the health status of its residents and address health disparity challenges.

Sources:

 U.S. Department of Health and Human Services. Healthy People 2020.  County Health Rankings and Roadmaps, 2010-2013. University of Wisconsin Population Health Institute.  United Health Foundation, 2012. America’s Health Rankings.

Quick Facts

Positive Trends:

 Wake County is ranked t he #1 healthiest county in North Carolina.

Life expectancy

 The average life expectancy of a Wake County resident is 81.3 years, higher than the Healthy NC 2020 target of 79.5 years.

Maternal and infant health

 Teen pregnancy rate among females aged 15-19 has declined 36% since 2007.

Leading causes of death

 The heart disease death rate in Wake County has decreased 30%.

Communicable diseases

 Since 2010, TB rates in Wake County have declined more than 50%.

Areas for Improvement:

Self-reported health status

 18.6% of residents reported fair or poor health. Wake County residents with higher income and education are more likely to report good health.

Leading causes of death

 The 3 leading causes of death in Wake County are cancer, heart disease, and stroke. Promoting healthy lifestyles (tobacco cessation, physical activity, and nutrition) greatly reduces the risk of developing those diseases.

 African Americans and Hispanics in Wake County experience disproportionately higher mortality rates from cancer, heart disease, stroke, and diabetes.

Communicable diseases

 The number of confirmed cases of pertussis has increased in Wake County.

 More than half of all Chlamydia and gonorrhea cases in Wake County occur

among 15-24 year olds.

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Chapter 4| Health Status Page 78

Rankings

 Out of the 100 counties in North Carolina, Wake County was ranked by County Health Rankings as the #1 healthiest county in 2013.

 Wake County ranks #1 for health outcomes (including mortality and morbidity).  Wake County also ranks high for positive health behaviors, clinical care, and social and

economic factors.

 The only factor for which Wake County does not rank highly is Physical Environment, where Wake County places 10 out of 100.

County Health Rankings, 2013

Location County Rank (Out of 100)1

Health Outcomes Health Factors

Mortality Morbidity Health Behaviors

Clinical Care

Social & Economic Factors

Physical Environment

Wake County 1 1 2 3 4 10

Mecklenburg County

9 15 3 8 36 27

Source: County Health Rankings and Roadmaps, 2013. University of Wisconsin Population Health Institute. Note: 1 Rank of 1 equals "best".

When comparing various Wake County health factors, social and economic factors, and physical environment factors with National Benchmarks, or the tenth percentile nationally, Wake County is better than the national or Healthy NC 2020 benchmarks for premature death, suicides, physical inactivity, primary care physicians’ ratio, and residents with “some college”.

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Chapter 4| Health Status Page 79

Wake County Comparisons with National Benchmarks (*or Healthy NC 2020 if National Benchmark not available)

Source: County Health Rankings and Roadmaps, 2013. University of Wisconsin Population Health Institute. National benchmarks are the 90th percentile or 10th percentile, depending on whether the measure is framed positively.

Below is a table showing the 2013 County Health Rankings summary measures of health outcomes and factors for Wake County, Mecklenburg County, North Carolina, national benchmarks, and Healthy NC 2020 benchmarks if available. Additional measures, such as suicide rate, fruit and vegetable intake, and Chlamydia infections were also included.

= b

e tt e r

th a n

Health Factor • Premature death

• Suicide rate

• Physical inactivity

• Primary care physicians ratio

Social & Economic Factors

• Some college

= s

a m

e a

s Health Factor

• Motor vehicle crash death rate

• Diabetic screening

• Mammography screening

• Drinking water safety

= w

o rs

e t h a n

Health Factor • Poor or fair health

• Poor physical health days

• Poor mental health days

• Low birthweight

• Adult smoking

• Adult obesity

• Five or more services of fruit and vegetables per day*

• Excessive drinking

• Sexually transmitted infections

• Teen birth rate

• Uninsured

• Preventable hospital stays

= w

o rs

e t h a n Social & Economic

Factors

• High school graduation*

• Unemployment

• Children in poverty

• Inadequate social support

• Children in single- parent households

• Violent crime rate

Physical Environment

• Air pollution – particulate matter days

• Access to recreational facilities

• Limited access to healthy foods

• Fast food restaurants

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 80

County Health Rankings Details, 2013

Health Factor Wake

County Mecklenburg

County NC

National Benchmark

Healthy NC 2020

Health Outcomes: Mortality

Premature death per 100,000 4,954 6,039 7,480 5,317 N/A

Suicide rate per 100,000¹ 8.9 9.1 12.1 10.2 8.3

Health Outcomes: Morbidity

Poor or fair health 12% 15% 18% 10% 9.9%

Poor physical health days 2.7% 3.0% 3.6% 2.6% N/A

Poor mental health days 2.6% 3.3% 3.4% 2.3% 2.8%

Low birth weight¹ 7.9% 9.0% 9.1% 6.0% N/A

Health Factors: Health Behaviors

Adult smoking 14% 15% 21% 13% 13%

Adult obesity 26% 26% 29% 25% N/A

Physical inactivity 18% 20% 25% 21% N/A

Five or more servings of fruit and vegetables per day2

25.9% 21.7% 20.6% N/A 29.3%

Excessive drinking, 2005-2011 15% 16% 13% 7% N/A

Motor vehicle crash death rate per 100,000¹

8.7 8.4 15.5 12 N/A

Chlamydia infections per 100,0003 527 810.8 564.8 92 N/A

Teen birth rate per 1,000 28 42 46 21 N/A

Health Factors: Clinical Care

Uninsured 16% 18% 19% 11% 8%

Primary Care physicians ratio* 1240:1 1,148:1 1,480:1 1,067:1 N/A

Preventable hospital stays per 1,000 50 47 63 47 N/A

Diabetic screening 90% 87% 88% 90% N/A

Mammography screening 73% 65% 69% 73% N/A

Social & Economic Factors

High school graduation* 81% 76% 80% N/A 94.6%

Some college 77% 72% 62% 70% N/A

Unemployment 8.3% 10.7% 10.5% 5.0% N/A

Children in poverty 16% 24% 25% 14% N/A

Inadequate social support 18% 18% 21% 14% N/A

Children in single-parent households 27% 35% 35% 20% N/A

Violent crime rate per 100,000 301 679 411 66 N/A

Physical Environment

Air pollution-particulate matter days 12.6 13.2 12.9 8.8 N/A

Drinking water safety 0% 0% 3% 0% N/A

Access to recreational facilities per 100,000 15 16 11 16 N/A

Limited access to healthy foods* 4% 7% 7% 1% N/A

Fast food restaurants 51% 46% 49% 27% N/A

Sources: County Health Rankings and Roadmaps, 2013. University of Wisconsin Population Health Institute. ¹NC State Center for Health Statistics, County Data Book, 2007-2011. ²NC State Center for Health Statistics, Behavioral Risk Factor Surveillance Data, 2009. 3 NC DHHS, Division of Public Health, Epidemiology Section, Communicable Disease Branch. Facts and Figures, Annual Reports. North Carolina 2011. Chlamydia rates per 100,000. Notes: Data presented as county average. *Data should not be compared with prior years due to changes in definition. National benchmarks are the 90th percentile of all counties in the country, depending on whether the measure is framed positively.

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Chapter 4| Health Status Page 81

Self-Reported Health Status

Self-assessed health status is a measure of how an individual perceives his or her health, rating it as excellent, very good, good, fair, or poor. Self-assessed health status has been validated as a useful indicator of health for a variety of populations and allows for broad comparisons across different conditions and populations (U.S. Department of Health and Human Services., Healthy People 2020).

Statistics, Targets, and Disparities

According to the 2013 Community Health Opinion Survey, 18.6% of residents reported their health to be fair or poor, compared to 7.9% in the 2010 Behavioral Risk Factor Surveillance Survey.

 The Healthy NC 2020 target is to reduce the percentage of adults reporting fair or poor health to 9.9%.

Sources: 2013 Wake County Community Health Opinion Survey. NC State Center for Health Statistics, Behavioral Risk Factor Surveillance Data, 2010.

Wake County residents with higher incomes and more education are more likely to report having good health. Additionally, non-whites in Wake County are less likely than whites to report good health.

 Wake County residents with household incomes less than $50,000 were 3.3 times more likely to report fair or poor health.

 Wake County Residents with a high school education or less were 2.2 times more likely to report fair or poor health compared to those with some college.

 In Wake County, 11.3% of non-whites reported fair or poor health compared to 6.1% for whites.

Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010.

Fair Poor

Wake CHOS 14.7 3.9

Wake BRFSS 2010 6.7 1.2

P e rc

e n t

Percent of Residents Who Experience "Fair" or "Poor" Health 95% Confidence Limits

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Chapter 4| Health Status Page 82

Community Perceptions

Within all focus groups, residents discussed what does being healthy personally mean to them. In addition to identifying being healthy as the absence of sickness and engaging in healthy behaviors, residents also felt that personal health meant physical, mental, spiritual, and financial well-being. Other residents associated personal health with self-sufficiency and independence and the ability to continue to help others. Lastly, some residents felt that personal health was closely linked to access to resources, such as a secure place to live, access to regular and affordable health care, and equal mobility access to health and recreation facilities.

Maternal and Infant Health

The well-being of mothers, infants, and children determines the health of the next generation and can

help predict future public health challenges for families, communities, and the health care system (U.S.

Department of Health and Human Services., Healthy People 2020).

Statistics, Targets, and Disparities

PREGNANCIES AND BIRTHS

Among all women in Wake County of child-bearing age (ages 15-44), the pregnancy rate is

declining in Wake County, from a high point of 88.8 per in 2008 to a rate of 73.6 in 2011 (a

decrease of 17%).

Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2007-2013).

100

110

2005 2006 2007 2008 2009 2010 2011

R a te

Pregnancy Rate among Females Aged 15-44, 2005-2011 Rate per 1,000 population women of reproductive age

Wake County Mecklenburg County State of NC

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 83

The pregnancy rate is highest among Hispanic women in Wake County. In 2011, the pregnancy rate among Hispanic women (104.0 per 1,000 women of reproductive age) was 41% higher than the overall pregnancy rate (73.6 per 1,000 women of reproductive age).

Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2007-2013). Note: Race and ethnicity data collected by the NC Center for Health Statistics is reported as two separate dimensions. Other races include American Indian and Asian races. Ethnicity is defined as Hispanic and Non-Hispanic. Thus, persons of Hispanic ethnicity may be of any race.

The pregnancy rate for teenagers in Wake County (females aged 15-19) has been declining in Wake County, from 43.6 per 1,000 population of women of reproductive age in 2007 to 28.1 in 2011 (a 36% decrease).

Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2007-2013).

61.9

84.8 80.9

104.0

100

120

White, Non- Hispanic

African American,

Non-Hispanic

Other, Non- Hispanic

Hispanic

R a te

Wake County Pregnancy Rate among Females Aged 15-44 by Race and Ethnicity, 2011

Rate per 1,000 population women of reproductive age

2005 2006 2007 2008 2009 2010 2011

R a te

Pregnancy Rate among Females Aged 15-19 in Wake County, 2005-2011

Rate per 1,000 population women of reproductive age

Wake County Mecklenburg County State of NC

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 84

Among those pregnant teens ages 15-19, the pregnancy rate is highest among Hispanic females, where the rate (104 per 1,000 population of females aged15-19) was more than triple the overall teen pregnancy rate (28.1 per 1,000 population of females aged15-19) in 2011.

The percent of teen pregnancies by zip code in Wake County shows that the concentration of teen pregnancies in 2011 is in east Raleigh and the eastern part of the county, with zip codes east of Highway 401 having a higher prevalence of teen pregnancy compared with other zip codes in the County. The zip code 27610 had the highest percent of teen pregnancies in 2011, with 19.6%.

61.9

84.8 80.9

104.0

100

120

White, Non- Hispanic

African American,

Non-Hispanic

Other, Non- Hispanic

Hispanic

R a te

Wake County Pregnancy Rate among Females Aged 15-19 by Race and Ethnicity, 2011

Rate per 1,000 population women of reproductive age

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Chapter 4| Health Status Page 85

Map of Teen Pregnancies among Females Aged 15-19 by Zip Code in Wake County, 2011

Notes: Percentages calculated based on total births in zip code. 131 teen pregnancies were missing zip code in 2011.

PRENATAL CARE AND PR EGNANCY RISK FACTORS

After an increase between 2006 and 2009, the percent of women in Wake County who received prenatal care in the first trimester has declined to 68.5% in 2011, an 18% decrease since 2009.

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Chapter 4| Health Status Page 86

Source: NC State Center for Health Statistics, Basic Automated Birth Yearbook (BABY Book). Note: Due to NC adapting the revision of the U.S. Standard Certificate of Live Birth in August of 2010, data on prenatal care initiation are not considered comparable between the two certificates and are excluded from the tables for 2010.

Smoking during pregnancy is associated with multiple adverse birth outcomes, including low birth weight and pre-term deliveries. Women who smoke during pregnancy are more likely to have a baby who is premature, who has a low birth weight, or who dies of Sudden Infant Death Syndrome (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

While the percent of births to mothers who reported that they smoked during pregnancy has been consistently lower in Wake County than in Mecklenburg County or statewide, the percentage increased, from 2.6% in 2008 to 3.3% in 2011.

 The Healthy NC 2020 target is to reduce the percentage of women who smoke during pregnancy to 6.8%.

Source: NC State Center for Health Statistics, Vital Statistics, Volume 1. Note: Due to NC adapting the revision of the U.S. Standard Certificate of Live Birth in August of 2010, data on tobacco use are not considered comparable between the two certificates and are excluded from the tables for 2010.

2005 2006 2007 2008 2009 2011

P e rc

e n t

Percent of Women Receiving Prenatal Care in the First Trimester, 2005-2011

Wake County Mecklenburg County State of NC

2005 2006 2007 2008 2009 2011

P e rc

e n t

Percent of Births to Mothers Who Smoked Prenatally, 2005-2011

Wake County Mecklenburg County State of NC

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Chapter 4| Health Status Page 87

High Parity is an indicator that identifies the number of live births to women with five or more previous live births as a percent of all live births in a given place and time. Wake County had a lower rate of high parity births (among mothers under 30 and aged 30 and over) and a lower rate of short interval births (with interval from last delivery to conception of 6 months or less) compared to Mecklenburg County and North Carolina in 2007-2011.

High Parity and Short Interval Births in Wake County, Aggregate Period, 2007-2011

Location

High Parity Births Short Interval Births

Mothers < 30 Mothers > 30

No.1 %2 No.1 %2 No.3 %4

Wake County 4,475 14.3 6,779 20.2 4,931 11.5

Mecklenburg County 6,371 16.5 6,778 20.5 5,662 12.0

State of NC 70,404 17.2 47,110 21.2 52,600 12.6

Source: NC State Center for Health Statistics, County-level Data, County Health Data Book, 2013. Notes: 1 Number at risk due to due to high parity. 2 Percent of all births with age of mother in category indicated. 3 Number with interval from last delivery to conception of six months or less. 4 Percent of all births excluding 1st pregnancies.

A low birth weight birth is defined as a live born infant weighing 2500 grams or less (≤5 pounds, 8 ounces). The percent of low birth weight births among all racial groups in Wake County remained relatively unchanged (and lower than comparable Mecklenburg County and state rates) between 2006-2010 and 2007-2011. The highest percent of low birth weight births occurred among the African American population.

Low (< 2,500 Grams) Birth Weight Births Trend, by Race and Ethnicity, Aggregate Periods, 2006-

2010 and 2007-2011

Location Percent of Low Birth Weight (< 2,500 Gram) Births

2006-2010 2007-2011

Total White, Non-

Hispanic

Black, Non-

Hispanic

Other Non-

Hispanic

Hispanic Total White, Non-

Hispanic

Black, Non-

Hispanic

Other Non-

Hispanic

Wake County 7.8 6.4 13.1 7.3 6.0 7.9 6.4 13.1 7.6 6.2

Mecklenburg County

9.3 6.8 14.3 9.9 6.7 9.4 6.7 14.5 10.2 6.9

State of NC 9.1 7.7 14.4 9.3 6.3 9.1 7.7 14.3 9.4 6.5

Source: NC State Center for Health Statistics, County-level Data, County Health Data Books. Note: Race and ethnicity data collected by the NC Center for Health Statistics is reported as two separate dimensions. Other races include American Indian and Asian races. Ethnicity is defined as Hispanic and Non-Hispanic. Thus, persons of Hispanic ethnicity may be of any race.

The percent of low birth weight births by zip code in Wake County shows a concentration in eastern Raleigh and the eastern part of the county. The zip code 27610 had the highest percent (11.1%) of low birth weight births in 2007-2011.

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Chapter 4| Health Status Page 88

Map of Low Birth Weight Births by Zip Code in Wake County, 2007-2011

Notes: Percentages calculated based on total births in zip code. Grey areas indicate missing data or low total number of births.

INFANT MORTALITY

In Wake County, 437 babies under the age of 1 died in Wake County during 2007-2011. The most prevalent causes of infant mortality are birth defects, prematurity, low birth weight, and Sudden Infant Death Syndrome (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011). The infant mortality rate increased in Wake County between 2001-2005 and 2005-2009 and has since decreased slightly since that time. Since 2005-2009, the infant mortality rate in Wake County has exceeded the Mecklenburg County rate.

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Chapter 4| Health Status Page 89

Source: NC Center for Health Statistics, County-level Data, County Health Data Books (2007-2013).

The greatest disparity in infant mortality exists among African Americans in Wake County, where African Americans suffer from a disproportionately higher infant mortality rate compared to all other groups. In 2011, the infant mortality rate among African Americans is 3.2 times higher than among whites.

R a te

Infant Mortality Rate 2001-2005 through 2007-2011

Rate per 1,000 births

Wake County Mecklenburg County State of NC

4.5

14.4

3.2 5.5

0 2 4 6 8

10 12 14 16

White, Non- Hispanic

African American, Non-

Hispanic

Other, Non- Hispanic

Hispanic

R a te

Wake County Infant Mortality Rate by Race and Ethnicity, 2007-2011

Rate per 1,000 births

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 90

Resources

 In 2012, Wake County Human Services provided maternal health services

to 4,844 clients.

 Services for low-risk pregnancies are provided at county clinics , while services for high-risk pregnancies are provided at WakeMed.

Community Perceptions

In the 2013 Community Health Opinion Survey, 90.8% of residents agreed that Wake County is a good place to raise children, compared to 84% in 2010. In the focus groups, maternal and infant health was not a cross-cutting theme identified as affecting the health of the community; however, the service provider focus group discussed that there are not enough resources for low and no-income residents in Wake County, especially for prenatal care.

Approximately 20% of surveyed parents reported that they talk to their children about sexual activity, and 5.2% of parents think their child or their child’s friends are actually engaging in sexual activity.

Life Expectancy, Leading Causes of Death, and Chronic Disease

Life expectancy is the average number of additional years that someone at a given age would be expected to live if he/she were to experience throughout life the age-specific death rates observed in a specified reference period.

Statistics, Targets, and Disparities

According to data from the NC State Center for Health Statistics, the life expectancy at birth for a Wake County resident using the 2009-2011 reference period is 81.3 years (an increase of 4.4 years from the 1990-1992 reference period), compared to 80 years for Mecklenburg County residents, and 78.2 years statewide.

The life expectancy at birth using the 2009-2011 reference period for African Americans in Wake County is 77.3 years, which is 6% lower than the life expectancy for white residents during that same time period (82.1 years).

 The Healthy NC 2020 target is to increase the average life expectancy to 79.5 years. The leading cause of death in Wake County, Mecklenburg County, and North Carolina is cancer, in contrast with heart disease as the national leading cause of death. Compared to the United States, Wake County has lower mortality rates for every presented cause of death except cerebrovascular disease (stroke), where Wake County’s mortality rate is 15% higher than the national rate.

http://www.wakegov.com/humanservices/Pages/default.aspx

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Chapter 4| Health Status Page 91

Overall Age-Adjusted Mortality Rates for the 15 Leading Causes of Death, Aggregate Period, 2007-2011, Except as Noted

Rank / Cause of Death Wake

County Mecklenburg

County State of

United States (2011)

1. Cancer 157.3 166.0 179.7 168.6

Trachea, Bronchus and Lung 41.7 45.9 54.5 45.9

Prostate 24.0 25.6 24.3 8.3 2

Breast 23.4 23.4 23.0 12.0 2

Colon, Rectum, and Anus 12.0 14.8 15.5 15.3

Pancreas 9.9 9.8 10.5 10.9

2. Diseases of the Heart 137.5 142.6 179.3 173.7

3. Cerebrovascular Disease 43.6 40.6 46.0 37.9

4. Chronic Lower Respiratory Disease 31.6 34.9 46.6 42.7

5. Alzheimer's Disease 20.0 43.6 29.0 24.6

6. All Other Unintentional Injuries 19.0 20.0 29.2 38.0

7. Diabetes Mellitus 18.1 17.5 22.0 21.5

8. Nephritis, Nephrotic Syndrome, and Nephrosis 14.6 19.1 18.6 13.4

9. Pneumonia and Influenza 10.5 14.1 17.9 15.7

10. Septicemia 10.0 12.3 13.6 10.5

11. Suicide 8.9 9.1 12.1 12.0

12. Unintentional Motor Vehicle Injuries 8.7 8.4 15.5 10.9

13. Chronic Liver Disease and Cirrhosis 5.1 7.1 9.3 9.7

14. Homicide 3.1 7.2 6.3 3.6

15. Acquired Immune Deficiency Syndrome 2.6 6.3 3.5 2.4

Total Deaths All Causes (some causes are not listed above) 648.8 716.7 808.4 740.6

Source: Source: NC State Center for Health Statistics, County Health Data Book (2013), Mortality, 2007-2011 Race-Specific and Sex- Specific Age-Adjusted Death Rates by County. U.S. data from the National Center for Health Statistics, National Vital Statistics Reports, Volume 61, Number 6 (October 10, 2012). Note: Rate equals the number of events per 100,000 population; standard year is the 2000 U.S. population.

 Compared to white non-Hispanic residents in Mecklenburg County, white non-Hispanic residents of Wake County had lower mortality rates for all leading causes of death except: Cerebrovascular Disease (13.5% higher) and Diabetes (10% higher).

 Compared to Mecklenburg County, African-American residents of Wake County have lower mortality rates for all leading causes of death except Cerebrovascular Disease (7% higher), Diabetes (20% higher) and Unintentional Motor Vehicle Injuries (11.2% higher).

 Among Hispanics, Wake County mortality rates for Cancer (4.8% higher), Heart Disease (10%), Unintentional Injuries (34.7% higher), and Motor Vehicle Injuries (33% higher) are higher compared to Mecklenburg County.

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 92

Race-Specific Age-Adjusted Death Rates for the 15 Leading Causes of Death, Aggregate Data, 2007-2011

Wake County Mecklenburg County

Cause of Death White African- American

Other Races

Hispanic White African- American

Other Races

Hispanic

1. Cancer 155.9 192.1 85.0 72.6 156.9 219.2 76.6 69.3

2. Diseases of the Heart 134.1 177.5 67.0 47.3 134.4 189.5 52.3 43.0

3. Cerebrovascular Diseases 41.0 61.2 22.4 N/A 36.0 57.2 30.1 21.6

4. Chronic Lower Respiratory Disease 35.2 21.3 N/A N/A 38.0 30.5 N/A N/A

5. Alzheimer's Disease 21.1 17.4 N/A N/A 44.1 51.8 N/A N/A

6. Unintentional Non-Motor Vehicle Injury 20.5 15.5 N/A 12.4 22.0 18.5 N/A 9.2

7. Diabetes Mellitus 13.7 43.6 N/A N/A 12.4 36.3 N/A N/A

8. Nephritis, Nephrotic Syndrome and Nephrosis 11.8 30.7 N/A N/A 13.2 41.7 N/A N/A

9. Pneumonia and Influenza 10.5 11.7 N/A N/A 14.5 15.1 N/A N/A

10. Septicemia 8.7 17.1 N/A N/A 11.3 17.7 N/A N/A

11. Suicide 11.0 3.6 N/A N/A 12.3 4.5 N/A N/A

12. Unintentional Motor Vehicle Injuries 7.4 10.9 N/A 14.1 7.5 9.8 N/A 10.6

13. Chronic Liver Disease and Cirrhosis 5.7 3.6 N/A N/A 7.8 5.9 N/A N/A

14. Homicide 1.2 8.1 N/A 4.4 2.1 15.2 N/A 8.1

15. Acquired Immune Deficiency Syndrome 0.7 9.6 N/A N/A 1.5 18.3 N/A N/A

Total Deaths All Causes (Some causes are not listed above)

630.5 832.8 317.5 292.5 668.7 959.2 297.8 264.4

Source: NC State Center for Health Statistics, County Health Data Book (2013), Mortality, 2007-2011 Race-Specific and Sex-Specific Age-Adjusted Death Rates by County. Notes: Rate equals the number of events per 100,000 population; standard year is the 2000 U.S. population. “N/A” indicates a likely unstable rate based on a small (fewer than 20) number of cases. Race and ethnicity data collected by the NC Center for Health Statistics is reported as two separate dimensions. Other races include American Indian and Asian races. Ethnicity is defined as Hispanic and Non-Hispanic. Thus, persons of Hispanic ethnicity may be of any race.

CANCER

Cancer is the leading cause of death in Wake County. According to the Centers for Disease Control and Prevention, a person's cancer risk can be reduced by receiving regular medical care, avoiding tobacco, limiting alcohol use, avoiding excessive exposure to ultraviolet rays from the sun and tanning beds, eating a diet rich in fruits and vegetables, maintaining a healthy weight, and being physically active. In addition, screening for cervical, colorectal, and breast cancers helps find these diseases at an early, often highly treatable stage (Centers for Disease Control and Prevention, Cancer Prevention and Control website).

The overall cancer mortality rate in Wake County has declined 11% from 178.3 per 100,000 population in 2002-2004 to 157.3 in 2007-2011. The Wake County cancer mortality rate is 12.5% lower than the state rate (179.7).

2013 Wake County Community Health Needs Assessment

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Source: NC State Center for Health Statistics, County Health Data Books (2006-2013), Mortality, Race-Specific and Sex-Specific Age-

Adjusted Death Rates by County.

In 2007-2011, Wake County had lower (or same) mortality rates for colon, lung, female breast, and prostate cancers when compared to Mecklenburg County or North Carolina.

 The Healthy NC 2020 target is to reduce the colon cancer mortality rate (per 100,000) population to 10.1.

Cancer Mortality Rates for Selected Sites, 2007-2011

Location Colon/Rectum Lung/Bronchus Female Breast

Prostate All

Cancers

Wake County 11.7 14.9 22.8 24.3 157.2

Mecklenburg County 14.7 46.4 23.1 25.6 166.5

State of NC 15.3 54.6 22.8 24.4 179.9

Source: NC State Center for Health Statistics, Health Data, Cancer, Cancer Data Available from SCHS, Annual Reports, NC Cancer Mortality Rates for All Counties by Specified Site. Note: Rate per 100,000 population.

Screenings

According to the 2013 Community Health Opinion Survey, approximately 3 out of 4 residents aged 50 or older (78%) reported that they had a colonoscopy. For males aged 40 or older, 59% have annual prostate exams. Approximately 61% of females aged 40 and over have a mammogram every year, and 78% of females over 21 have a pap smear at least every other year.

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Overall Total Cancer Morality Rate Trend, 2000-2011 Rate per 100,000 population

Wake County Mecklenburg County State of NC

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Disparities

In 2007-2011, African Americans in Wake County had the highest mortality rate from cancer (192.1 per 100,000 population) than other races in the County.

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013), Mortality, Race-Specific and Sex-Specific Age- Adjusted Death Rates by County. Note: Race and ethnicity data collected by the NC Center for Health Statistics is reported as two separate dimensions. Other races include American Indian and Asian races. Ethnicity is defined as Hispanic and Non-Hispanic. Thus, persons of Hispanic ethnicity may be of any race.

HEART DISEASE Heart disease is the second leading cause of death for residents in Wake County. The risk for heart disease also increases as a person ages. In addition to behavioral risk factors, obesity, high blood pressure, high cholesterol, and diabetes are other known risk factors for heart disease (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

The heart disease mortality rate decreased dramatically in Wake County, 30% from 195.6 per 100,000 population in 2000-2004 to 137.5 per 100,000 population in 2007-2011. The 2007-2011 heart disease mortality rate in Wake County is 23% lower than the state rate (179.3 per 100,000 population).

 The Healthy NC 2020 target is to reduce the cardiovascular disease mortality rate (per 100,000) population to 161.5.

155.9

192.1

85.0 72.6

Racial Disparities in Total Cancer Mortality Rates, Wake County, 2007-2011

Rate per 100,000 population

White African-American Other Races Hispanic

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Source: NC State Center for Health Statistics, County Health Data Books (2006-2013), Mortality, Race-Specific and Sex-Specific Age-

Adjusted Death Rates by County.

In 2007-2011, African Americans in Wake County also had the highest mortality rate from heart disease (177.5 per 100,000 population), where the mortality rate was 32% higher than white non- Hispanics in the County (134.1 per 100,000 population).

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013), Mortality, Race-Specific and Sex-Specific Age-

Adjusted Death Rates by County. Note: Race and ethnicity data collected by the NC Center for Health Statistics is reported as two separate dimensions. Other races

include American Indian and Asian races. Ethnicity is defined as Hispanic and Non-Hispanic. Thus, persons of Hispanic ethnicity may be

of any race.

CEREBROVASCULAR DISEASE (STROKE) Stroke is the 3rd leading cause of death in Wake County. A stroke occurs when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts. The risk for stroke can be greatly reduced through lifestyle changes and, in some cases, medication.

120

140

160

180

200

220

240

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Heart Disease Mortality Rate Trend, 2000-2011 Rate per 100,000 population

Wake County Mecklenburg County State of NC

134.1

177.5

67.0 47.3

Racial Disparities, Heart Disease Mortality Rates in Wake County, 2007-2011 Rate per 100,000 population

White African-American Other Races Hispanic

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The stroke mortality rate in Wake County declined 37% from 68.6 per 100,000 population in 2000- 2004 to 43.6 per 100,000 population in 2007-2011.

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013), Mortality, Race-Specific and Sex-Specific Age- Adjusted Death Rates by County.

In 2007-2011, the stroke mortality rate was higher among African-Americans in Wake County compared to whites. The stroke mortality rate among African-American males (70.7 per 100,000 population) was 77% higher than the rate among white males (40 per 100,000 population), and the mortality rate among African American females (55.4 per 100,000 population) was 36% higher than white females (40.7 per 100,000 population).

Source: NC State Center for Health Statistics, County-level Data, County Health Data Book (2013), Mortality, 2007-2011 NC Resident Race/Ethnicity and Sex-Specific Age-Adjusted Death Rates, by County. Note: Race and ethnicity data collected by the NC Center for Health Statistics is reported as two separate dimensions. Other races include American Indian and Asian races. Ethnicity is defined as Hispanic and Non-Hispanic. Thus, persons of Hispanic ethnicity may be of any race.

80 R

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Stroke Mortality Rate Trend, 2000-2011 Rate per 100,000 population

Wake County Mecklenburg County State of NC

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CHRONIC LOWER RESPIR ATORY DISEASE

Chronic lower respiratory disease (CLRD) comprises three major diseases: chronic bronchitis, emphysema, and asthma. The most important modifiable risk factors for CLRD are: tobacco use, other exposures to indoor and outdoor air pollutants, allergens, occupational exposure, and to a lesser extent than for other chronic diseases, unhealthy diet, obesity and overweight, and physical inactivity (World Health Organization, Risk Factors for Chronic Respiratory Diseases, 2007). CLRD is the 4th leading cause of death in Wake County. In 2007-2011, the CLRD mortality rate in Wake County is 32% lower than the statewide rate and 9.5% lower than the Mecklenburg County rate.

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013), Mortality, Race-Specific and Sex-Specific Age- Adjusted Death Rates by County.

While there were not enough deaths attributable to CLRD to compute stable rates among “Other Races” and Hispanics in 2007-2011, the mortality rate among white non-Hispanics (35.2 per 100,000 population) is 65.3% higher than the rate among African-Americans (21.3 per 100,000 population).

ASTHMA Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible breathing problems due to airway narrowing and obstruction. These episodes can range in severity from mild to life threatening. Daily preventive treatment can prevent symptoms and attacks and enable individuals who have asthma to lead active lives (U.S. Department of Health and Human Services. Healthy People 2020).

 Approximately 1 out of every 10 adults (10.2%) in Wake County reported in 2010 that they have ever had asthma, compared to 12.5% in Mecklenburg County and 12.6% statewide.

 Non-whites in Wake County are 1.8 times more likely to have been diagnosed with asthma (14.5%) than whites (8.1%).

Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance Data, 2010.

In Wake County, the hospital discharge rate of individuals of all ages with a primary diagnosis of asthma increased between 2006 and 2009.

The discharge rate of children aged 0-14 diagnosed with asthma increased steeply between 2006 and 2009. Though it has since declined, the 2011 discharge rate (168.4 per 100,000 population) was 43% higher than the 2006 rate of 118.1 per 100,000 population.

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CLRD Mortality Rate Trend, 2000-2011 Rate per 100,000 population

Wake County Mecklenburg County State of NC

2013 Wake County Community Health Needs Assessment

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Source: NC State Center for Health Statistics, County-level Data, County Health Data Book (2008-2013), Morbidity, Asthma Hospital Discharges (Total and Age 10-14) per 100,000 Population.

During the 2011-2012 school year, the Wake County Public School System’s School Nurse program provided interventions for asthma for 3,642 students (Wake County Human Services, Quarterly Report Workbook, 2011-2012).

DIABETES

The majority (90-95%) of all people diagnosed with diabetes have type 2 diabetes. Diabetes can lead to serious and costly health problems such as heart disease, stroke, and kidney failure. Being overweight, obese and older are risk factors for diabetes (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

 Approximately 5.2% of Wake County residents reported that they have ever had diabetes, compared to 8.8% in Mecklenburg County and 9.8% statewide.

o The Healthy NC 2020 target is to reduce the percentage of adults with diabetes to 8.6%.

 Wake County residents with a household income of $50,000 or more were 2.2 times less likely (4%) to have ever been diagnosed with diabetes than those with household incomes less than $50,000 (9%).

 Approximately 7.1% of non-whites reported that they ever had diabetes compared to 4.1% for whites.

Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance Data, 2010.

According to hospital data for Wake County residents, an increasing number of patients have been discharged from Wake County Emergency Departments with diabetes-related diagnoses. In the 2012 fiscal year, more than 1,700 Wake County patients were seen in Wake County Emergency Departments for diabetes (types 1 and 2) related issues, a 17% increase since 2010 (1,478 patients) (Truven Health Analytics, prepared by WakeMed Health and Hospitals, 2013).

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Hospital Discharge Rates for Primary Diagnosis of Asthma, Wake County, 2006-2011 Rate per 100,000 population

All Ages Age 0-14

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Resource

Community Care of Wake and Johnston

Counties offers Living Healthy and Living Healthy with

Diabetes workshops, which are 6 week long workshops that

meet for 2.5 hours each week.

Those who have participated in the

program, when compared to those

who did not, demonstrated

significant improvements in:

exercise, cognitive symptom

management, communication with

physician, self- reported general

health, health distress, fatigue,

disability, social/role activities

limitations. They also spent fewer

days in the hospital and tended to have

fewer

hospitalizations.

Diabetes is the 7th leading cause of death for residents in Wake County. The Wake County diabetes mortality rate has decreased 29%, from a high point of 25.4 per 100,000 population in 2001- 2005 to 18.1 per 100,000 population in 2007-2011.

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013), Mortality,

Race-Specific and Sex-Specific Age-Adjusted Death Rates by County.

In 2007-2011, there were too few deaths attributed to diabetes among “Other Races” and Hispanic residents in Wake County to compute stable mortality rates. However, the rate among African Americans (43.6 per 100,000 population) is more than 3 times the rate among whites (13.7 per 100,000 population).

The diabetes mortality rate among African American males (52.1 per 100,000 population) is nearly 3 times higher than the rate among white males (18.1 per 100,000 population). The mortality rate among African American females (37.7 per 100,000 population) is 3.5 times the rate among white females (10.1 per 100,000 population).

Community Perceptions

In the 2013 Community Health Opinion Survey, respondents were asked if a health professional had ever diagnosed them with a list of health conditions. The top 3 leading conditions that residents self- reported was high blood pressure (BP), overweight/obesity, and high cholesterol.

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Diabetes Mortality Rate Trend, 2000-2011 Rate per 100,000 population

Wake County Mecklenburg County State of NC

http://www.ccwjc.com/living_healthy.asp

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Chapter 4| Health Status Page 100

Source: 2013 Wake County Community Health Opinion Survey.

In three focus groups, diabetes was identified as a health concern for Wake County, and in one focus group there was discussion among persons about the challenges of managing diabetes with limited Medicare resources. The Hispanic focus group identified additional health concerns, including cancer, high blood pressure, and high cholesterol.

“There are [diabetic] medications that Medicare will not cover and there have been some that I needed and for a monthly supply, it’s more than $100. I’m too embarrassed to tell anyone in my family or whatever. I just don’t take it. I just wait and hold and maybe something better will happen.”

- Community member

1.4

1.5

4.6

6.1

7.1

11.3

13.4

14.2

16.7

19.6

22.9

28.1

0 5 10 15 20 25 30

Congestive Heart Failure

COPD

Heart Disease

Osteoporosis

Diabetes

Chronic Pain

Cancer

Asthma

Depression

High Cholesterol

Overweight, Obese

High BP

Percent

Percent of Self-Reported Health Conditions (Wake CHOS, 2013)

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 101

Resources

The Wake County communicable

disease program works to prevent and control the

spread of communicable diseases and

vector-borne illness among people who

work, eat, play, and live in Wake

County. The program works to do the following:

 Describe disease trends.

 Identify and control the sources of infection.

 Educate the public.

 Take measures to prevent disease.

 Plan for and respond to public health emergencies.

Handwashing is one of the most

effective ways to prevent the spread of many types of

infection and illness in all settings

including home, workplace, child

care facilities, and hospitals).

Communicable Diseases and Immunization

Statistics, Targets, and Disparities

The prevention of communicable diseases is part of the historic foundation of public health practice. Fortunately, many communicable diseases such as chicken pox, measles, influenza, and hepatitis B can be prevented through immunizations. Foodborne illnesses are among the most common of communicable diseases, and they can lead to illness, hospitalizations, and even deaths. Foodborne illnesses are not vaccine preventable, but are potentially preventable through hand hygiene, safe food preparation, and proper storage (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Certain communicable diseases are required by law to be reported to local health departments by physicians, school administrators, child care operators, medical facilities, and operators of restaurants and other food or drink establishments.

 There are 71 “reportable” diseases specified in the N.C. Administrative Code rule.

 After initial notification about a case or cases of a communicable disease occurs in Wake County, Wake County Human Services begins an investigation, collecting details such as demographic, clinical, and epidemiological information.

 After verifying that a reported case meets the reporting requirements in the standardized case definitions, it is reported electronically to the N.C. Division of Public Health via the North Carolina Electronic Disease Surveillance System (NC EDSS) and then to the Centers for Disease Control and Prevention’s National Notifiable Diseases Surveillance System.

Source: Wake County Human Services, Public Health Division, Public Health Quarterly Report, Jan.-Mar. 2013.

http://www.wakegov.com/humanservices/publichealth/information/diseases/Pages/default.aspx

http://www.wakegov.com/humanservices/publichealth/information/diseases/Pages/handwashing.aspx

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GENERAL COMMUNICABLE DISEASES

In 2012, there were 48 cases of general communicable diseases reported in Wake County. Approximately 30% of those cases were Streptococcal infection, Group A, invasive and 25% were Haemophilus influenzae, invasive disease.

General Communicable Diseases in Wake County, 2008-2012

2008 2009 2010 2011 2012

Disease Case Count

Rate Case Count

Rate

Brucellosis 0 0 0 0 0 0 0 0 1 *

Creutzfeldt-Jakob Disease 0 0 4 * 1 * 1 * 2 *

Cryptosporidiosis 6 * 5 * 2 * 0 0 4 *

Dengue 1 * 0 0 2 * 2 * 1 *

Haemophilus influenzae,

invasive disease 10 * 12 * 11 * 9 * 12 *

Hemolytic-uremic syndrome (HUS)

1 * 2 * 1 * 0 0 0 0

Hepatitis A 15 * 2 * 2 * 2 * 2 *

Hepatitis C, acute 1 * 1 * 1 * 1 * 3 *

Influenza (NOVEL virus infection)

0 0 144 16.0 0 0 0 0 0 0

Legionellosis 3 * 3 * 4 * 8 * 3 *

Meningococcal disease 0 0 0 0 1 * 3 * 1 *

Q Fever 0 0 0 0 0 0 1 * 1 *

S. aureus with reduced susceptibility to vancomycin

2 * 0 0 0 0 0 0 1 *

Streptococcal infection, Group A, invasive

8 * 10 * 13 * 27 2.9 15 *

Toxic shock syndrome, streptococcal

1 * 0 * 2 * 2 * 0 *

Tularemia 1 * 0 0 0 0 0 0 0 0

Vibrio infection, other 0 * 1 * 1 * 1 * 2 *

Source: NC Electronic Disease Surveillance System, accessed 3/19/13. Note: counts include all cases meeting the suspect, probable, and confirmed North Carolina communicable disease case definitions. Notes: Rates per 100,000 population. *Rates based on fewer than 20 cases are unreliable and not displayed. Reportable communicable diseases with NO reported cases in the period 2008-2012 were not included in the above table. Because cases are routinely updated, case numbers may change. (Data was extracted 3/19/2013. Case definitions for these diseases are available at http://epi.publichealth.nc.gov/cd/lhds/manuals/cd/case_defs.html.

 Group A Streptococcus is a bacterium often found in the throat and on the skin. People may carry group A streptococci in the throat or on the skin and have no symptoms of illness. Most Group A Streptococcus infections are relatively mild illnesses such as "strep throat," or impetigo. Occasionally these bacteria can cause severe and even life-threatening diseases when bacteria get into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. These infections are termed "invasive Group A Streptococcus disease."

 Haemophilus influenzae, invasive disease can cause serious invasive illness such as meningitis, bacteremia, epiglottitis, and pneumonia. Hib infection is spread primarily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes.

Source: Centers for Disease Control and Prevention website.

http://epi.publichealth.nc.gov/cd/lhds/manuals/cd/case_defs.html

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VACCINE PREVENTABLE DISEASES

For vaccine preventable diseases in Wake County, there were 161 cases reported in 2012. Of those cases, 71% were chronic Hepatitis B cases, 3% acute Hepatitis B cases, 25% were pertussis or whooping cough cases, and 2% were adult influenza deaths. The number of confirmed cases of pertussis reported in Wake County during January through December 12, 2012 increased more than 3 times the average number reported over the last ten years.

Vaccine Preventable Diseases in Wake County, 2008-2012

2008 2009 2010 2011 2012

Disease Case Count

Rate Case Count

Rate

Hepatitis B, acute 5 * 7 * 4 * 4 * 4 *

Hepatitis B-chronic 100 11.5 104 11.6 180 19.9 202 21.7 114 12.3

Influenza, pediatric death

(< 18 years of age) 0 0 1 * 0 0 1 * 0 0

Influenza, adult death (18 years of age)

0 0 0 0 0 0 7 * 3 *

Mumps 1 * 0 0 0 0 0 0 0 0

Pertussis (whooping cough) 12 * 10 * 19 * 6 * 40 4.30

Poliomyelitis, paralytic 0 0 0 0 0 0 0 0 0 0

Rubella 0 0 0 0 0 0 0 0 0 0

Rubella, congenital syndrome

0 0 0 0 0 0 0 0 0 0

 Hepatitis B is a liver disease that results from infection with the Hepatitis B virus. Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

o Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus.

o Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body. Chronic Hepatitis B is a serious disease that can result in long- term health problems, and even death.

 Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis. Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe. Pertussis most commonly affects infants and young children and can be fatal, especially in babies less than 1 year of age.

Source: Centers for Disease Control and Prevention website.

http://epi.publichealth.nc.gov/cd/lhds/manuals/cd/case_defs.html

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PNEUMONIA AND INFLUE NZA

The mortality rate due to pneumonia and influenza decreased 31.8% in Wake County, from 15.4 per

100,000 population in 2000-2004 to 10.5 per 100,000 population in 2007-2011. In 2007-2011,

the pneumonia and influenza mortality rate in Wake County was 41.3% lower than the rate for NC

(17.9) and 25.5% lower than the Mecklenburg County rate (14.1).

 The Healthy NC 2020 target is to reduce the pneumonia and influenza mortality rate (per 100,000 population) to 13.5.

FOODBORNE ILLNESSES

During 2008 through 2012, the three most commonly reported foodborne illnesses in Wake County were salmonellosis, campylobacteriosis, and shigellosis. Cases of some foodborne diseases caused by other microorganisms are not required to be reported under NC communicable disease law. However, all foodborne outbreaks are required to be reported to local health departments and the NC Division of Public Health.

Source: North Carolina Electronic Disease Surveillance System. Notes: Counts include all cases meeting the suspect, probable, and confirmed North Carolina communicable disease case definitions. Poisoning includes ciguatera, mushroom, and scrombroid fish. Other includes Cyclosporiasis, Q fever, Staphylococcus aureus, typhoid, Vibrio vulnificus and vibrio infection other than cholera and vulnificus and listeriosis.

SEXUALLY TRANSMITTED INFECTIONS

Sexually transmitted infections (STIs) refer to more than 25 infectious organisms that are transmitted primarily through sexual activity. STI prevention is an essential primary care strategy for improving reproductive health. Despite their burdens, costs, and complications, and the fact that they are largely preventable, STIs remain a significant public health problem in the United States.

 Untreated STIs can lead to serious long-term health consequences, especially for adolescent girls and young women.

 The Centers for Disease Control and Prevention estimates that undiagnosed and untreated STIs cause at least 24,000 women in the United States each year to become infertile.

1% 2% 2% 4%

19%

66%

Reported Foodborne Illness in Wake County, 2008- 2012

Poisoning

Hepatitis A

Other

Shigella

E coli

Campylobacter spp.

Salmonella, nontyphoidal

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 Because many cases of STIs go undiagnosed and some common viral infections, such as human papillomavirus (HPV) and genital herpes are not reported, the reported cases of chlamydia, gonorrhea, and syphilis represent only a fraction of the true burden of STIs in the United States.

Source: U.S. Department of Health and Human Services. Healthy People 2020.

In 2012, there were 4,468 cases of Chlamydia reported in Wake County, 1,336 cases of Gonorrhea, and 742 cases of non-gonococcal urethritis.

Sexually Transmitted Infections in Wake County, 2008-2012

2008 2009 2010 2011 2012

Disease Case Count

Rate Case Count

Rate

AIDS 120 13.8 109 12.1 84 9.3 76 8.4 data not available

Chancroid 0 0 0 0 1 * 0 0 0 0

Chlamydia 3,121 359.5 3,590 400.1 4,530 502.8 4,748 510.7 4,638 498.8

Gonorrhea 1,030 118.7 1,010 112.6 1,249 138.6 1,355 145.7 1,336 143.7

Granuloma inguinale 1

0 0 0 0 0 0 0 0

HIV 203 23.4 186 20.7 170 18.9 153 17 data not available

Non-gonococcal urethritis 351 40.4 292 32.6 372 41.0 514 55.3 742 79.8

PID 138 15.9 115 12.8 192 21.2 273 29.4 246 26.5

Syphilis , primary 7 * 14 * 3 * 13 * 7 *

Syphilis, secondary 25 2.9 58 6.5 38 4.2 31 3.3 45 4.9

Syphilis, early latent 13 * 44 4.9 42 4.6 32 3.4 27 2.9

Syphilis, latent, unknown duration

8 * 18 * 17 * 8 * 14 *

Syphilis, late latent 38 4.5 48 5.4 35 3.9 56 6.0 36 3.9

Syphilis, late with symptoms 1 * 1 * 0 0 0 0 0 0

Syphilis, neurosyphilis 3 * 3 * 0 0 0 0 0 0

Syphilis, congenital 0 0 0 0 1 * 1 * 0 0

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 106

The rates for chlamydia and gonorrhea in Wake County have increased steadily from 2008 through 2011, but have declined slightly from 2011 to 2012. Both the chlamydia and gonorrhea rates for Wake County are generally lower than the overall rates in North Carolina. However, both North Carolina and Wake County rates are higher than national rates.

Source: NC Electronic Disease Surveillance System. Note: *2012 rate for NC is preliminary.

In Wake County, more than half of all reported cases of chlamydia (66%) and gonorrhea (51%) occur among 15-24 year olds. The highest percent of chlamydia and gonorrhea cases are among African American youth.

Source: NC Division of Public Health Communicable Disease Branch.

0 10 20 30 40 50 60 70 80

Native American

Asian, Pacific Islander

Hispanic

Unknown

White

African American

Percent

Native American

Asian, Pacific Islander

Hispanic Unknown White African

American

% Gonorrhea 1 1 4 14 9 72

% Chlamydia 1 1 10 16 17 56

Percent of Total Number of Gonorrhea and Chlamydia Cases among Ages 15-24 by Race and Ethnicity, Wake County, 2012

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 107

Resource

For prevention, early identification and treatment of

sexually transmitted infections, Wake County Human

Services integrated its testing services for HIV, syphilis,

chlamydia, gonorrhea,

hepatitis, and TB in 2012 by offering

simultaneously testing to clients at

community and clinical testing sites. Integrated testing

of high risk populations

increases detection and treatment of

sexually transmitted infections and TB.

This enhanced testing is made

possible through the Center for

Disease Control (CDC) Program

Collaboration and Service Integration (PCSI) and other grant funding.

Source: Wake County 2012 State of the County

Health Report.

HIV/AIDS

In 2011, the HIV incidence rate (or the number of newly diagnosed

individuals per 100,000 population) in Wake County (17) was 30%

lower than the 2007 rate (24.4). As of December 31, 2011, there

were 2,721 individuals who had been diagnosed with HIV/AIDS

living in Wake County (NC DHHS, Division of Public Health,

Epidemiology Section, Communicable Disease Branch. 2011

HIV/STD Surveillance Report).

The AIDS mortality rate in Wake County decreased 41%, from 4.4

per 100,000 population in 2000-2004 to 2.6 per 100,000

population in 2007-2011. When compared to Mecklenburg County

and NC, Wake County has had consistently lower AIDS mortality

rates, where the 2007-2011 rate in Mecklenburg County (6.3 per

100,000 population) was more than twice the rate of Wake County

(2.6 per 100,000 population) (NC State Center for Health Statistics,

County-level Data, County Health Data Books, 2007-2013).

TUBERCULOSIS

Since 2010, TB rates per 100,000 population in Wake County have declined more than 50%. While the numbers may be small, TB is a highly contagious disease and left untreated can cause outbreaks and severe disease. Surveillance, prevention, and treatment of TB and other communicable disease remains crucial for the health of our residents. In 2012, Wake County Human Services staff provided 2,177 TB-related home visits to ensure treatment compliance; provide medical follow up, and distribute preventive medications to those exposed to Latent TB infections.

Source: NC Electronic Disease Surveillance System.

2008 2009 2010 2011 2012

TB 4.6 2.4 4.1 3.1 1.7

0.5

1.5

2.5

3.5

4.5

R a te

TB Rates, Wake County, 2008-2012 Rate per 100,000 population

http://www.wakegov.com/humanservices/publichealth/information/hiv/Pages/locations.aspx

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 108

Improving Tdap Immunizations for Wake County Residents and First Responders

To improve immunization rates, the NC Immunization Program (NCIP) provided Tdap

(Tetanus, Diphtheria, and Pertussis) vaccine at no cost to loca l health departments

and private provider practices beginning in the spring 2012. Wake County Human

Services partnered with Wake County EMS to improve Tdap immunizations rates with

special emphasis on Wake County residents, employees and first responder personnel.

During the period from May through September 2012, over 5,400 doses of Tdap were

administered by WCHS and EMS, including doses administered to nearly 2,200 Wake

County staff and first responder personnel immunized through this partnership in

targeted clinics throughout the county. First responder personnel, including local Police

and Fire department staff, were visited by EMS personnel at their wor k sites to receive

their Tdap vaccination, and additional clinics were offered at a variety of locations

serving State of NC and Wake County government staff.

Source: Wake County 2012 Annual Report.

IMMUNIZATION

The increase in life expectancy during the 20th century is largely due to improvements in child survival; this increase is associated with reductions in infectious disease mortality, due largely to immunization. However, communicable diseases remain a major cause of illness, disability, and death. Immunization recommendations in the United States currently target 17 vaccine-preventable diseases across the lifespan (U.S. Department of Health and Human Services. Healthy People 2020). For every dollar spent on the U.S. childhood immunization program, 5 dollars in direct costs and 11 dollars in additional costs to society are saved (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011). In 2011, approximately 65% of children between the age of 19-35 months had received the recommended vaccination series, with an overall NC rank of 70 out of 100.

 The Healthy NC 2020 target is to increase the percentage of children aged 19-35 months who receive the recommended vaccines to 91.3%.

Percent and Rank of Children Aged 19-35 Months with Recommended Vaccination Series, 2011

Location Percent Rank

Wake County 65% 70

Mecklenburg County 63% 74

State of NC 65% N/A

Source: NC Immunization Program. Annual Immunization Assessment and Ranking, 2011. Notes: Rank of 1 equals "best". County rates include all children in the NC Immunization Registry who have that county recorded as their county of residence. Data does not necessarily represent true immunization ‘coverage’, but rather compliance with immunization data entry. The recommended vaccination series is 431331, i.e. 4 DTaP, 3 Polio, 1 MMR, 3 HIB, 3 HEPB and 1 VAR, and is assessed at 24 months of age. The assessment was conducted on October 2, 2011 and included children within the birth date range from October 2, 2008 to October 2, 2009.

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 109

Disability and Care -giving

People living with disabilities play an important and valued role in every community. The U.S. Census in 2000 counted 49.7 million people with some type of long-lasting condition or disability. Disability is part of human life, and an impairment or condition does not define individuals, their health, or their talents and abilities. Compared with people without disabilities, people with disabilities are more likely to experience difficulties or delays in getting the health care they need. (U.S. Department of Health and Human Services. Healthy People 2020). Statistics, Targets, and Disparities

In 2010, 1 in 4 Wake County adults (24.9%) reported disability status, either being limited in activities because of physical, mental, or emotional problems; or having a health problem that requires special equipment such as a wheelchair (NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010).

Wake County is home to 1,348 blind or visually impaired individuals, which is 6.4% of all blind or visually impaired individuals in the state of NC (Log into North Carolina (LINC) Database, Topic Group Vital Statistics and Health).

There are currently three state developmental centers providing services for persons with developmental disabilities in North Carolina:

 Caswell Developmental Center in Kinston (capacity of 429 serving 38 counties in the Eastern region of the state).

 Murcoch Developmental Center in Butner (capacity of 575 serving the 25 counties in the Central Region).

 J. Iverson Riddle Developmental Center in Morganton (capacity of 350 serving the 37 counties in the Western Region).

The number of Wake County residents served in state-run developmental disability centers has declined 55% since 2007.

Persons Served in NC State Developmental Centers (2005-2010)

Location Number of Persons Served

2005 2006 2007 2008 2009 2010

Wake County 77 80 83 21 26 37

Mecklenburg County 98 68 68 64 68 68

State of NC 2,172 1,690 1,713 1,409 1,404 1,375

Source: NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services, Statistics and Publications, Reports and Publications, Statistical Reports, Developmental Centers (FY2005-FY2010).

According to the 2013 Community Health Opinion Survey, 26% of residents reported that they provide some care for a family member or friend with a disability or long-term illness.

2013 Wake County Community Health Needs Assessment

Chapter 4| Health Status Page 110

Resources

The Children with Special Health Care Needs helpline is a toll-free referral

help line for those living with, caring for, and concerned about a child with special health care needs. The helpline

provides information about

programs and funding resources available to NC

residents.

1-800-737-3028

The Arc of Wake County offers

advocacy, information, and

referral services for individuals with intellectual and other disabilities and/or families

who need assistance in negotiating the

often complex system of services.

Alliance of

Disability

Advocates is

committed to

assisting people

with disabilities to

live independently

and become

productive full

participants in

society.

Community Perceptions

Caring for a special needs family member was the #7 issue that residents wanted more information about.

Source: 2013 Wake County Community Health Opinion Survey.

In focus groups with persons living with physical or developmental disabilities or their caregivers, equal mobility access to health and recreation facilities was identified as a key element to personal health. Like accessing mental health services, there was a socioeconomic divide of knowing how, when, and in what ways individuals and caregivers can access (and navigate) disability services. A few focus group participants were concerned about the few resources available for survivors of Traumatic Brain Injury, and the difficulty of navigating the system with those needs. Parents of children living with disabilities were concerned about their ability to adequately provide care as they grow older and felt that services need to respond to the aging of the client and caregiver population.

Additionally, the competency of health care providers who interact with persons living with disabilities was identified as a key improvement needed in the health care system.

“Unless you have a sighted guide or a companion to help you

interact with the medical system, then you're shunted off to the

side, such as the nurse may not talk to you. You're the patient.

She should talk to you. They're talking to this visual person n ext

to you. They give instructions to the visual person next to you

instead of giving it to you, the blind person.”

- Community member

Eating Well,

Nutrition

Child Care,

Parenting

Stress Mgmt

Exercising, Fitness

Crime Prevention

None

Caring For

Special Needs

Family

Health Behaviors 8.61 7.29 6.07 5.17 4.83 4.78 4.56

P e rc

e n t

Health Behavior Information Gaps (Wake CHOS, 2013) 95% Confidence Limits

http://www.ncdhhs.gov/dph/wch/families/helplines.htm

http://www.arcwake.org/advocacy.html

http://www.alliancecil.org/aboutus.htm

2013 Wake County Community Health Needs Assessment

Page 111

CHAPTER 5:

MENTAL HEALTH AND SUBSTANCE USE

2013 Wake County Community Health Needs Assessment

Chapter 5| Mental Health and Substance Use Page 112

CHAPTER 5 | MENTAL HEALTH AND SUBSTANCE USE Mental health, an integral part of individual health, is important throughout the lifespan. Individuals with poor mental health may have difficulties with interpersonal relationships, productiveity in school or the workplace, and in their overall sense of well-being.

Substance use and abuse are major contributors to death and disability in North Carolina. Addition to drugs or alcohol is a chronic health problem, and people who suffer from abuse or dependence are at risk for premature death, comorbid health conditions, injuries, and disability.

Source:

 NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011.

Mental Health

Statistics, Targets, and Disparities

MENTAL HEALTH DAYS

The number of poor mental health days within the past 30 days is used as one measurement of a person’s health-related quality of life. Poor mental health includes stress, depression, and other emotional problems that can prevent a person from successfully engaging in daily activities. In 2010, 3.2% of Wake County adults reported poor mental health days in the past 30 days, compared to 5.4% in Mecklenburg County and 5.9% statewide (NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010).

 The Healthy NC 2020 target is to decrease the average number of poor mental health days among adults in the past 30 days to 2.8.

SUICIDE

The 2007-2011 suicide mortality rate in Wake County (8.9 per 100,000 population), was 26% lower

than the state rate (12.1 per 100,000 population) and 2% lower than the Mecklenburg County rate

(9.1 per 100,000 population).

 The Healthy NC 2020 target is to reduce the suicide rate (per 100,000 population) to 8.3.

Quick Facts

Positive Trends:

 3.2% of Wake County residents reported poor mental health days within the past month, compared to 5.9% statewide.

Areas for Improvement:

 12% of Wake County residents reported that they are not sure where to seek help for a mental health or drug/alcohol abuse problem.

 Wake County Emergency Departments have seen in increase in the number of patients seen for mental and behavioral health disorders.

 Access to mental health and substance use services is a growing concern for residents and there is a socioeconomic divide of knowing how, when, and in what ways one can access services.

2013 Wake County Community Health Needs Assessment

Chapter 5| Mental Health and Substance Use Page 113

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013), Mortality, Race-Specific and Sex-Specific Age-

Adjusted Death Rates by County.

The 2007-2011 suicide rate among whites in Wake County (11 per 100,000 population), was more than triple the rate among African Americans (3.6 per 100,000 population). Additionally, the suicide mortality rate among males in Wake County (14 per 100,000 population) was approximately 3 times higher than the female rate (4.3 per 100,000 population).

Community Perceptions

According to the 2013 Community Health Opinion Survey, 17% of Wake County adults reported being diagnosed with depression at some point in their lives. Residents identified stress management as the #3 issue they wanted more information about.

Additionally, mental health services were identified as the #4 service needing improvement in Wake County.

Source: 2013 Wake County Community Health Opinion Survey.

R a te

Suicide Mortality Rate Trend, 2000-2011

Wake County Mecklenburg County State of NC

Positive Teen Activities

Availability of Employment

Higher Paying Employment

Mental Health Services

Road Safety, Maintenance

Support to Help Manage Health

Conditions

More Affordable,

Better Housing

Services 9.28 7.82 7.55 7.36 6.49 5.9 5.72

P e rc

e n t

Services Identified as in Need of Improvement (Wake CHOS, 2013) 95% Confidence Limits

2013 Wake County Community Health Needs Assessment

Chapter 5| Mental Health and Substance Use Page 114

Resources

Alliance Behavioral Health care

manages the public mental health, intellectual/

developmental disability and

substance abuse services for the

citizens of Durham, Wake, Cumberland

and Johnston counties. These

services are delivered by a

network of private providers who contract with

Alliance.

Wake Crisis and

Assessment Services

are available to

anyone in need

of help in a crisis

related to a mental

illness, a

developmental

disability or an

addiction.

(919) 250-1260

When asked where to go for a mental health or drug/alcohol abuse problem, almost 1 in 3 residents surveyed by the 2013 Community Health Opinion Survey said a doctor, followed by other (21%), therapist (15%), religious official or minister (12%), and family (8%). Twelve percent of respondents said they are not sure where to seek help, compared to 16% reported in 2010.

Within all focus groups, mental and spiritual well-being was identified as a key element of personal health. Mental health was considered a growing concern among focus group participants, where insurance and cost are major barriers to accessing mental health services. The socioeconomic divide of knowing how, when, and in what ways one can access mental health services surfaced as a cross-cutting theme.

Mental health care is not covered on most insurance plans.

And so, I feel like it’s very difficult for people to access mental

health care resources.”

- Community member

Many participants voiced concern over homelessness and how that disproportionately affects those living with mental health issues. Additionally, some residents felt that the mental health services will need to adapt to meet future demand.

“Now, right now, North Carolina’s facing a huge influx of

veterans coming home with PTSD and brain injury who are

likely to get into substance abuse issues, to get into behavioral

issues, and so forth, and their families are going to be victims

of all of that. And so those kids of those families are also

going to need supports. So we have to have a system that’s

capable not only of serving the needs and providing support to

now, but also monitoring and anticipating what’s going to be

needed down the road. You can’t just stop at one point;

you’ve got to be looking.”

- Community member

http://www.alliancebhc.org/

http://www.wakegov.com/humanservices/locations/wakebrook/Pages/default.aspx

2013 Wake County Community Health Needs Assessment

Chapter 5| Mental Health and Substance Use Page 115

MENTAL HEALTH SERVICES AND FACILITIES

The NC Department of Health and Human Services reports the number of licensed mental health facilities by county.

 As of April 2013, Wake County had 299 licensed facilities with a capacity of 1,167.

 Facilities range from supervised living facilities for adults and minors, day treatment and activity programs for adults, residential and day treatment programs for Substance Abuse (SA), Intellectual/Developmental Disabilities (I/DD) and Mental Health (MH), detoxification programs, psychosocial rehabilitation, inpatient and outpatient substance abuse treatment, respite services for caregivers, and outpatient methadone clinics.

Despite some fluctuation, the number of individuals served by local mental health programs in Wake County has increased 28% from 15,476 in 2005 to 19,771 in 2010.

Persons Served by Area Mental Health Programs, 2005-2010

Location Number of Persons Served

2005 2006 2007 2008 2009 2010

Wake County 15,476 14,811 16,720 17,179 17,157 19,771

Mecklenburg County 40,712 33,956 29,415 38,559 37,481 38,944

State of NC 337,676 322,397 315,338 306,907 309,155 332,796

Source: Log Into North Carolina (LINC) Database, Topic Group Vital Statistics and Health. Note: All clients of a community-based Area Program for mental health, developmental disabilities, and drug and alcohol abuse active at the beginning of the state fiscal year plus all admissions during the year. Also included are persons served in three regional mental health facilities. Multiple admissions of the same client are counted multiple times. County of residence is reported at the time of admission. North Carolina data include clients reported to reside out-of-state and sometimes contains individuals of unknown county of residence.

According to hospital data Wake County emergency departments have experienced an increase in the number of patients seen for mental, behavioral, and neurodevelopmental disorders. In the 2012 fiscal year, 4,715 patients were discharged from Wake County emergency departments with diagnoses within this category, with the most frequent principal diagnosis being “Anxiety State Not Otherwise Specified” with 837 patients. Excluding drug and alcohol related diagnoses; patients are also seen in the emergency department for panic disorder, depressive disorder, and psychosis (Truven Health Analytics, prepared by WakeMed Health and Hospitals, 2013).

Wake County's Local Management Entity (LME) is Alliance Behavioral Healthcare, which also serves as the LME for Durham, Cumberland, and Johnston counties.

 The LME exists to refer patients needing mental health, substance abuse and developmental disability services to the appropriate providers.

 Wake County has a wide range of service providers, with an emphasis on residential and in- home-based service providers and on services for those with developmental disabilities.

Alliance currently lists 559 mental health, substance abuse, and developmental disability providers in the mental health local management entity/area program network, though this list may include duplicates of those providing services in multiple categories.

2013 Wake County Community Health Needs Assessment

Chapter 5| Mental Health and Substance Use Page 116

Available Services and Providers in the Mental Health Local Management

Entity/Area Program Network (Medicaid), 2013

Service Number of Providers

in Wake County

Assertive Community Treatment Team 5

Child Day Treatment 10

Community Support Team 25

Facility-Based Crisis 1

Intellectual/Developmental Disabilities Residential Supports Level 1 70

Intellectual/Developmental Disabilities Residential Supports Level 2 71

Intellectual/Developmental Disabilities Residential Supports Level 3 78

Intellectual/Developmental Disabilities Residential Supports Level 4 69

Intermediate care facilities for individuals with mental retardation 22

Innovations-In Home Intensive Supports 32

Innovations-In Home Skill Building 50

PATH 1

Personal Care 74

Level 3 Residential 17

Mobile Crisis 8

Supported Employment 33

Level 2 Placing Agencies (Family type) 14

Level 4 Residential 0

Non-Hospital Detoxification 1

Substance Abuse - Intensive Outpatient 16

Psychosocial Rehabilitation 11

Substance Abuse - Comprehensive Outpatient 5

Inpatient 1

Child Mental Health/Substance Abuse Intensive In-Home 28

Innovations Intellectual/Developmental Disability Day Supports 28

Multi-Systemic Therapy 2

Psychiatric Residential Treatment Facility 6

Level 2 Residential (Program type) 4

Innovations Intellectual/Developmental Disability Community Guide 12

Total 559

Source: Alliance Behavioral Health care, Quality Management Department, 4/4/13.

2013 Wake County Community Health Needs Assessment

Chapter 5| Mental Health and Substance Use Page 117

Resources

Community Care of Wake and Johnston Counties (CCWJC) provides a resource

list of substance abuse resources in

Wake County, including service

types, payor source, and specialties.

WakeBrook Recovery Center is operated by UNC

Hospital and is a dual-diagnosis substance abuse

treatment hospital for men, women

and families. High- priority populations include pregnant,

IV, and HIV- positive drug users.

Substance Use

Statistics, Targets, and Disparities

 In Wake County, 15% of residents binge drink (males having five or more drinks on one occasion OR females having four or more drinks on one occasion), which is more than twice the national benchmark of 7% (County Health Rankings and Roadmaps, 2013).

 The number of methampetamine labs discovered in Wake County in 2012: 6 (NC Department of Justice, State Bureau of Investigation).

There are currently three Alcohol and Drug Abuse Treatment Centers in North Carolina: Julian F. Keith in Black Mountain, R.J. Blackley in Butner, and Walter B. Jones in Greenville. The number of Wake County residents being served in state Alcohol and Drug Abuse Treatment Centers has increased, from 30 in 2005 to 140 in 2010.

Persons Served in NC State Alcohol and Drug Treatment Centers,

2005-2010

Location 2005 2006 2007 2008 2009 2010

Wake County 30 50 97 70 122 140

Mecklenburg County

155 195 210 239 180 196

State of NC 3,732 4,003 3,733 4,284 4,812 4,483

Source: Log Into North Carolina (LINC) Database, Topic Group Vital Statistics and Health (Data Item 518). Note: Sometimes referred to as "episodes of care", these counts reflect the total number of persons who were active (or resident population) at the start of the state fiscal year plus the total of first admissions, readmissions, and transfers-in which occurred during the fiscal year at the three state alcohol and drug treatment centers. Excluded are visiting patients and outpatients. Multiple admissions of the same client are counted multiple times. County of residence is reported at the time of admission. North Carolina data include clients reported to reside out-of-state.

http://www.ccwjc.com/Forms/Behavioral%20Health/Substance%20Abuse%20Resources.pdf

http://www.wakegov.com/humanservices/locations/wakebrook/Pages/default.aspx

2013 Wake County Community Health Needs Assessment

Chapter 5| Mental Health and Substance Use Page 118

Wake County Mental Health, Substance Abuse, and Developmental Disability Crisis and Provider Contacts

Locating Service Providers Online:

www.AllianceBHC.org

Alliance Behavioral

Health care Access Line (24/7): 1-800 510-9132

Crisis Response

Mobile Crisis Assistance (24/7): 1 -877-626-1772

Emergency: If calling 911 in response to a mental health emergency, request a Crisis Intervention

Team (CIT) Officer

Community Perceptions

According to the 2013 Community Health Opinion Survey, residents identified drug and alcohol abuse as the #4 community concern. When asked where to go for a mental health or drug/alcohol abuse problem, almost 1 in 3 residents said a doctor, followed by other (21%), therapist (15%), religious official or minister (12%), family (8%). Twelve percent of respondents said they are not sure where to seek help.

Source: 2013 Wake County Community Health Opinion Survey.

file:///C:/Users/tmontoya.SPH-INC63048/Downloads/www.AllianceBHC.org

2013 Wake County Community Health Needs Assessment

Page 119

CHAPTER 6:

MODIFIABLE HEALTH RISKS

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 120

CHAPTER 6 | MODIFIABLE HEALTH RISKS The leading causes of death in Wake County (cancer, heart disease, and stroke) are chronic diseases. Chronic diseases are among the most common, costly, and preventable of all health problems in the U.S. People who suffer from chronic diseases such as heart disease, stroke, diabetes, cancer, obesity, and arthritis experience limitations in function, health, activity, and work, affecting the quality of their lives as well as the lives of their families. Underlying these diseases and conditions are modifiable health behaviors such as:

 Poor nutrition  Lack of physical activity  Tobacco use  Excessive alcohol consumption

Increasing access to healthy and affordable food, recreation, tobacco cessation services, and substance abuse treatment can help Wake County residents reduce their risk for illness and death due to chronic diseases.

Sources:

 Centers for Disease Control and Prevention. (2009). The Power of Prevention: Chronic disease…the public health challenge of the 21st century.

 Centers for Disease Control and Prevention. (2008). North Carolina: Burden of chronic diseases.

Nutrition

Good nutrition is essential to good health and a healthy weight. Fruits and vegetables have been shown to guard against many chronic diseases, including cardiovascular disease, type 2 diabetes, and some cancers (U.S. Dept of Health and Human Services, Dietary Guidelines for Americans, 2005).

Statistics, Targets, and Disparities

Almost 3 out of 4 residents (74.1%) in Wake County do not eat enough fruits and vegetables (NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2009). The Healthy NC 2020 target is to decrease that number to 70.7% by 2020.  The percent of residents who eat five fruits and vegetables a

day is 24% higher among whites in Wake County than non- whites.

 Residents in Wake County with a household income of $50k or more are 1.8 times more likely to eat 5 fruits and vegetables than those earning less than $50k.

Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2009.

Quick Facts

Access to Healthy Food

 Percent of all restaurants in Wake County that are fast-food: 51%.

Source: County Health Rankings and Roadmaps, 2013. University of Wisconsin Population Health Institute).

 6% of low-income residents in Wake County do not live close to a grocery store.

Source: 2012, USDA Food Environment Atlas.

Positive Trends:

 Since 2008, there has been an overall decrease in overweight and obese adults in Wake County.

 The percent of current smokers in Wake County has dropped 26% drop from 2001.

 The Wake County homicide mortality rate per 100,000 population (3.1) is half of the state rate (6.3).

Areas for Improvement:

 3 out of 4 residents do not eat enough fruits and vegetables.

 10% of residents do not participate in any exercise.

 Wake County residents with a household income of $50k or more are 1.6 times more likely to have visited a dentist, dental hygienist, or a dental clinic than those earning less than $50k.

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 121

Community Perceptions

In the 2013 Community Health Opinion Survey (CHOS), 8.4% of residents did not think that they could “easily access healthy, affordable food.” In addition, residents identified eating well/nutrition as the top issue they wanted more information about.

Source: 2013 Wake County Community Health Opinion Survey.

Within all focus groups, access to healthy, affordable food in school and community settings was identified as a key element of a healthy community. Many residents voiced concern over access to healthy foods, particularly in communities where grocery stores and transportation options are limited.

“That’s why in the Southeast Raleigh area, the low populated areas and low economic rates,

they’re suffering from chronic illnesses. Why? Because it’s -- they’re obese because of the food

options that we have. Just recently, they shut down two of the Kroger’s that are in the Southeast

Raleigh area. A lot of the people that lived over there, that was their only source to get some

type of healthy food. The closest market is -- it’s not even close, actually. It’s at least 20, 30

minutes away.”

- Community member

Eating Well, Nutrition

Child Care, Parenting

Stress Management

Exercising, Fitness

Crime Prevention

None Caring For

Special Needs Family

Health Behaviors 8.61 7.29 6.07 5.17 4.83 4.78 4.56

P e rc

e n t

Health Behavior Information Gaps (Wake CHOS, 2013) 95% Confidence Limits

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 122

Physical Activity

Physical activity is a key factor in affecting overall health as well as body weight. Regular physical activity reduces the risk of heart disease, stroke, hypertension, and type 2 diabetes (CDC, Overweight and Obesity: Childhood overweight and obesity, 2009).

Statistics, Targets, and Disparities

In Wake County, 82.9% of adults reported that they participated in physical activities in the past month (NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010).  Males in Wake County are more likely than females to participate in physical activities (88.1% versus

77.9%).

 Income and education are also related to physical activity: residents in Wake County with some college and household income over $50k are more likely to exercise.

Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010.

The Healthy NC 2020 target is to increase the percentage of adults getting the recommended amount of physical activity (at least 30 minutes of moderate activity 5 or more days a week or vigorous activity for at least 20 minutes 3 or more days a week) to 60.6%.

Community Perceptions

According to the 2013 Community Health Opinion Survey, the majority of residents exercise in their neighborhood (30.6%), followed by residents who exercise at public parks or trails, home, or private gyms. Only 5% of residents reported that they exercise at work or at a school setting.

Source: 2013 Wake County Community Health Opinion Survey.

Additionally, 10% of Wake County residents reported that they do not engage in any physical activity. Of the 10% who said they do not exercise, the reasons why they do not exercise included the following: physically unable, not enough time, do not like it, too expensive, no childcare, no safe place, and other.

Faith Community

Malls Other School setting

Work Private

Gym, pool Home

Public park, trail

Neighbor- hood

Places 0.00 0.00 1.07 1.79 5.37 27.41 27.51 29.18 30.60

P e rc

e n t

Places for Exercise (Wake CHOS, 2013) 95% Confidence Limits

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 123

Current Initiatives

In 2011, the Wake

County "Farm to

Family" Food Finder

was developed. This

service markets the

availability and

access points of

local foods in

Wake County

through an online,

interactive Google

map that was

created through the

collaborative

efforts of Wake

County Cooperative

Extension and the

community health-

focused

collaborative,

Advocates for

Health in Action

(AHA).

The City of Raleigh

Parks and

Recreation staff

maintained 78 miles

of paved and

unpaved trails. On

September 24,

2012 an additional

trail, “The House

Creek Greenway

Trail,” was

dedicated

connecting

completed

bicycle/pedestrian

routes in the county.

Source: 2013 Wake County Community Health Opinion Survey.

Note: Includes responses from only the respondents who said they do not exercise.

From the focus groups, some focus group participants felt that Wake County’s recreation resources were an asset to the community. “I didn’t realize how many -- and even in my own neighborhood that

I’ve lived in for seven years, I never really noticed that there was this

much stuff to do, like outside activities. There’s like biking and then you

can have camp areas. And I had no clue of that, which I think it’s

amazing.”

- Community member

However, other focus groups identified needs for safer, more affordable, and more accessible recreation facilities in Wake County. “I would like [to see improvements in] other services for children and

youth, maybe recreational centers. I have to go to Apex because there

is not that much here, and if there is, it’s expensive.”

- Community member

16%

30%

32%

Reasons Residents Do Not Exercise Wake CHOS, 2013

No Safe Place

No Childcare

Too Expensive

Other

Do Not Like It

Not Enough Time

https://maps.google.com/maps/ms?ie=UTF8&oe=UTF8&msa=0&msid=210292701217115466553.0004a4098f63fc11e6e07

http://www.raleighnc.gov/arts/content/PRecDesignDevelop/Articles/CapitalAreaGreenwayTrailSystem.html

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 124

Overweight and Obesity

Overweight and obesity pose significant health concerns for both children and adults. Excess weight increases an individual’s risk of developing type 2 diabetes, high blood pressure, heart disease, certain cancers, and stroke (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Statistics, Targets, and Disparities

In Wake County, almost 2 out of 3 adults (59.9%) is either overweight or obese (NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2009). Even though the percent of adults who are overweight or obese continues to steadily increase across the state, there has been an overall decrease in overweight or obese adults in Wake County since 2008. The Healthy NC 2020 target is to reduce the percent of overweight or obese adults to 61.9%.

Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System.

After increasing from 16.2% in 2006 to 18.4% in 2008, the percentage of children aged 2-4 in Wake County who are overweight has since decreased to 16.9%.

50.0

55.0

60.0

65.0

70.0

2006 2007 2008 2009 2010

P e rc

e n t

Prevalence of Adults Who Are Overweight or Obese, 2006-2010

Wake County Mecklenburg County State of NC

Measuring Obesity

BMI = Body Mass Index

Relationship between height and weight that is associated with body fat

 Overweight = BMI of 25 to 29  Obese = BMI of 30 or more

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 125

Source: Eat Smart, Move More, Data on Children and Youth in NC, North Carolina Nutrition and Physical Activity Surveillance System (NC-NPASS), NC-NPASS Data (2006-2011).

Community Perceptions

According to the 2013 Community Health Opinion Survey, only 23% of adults said they have ever been told by a health care provider that they had issues with overweight or obesity. In the focus groups among service providers, one need identified was early childhood education (in both nutrition and physical activity) to help prevent obesity.

Strategies to Prevent and Reduce Obesity by Promoting Healthy Eating and Physical Activity

Source: NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011.

14.0

15.0

16.0

17.0

18.0

19.0

2006 2007 2008 2009 2010 2011

P e rc

e n t

Prevalence of Overweight/Obesity Among Children Ages 2-4 in Wake County, 2006-2011

Overweight Obese

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 126

Resources

QuitlineNC

provides free

cessation services

to any North

Carolina resident

who needs help

quitting tobacco

use. Quit Coaching

is available in

different forms,

which can be used

separately or

together, to help

any tobacco user

give up tobacco.

Telephone Service is available 24/7 toll-

free at: 1-800-QUIT-NOW (1-800-784-8669).

Quit coaching is available by phone

in English and Spanish, with

translation service available for other

languages.

WebCoach is available 24 hours a day online. You can use it in addition to

your telephone coaching, or you can

chose to quit entirely online.

Visit:

www.quitlinenc.com

Tobacco

Tobacco use is the leading cause of preventable death in North Carolina. Approximately 30% of all cancer deaths and almost 90% of lung cancer deaths are caused by smoking (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Statistics, Targets, and Disparities

In Wake County, 16.2% of adults are current smokers, a 26% drop from 2001(NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010).  In Wake County, the percent non-white residents who are current smokers is 1.7 higher than whites.  Residents with a high school education or less are 2.6 times as likely to smoke as college graduates in Wake County. Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010.

The Healthy NC 2020 target is to decrease the percentage of adults who are current smokers to 13%. Additionally, in 2010, 4.4% of Wake County residents reported that they were exposed to secondhand smoke in the workplace in the past seven days (NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010). The Healthy NC 2020 goal is to decrease the percentage of people exposed to secondhand smoke in the workplace to 0%.

Community Perceptions

Residents who identified as smokers were asked in the 2013 Community Health Opinion Survey where they would go for help in order to quit. Of those respondents, the majority (30%) reported that they would seek help from their doctor, followed by quitting “cold turkey” (abruptly giving up the habit) (22%), and pharmacy (11%). Twenty percent of those respondents were not interested in quitting and 7% did not know where to go for help quitting.

Source: 2013 Wake County Community Health Opinion Survey. Note: Includes responses from only the respondents who said they smoke (16%).

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 127

Injury and Violence

Injury is a leading cause of death and disability in North Carolina. In 2010, among the 4,405,739 civilian visits to the Emergency Department in North Carolina, 24.8% of those visits received an injury diagnosis (UNC Department of Emergency Medicine Carolina Center for Health Informatics Report, Overview and Analysis of NC DETECT Emergency Department Visit Data for Injuries, 2010).

Statistics, Targets, and Disparities

From 2007-2009, there were 968 deaths from injuries in Wake County, with the leading causes from motor vehicle injuries, falls, poisoning, and firearms.

Top 5 Causes of Injury Death, Hospitalization, and Emergency Department (ED) Visits in Wake County, All Ages, 2007-2009

Source: North Carolina Division of Public Health, Injury and Violence Prevention Branch Surveillance Unit, Leading Causes of Injury Death, Hospitalization, and Emergency Department Visit Data. Notes: NC residents based on county and state. *Excluding adverse effects within health care settings and missing diagnosis codes.

MOTOR VEHICLE INJURIES

In 2011, there were 22,454 reportable traffic crashes in Wake County, where 26.7% resulted in non- fatal injuries and 60 reportable crashes (2.7%) resulted in fatalities (UNC Chapel Hill, Highway Safety Research Center, 2011). Additionally, 843 (3.8%) of those crashes in 2011 were alcohol- related. Motor vehicle injuries and other intentional injuries are the leading causes of death for Wake County residents aged 20 to 39 years. From 2007-2011, of the 379 deaths due to motor vehicle injuries in Wake County, 42% (160) were aged 20-39. Thirty-two percent of the deaths were among 40-64 year olds. The unintentional motor vehicle death rate has decreased 29.3% in Wake County from 12.3 per 100,000 population in 2000-2004 to 8.7 in 2007-2011.

Le a d

in g C

a u se

s o f

In ju

ry D

e a th

1. Motor vehicle, unintentional=225

2. Fall, unintentional =141

3. Poisoning, unintentional=140

4. Firearm, self- inflicted=114

5. Firearm, assault=56

Other =292

TOTAL = 968

Le a d

in g C

a u se

s o f

In ju

H o sp

it a li z a ti o n *

1. Fall, unintentional=5,012

2. Motor vehicle, unintentional=1,475

3. Unspecified, unintentional=975

4. Other classification, unintentional=845

5. Poisoning, self- inflicted=795

Other =3,711

TOTAL=12,813

Le a d

in g C

a u se

s o f

In ju

ry E

V is it s*

1. Fall, unintentional=38,051

2. Motor vehicle, unintentional=20,960

3. Struck, unintentional=20,042

4. Overexertion, unintentional=12,494

5. Cut/pierce, unintentional=9,709

Other =42,991

TOTAL=144,247

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 128

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013).

For Hispanic residents in Wake County, the unintentional motor vehicle death rate (14.2 per 100,000 population) was higher than the rate among white non-Hispanic residents (7.4) and African-American non-Hispanic residents in 2007-2011.

UNINTENTIONAL FALLS

In Wake County, unintentional falls are the second leading cause of injury-related deaths. More than 75% of falls in North Carolina occur in adults aged more than 65 years and fall-related deaths are expected to increase as the population increases and ages (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011). From 2007-2011, the unintentional falls death rate in Wake County was 7.7 per 100,000 population (Death Certificate Database, State Center for Health Statistics NCHS Bridged Population Estimates). The Healthy NC 2020 target is to reduce the unintentional falls mortality rate to 5.3 per 100,000 population.

UNINTENTIONAL POISONING

The majority of unintentional poisoning deaths are the results of misuse of prescription narcotics. From 2000-2007, North Carolina experienced a dramatic increase (139%) in unintentional poisoning deaths (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Source: NC State Center for Health Statistics, County-level Data, County. Health Data Book (2013), Mortality, 2007-2011 NC Resident Race/Ethnicity

and Sex-Specific Age-Adjusted Death Rates, by County.

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 129

From 2007-2011, the unintentional poisoning death rate for Wake County was 5.2 per 100,000 population (Death Certificate Database, State Center for Health Statistics NCHS Bridged Population Estimates). The Healthy NC 2020 target is to reduce the unintentional poisoning mortality rate to 9.9 per 100,000 population.

VIOLENT DEATHS

 In 2010, there were 103 deaths (11.4 per 100,000 population) as a result of violence in Wake County.

 In 2010, one Wake County resident died from an unintentional firearm injury.

Source: NC Violent Death Reporting System Annual Report, 2010, NC DPH Injury and Violence Prevention Branch.

HOMICIDE

Homicide is a completely preventable cause of death. Arguments (abuse or conflict), intimate partner violence, drug involvement, and serious crimes are the most common event circumstances for homicides (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011). The Wake County homicide mortality rate has been consistently lower than the state rate, where the Wake County rate is half of the state rate. The homicide mortality rate in Wake County has decreased, from 3.7 per 100,000 population to 3.1 in 2007-2011. The Healthy NC 2020 target is to reduce the homicide mortality rate to 6.7 per 100,000 population.

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013).

Although no stable rate could be calculated for Other Races in Wake County, the homicide death rate among Wake County African-American non-Hispanics (8.1 per 100,000 population) was double the rate among Hispanic residents (4.4) and nearly seven times higher than the rate among white non- Hispanics (1.2).

0.0

2.0

4.0

6.0

8.0

10.0

Homicide Mortality Rate Trend, 2000-2011

Rates per 100,000 population

Wake County Mecklenburg County State of NC

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 130

Source: NC State Center for Health Statistics, County Health Data Books (2006-2013).

Community perceptions

In the majority of focus groups, safety was identified as a key element of a healthy community. According to the 2013 Community Health Opinion Survey, residents identified violent crimes as the #6 community concern.

Additionally, residents identified crime prevention as the #5 issue they wanted more information about.

1.2

8.1

N/A

4.4 2.1

15.2

N/A

8.1

3.4

13.8

8.0 7.3

White, Non- Hispanic

African American, Non-Hispanic

Other Races Hispanic

Racial and Ethnic Disparities in Homicide Mortality, 2007-2011

Rates per 100,000 population

Wake County Mecklenburg County State of NC

Unemployment Employment

Opportunities

School Reassignment

Traffic Congestion

Low Income, Poverty

Drug and Alcohol Abuse

Violent Crimes Homelessness

Issues 11.52 10.48 8.47 8.37 5.76 5.18 4.91

P e rc

e n t

Issues that Affect the Quality of Life in Wake County (Wake CHOS, 2013) 95% Confidence Limits

Source: 2013 Wake County Community Health Opinion Survey.

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 131

Oral Health

Studies have shown direct links between oral infections and other conditions, such as diabetes, heart disease, stroke, and poor pregnancy outcomes (NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011).

Although there is some data is available on oral health and dental services in Wake County, this Community Health Needs Assessment does not provide an in-depth review of oral health for the county, a limitation that can be addressed in future assessments.

Statistics, Targets, and Disparities

Three out of 4 residents (75%) in Wake County reported visiting a dentist, dental hygienist, or dental clinic within the past year.  The percent of residents who have visited a dentist, dental hygienist, or a dental clinic in the past year

is 43% higher among whites in Wake County than non-whites.

 Residents in Wake County with a household income of $50k or more are 1.6 times more likely to have visited a dentist, dental hygienist, or a dental clinic in the past year than those earning less than $50k.

Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2010.

According to hospital data for Wake County residents, an increasing number of discharges have been made from Wake County Emergency Departments with dental/oral health-related diagnoses, where more than 4,800 patients have been seen for dental/oral health issues in the 2012 fiscal year (Truven Health Analytics, prepared by WakeMed Health and Hospitals, 2013). Among the youngest Medicaid recipients, a higher percentage of 1-5 year olds in Wake County received dental services in 2010 (56.5%), compared to Mecklenburg County (48%) or North Carolina (31.6%).

Medicaid Recipients Utilizing Dental Services in the Past 12 Months, Ages 1-5, 2010

Location Number Eligible for

Services* Number Receiving

Services** Percent Eligibles

Receiving Services

Wake County 24,148 13,637 56.5

Mecklenburg County 34,638 16,624 48.0

State of NC 679,139 214,786 31.6

Source: NC State Center for Health Statistics, HealthStats. Children Enrolled in Medicaid Who Received Any Dental Service During the Previous 12 Months 2010. Notes: *NC SCHS HealthStats calculated the denominator (# Eligible for Services) as: all North Carolina resident children aged 1-5 years who were eligible three or more continuous months during the same federal fiscal year. ** NC SCHS HealthStats calculated the numerator (# Receiving Services) as: children aged 1 to 5 years that received any dental services during the federal fiscal year (Oct 1st - Sept 30th).

Wake County Human Services provides dental services for children ages 0-18 years and pregnant women including exams, cleanings, fluoride applications, sealants, restorations, extractions, space maintenance, and education. In the 2012 fiscal year, Wake County Human Services performed over 1,200 adult dental procedures for 535 patients, and more than 32,000 child health dental procedures for nearly 4,000 patients.

2013 Wake County Community Health Needs Assessment

Chapter 6| Modifiable Health Risks Page 132

Resources

 The North Carolina Medicaid and NC Health Choice Dental List provides a referral

list by county of dentists who are enrolled in the NC Medicaid Program and are

willing to provide care to Medicaid recipients.

 The North Carolina Safety Net Dental Clinics are non-profit dental facilities where

low income families or individuals can go for dental care. Most clinics accept

insurance, N.C. Medicaid and N.C. Health Choice for Children. Many of these clinics

also provide services on a sliding -fee scale to low-income patients who have no dental

insurance.

In 2012, the John Rex Endowment made a gift of $160,000 to Wake County to increase access to dental care for children, make the County's dental clinic more efficient, and upgrade to digital X-rays.

Community perceptions

In two of focus groups, some needs were identified in the area of oral health. The persons living with physical disabilities focus group identified the general need of dental coverage and access to low- cost dental care. Additionally, the senior focus group identified the needs of a list of dentists in Wake County who accept Medicare patients and how to access dental resources available through the State University system.

Wake County Human Services Dental Services Utilization, Fiscal Year 2010-2012

FY2010 FY2011 FY2012

Adult Dental

Unduplicated patient count 529 598 535

Number of Visits 702 809 674

Number of procedures 1,289 1,540 1,227

Dental Orthodontics

Unduplicated patient count 182 143 141

Number of Visits 627 560 516

Number of procedures 1,162 1,075 944

Dental Child Health

Unduplicated patient count 4,350 3,830 3,966

Number of Visits 7,935 6,844 7,437

Number of procedures 32,754 28,043 32,782

Dental Hygiene

Unduplicated patient count 1,398 1,248 1,415

Number of Visits 916 794 866

Number of procedures 5,185 4,328 5,557

Source: Wake County Human Service Patient Management System.

http://www.ncdhhs.gov/dma/dental/dentalprov.htm

http://www.ncdhhs.gov/dph/oralhealth/services/safety-net.htm

2013 Wake County Community Health Needs Assessment

Page 133

CHAPTER 7:

ACCESS TO HEALTH SERVICES

2013 Wake County Community Health Needs Assessment

Chapter 7| Access to Health Services Page 134

CHAPTER 7 | ACCESS TO HEALTH SERVICES There are an estimated 1.7 million uninsured individuals less than age 65 living in North Carolina. There are disparities in access to care based on race/ethnicity, employment, gender, and income level.

The Patient Protection and Affordable Care Act (PPACA), passed by Congress in April 2010, requires that by 2014 most people have health insurance. The new laws can expand Medicaid coverage to all people under the age of 65, including childless adults, with incomes up to 133% of the Federal Poverty Level. Each state is tasked with implementation of the PPACA, which includes educating uninsured individuals about insurance options available to them and helping them enroll.

In North Carolina, a decision to participate in Medicaid expansion would provide insurance coverage to approximately 500,000 residents, according to the North Carolina Institute of Medicine. In 2013, the North Carolina legislature approved a bill prohibiting the Medicaid expansion.

In Wake County, the amount of health care providers and facilities is considered a community asset and draws new residents to the county. Community perceptions of health care access includes difficulty finding primary care providers and providers who accept Medicare and Medicaid patients, as well as difficulty for low/no-income residents accessing services, particularly prenatal care.

Increasing access to comprehensive, quality health care services is important for improving the overall quality of care and helping reduce costs, but it’s also important for the achievement of health equity and increasing the quality of a healthy life for everyone.

Sources:

 NC Institute of Medicine. Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NC Institute of Medicine; 2011.  U.S. Department of Health and Human Services. Healthy People 2020.  County Health Rankings and Roadmaps, 2013. Access to Care. University of Wisconsin Population Health Institute.  Wake County Human Services, State of the County Health Report, 2012.  North Carolina Institute of Medicine. Examining the impact of the Patient Protection and Affordable Care Act in North Carolina Medicaid

expansion option issue brief, 2013.

Quick Facts

Positive Trends:

 Wake County residents feel that the local health care system is a key community asset.

 The majority of residents (81.5%) felt that they could access good health care in Wake County.

 Raleigh-Wake Emergency Communications Center received over half a million 911 call in 2011. 86% of those calls were answered within 10 seconds.

Areas for Improvement:

 Wake County Emergency Departments have seen in increase in the number of patients seen for mental and behavioral health disorders.

 Wake County residents with household incomes of less than $50,000 are 9.2 times more likely to be uninsured than residents with higher household incomes.

 Residents were concerned about the difficulty for low/no-income residents accessing health care services.

2013 Wake County Community Health Needs Assessment

Chapter 7| Access to Health Services Page 135

Health Professionals, Hospitals, and Health Care Facilities

Access to care requires not only financial coverage, but also access to providers and facilities. The sufficient availability of primary care physicians, and when needed, referrals to specialty care, is essential for preventive and primary care. One research study found that each increase of one primary care physician per 10,000 population is associated with a reduction in the average mortality by 5.3%. (County Health Rankings and Roadmaps, 2013. University of Wisconsin Population Health Institute).

Statistics, Targets, and Disparities

HEALTH PROFESSIONALS

For all four years presented, the ratios of each type of provider to the population have remained relatively unchanged in Wake County, indicating that the addition of health care providers to the community has kept pace with Wake County’s growing population.

Source: Cecil G. Sheps Center for Health Services Research, North Carolina Health Professions Data System, North Carolina Health Professions Data Books. Notes: In 2011, there were changes in the data collection process for primary care physicians. Primary care physicians are those who report their primary specialty as family practice, general practice, internal medicine, pediatrics, or obstetrics/gynecology. Abbreviations used: MDs (Physicians), RNs (Registered Nurses), DDSs (Dentists), Pharms (Pharmacists).

In 2011, there were 23.9 actively practicing physicians for every 10,000 Wake County residents, a ratio higher than North Carolina, but lower than Mecklenburg County. Wake County also as the highest ratio of registered nurses to the population, with a ratio of 102.1 active nurses to 10,000 population, compared to 111.5 in Mecklenburg County and 95.1 statewide. When compared to

2008 2009 2010 2011

MDs 23.3 23.6 23.69 23.85

Primary Care MDs 10.0 10.0 10.23 8.72

DDSs 6.6 6.7 6.82 6.96

RNs 102.1 103.5 104.34 105.04

Pharms 12.0 11.4 12.11 12.14

100

120

R a ti o

Active Health Professionals in Wake County, 2008-2011 Ratio per 10,000 Population

2013 Wake County Community Health Needs Assessment

Chapter 7| Access to Health Services Page 136

2010 data, the number of Wake County primary care physicians in 2011 dropped by 14%; however, this change reflects changes in the data collection process. The decrease in the number of primary care physicians should not be interpreted as primary care practitioners leaving active practice in Wake County.

Active Health Professionals per 10,000 Population, 2011

Location MDs Primary Care MDs DDS RNs Pharms

Wake County 23.85 8.72 6.96 105.04 12.14

Mecklenburg County 27.71 9.46 6.3 116.12 10.67

State of NC 22.07 7.78 4.35 98.60 9.51

Source: Cecil G. Sheps Center for Health Services Research, North Carolina Health Professions Data System, North Carolina Health Professions Data Books. Note: Abbreviations used: MDs (Physicians), RNs (Registered Nurses), DDSs (Dentists), Pharms (Pharmacists). Primary Care Physicians are those who report their primary specialty as family practice, general practice, internal medicine, pediatrics, or obstetrics/gynecology.

LICENSED HOSPITALS, HOSPICES, AND HOME HEALTH FACILITES

A key community asset for Wake County is that there are 4 hospitals located within the county,

offering the following services to residents:

 Level one trauma center

 Heart centers

 Critical care

 Children's emergency department (ED)

 Woman's pavilion and birth centers

 Cancer centers

 Medical helicopter services

Source: Wake County Department of Emergency Medical Services, 2012.

The table below identifies the key characteristics of each hospital in Wake County, including the

number of hospital beds, nursing home beds, operating rooms, and trauma designation.

2013 Wake County Community Health Needs Assessment

Chapter 7| Access to Health Services Page 137

Characteristics of Licensed Hospitals in Wake County, 2013

Name Hospital Beds Nursing Home Beds

Operating Room(s)

Trauma Designation

Duke Raleigh Hospital General: 186 0  Shared Inpatient/Ambulatory

Surgery: 15

 Endoscopy: 3

Rex Hospital General: 433 120

 C-Section: 3

 Ambulatory Surgery: 3

 Shared Inpatient/Ambulatory Surgery: 24

WakeMed General: 575

Rehab: 84

 Open Heart Surgery: 4

 C-Section: 3

 Ambulatory Surgery: 4

 Shared Inpatient/Ambulatory Surgery: 18

 Endoscopy: 6

Level I

WakeMed Cary Hospital

General: 156 36

 C-Section: 2

 Shared Inpatient/Ambulatory Surgery: 9

 Endoscopy: 4

Source: NC Department of Health and Human Services, Division of Health Service Regulation. Report as of May 2013. Note As of June 2013, there are 2 approved hospitals (WakeMed Women’s Hospital and Holly Springs Hospital) that are not yet open in Wake County.

In 2010, there were 1,350 general hospital beds (designated for short-stay use) in Wake County. The rate of general hospital beds in Wake County per 10,000 population in 2010 (15.0) is 30% lower than the rate in Mecklenburg County (21.7) and the state (21.7).

General Hospital Beds per 10,000 population, 2004-2010

Location 2005 2006 2007 2008 2009 2010

Wake County 16.0 15.2 14.5 14.8 15.0 15.0

Mecklenburg County

24.7 23.7 22.8 22.2 21.9 21.7

State of NC 23.5 22.9 22.4 22.1 22.0 21.7

Source: Log Into North Carolina (LINC) Database, Topic Group Vital Statistics and Health. Note: Defined as "general acute care beds" in hospitals; that is, beds which are designated for short-stay use. Excluded are beds in service for dedicated clinical research, substance abuse, psychiatry, rehabilitation, hospice, and long-term care. Also excluded are beds in all federal hospitals and state hospitals. Rates per 10,000 population were calculated using population estimates from the NC State Center for Health Statistics, NCHS Bridged Population Data.

The number of nursing facility beds in Wake County has remained relatively unchanged at around 2,300 since 2006. In 2010, the rate of nursing facility beds per 10,000 population in Wake County (26.1) is 23% lower than the rate in Mecklenburg County (33.7) and 45% lower than the state rate (47.3).

2013 Wake County Community Health Needs Assessment

Chapter 7| Access to Health Services Page 138

Nursing Facility Beds per 10,000 population, 2005-2010

Location 2005 2006 2007 2008 2009 2010

Wake County 29.0 29.5 28.1 26.9 26.5 26.1

Mecklenburg County 38.6 37.0 35.3 34.2 33.7 33.7

State of NC 50.7 49.9 48.8 47.8 47.2 47.3

Source: Log Into North Carolina (LINC) Database, Topic Group Vital Statistics and Health. Notes: Includes beds licensed as nursing facility beds, meaning those offering a level of care less than that offered in an acute care hospital, but providing licensed nursing coverage 24 hours a day, seven days a week. Rates per 10,000 population were calculated using population estimates from the NC State Center for Health Statistics, NCHS Bridged Population Data. As of June 2013, there are 200 approved nursing facility beds in Wake County that are not yet developed.

There are seven hospice/home health and hospice facilities in Wake County, with all but one currently accredited. During the 2011 fiscal year, 1,955 patients were admitted into Hospice in Wake County.

Licensed Hospice Facilities in Wake County, April 2013

Facility Name Location Accreditation

Status

Amedisys Hospice Garner Accredited

Community Home Care & Hospice Raleigh Accredited

Continuum Home Care & Hospice of Wake County Raleigh

Duke Hospice Raleigh Accredited

Heartland Home Health Care & Hospice Raleigh Accredited

Hospice of Wake County, Inc. Raleigh Accredited

Liberty Home Care and Hospice Raleigh Accredited

Source: Source: NC Department of Health and Human Services, Division of Health Service Regulation. Report as of April 2013.

2013 Wake County Community Health Needs Assessment

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There are 13 home health-only facilities in Wake County, and 7 are currently accredited. During the 2011 fiscal year, 14,163 patients were admitted into home health in Wake County.

Licensed Home Health Only Facilities in Wake County, April 2013

Facility Name Location Accreditation

Status

Bayada Home Health Care, Inc. Raleigh Accredited

Gentiva Health Services Raleigh

Heartland Home Health Care Raleigh Accredited

Horizons Home Care Raleigh

Intrepid USA Health care Services Raleigh

Liberty Home Care Raleigh Accredited

Medi Home Health Agency Raleigh

Pediatric Services of America Raleigh Accredited

Professional Nursing Service and Home Health Garner

Rex Home Services Raleigh Accredited

UniHealth Home Health Raleigh

WakeMed Home Health Raleigh Accredited

Well Care Home Health, Inc. Raleigh Accredited

Source: Source: NC Department of Health and Human Services, Division of Health Service Regulation. Report as of April 2013.

HOSPITAL EMERGENCY D EPARMTENT AND HOSPITALIZATION USE

The total number of patients treated in Wake County emergency departments has increased each of the past three fiscal years. Since 2010, the number of patients seen in Wake County emergency departments has increased 7.3%. While the number of people from other counties being treated in Wake County’s emergency departments has fluctuated, the number of Wake County residents being treated outside of Wake County over the same period has also grown.

Around 60,000 Wake County residents are hospitalized each year. The total number of Wake County residents seen as inpatients (in Wake County facilities or outside of Wake County) has decreased each year since 2010. Approximately 25,000 residents from other counties were treated as inpatients in Wake County facilities.

Of the 134,307 surgeries performed in Wake County facilities in the 2010 fiscal year, 82% were inpatient procedures and 18% were outpatient procedures.

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Summary of Hospital Emergency Department, Inpatient Discharges, and Surgery Data,

Wake County Residents and Facilities, 2010-2012 Fiscal Years

According to the 2010 U.S. Census, Wake County’s population is 49% male and 51% female. However, during the 2012 fiscal year, 57% of emergency department patients who live in Wake County were female. Similarly, among Wake County residents being treated as inpatients during the 2012 fiscal year, approximately 62% were female. Fifty-eight percent of inpatient or outpatient surgical patients in Wake County during the 2012 fiscal year were female.

FY2010 FY2011 FY2012

EMERGENCY DEPARTMENTS

Wake County Residents Treated in any NC Facility 234,644 244,970 264,919

Wake County Residents Treated in Wake County Facilities 212,685 219,868 229,478

Wake County Residents Treated Outside Wake County 21,979 25,102 35,441

Residents of Other Counties Treated in Wake County Facilities

38,381 37,697 39,982

Total Number of Patients Treated in Wake County Facilities 251,066 257,565 269,460

INPATIENT DISCHARGES

Wake County Residents Discharged from Wake County Facilities

61,567 60,322 59,167

Residents of Other Counties Discharged from Wake County Facilities

25,143 25,266 25,179

Wake County Patients Leaving Wake County for Inpatient Care

11,450 12,274 12,557

Total Wake County Inpatients 73,017 72,596 71,724

SURGERIES

Total Inpatient Surgery Cases - - 109,638

Total Outpatient Surgery Cases - - 24,669

Inpatient Surgery Cases among Wake County Residents - - 83,440

Outpatient Surgery Cases among Wake County Residents - - 16,571

Inpatient Surgery Cases among non-Wake Residents - - 26,198

Outpatient Surgery Cases among non-Wake Residents - - 8,098

Wake County Residents leaving the County for Inpatient surgery

- - 14,689

Wake County Residents leaving the County for Outpatient surgery

- - 4,925

Wake County Residents who were Inpatient Surgery Patients (both in-county+out of county)

98,129

Wake County Residents who were Outpatient Surgery Patients (both in-county+out of county)

21,496

Residents of Other Counties who had Surgery performed in Wake County (inpatient or outpatient)

34,296

Source: Truven Health Analytics, prepared by WakeMed Health and Hospitals, 2013. Note: Data based on July 1 to June 30th fiscal year. All Emergency Department data excludes admits. Normal newborns excluded (mother is already included).

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One in four Wake County residents receiving care in any NC emergency department is children under the age of 18. One in three Wake County residents undergoing inpatient treatment in NC facilities is over the age of 65. Additionally, 41% of all Wake County surgical patients in NC facilities are adults aged 45-64.

Percent of Wake County Residents Receiving Emergency Department Care, Inpatient Treatment, or Surgery by Age Group, 2012 Fiscal Year

Age Group

Emergency Department

Inpatient Surgery

No. % No. % No. %

Under the age of 18 64,997 24% 6,437 9% 9,242 7%

Aged 18-44 118,632 42% 24,341 34% 29,779 25%

Aged 45-64 54,504 18% 17,858 25% 49,280 41%

Aged 65 and over 26,786 10% 23,088 32% 31,324 26%

For Wake County residents treated in NC emergency departments in the 2012 fiscal year, the largest payor category (34%) was commercial insurance programs, Blue Cross and Blue Shield (BCBS), or managed care programs. For Wake County inpatients treated in any NC facility, those covered by commercial insurance programs, BCBS, or managed care programs represented the largest group (40%), followed by Medicare (35%). Among Wake County surgical patients, the majority (64%) are commercial insurance programs, BCBS, or managed care programs.

Percent of Wake County Residents Receiving Emergency Department Care, Inpatient Treatment, or Surgery by Payor Category, 2012 Fiscal Year

Payor Category

Emergency Department

Inpatient Surgery

No. % No. % No. %

Unassigned 816 0% 173 0% 152 0%

Commercial, BCBS, or Managed

90,119 34% 28,662 40% 76,977 64%

Medicaid 63,118 24% 11,479 16% 6,976 6%

Medicare 34,697 13% 25,168 35% 29,415 25%

Workers Comp 2,473 1% 182 0% 1,070 1%

Self-pay or charity 69,414 26% 3,795 5% 2,964 2%

Other 4,282 2% 2,265 3% 2,029 2%

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In the 2012 fiscal year, the leading principal diagnosis for emergency department patients (both Wake County residents and others) treated in Wake County facilities is chest pain.

Top 10 Principal Diagnoses for Emergency Department Patients

in Wake County Facilities in 2012 Fiscal Year

ICD 9/10 Code

Description FY2012

786.59 Other chest pain 10,391

784.0 Headache 6,837

780.60 Fever, unspecified 5,326

599.0 Urinary tract infection, site not specified 4,886

789.09 Abdominal pain, other specified site 4,863

724.2 Low back pain 4,473

465.9 Acute upper respiratory infections of

unspecified site 4,263

959.01 Head injury, unspecified 4,208

847.0 Neck sprain 3,752

787.01 Nausea with vomiting 3,728

Source: Truven Health Analytics, prepared by WakeMed Health and Hospitals, 2013. Note: Data based on July 1 to June 30th fiscal year. All Emergency Department data excludes admits.). Normal newborns excluded (mother is already included).

When examining the changes in geographic distribution of Wake County residents treated in any NC emergency department, the zip codes that saw the largest percent increases in ED patients from the 2010 to 2012 fiscal year were:

 27592: 38.6%

 27529: 37%

 27617: 25.6%

 27560: 22.1%

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Map of Percent Change of Emergency Department Patients from Wake County

Treated at Any NC Facility, 2010 to 2012 Fiscal Year

Note: Data based on July 1 to June 30th fiscal year. All Emergency Department data excludes admits.). Normal newborns excluded (mother is

already included). Several of the 276* zip codes reported as Wake County zip codes but did not correspond to assigned Wake County zip codes

were excluded.

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During the 2012 fiscal year, the major diagnostic category (MDC) for Wake County inpatients treated in NC hospitals was pregnancy, child birth and the puerperium (the state of a woman during childbirth or immediately thereafter), followed by diseases and disorders of the circulatory system.

Top 10 Major Diagnostic Categories (MDC) for Wake County

Inpatients in NC Hospitals, 2012 Fiscal Year

MDC Description FY2012

014 Pregnancy, Childbirth, and the Puerperium 13,434

005 Diseases & Disorders Of The Circulatory System 8,968

008 Diseases & Disorders Of The Musculoskeletal System 6,707

006 Diseases & Disorders Of The Digestive System 6,417

004 Diseases & Disorders Of The Respiratory System 5,802

001 Diseases & Disorders Of The Nervous System 4,893

019 Mental Diseases & Disorders 4,050

011 Diseases & Disorders Of The Kidney And Urinary Tract 3,043

018 Infectious And Parasitic Diseases 2,961

010 Endocrine, Nutritional And Metabolic Diseases And Disorders 2,605

Source: Truven Health Analytics, prepared by WakeMed Health and Hospitals, 2013. Note: Data based on July 1 to June 30th fiscal year. Normal newborns excluded (mother is already included).

In general, hospitals receive Medicare payment on a per- discharge or per case basis for Medicare beneficiaries with inpatient hospital stays. During the 2012 fiscal year, the most frequent Medicare Severity Diagnosis Related Group (MS-DRG) of Wake County inpatients seen at any NC hospital were childbirth-related (vaginal or Cesarean, with or without complications), with over 7,000 patients. The second most frequent MS-DRG was psychoses, with more than 3,000 inpatient diagnoses in the 2012 fiscal year. The vast majority of Wake County residents treated as inpatients for psychoses were not treated in Wake County facilities. The most frequently performed inpatient surgery for Wake County residents in the 2012 fiscal year was low cervical C-section (3,659), followed by total knee replacements (1,522) and total hip replacements (753).

Three of the five most frequently performed outpatient surgeries for Wake County residents in the 2012 fiscal year were colonoscopy-related. Diagnostic colonoscopies accounted for 9,393 surgeries, while procedures with biopsies accounted for another 9,714 cases, and lesion removal procedures accounted for an additional 7,343 surgeries, for a total of 26,450 surgeries. More than 7,500 outpatient cataract surgeries were performed in fiscal year 2012 and more than 7,200 upper gastro- intestinal (GI) endoscopies with biopsy were performed.

Preventable Hospital Stays

 For every 1,000 hospital stays in Wake County, 50 are considered preventable.

Source: Hospitalization rate for ambulatory-care

sensitive conditions per 1,000 Medicare enrollees,

2010, Dartmouth Atlas of Health Care.

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Top Inpatient and Outpatient Surgical Procedures for Wake County Patients, 2012 Fiscal Year

Principal Procedure FY2012

Inpatient

Low cervical c-section 3,659

Total knee replacement 1,522

Total hip replacement 763

Laparoscopic cholecystectomy (gall bladder removal) 609

Lap gastroenterostomy (ulcer surgery) 472

Outpatient

Colonoscopy and biopsy 9,714

Diagnostic colonoscopy 9,393

Cataract surgery w/iol 1 stage 7,562

Lesion removal colonoscopy 7,343

Upper GI endoscopy biopsy 7,216

Source: Truven Health Analytics, prepared by WakeMed Health and Hospitals, 2013. Note: Data based on July 1 to June 30th fiscal year. All Emergency Department data excludes admits.). Normal newborns excluded (mother is already included).

FEDERALLY QUALITFIED HEALTH CARE CENTER UTILIZATION

Federally-Qualified Health Centers (FQHC) are private, nonprofit, community-directed organizations that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, cultural, or other barriers.

Part of 34 FQHCs in North Carolina, Wake Health Services has 25,000 active patients in both medical and dental practices from both Wake and Franklin counties. In 2011, the leading service delivered by Wake Health Services was for high blood pressure, with 6,558 patients and over 20,000 service encounters.

Services Delivered by Wake Health Services, Wake and Franklin Counties, 2008-2011

Diagnosis

Services Delivered by Primary Diagnosis

2008 2009 2010 2011

No. pts. No.

encounters No. pts.

No. encounters

No. pts.

No. encounters

No. pts.

No. encounters

Alcoholism 149 425 164 391 386 1,067 1,504 3,308

Attention deficit disorder 342 753 354 758 436 1,011 1,076 2,264

Depression 381 646 262 487 1,818 4,160 2,043 4,722

Diabetes Types 1 and 2, child and adult

2,307 5,922 2,028 5,492 2,846 11,040 2,473 8,929

Heart disease 400 269 365 591 859 1,912 806 1,760

High blood pressure 4,674 10,712 4,049 8,760 6,228 18,774 6,558 20,029

Mental health disease 237 415 379 617 767 1,522 1,706 3,416

Stress/Post-traumatic stress disorder

203 287 297 468 833 1,629 1,076 2,264

Source: Wake Health Services. 2008-2011 Uniform Data System Reports. Note: Services based on primary diagnosis. Definitions by ICD-9 Codes used for Uniform Data System.

Image Source: Wake Health Services

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New Initiative

In June 2012, staff

from Wake

County’s Health

Promotion Chronic

Disease Prevention

Section partnered

with Wake's EMS

Advanced Practice

Paramedics

Program (APP).

Staff accompanies

APPs on site (home)

visits to implement

a health coaching

model. Jointly, they

complete

environmental and

physical

assessments;

provide

navigational

support and assist

with securing

medical care

through multiple

providers; and

develop a

personalized care

plan for the

patients with high

frequency

encounters.

EMERGENCY MEDICAL SERVICES UTILIZATION

In the 2010-2011 fiscal year, the he Wake County Department of Emergency Medical Services answered nearly 90,000 calls. Around 12% of the calls were cancelled and approximately 61% resulted in the dispatching of emergency advanced life support services, a trend similar to previous years.

Summary of Services Delivered by County Emergency Medical Services, 2007-08 through 2010-11

Location FY2007-08 FY2008-09 FY2009-10 FY2010-11

Advanced Life Support, Emergency

51,225 53,025 56,230 54,434

Calls Cancelled 10,958 11,826 12,588 11,214

Total Calls Answered*

69,549 72,392 92,219 89,361

Source: Wake County EMS PCR System. Wake EMS System is the primary 911 provider for Wake County. A medical record is generated for each patient – a call is an event – with zero to multiple patient records. Total Calls includes transports, non-transports and other responses (fire scene stand-by, etc.)

The Raleigh-Wake Emergency Communications Center provides communication support to law enforcement, fire, and EMS agencies to deliver appropriate, timely, and safe response to calls for service by dispatching 911 services to the 12 municipalities in Wake County.

In 2011, the Center received over half a million 911 calls, an average of almost 1,400 per day. Approximately 86% of those calls were answered within 10 seconds. Over 60% of the 911 calls resulted in dispatching law enforcement, nearly 16% resulted in EMP dispatches and around 12% resulted in fire dispatches (Raleigh- Wake Emergency Communications 2011 Annual Report).

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LONG- TERM CARE FACILITIES Wake County currently has 31 licensed adult care homes, with a capacity of 2,577.

 Sixteen of those facilities have a four- star rating from the NC Division of Health and Human Services.

 In Wake County there are 17 nursing homes, with 2,124 nursing facility beds and a total adult care capacity of 226.

Source: NC Department of Health and Human Services, Division of Health Services Regulation (DHSR), Licensed Facilities, Adult Care Homes, Family Care Homes, Nursing Facilities.

MENTAL HEALTH SERVICES AND FACILITIES

The NC Department of Health and Human Services reports the number of licensed mental health facilities by county.

 As of April 2013, Wake County had 299 licensed facilities with a capacity of 1,167.

Despite some fluctuation, the number of individuals served by local mental health programs in Wake County has increased 28% from 15,476 in 2005 to 19,771 in 2010.

Persons Served by Area Mental Health Programs, 2005-2010

Location Number of Persons Served

2005 2006 2007 2008 2009 2010

Wake County 15,476 14,811 16,720 17,179 17,157 19,771

Mecklenburg County 40,712 33,956 29,415 38,559 37,481 38,944

State of NC 337,676 322,397 315,338 306,907 309,155 332,796

Definitions

 Nursing homes are facilities that provide nursing or convalescent care for three or more persons. A nursing home provides long term care of chronic conditions or short term convalescent or rehabilitative care. All nursing homes must be licensed in accordance with state law.

 Adult care homes are residences for aged and disabled adults who may require 24-hour supervision and assistance with personal care needs. Medical care may be provided on occasion but is not routinely needed.

Source: North Carolina Division of Aging and Adult Services.

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diagnoses within this category, with the most frequent principal diagnosis being “Anxiety State Not Otherwise Specified” with 837 patients. Excluding drug and alcohol related diagnoses; patients are also seen in the emergency department for panic disorder, depressive disorder, and psychosis (Truven Health Analytics, prepared by WakeMed Health and Hospitals, 2013).

Wake County's Local Management Entity (LME) is Alliance Behavioral Healthcare, which also serves as the LME for Durham, Cumberland, and Johnston counties.

 The LME exists to refer patients needing mental health, substance abuse and developmental disability services to the appropriate providers.

 Wake County has a wide range of service providers, with an emphasis on residential and in- home-based service providers and on services for those with developmental disabilities.

Available Services and Providers in the Mental Health Local Management Entity/Area Program Network (Medicaid), 2013

Service Number of Providers

in Wake County

Assertive Community Treatment Team 5

Child Day Treatment 10

Community Support Team 25

Facility-Based Crisis 1

Intellectual/Developmental Disabilities Residential Supports Level 1 70

Intellectual/Developmental Disabilities Residential Supports Level 2 71

Intellectual/Developmental Disabilities Residential Supports Level 3 78

Intellectual/Developmental Disabilities Residential Supports Level 4 69

Intermediate care facilities for individuals with mental retardation 22

Innovations-In Home Intensive Supports 32

Innovations-In Home Skill Building 50

PATH 1

Personal Care 74

Level 3 Residential 17

Mobile Crisis 8

Supported Employment 33

Level 2 Placing Agencies (Family type) 14

Level 4 Residential 0

Non-Hospital Detoxification 1

Substance Abuse - Intensive Outpatient 16

Psychosocial Rehabilitation 11

Substance Abuse - Comprehensive Outpatient 5

Inpatient 1

Child Mental Health/Substance Abuse Intensive In-Home 28

Innovations Intellectual/Developmental Disability Day Supports 28

Multi-Systemic Therapy 2

Psychiatric Residential Treatment Facility 6

Level 2 Residential (Program type) 4

Innovations Intellectual/Developmental Disability Community Guide 12

Total 559

Source: Alliance Behavioral Health care, Quality Management Department, 4/4/13.

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SCHOOL HEALTH

The Wake County Human Services department provides the school nurses who work in the Wake County Public School System. School nurse staff address issues from the dispensing and administering of medication (including insulin injections, epinephrine shots for allergic reactions, and pain reliever for headaches), to assisting with medical procedures (e.g. catheterizations), and providing counseling and case management services.

 During the 2011-2012 school year, the School Nurse program provided 17,925 screenings to students in Wake County, the majority being vision (7,763) and dental (6,277).

 3,158 individual counseling sessions were conducted, with 885 sessions involving bullying or violent behavior, 829 sessions related to depression, psychological problems or suicidal thoughts, and 716 sessions related to hygiene or puberty.

 11,753 individual interventions were conducted for chronic illnesses suffered by students (not including asthma or diabetes treatments).

 53,694 conferences were held, 42% with parents, 39% with teachers, and 17% with other professionals.

 2,045 presentations were given by school nurses to the majority of school staff.

Source: Wake County Human Services. Quarterly Report Workbook 2011-2012.

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Resources

The Capital Care

Collaborative, a

program of the

Wake County

Medical Society,

allows members to

provide medical

care in a

coordinated fashion

for the low-income

community. Wake

County Human

Services and three

major Wake

County hospitals

are part of the

collaborative.

Alliance Medical

Ministry is a faith-

led non-profit

organization whose

mission is to serve

working uninsured

adults of Wake

County in need of

affordable health

care.

Wake Health

Services is a

private, nonprofit

Community Health

Center offering

primary care and

support services to

more than 25,000

patients who are

medically

underserved or

who have limited

access to health

care.

Health Insurance Coverage and Access

Health insurance coverage helps patients get into the health care system and receive preventive health services. Uninsured people are less likely to receive medical care, more likely to die early, and more likely to have poor health status (U.S. Department of Health and Human Services. Healthy People 2020).

Statistics, Targets, and Disparities

UNINSURED

In 2010-2011, approximately 16% of the non-elderly population (under the age of 64) lacked health insurance, compared to 17.5% in Mecklenburg County and 18.9% statewide.

 The Healthy NC 2020 target is to reduce the percentage of non-elderly uninsured individuals to 8%.

Source: North Carolina Institute of Medicine, NC Health Data, Uninsured Snapshots, North Carolina County-Level Estimates of the Uninsured.

According to the 2010 Behavioral Risk Factor Surveillance survey, non-elderly Wake County residents with household incomes of less than $50,000 are 9.2 times more likely to be uninsured (43.4%) than residents with higher household incomes (4.7%).

 Similarly, residents with a high school education or less are 4.5 times more likely to be uninsured than those with some college or higher.

 Non-white residents in Wake County are 6.3 times more likely to be uninsured than whites.

 Men are also 2.3 times more likely to be uninsured than women in Wake County.

Source: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2009.

0.0

5.0

10.0

15.0

20.0

25.0

2006-07 2008-09 2010-11

P e rc

e n t

Years

Percent of Population Ages 0-64 without Health Insurance, 2010-11

Wake County

Mecklenburg County

State of NC

http://www.capitalcarecollaborative.com/

http://www.alliancemedicalministry.org/

http://www.whsi.org/

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HEALTH COVERAGE AND CHILDREN

According to the NC Institute of Medicine estimates of the uninsured for 2010-2011, approximately 8% of children under the age of 18 in Wake County lacked health insurance.

NC Health Choice is a health insurance program for children whose families make too much money to qualify for Medicaid, but don’t make enough money to afford private health insurance. The number of children in Wake County who are eligible for NC Health Choice has increased each year since the 2007 fiscal year. In 2010, 10,311 children in Wake County were eligible for NC Health Choice and 71% of those eligible were enrolled in the program.

NC Health Choice (NCHC) Enrollment, 2007-2012

Location

FY2007 FY2008 FY2009 FY2010

No. Children Eligible

% Eligibles Enrolled

No. Children Eligible

% Eligibles Enrolled

No. Children Eligible

% Eligibles Enrolled

No. Children Eligible

% Eligibles Enrolled

Wake County

7,976 15% 8,929 44% 10,131 54% 10,311 71%

Mecklenburg County

9,284 10% 10,420 36% 11,396 51% 11,668 72%

State of NC 12,2837 22% 13,1446 66% 14,0141 74% 14,3022 86% Source: NC Division of Medical Assistance, Statistics and Reports, Medicaid Data, County-Specific Snapshots for NC Medicaid Services, 2008- 2010.

MEDICAID

Medicaid is a health insurance program that serves children, adults, and families. Family and Children's Medicaid covers children, parents, pregnant women, and family planning services. Adult Medicaid covers aged, blind and disabled individuals.

The percent of the Wake County population that is eligible for Medicaid remained steady at 9% for 2007-2009 and increased to 10% in the 2010 fiscal year, where 88,470 residents were considered eligible for Medicaid. The average cost per adult enrolled in Medicaid increased each fiscal year from 2007-2009, but declined from $7,707 to $7,371 between 2009 and 2010 (NC Division of Medical Assistance, Statistics and Reports, Medicaid Data, County-Specific Snapshots for NC Medicaid Services, 2006-2010).

Community Care of North Carolina/Carolina ACCESS (CCNC/CA) is a primary care case management health care plan for a majority of Medicaid recipients. The percentage of Medicaid eligibles enrolled in CCNC/CA has remained almost unchanged in Wake County between 2008 and 2010, holding steady between 64% and 65%.

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Source: NC Division of Medical Assistance, Statistics and Reports, Medicaid Data, County-Specific Snapshots for NC Medicaid Services, 2006-2010.

PREVENTIVE SERVICES

Clinical preventive services are very effective in preventing disease or detecting disease early, when treatment is more effective.

According to the 2013 Community Health Opinion Survey, 70% of Wake County residents reported that they received a routine health check up in the past year.

Source: 2013 Wake County Community Health Opinion Survey.

FY2006-07 FY2007-0 FY2008-09 FY2009-10

P e rc

e n t

Percent of Medicaid Eligibles Enrolled in CCNC/CA, 2006-2010

Wake County Mecklenberg County State of NC

70%

17%

1% 1%

Residents Reporting Routine Check-up in Past Year (Wake County CHOS, 2013)

>1 year

1-2 years

3-5 years

5+ years

Never

Don’t know

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Residents also reported receiving the following health care screenings:

 Colonoscopy (persons aged 50 and older): 78%

 Annual prostate exam (males aged 40 and older): 59%

 Annual mammogram (females aged 40 and older): 61%

 Pap smear every other year (females over 21): 78%

Source: 2013 Wake County Community Health Opinion Survey.

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.

 After increasing from the 2006-2007 through 2008-2009, the percent of those eligible for Health Check services who actually receive those services had decreased by 28% in fiscal year 2009-2010 from the high point in 2008-2009 for all jurisdictions. In Wake County it, continued fall, slightly, during the 2010-2011 fiscal year.

Source: NC Division of Medical Assistance, Statistics and Reports, Health Check Participation Data. Note: The participation ratio is calculated by dividing the number of eligibles receiving at least one initial screening service by the number of eligibles who should receive at least 1 initial or period screenings (not shown in the table).

Community Perceptions

According to the 2013 Community Health Opinion Survey, 2 out of 3 residents go to a doctor’s office most often when sick (68.7%), followed by hospital (7%), urgent care (6%), and ER (6%). In 2010, 65% of residents reported that they go to a doctor’s office most often when sick.

FY2006-07 FY2007-0 FY2008-09 FY2009-10 FY2010-11

R a ti o

EPSDT Health Check Participation Ratio, 2006-2011

Wake County Mecklenburg County State of NC

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Source: 2013 Wake County Community Health Opinion Survey.

The majority of residents reported that they receive their care when they are sick in Raleigh (63%) followed by Cary (14%), Knightdale (5%), Fuquay-Varina (4%), Durham (3%), and other towns (7%). Four percent refused to respond to the question. Alternative medicine also was being used by residents, where almost 1 out of 5 residents (19%) report alternative medicine use, including visiting a chiropractor, acupuncturist, and taking home remedies.

As far as health care access, the majority of residents (81.5%) felt that they could access good health care in Wake County. When asked what the top 3 community issues were in Wake County, 4.5% said lack of or inadequate health insurance. Of survey respondents who are insured, the majority are covered by the following plans:

 Blue Cross and Blue Shield of North Carolina: 33.5%  Medicare: 14.6%  United Healthcare: 9.7%  CIGNA: 7.8%  Medicaid/Carolina ACCESS/Health Choice: 4.6%

In the past year, more than one in ten (13%) of the 2013 Community Health Opinion Survey respondents reported they had trouble getting the health care they needed, which was the same as reported in 2010. Of those, the most common barriers to accessing health care in 2013 are:

 No insurance (7%)  Out-of-pocket costs (4%)  Could not get appointment (4%)  No separate dental (2%)  Didn’t know where to go (2%)  Insurance not accepted (2%)

0 20 40 60 80

No Response

Open Door Clinic

Health Dept

Pharmacy, Minute Clinics

Free, Low Cost Clinics

Other

Urgent Care

Hospital

Doctor's Office

Percent

Where Residents Go Most Often When Sick (Wake CHOS, 2013) 95% Confidence Limits

2013 Wake County Community Health Needs Assessment

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In the focus groups, several themes emerged with health care access. The increasing amount of health care providers and facilities in Wake County was considered a community asset and draws new residents to the county. However, many participants mentioned that these options are available only to those who can afford, get to, or navigate the system, including accessing mental health services.

I think we have wonderful resources and opportunities for those who can afford them. I

don’t think all of us are able to have access to them though.”

- Community member

Almost all focus groups discussed the difficulty finding primary care providers and providers who accept Medicare and Medicaid patients. Residents were concerned about the difficulty for low/no- income residents accessing services, particularly with prenatal care. Many residents felt that this access gap is causing residents to use the emergency department for primary care.

“If people can’t get basic health care which is a crime really and they always fall back

on ‘yeah but they can always go to the emergency room’ and that’s not the answer. We

need to take care of our people – even the people who don’t have money.”

- Community member

“I'm looking at it from the perspective of the people that are legislating right now who

do not want to expand the health care to the uninsured which guarantees much more

people in North Carolina if they are homeless will not have access to proper health care.

And unless it is remedied, people are going to be ba sically living on the edge like

they're doing. They might not be having any kind of preventive care. They'll only go to

hospitals only when they're about to die or something is really wrong. So then things

could be done to actually prevent people from gett ing sick in the first place…”

- Community member

To improve health care access, focus group participants suggested increasing the number of clinics that run outside of normal (9-5) business hours, increase transportation options to Triangle area-hospitals, and ensure that culturally and linguistically appropriate services are provided (in particular, training professionals on how to work with the Spanish-speaking community and persons living with disabilities).

Image Source: Rex Health care. Community Health Day where all Wake County hospitals participated.

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CHAPTER 8:

HEALTH OF THE ENVIRONMENT

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CHAPTER 8 | HEALTH OF THE ENVIRONMENT Humans interact with the environment constantly. These interactions affect quality of life, years of healthy life lived, and health disparities.

The World Health Organization (WHO) defines environment, as it relates to health, as “all the physical, chemical, and biological factors external to a person, and all the related behaviors.”

Adequate environmental quality in terms of clean air and water are prerequisites for health. Additionally, the built environment, which refers to human-made resources and infrastructure designed to support human activity (such as buildings, roads, parks, restaurants, and grocery stores) can also have an impact health.

Sources:

 U.S. Department of Health and Human Services. Healthy People 2020.

 World Health Organization (WHO). Preventing disease through healthy environments. Geneva, Switzerland: WHO; 2006.

 County Health Rankings and Roadmaps, 2010-2013. University of Wisconsin Population Health Institute.

Environmental Rankings

The 2013 County Health Rankings ranks North Carolina counties according to their summary measures of health outcomes and health factors. Counties also receive a rank for mortality, morbidity, health behaviors, clinical care, social and economic factors, and the physical environment. Although Wake County was ranked by County Health Rankings as the #1 healthiest county in 2013, the summary measure for which Wake County does not rank highly is physical environment, where Wake County places 10th out of 100. The physical environment measures included:

 Air pollution-particulate matter days

 Drinking water safety

 Access to recreational facilities per 100,000

 Limited access to healthy foods

 Fast food restaurants

Quick Facts

Positive Trends:

 99% Air Quality Index days were moderate to good air quality in Wake County.

 No health-based violations have occurred in any of the large community water systems since 2010.

 Local parks account for another 13,665 acres of land and Wake County is ranked 3rd in the state with only 2 other counties with more local park land in North Carolina.

Areas for Improvement:

 In Wake County, 38,115 residents have limited access to healthy foods.

 Many residents voiced concern over access to healthy foods, particularly in communities where grocery stores and transportation options are limited.

 Some residents identified the needs for safer, more affordable, and more accessible

recreation facilities in Wake County.

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County Health Rankings, Physical Environment Measure Details, 2013

Health Factor Wake

County Mecklenburg

County NC

National Benchmark

Healthy NC 2020

Air pollution-particulate matter days 12.6 13.2 12.9 8.8 N/A

Drinking water safety 0% 0% 3% 0% N/A

Access to recreational facilities per 100,000 15 16 11 16 N/A

Limited access to healthy foods* 4% 7% 7% 1% N/A

Fast food restaurants 51% 46% 49% 27% N/A

Source: County Health Rankings and Roadmaps, 2013. University of Wisconsin Population Health Institute. Data presented as county average. Note: *Data should not be compared with prior years due to changes in definition.

Environmental Health

Statistics, Targets, and Disparities

AIR QUALITY

Poor air quality is linked to premature death, cancer, and long-term damage to respiratory and cardiovascular systems. Progress has been made to reduce unhealthy air emissions, but, in 2008, approximately 127 million people lived in U.S. counties that exceeded national air quality standards. Decreasing air pollution is an important step in creating a healthy environment (U.S. Department of Health and Human Services. Healthy People 2020).

The two main air quality issues in North Carolina are ground-level ozone, the main ingredient in "smog" and particle pollution. Both of these pollutants are mainly caused by emissions from automobiles and from the coal-burning power plants that supply most of our electricity. In addition, smoke from outdoor burning and wildfires significantly contribute to ozone and particle pollution.

According to the 2012 Air Quality Index (AQI) summary, 99% of days had moderate to good air quality in Wake County. Four days in 2012 were unhealthy for sensitive groups in Wake County.

Air Quality Days, 2012

Metro Area or County No. Days with AQI

Number of Days When Air Quality Was:

Good Moderate Unhealthy

for Sensitive Groups

Unhealthy Very

Unhealthy

Raleigh-Cary 366 262 99 4 1 n/a

Wake County 366 267 95 4 n/a n/a

Charlotte-Gastonia-Concord 366 230 125 10 1 n/a

Mecklenburg County 366 239 118 9 n/a n/a

Source: U.S. Environmental Protection Agency. Air Quality Index Reports, 2011. Retrieved on May 23, 2012. Note: “Unhealthy for sensitive groups”: When air quality is in this range, people that are included in a sensitive group, whether the sensitivity is due to medical conditions, exposure conditions, or inherent susceptibility, may experience respiratory effects when engaged in outdoor activities. For ozone, the sensitive group includes children; people with lung diseases, such as asthma, chronic bronchitis, and emphysema; older adults; and active people who work or exercise outdoors. “Unhealthy”: When air quality is in this range, any individual who is active outdoors may experience respiratory effects. “Very Unhealthy”: when air quality is in this range, it is expected that there will be widespread effects among the general population and more serious effects in members of sensitive groups.

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A daily index value is calculated for each air pollutant measured. The highest of those index values is the AQI value, and the pollutant responsible for the highest index value is the "Main Pollutant." In 2012, particulate matter was measured as the main pollutant for 217 days in Wake County and Ozone was measured as the main pollutant for 149 days. Particulate matter is usually categorized on the basis of size, and includes dust, dirt, soot, smoke, and liquid droplets emitted directly into the air by factories, power plants, construction activity, fires and vehicles. Ozone, the major component of smog, is not usually emitted directly but rather formed through chemical reactions in the atmosphere. Precursor compounds like volatile organic compounds (VOC) and oxides of nitrogen (NOx) react to form O3 when stimulated by ultraviolet radiation and temperature, so peak O3 levels typically occur during the warmer and sunnier times of the day and year. VOCs are chemicals that play a role in forming ozone and are emitted from a variety of sources, including automobiles, chemical and paint manufacturing plants, dry cleaners, and other facilities that use solvents and paint.

Primary Air Pollutants, 2012

Metro Area or County No. Days with AQI CO NO2 O3 SO2 PM2.5 PM10

Raleigh-Cary 366 n/a n/a 155 n/a 211 n/a

Wake County 366 n/a n/a 149 n/a 217 n/a

Charlotte-Gastonia-Concord 366 n/a 1 145 n/a 220 n/a

Mecklenburg County 366 n/a 2 154 n/a 210 n/a

Source: U.S. Environmental Protection Agency. Air Quality Index Reports, 2011. Retrieved on May 23, 2012. Note: Criteria air pollutants (CAPS) are six chemicals that can injure human health, harm the environment, or cause property damage: carbon monoxide, lead, nitrogen oxides, particulate matter, ozone, and sulfur dioxide. The EPA has established National Ambient Air Quality Standards (NAAQS) that define the maximum legally allowable concentration for each CAP, above which human health may suffer adverse effects.

WATER SYSTEMS Surface and groundwater quality applies to both drinking water and recreational waters. Contamination by infectious agents or chemicals can cause mild to severe illness. Protecting water sources and minimizing exposure to contaminated water sources are important parts of environmental health (U.S. Department of Health and Human Services. Healthy People 2020).

The majority of Wake County residents are served by Community Water Systems, the largest water system is the City of Raleigh, serving approximately 486,000 people from a primarily surface water source. While most of the community water systems use groundwater, the largest community water systems (City of Raleigh and the Town of Cary) within the county used purchased surface water.

No health-based violations (the amount of contaminant exceeded safety standard or water has not been treated properly) have occurred in any of the large community water systems since 2010.

Active Water Systems, 2013

County

Number Community

Water Systems

Population Served by

CWSs

Number NonTransient/

NonCommunity Water Systems

Population Served by

NonTransient/ NonCommunity Water Systems

Number Transient Non-

Community Water Systems

Population Served by T-NC

WSs

Wake County

306 805,836 10 2,446 147 23,769

Source: U.S Environmental Protection Agency Safe Drinking Water Information System. Safe Drinking Water Search for the State of North Carolina. Note: Total population served contains some duplicated persons, since both businesses and residences are included.

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Since the majority of the Wake County population is served by community water systems (primarily run by municipalities), there is not much well-related activity in the county. In 2012, 267 new well permits were issued in Wake County. Environmental Health also evaluated approximately 500 wells and provided consultative visits to 214 wells.

Wake County Environmental Health Well Activity, 2011-2012

Activity 2011 2012

Well Sites Evaluated 498 496

Well Site Consultative Visits 112 214

Well Construction Permits Issued

New 270 267

Repair 102 116

Bacteriological Samples Collected 665 648

Other Samples Collected 308 427

Source: Eric Green, DWQ Coordinator Wake County Department of Environmental Services, January 31, 2013.

Most of Wake County residents are on public sewer systems. There was an increase between 2011 and 2012 in the number of sites visited, evaluated, and permits issued for the installation of septic tanks. There are eight wastewater collection systems that carry sewage to a waste water treatment plant in Wake County.

Wake County Environmental Health On-Site Wastewater Activity, 2010-2011

Activity 2011 2012

Site Visits (all OSWW Field Activities not listed below) 1098 1412

Sites Evaluated (or Re-evaluated) 467 669

Operation Permits Issued 830 932

Improvement Permits Issued - Repair or replace malfunctioning system - -

Construction Authorizations

New, Revision or Relocation 458 535

Repair/Replacement of Malfunctioning System 143 111

Sewage Complaints Investigated 379 371

Source: Eric Green, DWQ Coordinator Wake County Department of Environmental Services, January 31, 2013.

Groundwater Contamination in Northern Wake County

In 2012, the U.S. Environmental Protection Agency (EPA) responded to health concerns in northern Wake County related to groundwater contamination. The chemical TCE (trichloroethylene) had been detected in approximately 34 wells tested by the EPA and NC Department of Environmental and Natural Resources (DENR). An additional 149 wells in this area have been tested and found to have no contaminants. The EPA responded with federally funded waterline extensions, well filters, and bottled water to mitigate the concerns. The State Division of Public Health is the lead health responder and is working with residents to advise them on health related issues. DENR is working with EPA in the ongoing testing of water sources. Wake County is playing a supportive role in coordination of activities, seeking ongoing federal and state resources, and collaborating with federal and state authorities.

Source: 2012 Wake County State of the County Health Report.

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Resource

Household

hazardous

materials cannot

be disposed in the

landfill because of

their caustic

properties and

potential for

environmental

contamination.

Wake County has

established a

hazardous waste

collection program

where residents

can drop off these

materials for

proper disposal by

a certified

Household

Hazardous Waste

contractor.

Image So urce: Wa ke Co unty

WASTE AND RECYCLING The health effects of toxic substances and hazardous wastes are not yet fully understood. Research to better understand how these exposures may impact health is ongoing. Meanwhile, efforts to reduce exposures continue. Reducing exposure to toxic substances and hazardous wastes is fundamental to environmental health (U.S. Department of Health and Human Services. Healthy People 2020).

The Wake County Solid Waste Management is a division of the Environmental Services department. The Solid Waste Management Division provides various services to generators from both the municipalities and the unincorporated areas of the County. Wake County Solid Waste provides an array of solid waste services including disposal and recycling facilities and operations, litter and illegal dumping enforcement as well as outreach and education programs. The Solid Waste Management Division manages 17 waste facilities:

 11 Convenience Centers  2 Household Hazardous Waste Facilities  2 Multi-Material Recycling Facilities  2 municipal solid waste disposal facilities.

According to the Wake County Solid Waste Management Plan:

 From the 2008-2011, the total amount of waste generated in Wake County and disposed in a landfill has declined by 20%.

 The decrease in the amount of waste disposed in a landfill coupled with the increase in population has resulted in a per capita waste disposal rate decline of 30%, from 1.44 to 1.00 tons per person per year.

 All municipalities in Wake County have begun to phase in

roll‐out recycling carts in place of the 18 gallon bin and have expanded the types of recyclable materials collected curbside. Overall, 24% of residential waste was recycled in the 2011 fiscal year, an increase of 4% since 2008. Source: Wake County Solid Waste Management Plan, July 2012.

http://www.wakegov.com/recycling/division/facilities/pages/hhw.aspx

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The U.S. Environmental Protection Agency (EPA) maintains information in a national database called the Toxics Release Inventory (TRI) that contains detailed information on nearly 650 chemicals and chemical categories that over 23,000 industrial and other facilities manage through disposal or other releases, recycling, energy recovery, or treatment. The data are collected from industries including manufacturing, metal and coal mining, electric utilities, commercial hazardous waste treatment, and other industrial sectors. Section 313 of the Emergency Planning and Community Right to Know Act (EPCRA) of 1986 was enacted to facilitate emergency planning, to minimize the effects of potential toxic chemical accidents, and to provide the public with information on releases of toxic chemicals in their communities. The Pollution Prevention Act (PPA) of 1990 mandates collection of data on toxic chemicals that are treated, recycled, and combusted for energy recovery. Together, these laws require facilities in certain industries, which manufacture, process, or use toxic chemicals above specified amounts, to report annually on disposal or other releases and other waste management activities related to these chemicals.

In 2011, there were four facilities in Wake County that reported chemical disposal or other releases in Wake County, with approximately 345,000 total releases in pounds. The North Carolina average is 58,992 pounds. This information does not reflect whether or not the public has been exposed to those chemicals and estimates are not sufficient to determine exposure or calculate potential adverse health effects.

Reported Chemical Disposal or Other Releases in Wake County (in pounds), 2011

County Total On- and Off-Site

Disposal or Other Releases, In Pounds

Compounds Released in

Greatest Quantity

Quantity Released, In

Pounds Releasing Facility

Wake County

344,795

Ammonia 150,392 Kellog's Snacks, Cary Baker

Ammonia 112,783 Ajinomoto North America

Nitrate Compounds

32,480 Mallinckrodt, LLC

N-Hexane 16,600 Cargill, Inc

Source: U.S. Environmental Protection Agency. Toxic Release Inventory Reports: Chemical Reports, 2011. Retrieved on November 6, 2012 from US EPA TRI Explorer, Release Reports by Facility, Chemical Reports. Note: reporting year (RY) 2011 is the most recent TRI data available. Facilities reporting to TRI were required to submit RY 2011 data to EPA by July 1, 2012. This dataset includes revisions processed by EPA as of February 28, 2013 for the years 1988 to 2011. Revisions submitted to EPA after this time are not reflected in TRI Explorer reports. Users of TRI information should be aware that TRI data reflect releases and other waste management activities of chemicals, not whether (or to what degree) the public has been exposed to those chemicals. Release estimates alone are not sufficient to determine exposure or to calculate potential adverse effects on human health and the environment.

The North Carolina Childhood Lead Poisoning Prevention Program (CLPPP) currently coordinates clinical and environmental services aimed at eliminating childhood lead poisoning. Using data that is most currently available, there were approximately 12,000 children aged 6 months to 6 years tested for blood lead poisoning in 2010. Of those children tested, 6 had lead blood levels of 10-19 micrograms per deciliter (µg/dL). In 2012, the Centers for Disease Control and Prevention (CDC) changed the recommendation to begin diagnostic testing for all children who have an initital blood test result of 5 or greater micrograms per deciliter (µg/dL); however, environmental investigations guidelines remain unchanged.

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Childhood Blood Surveillance Data, 2010

Location

Ages 1 and 2 Years Tested for Lead Poisoning

Ages 6 Months to 6 Years

Target pop. No. tested %

tested Tested Among

Medicaid *

Lead ≥10

% ≥10

No. tested

≥10 -19

≥20

Wake County 26,552 10,441 39.3 78.9 27 0.3 12,254 6 -

Mecklenburg County 29,355 9,618 32.8 67 24 0.2 12,176 8 -

State of NC 257,543 132,014 51.3 81.1 519 0.4 162,06 0

146 24

Source: North Carolina Childhood Blood Lead Surveillance Data, NC Environmental Health Section, Children’s Environmental Health Branch, 2010. Note: Target population is based on the number of live births in 2008 and 2009. *Includes ages 9-11 months. "Target Population" is based on the number of live births in preceding years. "Number Tested" is an unduplicated count of children tested for lead poisoning within the calendar year. "Percent Tested" is the number of children tested divided by the target population. Children are counted as being tested for lead poisoning in successive years until they are confirmed to have a lead level >10 micrograms per deciliter (µg/dL). Confirmation is based on a child receiving two consecutive blood lead test results >10 µg/dL within a six-month period. "Confirmed" lead levels are based on the confirmation date and are classified according to the highest level confirmed during the calendar year. The categories "Confirmed 10-19" and "Confirmed >20" are mutually exclusive. "Percent Tested Among Medicaid” is based on a data match of blood lead tests with Medicaid encounter data and includes ages 9-35 months. This larger 9-35 months category reflects Health Check visits and blood lead testing for children around their first and second birthdays and up to age three.

RABIES AND VECTOR-BORNE DISEASES

From 2008-2012, there were no reports of human rabies in Wake County. In 2012, there were 16 reported cases of animal rabies in Wake County.

Animal Rabies Cases, 2008-2012

County Total Number of Animal Rabies Cases

2008 2009 2010 2012

Wake County 14 14 23 16

Mecklenburg County 14 32 29 34

State of NC 452 473 397 429

Source: NC Division of Public Health, Epidemiology. Rabies. Facts and Figures. Rabies by County, Tables by Year.

Vector-borne diseases are illnesses caused by an infectious microbe that are transmitted most commonly by ticks, mosquitoes, and fleas. Vector-borne diseases are among the most complex of all infectious diseases to prevent and control.

The vector-borne diseases that occur most often in Wake County are caused by ticks. For tickborne diseases (ehrlichiosis, Lyme disease, and Rocky Mountain spotted fever), many more cases are suspected and investigated than can be confirmed, likely due to the difficulty of getting clinical and/or laboratory information needed to meet the confirmed case definition.

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Tickborne Diseases in Wake County, 2008-2012

2008 2009 2010 2011 2012

Disease Confirmed

Suspect, Probable,

and Confirmed

Confirmed

Suspect, Probable,

and Confirmed

Confirmed

Suspect, Probable,

and Confirmed

Confirmed

Suspect, Probable,

and Confirmed

Confirmed

Suspect, Probable,

and Confirmed

Ehrlichia 0 1 0 0 0 0 0 0 0 1

Ehrlichia, HE 0 1 0 0 0 5 0 14 0 10

Ehrlichia, HME 3 8 0 18 3 44 2 64 1 61

Lyme Disease 7 9 3 102 5 111 3 55 2 32

Rocky Mountain Spotted Fever

3 50 0 49 2 91 1 110 0 170

Source: NC Electronic Disease Surveillance System, accessed 3/19/13. Note: counts include all cases meeting the suspect, probable, and confirmed North Carolina communicable disease case definitions. Notes: Case definitions for these diseases are available at http://epi.publichealth.nc.gov/cd/lhds/manuals/cd/case_defs.html

Community Perceptions

According to the 2013 Community Health Opinion Survey, the majority of residents (86.8%) think that the environment in Wake County is clean and safe. Only 2.8% of residents surveyed thought that clean water and pollution were top community issues in Wake County. Clean air/water or exposure to environmental hazards did not come up in any of the focus groups.

Built Environment

Statistics, Targets, and Disparities

PARK AND RECREATION FACILITIES

Wake County contains nearly 9,500 acres of state or federal park land. Local parks account for another 13,665 acres of land and Wake County is ranked 3rd in the state with only 2 other counties with more local park land in North Carolina.

Based on the number of residents per unit, Wake County ranks in the top half of North Carolina counties for local residents’ access to baseball fields, softball fields, soccer fields, multi-purpose fields, tennis courts, volleyball courts, picnic shelters, playgrounds, and trail miles.

Wake County ranks in the lower half of North Carolina counties for residents’ access to football fields, basketball courts, and swimming pools.

http://epi.publichealth.nc.gov/cd/lhds/manuals/cd/case_defs.html

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Public Recreational Acreage and Facilities, 2010

Number State Rank

Baseball fields 129 48th

Softball fields 81 45th

Football fields 6 66th

Soccer fields 91 41st

Multi-Purpose fields 54 35th

Basketball courts 95 55th

Tennis courts 219 32nd

Volleyball courts 35 36th

Picnic Shelters 174 45th

Playgrounds 169 36th

Swimming Pools 7 60th

Trail Miles (walking, biking, etc) 223 43rd

Source: N.C. Division of Parks & Recreation. North Carolina Outdoor Recreation Plan 2009- 2013. Note: State Rankings are according to county residents per park acre or per recreational

facility.

FOOD ACCESS

Although research on the food access is still in its early stages, there is some evidence showing that access to fast food restaurants and having limited access to healthy foods are associated with overweight, obesity, and premature death.

Limited access to healthy foods captures the percent of the population who are low income (family income less than or equal to 200% of the federal poverty threshold) and do not live close to a grocery store (defined as living less than 10 miles from a store in rural areas and less than 1 mile urban areas).

 In Wake County, 38,115 residents have limited access to healthy foods or 4% of the county population, compared to 7% in Mecklenburg County and 7% statewide (County Health Rankings and Roadmaps, 2013. University of Wisconsin Population Health Institute).

Among children, fast food restaurants are the second highest energy provider following grocery stores. Environments with a large proportion of fast food restaurants have been associated with higher obesity and diabetes levels (County Health Rankings and Roadmaps, 2013. University of Wisconsin Population Health Institute).

In Wake County, there are approximately 737 fast food restaurants. The rate of fast food restaurants per 1,000 population is slightly higher in Wake County compared to Mecklenburg County and North Carolina.

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Fast Food Restaurants, 2007-2009

2007 2009 No. Rate No. Rate

Wake County 687 0.83 737 0.82

Mecklenburg County 685 0.80 723 0.79

State of NC 6,452 0.71 6,630 0.71

Source: U.S. Department of Agriculture, Food Environment Atlas Note: Includes the number of limited-service restaurants in the county. Limited-service restaurants include establishments primarily engaged in providing food services (except snack and nonalcoholic beverage bars) where patrons generally order or select items and pay before eating.

Supermarkets traditionally provide healthier food options than convenience or corner stores. In Wake County, there are approximately 167 supermarkets and grocery stores. The rate of supermarkets and grocery stores per 1,000 population is about the same when compared to Mecklenburg County and North Carolina; however, there was a slight decrease for all jurisdictions from 2007 to 2009.

Supermarkets and Grocery Stores, 2007-2009

2007 2009 No. Rate No. Rate

Wake County 176 0.21 167 0.19

Mecklenburg County 185 0.21 187 0.20

State of NC 1,848 0.20 1,785 0.19

Source: U.S. Department of Agriculture, Food Environment Atlas. Note: Rate per 1,000 population. Grocery stores include establishments generally known as supermarkets and smaller grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, fish, and poultry. Included in this industry are delicatessen-type establishments primarily engaged in retailing a general line of food. Convenience stores, with or without gasoline sales, are excluded. Large general merchandise stores that also retail food, such as supercenters and warehouse club stores, are excluded.

Community Perceptions

In the 2013 Community Health Opinion Survey, 84.9% of residents felt that they could “easily access healthy, affordable food” and 83.8% felt that they could find enough recreational and entertainment opportunities in Wake County. Only 3.4% of residents said that better or more recreational facilities are needed in Wake County, and 2.7% felt that food assistance services needed to be improved.

“I was really shocked with was the Kroger that closed their offices within the area. I

mean they just left this entire community with no fresh foods or fruits or vegetables like

they didn’t care.”

- Community member

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Chapter 8| Health of the Environment Page 167

“That’s why in the Southeast Raleigh area, the low populated areas and low economic rates,

they’re suffering from chronic illnesses. Why? Because it’s -- they’re obese because of the food

options that we have. Just recently, they shut down two of the Kroger’s that are in the Southeast

Raleigh area. A lot of the people that lived over there, that was their only source to get some

type of healthy food. The closest market is -- it’s not even close, actually. It’s at least 20, 30

minutes away.”

- Community member

For access to recreation, there was a mix of responses from residents. Some focus group participants felt that Wake County’s recreation resources were an asset to the community, while others identified the need for safer, more affordable, and more accessible recreation facilities in Wake County.

“I didn’t realize how many -- and even in my own neighborhood that I’ve lived in for seven years, I

never really noticed that there was this much stuff to do, like outside activities. There’s like biking

and then you can have camp areas. And I had no clue of that, which I think it’s amazing.”

- Community member

“I would like [to see improvements in] other services for children and youth, maybe recreational centers. I have to go to Apex because there is not that much here, and if there is, it’s expensive.” - Community member

2013 Wake County Community Health Needs Assessment

Page 168

CHAPTER 9:

PARTNERSHIPS AND RESOURCES FOR COMMUNITY HEALTH IMPROVEMENT

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Chapter 9| Community Assets and Resources Page 169

CHAPTER 9 | PARTNERSHIPS AND RESOURCES FOR COMMUNITY HEALTH IMPROVEMENT The community health needs assessment process not only identifies the factors affecting the county’s health, but also the resources available and needed to address those factors. Home to 5 colleges and universities, 3 major hospital systems, the state capital, the Research Triangle Park, and a strong network of community-based and non-profit organizations, Wake County is a resource-rich community compared to the majority of other counties in North Carolina. Wake County has also been consistently ranked as one of the best places in the United States to live, work, and raise a family. Over the past two years, the Wake County area has been recognized as: #1 Healthiest County in NC (Wake County, NC) CountyHeatlthRankings.org March 2013 #1 Best Place to Live (Raleigh-Wake County, NC) Bloomberg-Businessweek.com America's Best Cities January 2012 #1 Real Estate Market to Watch in 2012 (Raleigh-Cary, NC) Inman News, February 2012 #1 Fastest Growing City in the U.S. (Raleigh, NC) Forbes, March 2013 Top 10 City for Business in 2013 (Raleigh-Durham, NC) Thumbtrack.com, April 2013

#5 Best City for Raising a Family (Raleigh, NC) Forbes, April 2012 #5 Most Cost-Attractive Business Location (Raleigh, NC) KPMG, March 2012 #5 America’s New Tech Hot Spots (Raleigh-Cary, NC) Forbes, March 2013 #5 Most Eco-Friendly City (Raleigh, NC) Thumbtack.com, July 2012 #7 Metro with Most College- Educated Residents (Raleigh-Cary, NC) Brookings Metropolitan Policy Program, May 2012

#7 Best Bang For Your Buck City (Raleigh-Durham, NC) TheFiscalTimes.com, June 2012 #8 Mid-Sized American City of the Future for 2013-14 (Raleigh, NC) fDi Intelligence, April 2013

#8 Largest Increase in Jobs from 2011-2012 (Raleigh-Cary, NC) U.S. Bureau of Labor Statistics, May 2013 #11 Healthiest City for Women (Raleigh, NC) Women's Health, January 2013

The wealth of resources, services, and collaboratives working to improve the health of residents in Wake County are major community assets that should be celebrated and leveraged to help residents who are facing major health disparities, needs, and challenges.

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Community Support for Health Improvement

In order to effectively meet the needs of Wake County residents, establishing effective partnerships is essential. With changes to the health care and mental health systems, increases in chronic and communicable diseases, and challenges of the economic climate, building partnerships with public health, hospitals and health care organizations, non-profits, and other non-traditional partners is essential for community health improvement. These partnerships continue to make a difference in Wake County’s ability to:

 Monitor and investigate the health needs and issues in the community  Mobilize community partnerships to improve community health  Educate and empower residents to live healthier lives  Develop programs and policies that that support community health improvement efforts  Increase residents’ access to health and mental health services

Some key partnerships that support community health improvement include:

 The Capital Care Collaborative includes Wake County Human Services, 3 major hoispitals, and providers of care to the working poor and indigent in Wake County. The Collaborative focuses on data sharing to assure better access and outcomes for clients, and planning for more seamless health care delivery system in Wake County.

 A partnership network was established to address the issues of overweight and obesity in Wake County called Advocates for Health in Action (AHA). AHA is a group of more than 50 diverse organizations and community members who are shaping the environment throughout Wake County so that healthful eating and physical activity are the way of life. AHA works to achieve its mission by shaping policy and environments that ensure available and affordable access to healthful foods and physical activity for all community members.

 Wake County also has multiple groups that strive to increase youth health resources through partnership and collaboration, including:

o Human Services Public Health o School Health Advisory Council (SHAC) o Wake County Public Schools and Wake County Human Service School Based Nursing

Program o Wake County Collaborative, an advocacy group for child health o Youth Empowered Solutions (YES!) o Youth Thrive, collaborative partnership working together to support all youth so they

can become productive adults

http://www.capitalcarecollaborative.com/

http://www.advocatesforhealthinaction.org/

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Resources, Initiatives, and Collaboratives

Resources including collaboratives, education, programs, and policies that address major health factors and concerns in Wake County are listed below. This listing of recent resources and initiatives does not include all resources in Wake County. For a more up-to-date and comprehensive listing of Wake County resources, visit:

 United Way of the Greater Triangle 2-1-1 resource and referral information line that uses the Triangle's most comprehensive database of human service resources to serve small business owners, Employee Assistance Programs (EAPs), nonprofit agencies, and government agencies: http://www.unitedwaytriangle.org/211/

 2012 Wake County Human Resources Guide: http://www.wakegov.com/humanservices/social/senior_adult/documents/resguide2012.pdf

 2013 Wake County Latino Resource Guide: http://www.wakegov.com/humanservices/espanol/Documents/Latino%20Resources%20Guide%202013.pdf

Addressing Economic Challenges

Strategies to address economic challenges in Wake County include increasing low-income housing options, streamlining services for the homeless, providing food and utility assistance, offering opportunities for residents to improve self-sufficiency, and linking residents to career resources.

 In 2012, Wake County Commissioners approved loans for 271 units in Raleigh, Cary, Rolesville, Holly Springs, Garner and Wendell. Several of the projects are designed for tenants who frequently have trouble finding housing, including senior citizens, disabled veterans and handicapped adults. The Commissioners also approved funding for 15 single family homes in Apex, to be built by Habitat for Humanity for low income, first time home buyers. County financing in prior years helped to support several rental communities that opened 2012, including: Meadow Creek Commons Apartments, Highland Terrace Apartments, Sandy Ridge Apartments, and Mingo Creek Apartments.

 The Second Chance Housing program at Brookridge Apartments received a National Association of Counties Achievement Award. The program provides housing to people who are working to move beyond problems including bad credit, a history of evictions, criminal history or disability. In 2011, half of the tenants in the apartment complex were Second Chance tenants, with 65% reporting to have been formerly homeless.

 Project Homeless Connect, an annual event that helps homeless people with basic needs, was streamlined to better meet the needs of the community. The event provides haircuts, coats and blankets, hygiene kits and ID cards; services like behavioral health care, employment, housing and legal assistance; and access to benefits including Medicaid, WIC and food stamps.

 The Warmth for Wake heating assistance program experienced one of its best years yet, raising more than $34,000 and delivering 153 loads of firewood and 52 space heaters to families who were in danger of being without heat during the winter.

http://www.unitedwaytriangle.org/211/

http://www.wakegov.com/humanservices/social/senior_adult/documents/resguide2012.pdf

http://www.wakegov.com/humanservices/espanol/Documents/Latino%20Resources%20Guide%202013.pdf

https://www.facebook.com/phcraleigh

http://www.wakegov.com/humanservices/social/energy/Pages/warmthforwake.aspx

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 The food pantry at Urban Ministries of Wake County serves over 8,000 families and 9,000 children each year. With donated food and food from the Food Bank of North Carolina, clients receive a week’s worth of groceries to sustain their family’s food needs.

 The Middle Class Express (MCE) is an innovative approach to help low-income Wake County residents make progress towards economic and social self-sufficiency that ensures access to employment, educational, and financial development opportunities and other health and human service resources. This approach provides participants Life Coaching and Life Planning to achieve a Middle Class lifestyle in 5 years. It concentrates on strategies to help individuals and families fulfill their life goals as they gain new skills and knowledge, moving them closer to the fulfillment of their life plan. In 2012, 174 participants have enrolled and 74% of participants who have been in the program 12 months are employed. Less than 25% were employed when they started the program.

 Wake County Human Services partnered with a prominent faith community to host Club Choice, a Human Capital Development initiative to help families move from use of multiple human services to self-sufficiency. Activities include health promotion and education as part of the program, as well as an emphasis on education, work, weight loss, and financial planning.

 The JobLink Career Center at the Millbrook Human Services Center was honored at the Enable America Governor's Reception for improving employment opportunities for people with disabilities. JobLink Career Centers served 70,000 job seeking customers with workforce related support and services across Wake County.

 In 2012, Wake County Public Libraries partnered with Raleigh's Parks and Recreation Department to offer a temporary computer lab and after school story time at Roberts Park and Community Center while Richard B. Harrison Library was being renovated. Hundreds of residents used the lab to search and apply for jobs during the three months it was open.

Increasing Access to Health Care and Mental Health

Increasing access to health care and mental health strategies include providing quality health care for uninsured adults living in Wake County, increasing enrollment in Medicaid, providing early and quality health care to first time mothers, advocating for school-based health centers, offering screening and testing services, and increasing the capacity of essential mental health services.

 To enhance community capacity to enroll eligible Medicaid recipients, a partnership was developed with WakeMed, Community Care of Wake and Johnston Counties, and Wake County Human Services. In 2012, 6 case manager positions were funded by WakeMed, which will add Medicaid staff to other WakeMed locations and to a physician practice.

 In 2012, free medication was dispensed through the Prescription Assistance Program equating to $140,320 savings to patients.

http://www.urbanmin.org/food-assistance/

http://www.wakegov.com/humanservices/director/initiatives/hcd/pages/individuals_families.aspx

http://www.wakegov.com/humanservices/director/initiatives/pages/clubchoice.aspx

http://www.joblinkcc.com/centers/centerInfo.asp?ctrID=51

http://www.wakegov.com/services

http://www.wakegov.com/libraries/Pages/default.aspx

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 Youth Empowered Solutions (YES!) has been advocating for school-based health centers (SBHCs). YES! utilizes the Youth Empowerment Model to spearhead grassroots advocacy campaigns to engage the community in supporting the development of SBHCs within Wake County Public Schools.

o Work towards getting a school-based health center in Wake County has seen some great successes: the establishment of the Wake School-Based Health Center Task Force, the work of the Wake School Health Advisory Committee officially recommending the establishment of an SBHC, the establishment of partnerships between Wake County Human Services, Wake Health Services, Rex Hospital, and UNC Health Care.

o Unfortunately due to turnover in the Wake County Superintendent position in 2012, the project is being delayed. However, there are plans to maintain a relationship with Wake County Public School Staff and Board Members to be able to take advantage of this opportunity once a new Superintendent is hired.

 In 2012, 8 prenatal care providers in Wake County have enrolled as Pregnancy Medical Homes with the goal of improving the quality of perinatal care given to Medicaid recipients.

 Wake County Human Service clinics have implemented a Presumptive Eligibility program for pregnant women in all prenatal clinics including Sunnybrook and the Eastern, Northern, and Southern Regional Centers. NC Medicaid allows for presumptive eligibility for pregnant women under the State Plan.

 Wake County Health Services implemented business processes that enhance Medicaid access and utilization. “Medicaid is Everyone’s Business” training is ongoing and required for all staff.

 In June 2012, staff from Wake County’s Health Promotion Chronic Disease Prevention Section partnered with Wake's EMS Advanced Practice Paramedics Program (APP). Staff accompanies APPs on site (home) visits to implement a health coaching model. Jointly, they complete environmental and physical assessments, provide navigational support and assist with securing medical care through multiple providers, and develop a personalized care plan for the patients with high frequency encounters.

 In 2012, the John Rex Endowment made a gift of $160,000 to increase access to dental care for children, make the County's dental clinic more efficient, and upgrade to digital X-rays.

 For prevention, early identification, and treatment of sexually transmitted infections, Wake County Human Services testing services for HIV, syphilis, Chlamydia, gonorrhea, hepatitis, and TB were integrated in 2012 by offering them simultaneously to clients at community as well as clinical testing sites. Integrated testing of high risk populations increases detection and treatment of sexually transmitted infections and TB. This enhanced testing is made possible through the Center for Disease Control (CDC) Program Collaboration and Service Integration (PCSI) and other grant funding.

http://www.rexendowment.org/

http://www.wakegov.com/humanservices/publichealth/information/hiv/Pages/locations.aspx

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MENTAL HEALTH AND SU BSTANCE USE

 Wake joined with Durham County to create Alliance Behavioral Healthcare to manage behavioral health services in Durham, Cumberland, Johnston, and Wake counties. The partners joined with UNC Health Care to work to improve behavioral health care for residents with mental health, intellectual/developmental disabilities, and substance abuse needs. The group seeks to strengthen essential services, address gaps, and optimize resources for efficient and effective delivery of services throughout the community, while ensuring continuity of service to consumers.

 In November 2010, the Wake County Board of Commissioners dedicated a new 19-acre mental health and addictions treatment

campus, called WakeBrook, to the citizens of Wake County. The two- building campus, part of Wake’s Mental Health Continuum of Care, provides a range of services to citizens with mental health, developmental disabilities, and substance abuse needs. The new facilities provide more space for outpatient crisis and assessment needs, inpatient substance abuse services, non-hospital medical detox, and facility-based crisis services.

Increasing Access to Healthy Foods

 Through collaborative efforts of Wake County Cooperative Extension and the community health-focused collaborative, Advocates for Health in Action (AHA), a "Farm to Family" Food Finder was developed to market the availability and access points of local foods in Wake County through an online, interactive Google map.

 In March 2013, Wake County residents participated with the annual “Dig In” event designed to educate about building, maintaining, and sustaining a community garden and strengthening the local food economy.

 In 2011-2012, a partnership between the Alice Aycock Poe Center for Health Education and Wake County Human Services’ Food and Nutrition Service Program yielded monthly educational sessions for over 100 SNAP participants. Additional sessions, in English and Spanish, were held at Millbrook Regional Center for more than 50 participants.

 Color Me Healthy is a program developed to reach children ages four and five with fun, interactive learning opportunities geared towards physical activity and healthy eating. In 2011-2012, the Color Me Healthy curriculum for providers was introduced, where 54 participants from 30 child care facilities serving approximately 1,600 children attended trainings in Wake County. In addition, the Wake County Cooperative Extension provided Color Me Healthy training to 67 Wake County child care providers.

 Of the 14 known farmers’ markets in Wake County, four provide Electronic Benefits Transfer (EBT) for Supplemental Nutrition Assistance Program (SNAP) participants.

WakeBrook, Image Source: Wake County

http://www.alliancebhc.org/

http://www.wakegov.com/humanservices/locations/wakebrook/Pages/default.aspx

https://maps.google.com/maps/ms?ie=UTF8&oe=UTF8&msa=0&msid=210292701217115466553.0004a4098f63fc11e6e07

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 In 2011, Advocates for Health in Action (AHA) was awarded a Farmers Market Promotion Program (FMPP) Grant through the U.S. Department of Agriculture to work with the Wendell and Fuquay-Varina Farmers’ Markets. The grant helped both markets to become established with a part-time market manager, promotion, and the capacity to process EBT for SNAP participants.

 In 2012, Wake County Health Promotion Staff created bi-lingual signage promoting EBT acceptance at the Western Wake, Raleigh Downtown, Wendell, and Fuquay-Varina Farmers Markets and posted signage at the Wake County Sunnybrook, Swinburne, Eastern, and Southern Regional Center Buildings.

 The Wake County Cooperative Extension’s Expanded Food and Nutrition Education Program (EFNEP) provides nutrition and cooking education to Supplemental Nutrition Assistance Program (SNAP)-eligible families. From October 2011 to August 2011, EFNEP reached 462 clients impacting 2005 people in households; 69% of clients have increased consumption of fruits as a result of program and 58% have increased consumption of vegetables as a result of program.

 In 2010-2011, the Wake County Cooperative Extension and Wake County Public School System’s School Health Advisory Council (SHAC) partnered to advocate for improved healthful food choices and physical activities in schools and childcare centers.

 Community gardens in Wake County have grown from 10 to 33 via the efforts of the Advocates for Health in Action (AHA) network of partners who provide technical assistance and advocate for fresh, affordable produce. Extra produce is commonly donated to organizations such as the Inter-Faith Food Shuttle. Additionally, AHA has provided technical support to Wake County Smart Start and helped secure donations to start learning gardens at 16 Wake

County daycare centers.

 The Sport Snack Game Plan was implemented with the Capital Area Soccer League (CASL) and more than 80 area physicians have signed in support of the Game Plan. Through partnership with CASL, over 10,000 children were impacted with healthy snacks.

Increasing Access to Recreation and Physical Activity

 The City of Raleigh Parks and Recreation staff maintained 78 miles of paved and unpaved trails. On September 24, 2012 an additional trail, “The House Creek Greenway Trail” was dedicated, connecting completed bicycle/pedestrian routes in the county.

 Greenway, an iPhone application that integrates the City of Raleigh’s GIS data, was created to make Raleigh’s Greenway system more user-friendly. The “app” was the winner of the top prize at CityCamp Raleigh in 2012. Users can download the application to their iPhone from the Apple iTunes store.

Image Source: AHA

http://www.advocatesforhealthinaction.org/

http://www.caslnc.com/

http://www.raleighnc.gov/arts/content/PRecParks/Articles/ParksFacilities.html

http://rgreenway.com/

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 In 2012, the American Tobacco Trail was named the Best Place to Run and the Best Place to Bike by Cary Magazine for the third year in a row. The magazine also named Lake Crabtree County Park both the Best Place to Ride a Bike and the Best Place to Go for a Run in Morrisville.

 Over 6,000 copies of Trails & Greenways of Wake County pocket guides have been distributed via the following venues: parks and recreation departments, medical clinics, pediatrician offices, faith and community groups, schools and libraries, community coalitions, and businesses.

 Wake County Human Services’ Health Promotion Chronic Disease Prevention (HPCDP) staff assisted with the completion of the New Bern Avenue Corridor Rapid Assessment on safe crosswalks, sidewalks, disability accessibility designs, walkability to schools, and access to healthy foods.

Improving Worksite Wellness

 In 2010, Wake County Human Service’s Health Promotion Chronic Disease Prevention (HPCDP) program partnered with Sigma Electronics in Garner, NC to provide quarterly Lunch-N-Learn sessions, and mapped out a walking route on the property. Additionally, the Sigma Electronics wellness coordinator began an employee newsletter and annual employee wellness fair. In 2011- 2012, HPCDP staff initiated discussion with the Department of Revenue (DOR) to establish a worksite wellness committee and programming for employees.

 In 2012, Wake County Government partnered with Living Well at Work to help county employees manage their diabetes and save on medical costs. The program, which received a National Association of Counties Award, had high attendance, improved the employees' health, and saved an estimated $1,200 per participant per year in medical costs. In addition, Know Your Numbers is a new wellness initiative that is linked to the county's health insurance plan. County employees, retirees, and spouses are asked to get an annual biometric screening to identify health risk factors and prevent chronic medical conditions.

Increasing Transportation Options

 Wake County is collaborating with municipal governments, Triangle Transit, regional transportation agencies, and the business community to begin discussions about long-term transportation needs. In 2011, Wake County worked with partners to develop a draft plan for providing efficient and effective modes of transportation for residents. The county prepared the plan in partnership with regional transit and planning organizations and all municipalities.

 Wake County leaders were joined by the U.S. Department of Transportation secretary to announce a $600,000 grant to expand the Wake Coordinated Transportation Service (WCTS) call center. The Veterans Transportation and Community Living Initiative grant will provide a 24/7 telephone system to:

o Access automated transportation, Veterans Services and Human Services information. o Retrieve real-time "where is my ride?" customer ride status information. o Schedule trip reservation requests. o Speak with a live WCTS customer service agent during business hours.

Image Source: Wake County

http://www.wakegov.com/parks/att

http://www.wakegov.com/parks/lakecrabtree

http://www.wakegov.com/parks/about/pages/trailsgreenways.aspx

http://www.wakegov.com/planning/transport

http://www.wakegov.com/veterans

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 The Center for Volunteer Caregiving is a non-profit, faith-based organization that provides volunteer services, including round trip transportation services, for Wake County seniors, family caregivers, and adults living with disabilities.

Improving Education and Lifelong Learning

 Libraries and Empire Properties partnered to have a modern mural dubbed the Fantastic Sky Race installed along two exterior walls of the Wake County parking deck in downtown Raleigh. The mural, designed by students from NC State University, has inspired library programs for all ages.

 The Wake County Board of Commissioners has worked with the Wake County Public School System and Wake Technical Community College to develop operating budget strategies that do not require increasing the property tax rate, yet sustain education as a priority in Wake County. Education funding comprises more than one-third of the county budget. The fiscal year 2012 budget increased the appropriation for the Wake County Public School System by $908,000, for a total appropriation of $314.4 million. Wake County's commitment to Wake Tech Community College was also maintained with $16 million appropriated for FY2012.

 A capital program plan has been developed for Wake Technical Community College for 2012 to 2017. It will sustain the college as it grows to accommodate future students and allow Wake Tech to maintain its position as one of the best community colleges in the nation.

 Wake Smart Start ensures that Wake County children (birth to 5 years) are successful in school and in life. Wake County Smart Start convenes stakeholders to assess local needs, fund local programs, ensure accountability, and leverage resources to support young children and families.

 Raleigh Promise is a post-secondary success partnership supported by the Raleigh Colleges and Community Collaborative, which includes 6 colleges and universities in Raleigh. The Collaborative also includes the City of Raleigh, Wake County Public School System, Wake County Human Services, businesses, faith-based organizations, nonprofits, teens, and college students. The goal of Raleigh Promise is to double the number of low-income youth in Raleigh who achieve a post- secondary credential and living-wage employment by 2025.

Improving Environmental Health

 In 2012, the Wake County Sustainability Task Force completed its work and compiled a report examining water resources conservation and management, solid waste reduction and management, and energy conservation and management.

 Stormwater rules for new developments were updated to establish new nitrogen and phosphorous limits specific to Falls Lake and Jordan Lake. This is the first time the county has established phosphorous limits. The requirements are intended to improve ground water quality near the lakes.

 Wake's Open Space Program, the first of its kind in North Carolina, is working with many partners to protect remaining open space in the county with the objective of protecting as much of the county's land area as permanent open space as possible. A new computer mapping system model was developed to evaluate open space properties. The model,

Image Source: Wake County

http://www.volunteercaregiving.org/transportation

http://www.wcpss.net/

http://www.waketech.edu/

http://wakesmartstart.org/index.php

http://raleighpromise.org/

http://www.wakegov.com/environment/admin/sustainability/Pages/default.aspx

http://www.wakegov.com/water/stormwater/management

http://www.wakegov.com/parks/openspace/Pages/default.aspx

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which received a national award, will be used as one of several tools to help prioritize the county's open space acquisitions.

 The Board of Commissioners approved changes to the Animal Control Ordinance to allow feral cats to be trapped, sterilized and vaccinated, and then released into their original location. The goal of the new policy - known as TNR for Trap, Neuter, Release - is to better manage the feral cat population.

 In 2011, to improve commercial recycling rates, the City of Raleigh expanded curbside recycling in the Central Business District. Over 150 businesses had joined the program. Similarly, other Towns have expanded recyclables collection programs, or are in the process of expanding them,

to include some businesses. Fuquay‐Varina is offering cardboard collection to the 214 businesses in its downtown area.

http://www.wakegov.com/pets/health/safety

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CHAPTER 10:

COMMUNITY PRIORITIES

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CHAPTER 10 | COMMUNITY PRIORITIES Once all of the data was collected from the Community Health Opinion Survey, focus groups, and existing health statistics, the next step in the community health needs assessment process is to involve the community in choosing the priorities that will be addressed in the next 3 yearss.

Community engagement is important not only when choosing health priorities, but also for generating recommendations and strategies for community health improvement and garnering community support for later decisions and actions.

Community Forum

On May 16th, 2013, five community forums were held simultaneously across Wake County to discuss the results of the CHNA process. Residents were invited to hear the main findings from the assessment and prioritize the issues to be addressed over the next 3 years.

The forums were located in the central, north, south, east, and west areas of Wake County at the following locations:

 Central: WakeMed Andrews Center, Raleigh  East: Wake County Human Services Eastern Regional Center, Zebulon  North: New Bethel Baptist Church, Rolesville  West: Senior Center, Cary  South: Wake County Southern Regional Center, Fuquay-Varina

Email invitations and flyers (Appendix I) were distributed to promote the event and encourage residents to attend.

Forum Demographics

A total of 95 people participated in the forums. Of those, 91 completed demographic information. The majority of participants attended the central forum, followed by the north forum.

Eight Phases of Wake County’s Community Health

Needs Assessment (CHNA) Process

A community assessment is a process that helps to identify factors affecting our county, determine resources needed to address these factors, and develop a plan of action to address community needs. There are 8 phases in the process: 1. Establish a community health assessment team 2. Collect primary data 3. Collect secondary data 4. Analyze and interpret county data 5. Determine health priorities 6. Create the CHNA document 7. Disseminate CHNA document 8. Develop community health action plans

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Source: NC Institute for Public Health

More females, African Americans, and persons with a Bachelor’s degree or higher attended the forum compared to Wake County’s general population. In addition, there was less representation at the forum among adults aged 18-29.

Demographic Characteristics of Wake County Community Forum Participants, 2013

Characteristic Community

Forum Participants

Wake Population

(2010 Census)

Gender

Male 25% 49%

Female 75% 51%

Race

White 49% 66%

African American 41% 21%

Asian/Pacific Islander 3% 5%

Native American 3% 0.5%

Other 4% 5%

Two or more races N/A 2.5%

Ethnicity

Hispanic or Latino 9% 10%

Age Groups

Aged 18-29 4% 17%

Aged 30-44 22% 24%

Aged 45-64 58% 24%

Aged 65 and older 15% 9%

Education

Bachelor’s degree or higher 80% 48% Source: NC Institute for Public Health, 2013. Race and ethnicity is reported as two separate dimensions. Ethnicity is defined as Hispanic and Non-Hispanic. Thus, persons of Hispanic ethnicity may be of any race.

18 17

Central North South East West

N u m

b e r

Wake County Community Forum Participants, 2013

Missing=4

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Forum Overview

The community forum began with a presentation on nine focus areas that were identified from the assessment by looking at the intersection of the Community Health Opinion Survey results, focus group themes, and existing health statistics:

 Mental health and substance use

 Disability and care-giving

 Education and lifelong learning

 Health care access and utilization

 Housing and homelessness

 Nutrition, physical activity, and obesity

prevention

 Population growth

 Poverty and unemployment

 Risky youth behavior

The presentation was followed by small group discussions and each participant was asked to rank the top 3 community topics by the following criteria:

 Impact: affects the largest number of people in the community

 Urgency: will have serious consequences if not addressed in next 3 years

 Community Concern: community is most concerned about this issue

 Realistic: community can realistically make progress over the next 3 years

After voting, small groups then discussed recommendations and next steps for improving community health.

Prioritization Method

A total of 95 ballots were completed. The ballot numbers by forum site are as follows:

 Central: 32 (34%)

 North: 17 (18%)

 South: 17 (18%)

 East: 12 (13%)

 West: 17 (18%)

 Total: 95

Image Source: Wake County

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The prioritization method used for the 2013 community forums is a modified version of the Hanlon Method for Prioritizing Health Problems, which is a technique endorsed by the National Association of County and City Health Officials to determine priorities based on explicitly defined criteria and feasibility factors. Once completed, the ballot forms were entered by NC Institute for Public Health staff in to Qualtrics survey software, which produced means from the ranking of the focus areas within the identified criteria categories (a lower rank equals a higher priority).

A formula was applied to get an overall priority score for each topic area: where the overall priority score:

= [IMPACT + CONCERN* + URGENCY] x REALISTIC

Note: Concern was an additional criteria added and urgency was not weighted.

One limitation is statistical significance between overall scores was not able to be determined.

Community Priorities

Based on the prioritization method used, the 2013-2016 Wake County CHNA community priorities are:

 Poverty and unemployment  Health care access and utilization  Mental health and substance use

Wake County Community Forum Focus Areas by Priority Score, 2013

Priority

Rank

2013 Wake County CHNA Priorities Overall Score

(lower

score=higher

priority)

1 Poverty and unemployment 9.7336

2 Health care access and utilization 10.769

3 Mental health and substance use 10.9823

4 Nutrition, physical activity, and obesity prevention 11.9226

5 Education and lifelong learning 12.3336

6 Population growth 13.2496

7 Disability and care-giving 14.9184

8 Risky youth behavior 15.663

9 Housing and homelessness 16.8688

Source: NC Institute for Public Health, 2013.

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Next Steps

Community priority setting represents marks the beginning of the community health improvement process.

An important use of the community priorities and assessment findings is to develop effective community health improvement strategies. The next step in this process is to develop plans of action and improvement for addressing the community priorities. Within their organizations, CHNA partners will be developing measurable objectives to address these priorities, using evidence-based strategies to address the priorities, and planning realistic evaluation methods.

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INDEX Affordable Care Act, 17, 134, 188, 189 Apex, 7, 31, 123, 167, 171, 242 assets, 17, 77, 169 Asthma, 97, 98, 246 Binge drinking, 188 Cancer, 91, 92, 93, 136, 246, 265 Cary, 32, 38, 137, 154, 158, 159, 162, 169,

171, 176, 180, 215, 242 child abuse, 59, 68, 69 Child Welfare, 7, 59, 60, 61, 69 children, 20, 48, 56, 59, 60, 61, 69, 72, 82,

90, 97, 108, 110, 123, 124, 131, 132, 141, 151, 153, 158, 162, 163, 165, 167, 172, 173, 174, 175, 235, 249, 250, 265, 266, 268

Chronic diseases, 120 Chronic lower respiratory disease, 97 civic engagement, 73 communicable diseases, 101, 102, 103, 108,

170 Community Engagement, 19 community forums, 21, 180, 183 community health improvement, 18, 22, 169,

170, 180 Community Health Needs Assessment, 17, 18,

20, 188, 235, 258, 260, 276 Community Health Opinion Survey, 19, 20, 21,

49, 51, 52, 56, 59, 63, 70, 71, 72, 74, 75, 81, 90, 93, 99, 100, 109, 110, 113, 114, 118, 121, 122, 123, 125, 126, 130, 152, 153, 154, 164, 166, 180, 182, 188, 213, 218, 235

Community Perceptions, 49, 52, 56, 59, 63, 72, 75, 82, 90, 99, 110, 113, 118, 121, 122, 125, 126, 153, 164, 166

community resources, 17, 22 County Health Rankings and Roadmaps, 65,

77, 78, 79, 80, 134, 135, 157, 158, 165 Crime, 65, 66, 239 dental, 131, 132, 145, 149, 153, 154, 173,

242, 269, 270, 271 dentist, 131, 244 diabetes, 45, 75, 94, 98, 99, 100, 120, 122,

124, 131, 149, 165, 176

disability, 71, 77, 108, 109, 110, 115, 127, 148, 171, 176, 242, 248, 251, 263, 267

disaster, 70, 71, 251, 252 Diversity, 27, 261, 272 domestic violence, 51, 67, 68 Duke Raleigh Hospital, 6, 17, 137 education, 18, 19, 44, 45, 49, 81, 122, 125,

126, 131, 150, 161, 171, 172, 175, 177, 236, 261, 265, 266, 270, 272, 273

Emergency Department, 127, 140, 141, 142, 143, 145, 188

environment, 19, 22, 44, 78, 157, 158, 159, 162, 164, 170, 236, 274

exercise, 75, 122, 123, 158, 245, 262, 265, 267, 268, 274

Faith, 6, 18, 75, 175, 245, 252 Federally-Qualified Health Centers, 145, 188 Financial Assistance, 59 Fuquay-Varina, 33, 154, 175, 180, 242 gangs, 66, 72 Garner, 28, 34, 138, 139, 171, 176, 242 health care, 19, 50, 57, 63, 75, 125, 153,

154, 170, 171, 174, 242, 265, 267, 272, 273

Health care access, 21 Health insurance, 57, 150 Healthy NC 2020, 19, 21, 45, 51, 78, 79, 81,

86, 90, 93, 94, 98, 104, 108, 112, 120, 122, 124, 126, 128, 129, 150, 188

Heart disease, 94, 145 Hispanic, 6, 27, 28, 30, 31, 32, 33, 34, 35,

36, 37, 38, 39, 40, 41, 42, 46, 50, 73, 83, 84, 87, 89, 91, 92, 94, 95, 96, 99, 100, 128, 129, 181, 252, 259, 264, 279

Holly Springs, 6, 26, 35, 171, 242 Homelessness, 50, 51, 52, 237, 254 homicide, 129 hospice, 137, 138 hospital, 77, 80, 97, 98, 115, 131, 136, 137,

138, 144, 147, 153, 169, 174, 244, 267, 270

Housing, 21, 27, 50, 51, 171, 182, 183, 238 infant mortality, 88, 89 initiatives, 22, 171

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Injury, 92, 110, 127, 129 juvenile justice, 65 Knightdale, 36, 154, 242 leading cause of death, 90, 92, 94, 95, 97,

99, 127 Lifelong Learning, 45, 177 low birth weight, 86, 87, 88 Mecklenburg County, 21, 27, 28, 45, 47, 51,

54, 56, 57, 58, 60, 61, 65, 66, 67, 68, 73, 78, 79, 80, 86, 87, 88, 90, 91, 92, 93, 97, 98, 104, 107, 108, 109, 112, 115, 117, 131, 135, 136, 137, 138, 147, 150, 151, 158, 159, 163, 165, 166

Medicaid, 116, 131, 134, 141, 148, 151, 152, 153, 154, 155, 163, 171, 172, 173, 189, 240, 241, 261, 263, 266, 267, 268, 269, 271, 273

Medicare, 100, 132, 141, 144, 154, 155, 189, 240, 241, 243, 260, 261, 262, 263, 269, 270, 271, 273

Mental health, 114, 145, 262, 263, 266, 273 Morrisville, 26, 37, 44, 45, 50, 54, 86, 88, 94,

98, 101, 108, 112, 124, 125, 126, 128, 129, 131, 134, 176

nutrition, 65, 75, 120, 121, 125, 175, 265, 266, 272

obesity, 21, 80, 94, 97, 99, 122, 124, 125, 165, 170, 182, 183, 273

partnerships, 18, 170, 173, 266 physical activity, 21, 65, 75, 122, 125, 170,

174, 182, 183, 272 Physical activity, 122, 274 poisoning, 127, 128, 129, 162, 163 Poverty, 21, 44, 54, 134, 182, 183, 237, 254 pregnancy, 82, 83, 84, 86, 131, 144 prenatal care, 85, 86, 90, 155, 173, 272,

273 primary care, 78, 104, 135, 151, 155, 266,

267, 269, 272, 274

priority, 17, 21, 177, 183, 273, 276, 277, 278

Raleigh, 6, 7, 17, 18, 24, 28, 30, 31, 32, 34, 36, 37, 38, 40, 41, 42, 63, 84, 87, 121, 137, 138, 139, 146, 154, 158, 159, 167, 169, 171, 172, 175, 177, 178, 180, 242, 261, 265, 273

Rankings, 19, 21, 65, 77, 78, 79, 80, 134, 135, 157, 158, 165

Rex Healthcare, 6, 8, 17, 18, 155 Rolesville, 6, 26, 39, 171, 180 Safety, 65, 66, 127, 236, 238, 239, 252,

261, 263, 264, 267, 269, 272 Sexually transmitted infections, 104 Smoking, 86, 239, 246, 274 social determinants of health, 44, 189 Stroke, 95 substance use, 21, 51, 182, 183 Tobacco, 126, 176, 239, 250 traffic, 33, 63, 64, 127, 270 Transportation, 63, 70, 176, 189, 237, 238,

243, 248, 252, 266, 269 unemployment, 21, 55, 57, 58, 59, 75, 182,

183 uninsured, 134, 150, 151, 155, 172, 274 United Way of the Greater Triangle, 6, 7, 9,

17, 18, 171 volunteer, 74, 239, 262 Wake County Human Services, 6, 7, 8, 9, 17,

18, 98, 101, 107, 131, 132, 134, 149, 170, 172, 173, 174, 176, 180, 189

Wake Forest, 26, 40, 242 Wake Health Services, 6, 7, 8, 9, 17, 18, 145,

173, 241, 263, 266 WakeMed, 6, 7, 8, 17, 18, 98, 115, 131,

137, 139, 140, 141, 142, 144, 145, 148, 172, 180, 271

Wendell, 7, 41, 171, 175, 242 Zebulon, 6, 42, 180, 242

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APPENDICES

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Appendix A: Glossary and Terms Page 188

APPENDIX A: GLOSSARY AND TERMS ACA: Affordable Care Act

ACS: U.S. Census Bureau American Community Survey

AHA: Advocates for Health in Action

AQI: Air Quality Index

Binge drinking: Males having five or more drinks on one occasion OR females having four or more

drinks on one occasion

BMI: Body Mass Index, the relationship between height and weight that is associated with body fat.

BRFSS: Behavioral Risk Factor Surveillance System

Built Environment: Refers to human-made (versus natural) resources and infrastructure designed to

support human activity, such as buildings, roads, parks, restaurants, and grocery stores.

CCNC/CA: Community Care of North Carolina/Carolina ACCESS

CDC: Centers for Disease Control and Prevention

CHNA: Community Health Needs Assessment

CHOS: Community Health Opinion Survey

Community Health Needs Assessment: A systematic collection, assembly, analysis, and dissemination

of information about the health of the community.

EOG: End of Grade test

ED: Emergency Department

EPA: Environmental Protection Agency

EPSDT: Early and Periodic Screening, Diagnosis and Treatment

FNS: Food and Nutrition Services

FQHC: Federally-Qualified Health Centers

Healthy NC 2020: Serves as the state’s health improvement plan by encompassing 13 focus areas

with 40 measurable objectives developed by the Governor’s Task Force for Healthy Carolinians.

Incidence: The number of new cases of a disease that occur during a specified period of time divided

by the number of persons at risk of developing the disease during that period of time.

LME: Local Management Entity

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Medicaid: the United States health program for families and individuals with low income and

resources.

Medicare: national social insurance program, administered by the U.S. federal government since

1965, that guarantees access to health insurance for Americans aged 65 and older and younger

people with disabilities as well as people with end stage renal disease (Medicare.gov, 2012) and

persons with Lou Gehrig’s Disease.

NCIPH: North Carolina Institute for Public Health

NHIS: National Health Interview Survey

PPACA: The Patient Protection and Affordable Care Act

Prevalence: The proportion of people in population affected by a disease or condition during a

specified period of time. Prevalence is calculated by dividing the number of affected persons in the

population during a specified period of time by the number of people in the population during that

period of time.

Rate: the number of cases (or deaths) divided by the number of people in the state and are usually

expressed as the number of cases (or deaths) per 100,000 people. Rates are useful for comparing

the cancer risk in different populations.

SCHS: State Center for Health Statistics

Social Determinants of Health: These characteristics are defined as social determinants of health,

which are the circumstances people are born, grow up, live, work, and age, as well as the systems put

into place to deal with illness.

TANF: Temporary Assistance for Needy Families program, also called Work First

TRI: Toxic Release Inventory

WCHS: Wake County Human Services

WCTS: Wake Coordinated Transportation Service

WFFA: Work First Family Assistance

WHO: World Health Organization

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APPENDIX B: LOW COST PRIMARY CARE SERVICES IN WAKE COUNTY

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APPENDIX C: EXISTING DATA SOURCES

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APPENDIX D: COMMUNITY HEALTH OPINION SURVEY METHODS Interview locations were determined using a two-stage cluster sampling method developed by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to assess public health needs following disasters. This method utilizes population-based sampling weights from each census block and allows for generalizability of the collected data to the population of Wake County.

The two-stage cluster sampling method is used to carry out Community Assessment for Public Health Emergency Response (CASPER). This method was first developed in the 1960s as a tool for local health departments to conduct rapid assessments of immunization coverage (Serfling & Sherman, 1965). The sampling method was adopted by the World Health Organization’s Expanded Program on Immunization and later by the Centers for Disease Control and Prevention for use in responses to natural disasters (Henderson & Sundaresan, 1982; Malilay, Flanders, & Brogan, 1996, CDC 2012). This efficient sampling scheme has been validated and used effectively for rapid assessment and estimation of a variety of population-level public health needs (Frerichs & Shaheen, 2001; Henderson & Sundaresan, 1982).

A typical two-stage cluster sample is a 30/7, where 30 clusters and 7 survey locations per cluster are selected for a total of 210 interviews. This method provides reasonably valid and precise estimates of the true population when the estimated proportion in the target population with the event of interest is between 10% to 90% (Binkin, Sullivan, Staehling, & NIieburg, 1992).

To balance the need for reasonably accurate results and efficient data collection a 40/7 two-stage cluster sample with 5 census blocks selected with a probability proportionate to size in each of the county’s eight health service zones was implemented. This ensured that each zone was represented in the sample with 35 interviews in each zone for a total sample size of 280. In the second stage of sampling, seven random interview locations within each selected block were identified.

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Selected Census Blocks and Health Zones

The selection process was automated using a GIS-based survey site selection toolkit developed by the CDC that operates within ESRI’s mapping software ArcGIS. In the first stage of sampling, 40 census blocks were randomly selected with a probability proportionate to the population size with the most populated census blocks more likely to be selected. Five census blocks were selected from each of the 8 health zones to ensure adequate representation.

In the second stage of sampling, seven random interview locations were selected in each census block. Interview teams attempted to conduct interviews at the selected addresses. If no one was home at the selected address or the resident refused to participate, then teams approached the next closest residence. This procedure was repeated until an interview was completed and then teams moved on to the next randomly selected address.

The survey was administered in March 2013. Interviewers obtained oral consent in English or Spanish before interviewing potential survey participants. Interviewers obtained oral informed consent before

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interviewing potential study participants, and were given a small thank-you gift (equivalent to $2-$3 dollars). Eligible participants were at least 18 years of age and residents of the selected household.

Interview teams were guided to the random survey locations using car GPS units (Garmin), handheld GPS units (Magellan MobileMapper) and field maps with current aerial photography (Google or Bing Maps). Responses were recorded at the time of the interview on hard copy surveys or electronically using the handheld GPS units.

Analyzing Primary Data

Data was analyzed in SAS 9.2 (Cary, NC), with weighted frequencies and 95% confidence intervals (CI) for each question in the community health opinion survey. Unlike a simple random sample of the entire county, households selected in cluster sampling have an unequal probability of selection. To avoid biased estimates, all data analyses include a mathematical weight for probability of selection. Survey weights were calculated using methods described in the CDC’s Community Assessment for Public Health Emergency Response (CASPER) toolkit (CDC, 2012). The weights incorporate the total number of households in the sampling frame, the number of households in the census block, and the number of interviews collected in each census block. These weights were calculated with a standard error for each frequency, from which 95% CIs were derived. Qualitative data was summarized into categorical variables where appropriate. Interpretations of these data are generalizable at the county level, as the sampling methods collects responses from residents throughout the county in weighted census blocks. These weights allow for the calculation of 95% CIs, which should be interpreted as the interval which contains the true value in 95% of repeated samples.

Demographic Results

A total of 281 surveys were collected over an 11-day period by 37 teams of trained interviewers.

When the demographics from survey respondents are compared to those in the Wake County Census 2010 estimates it is clear that data are representative of county residents. Race and ethnicity were asked as one question; therefore, total race/ethnicity numbers add up to more than 100% because the categories are not mutually exclusive.

Male Female

CHOS 40% 60%

Wake 49% 51%

20%

40%

60%

80%

P e rc

e n t

Community Health Opinion Survey Sample by Gender 95% Confidence Limits

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White African

American Other/Multi-

racial

CHOS 62% 22% 16%

Wake 66% 21% 13%

20%

40%

60%

80%

P e rc

e n t

Community Health Opinion Survey Sample Race Estimates 95% Confidence Limits

Hispanic Non-Hispanic

Wake 10% 90%

CHOS 10% 90%

20%

40%

60%

80%

100%

P e rc

e n t

Community Health Opinion Survey Sample Ethnicity Estimates

95% Confidence Limits

< High School

High School- Grad/Some

college

Bachelor’s degree+

CHOS 5% 40% 54%

Wake 8% 44% 48%

20%

40%

60%

80%

P e rc

e n t

Community Health Opinion Survey Sample Education Estimates

95% Confidence Limits

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Limitations

While the quality of the data from the community health opinion survey is high and likely some of the best survey data collected on the health of Wake County residents, there are some limitations as with any door-to-door survey. These limitations can include the following:

 We relied on volunteer interviewers to collect the data, some of whom were new to public health survey methods and using handheld GPS-enabled computers. Many of the volunteers participated for one day; those who participated for two or more days were most likely to be comfortable with the survey and technology.

 We were more likely to capture data from people at home during the day (i.e. women, elderly, unemployed/work from home, and persons living with a disability). However, we were able to balance this by surveying in the evenings and on Saturdays.

 In some instances, residents may over- or under-report behaviors and illnesses based on fear or social stigma or misunderstanding of the question being asked. In addition, respondents may be affected by recall bias, where they attempt to answer accurately but remember incorrectly.

 Throughout the report, the 95% Confidence Limits for this data are indicated where appropriate. The 95% Confidence Interval is a range above and below the observed estimate, where we would expect the “true” estimate to be 95% of the time, since observation is influenced by random error.

The Community Health Opinion Survey results are generalizable at the County-level. Results are not able to be broken down into racial/ethnic, gender, education, or income categories. However, the data is representative of Wake County as a whole.

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APPENDIX F: COMMUNITY HEALTH OPINION SURVEY RESULTS

 Source: North Carolina Institute of Public Health

 For information about methods, see the 2013 Wake County Community Health Needs Assessment report

PART 1: Community 1. How do you feel about this statement, “I can access good health care in Wake County”? (Consider the cost and quality, number of options, and availability of health care in the county).

Q1 Quality of Life Health care Access

Frequency Percent 95% Confidence Limits

Strongly Disagree 6 2.0982 0.4783 3.7181

Disagree 17 6.0714 3.3561 8.7867

Neutral 28 9.9107 5.9163 13.9052

Agree 113 40.1339 33.8008 46.4670

Strongly Agree 116 41.4286 34.5277 48.3294

No Response 1 0.3571 0.0000 1.0795

2. “I think Wake County is a good place to raise children”? (Consider the quality and safety of schools and child care programs, after school programs, and places to play in this county).

Q2 Quality of Life: Raising Children

Frequency Percent 95% Confidence Limits

Strongly Disagree 2 0.7143 0.0000 1.7227

Disagree 6 2.1429 0.1935 4.0922

Neutral 16 5.6696 2.9851 8.3542

Agree 136 48.3036 42.6205 53.9866

Strongly Agree 119 42.5000 36.2974 48.7026

No Response 2 0.6696 0.0000 1.6173

3. “I think Wake County is a good place to grow old”? (Consider the county’s elder-friendly housing, transportation to medical services, recreation, and services for the elderly).

Q3 Quality of Life: Growing Old

Frequency Percent 95% Confidence Limits

Strongly Disagree 2 0.7143 0.0000 1.7227

Disagree 10 3.5268 1.0645 5.9891

Neutral 51 17.9911 13.3345 22.6476

Agree 138 49.1667 42.7052 55.6282

Strongly Agree 78 27.8869 22.3113 33.4625

No Response 2 0.7143 0.0000 1.7227

http://www.wakegov.com/humanservices/data/Documents/2010CommunityAssessmentFullDocumentApril11%20%281%29.pdf

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4. “I can find enough economic opportunity in Wake County”? (Consider the number and quality of jobs, job training/higher education opportunities, and availability of affordable housing in the county).

Q4 Quality of Life: Economic Opportunity

Frequency Percent 95% Confidence Limits

Strongly Disagree 4 1.4286 0.0405 2.8167

Disagree 26 9.1964 5.1261 13.2668

Neutral 49 17.3810 12.4042 22.3577

Agree 141 50.2381 43.9192 56.5570

Strongly Agree 61 21.7560 15.9898 27.5222

5. “I feel safe living in Wake County.” (Consider how safe you feel at home, in the workplace, in schools, at playgrounds, parks, and shopping centers in the county).

Q5 Quality of Life: Safety

Frequency Percent 95% Confidence Limits

Strongly Disagree 1 0.3571 0.0000 1.0795

Disagree 15 5.3571 2.3076 8.4067

Neutral 28 9.9107 6.3408 13.4806

Agree 163 57.9315 51.9263 63.9368

Strongly Agree 74 26.4435 20.4519 32.4350

6. “I think there’s enough help for people during times of need in Wake County”? (Consider social support in this county: neighbors, support groups, faith community outreach, community organizations, and emergency monetary assistance).

Q6 Quality of Life: Help in Times of Need

Frequency Percent 95% Confidence Limits

Strongly Disagree 12 4.2857 1.7095 6.8619

Disagree 32 11.2054 7.0447 15.3660

Neutral 65 23.1250 17.5670 28.6830

Agree 126 44.9256 38.7902 51.0609

Strongly Agree 45 16.1012 11.1846 21.0177

No Response 1 0.3571 0.0000 1.0795

7. “I think the environment in Wake County is clean and safe”. (Consider clean air, safe drinking water, free from polluted sites, safe food supply, sufficient garbage collection and disposal, access to recycling, control of animals (domestic and wild) and control of insects/rodents).

Q7 Quality of Life: Environment

Frequency Percent 95% Confidence Limits

Strongly Disagree 2 0.7143 0.0000 1.7227

Disagree 11 3.8839 1.3699 6.3980

Neutral 24 8.5714 5.0174 12.1255

Agree 198 70.4315 63.6934 77.1697

Strongly Agree 46 16.3988 11.8193 20.9784

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8. “I can find enough recreational and entertainment opportunities in Wake County”. (Consider parks, museums, restaurants, movie theaters, sports, nature trails).

Q8 Quality of Life: Recreation and Entertainment

Frequency Percent 95% Confidence Limits

Strongly Disagree 4 1.3839 0.0369 2.7310

Disagree 18 6.3839 3.6684 9.0995

Neutral 24 8.4821 5.1327 11.8316

Agree 142 50.3571 43.1562 57.5581

Strongly Agree 93 33.3929 25.8715 40.9142

9. “I can easily access healthy, affordable food?”

Q9 Quality of Life: Health, Affordable Food

Frequency Percent 95% Confidence Limits

Strongly Disagree 5 1.7411 0.2469 3.2353

Disagree 19 6.6964 3.4458 9.9471

Neutral 19 6.6964 3.4846 9.9082

Agree 170 60.5506 54.4490 66.6522

Strongly Agree 68 24.3155 18.3440 30.2870

10. In your opinion, what are the TOP THREE (3) issues that most affect the quality of life in Wake County?

Q10 Community Issues: 1

Frequency Percent 95% Confidence

Limits

Unemployment/Employment Opportunities 92 11.52 7.41 15.62

School Reassignment 84 10.48 6.57 14.40

Low Income/Poverty 67 8.37 4.85 11.89

Traffic Congestion 67 8.47 4.71 12.23

Drug and Alcohol Abuse 45 5.76 2.88 8.64

Violent Crimes 40 5.18 2.08 8.28

Homelessness 38 4.91 2.07 7.74

Gun Violence/Accidents 35 4.54 1.95 7.12

Access to Quality Education 35 4.39 1.91 6.87

Lack of/Inadequate Health Insurance 35 4.46 1.91 7.01

Affordable/Safe Transportation 26 3.36 0.96 5.76

Discrimination/Racism 23 2.94 0.74 5.13

Dropping Out of School 23 2.95 0.95 5.00

Access to Educational Opportunities 19 2.37 0.54 4.26

Domestic Violence 18 2.31 0.36 4.29

Lack of Access to Primary Care Physicians 18 2.29 0.46 4.14

Clean Water 12 1.51 0.35 2.68

Pollution 10 1.33 0.20 2.45

Rape/Sexual Assault 9 1.17 0.10 2.46

Elder Abuse 7 0.92 0.02 2.05

Child Abuse 7 0.93 0.10 1.87

School Suspensions of Expulsions 5 0.65 0.00 1.62

Animal/Pest Control 5 0.66 0.09 1.23

Other 34 4.35 1.34 7.36

None 30 3.70 0.92 6.47

Frequency Missing = 1

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11. In your opinion, which THREE (3) of the following services need the most improvement in your neighborhood or community?

Q11 Services In Need of Improvement:

Frequency Percent 95% Confidence Limits

Positive Teen Activities 74 9.28 5.39 13.17

Availability of Employment 62 7.82 4.15 11.48

Higher Paying Employment 59 7.55 4.03 11.06

Mental Health Services 57 7.36 3.92 10.79

Road Safety/Maintenance 51 6.49 3.48 9.50

Support to Help Me Manage My Health Conditions 46 5.90 2.91 8.90

More Affordable/Better Housing 45 5.72 2.53 8.90

Counseling/Mental Health/Support Groups 31 3.97 1.74 6.21

Services For Disabled People 29 3.66 1.37 5.94

None 29 3.81 1.46 6.40

No Response 29 3.57 1.12 6.14

Child Care Options 28 3.55 1.24 5.85

Better Law Enforcement 28 3.62 1.17 6.08

Better/More Recreational Facilities 27 3.42 1.10 5.75

Access to Assistance For Food 21 2.72 0.75 4.74

Animal/Pest Control 21 2.73 0.86 4.64

Emergency Preparedness and Response 21 2.72 0.75 4.70

Transportation Options 18 2.33 0.54 4.11

Better/More Healthy Food Choices 16 1.95 0.38 3.64

Healthy Family Activities 15 1.97 0.49 3.54

Other 15 2.01 0.41 3.75

Number of Health Care Providers 12 1.49 0.06 3.14

Culturally Sensitive Health Services 11 1.34 0.24 2.64

Clean Water 10 1.30 0.17 2.62

Gun Safety 9 1.17 0.02 2.48

More Affordable Health Services 8 1.01 0.02 2.22

Elder Care Options 7 0.88 0.00 2.01

Better Educational Opportunities 5 0.65 0.00 1.65

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12. In your opinion, which THREE (3) health behaviors do people in your own community need more information about?

Q12 Health Behaviors: 1

Frequency Percent 95% Confidence Limits

Eating Well/Nutrition 68 8.61 4.54 12.67

Child Care/Parenting 59 7.29 4.22 10.36

Stress Management 46 6.07 3.22 8.92

Exercising/Fitness 40 5.17 2.29 8.05

None 39 4.78 1.06 8.58

Crime Prevention 38 4.83 1.99 7.66

Caring For Family Members with Special Needs/Disabilities 37 4.56 2.09 7.02

Anger Management 37 4.68 2.12 7.24

Driving Safely 36 4.59 1.85 7.33

Safe Driving Skills/Behavior 35 4.44 1.74 7.14

Managing Weight 33 4.21 1.74 6.68

Going to the Doctor For Periodic Check-ups and Screening 28 3.54 1.07 6.00

Managing Chronic Conditions 26 3.32 1.36 5.28

Gun Safety Training 26 3.37 1.10 5.64

Substance Abuse Prevention 26 3.34 1.00 5.69

Domestic Violence Prevention 25 3.29 1.18 5.50

How to Prepare for an Emergency/Disaster 24 3.13 1.06 5.21

Quitting Smoking/Tobacco Use Prevention 21 2.63 0.71 4.55

Going to a Dentist For Check-ups/Preventative Care 20 2.52 0.62 4.43

Elder Care 20 2.48 0.70 4.31

Getting Flu Shots and Other Vaccines 19 2.49 0.43 4.60

Other 17 2.16 0.47 3.96

Preventing Unwanted Pregnancies 14 1.85 0.49 3.38

Suicide Prevention 12 1.57 0.28 2.98

Preventing Sexually Transmitted Diseases 9 1.16 0.02 2.46

Getting Prenatal Care During Pregnancy 8 1.03 0.01 2.42

Rape/Sexual Abuse Prevention 8 1.05 0.00 2.27

Using Child Safety Seats 7 0.86 0.00 1.97

Using Seat Belts 5 0.63 0.00 1.61

No Response 3 0.36 0.00 0.89

Frequency Missing = 1

13. Since this time last year, have you done any volunteer activities through or for an organization?

Q13 Any Volunteer Activity In Past Year

Frequency Percent 95% Confidence Limits

No 132 46.7560 38.7991 54.7128

Yes 148 52.8869 44.8488 60.9250

No Response 1 0.3571 0.0000 1.0795

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(If Yes), which types of organizations did you work with?

Q13B Which types of organizations did you work with?

Type of Organization Frequency Percent 95% Confidence Limits

School

Yes 28 9.9554 5.6682 14.2425

No 253 90.0446 85.7575 94.3318

Non-Profit

Yes 46 16.4137 11.5903 21.2371

No 235 83.5863 78.7629 88.4097

Civic

Yes 14 4.9107 2.0958 7.7257

No 267 95.0893 92.2743 97.9042

Health

Yes 18 6.4286 3.1650 9.6922

No 263 93.5714 90.3078 96.8350

Religious/Spiritual

Yes 61 21.9792 15.6072 28.3511

No 220 78.0208 71.6489 84.3928

Community

Yes 38 13.4375 8.5060 18.3689

No 243 86.5625 81.6311 91.4940

Sports

Yes 6 2.0982 0.4783 3.7181

No 275 97.9018 96.2819 99.5217

Other

Yes 16 5.7738 2.5162 9.0314

No 265 94.2262 90.9686 97.4838

PART 2: Health

14. In general, would you say that your health is…

Q14 Personal Health Rating

Frequency Percent 95% Confidence Limits

Excellent 72 25.6399 19.7717 31.5081

Good 157 55.7738 50.0974 61.4502

Fair 41 14.7024 9.7951 19.6097

Poor 11 3.8839 1.1653 6.6026

15. During the past 12 months, was there any time when you did not have any health insurance coverage? (This

includes private insurance purchased through work or individually, military health benefits (Tricare, VA, etc.), Medicare, Medicaid, or any other program that assists with providing health services at a reduced cost.)

Q15 Did Not Have Health Insurance In Past 12 Months

Frequency Percent 95% Confidence Limits

No 228 81.2798 73.5173 89.0422

Yes 51 18.0059 10.1359 25.8760

Don't Know 2 0.7143 0.0000 1.7227

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If you have health insurance, what is your primary health insurance plan? This is the plan which pays the medical bills first or pays most of the medical bills.

Q16 Primary Health Insurance Plan

Frequency Percent 95% Confidence Limits

The State Employee Health Plan 10 3.6440 1.3502 5.9377

Blue Cross and Blue Shield of North Carolina 94 33.5275 26.3421 40.7129

United Health care 27 9.6924 5.8968 13.4879

CIGNA 22 7.8405 4.4185 11.2625

Aetna 6 2.2103 0.5035 3.9171

Wellpath/Coventry 3 1.0753 0.0000 2.2980

Other Private Plan Purchased From Employer/Workplace 7 2.5090 0.7458 4.2721

Other Private Plan Purchased Directly From Insurance Company 3 1.0753 0.0000 2.2980

Medicare 41 14.5609 8.0523 21.0696

Medicare Supplement Plan 1 0.3584 0.0000 1.0833

Medicaid/Carolina ACCESS/Health Choice 55 13 4.6147 1.7922 7.4372

The Military, Tricare, CHAMPUS, or VA 6 2.1505 0.4934 3.8077

No Health Plan of Any Kind 42 14.9343 7.9333 21.9353

Other (Government Plan) 3 1.0902 0.0000 2.3392

Don't Know/Not Sure 2 0.7168 0.0000 1.7287

Frequency Missing = 1

16. Where do you go most often when you are sick? Q17 Where Goes When Sick

Frequency Percent 95% Confidence Limits

Doctor's Office 193 68.7054 60.3820 77.0287

Free/Low Cost Clinics 10 3.5714 0.5110 6.6319

Wake County Health Dept. Wake Health Services 4 1.3839 0.0369 2.7310

Hospital 19 6.7857 3.0571 10.5143

Emergency Room 18 6.2500 2.5196 9.9804

Open Door Clinic 1 0.3571 0.0000 1.0795

Pharmacy/Retail Minute Clinics 6 2.2619 0.1363 4.3875

Urgent Care 18 6.4435 3.1726 9.7143

Other 11 3.9286 1.6180 6.2392

No Response 1 0.3125 0.0000 0.9446

2013 Wake County Community Health Needs Assessment

Appendix F: Community Health Opinion Survey Results Page 242

17b. In which city or town is it [answer from Q17] located?

Q17B City Where Destination of Choice Located When Sick

Frequency Percent 95% Confidence Limits

Apex 2 0.6739 0.0000 1.6330

Carrboro 1 0.3594 0.0000 1.0862

Cary 39 13.9263 5.1239 22.7288

Chapel Hill 1 0.3145 0.0000 0.9545

Clayton 3 1.0782 0.0000 2.3040

Durham 8 2.8751 1.0152 4.7350

Fuquay-Varina 11 3.9084 0.0000 8.7859

Garner 2 0.7188 0.0000 2.1724

Holly Springs 3 1.0332 0.0000 2.6102

Knightdale 13 4.8518 0.4565 9.2470

Other 1 0.3594 0.0000 1.0862

Raleigh 177 63.3124 51.4889 75.1358

Refused/No Res 5 1.7969 0.2583 3.3356

Wake Forest 3 1.0782 0.0000 2.6865

Wendell 3 1.0782 0.0000 3.2587

Zebulon 1 0.4193 0.0000 1.2673

Frequency Missing = 2

17. About how long has it been since you last visited a doctor for a routine checkup? This does not include any

times you visited the doctor because you were sick, pregnant or for chronic disease.

Q18 How Long Since Last Visit To Doctor For Routine Checkup

Frequency Percent 95% Confidence Limits

Within Past Year 196 69.8363 64.0149 75.6578

1-2 Years Ago 50 17.6339 13.7623 21.5056

3-5 Years Ago 22 7.8720 4.6018 11.1422

More Than 5 Years Ago 9 3.2292 1.0243 5.4340

I have never had a routine checkup 2 0.7143 0.0000 1.7227

Don't Know/Not Sure 2 0.7143 0.0000 1.7227

18. In the past 12 months, did you ever have a problem getting the health care you needed? Please include any problems you had filling a prescription or getting mental, disability or dental care?

Q19 Problem Getting Needed Health Care in Past 12 Months

Frequency Percent 95% Confidence Limits

No 244 86.7708 81.7647 91.7770

Yes 37 13.2292 8.2230 18.2353

2013 Wake County Community Health Needs Assessment

Appendix F: Community Health Opinion Survey Results Page 243

19. Which of these problems did you have? I have a list of different type of problems that you may have encountered.

Q20 Problem Getting Health Care

Type of Problem Frequency Percent 95% Confidence Limits

No Insurance

Yes 19 6.7857 3.3562 10.2152

No 262 93.2143 89.7848 96.6438

No Transportation

Yes 1 0.3571 0.0000 1.0795

No 280 99.6429 98.9205 100.000

No Separate Dental

Yes 5 1.7857 0.2555 3.3160

No 276 98.2143 96.6840 99.7445

No Child Care

Yes 1 0.3571 0.0000 1.0795

No 280 99.6429 98.9205 100.000

Insurance Did Not Cover needed

Yes 3 1.0714 0.0000 2.2901

No 278 98.9286 97.7099 100.000

Did not Know Where to Go

Yes 5 1.8452 0.2602 3.4302

No 276 98.1548 96.5698 99.7398

Could Not Afford out-of-pocket cost

Yes 12 4.2411 2.1410 6.3412

No 269 95.7589 93.6588 97.8590

Can Afford, but I don’t Want to Pay Cost

Yes 1 0.3571 0.0000 1.0795

No 280 99.6429 98.9205 100.000

Could not Get Appointment

Yes 10 3.5714 1.3165 5.8263

No 271 96.4286 94.1737 98.6835

Language barrier

Yes 0 0 0.0000 0.000

No 281 100.000 100.000 100.000

Insurance not Accepted

Yes 2 0.7143 0.0000 1.7227

No 279 99.2857 98.2773 100.000

Problems with Medicare D

Yes 1 0.3571 0.0000 1.0795

No 280 99.6429 98.9205 100.000