Community Assessment’s author shares insights from new report

Providing ‘better understanding of disparities’ is helpful to agencies involved, community

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The newest edition of the Chatham County Community Assessment has been published. This collaborative effort between the Chatham Health Alliance, the Chatham County Public Health Department (CCPHD), and Chatham Hospital was assembled with the help of a large group of people, but the assessment’s primary author is Maia Fulton-Black. This week, we speak with her about the assessment and how it will be used.

Fulton-Black is the population health data scientist at the Chatham County Public Health Department, where she has worked for almost two years. She was named CCPHD Employee of the Year for her efforts on the 2021 Chatham County Community Assessment and response to the COVID-19 pandemic.

A Vermont native, she holds a Master of Public Health degree in epidemiology/biostatistics from Tufts University. She has previously worked for the New York City Department of Health and Mental Hygiene and the Harvard T.H. Chan School of Public Health, focusing on public health data, health equity, program evaluation and survey methodology.

You’re listed as the editor of the Community Assessment, so let’s start with a high-level view: why is this assessment (done every three years) so vital, and why is the information it contains important?

The Chatham County Community Assessment process is a unique opportunity to not only gather timely, nuanced local data on topics not available through any other sources, but also serves as a point of collaboration between many community-focused partners and community members themselves throughout the county.

Crucially, this assessment takes a wide view on the idea of “health,” diving into many aspects of well-being, from “nuts and bolts” things like eating fruits and vegetables to mental health, housing and food security, experiences with discrimination, and access to child care. This information helps us understand what issues are affecting Chatham community members, where there are areas of inequity and need for resources, and how those things are changing over time. Many organizations, including the three major partners (Chatham Health Alliance, Chatham Hospital, and the Chatham County Public Health Department) use the assessment to inform how to best serve the community in the future.

As you put together the assessment and worked through the data, can you talk about one or two surprises — one or two findings that were particularly unexpected?

The sharp increase in unintentional overdose deaths in the past several years, culminating in Chatham County’s rate exceeding the overall state rate for the first time in 2021, was a notable finding in this year’s assessment. Of course, this is a much larger-scale issue, but it really hits home to see our local numbers reach new highs and only highlights the important work that many community members and organizations are doing together to both increase access to support services and reduce harms from substance use, misuse and abuse.

Another interesting finding that I would love to explore more was that 16% of adults in Chatham County (and more than 25% of Hispanic/Latinx adults) said that having no sidewalks where they needed to walk was a barrier to their everyday transportation.

What data/results were you and others most troubled by or concerned about?

The breadth and depth of the impact of systemic racism and other forms of marginalization across all areas of health explored in this assessment are troubling to see. For example, Black/African American and Hispanic/Latinx residents were nearly four times as likely to experience poverty in 2020 compared to the overall county average, which in turn impacts housing, access to healthcare, food security and so much more. This finding underscores the importance of a continued commitment to equity from CCPHD and our partners.

Additionally, the increase in poor mental health indicators, such as stress, depression and anxiety, in both youth and adults is concerning. This trend unfortunately mirrors what we are seeing in mental health metrics at the state and national levels as well. Based on these findings, mental health was selected, alongside substance use, as a priority area for strategic planning for the next three years by the Chatham Health Alliance.

What’s the methodology you and others working on aspects of this assessment use to follow-up? And what are the key steps and milestones in that process?

We use a cohort approach where households are randomly selected to reflect the adult population of Chatham County. Those who consent to join the cohort are invited to participate in annual surveys, as they have done each year since 2018. We try to contact those selected through as many avenues as possible in order to give everyone a chance to participate, including via mail, email and phone calls.

In this cycle, we sought to expand the cohort in order to be able to break down the data by demographic groups, such as age, race/ethnicity, gender, etc. This was a major milestone for the cohort survey, offering a better understanding of disparities among different populations in Chatham that can be obscured by overall outcomes for the county.

One of the key findings addressed in the assessment was worsening mental health indicators. How much impact can local strategies have on that particular problem?

Mental health, along with substance use, was selected as a priority area for the next three years by the Chatham Health Alliance. It is important to recognize that mental health is deeply intertwined with many other aspects of health and well-being explored in the assessment. As our results show, stress, anxiety and depression are often related to money and employment, concern over personal and family health issues, experiences with discrimination, and more. Therefore, collaboration on this issue is key to making positive changes and the collective impact of many working around these common priorities has great potential to move the needle and positively impact the community.

How will the stakeholders and agencies involved collaborate to address issues raised in the assessment?

The Chatham Health Alliance is currently convening its subcommittees (Equity; Access to Comprehensive Health Services; Economic Stability and Resilience; and Healthy Eating, Active Living) to develop strategic plans, also known as Community Health Improvement Plans, around priority issues raised in the assessment. The Alliance is a great place for community members and organizations interested in organizing around local health issues to convene and work together.

We are also working to make the results of the assessment available to everyone who is interested through a variety of avenues including sharing infographics on our Facebook page and taking a closer look at some issues with our topical fact sheets (including gun violence and safety, illicit substance and prescription drug abuse and more to come). We hope that this will encourage local organizations and community members to learn more about health in Chatham County and get involved in the issues they are passionate about.

To read the full Community Assessment, go to https://www.chathamcountync.gov/home/showpublisheddocum-
ent/60-843/637922593587487258.

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