Health Alliance, CCPHD & Chatham Hospital prep for new study


Anyone who’s taken a deep dive into Chatham’s 2018 Community Assessment report knows it as a treasure trove of information about the heart and health of Chatham County and its people.

Now, organizers of the “CA,” as they term it, are readying for a new assessment — and like just about everything else, COVID-19 is leaving its mark.

“We know that the pandemic has had enormous and far-reaching impacts on the lives of community members,” says Julie Wilkerson, the executive director of the Chatham Health Alliance, which collaborates with the Chatham County Public Health Department and Chatham Hospital on the project. “That’s why it is especially important for us to do this assessment now to have a better understanding of the impact the last three years have had on community well-being.”

It’s been three years since that last community health assessment survey and report, required for public health department accreditation and for all nonprofit hospitals in North Carolina.

That previous Community Assessment — a 266-page document with more than 100 pages of findings, supplemented by another 140 pages of references, appendices and colorful charts and infographics — was created from information collected in Chatham County during the spring of 2018. The data, drawn from specially created local surveys and research, was analyzed that summer and the report drafted over the winter months. After final refining by the Health Alliance and the county’s board of health, the final product was delivered to the N.C. Dept. of Public Health in March 2019 and to the community shortly thereafter.

Data and findings in the CA report examined life expectancy and the leading causes of death in Chatham County. The report looked at the state of “bare necessities” here — such as affordable housing, homelessness and food insecurity — and issues related to behavioral health, including ACEs (adverse childhood experiences), chronic disease, community cohesion, economic growth, the environment, health care and personal development. It wraps up with sections on safety, sexual health and substance abuse, addressing topics such as elder welfare, emergency preparedness, violent crime, prenatal care and tobacco use.

A warehouse of information

In addition to being a portable warehouse of important information about Chatham and its people, the CA is used to address the top issues identified as adversely affecting the health of county residents, plus to develop a prioritized list of issues that need to be addressed to improve the quality of life here.

In 2018, those “top health impact priorities” in Chatham County were access to comprehensive health services, poverty and obesity and physical inactivity.

“It’s a comprehensive, collaborative process that gathers information about health and well-being of residents in order to understand the needs, challenges, strengths and opportunities that exist in the Chatham community,” said Maia Fulton-Black, the Chatham County Public Health Department’s population health data scientist. “It allows us to monitor changes over time, identify and address disparities within the community, and develop and implement appropriate interventions to address community needs.”

Wilkerson said her organization and other community members use the CA data to prioritize the focus areas and work of the Alliance, and to apply for funding that can be used for responses to community needs.

While Chatham Hospital and the CCPHD may be more well known, the Health Alliance describes itself as a “collaborative of local professionals and community members” working together to improve health and well-being in Chatham County. Wilkerson and her staff define the vision of the CA as “the core resource of high-quality data for improved understanding of the needs, perceptions and experiences of Chatham residents, enabling focused, collective efforts toward improving community health and well-being.”

And Fulton-Black called the CA “an iterative process,” allowing for continuous evaluation and improvement — meaning that, among other things, an already-established group of survey participants could provide information about the impact of the COVID-19 pandemic as it unfolded.

Its main purpose, though, are the report’s “takeaways” — outcomes identified as prioritized areas of need in the county. In addition to access to health services, obesity and poverty, other top areas of need listed in the 2018 CA were healthy eating and water quality. The main hindrances to quality of life were listed as low income/poverty, recreational programs for youth, pollution, illicit drug use and lack of transportation.

‘Nuts and bolts questions’

The 2021 Community Assessment will be the first chance to look at what, if anything, has changed since 2018.

“The survey will ask questions on a wide variety of topics related to health and well-being, from nuts and bolts questions on fruit and vegetable consumption to questions aimed at understanding social drivers of health, social connectedness, and barriers to reaching optimal health,” Fulton-Black said. “This is a unique opportunity to ask those questions that we can’t find out anywhere else.”

She said households asked to participate in the survey are randomly selected by census block, resulting in a cohort of survey respondents that are statistically representative of Chatham County.

“This time around,” she said, “we are seeking to increase representation from marginalized communities by adding new members to the cohort so that we can disaggregate the data in order to better identify and understand disparities in the county.”

Over the last three years, Wilkerson said the Alliance subcommittees — action teams made up of Alliance members, agency and community members — have worked on identified strategies for key takeaways.

“Some notable successes are the building of a trail at a school in Siler City, working with the Pittsboro Farmer’s market on bringing SNAP/EBT (federal assistance programs that provide food-purchasing assistance for low- and no-income people) to the market, and developing and implementing the mobile co-location of resources — the Community Resource Hub — which has held over 30 events in 2021 all over the county,” she said.

The pandemic caused some strategies developed from the 2018 report to be paused or amended. For example, the goal of developing a living wage policy for Chatham changed to helping employers navigate COVID protocols and employee benefits over the pandemic.

And COVID will also impact the data gathering process for the 2021 report, set to kick off soon.

“Usually, a large portion of the responses are collected via door-to-door surveying, where volunteers go out in teams and knock on doors in person,” Fulton-Black said. “Unfortunately, due to the rise in cases caused by the Delta variant, we are not able to undertake that this year.”

The state Institute of Public Health worked with the Alliance to expand data collection methods through other means, she said, including by mail, telephone and email.

“That will mean approximately 1,300 additional households from the previously selected census blocks will be added to the sample this year,” she said. “This expansion seeks to account for reduced rate of participation without door-to-door surveying in order to reach our minimum number of responses needed for robust and reliable data analysis while maintaining the integrity of our established protocol.”

On the bright side, Fulton-Black said, that will potentially provide the opportunity for more people to participate and will give data collection teams more information to inform our methodology in future assessments.

It’s important work, Wilkerson says.

“It helps us understand the experiences of our neighbors,” she said.