Community Needs Health Assessment 2021

10 JOHNST ON COUNTY , NORTH CAROLINAPageContact Information An electronic copy of this report is available on HealthENCorg This report will be available at johnstonnccom health and johnstonhealthorg Paper copies will be distributed to the Public Library of Johnston County and Smithfield and a copy can be obtained by contacting The Health Education Department at the Johnston County Public Health Department , at 919 - 989 - 5200 or health_dept @ johnstonnccom PageTable of Contents Contact Information 2 Executive Summary 5 Vision Statement 5 Leadership 5 Partnerships Collaborations 6 Th eoretical Framework Model 6 Collaborative Process Summary 7 Key Findings 8 Health Priorities 8 Next Steps 8 Chapter 1 Introduction 9 Description of County 9 Overview of Health ENC 9 Overvi ew of Community Health Needs Assessment Process 9 Participating Health ENC Counties 10 Health Data Sources 10 Primary Data – Community Survey 10 Secondary Data Sources 11 Health y North Carolina 2030 HNC 2030 – Secondary Data Points 11 NC State Center for Health Statistics – Secondary Data Points 11 Robert Wood Johnson County Health Rankings and Roadmaps – Secondary Data Points 11 Limitations 12 Chapter 2 Demogr aphic Profile 13 Total Population 13 Minority Populations 13 Population Growth 14 Age Groups 14 Military Veteran Populations 15 Military Population 15 Veteran Population 15 Birth Rates 16 Analysis of Demo graphic Data 16PageChapter 3 Socioeconomic Profile 17 NC Department of Commerce Tier Designation 17 Income 18 Poverty 18 Poverty by Race and Ethnicity 19 Children in Poverty 19 Older Ad ults in Poverty 20 Disabled People in Poverty 20 Housing 20 Median Monthly Housing Costs 20 Median Monthly Household Costs in Johnston County and Surrounding Counties 21 Severe Housing Problems 21 Food Insecurity 22 Households with SNAP Benefits 22 Education 22 Educational Attain ment 22 High School Drop Out Rate 23 High School Suspension Rate 23 Transportation 24 Crime and Safety 24 Juvenile Crime 25 Child Abuse 26 Incarceration 26 Civic Politica l Engagement 27 Analysis of Socioeconomic Profile 27 Chapter 4 Clinical Care Profile 28 Health Insurance Coverage 28 Go vernment Health Insurance Only Coverage – Medicaid , Medicare , Tricare 28 Primary Care Practitioners 29 Analysis of Clinical Care Profile 30 Chapter 5 Chronic and Communicable Disease Profile 31 Leading Causes of Death 31 Leading Causes of Injury Death 32PagePage pageNumber5Leading Causes of Hospitalizations 32 Leading Causes of Emergency Department Visits 32 Top Ten Reportable Communicable Diseases 33 Analysis of Chronic and Communicable Disease Profile 33 Chapter 6 HNC 2030 Indicator Rankings by Health ENC Regions 35 Chapter 7 County Health Ranking Indicators 36 Population Health Model 36 Chapter 8 Survey Findings 37 Chapter 9 Inventory of Resources 39 CHNA References 41 CHNA Appendi ces 43 Appendix A Community Survey Instrument 43 Appendix B HNC 2030 Profile of County 97 Appendix C Supplemental Data … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … 97 Appendix D Community Resou rce Guide … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … 121 Appendix E Behavioral Health Resour ces … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … … 195PagePage pageNumber6Executive Summary Johnston County is pleased to present the 2022 Community Health Needs Assessment CHNA The CHNA reviews health indicators , gathers community survey results , sets health priorities , and develops action plans to address priority areas This report provides an overview of the methods and process used to identify and prioritize significant health needs in Johnston County Vision S tatement It is with great diligence that Johnston County and its health affiliates present the newest rendition of the Community Health Needs Assessment CHNA 2022 We stron gly believe that this report and its proposed initiatives will foster a path from which to provide Johnston County residents with services tailored to our communities ’ most pressing health needs Through the collaborative efforts of Johnston Health , Johnst on County Public Health Department and partners , it is our hope that the information reflected in this report will be utilized to reduce the socioeconomic health burden within Johnston County Moreover , we hope to b olster the scope and reach of our communi ty outreach endeavors to better aid our underserved residents through efforts encompassing health education , accessibility , affordability , and public services Leadership The Johnston County CHNA 2022 was collated , evaluated , and established following a bi - sectoral leadership model through UNC Johnston Health and the Johnston County Public Health Department Contributing leaders , their names , organization , and titles are as follows • April Culver , JH , VP Marketing , Communications , and Strategy • Kimetha Fulwood , JCPHD , Health Education Supervisor • Leah Joh nson , JH , Corporate and Community Outreach Coordinator • Marilyn Pearson , MD , JCPHD , Health Director In this report , the aforementioned Johnston County leaders and collaborative partners detail a meaningful evaluation of the predominant health needs across Johnston County to guide planning efforts that will be utilized to address current community necessities Special attention has been given to the needs of vulnerable populations , unmet health needs or gaps in services , with additional input gathered from current Johnston County residents This report will be used to identify and develop actionable ventures from which to provide and connect community members with resources to improve the health challenges intrinsic to their respective regions The 2022 CHNA was developed through a partnership between Johnston Health , the Johnston County Public Healt h Department , and Health ENC PagePage pageNumber7Partnerships Collaborations Partner Type 1 Brody School of Medicine Additional Partnership 2 Duke Endowment Additional Partnership 3 Foundation Health Leadership and Innovation LHI Additional Partnership 4 Health ENC Additional Partnership 5 Johnston County Public Health Department Collaborating Partnership 6 Johnston Health Collaborating Partnership T heoretical F ramework M odel The methods that were utilized to ascertain , and subsequently prioritize , the evolving health needs of Johnston County residents are detai led in Chapter 1 of this report A synopsis of the data collection methods is as follows Following the retrospective analysis of aggregate data from state and national bureaus , significant community health needs were selected and stratified to objectively serve as viable endpoints from which to guide plausible health improvement interventions in Johnston County Data stratification in this report is firstly delineated through grouping based on data source ; ie , designated primary and secondary datasets originating from resident surveys and university government institutions , respectively Subsequently , community variables directly or indirectly associated with barriers to health were extrapolated from the collated datasets and prioritized as a function of our current regional needs and available resources PagePage pageNumber8The 2022 Community Health Needs Assessment data sets were sourced from the following institutions CHNA 2022 Collated Data Sources Primary Secondary Johnston County Community Survey Collection period April – June , 2021 N 450 regional representative random sample Health ENC Report Office of Health Access in the Brody School of Medicine at East Carolina University NC Department of Health & Human Services US Census Bureau , American Community Survey East Carolina University Departmen t of Public Health NCEDSS - Communicable Disease Data County Health Rankings Behavioral Risk Factor Surveillance System BRFSS The aforementioned prioritization process will enable Johnston County and its institutional partnerships to objectively address and maximize collaborative efforts to ameliorate community health needs within the construct of the various action plans proposed in this report Collaborative P rocess S ummary Health ENC partners began collaborating on the structure of the 2021 - 2022 CHN primary data survey in October 2020 & fi nalized the survey in March 2021 Community input was solicited throughout April & May Primary data was analyzed and secondary data compiled by the Brody School of Medicine and delive red in September of 202 1 The JCPHD & Johnston Health then hosted various CHN prioritization - setting discussions with key stakeholders during November 2021 , after which a survey was disseminated to all key stakeholders In January 2022 , the JCPHD & Johnsto n Health held a CHN Priority Discussion in which they analyzed the findings of our priority - setting survey and unanimously finalized the 2021 - 2022 CHN health priorities for Johnston County Completion of the CHNA began forthwith and was finalized on April 2022 PagePage pageNumber9Key F indings Health P riorities Johnston County has selected the following as the health priorities 1 Access to Care 2 Substance Use Disorders 3 Transportation Next S teps The next step in the CHNA process is to develop Community Health Improvement Plans CHIPs These plans will include detailed strategies and action plans to address Johnston County’s three identified health priorities of Access to Care , Substance Use Disorders and Transportation The Leadership Team will engage variou s community partners and community members to determine the best way to address the priorities The process includes reviewing community assets , reviewing the drivers of community health and selecting a type of strategy The team will use Results Based A ccountability framework to report CHIPs Community progress on the CHIPs will be reported for the next two years , then another CHNA will be created Page0Chapter 1 Introduction Description of County Johnston County was established in 1746 and is the 11th largest county in the state Johnston County Public Health Department is located in Smithfield , the county seat Johnston Health , the county hospital system , has campuses located in Smithfield and Clayton that provide outpatient , inpatient , and em ergenc y services Three major highways , I - 95 , I - 40 , and highway 70 , run through the county which has 11 townships and an estimated population of 209,339 US Census Bureau 2019 The majority of the population is White 772 - not Hispanic or Latino , wit h 16 Black , 27 two or more races , and 136 Hispanic or Latino Persons under 18 make up the largest percentage of the population 252 , the percent of those over 65 is 13 US Census Bureau 2019 Retail , manufacturing , agritourism , healthcare , and educational services are the main industries The top five employers are Johnston County Schools , Johnston Health , Grifols Therapeutics , Johnston County Government , and Asplundh Tree Expert Company John ston County is one of the fastest growing counties in the state and is projected to have the highest percentage growth over the next ten years This growth has and is leading to county - wide challenges to human service agencies , access to care , schools , and connecting those in rural areas to the more centralized resources Overview of Health ENC Health ENC is a collaborative initiative of health departments and hospitals in eastern North Carolina The collaborative serves 35 counties with 34 participating he alth departments and 31 participating hospitals The collaborative uses a shared approach for primary and secondary data collection to produce a comprehensive Regional Community Health Needs Assessment every three years that can be used to partially satisf y requirements for North Carolina Local Health Department Accreditation and the Internal Revenue Service requirement under the Patient Protection and Affordable Care Act for charitable hospitals Overview of Community Health Needs Asse ssment Process The Community Health Needs Assessment Process gathers population health data that county health departments , hospitals , and community groups can use to • Identify key health needs issues in eastern North Carolina Communities • Develop strategies and action pl ans based upon data aim to improve the quality of life • Collaborate to m aximize results by having a collective impact in the region • Maintain local control and decision - making about the choice of health priorities and in terventions , and • Improve health , par tnerships and communication Page1Participating Health ENC Counties Health ENC serves the following counties Beaufort , Bertie , Bladen , Camden , Carteret , Chowan , Craven , Cumberland , Currituck , Dare , Duplin , Edgecombe , Franklin , Gates , Greene , Halifax , Hertford , Hoke , Hyde , Johnston , Jones , Lenoir , Martin , Nash , Northampton , Onslow , Pamlico , Pasquotank , Pender , Perquimans , Pitt , Sampson , Tyrrell , Washington , and Wayne Counties Health Data Sources Primary Data – Community Survey Survey Methodology Design Health ENC Steering Committee structured the primary data collection for participating health departments and hospitals The primary data used in the Community Health Needs Assessment s include d 1 a community survey that could be distributed online or by a paper submission and 2 focus group discussions in some counties The Health ENC Steering Committee did not encourage focus groups for the 2021 - 2022 Community Health Needs Assessments because of the global COVID - 19 pandemic However , some counties we re able to hold focus group discussions safely despite significant challenges in collecting enough survey responses to accurately represent their community’s population Survey Design The Health ENC Steering Committee developed a primary survey to gather information from community members about their health concerns A workgroup of Steering Committee members convened and examined survey questions utilized in the 2018 - 2019 Community Health Needs Assessment The workgroup also examined data readily availab le from secondary data sources The workgroup focused on developing survey questions to obtain data from community members which was not readily available in the secondary data or where secondary data was weak In addition , workgroup members worked to co mbine questions where appropriate and to be more inclusive in the wording of response choices The Steering CommitteePage2reviewed the sample survey questions and made a few additional revisions to assure the survey only contained questions where community in put was needed to guide health priority selection and strategic action planning Once the survey questions were finalized , the Steering Committee decided on targets for each county Because the survey was a convenience sample that was being conducted duri ng a global pandemic COVID - 19 , each county was asked to complete a minimum of 300 surveys with representation from as many community groups as possible to assure sufficient sampling to represent the full community The target of 300 surveys per county w as identified through previous work with data analysis vendors who examined each county’s population and confirmed this number should provide an accurate reflection of the total county’s population if responses reflected the population demographics equally The surveys were made available to the public from April 1 – June 30 , 2021 Surveys were made available in paper format and electronically using the REDcap software Health ENC partners received feedback throughout the survey period on the age , gende r , race ethnicity , and language of survey respondents to assist them in promoting the surveys to various community members within their counties At the completion of the survey period , 16,661 English surveys and 502 Spanish surveys were completed Most counties did not have an equally distributed response to surveys to represent their entire county’s population As a result , survey responses should be considered as only one component of information utilized to select health priorities The most underse rved populations ’ feedback is not adequately reflected in most surveys Health ENC partners were encouraged to include key stakeholders , who served these populations , in the health priority selection process to assure many of their clients ’ health needs w ere considered There were 25 questions on the Johnston County survey The survey was distributed online and on paper Key Areas Examined • Quality of life , health behaviors , health perceptions • Preventative services , exercise , and access to care Johnston County Responses • 415 Total English Total in ENC survey 16,661 • 35 Total Spanish Total in ENC survey 502 Secondary Data Sources Healthy North Carolina 2030 HNC 2030 – Secondary Data Points NC Sta te Center for Health Statistics – Secondary Data Points Robert Wood Johnson County Health Rankings and Roadmaps – Secondary Data Points Cecil G Sheps , Center for Health Services Research , UNC – Secondary Data Points US Census Bureau ACS 5 - year Estimate – Secondary Data Points Health ENC Report – Primary Data Questions – Quality of Life , Behavior NC Office of State Mgm t & Budgget Pop Projections and US Census – Secondary Data Points NC Dept of Public Instruction – Secondary Data Points NC Dept of Commerce – Secondary Data Points NC State Bureau of Investigations , uniform crime report – Secondary Data PointsPage3NC Dept of Public Safety – Secondary Data Points Annie E Casey Foundation Kids Count Data Center – Secondary Data Points Limitations • The data presented repres ents a snapshot of the population , economic and leading health and wellness issues in eastern NC communities • It includes primary data gathered from community surveys and secondary data from health and other sources • This information can be used as a guide for helping communities identify leading health issues in the Health ENC County Region • Other health issues , data and resources may be available that were not listed here that communities may wish to consider when establishing health priorities Page4Chapt er 2 Demographic Profile Total Population • In 2019 , Johnston County had a population estimate of 209,339 190,843 196,374 202,692 209,339 180,000 185,000 190,000 195,000 200,000 205,000 210,000 215,000 2016 2017 2018 2019 Figure 1a Total Population USCensus Minority Populations The White population accounts for 772 of the total population in Johnston County , with the Black or African American population accounting for 160 of the total population The White population in Johnston County 772 is more than the White populatio n in North Carolina 687 and the Health ENC counties 649 The Black or African American population in Johnston County 160 is less than the Black or African American population in North Carolina 214 and the Health ENC counties 300 The Hi spanic or Latino population comprises 136 of Johnston County which is significantly higher than North Carolina 94 and Health ENC Counties 96 772 160 07 06 - 27 136 687 214 12 29 01 27 94 649 300 10 13 01 35 96 - 100 200 300 400 500 600 700 800 900 White Black Am Indian or Alaska Native Asian Native Hawaiian & Other Pacific Islander Multiracial Two or More Races Hispanic or Latino Percent of Population by Race Ethnicity Census , 2015 - 2019 Johnston North Carolina Health ENC CountiesPage5Population Growth • The projected population growth for Johnston County for 2029 is estimated at 259 , 553 persons • From 2010 to 2019 , the total population of Johnston County has increased by an overall 24 Note Population projection for 2029 comes from the NC Office of State Mgmt and Budget Pop Projections All the other population data is from the Census 168,878 190,843 196,374 202,692 209,339 259,553 - 50,000 100,000 150,000 200,000 250,000 300,000 Figure 1b Population and Projected Population for 2029 Age Groups Johnston NC HealthENC Overall , Johnston County residents have slightly more children & adolescents 0 - 14 and middle - aged residents 35 - 54 than residents of North Carolina and the Health ENC region The 45 - 54 age group contains the highest percent of the popu lation at 151 , while the 5 - 14 age group contains the next highest percent of the population at 148 , followed by the 35 - 44 age group at 141 Upper middle aged & senior aged population 55 + is lower than the rest of the state of NC and the ENC countie s Page6Military Veteran Populations Military Population • The percentage of Military Population in Johnston County is 01 • Compared to the counties in Health ENC 48 and North Carolina 11 , Johnston County has a smaller population • Percent of Military Veteran population as a whole decreasing across Johnston County , NC , and ENC counties when compared to 2019 statistics • • 01 11 48 - 10 20 30 40 50 60 Johnston North Carolina Health ENC Counties Percent of Population in Military 2015 - 2019 Veteran Population The veteran population is given as a percent of the civilian population aged 18 years an d older and this data is used for policy analyses , to develop programs , and to create budgets for veteran programs and facilities Johnston County has a veteran population of 93 in 2015 - 2019 , compared to 84 for North Carolina and 121 for Health ENC c ounties 93 84 121 - 20 40 60 80 100 120 140 Johnston North Carolina Health ENC Counties Percent of Population that are Veterans 2015 - 2019 Page7Birth Rates Birth rates are important measures of population health The birth rate is usually the dominant factor in determining the rate of population growth ; however , population growth is also driven by the age structure of the populati on eg , deaths , immigration and emigration The Johnston County birth rate demonstrated an overall decrease over the period presented below , with a similar trend seen in the Region and the state Johnston County’s decreasing trend is to a lesser degree due to a rebound increase in birth rate year over year from 2018 - 2019 122 118 113 120 119 117 115 113 131 131 127 127 100 105 110 115 120 125 130 135 2016 2017 2018 2019 Live Birth Rate per 1000 Population NC SCHS Johnston NC HEALTHENC Analysis of Demographic Data Johnston County’s population by race is majority white 772 followed by similar numbers of black 16 and Hispanic 136 The county continues a steady rise in population based on a 2019 total population of 209,339 and a projected increase to 259 , 553 in 2029 During the time period represented approximately 2015 - 2019 , Johnston County has a 10 percent population of veterans as oppose d to less than 1 percent of its population serving in the military Birth rates have slowly trended down during this period meeting with a quick rebound in births during 2018 - 2019 Birth rate is often seen as an indicator of population health and growth Page8Chapter 3 Socioeconomic Profile NC Department of Commerce Tier Designation The North Carolina Department of Commerce annually ranks the state’s 100 counties based on economic well - being and assigns each a Tier designation The 40 most distressed c ounties are designated as Tier 1 , the next 40 as Tier 2 and the 20 least distressed as Tier 3 Johnston County has been assigned a Tier 3 designation for 2021 Johnston County has been assigned a Tier 3 designation for 2021 County Tiers are calculated usin g four factors • Average unemployment rate • Median household income • Percentage growth in population • Adjusted property tax base per capitaPage9Income Federal poverty thresholds are set every year by the Census Bureau and vary by size of family and ages of family members A high poverty rate is both a cause and a consequence of poor economic conditions Children in poverty are more likely to have physical health problems , behavioral problems and emotional problems Seniors who live in poverty are an especial ly vulnerable group due to increased physical limitations , medical needs , and social isolation Persons with a disability are more likely to live in poverty compared to the rest of the population Without adequate income , individuals with disabilities may not be able to afford necessary expenses , such as rent or mortgage , utility bills , medical and dental care , and food • In Johnston County an estimated 130 of the population lives below the poverty level , compared to 150 of the population in NC and 175 for the Health ENC region Median household income reflects the relative affluence and prosperity of an area Areas with higher median household incomes are likely to have a greater share of educated residents and lower unemployment rates Figure 14 sh ows the median househo ld income in Johnston County 59,865 , wh ich is slightly higher than the median household income in North Carolina 54,602 The average median household income increased at a 2 higher clip than the state of North Carolina since 20 19 Compared to counties in the Health ENC region Johnston County has a very high median household income In the region , 32 counties have a lower median household income than Johnston County 59,865 54,602 51,000 52,000 53,000 54,000 55,000 56,000 57,000 58,000 59,000 60,000 61,000 Johnston North Carolina Median Household Income in Dollars 2015 - 2019 Poverty 13 15 175 - 2 4 6 8 10 12 14 16 18 20 Johnston North Carolina Health ENC Counties Percent People Living Below Poverty Level 2015 - 2019 Page0Poverty by Race and Ethnicity Source US Censu s Bureau ACS 5 - year Estimate https datausaio profile geo johnston - county - nc # economy The most common racial or ethnic group living below the poverty line in Johnston County , NC is White , followed by Hispanic and Black The Census Bureau uses a set of money income thresholds that vary by family size and composition to determine who classifies as impoverished If a familys total income is less than the familys threshold than that family and every individual in it is considered to be living in poverty Data from the Census Bureau ACS 5 - year Estimate Children in Poverty The rate of both children and older adults below the poverty level is slightly lower for Johnston County when compared with NC and the Health ENC Counties 19 21 255 - 5 10 15 20 25 30 Johnston North Carolina Health ENC Counties Percent Children Living Below Poverty Level 2015 - 2019 Page1Older Adults in Poverty • The rate of adults age 65 + years living in poverty is 13 lower in Johnston County when compared with NC and the Health ENC counties by 25 78 91 103 - 20 40 60 80 100 120 Johnston North Carolina Health ENC Counties Percent Adults 65 + Living Below Poverty Level 2015 - 2019 Disabled People in Poverty The percent of disabled people living in poverty in Johnston County 19 is slightly lower than the rate for North Carolina 20 19 20 18 18 19 19 20 20 21 Johnston North Carolina Percent Persons with Disability Living Below Poverty Level 2015 - 2019 Housing The average household size in Johnston County is 282 people per household owners and 286 people per household renters , which is slightly higher than the North Carolina valu e of 257 people per household owners and for renters 243 people per household High costs of homeownership with a mortgage can strain both homeowners and the local housing market This figure shows mortgaged owners median monthly household costs in the Health ENC region In Johnston County , the median housing costs for homeowners with a mortgage is 1,277 This is slightly lower than the North Carolina value of 1,314 , and is lower than 8 counties in the Health ENC region Gross housing costs have i ncreased across the board since 2019 Median Monthly Housing Costs 1,277 1,314 1,250 1,260 1,270 1,280 1,290 1,300 1,310 1,320 Johnston North Carolina Median Monthly Housing Costs for Owners with a Mortgage in Dollars ACS 2015 - 2019 Page2Median Monthly Household Costs in Johnston County and Surrounding Counties Severe Housing Problems • Safe and affordable housing is an essential component of healthy communities , and the effects of housing problems are widespread • Housing problems include overcrowding , high housing costs , lack of kitchen , or lack of plumbing facilities • Slightly more than 130 of households in Johnston County have severe housing problems , compared to 150 in North Carolina and 161 in Health ENC Counties 13 15 161 - 5 10 15 20 Johnston North Carolina Health ENC Counties Percent with Severe Housing Problems County Health Rankings 2013 - 2017 Page3Food Insecurity Households with SNAP Benefits The Supplemental Nutrition Assistance Program SNAP is a federal assistance program that provides low - income families with electronic benefit transfers EBTs that can be used to purchase food The goal of the program is to increase food security and redu ce hunger by increasing access to nutritious food • The percent of households with SNAP ben efits in Johnston County is 13 , which is the same as the state value of 13 and 37 lower than the Health ENC County region 13 13 167 - 2 4 6 8 10 12 14 16 18 Johnston North Carolina Health ENC Counties Percent of Households with SNAP Benefits in the Last 12 Months ACS 2015 - 2019 Education Educational Attainment Graduating from high school is an important personal achievement and is essential for an individual’s social and economic advancement Graduation rates can also be an important indicator of the performance of an educational system Having a bachelor’s d egree opens up career opportunities in a variety of fields and is often a prerequisite for higher - paying jobs • In Johnston County , the percent of residents 25 or older with a high school degree or higher was lower 869 than the state value 878 but s lightly higher the Health ENC region 866 • Percent with a higher education attainment in Johnston County was lower 22 9 compared to NC 313 but higher than the Health ENC region 220 • Both levels of education were attained to a higher degree in Johnston County , North Carolina , and ENC counties since 2019 869 229 878 313 866 220 - 100 200 300 400 500 600 700 800 900 1000 With a High School Degree or Higher With a Bachelors Degree or Higher Percent of People 25 + with High School or Higher and Bachelors Degree or Higher ACS 2015 - 2019 Johnston North Carolina Health ENC CountiesPage4High School Drop Out Rate High school dropouts earn less income than high school and college graduates , and are more likely to be unemployed High school dropouts are generally less heal thy and require more medical care Further , high school dropout rates are linked with heightened criminal activity and incarceration rates , influencing a community’s economic , social , and civic health • Johnston County’s high school dropout rate was 11 in 2019 - 2020 , which was lower than the rate in North Carolina 15 and lower than the Health ENC region 14 • Johnston County’s high school dropout rate has been inconsistent over the past four measurement periods 14 12 19 11 23 22 20 15 24 22 20 14 00 05 10 15 20 25 2016 - 17 2017 - 18 2018 - 19 2019 - 20 High School Drop Outs per 100 Students NC DPI Johnston County NC HEALTHENC High School Suspension Rate High school suspension is a form of discipline in which a student is temporarily removed from a classroom and or school due to a violation of school conduct or code Higher rates of suspension can be related to high rates of antisocial or delinquent behaviors , which may further contribute to potential future involvement in the juvenile justice system Additionally , schools with higher suspension rates have higher rates of law or board of education violations and generally spend more money per student • Johnston C ounty’s rate of high school suspension 93 per 100 students was lower than North Carolina’s rate 116 and lower than the Health ENC counties 155 in 2019 - 2020 155 106 87 93 182 179 150 116 241 230 208 155 00 50 100 150 200 250 300 2016 - 17 2017 - 18 2018 - 19 2019 - 20 High School Suspensions per 100 Students NC DPI Johnston County NC HEALTHENCPage5Transportation 02 05 10 18 04 29 - 05 10 15 20 25 30 35 Workers Commuting by Public Transportation Workers Who Walk to Work Percent of Workers by Mode of Commuting to Work ACS 2015 - 2019 Johnston North Carolina Health ENC Counties 830 809 809 795 800 805 810 815 820 825 830 835 Johnston North Carolina Health ENC Counties Percent Workers Who Drive Alone to Work ACS 2015 - 2019 Public transportation offers mobility , particularly to people without cars Transit can help bridge the spatial divide between people and jobs , services , and training opportunities Public transportation also reduces fuel consumption , minimizes air pollution , and relieves traffic congestion Walking to work helps pro tect the environment , while also providing the benefit of daily exercise • Likely due to rurality in Johnston County , an estimated 02 of residents commute to work by public transportation , compared to the state value of 10 Approximately 05 of residen ts walk to work , which was lower than the state value of 18 An estimated 83 of workers 16 and older drive alone to work , compared to 809 in NC Percent of workers driving alone is down across the board since 2019 Crime and Safety 1768 1661 2019 1874 375 3837 3575 4077 0 50 100 150 200 250 300 350 400 450 2016 2017 2018 2019 Violent Crime Rate per 100,000 Population Johnston NC 20103 17069 15619 14896 27868 26778 24126 25015 0 500 1000 1500 2000 2500 3000 2016 2017 2018 2019 Property Crime Rate per 100,000 Population Johnston NC Both violent crime and property crime are used as indicators of a community’s crime and safety Violence negatively impacts communities by reducing productivity , decreasing property values and disrupting social services Violent crime includes four offenses murder an d non - negligent manslaughter , rape , robbery , and aggravated assault Property crime includes the offenses of burglary , larceny - theft , motor vehicle theft , and arson • From 2016 to 2019 , the violent crime rate in Johnston County increased from 1768 to 1874 but it is still significantly lower than the state average increased from 375 - 4077 Page6• During the same time period , the property crime rate decreased from 20103 to 14896 , which was lower than the NC rate Juvenile Crime 055 031 059 042 153 145 137 097 11 092 079 078 0 02 04 06 08 1 12 14 16 18 2017 2018 2019 2020 Juvenile Undisciplined Rate per 1,000 Pop Age 6 - 17 Johnston NC HEALTHENC 1237 895 1417 1981 1958 1618 1682 1808 227 174 184 214 0 5 10 15 20 25 2017 2018 2019 2020 Juvenile Delinquent Rate per 1,000 Pop Age 6 - 15 for 2020 Age 6 - 17 Johnston NC HEALTHENC Youth who commit a crime may not gain the educational credentials necessary to secure employment and succeed later in life Negative peer influences , history of abuse neglect , mental health issues , and significant family problems increase the risk of juvenile arrest The juvenile jus tice system aims to reduce juvenile delinquency through prevention , intervention , and treatment services The undisciplined rate describes juveniles who are unlawfully absent from school , regularly disobedient and beyond disciplinary control of the parent guardian , are regularly found where it is unlawful for juveniles to be , or have run away from home for mor e than 24 hours • In 2020 , the juvenile undisciplined rate in Johnston County 042 was lower than the rate in North Carolina 097 and the Health ENC region 078 This rate is down across the board from 2017 - 2020 • In 2020 , the juvenile delinquent rat e for Johnston County 1981 was higher than NC 181 but lower than the Health ENC region 214 There was a very large increase in the juvenile delinquent rate in Johns t on County from 2017 - 2020 Page7Child Abuse 92 82 75 61 93 92 87 80 95 100 93 88 00 20 40 60 80 100 120 2015 2016 2017 2018 Child Abuse Reports Substantiated Rate per 1000 Population Age 0 - 18 Johnston NC HEALTHENC Child abuse includes physical , sexual , and emotional abuse All types of child abuse and neglect can have long lasting effects throughout life , damaging a child’s sense of self , ability to have healthy relationships , and ability to function at home , at wor k , and at school • The 2018 child abuse rate in Johnston County was lower 61 per 1,000 pop than NC 80 per 1,000 pop and the Health ENC 88 Incarceration According to the US Bureau of Justice Statistics , approximately one out of 1 00 adults in the US are in jail or prison Conditions in jails and prisons can lead to an increased risk of infectious diseases such as tuberculosis and hepatitis C , as well as assault from other inmates After incarceration , individuals are likely to fa ce a variety of social issues such as employment discrimination , disruption of family relationships and recidivism • Over the past four measurement periods , the incarceration rate in Johnston County has decreased • In 2019 - 2020 , the incarceration rate in Joh nston County was lower 3009 per 1,000 population than NC 3042 and the Health ENC region 3452 • ENC region made a significant jump in its incarceration rate , jumping the state of NC as the leader 3359 358 347 3009 369 3614 3474 3042 416 4122 3904 3452 0 50 100 150 200 250 300 350 400 450 2016 - 2017 2017 - 2018 2018 - 2019 2019 - 2020 Incarceration Rate per 100,000 Population NC Dept of Public Safety Johnston NC HEALTHENCPage8Civic Political Engagement Exercising the right to vote allows a community to choose elected officials and hold them accountable Voting ensures that all citizens have the opportunity to voice their opinions on issues such as the use of tax dollars , civil rights and fo reign policy By voting , individuals shape their communities and influence the next generation of society A high level of voter turnout indicates that citizens are involved and interested in who represents them in the political system • Johnston County has a lower percent of residents of voting age 743 than North Carolina 776 and the Health ENC Counties 771 743 776 771 720 730 740 750 760 770 780 Johnston North Carolina Health ENC Counties Percent of Population of Voting Age ACS 2015 - 2019 Analysis of Socioeconomic Profile These drivers of health all contribute to the overall wellbeing of the health of Johnston County Socioeconomics refers to the relationship between a group of people and their surroundings This includes things like Income , Education and Employment , Pover ty , Housing , Food insecurities and Transportation These things influence one another For example , the high school dropout rate 11 , is lower than the state or health ENC counties which creates access to better paying jobs , and in turn makes the median household income higher than that of the state and health ENC counties The median household income in Johnston County is 59,865 However , there is still 13 of the Johnston County population that live in poverty Without adequate income , housing and foo d insecurities can occur This can negatively affect the physical , social , and emotional health of both children and adults Transportation is also a driving factor in being able to have adequate income , which determines the ability to provide things like safe housing and nutritious foods Johnston County has a lower percentage 2 of persons who drive alone to work or who use public transportation Because it is a rural county , public transportation is not offered , and walking is no t accessible The empl o yment rate is negatively affected by lack of tra nsportation Overall Johnston County is one of the least distressed counties in North Carolina , but there are still many things to do to improve the health of the overall community Page9Chapter 4 Clinical Care Profile Health Insurance Coverage 864 873 870 858 860 862 864 866 868 870 872 874 Johnston North Carolina Health ENC Counties Percent Age 0 - 64 with Health Insurance ACS 2015 - 2019 Medical costs in the United States are very high People without health insurance may not be able to afford medical treatment or prescription drugs They are also less likely to get routine checkups and screenings , so if they do become ill they may not seek treatment until the condition is more advanced , and therefore more difficult and costly to treat • Nearly 14 of the population 0 - 64 years of age in Johnston County are uninsured • The rate of individuals aged 0 - 64 years old that have health insurance coverage in Johnston County was 864 , which was lower than the rate for North Carolina 873 and the Health ENC region 870 Government Health Insurance Only Coverage – Medicaid , Medic are , Tricare This graph shows the percent of the population only receiving health insurance through Medicaid , Medicare , or military healthcare TRICARE • In Johnston County , 139 of the population report receives health insurance coverage through Medicaid , 42 Medic are and 04 Tricare 139 42 04 134 55 04 158 50 06 - 20 40 60 80 100 120 140 160 180 Receiving Medicaid Only Receiving Medicare Only Receiving Tricare Only Percent of People Only Receiving Health Insurance Through Medicaid , Medicare , Tricare ACS 2015 - 2019 Johnston North Carolina Health ENC CountiesPage0Primary Care Practitioners https nchealthworkforceuncedu blog primary_care_nc Access to primary care is necessary to improving the health outcomes of communities With the recent spread of the novel coronavirus in North Carolina , primary care is critical as an entry - point to further care Many rural areas of North Carolina lack adequate access to primary care providers The disparities in access between rural and metropolitan areas have continued to grow despite an overall increase of physicians in NC On the map above , if a County is shaded in green , it indicates the county is meeting the NC Institute of Medicine’s NCIO M target ratio of 1 primary care provider to every 1,500 people Johnston County is orange , and therefore , does not meet the NC Institute of Medicine’s NCIOM target ratio of 1 primary care provider to every 1,500 people Currently , 60 of NC’s 100 cou nties meet the NCIOM’s target As shown in this figure , seven counties were substantially below target Anson , Northampton , Franklin , Warren , Gates , Tyrrell and Camden Camden has a population of just over 10,000 , and no primary care providers The NCIOM d efinition of primary care clinician includes physicians , nurse practitioners NPs , physician assistants PAs and certified nurse midwives CNMs https nchealthworkforceuncedu bl og primary_care_nc Page1https nchealthworkforceuncedu interactive supply As shown in this figure , the number of physicians per 10,000 population Johnston County has increased fro m 697 physicians in 2000 to 728 in 2019 which is below the state rate of 243 per 10,000 population Source North Carolina Health Professions Data System , Program on Health Workforce Research and Policy , Cecil G Sheps Center for Health Services Research , University of North Carolina at Chapel Hill Created September 29 , 2021 at https nchealthworkf orceuncedu interactive supply Analysis of Clinical Care Profile Access to care is a priority that Johnston County has been working on for many years Improving health outcomes is dependent on increasing access to care Access to healthcare is influenc ed by the number of providers available in a given area , healthcare coverage , and accessibility The NCIOM recommends 1 provider per every 1,500 persons Johnston County is not meeting that target 728 providers per 10,000 people is the current rate of pr imary care providers in Johnston County Increasing the number of providers MD’s , Nurse Practitioners , Physician Assistants , and Behavioral health providers could decrease the number of emergency department visits Having more providers would increase t he number of persons receiving evidence based preventive healthcare Health insurance rates directly affect the percentage of persons receiving preventive care The percentage of persons with health insurance in Johnston County 864 is less than that of the state and health ENC counties However , 139 of persons receive Medicaid which is slightly higher than the state rate Without health insurance persons are less likely to access healthcare services Increasing health insurance rates , number of provid ers and making healthcare more accessible will improve the overall health of the Johnston County community Page2Chapter 5 Chronic and Communicable Disease Profile Leading Causes of Death Johnston County North Carolina Health ENC Counties Rank Cause Deaths Rate Rank Cause Deaths Rate Rank Cause Deaths Rate 1 Cancer 335 16003 1 Cancer 19,963 19034 1 Heart Disease 4546 2102 2 Heart Disease 331 15812 2 Heart Disease 19,661 18746 2 Cancer 4345 20091 3 Cerebrovascular Disease 96 4586 3 Chronic Lower Respiratory Diseases 5,411 5159 3 Cerebrovascular Disease 1215 5618 4 Alzheimers Disease 93 4443 4 Cerebrovascular Disease 5,203 4961 4 Chronic Lower Respiratory Diseases 1114 5151 5 Chronic Lower Respiratory Diseases 81 3869 5 Other Unintentional Injuries 4,683 4465 5 Other Unintentional Injuries 1006 4652 6 Other Unintentional Injuries 77 3678 6 Alzheimers Disease 4,508 4298 6 Alzheimers Disease 918 4245 7 Diabetes Mellitus 43 2054 7 Diabetes Mellitus 3,127 2981 7 Diabetes Mellitus 838 3875 8 Nephritis Nephrotic Syndrome and Nephrosis 40 1911 8 Nephritis Nephrotic Syndrome and Nephrosis 2,121 2022 8 Nephritis Nephrotic Syndrome and Nephrosis 476 2201 9 Pneumonia and Influenza 38 1815 9 Pneumonia and Influenza 1,730 1649 9 Motor Vehicle Injuries 460 2127 10 Septicemia 38 1815 10 Motor Vehicle Injuries 1,608 1533 10 Pneumonia and Influenza 382 1766 Notes Leading causes of death are calculated based on the crude number of deaths per 100,000 population in 2019 Deaths North Carolina State Center for Health Statistics 2019 Vital Statistics Public Use Data Files , downloaded from the Odum Institute for Research in Social Science at UNC - Chapel Hill Dataverse web site , May 2021 Population National Center for Health Statistics 2019 Bridged - Race Population Estimates https www cdcgov nchs nvss bridged_racehtm Analysis by ECU Department of Public Health , Health Systems Research and Development This table shows the leading causes of mortality in Johnston County , North Carolina , and Health ENC Counties in 2019 Many of th ese chronic conditions death rates are higher than the state and the Health ENC County Region rates Page3Leading Causes of Injury Death MVT – motor vehicle traffic 2016 - 2019 , all ages Source https wwwinjuryfreencncdhhsgov DataSurveillance indexhtm # genData Leading Causes of Hospitalizations MVT – motor vehicle traffic 2016 - 2019 , all ages Source https wwwinjuryfreencncdhhsgov DataSurveillance indexhtm # genData Leading Causes of Emergency Department VisitsPage4MVT – motor vehicle traffic 2016 - 2019 , all ages Sou rce https wwwinjuryfreencncdhhsgov DataSurveillance indexhtm # genData Top Ten Reportable Communicable Diseases 5424 1536 1505 270 203 160 104 092 080 080 0 100 200 300 400 500 600 700 800 900 1000 Chlamydia Hepatitis C - Chronic Gonorrhea Salmonellosis Nongonococcal urethritis Campylobacter infection Pertussis HIV Hepatitis B – Chronic Carrier Syphilis – 04 Unknown Duration or Late Syphilis Cases Top 10 Communicable Diseases Note To view and compare communicable disease rates in your county with NC State - wide rates , reported number of cases , etc , view the custom dashboard https NCD3NorthCarolinaDiseaseDataDashboard Preventing and controlling the spread of communicable diseases are a top concern among communities The top communicable diseases as reported by NC DHHS in Johnston County in 2018 are shown above Chlamydia ranked highest among percent of cases reported Chlamydia is a common STD that can infect both men and women It can cause serious , permanent damage to a womans reproductive system Communicable case counts and rates at the state and county level can be found by following the weblink in the slide An alysis of Chronic and Communicable Disease Profile Cancer has succeeded heart disease as the leading cause of death in Johnston County and North Carolina However , in ENC counties heart disease is still the leading cause Alzheimer’s disease is the fourt h cause of death in Johnston County despite having less elderly population The leading cause of injury death is motor vehicle traffic The leading cause of emergency visits and hospitalizations are falls , followed by motor vehicle traffic Chlamydia is t he highest reported communicable disease , followed by Hepatitis C and gonorrhea Page6Chapter 6 HNC 2030 Indicator Rankings by Health ENC Regions Indicators Measures Johnston NC Health Outcomes Premature Death 6,700 7600 Low Birthweight 8 9 Health Factors Health Behaviors Adult Smoking 20 18 Adult Obesity 35 32 Food E nvironment I ndex 82 68 Clinical Care Uninsured 14 13 Primary Care Physicians 3,690 to 1 1400 to 1 Preventable H ospital S tays 5567 4539 Flu Vaccinations 53 52 Social & Economic Factors Income I nequality 41 47 Social Associations 84 115 Injury D eaths 67 77 Physical Environment Areas of Strength Areas to Explore Source County Health Rankings https wwwcountyhealthrankingsorg Page7Chapter 7 County Health Ranking Indicators Population Health Model The County Health Rankings are based on a model of community health that emphasizes the many factors that influence how long and how well we live The Rankings use more than 30 measures that help communities understand how healthy their residents are today health outcomes and what will impact their health in the future health factors Explore the Model to learn more about these measures and how they fit together to provide a profile of community health • There are many factors that influence how well and how long people l ive • The County Health Rankings model right is a population health model that uses data from different sources to help identify areas of concerns and strengths to help communities achieve health and wellness • The Rankings provides county - level data on h ealth behavior , clinical care , social and economic and physical environment factors Page8Chapter 8 Survey FindingsPage0Chapter 9 Inventory of Resources Johnston County has numerous resources available When it comes to our three priority areas of access to care , substance disorders and transportation , there is room for improvement There are limited options for transportation in Johnston County Johnst on County is a rural county that does not have a public transportation system Having a resource for transportation or mobile services would improve the health of residents by increasing access to community resources Additionally , Substance use disorder s have become more prevalent over the years There are limited in county resources for inpatient treatment , post overdose services and Narcan access Having the aforementioned resources would create better health outcomes for those impacted by Substance use disorders An increase in resources in Johnston County is a step in the right direction for Healthier Johnston County residents Double click to openPage1Chapter 10 Community Prioritization Process JCPHD & Johnston Health complied a summary of all secondary & primary data into a CHNA priority setting PowerPoint which was then presented to various community stakeholders These stakeholders include The Johnston Health Board of D irectors , Johnston County Housing Think Tank NC Community Action Association , Johnston County Board of Health , Johnston County Safety Net , Johnston County Faith Network and Johnston County Opioid Taskforce After each priority setting presentation , a sur vey was sent out to all participants allowing them to individually prioritize each of our key findings Previously , these discussions and prioritization activities would have been conducted in person , but due to COVID - 19 restrictions were held via teleconf erence & SurveyMonkey Taking into consideration key stakeholder feedback & properly weighing secondary data sources , the JCPHD & Johnston Heath unanimously voted to adopt the following three health priorities for the 2021 - 2022 CHNA 1 Access to Care 2 Substa nce Use Disorders 3 TransportationPage2CHNA References Social and Economic Factors Source Years Population US Census Bureau ACS 5 - year Estimate 2015 - 2019 Projected Population NC Office of State Mgmt & Budget Pop Projections and US Census 2021 General population characteristics Census Population Estimates 2015 - 2019 Education US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Employment US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Income US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Minority Populations US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Military Population US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Veteran Population US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Birth Rate NC State Center for Health Stati stics 2016 - 2019 Poverty of population with income lt; 200 of poverty level US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Poverty by race and ethnicity US Census Bureau ACS 5 - year Estimate 2013 - 2019 Children in poverty US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Older adults in poverty US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Disabled people in poverty US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Housing – Median monthly costs US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Housing – median monthly costs in surrounding counties US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Employment by industries US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Food Insecurity US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Percent of population below 200 by zip code US Census Bureau , ACS 5 - year Estimate 2015 - 2019 Educational attainment US Census Bureau , ACS 5 - year Estimate 2015 - 2019 High School dropout rate dropout per 100 students NC Dept of Public Instruction 2016 - 2020 High School suspension rate suspension per 100 students NC Dept of Publi