The Cumberland County Department of Public Health and Cape Fear Valley Health released the county’s latest Community Health Needs Assessment earlier this month. The 138-page report specifies what health issues the department and its partners will focus on for the next three years until the next assessment is completed.
Using feedback from an online survey and four focus groups, the stakeholders of the 2024 report selected behavioral, maternal and infant, and physical health as the county’s top priorities.
“Our overarching goal is just to have healthy people in a healthy community,” said Tamra Morris, the public health department’s deputy director. “And one of the main ways that we do that is to collaborate and listen to the people who we’re doing this for.”
The state requires the county to track its success in addressing identified health priorities through a community health improvement plan. The plan provides a scorecard that shows whether the county is making progress toward metrics like equitable access to services. Department leaders are developing the latest plan based on the 2024 assessment’s priorities and determining what metrics to track.
Behavioral health
The behavioral health priority encompasses mental health and substance use disorders. It’s the second time the community identified mental health as a priority issue, the first being in the 2021 assessment. Substance use disorders have been a community priority since the 2016 assessment.
Sixty-four percent of the assessment’s 1,256 survey responses indicated mental health was among the top three health problems affecting the community. Two-thirds of respondents reported having at least one poor mental health day in the last 30 days. On average, residents reported seven poor mental health days, more than the state and national averages.
The county also has higher rates of deaths of despair — suicides, alcohol poisonings and drug overdoses associated with poor mental health — than the state. Almost 75 per every 100,000 county residents die deaths of despair every year, according to data from the Centers for Disease Control and Prevention analyzed in the report. That’s 16 more people per every 100,000 in the state.
Half of the assessment’s survey respondents also said alcohol and drug addiction was a top-three health problem in the county. The county is about level with state averages for alcohol-involved car crashes and the percentage of adults reporting excessive drinking.
The county, primarily through the Cumberland-Fayetteville Opioid Response Team and its efforts like the Recovery Resource Center and naloxone distribution, has seen a steady decrease in emergency department visits for overdoses over the last three years, according to data from the North Carolina Department of Health and Human Services. The health assessment found county ED visit rates specifically related to opioids among Medicare beneficiaries were lower than the statewide rate, with 35 people per every 100,000 going to a county ED compared to 43 across the state.
However, the county’s overdose death rates remain among the highest in the state. The county health needs assessment shows that almost 37 per 100,000 county residents die of an opioid overdose each year compared to 25 per 100,000 across the state.
These statistics come as the assessment found that Cumberland County has higher ratios of mental health, substance use and buprenorphine (a drug used to treat opioid use disorder) providers than the state overall. Despite the high ratios, 40% of survey respondents who said they had poor mental health days reported being unable to get mental health care within the last 12 months.
CityView previously reported on residents’ difficulty accessing mental health care, their reasons including stigma in seeking care and the inability to find an available provider. Morris said another issue is the county’s lack of inpatient treatment options. Cumberland County has no inpatient treatment facilities for mental health or substance use disorders. Instead, local providers connect residents with centers in places like Wake and New Hanover counties.
“We have plans for the future to bring inpatient treatment services to Cumberland, but I think that that’s usually where that deficit is really seen in access to care,” Morris said.
Maternal and infant health
The March of Dimes, a source for U.S. maternal and infant health-related data, ranks North Carolina 32nd in the nation for maternal and infant health. Cumberland County fares worse in many categories. The county’s infant mortality rate in 2023 was double the state average with a total of 70 infant deaths, data from the N.C. State Center for Health Statistics shows.
About one in every nine pregnancies in Cumberland County resulted in a preterm birth last year, the highest rate in the state, according to the state’s Maternal and Infant Health Data Dashboard and the March of Dimes. The county health needs assessment also highlighted that over 10% of babies born in the county have a low birthweight, meaning they are born weighing less than 5 pounds and 8 ounces.
“For maternal mortality and birth outcomes, we are not doing as well as we would like,” Morris said. “So at the stakeholder meeting, them prioritizing maternal health as one of our priorities for the next cycle was not surprising.”
The assessment attributes much of these statistics to poor access to care. When asked to identify top barriers to care, most survey respondents pointed to high costs, no insurance, long wait times, lack of transportation and insurance not being accepted. In focus groups, residents brought up how the costs of medication and appointment co-pays prevented people from getting care. They also spoke about the lack of affordable childcare, an issue across the state.
The county’s public health department is working to increase access to maternal health care, including helping underinsured and uninsured residents get doula care and providing Uber Health rides.
Physical health
Morris said physical health was specifically selected by the county health needs assessment’s stakeholders, despite not being specified in any of the focus groups or the survey results. When describing physical health, the assessment cited chronic conditions plaguing county residents and the low availability of exercise options.
According to the assessment, 17.6% of residents report having poor or fair health. It stated the county has notably higher rates of a handful of chronic conditions than the state, especially when it comes to obesity, hypertension and diabetes rates. Obesity was the third most identified health problem by survey respondents.
The assessment found that 608 per every 1,000 people in the county visited the emergency room in 2022, 45 more than the state average. The county also had a higher rate of preventable hospitalizations than the state with a total of 3,653 per every 100,000 Medicare beneficiaries in 2021, 1.23 times more than the state.
Like with behavioral health, these statistics come despite the county having a higher ratio of primary care providers than the state average. And similar to issues with maternal and infant health, the assessment ties the county’s poor physical health to access to care. It states the high emergency room visit rates suggest “potential challenges in managing chronic conditions through preventive care” and that “residents may face challenges in accessing or maintaining consistent care for chronic conditions.”
The assessment also noted the lack of access to exercise opportunities, including a lower ratio of recreational facilities than the state and poor pedestrian infrastructure. The focus group of Cape Fear Valley Medical Center health care workers noted a lack of places to exercise across the county, including sidewalks and bike-friendly roads.
Fayetteville was ranked as the least walkable city in America last year by WalkScore, a website that awards a given address, neighborhood or city a score out of 100 based on the number of walking routes to amenities like grocery stores and post offices.
The Environmental Protection Agency also provides a National Walkability Index score, which is based on density, land use diversity and proximity to transit. Cumberland County’s score is 7 out of 20, according to the community health needs assessment.
Food security was also a concern since diet is tied to a person’s health. The assessment flagged the county’s high rate of food insecurity, low access to healthy foods and high number of fast food restaurants.
“We are never backing down from a challenge. We recognize that there are areas that need improvement in this community and we’re committed to those,” Morris said. “We’re hoping that residents will be as well. If you have an opportunity to lend your voice or to take part in a program or service or contribute to conversations about how we can influence this place where we call home, then I would encourage folks to do so.”
Physical copies of the community health needs assessment are available at Cumberland County Public Library’s eight locations. A virtual copy can be downloaded from the Department of Public Health’s website.
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the CityView News Fund.