2011/12 Community Health Needs Assessment Summary- an assessment of Lenoir County conducted jointly by the Lenoir County Health Department and Lenoir Memorial Hospital

2011/12 Lenoir Memorial Hospital Community Health Needs Assessment Summary:

An assessment of Lenoir County conducted jointly by the Lenoir County Health Department and Lenoir Memorial Hospital. 

During 2011, a community health needs assessment (CHNA) was conducted by Lenoir Memorial Hospital and the Lenoir County Health Department for the 59,495 residents of Lenoir County, North Carolina. Lenoir County includes its county seat, Kinston, a city of 22,000 residents located in the coastal plains of eastern North Carolina. Lenoir Memorial Hospital primarily serves the population of Lenoir County and surrounding counties with the overwhelming majority of all hospital discharges over the last two years coming from Lenoir County. The mission of Lenoir Memorial is to ensure exceptional healthcare for the people we serve. The values of the hospital include the plan for innovation that is visionary, creative, and serves as a catalyst for improving the health of the community. A strategic priority for Lenoir Memorial is to deliver contemporary healthcare services consistent with identified community need.

Description of Community Served by the HospitalLenoir County is a rural community located in a designated Tier One County. This annual ranking by the NC Department of Commerce is based on the economic well-being of residents with the Tier One assignment given to the 25 most distressed counties in NC. The local area economy is heavily dependent on agriculture and manufacturing. Traditionally this meant the sale of tobacco. However, recently several businesses have opened and expanded operations resulting in job creation. These include Sanderson Farms, Spirit Aerosystems, West Pharmaceuticals, Pioneer Hi-Bred International and Smithfield Foods. The per capita income for county residents based on 2009 data is $18,877 compared to $24,547 for the state. Lenoir County’s median family income in 2009 is $34,213 compared to $43,754 statewide. The percentage of county residents below federal poverty level based on 2009 data is 20.1% compared to 16.25% for state residents. Those below the median income level have been disproportionately impacted by the recession and the proportion of the population living below poverty has increased over the past decade. County racial/ethnic composition is 53.4% white, and 40.5% black with 7.5% other minorities, from the US 2010 Census data. This compares to the state’s racial/ethnic profile of 68.5% white, 21.5% black and 12% other minorities. The Hispanic/Latino population has been the fastest growing Lenoir County population since 2000. Data and tables detailing the current demographic including income levels, age, race/ethnicity, and educational attainment for Lenoir County with a comparison to NC, is included in the full 2011 Lenoir County Community Health Assessment posted on the Lenoir Memorial Hospital website.

Who was Involved in Assessment The assessment process was initiated and co-chaired jointly by Lenoir Memorial Hospital and Lenoir County Health Department. The existing collaboration for Community Health Needs Assessment over the past years has been a positive one for these two organizations.  The Lenoir County Health Department agreed to move the cycle of assessment to every three years from an existing four year interval in order to support the new requirement for hospitals to move to a three year cycle. These entities provided roughly equal financial and in-kind support for the assessment process, however the Lenoir Memorial Foundation provided a $4000 grant to support the costs of printing, mailing, and inserting 10,196 CHNA community perception surveys in a Sunday Free Press edition on September 11, 2011. Additionally, thousands of surveys were distributed widely throughout the county and in each municipality from August, 2011- November, 2011. The Lenoir County Alliance for a Healthy Community task force, representing over 30 Lenoir County community organization and agency leaders from diverse community perspectives, were committed to the assessment process, and distributed surveys and stayed informed on the timeline at monthly meetings. They offered valuable input and recommendations in the prioritization process once survey results were in.  This helped to ensure that input from persons with broad knowledge of the community were involved.  The Kinston Free Press also provided media coverage about the importance of completing surveys in an attempt to increase diverse participation. Physicians and health care providers at Lenoir Memorial, Kinston Community Health Center and physician practices were also asked to participate in the survey process. Staff from the Health Department used a Survey Monkey calculator and analysis tool in order to provide the results of the 729 returned surveys. This represents more than a 50% increase in returned surveys compared to the 2007 CHNA process. Lenoir County Health Department health promotion staff compiled statewide and Lenoir County statistical public health data for presentation of community health status in the report.

Those organizations who committed to the assessment and planning process and continue to attend monthly meetings of the Lenoir County Alliance for a Healthy Community are found in a listing in the full 2011 Lenoir County Community Health Assessment posted on the Lenoir Memorial Hospital website.

How the Assessment was Conducted The Lenoir County CHNA began with a review of the 2007 CHNA conducted by the Lenoir County Health Department and Lenoir Memorial Hospital. This information was updated with more recent statistics from county, state, and national sources. New data sources were identified and incorporated including the newly published County Health Rankings and the NC State Center for Health Statistics, and other relevant information resources.

The initial review included analysis of trends and comparisons of secondary data within the community and with other communities in eastern NC. Members of the Lenoir County Alliance for a Healthy Community held discussions at several meetings to gather a larger understanding of the secondary data and survey results. With the assistance of these groups, a list of possible major problems or community needs was acknowledged under four main categories including: Living in Our Community, Unhealthy Behaviors, Violence, and Disease and Disabilities. Members of the Lenoir County Alliance for a Healthy Community agreed on a set of criteria to use in order to rank major health needs identified through the fact finding process. The top 12 issues were then identified through a voting process that attached an importance of rank by using a colored dot ranking process. The 12 most important issues identified were: illegal drug abuse/substance and youth violence/gangs; obesity; job opportunities; poor eating habits/lack of good nutrition; responsible parenting; youth access to and use of guns; illegal drugs; high blood pressure; diabetes; cigarette smoking among people under age 18; drinking and driving; and lack of physical activity or exercise. Of the twelve issues ranked, it was decided that four problems would be selected based on:

1. 
   
2. the availability of community resources to address the need,
   
3. current and potential actions in any given area of focus,
   
4. likelihood of being able to impact the issue with measureable results, and
   
5. the breadth of issue as it impacts the county population groups.
   

After discussion, members were then given an opportunity to revise their rankings and these individual rankings were summed to produce a composite ranking. Discussion and consensus was gained for prioritization.

The prioritization process identified the following four priority issues for the community over the next three years:

• 
  
• Obesity (physical activity and nutrition),
  
• Diabetes,
  
• High Blood Pressure, and
  
• Responsible Parenting
  

It should be noted that the assessment process identified some gaps in information. The demographics of the survey respondents did not closely mirror the community demographics. However, the process included various means to obtain input from the entire county such as having surveys available throughout the community in trusted locations. Surveys were located in agencies that serve as safety nets such as the Department of Social Services, Lenoir County Health Department and Kinston Public Housing. Churches were a particular target for surveys and the surveys were printed in both English and Spanish and did not require names in order to protect confidentiality.

Health Needs IdentifiedThe health of Lenoir County residents continues to be poor.  Lenoir County ranks 88^th lowest, in all NC counties, for overall health outcomes by the 2012 County Health Rankings measures. The ten leading causes of death in Lenoir County are similar to the overall causes in NC but the top two leading causes of death in Lenoir, heart disease and cancer, are switched for the state. Lenoir County has some of the highest rates of heart disease in NC. A comparison of the surrounding counties of Greene, Duplin, and Pitt reveals that the five leading causes of death were the same as Lenoir County during the same period. However, Lenoir County’s rate per 100,000 for each of the five leading causes of death is higher in all diseases. Craven and Wayne counties five leading causes of death are much like the state’s leading causes of death.

Many deaths are preventable in Lenoir County and involve risky behavior and lifestyles. The major causes of preventable death continue to be tobacco use, unhealthy diet, a lack of physical exercise, alcohol misuse, firearms, sexual behavior, and illicit drug use.

Health statistics reveal that Lenoir County’s infant mortality rate for the five year period from 2005-2009 is 10.0 compared to the state of 8.3. Low birth weight/prematurity is the primary cause of infant deaths. Data reveals that infant mortality rates for minorities is significantly higher than for whites.

Diabetes is the 5^th leading cause of death in our community with preventable Type 2 making up the majority of cases. Obesity and lifestyle are factors.

The surrounding counties rates for all cancers were lower than Lenoir County from 2006-2010. Lenoir County ranks higher than the state averages for age adjusted incidences of cancers found in the colon, lung, breast, and prostate categories.

Lenoir County ranks 5^th in all NC counties pertaining to AIDS cases. This rank is based on a three year average rate. The rates of gonorrhea and syphillis are also above state averages with the burden of these diseases seen in minorities.

As noted previously, the African-American and other minorities population in Lenoir County is almost double that for the state. It is known that African-Americans have higher death rates from heart disease, cancer, HIV, diabetes, homicide, and stroke compared to whites. Lenoir County’s statistics document higher than state averages in most of these areas.

Other indicators for community health status are found in the full 2011 Lenoir County Community Health Needs Assessment posted on the Lenoir Memorial Hospital website.

Community Assets IdentifiedThe assessment identified a number of strong community assets, including Lenoir Memorial Hospital and its community benefit programs, Kinston Community Health Center, Lenoir County Alliance for a  Healthy Community, and dozens of health and human service agencies in Lenoir County. Lenoir County Transit, Boys & Girls Club, local law enforcement, and volunteerism in Lenoir County were also identified as assets. The full list is found within the full 2011 CHNA on the Lenoir Memorial website.