By Ali Edwards

The executive steering committee for Rowan County’s upcoming Community Health Needs Assessment met again Monday, Feb. 10, at St. John’s Lutheran Church. This month’s agenda focused on health behaviors and outcomes, featuring multiple presentations by local figures from various organizations.

Chronic disease

Rowan County’s public health director, Alyssa Harris, took the floor to highlight chronic disease in Rowan County. Harris explained that “just by your zip code alone, you have some sort of connection back to that length of life, and unfortunately, it’s a bigger impact on your health than your genetic code is. What I want us to think about is years of potential life lost. So, with the average longevity of 75 or 76 years old here in Rowan County, what does it mean to die before then? And what is that impact to our economy, to our families, to our education system?”

Harris explained that, as people die younger and younger, the impact of years of life lost adds up. Additionally, Rowan County’s rates of potential years of life lost are on the rise, surpassing that of N.C.’s and the United States’ overall average, which Harris noted “means we have younger and younger people dying of different conditions here in Rowan County.”

The more recent available data indicates that the leading cause of death in Rowan County is heart disease, followed by cancer, chronic lower respiratory diseases, and all other unintentional injuries (including overdoses and suicides). Harris asked committee members to “think about what might be causing this, and then what can we do to address it?”

Regarding heart disease, Harris said, “We know that the causes are lifestyle factors, so things like smoking, unhealthy diet, lack of physical activity, obesity, medical conditions like high blood pressure, high cholesterol, diabetes, and some genetic conditions. We know that genetics can set that the stage so that the environment may then cause these issues to come up.”

Rowan County has a slightly higher rate of coronary heart disease than N.C. and the U.S., but, contrarily, holds a more than 50 percent increase in rates of heart disease mortality than N.C. or the U.S. Men and non-Hispanic Black populations are impacted at a higher rate. Harris explained it can be challenging to define the ‘Why,’ stating, “I think there would be a lot of factors into why. Why do we have a higher mortality rate for some of these chronic conditions than other communities?” Harris also postulated, “Maybe there is a silence around some of the men’s health issues that we need to discuss more.”

Cancer, the second leading cause of death in Rowan County, shares similar trends. Rowan County’s rates of cancer diagnoses are near those of N.C. and the U..S, but cancer mortality in Rowan County is significantly higher than that of N.C. and the U.S. Rowan County’s neighbor, Cabarrus County, also has considerably lower cancer mortality rates.

“We need to dive into that and find out why. Why does Cabarrus County have a lower rate? What can we learn from these other communities?” asked Harris.

Respiratory infections like asthma, COPD, and pulmonary fibrosis are the third leading cause of mortality in Rowan County, caused by environmental factors, tobacco, infections and more. Harris explained that, as more data is available, we will also see the effects of COVID-19 on this data, stating that “we continue to see the impacts of vaccine-preventable diseases on the cause of death.”

Harris explained that obesity, another chronic disease, is “an underlying factor for a lot of these other chronic conditions, “with 33.9 percent of individuals in Rowan County classified as obese. “Not overweight, but obese,” stated Harris.

Harris concluded by explaining that, overall, these diseases create a significant impact on years of life loss in Rowan County. “We want Rowan County residents to live their best and healthiest lives and be able to do the things they want to do,” said Harris.

Primary care

Community Care Clinic of Rowan County Executive Director Krista Woolly was next up and discussed the resources available through this clinic, explaining that they offer “free medical, dental and pharmacy. We really fill in the gap between what a primary care physician can do and then for those with no insurance at all, no Medicaid, no Medicare, no benefits at all. Our goal is to see anybody and everybody in Rowan County who needs healthcare.”

Woolly listed diabetes education as a service available at the Community Care Clinic.

“In N.C., about 13 percent of adults have diabetes; at our clinic, it’s about 40 percent. So, we do chronic conditions every day,” Woolly said. Although used to test for many other conditions, Woolly also explained that “we now have a lab in-house, and because our patients may or may not have access to transportation, or the ability to take off work, we can go ahead and find out right then if we need to increase their insulin.”

Food pharmacies are also a component of the Community Care Clinic. “A lot of people talk about food pharmacies, but I really think we do this well because the doctor actually distributes the food. She might come in and say, ‘Karen, you want to eat more fruits and vegetables.’ So, right now, on our recipe board, we have vegetarian chili, oven-baked chickpeas and overnight oats. And we can give you those shelf-stable ingredients in a bag given by the doctor. And we all know that we all do better if we are prescribed something by a doctor.” This means “Karen” will likely be getting more fruits and vegetables.

Additionally, the Community Care Clinic has recently partnered with the literacy council and will provide English classes to accommodate the increase in Spanish-speaking patients. Although the Community Care Clinic has three bilingual staff members, Woolly explains that this class is still essential to health care because we know “that not understanding your physician or dentist is a social determinant of overall health.”

Woolly explained that overall health can only be impacted by 20 percent within a clinical setting (such as a primary care physician), with 80 percent of the impacts coming from the individual patient. But at the Community Care Clinic, a doctor might write on a prescription pad, for example, “three apples a week. You don’t start at the top and then fail, but you start at the bottom and move up, and we have had such good results from that,” Woolly said.

Additionally, the Community Care Clinic provides dental services not only to Rowan County residents but also to Davie, Stanley and Iredell County residents.

Dental care

Dr. Brett Leslie, DMD at the Community Care Clinic of Rowan, spoke next about dental care in Rowan County.

“We are still experiencing a shortage of dental hygienists and dental assistants. A lot of them left the field during COVID. But as you know, that doesn’t tell the whole story. Of all the state’s dentists, only 42 percent of those accept Medicaid. However, only 28 percent are what we refer to as ‘meaningful Medicaid providers,’ which means that they bill over $10,000 to Medicaid annually. $10,000 worth of dental care is not a lot.” Essentially, this equates to about 3,000 Medicaid patients to one meaningful Medicaid provider. Leslie stated that “the sweet spot for solo dentist practice is about 1,500 patients to one provider.”

To further compound this issue, only 14 dentists in Rowan County accept N.C. Medicaid, with only seven of those providers accepting new Medicaid patients. Those accepting new patients have limited availability for first appointments, with a typical wait time of around six months. “Therefore, we are considered a health professional shortage area when it comes to dental care for the low-income populations. We are not a geographic shortage; we have enough dentists for our population, but not when it comes to the low-income population in particular.”

Leslie stated that Rowan County would need 11 additional dentists accepting Medicaid to treat the low-income population effectively. This lack of accessibility is a significant cause behind 31 percent of Medicaid recipients in Rowan County not being able to secure dental care.

Leslie explained there is a reason that dentists aren’t accepting Medicaid.

“Our Medicaid reimbursement rates are very, very, very low. We have not increased our reimbursement rate since 2008. But everything has gotten so much more expensive since then.” Leslie said he does not fault dental providers for not accepting this coverage, as “It just doesn’t make financial sense for them to accept Medicaid.”

However, there is hope, as House Bill 60 was recently introduced to the legislature and may help remedy this, as this bill proposes Medicaid reimbursement rates of 30 percent.

The shortage of dental providers creates significant impacts on the individual and society. “You lose work productivity because of dental issues,” Leslie explained, with $45 billion of lost productivity and 34 million lost school hours. “Teeth are not just for chewing; they are for our self-esteem and our self-image.”

Chronic health conditions also arise from not having routine dental care.

“Dental health is part of overall health. There is a strong correlation between gum disease and diabetes,” stated Leslie. Heart disease is also linked to periodontal disease. Leslie explained that inflammation from dental disease can travel to the rest of the body and continue to cause inflammation elsewhere, including the cardiovascular system.

About 49 percent of Rowan County residents do not have any dental coverage. That’s where safety net dental clinics like the Community Care Clinic make an impact. Cost is the primary reason individuals do not seek dental care, and “at the community care clinic, we eliminate the biggest barrier. We also try to work on things like transportation and things like that,” said Leslie. “We offer a wide variety of services at the clinic, including dentures and partial dentures that replace lost teeth.”

Currently, Rowan County has five safety net dental clinics. China Grove Family Medicine and Salisbury Health Center offers emergency and restorative services on a sliding fee scale. Davidson County Community Learning Center provides comprehensive care on a sliding fee scale. Both Smile Center for Children and the Community Care Clinic of Rowan County offer free dental services.

Mental health

Billy West, president and CEO of Daymark Recovery Services, was the final presenter at the meeting, providing information on the opening of Rowan County’s new Behavioral Health Urgent Care (BHUC) facility. This clinic will help provide 24/7 care to anyone suffering from a behavioral health crisis or simply needing help outside of normal hours, where, before, help was only available at the emergency department. Your capacity to pay for services and whether or not you have coverage is irrelevant. West added that the BHUC is a place you can go “when you are having some sort of mental health or substance use type of illness or emergency. You can come and get an assessment or a referral. Sometimes that referral is immediate, particularly around substance use.”

Daymark has continuously operated under the notion that “if you come into the clinic, you’ll get seen. No one will have a bill that they can’t pay.” West explains that upholding this model was sometimes tricky in other BHUCs in the state, and cuts had to be made to overall services so that indigent patients could still utilize services. However, in 2023 and 2024, Medicaid expansion enabled many more clients to obtain coverage and receive mental health services, as well as providing mental health facilities with critical additional funding. West said that facilities can provide more staff, care, and even care management teams. “So those are all really good things,” said West.

“When the BHUC opens, you will see detox admission numbers go up. That’s not a bad thing; that’s folks getting what they need,” said West.
He remarked that these immediately accessible detox services for an individual with substance use would create more prolonged periods of recovery for that person. Additionally, this resource will decrease the likelihood of relapses and reduce the duration and severity of relapses.

West also remarked on diseases and conditions that are often simultaneously present with a mental health diagnosis, stating that hypertension and diabetes are the top two co-morbidities. At Rowan County’s new BHUC, providers can address these conditions alongside mental health concerns. West provided an example, mentioning that if a patient comes into the facility who’s a diabetic and hasn’t had their prescriptions in a few months, the BHUC will prescribe the medication and schedule the patient with an appointment with a primary doctor. West refers to this as “practicing at the top of your license,” something his entire team is encouraged to do.

The Rowan County Behavioral Health Urgent Care will open next month, and West states the facility will “probably start out at about 12 hours for the first two weeks, we’ll get everyone trained and then it’ll go live 24/7.” West expects an immense positive impact on Rowan County. “The reality is that our patients will be healthier with this,” said West.

The Behavioral Health Urgent Care is located in Daymark’s current building beside the West End Plaza at 2129 Statesville Boulevard.

The community health needs assessment is a quadrennial undertaking required by the state to compile comprehensive public health data from a county. The process establishes priority objectives derived from public health concerns and gives officials directional guidance for addressing those issues that rise to the top.

The next steering committee will be held on March 10, focusing on physical environments affecting health outcomes.