Anson County. State of the County Health Report December 2017

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1 2017 Anson County State of the County Health Report December 2017

2 State-of-the-County Health Report 2017 The Anson County Health Department, through this report (SOTCH), is presenting current information on the status of Anson County s most pressing health issues, as determined in the 2016 Community Health Assessment. The SOTCH report provides an update of progress made, information gained, and lessons learned during this year. Partnering with numerous stakeholders in the community, our main focus currently is teen pregnancy/stds, childhood obesity and hypertension. The Anson County Health Department (ACHD) and the local hospital, Carolinas HealthCare System Anson (CHS Anson) partnered to conduct the 2016 Community Health Assessment (CHA). These partners convened a core committee, the Community Health Assessment Planning Group, to guide the process, and they contracted with a consultant experienced in CHAs to assist in the collection of data and conducting the analysis. The following steps were involved in the CHA process: Primary Data was obtained through surveys. Five hundred forty six surveys were obtained from the public. Twenty seven key informant interviews were completed, and a community focus group was held to get input directly from the citizens of Anson County for the CHA. An inventory of health and wellness resources was compiled and included in the CHA report. Secondary data was gathered from sources recommended by CHA guidelines, the core committee and key informants. The core committee and a group of community stakeholders analyzed the public input, secondary data and the resource inventory. Three Community Health Action Plans were developed and are to be executed over the next 3 to 4 years. Since 2011 Anson County has consistently ranked as one of the 20 least healthy counties in North Carolina according to the County Health Rankings Organization. Health professionals and the public are aware, and have been for a long time, of the specific health problems in the county. The CHA core committee and the other stakeholders decided to focus on intervention and prevention in choosing the three priorities. Following the two previous CHAs, broad areas were chosen as priorities and this made it difficult to measure impact. Also, because the current problems in the county have existed for decades, the CHA team understands that a culture change is necessary to have a true and lasting impact. They feel that narrowing the focus by disease and/or target population will have the best chance at making a culture change. Based on these factors, the following priorities were chosen and Action Plans were prepared: Childhood Obesity Decrease STD/Teen Pregnancy Prevention Hypertension Prevention and Control The local hospital, CHS Anson, is serving as the Lead Agency for childhood obesity and hypertension, and the Health Department is taking the lead on teen pregnancy and STDs. All three priorities are in alignment with the Healthy North Carolina 2020 Objectives.

3 OBESITY Obesity continues to be an epidemic in our country today as well as in our state and our county. Continued efforts are being made in the fight against this dangerous, and often fatal, plague of society. Team efforts are being implemented to aid in both the prevention and management of this disease by Carolinas HealthCare System Anson, the Health Department, and other local agencies. Childhood obesity is of special concern due to the damage done to the child s health, as well as the elevated cost of medical care to treat problems associated with it. Hypertension is often seen in children who are obese as well as diabetes. Children are frequently bombarded with televised commercials for fast foods, sweets and use of internet games. Education must continue for the parents and relatives of these young ones as well as the kids themselves. Children and their families must be challenged in positive ways to make lifestyle changes to address these issues. CHS Anson launched an obesity management program in the schools targeting the children in all of the county s elementary schools. Attention was given on improving one s diet via nutrition education. Physical activity was encouraged on a regular basis. The nationally recognized and evidence based 5210 Youth Nutrition Program was implemented in this endeavor. The 5210 program encourages five servings of fruits and vegetables daily, no more than two hours of screen time per day, one hour of activity or play time and zero sugary drinks. The schools and the hospital are also working with the local Smart Start agency, the Anson County Partnership for Children, in this initiative. Below are some of the activities and achievements since the 5210 program was implemented: 1. A meeting was held with site champions from each school to discuss the success of the program in and ways the program can be improved in school year. 2. Beginning of the year assessments have been completed at each Elementary School-6 in total. 3. Beginning of the year banner presentations and program review assemblies are being scheduled for the first 2 weeks of January In addition to the above, Anson County Parks and Recreation is offering a variety of spring sports to the youth in the county. Tee ball is for ages 4 to 6, coach pitch ages 7 to 8, baseball ages 9 to 12, soccer ages 3 to 4. These activities are offered for a minimal fee of twenty-five dollars. Also, volleyball has been introduced this year for children Exercise is a good way for these young ones to aid with weight loss. Lessons in swimming are made available in summer months to children and adults for a minimal fee. Jump Rope for Heart is a program in the public schools that is being used to encourage children to be active by jumping rope. It also teaches them healthy heart habits and focusing on a healthy diet. This program was implemented through the American Heart Association. Monies have been raised from the local community to help fund these programs, and to educate the public regarding the lifetime benefits for our children in maintaining a healthy lifestyle. The public schools in Anson County have been involved with this important program for some time. On February 17 th, two nurses from the Health Department participated in an exercise program with kids at Headstart. The parents also participated in this program. It is important to get the families involved so that these healthy activities become a habit. On February 27 th, a nurse from the Health Department, along with several community partners, participated in a health fair at one of the local elementary schools.

4 Information was provided on obesity, hypertension, smoking cessation, WIC, STD s, Family Planning, immunizations, and mental health to the parents and others in the community. In March, two health fairs were conducted. One was focused on Special Needs teens from the local schools and another county. Brochures were distributed focusing on healthy diet, weight loss, smoking cessation, exercise, diabetes, services offered at the Health Department, WIC, puberty and other topics of interest. The second health fair was held at another school in the county one afternoon after classes were over. This fair focused on reaching out to the parents as well as students on healthy habits such as diet, exercise, puberty, smoking cessation, diabetes, and hypertension. A nurse was present to answer questions. Local churches in the county offer a variety of health topics available to the public. For example, AME Zion Church offers gospel aerobics to the public weekly. The Anson County Field of Dreams sports complex continues to offer a variety of sports for the youth of the county, providing significant opportunities for exercise and activity. The Discover Anson Bike Ride for bike enthusiasts continues to be a welcome annual event for novices as well as more experienced bikers. In addition, walking trails are available at Anson s local public parks as well as playgrounds for the kids during summer months. Lilesville, Polkton, and Peachland offer walking tracks to accommodate the walking enthusiasts of the county. Parks and Recreation offer a variety of activities throughout the year to adults and kids of all ages. In the summer swimming is offered. In the fall, basketball is available for the young ones. Aerobics classes are offered weekly at a local gym with the option to pay per class. A nurse employed by the health center leads them. This class is being offered to the citizens of the county of Anson. Each participant is encouraged to have their doctor s approval before beginning an exercise class. In May, the annual health fair for senior citizens was held at the Lockhart Taylor Center. Approximately 100 senior citizens and workers were presented with brochures on healthy living. These brochures were on smoking cessation, diabetes, hypertension, weight management via exercise and healthy diet. Blood pressure checks were done for the citizens by nurses from the Health Department. In May, the HOLLA! Center had a 5 K run/walk for folks of all ages. The HOLLA! Center program helps our children to develop and sustain good habits such as healthy eating, exercise, and a reading program to aid kids with improvement in literacy.

5 In May, the local schools partnered with the CHS Anson to encourage kids utilizing the 5210 program. Backpacks were given with water bottles, jump ropes and frisbees along with 5210 magnets. The famous quarterback of the Carolina Panthers, Cam Newton, also paid a visit to a local school to encourage the children in developing a healthy diet and participating in physical activities. Several farmers markets in the county continue to offer a variety of fresh seasonal fruits and vegetables to the public. Various markets are located throughout the county to make fresh produce readily accessible to the citizens of Anson County. On October 9 th, a new Public Health Educator was hired at Anson County Health Department. She is currently being introduced to key players in the community and is developing a variety of initiatives to improve the health of the local citizens. In November, the new local Public Health Educator participated in a program for local veterans. She presented them with a variety of information on various health topics of interest. The Health Educator has been quite busy since beginning her new position! From presentations at local clubs to daycare and senior sites she has offered education and related information on numerous subjects. Some of these are: exercise presentations, health statistics, community health assessment and personal hygiene. Hypertension Hypertension has long been a condition that causes many health problems. Frequently, high cholesterol is seen along with high blood pressure as are diabetes, heart disease and kidney disease to mention just a few. In Anson County, 2.4% of deaths are caused by hypertension. Hypertension increases with age as one might expect. In year-old adults it jumps from 12.6% to 45.2% in adults 35 to 54 years old. CHS Anson hopes to implement the Check. Change. Control. (CCC) program by summer of The program incorporates the concepts of remote monitoring and online tracking as key features to improve outcomes in hypertension management, physical activity, and weight reduction. This program will be offered in conjunction with the American Heart Association. CHS Anson is focusing on adults in the 35 to 54 age group. It is hoped that by earlier intervention, as one ages, less problems associated with this health problem will occur. Below are listed some of the initiatives undertaken by the hospital in implementing the Hypertension Action Plan: 1. A mobile unit will continue to perform blood pressure screenings in 10 set locations throughout the county. 2. Additional services for control of hypertension are being explored to use on the mobile unit. 3. CHS Anson s Community Health Nurse, Patient Navigator, Faith Community Health Ministry Coordinator, Carolinas Primary Care Practice Manager, and the Anson County Health Department Nursing Supervisor, met with Marques Fitch, Director of Community Impact for the Greater Charlotte Chapter of the American Heart Association (AHA) to plan for implementing the Check. Change. Control. Program. 4. Mr. Marques informed the group as of November 13 th, the AHA has lowered the blood pressure threshold to 130/80 now considered to be hypertension. 5. Due to this change, there is a delay in getting resources the AHA typically provides for their partners. The AHA will provide them as soon the revised materials in support of the new guidelines are available.

6 6. Mr. Marques discussed implementation of the CCC program. It was decided for each individual in attendance to create an account for CCC and to navigate through the program. Subsequently, Mr. Marques will return to follow up and answer specific questions the group may have. 7. This follow up meeting has yet to be scheduled. The Anson County Health Department continues to play a role in the prevention of hypertension by offering brochures on hypertension, healthy diet, exercise, and smoking cessation. Counseling is offered as clients come in and are found to have the elevated blood pressure. They are then referred to other providers, including CHS Anson, to treat the disease. In addition, the Health Department has agreed to serve as one of the entry points into the CCC program. Hopefully, as we approach this problem with a team effort positive outcomes will become the norm instead of the exception. Sexually Transmitted Disease Sexually transmitted diseases continue to be a significant problem in Anson County. These diseases are highly preventable when appropriate preventive measures are taken. Much effort has been given through the years by the Health Department to reach the community to aid in control and management of STDs. Unfortunately, Anson County continues to have some of the highest STD rates in NC, and currently has the highest rate of newly diagnosed Gonorrhea cases in the state. Gonorrhea cases increased by 17.3% between 2010 and Also, Syphilis cases were up significantly, with a 68% increase from 2010 through 2015! On the plus side, there was a 22.1% decrease in the number of HIV cases from 2010 through There is still much work to be done through education of the public on the prevention and treatment of these diseases. With the funding approved for a Public Health Educator in fiscal year 2018, a major sustained STD educational effort is being developed. Health fairs throughout the year have provided individuals with STD prevention brochures and education. Also, Health Department RNs are available to counsel those that show interest in knowing more about the services offered in public health, and how to get the help needed for both prevention and treatment of STDs. The Making Proud Choices program continues to be taught in the schools of Anson County. This program focuses on reaching young teens in the seventh and eighth grades with education on choices to help prevent sexually transmitted diseases. It aids the teens in being more aware of their behaviors and the impact of the choices that they make. It helps them realize the consequences of those choices, and how their lives could be affected if they choose to become sexually active. On October 3 rd a nurse from the Health Department made a presentation on sexually transmitted disease and family planning with unemployed women at the Lockhart Taylor Center.

7 Teen Pregnancy Prevention Teen pregnancy prevention has long been a challenge for Anson County. According to the N. C. Center for Health Statistics 2015 report, the rate for teen pregnancies in Anson County was 48.3% (approximately 72 pregnancies) compared to the state average of 28.2%. According to the Anson County 2016 Community Health Assessment, Anson County s 2015 percentage of Total Pregnancies that were teens was only 1.4% less than the highest Peer County. Education continues for these teens to help direct them to making safe and healthy choices. Family Planning is offered at the Health Department to help teens to choose appropriate methods of birth control to prevent unwanted pregnancies. Abstinence is also taught. Verbal counseling is offered by the nurses. Brochures are also given as indicated. Follow up is done with many of these teens to make certain they are not having problems with their choice of birth control, and to address their questions and concerns. Again, the seventh and eighth graders are targeted in the schools with the Making Proud Choices curriculum. The program coordinator in the schools, school social worker, and the school nurse all work together to aid these young teens to find healthy and beneficial options for pregnancy prevention. HOPE Ministries had a five K race in October at South Piedmont Community College in Anson County. This ministry is a Christian based organization focused on helping the indigent pregnant women of Anson County to get counseling related to prenatal care. They also aid with giving women diapers and supplies for their infant. The ministry also provides ultrasound exams. This ministry strives to bring women the assistance they need at a very important time in their lives. In August, the ACHD s Family Planning Coordinator conducted a program for the local school teachers on the family planning services, STD s, and immunizations available at the Health Department. The nurse was also available for any questions raised by the participants. During 2017, the Family Planning Coordinator also held classes at the Lockhart Taylor Center for the Work First Students on family planning services, STD s, and other areas of interest.

8 OTHER MAJOR DEVELOPMENTS IN 2017 The reaccreditation survey for the Anson County Health Department was conducted on September 7 th and 8 th. The Health Department met 146 of the 147 activities required for accreditation. On December 19 th, the Health Department was formally reaccredited by the North Carolina Local Health Department Accreditation Board. Of the nine Health Departments reaccredited at the December 19 th meeting, four met the new standard of Reaccreditation With Honors. Anson was one of the four. This was a significant achievement for a rural health department with only 19 staff members. A Breastfeeding Peer Counselor Program was implemented through the WIC program at the Health Department. A trained counselor is now able to assist women who are interested in offering breastfeeding to their infants. Healthier babies and moms result from this healthy alternative to formula fed infants. After an analysis of several vendors, CureMD was selected to provide an Electronic Medical Record for the Health Department. Files were imported from Avatar HIS, the state department system, in February Training sessions were held throughout the year for the staff. The financial portion of the EMR went live in April, and the clinical EMR went live in June. Presently, all clinical patients are being processed with Cure MD. Cure MD is also working closely with the NC HIE project to ensure the ability to submit client s records as required by NC Statute in June Internally, all documents and information have been submitted to the NC HIE administration and have been approved. The Health Department has not had a Public Health Educator for several years. While the Health Department had three at one time, the positions were eliminated by the county over the last ten years due to budget constraints. After several years of effort, the County Commission approved funding for a Public Health Educator in the county s budget. A search was initiated in July and the new Public Health Educator was hired in October. A major priority in 2018 and beyond is to rebuild a comprehensive and sustained program of public health education in the county to address the issues outlined in this report.

9 LET S DO DATA! Health Data Results Highlights of collected data, Primary (public input) and Secondary, are presented here; additional details and charts are provided in the Community Input Results and Analysis and the Databook Appendices. Overall Health Picture One of the common measures used by the State of North Carolina and its individual counties is the County Health Rankings done by the County Health Rankings Organization. The following table provides some of those key rankings for Anson County, its Peer Counties and the State. The best county is highlighted in lavender and the worst county is highlighted in orange. CHA Table #7 Health Indicator Anson Bladen Montgomery Pasquotank Richmond Scotland Vance State Overall Rank out N/A of 100 Poor or Fair 25% 24% 22% 19% 23% 26% 24% 19% Health Poor physical health days Poor mental health days Low birthweight 12% 10% 9% 10% 11% 13% 12% 9% Adult Smoking 24% 23% 21% 19% 21% 25% 22% 19% Adult Obesity 35% 35% 32% 34% 37% 37% 37% 29% Physical inactivity % adults 20 & over reporting no leisure-time physical activity 30% 33% 28% 28% 32% 27% 33% 25% Access to exercise opportunities % adults living reasonably close to physical activity location Excessive Drinking 6% 35% 77% 69% 60% 66% 69% 75% 13% 12% 13% 15% 13% 12% 12% 15% Anson County ranked poorest in one Indicator: Access to exercise opportunities at 6% Anson was 29% lower than the County with the next closest ranking and 71% lower than the County with the best ranking. Anson County was only 1 to 3 percentage/ratio/rate points above the County with the poorest ranking in: o Poor or Fair Health o Low Birthweight o Adult Smoking o Adult Obesity o Excessive Drinking

10 The following chart illustrates the percentage of Public Survey participants who have Hypertension alone and who have other conditions that are related to Hypertension. It is important to remember that all of the pie slices other than the large blue section (54%) represent someone that has Hypertension. CHA Graph #19 Hypertension & Interrelated Chronic Health Conditions 8.0% 4.0% 2.0% No Chronic Disease Condition Hypertension Only 9.0% Hypertension & Obese Hypertension, Obese & High Cholesterol 54.0% Hypertension, Obese, High Cholesterol & Diabetes 23.0% Hypertension Obese, High Cholesterol, Diabetes & Heart Disease

11 Childhood Overweight/Obesity The following table and Graphs provide data on the percentage of overweight and obese 2 to 4 years olds for Anson County, its Peer Counties and the State. This data is from the NC-NPASS (North Carolina-Nutrition and Physical Activity Surveillance System). CHA Table #24 Rate County/State Trend 2010 to 2012 Anson County 15.2% 18.3% + 3.1% Percentage of State 16.1% 14.9% -1.2% Overweight Bladen County 17.0% 14.9% -2.9% (85 th to 95 th Montgomery County 17.0% 15.4% -1.6% Percentile) Pasquotank County 17.6% 13.3% -4.3% Children 2 through 4 Richmond County 10.0% 12.7% +2.7% years of age Scotland County 14.1% 10.4% -3.7% Vance County 11.1% 11.9% +.8% Percentage of Obese (Above 95 th Percentile) Children 2 through 4 years of age Percentage of Overweight & Obese (85 th Percentile and above) Children 2 through 4 years of age Anson County 16.6% 19.2% +2.7% State 15.6% 14.5% -1.1% Bladen County 17.3% 15.9% -1.4% Montgomery County 17.0% 15.4% -1.6% Pasquotank County 15.0% 15.9% +.9% Richmond County 9.4% 13.1% +3.7% Scotland County 13.6% 12.8% -.8% Vance County 12.9% 11.3% -1.6% Anson County 31.8% 37.5% +5.7% State 31.7% 29.4% -2.3% Bladen County 34.3% 30.8% -3.5% Montgomery County 34.0% 30.8% -3.2% Pasquotank County 32.6% 29.2% -3.4% Richmond County 19.4% 25.8% +6.4% Scotland County 27.7% 23.2% -4.5% Anson County was one of 3 counties in its Peer County group with an increase in the percentage of Overweight Children Ages 2 through 4. Anson had the highest percentage increase. Anson County was one of 3 counties in its Peer County group with an increase in the percentage of Obese Children Ages 2 through 4. Anson had a 1% less increase than Richmond County which had the highest increase. Anson County was one of 2 counties in its Peer County group with an increase in the percentage of Overweight & Obese Children Ages 2 through 4. Anson had the highest percentage of Overweight & Obese. Anson had a.7% less increase than Richmond County the only other County with an increase.

12 The following Graph depicts the 2012 statistics on Overweight and Obese Children Ages 2 through 4 in Anson County, its Peer Counties and the State. CHA Graph #20 Anson County had the highest rate of Overweight and Obese children Ages 2 through 4 in 2012 within its Peer County Group. In 2012 Anson County s percentage of Overweight & Obese Children Ages 2-4 was 8.1% higher than the State s percentage. Anson County s rate in 2012 was 6.7% higher than the next 2 highest counties.

13 CHA Graph #21 A 2012 report on the North Carolina Statewide CHAMP (Child Health Assessment and Monitoring Program) Survey Results on Weight and Height show that: 14.3% of Children ages 2 through 17 in North Carolina are Overweight (85 th to 94 th Percentile) 18.4% of Children ages 2 through 17 in North Carolina are Obese (95 th and above Percentile) 32.4% of Children ages 2 through 17 in North Carolina are Overweight or Obese These are statewide statistics, but based on the statistics for Children ages 2 4 provided on the previous pages, it is likely that Anson s statistics for Children ages 2 through 17 would be higher than the State numbers.

14 Teen Pregnancy The information in the following tables and graphs is from the NC State Center for Health Statistics 2015 report on Pregnancy, Fertility, Abortion, and Fetal Death Rates. Note: The NC State Center for Health Statistics states: The data presented are for all North Carolina pregnancies. Total pregnancies represent the sum of all induced abortions, live births, and fetal deaths 20 or more weeks of gestation reported in the state. Not included are spontaneous fetal deaths (still births) occurring prior to 20 weeks gestation, which are not reportable to the state. Special emphasis is placed on abortions, given that they are not reported in other SCHS publications. Anson County is in PCR (Prenatal Care Region) III, the Southwestern Region. The counties in Region III are: Cleveland Lincoln Gaston Mecklenburg Cabarrus Stanly Union Anson CHA Graph #24

15 CHA Graph #25 Anson County s 2015 percentage of Total Pregnancies that were Teens is only 1.4% less than the highest Peer County. Anson s percentage is higher than 3 Peer Counties, Region III and the State. The following Graphs compare the racial breakdown of the Anson Teen Pregnancies with that of the County population. CHA Graph #26 CHA Graph #27 These percentages from American Community Survey (ACS) of the US Census. The Teen Pregnancy percentages are comparable to the Population percentages. The Female 15 to 19 Age Population is very different from the general population percentages. According to the American Community Survey (ACS) the general population is as follows: African American 49%, Caucasian 48%, Asian -.3%, Native American 1.2%, Multi-Cultural 1% and Hispanic 3.3%, Other.5%.

16 The following table and Graph compare Anson County s 2015 Teen Pregnancy rate with historical rates in Anson, its Peer Counties, Region III and the State. CHA Table #27 Total Teen (Ages 15-19) Pregnancy Rate per 1, Trend 2008 to 2015 Anson % Bladen % Montgomery % Pasquotank % Richmond % Scotland % Vance % Region % State % Anson County had the lowest percentage of improvement compared to all its Peer Counties, the Region and the State.

17 CHA Graph #28 This Graph compares the Anson County Teen Pregnancy Trend with its geographically nearest Peer Counties (Montgomery, Richmond and Scotland), Region III and the State. Anson County s trend has been inconsistent, alternating between improvement and worsening, but increased by 18% from 2014 to Following is the opinion of the public, by method of input, on how much of a problem Teen Pregnancy is in the County. 88% of Public Survey participants said that Teen Pregnancy is a Health Problem (56% Major, 32% Somewhat) only 4% said it is not a problem. It was the #5 Health Problem in the survey. 7% of Key Informants said that Teen Pregnancy is a problem. The Focus Group included Teen Pregnancy in the list of Health Problems. In the 2012 CHA the public opinion was: 86.3% of the Survey Participants said that Teen Pregnancy is a problem (Major or Somewhat) 13% of the Key Informants listed it as a Major Health Concern

18 Sexually Transmitted Diseases Information in this section is based on reported cases. County Health Rankings Sexually Transmitted Infections (STI) in the County Health Rankings are measured as the chlamydia incidence (number of new cases reported) per 100,000 population. This rate does not take into consideration any other type of STD. The following Graph illustrates the statistics from County Health Rankings Organization for Anson County, the State and Anson s Peer Counties Databook Graph #27 Anson s STD rate (Chlamydia incidence) is: o 12 points higher than the State rate o Higher than 2 of its Peer Counties o Lower than 4 of its Peer Counties According to the County Health Rankings the STD rate for Anson County has been stagnant from 2007 to However, the following Graph shows that the rate in fact increased dramatically before it returned in 2013 to approximately the same rate as Also, it is important to note that the rate in County Health Rankings is solely based on new Chlamydia cases per 100,000 and does not take other STDs into account. Databook Graph #28

19 Statistics from 2014 North Carolina HIV/STD Surveillance Report for State, Anson and Peer Counties Databook Table #23 The Trend column shows the percentage the County s rate Improved or Worsened Rate County/State Trend 2010 to 2015 Newly Anson County % Diagnosed State % Chlamydia Bladen County % Rates per Montgomery County % 100,000 residents Pasquotank County % Richmond County % Scotland County % Vance County % Newly Diagnosed Gonorrhea Rates per 100,000 residents Newly Diagnosed Early Syphilis Primary & Secondary Rates per 100,000 residents Newly Diagnosed Early Syphilis Early Latent Rates per 100,000 residents Newly Diagnosed HIV Rates by County of Residence at Diagnosis per 100,000 residents Anson County * +17.3% State % Bladen County % Montgomery County % Pasquotank County % Richmond County % Scotland County % Vance County % Anson County % State % Bladen County % Montgomery County % (2011 to 2015) Pasquotank County % Richmond County Scotland County Vance County % Anson County State Bladen County Montgomery County Pasquotank County Richmond County Scotland County Vance County Anson County % State % Bladen County % Montgomery County % Pasquotank County % Richmond County % Scotland County % Vance County % * Anson County had the highest rate in the State in Only 8 counties had a rate higher than 300.

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22 References The Anson Express Newspaper The Anson Record Newspaper County Health Rankings.Org 2016 Anson County Community Health Assessment SOTCH report presented by the Anson County Health Department in collaboration with community partners. December 2017