1 HAYWOOD ST., SUITE 425
ASHEVILLE, NC 28801
Social determinants of health are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”
Some environmental conditions enhance quality of life and positively influence population health outcomes.
Examples of these conditions include:
“safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/ health services, and environments free of life-threatening toxins.”
These social and environmental conditions contribute significantly to health outcomes. In fact, research suggests that up to 80 percent of patient health outcomes are determined by social and environmental factors, rather than clinical care.
The number of deaths that can be linked to poverty, racism, and other social factors is comparable to leading causes of death in the US, such as heart attacks, stroke, and lung cancer.
One of Healthy People 2030’s 5 overarching goals is specifically related to SDOH: “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”
What do the numbers say?
Explore the regional WNC Data Set to review local and regional poverty data in more depth.
Percent Total Population Below 100% Poverty Level, 2014-2018
Source: ACS, 2020
“While repercussions resulting from poverty are present at all ages, children in poverty may experience lasting effects on academic achievement, health, and income into adulthood.
Low-income children have an increased risk of injuries from accidents and physical abuse and are susceptible to more frequent and severe chronic conditions and their complications such as asthma, obesity, diabetes, ADHD, behavior disorders, and anxiety than children living in high income households.”
(County Health Rankings and Roadmaps, 2019)
Poverty disproportionately impacts our youngest residents.
Almost a quarter of children (20.5%) under the age of 18 in WNC were living below poverty level in 2015-2019.
(ACS, 2021)
“The ongoing stress and challenges associated with poverty can lead to cumulative health damage, both physical and mental.”
County Health Rankings and Roadmaps, 2019
Adverse Childhood Experiences, or ACEs, also can impact children’s health into adulthood. Chronic stressful or traumatic childhood experiences can alter brain development and the immune system, leading to lasting physiological and cognitive changes.
A large and growing body of evidence shows that ACEs have a significant negative effect on a broad range of cognitive, socio-emotional, and health outcomes over the lifespan, including risk for chronic disease, mental illness, violence, and being a victim of violence.
North Carolina Social Determinants of Health by Regions
The North Carolina Department of Health and Human Services’ State Center for Health Statistics has created an interactive map with a series of overlays showing social determinants of health indicators in North Carolina, including the economic, social and neighborhood, and housing and transportation status of residents across the state.
Food Insecurity, Housing Instability, Transportation Challenges, and Interpersonal Violence and Toxic Stress
The North Carolina Department of Health and Human Services, in collaboration with stakeholders, identified four priority domains of Social Determinants of Health:
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Food Insecurity
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Housing Instability
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Transportation Challenges
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Interpersonal Violence and Toxic Stress
These conditions not only have a deep impact on a person’s health, safety and well-being, but also on healthcare utilization and costs.
Now, let’s explore each of these four domains in western North Carolina…
Food Insecurity
Food Insecurities per County, by Year
Source: WNC Healthy Impact Community Health Survey, 2018-2021
More than half of very low-income adults in WNC have experienced food insecurity in the past year.
(WNCHN – WNC Healthy Impact Community Health Survey, 2021)
Food Insecure represents those who responded “often true or sometimes true” to either: 1) Worried about whether our food would run out before we got money to buy more or 2) The food we bought just did not last, and we did not have enough money to get more.
Approximately 20% of adults are food insecure in WNC.
The following adult populations were significantly more likely to be food insecure in 2021:
- Women (24.9%)
- Adults aged 18-39 (26.3%)
- Very low (54.6%) and low income (31.7%)
- Those identifying as either Black (29.6%), Hispanic (35.7%), or AI/AN, Indigenous (57.8%)
(WNCHN – WNC Healthy Impact Community Health Survey, 2021)
Differences in health outcomes across social groups, economic status, and racial/ethnic identity are closely linked with disparities in social determinants of health, which disproportionately burden individuals and communities who experience systemic disadvantage and/or discrimination.
What does WNC say is the story behind food insecurity?
The items to the right and below are paraphrased themes that emerged from a 2018 regional survey of key informants. These responses do not:
- Necessarily reflect accurate or scientifically validated information about health determinants, outcomes, and/or strategies for change,
- Represent an exhaustive list of factors that can help or hurt efforts to address this key regional health issue.
The information in this section should be interpreted and used with care. It should be used only to help local health departments and agencies begin to understand community perceptions about local health issues. Communities are strongly encouraged to collect their own, local-level data to inform local planning and evaluation activities.
What’s Helping?
- Community food banks and pantries
- Churches and faith-based programs
- Collaborative community efforts
- Better awareness and education of issue
- Community Gardens
What’s Hurting?
- Access to healthy food
- Lack of awareness/education of issue and resources
- Funding
- Transportation
- Lack of resources
- Stigma/shame
Source: WNCHN – Online Key Informant Survey, 2018
“Agencies are collaborating to meet existing food needs. Desire to help exists and the community is supportive.”
(WNCHN – Online Key Informant Survey, 2018)
“We need a better distribution system, as well as a variety of food choices and sharing of knowledge so that people may supplement their diet with locally grown food.”
(WNCHN – Online Key Informant Survey, 2018)
Housing Instability
Adults with Housing Rent Greater than 30%, by Year
Source: ACS, 2020
Approximately, forty percent (42.9%) of households are rent burdened (Units Spending >30% Household Income on Housing) in WNC in 2015-2019.
(ACS, 2021)
Thirty percent of household income is a widely used and accepted standard to measure the extent of housing affordability problems across the country.
(Joint Center for Housing Studies of Harvard University, 2018)
Mapping Housing Affordability in North Carolina
The North Carolina Housing Coalition has developed a mapping tool in partnership with the North Carolina State University Geospatial Information Science and Technology Program. This tool explores different aspects of the housing affordability challenge faced by each county.
(North Carolina Housing Coalition, 2019)
Explore the 2019 County Profiles for additional county-level housing data, including: a comparison of what different jobs pay and changes in home prices, foreclosures, and rental options in communities.
What does WNC say is the story behind housing insecurity?
The items below are paraphrased themes that emerged from a 2018 regional survey of key informants. These responses do not:
- Necessarily reflect accurate or scientifically validated information about health determinants, outcomes, and/or strategies for change,
- Represent an exhaustive list of factors that can help or hurt efforts to address this key regional health issue.
The information in this section should be interpreted and used with care. It should be used only to help local health departments and agencies begin to understand community perceptions about local health issues. Communities are strongly encouraged to collect their own, local-level data to inform local planning and evaluation activities.
What’s Helping?
- Better awareness of the issue
- Increased housing
- Collaborative and focused community efforts
- Recent economic development
What’s Hurting?
- Lack of progress/no progress on this issue
- Lack of affordable housing
- Lack of funding
- County and city government and policies
- Cost of living
Source: WNCHN – Online Key Informant Survey, 2018
“The most important thing that has happened so far is simply the realization of the need.”
(WNCHN – Online Key Informant Survey, 2018)
“New housing is expensive and not affordable for low-income and seniors.”
(WNCHN – Online Key Informant Survey, 2018)
Transportation Challenges
Households Without a Vehicle, 2015-2019
Source: ACS, 2021
A total of 17,757 or 7.3% of occupied households (includes owner and renter occupied units) did not have access to a vehicle in 2015-2019.
(ACS, 2021)
“Because transportation touches many aspects of a person’s life, adequate and reliable transportation services are fundamental to healthy communities.”
What does WNC say is the story behind transportation challenges?
The items below are paraphrased themes that emerged from a 2018 regional survey of key informants. These responses do not:
- Necessarily reflect accurate or scientifically validated information about health determinants, outcomes, and/or strategies for change,
- Represent an exhaustive list of factors that can help or hurt efforts to address this key regional health issue.
The information in this section should be interpreted and used with care. It should be used only to help local health departments and agencies begin to understand community perceptions about local health issues. Communities are strongly encouraged to collect their own, local-level data to inform local planning and evaluation activities.
What’s Helping?
- Local agencies and organizations
- Increase in plans and support of access to transporation
- Better awareness of the issue
- Collaborative and focused community efforts
What’s Hurting?
- Lack of progress/no progress on this issue
- Lack of funding
- Lack of access to transportation
- Geography of WNC
- Lack of vision/strategic planning
Source: WNCHN – Online Key Informant Survey, 2018
“Growing talks among various community groups about the need of transportation.”
(WNCHN – Online Key Informant Survey, 2018)
“Lack of money, lack of a vision for the community and the need for someone/ group to take the lead.”
(WNCHN – Online Key Informant Survey, 2018)
Interpersonal Violence and Toxic Stress
“Interpersonal violence refers to violence between individuals, and is subdivided into family and intimate partner violence and community violence.”
“[Family and intimate partner violence] includes child maltreatment; intimate partner violence; and elder abuse, while [community violence] is broken down into acquaintance and stranger violence and includes youth violence; assault by strangers; violence related to property crimes; and violence in workplaces and other institutions.”
Number of Crisis Calls, by Fiscal Year
Source: North Carolina Department of Administration, 2020
The NC Council for Women and Youth Involvement (NCCFWYI) requires each state-funded domestic violence (DV) grantee to report semi-annually on client service provision. The above chart represents the number of crisis calls made to state-funded domestic violence agencies in WNC per fiscal year.
In WNC, there were 3,586 fewer crisis calls and 709 fewer clients served from fiscal year 2018 to 2019.
Sexual assault is often under-reported. Approximately, 230 out of every 1,000 sexual assaults are reported to the police, meaning about 3 out of 4 go unreported.
Department of Justice – National Crime Victimization Survey, 2017
What does WNC say is the story behind interpersonal violence?
The items below are paraphrased themes that emerged from a 2018 regional survey of key informants. These responses do not:
- Necessarily reflect accurate or scientifically validated information about health determinants, outcomes, and/or strategies for change,
- Represent an exhaustive list of factors that can help or hurt efforts to address this key regional health issue.
The information in this section should be interpreted and used with care. It should be used only to help local health departments and agencies begin to understand community perceptions about local health issues. Communities are strongly encouraged to collect their own, local-level data to inform local planning and evaluation activities.
What’s Helping?
- Local agencies and organizations
- Effective law enforcement
- Better awareness of the issue
What’s Hurting?
- Stigma of issue and cultural barriers
- Lack of focused community efforts
- Home environment
- Lack of funding
Source: WNCHN – Online Key Informant Survey, 2018
“Empowering more women, and educating both men and women.”
(WNCHN – Online Key Informant Survey, 2018)
“There is still a high degree of shame in being victimized. That is changing, but progress still must be made.”
(WNCHN – Online Key Informant Survey, 2018)
How is the region prioritizing social determinants of health?
The western North Carolina region includes 17 communities: 16 counties and Eastern Band of Cherokee Indians (EBCI)
How is the region prioritizing social determinants of health?
The western North Carolina region includes 17 communities: 16 counties and Eastern Band of Cherokee Indians (EBCI)
In the 2021 CHA cycle, one community selected social determinants of health as a key priority.
However, all WNC communities consider the social determinants of health as key drivers to addressing local key health priorities.
Navigating services like health, housing, employment, and transportation can be incredibly difficult, but these factors all contribute to our overall health.
NCCARE360 provides the opportunity for health to all North Carolinians by providing public access to resources and helping health and community-based organizations make electronic referrals, communicate in real time, securely share client information, and track outcomes together.
