1 HAYWOOD ST., SUITE 425
ASHEVILLE, NC 28801
Why are the Social Determinants of Health Important?
In the United States clinical care impacts only 20% of county-level variation in health outcomes, while social determinants of health affect as much as 50% of health outcomes. More specifically socioeconomic factors alone may account for 47% of health outcomes (Assistant Secretary for Planning and Evaluation, 2022). 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 (Galea, Tracy, Hoggart, DiMaggio, and Karpati, 2011). The North Carolina Department of Health and Human Services, in collaboration with stakeholders, identified four priority domains of Social Determinants of Health which include food insecurity, housing instability, transportation challenges, and interpersonal violence and toxic stress (NC DHHS, 2018). These conditions not only have a deep impact on a person’s health, safety and well-being, but also on healthcare utilization and costs (NC DHHS, 2018).
The North Carolina Department of Health and Human Services’ State Center of 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 transportation status of residents across the state.
Poverty
Between 2016 and 2020, 13.3% of the population in WNC were below the poverty level.
(WNCHN- WNC Healthy Impact Community Health Survey, 2021)
Percent Total Population Below 100% Poverty Level, 2014-2018
Source: ACS, 2020
Explore the regional WNC Data Set to review local and regional poverty data in more depth.
Percent of Individuals Living At or Below Poverty Status, 2015-2019
Source: American Community Survey, 2015-2019
What do the Numbers Say about Poverty?
Approximately 13% of adults in WNC fall under the poverty level. The adult populations most affected by poverty include:
- Those identifying as Black (18.9%), Hispanic (28.2%), or American Indian/Alaska Native, Indigenous (13.3%)
(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.
State and National Findings:
As of 2020, there were more women (12.9%) living in poverty when compared to men (10.6%).
The official poverty rate in 2021 was 11.6%, with $37.9 million people in poverty.
(United States Census Bureau, 2022)
Food Insecurity
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 per County, by Year
Source: WNC Healthy Impact Community Health Survey, 2018-2021
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.
2) The food we bought just did not last and we did not have enough money to get more.
Food Insecurity: Distance from the Nearest Grocery Store, 2015-2019
Source: American Community Survey, 2015-2019
What do the Numbers Say about Food Insecurity?
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 American Indian/Alaska Native, Indigenous (57.8%)
In 2020, 14.8%of households with children were food-insecure, up from 13.9% in 2019. In 2020, the households most commonly experiencing food insecurity were:
- Married couples with children (4.6%)
- Hispanic households with children (12.2%)
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.
State and National Findings:
In 2021, roughly 32% (32.1)of households with income below the federal poverty line were food insecure.
Rates of food insecurity in the United States were higher than the national average for single-parent households, as well as, for Black and Hispanic households. Food insecurities were also more common among large cities and rural areas when compared to suburban areas.
In 2020, 85.2% of households with children were food secure, while 14.8% were food-insecure, up from 13.9% in 2019.
Since March of 2020, food insecurities in families with children in the United States have risen by nearly two-thirds.
Housing Instability
Between 2016-2020, 41.9% of Western North Carolina’s population that rent housing were paying over 30% of their monthly income toward housing.
Adults with Housing Rent Greater than 30%, by Year
Source: ACS, 2020
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)
Percent of Households Spending Over 30% of Monthly Income on Rent or Mortgage, 2015-2019
Source: American Community Survey, 2015-2019
In 2021, 26.7% of WNC reported being worried or stressed about paying rent or a mortgage within the past year.
State and National Findings:
As of May 2022, the median listed rent for an available apartment rose above $2,000 a month.
As of January 2021, there were an estimated 15 million adults in the United States facing housing insecurity.
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 2023 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.
Transportation Challenges
As of May, 2020, more than one million rural households did not have access to a car. On a national level the majority of households without a car are in Urban areas with about 9% of households in urban counties not having access to a car.
In 2019, roughly 3% of households in Western North Carolina were without a vehicle.
Households Without a Vehicle, 2015-2019
Source: ACS, 2021
“Because transportation touches many aspects of a person’s life, adequate and reliable transportation services are fundamental to healthy communities.”
State and National Findings:
In 2019, 5% of the United States workforce relied on public transportation to get to work.
In 2021, 5.5% of North Carolina households did not have a vehicle, while 8.3% of United States households were without a vehicle.
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.”
In the 2020-2021 fiscal year there were over 17,000 (17,746 total) crisis calls in Western North Carolina.
Number of Crisis Calls, by Fiscal Year
Source: North Carolina Department of Administration, 2020-2021
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.
State and National Findings:
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 social determinants of health?
The items below are paraphrased themes that emerged from a 2021 regional survey of key informants. These responses do not:
- 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.
(WNCHN – Online Key Informant Survey, 2021)
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?
- Collaboration between community partners
- Foodbanks/Assistance programs
- Community/Family Assistance
- Awareness/Education
- Job training for employment assistance
What’s Hurting?
- Inflation
- Transportation
- Not enough support from the community
- Stigma/Pride
- Lack of higher paying jobs
What are we hearing?
“Many groups are working on a common goal of reducing youth substance use, adult substance misuse, food insecurity and issues related to poverty.”
“Affordable, safe and healthy housing creates an environment that is the foundation for much of one’s life. It impacts rest, work and health. Having access to this type of housing can reduce stress, allow for appropriate study for students, foster healthy family relationships and community relationships.”
“Affordable, safe and healthy housing creates an environment that is the foundation for much of one’s life. It impacts rest, work and health. Having access to this type of housing can reduce stress, allow for appropriate study for students, foster healthy family relationships and community relationships.”
“There are many technical service providers offering free assistance to both jobseekers and would-be entrepreneurs. There are programs to help people move from unemployment to employment.”
“Public transportation provides access to medical appointments, as well as meals at the senior center, transportation to employment, grocery shopping, etc.”
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.
What’s Happening Regionally?