D224 Final for Task 1 copy copy

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Western Governors University *

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Sociology

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Feb 20, 2024

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1 Colt Beachboard Western Governors University Global and Population Health Marcus Gaut December 12, 2023

2 D224 Task 1: Proposed Population-Based Intervention Bertie County is a rural county in northeastern North Carolina that spans 42 square miles (ECU). According to the U.S. Census Bureau, Bertie County has a population of 17,934, with 20.7% of the subpopulation living in poverty. The number of residents living in poverty is currently above the state average. The races in Bertie County are 60.4 % black, 3% white, 0.9% American Indian, 0.8% Asian, 0.1% Native Hawaiian and other pacific islander, 1.6% two or more races, 2.6% Hispanic Latino, and 1.6% white alone non-Hispanic. The gender percentage in Bertie County is 48.6% female and 51.4% male. Of the population in the county, 4.4% are persons under five years, 16.8% are persons under 18 years, and 25.2% are persons 65 years and over. The median household income is $37,571. The education level for Bertie County is 80.2% high school graduates, and 15% have a bachelor’s degree or higher (U.S). Crime rates for Bertie County are 1,669.0 per 100,000, violent crime 454.6 per 100,000, and property crime is 1,214.3 per 100,000 (Crime). There are 5,170 total working residents in Bertie County, with 1,286 working in government, 3,885 working in private industry, 317 working in agriculture, forestry, fishing, and hunting; 37 working in construction; 2,094 working in manufacturing; 63 working in wholesale trade; 252 working in retail trade; 165 working in transportation and warehousing; 10 working in information; 48 working in finance and insurance; 6 working in real estate and rental

3 and leasing; 27 working in professional technical service; 259 working in administrative waste services; 363 working in educational services; 639 working in health care and social assistance; 184 working in accommodation and food services; and 764 working in public administration (County). Bertie County has public transportation through the Choanoke Public Transportation Authority, which costs $2 per ride. Bertie County has one hospital. Primary care is available through Bertie Rural Health, Cashie Medical Center, and ECU Family Medicine. The ratio of primary care providers to patients is 1:893. Bertie County leads in the state food hardship index and ranked 13 th in infant mortality. Residents within the county currently have access to 5 food pantries and can apply, if eligible, for SNAP benefits and Meals on Wheels. Now, Bertie County is in the lower 25% of the unhealthiest counties in North Carolina. In addition to lower-than- average health rates, 11.9% of residents have no health insurance (Bertie County). A1 Protection from the weather is an environmental concern for Bertie County residents living below the poverty line. The outside temperatures can range from below freezing during the winter months to mid to high 90s during the summer, not including the heat index temperatures. These temperatures pose a risk to poverty-stricken residents due to their limited ability to obtain adequate heating and cooling. With scarce heating and cooling resources, the risk of residents having a heat stroke, hypothermia, or other serious health concerns increases. A2 Residents below the poverty line are at a higher risk than the larger population. For example, seniors and disabled populations living in poverty are at risk for multiple reasons, such as not adequately affording housing, utilities, food, health care, and transportation. Children living below the poverty line are also at risk for physical health and behavioral and emotional problems (Bertie).

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4 B1 Poverty is a social determinant of health affecting Bertie County’s residents. 20.7% of the population lives below the poverty line (U.S.). Living in poverty can result in the following: difficulty obtaining access to health care, nutritious food, transportation, and adequate housing due to affordability. As a result, the residents have an increased number of chronic diseases that go untreated, fail to seek proper health screenings, and have difficulty accessing nutritious foods. According to the 2022 Bertie County needs assessment, cancer was the leading cause of death in Bertie County, followed by heart disease (E.C.U). Cancer can be detected with appropriate health screenings and heart diseases can be prevented with proper diet, exercise, etc. Access to sufficient health care and nutritious food has the potential to decrease morbidity rates that can increase the residents' chances of having cancer and heart disease. The Bertie Ledger Advance describes the closure of Martin General Hospital as a controversial community health concern. The next closest hospital that residents can utilize is ECU Health Bertie, which adds additional time that could have been allocated to obtaining treatment rather than travel time. Due to the closure of Martin General Hospital, ECU Health Bertie experienced a 35% increase in volume. The increase in volume increases the strain on the hospital’s available resources (Foley). Residents who live in the community are most concerned with the limited access to quality and affordable healthcare. Most of the population desires to be healthier, but resource difficulty exists. Affording access to quality healthcare would increase the health of the overall population. The leading cause of injury visits to emergency departments is falls. The leading cause of injury admission to the hospital is falls.

5 Based on the collected data, poverty is reducing the quality of life for individuals living in Bertie County. If one can’t afford healthcare, then you aren’t able to obtain adequate treatment or screenings needed to prevent morbidity. Also, affected residents can’t afford nutritious food to maintain proper health. Eating nutritious foods is part of a healthy lifestyle and helps manage some disease processes. C1 One resource available to Bertie County’s impoverished residents is the Supplemental Nutrition Assistance Program. The program aims to provide nutritious food and increase food security by giving electronic money to use for the purchase of food (ECU). This is a necessary resource for the community, allowing poverty-stricken residents to obtain healthy food. A second resource for poverty-stricken residents is the Roanoke Public Transportation Authority. This transportation service provides transportation to citizens in the towns surrounding the county at a low cost. Low-cost transportation is necessary for the population because it allows people to get to doctor appointments and other needed places. D Two resources needed to address the SDOH for the impoverished residents would be establishing a homeless shelter within the county and increasing the number of affordable housing opportunities within Bertie County. D1 There is currently no homeless shelter located in Bertie County. The shelter nearest to Bertie County is in Greenville, NC, which is a little over an hour away. A homeless shelter is needed to provide adequate shelter for the residents to be protected from hazardous weather, to provide guests with nutritious meals, and to allow them to obtain sufficient clothing and basic first aid if needed. Establishing a homeless shelter in Bertie County will decrease the number of people living on the streets, increase their ability to clean themselves up and obtain food, and

6 lead to the potential for individuals to get jobs to provide better for themselves with living quarters, nutritious food, and health insurance. Affordable housing is needed within Bertie County. There is currently a limited number of housing allowance accommodations within the county, with only one offering housing to low- income families. Limited housing accommodations make it difficult for residents to find affordable and quality housing, especially those with families who are classified as something other than senior citizens. Increasing the number of cheap housing locations can allow individuals to allocate their money to other essential expenses like food and health insurance. E An intervention to be utilized after increasing the number of affordable housing opportunities is a program called The Housing Choice Voucher Program (HCU). “This program is designed to alleviate high housing cost burdens for qualifying low-income households” (Dawkins). Living in Bertie County allows me to see some people’s living standards. Typically, people have houses they try to afford, most of which are rented rather than owned. I work as an RN in a local hospital, and I ask my patients why they haven’t sought proper treatment sooner, responding that they have difficulty affording health care costs due to living expenses and trouble affording everyday “luxuries.” Increasing affordable housing can decrease the number of homeless residents and raise funds available to families to allocate toward food, health insurance, and transportation. Poverty-stricken residents can apply for Housing Choice vouchers. Suppose they meet the standard criteria, such as lower income, number of dependents based on income, or housing assistance needed. In that case, they will have the amount of income that can be used for rent decreased. If Bertie County adopted the Housing Choice Voucher program, at most 40% of the resident's income would be put towards eligible applicants’ rent.

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7 E1 Specific examples of how adopting the Housing Choice Voucher program for affordable housing would decrease the number of residents without health insurance, increase their ability to obtain nutritious food, and save money to work towards owning their home. Having the ability to spend less on rent would allow individuals to put their money toward other essential expenses. Having the benefit of obtaining affordable health insurance would decrease the number of morbidities and increase the number of annual health screenings for those who once couldn’t afford health insurance. Health is essential to some, and being able to afford health insurance hinders routine screenings if the individuals can’t afford the health insurance expenses. Affording nutritious food also contributes to a healthier individual by adding the extra nutrients the body requires. Having the money to save for a family to own their own home can also increase the individual or family's quality of life by decreasing mental strain on making ends meet to sustain a home that adds value to their lives. It can also increase the educational value to children by having the option of education choices within the county rather than having to go to a specific school based on their particular address.

8 References Bertie county - schs.dph.ncdhhs.gov. (n.d.-a). https://schs.dph.ncdhhs.gov/units/ldas/cha2018/BERTIE%20CHA%202018.pdf Bertie County | healthy communities NC. (n.d.-a). https://healthycommunitiesnc.org/profile/geo/bertie-county County profile Bertie County (NC) May 2022 demographics - nccommerce.com. (n.d.-b). https://accessnc.nccommerce.com/DemoGraphicsReports/pdfs/countyProfile/NC/37015.pdf Crime in North Carolina - 2022 - ncsbi.gov. (n.d.-c). https://www.ncsbi.gov/Services/Crime- Statistics/Crime-in-North-Carolina-Annual-Summaries/2022-Annual-Summary.aspx Dawkins, C., & Jeon, J. S. (2018). Housing Cost Burden in the Housing Choice Voucher Program: The Impact of HUD Program Rules. Cityscape, 20 (1), 39-62. https://www.proquest.com/scholarly-journals/housing-cost-burden-choice-voucher-program- impact/docview/2045302040/se-2 ECU health | eastern NC health care | find A doctor. (n.d.-d). https://www.ecuhealth.org/wp- content/uploads/2022/09/2022-Bertie-County-CHNA-Final.pdf Foley, J. (2023, August 11). ECU health bertie plans for additional patients. Bertie Ledger- Advance. U.S. Census Bureau quickfacts: Bertie County, North Carolina. (n.d.-e). https://www.census.gov/quickfacts/fact/table/bertiecountynorthcarolina/SBO010217

D224 Final for Task 1 copy copy

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