Chapter Six: Health

The health data reported in this section will focus on the conditions most pertinent to the three major demographic groups of the Trinity Court and Pritchard Park housing communities - the elderly, women of childbearing age, and children under the age of 18. Health data applicable to these communities are available at the state, county and, when available, local level (as defined by zip code). This section will focus mainly on issues of morbidity referring to women and children (92% of the Trinity Court and Pritchard Park communities) and review only the major issues of mortality, which are mostly due to advanced age - not a large factor in Trinity Court and Pritchard Park.

In the available data sources, most data reporting ethnic differences in health status are divided binomially into 'Caucasian' and 'Minority' categories. Since the majority of residents in the Trinity Court and Pritchard Park housing communities are African-American, where possible, attention will be paid to ethnically specific health statistics. The report of health data in this section will offer a clearer picture of the health discrepancies that exist at the county and state level, and more importantly, between the county and Trinity Court and Pritchard Park community levels.

MORTALITY

While the overall health status of African-Americans is improving, large disparities continue to exist in both incidence and death rates. African-Americans suffer higher mortality rates from most of the major causes of death. Explanations that have been offered include lower quality and less frequent attention from health care professionals (NC State Center for Statistics - Office of Minority Health, 1998). Additional explanations include differential levels of educational achievement, economic status, discrimination, and social and cultural influences in defining perceptions of illness and health. Poor relationships with health care professionals are a final contributing factor explaining the discrepancy in health status (NC State Center for Health Statistics - Office of Minority Health, 1998).

In the United States today, the life expectancy of the average African-American is 70 years, six to seven years less than that of his Caucasian counterpart. The overall unadjusted death rates per 1,000 for the years 1991 through 1995 for Orange County was 5.7 per 1,000. This compares to the same rate for the entire state of North Carolina, which was 8.9 per 1,000. Death counts and death rates for leading causes for North Carolina and Orange County are reported in Table 8.

Overall, leading causes of death in Orange County reflect those of the state. At the county level, reported rates of disease are lower, with the greatest difference seen in the ranking of diabetes mellitus, which is a death rate twice as low in Orange County when compared to that of the state. A smaller difference is the reversed ranking of pneumonia/influenza deaths compared to chronic obstructive pulmonary diseases (ranked fourth and fifth respectively at the county level and ranked in opposite order at the state level).

TABLE 8. DEATH COUNTS AND DEATH RATES FOR LEADING CAUSES FOR NORTH CAROLINA AND ORANGE COUNTY, 1991 - 1995

Source: NC State Center for Health Statistics - DEHNR (1997)

Race-Sex-Age-Adjusted rates for all causes of death for years 1991 through 1995 for North Carolina (reported per 100,000 population) include 642.3 for Caucasian males, 360.5 for Caucasian females, 1049.1 for minority males, and 551.9 for minority females. The overall adjusted death rate at the state level was reported to be 542.6 per 100,000. At the state level, only Caucasian women fall below the overall death rate. The adjusted death rate of minority males is twice that of the overall rate. The rate for minority women, at 551.9, falls close to the overall rate of the state (NC State Center for Health Statistics -Department of Environment, Health, and Natural Resources, 1997). At the county level, from 1991 through1995, the adjusted death rates are 491.2 for Caucasian males, 305.6 for Caucasian females, 946.8 for minority males, and 461.5 for minority females. The overall adjusted death rate for 1991 through 1995 at the county level was reported to be 437.8 per 100,000 (NC State Center for Health Statistics - DEHNR, 1997). Adjusted rates at the county level reflect the pattern seen at the state level, with minority males having a death rate at least twice that of the overall rate. Death rate comparisons of selected causes of death are reported in Table 9.

TABLE 9. LEADING CAUSES OF DEATH PER 100,000, COUNTY V. STATE V. HEALTHY CAROLINIANS 2000 OBJECTIVE, 1993-1995

Source: NC State Center for Health Statistics - DEHNR (1997)

Cardiovascular Disease (CVD) - A Closer Look. Heart disease is the leading cause of death in both the United States and North Carolina. Orange County has a lower rate of CVD than the state and nation. Age-adjusted heart disease death rates in North Carolina for 1996 are presented in Figure 1 on page 64. African-Americans are 1.5 times as likely to die of heart disease than are Caucasians. Explanations for this could be based on genetic factors, lifestyle choices, stress specific to culture, or multiple other reasons.

Diabetes - A Closer Look. A more detailed discussion of the prevalence of diabetes in the general population will follow in the Morbidity section of this chapter. However, it is important to take a brief look at the death rate due to diabetes at the state level. On page 64, Figure 2 shows the age-adjusted diabetes death rate in North Carolina in 1996. As can be seen, the diabetes death rate in African-American females is three times as high as their Caucasian counterparts. The death rate among African-American males is two and a half times greater than for Caucasian males.

HIV/AIDS - A Closer Look. A more in depth discussion of HIV/AIDS at the state, county, and local level will follow in the Morbidity section of this chapter. However, as a view of the number of deaths due to HIV/AIDS, Figure 3 on page 65 displays the age-adjusted AIDS death rate in North Carolina in 1996. At the state level, African-American males die from AIDS at a rate almost three times higher than African-American females and seven times higher than Caucasian males. Comparatively, African-American males have an AIDS death rate 100 times that of Caucasian women.

MORBIDITY

As stated in the introduction to this chapter, the incidence of disease in the community is of more interest to residents and service providers of Trinity Court and Pritchard Park. Because the population is disproportionately female and young, issues of acute disease and infection, especially those surrounding pregnancy and birth, and issues of children's health are of most interest.

However, to include those residents who are not women of childbearing age or children, a brief exploration of the leading causes of morbidity in the older age distribution of the Trinity Court and Pritchard Park housing communities is provided. Chronic diseases (including cancer, diabetes, and cardiovascular disease) are the health conditions most applicable to the older population in Trinity Court and Pritchard Park. The most common types of chronic disease affecting middle aged adults and the elderly are referred to in Table 8. Infectious diseases are those such as HIV/AIDS and many sexually transmitted diseases (STDs), which are highly communicable in the 18 through 44-year old age group.

Cancer. Figure 4 on page 65 reflects the age-adjusted incidence rates of cancer per 100,000 population in North Carolina and Orange County from 1991 through 1993.

Compared to their Caucasian counterparts, African-American males are 3.5 times as likely to die of prostate cancer. African-American females are more than twice as likely to die of cervical cancer than are Caucasian women, and these same females are 25% more likely to die from breast cancer than their Caucasian counterparts (NC State Center for Health Statistics - Office of Minority Health, 1998). Data specific to the incidence rate of cancer in Trinity Court and Pritchard Park are not available.

Cardiovascular Disease (CVD) Risk. County level data for the following cardiovascular risk factors and health behaviors are as follows. The size of the adult population in Orange County is 69,596. Currently, 19,424 (27.9%) smoke, 42,705 (27.9%) lead a sedentary lifestyle, 15,530 (22.3%) are obese, and 12,018 (17.3%) have high blood pressure (NC State Center for Health Statistics - DEHNR, 1997). Many of these lifestyle choice factors lead to cardiovascular disease. Upon further research, it appears that some or all of these predisposing factors are present in Trinity Court and Pritchard Park.

Diabetes. Diabetes is a large health concern, especially among the African-American population. As of 1993, an estimated 3,654 residents of Orange County were diagnosed with diabetes. It is important to acknowledge the fact that this number reflects only those cases of diabetes that have been diagnosed. The actual number of diabetes cases is feasibly twice as high (NC State Center for Health Statistics - DEHNR, 1997). Table 10 displays the estimated prevalence of diagnosed diabetes by race, sex, and age.

As seen in Table 10, diabetes is most prevalent in the 45 to 64 age group. Within this age group, African-American females suffer from diabetes at a rate twice as high as that of their Caucasian counterparts. Beginning at age 45, African-Americans suffer from diabetes at higher rates than do their Caucasian counterparts.

TABLE 10. ESTIMATED PREVALENCE OF DIAGNOSED DIABETES BY RACE, SEX, AND AGE, BASED ON THE 1988-1993 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM AND 1993 POPULATION ESTIMATES, ORANGE COUNTY, NORTH CAROLINA

* Rates are expressed per 1,000 population
Source: NC State Center for Health Statistics - DEHNR (1997)

HIV/AIDS. Since the 1980s, HIV/AIDS has been a steadily increasing health concern throughout the United States. The virus has disproportionately affected the African-American community. Among the heterosexual female population, African-American women have been particularly devastated by the disease. In 1996, HIV/AIDS was the leading cause of death among African-American North Carolinians ages 15 to 44 (NC State Center for Health Statistics - Office of Minority Health, 1998). The AIDS rate in Orange County for 1991 to 1995 was 8.3 per 100,000. The rate at the state level was 11.55 per 100,000 (NC State Center for Health Statistics - DEHNR, 1997). With these numbers, it is important to recognize that 71% of the state's newly reported cases of AIDS in adolescents and adults were among African-Americans. In children age 12 or younger, 93% of the AIDS cases in 1996 were in African-Americans as well. Overall, three-fourths of all new HIV infections were among African-Americans. In children age 12 or younger, the AIDS death rate for African-American females is 16 times that of Caucasian females. In sum, African-Americans in North Carolina are 8.5 times more likely to die from AIDS than are their Caucasian counterparts (NC State Center for Health Statistics - Office of Minority Health, 1997). Unfortunately, data specific to Trinity Court and Pritchard Park are not available.

Syphilis, Gonorrhea, Tuberculosis. Primary and secondary syphilis rates per 100,000 in Orange County for 1993 to 1995 were 5.11 for the total population and 21.05 for the minority population. Healthy People 2000 goals are to reduce these incidence rates to no more than 10 cases per 100,000 and no more than 65 cases per 100,000 for African-Americans (NC State Center for Health Statistics - DEHNR, 1997). Four total cases of syphilis were reported in 1997 for the zip code in which Trinity Court and Pritchard Park are located. Two cases occurred among African-American males ages 30 through 34 and 40 through 44; one occurred in an African-American female age 35 through 39; and one case was diagnosed in a male classified as 'Other' age 25 through 29 (NC Department of Health and Human Services, 1998).

Gonorrhea cases per 100,000 in Orange County for 1993 through 1995 occurred at a rate of 125.59 for the total population and 561.46 for the minority population. The Healthy People 2000 goal is to reduce incidence to 225 per 100,000 cases in the total population and 1,300 in the minority population. Fourteen total cases of gonorrhea were reported in 1997 for the zip code including Trinity Court and Pritchard Park. Seven cases occurred among African-American females, two cases each among Caucasian males and females, and three cases among African-American males. Incidence of gonorrhea in this population occurred in individuals ranging in age from 15 to 54 years old (NC Department of Health and Human Services, 1998). In 1996, the incidence rate for syphilis and gonorrhea were each 25 times higher for minorities than for Caucasians in North Carolina (NC State Center for Health Statistics - Office of Minority Health, 1998).

Cases of tuberculosis (TB) per 100,000 in Orange County in the time period between 1993 and 1995 were 5.9 compared to the state rate of 8.35. In 1996, the rate of TB was seven times as high for African-Americans as for Caucasians. For African-Americans the 1996 disease incidence rate per 100,000 was 22.0. For Caucasians, the rate was 3.1. Healthy People 2000 goals are to reduce the rate to 3.5 per 100,000. In 1996, the rate of TB was seven times as high for African-Americans as for Caucasians.

MATERNAL AND CHILD HEALTH

Issues of pregnancy, abortion, live births, and infant mortality are of particular importance to the residence of Trinity Court and Pritchard Park. Because the majority of residents in these two public housing communities are young women and their children, health status and disparities in these particular age groups are in need of special attention.

Reported Pregnancies. A total of 1,727 pregnancies were reported in Orange County in 1997 (1,191 Caucasian and 536 minority). Five hundred sixty-eight of these pregnancies resulted in induced abortions (Figure 5 on page 66), 1,155 were live births (Figure 6 on page 66), and four resulted in fetal death (Figure 7 on page 67). Abortion rates were higher among Caucasians, as were live births, and fetal deaths. A total of 666 women were not married.

Twenty-three percent of pregnant Caucasian women were unmarried compared to 64% of minority women. For Orange County, those in the 30 through 34 age group had the highest total number of pregnancies for married women. Those in the 20 through 24 age group had the highest total number of pregnancies for unmarried women.

Prenatal Care. In Orange County, 88% of women received prenatal care from 1993 to 1995. Seventy-one percent of African-American women received prenatal care, and 50% of Native-American women received prenatal care. The percentages for both African-American and Native-American women fall below the Healthy People 2000 goal that 90% of all pregnant women receive prenatal care in the first trimester of pregnancy (NC State Center for Health Statistics - DEHNR, 1997). Among African-American births in Orange County, 14.4% of births were classified as low birth weight (<2500g) and 4.5% were classified as very low birth weight (<1500g). The Healthy People 2000 objective is to reduce the percentage of low and very low birth rates to 9% and 2% respectively.

Teen Pregnancy. Pregnancy among adolescent females is among the most influential factors affecting placement, standard of living, and duration of stay in public housing. In Orange County, the pregnancy rate for females age 15 to 17 from 1993 through 1995 was 30.8 per 1,000 among Caucasians and 103.7 among minorities. There were a total of 5.1 Caucasian and 16.7 minority fetal deaths per 1,000 in Orange County, compared to 6.2 Caucasian and 13.2 per 1,000 among minorities at the state level.

In sum, African-Americans appear to have a higher percent of maternal risk factors than do Caucasian mothers. At the state level in 1996, 84% of African-American mothers and 53% of Caucasian mothers had one or more of the following maternal risk factors: age⁷, educational level⁸, four or more pregnancies, previous fetal death, or previous live birth followed by infant death (NC State Center for Health Statistics - Office of Minority Health, 1998). The African-American teen pregnancy rate is twice that of Caucasian teenagers, and African-American women are less likely to have adequate prenatal care (NC State Center for Health Statistics - Office of Minority Health, 1998).

Children's Health. While no detailed data exist on the county or neighborhood level, child health issues are highly relevant to the residents of Trinity Court and Pritchard Park. On the state level from 1991 to 1995, 57,907 cases of child abuse, neglect, and dependency were reported, of which 31.5% of the cases were substantiated. On the county level, 611 cases were reported, of which 45.5% of the cases were substantiated. No data were available regarding injury. No exact data were available for North Carolina children screened during the 1996 fiscal year or later.

Another health concern affecting children that should be addressed is lead poisoning. African-American children were nearly 2.5 times as likely as Caucasian children to have abnormally high blood lead levels. This level of lead in the blood could cause lead poisoning, which results in seizures, comas, death, and may also affect intellectual performance (NC State Center for Health Statistics - Office of Minority Health, 1998). Unfortunately, data at the county level were not available.

MENTAL HEALTH AND SUBSTANCE ABUSE

An estimated 12% of North Carolinians suffered from some form of mental illness in 1992 (Governor's Task Force on Health Objectives for the Year 2000, 1992). According to the North Carolina Office of State Planning, in 1995, Orange County ranked eighty-eighth out of 100 North Carolina counties for per capita number of persons served by mental health programs (North Carolina Office of State Planning, 1996).

In 1995, 2,278 people received treatment for mental health or substance abuse issues in Orange County (NC Department of Health and Human Services, 1997). The majority of individuals who received medical attention for mental health or substance abuse issues, did so at the Orange-Person-Chatham Mental Health Center (OPCMHC). The OPCMHC is the largest outpatient mental health facility in Orange County. This facility receives many of its referrals from the Carrboro Community Health Clinic. Few individuals who sought medical attention for their mental health or substance abuse issues used state run centers. In 1995, the OPCMHC served 2,460 patients. The most common purpose for treatment was substance abuse (OCHCTF, 1996). Figure 8 on page 67 shows a breakdown of diagnoses given to the 2,460-client population that was seen by the OPCMHC in 1995.

ENVIRONMENTAL HEALTH

The physical environment can significantly affect the health of a community. Health hazards stem from many sources including drinking water, air pollution, wild animals (those carrying rabies), sanitation and household toxins (e.g. lead-based paint).

Water. Residents of Chapel Hill receive their tap water from two relatively clean reservoirs, University Lake and Crane Creek reservoirs (Oppenheimer, 1989). The Crane Creek Reservoir is located approximately eight miles west of Carrboro, and University Lake is on Jones Ferry Road in Carrboro (Harbour, Haughton, & Schegloff, 1998). In 1977, the University of North Carolina at Chapel Hill, and the towns of Chapel Hill and Carrboro sold all of their water and sewer facilities to a non-profit agency, Orange Water and Sewer Authority (OWASA) (Shia, 1997). While an estimated 43,000 persons in Orange County (41% of the population) drink from ground water (Orange County Ground Water Center, 1998), the residents of Trinity Court and Pritchard Park are consumers of OWASA water.

The Triangle Area Water Supply Monitoring Project reported that tests conducted in 1994 through 1995 showed a microorganism named Giardia in University Lake. However, the current disinfecting process used by OWASA removes about 97% of harmful microorganisms. The treatment process makes drinking water safe for people with normal immune systems, but those with immune deficiencies are cautioned to boil their water.

OWASA also conducted its own study to accompany the report. Occasional trace amounts of organics and algae blooms (about 2% of the regulation limit) in Crane Creek were found (Gordon, 1996). OWASA officials report that the risk of synthetic organics is too small to justify installing a new treatment system, especially because charcoal is already used as a disinfectant in the filters. While water quality in Crane Creek is not pristine, it is generally good and in compliance with applicable regulatory standards. Risks from microbial pathogens, such as Giardia, are expected to remain low if animal waste practices and OWASA's treatment plant operation are sustained at their current, high level of performance (OWASA, 1997).

OWASA also adds fluoride to the water supply for the dental benefits that it provides to children, even though it is not a part of the water purification process. The fluoride supply is occasionally shut off when testing the distribution system (OWASA, 1998).

Air. Over the years, the established state and federal ozone and carbon monoxide limits have been exceeded in many North Carolina counties, including Orange County (North Carolina Department of Natural Resources and Community Development, 1989). Ozone is formed when sunlight interacts with emissions from cars, trucks, and coal burning power plants. At high levels, ozone smog can lead to irregular heartbeats, inflame the lungs, and cause respiratory problems (Leavenworth & Paik, 1998).

To combat the air quality problem, Chapel Hill adapted a new program on July 8, 1998 to encourage the use of public transportation, while also trying to keep the air clean. The program offers free mass transit on ozone alert days. "code red" alert signifies unhealthy conditions. This means that ozone levels measured over eight hours, are expected to rise over 105 parts per billion. The U.S. Environmental Protection Agency proclaimed that conditions are unhealthy for children, elderly, and persons with respiratory problems when ozone levels exceed 85 part per billion (Leavenworth, 1998). The Town of Chapel Hill is part of the Regional Air Quality Coalition working to reduce pollution throughout the area (Robiglio & Blythe, 1998). It is not known if the air quality problem actually impacted the health of Trinity Court and Pritchard Park residents, or whether they have taken advantage of the free public transportation on ozone alert days.

Rabies. There have been 131 confirmed cases of rabies (a virus that attacks the nervous system) in animals since an epidemic began in July 1996 in Orange County. An overwhelming majority of the cases involved raccoons. However, other animals including skunks, a fox, and two cats have tested positive for the virus. Through1998, many domesticated animals (189 dogs and 17 cats) had been exposed, or were suspected of being exposed, to rabid animals. In addition, 137 people have been exposed to, or are suspected of being exposed to, the rabies virus through 1998 (Siler, 1998). Despite the high incidence of rabies in Orange County, no known cases have been reported from residents of Trinity Court or Pritchard Park housing communities.

Sanitation. Residents of Chapel Hill, including those in Trinity Court and Pritchard Park, have garbage pickup and curbside collection of recyclables. Trash is picked up by Waste Industries, Inc., and recyclables are collected by Orange County Recycling. The trash and recycling go to the Orange Regional Landfill located on Eubanks Road, 1.5 miles west of Airport Road (Price, 1996). Additionally, a household hazardous waste collection service is available for Orange County residents to dispose of old paint, pesticides, cleaners, and solvents. Items such as automotive fluids, household batteries, and staining products can be dropped off at this site. Latex Paint Exchange is available along with the recently inaugurated ReUse Shelf (as of May 2, 1998). The ReUse Shelf offers free products to the public, such as auto wax and antifreeze that are either unused or in excellent condition (Beavers, 1998).

HEALTH POLICY ISSUES

Several state and local government policies have been enacted to ensure health care for residents of North Carolina at large, and Orange County in particular. Recent legislation specifically addresses the health needs of children and youth.

Smart Start. Smart Start is a comprehensive, public-private initiative that provides health and developmental programs and services to children under the age of six (North Carolina Partnership for Children Inc., 1998). The initiative ensures access to high-quality and affordable childcare, health care, and family services to residents of 55 counties in North Carolina, including Orange County. Governor Jim Hunt launched Smart Start out of the North Carolina Department of Human Resources in July of 1993.

In each local partnership, planning teams make decisions about the kinds of programs that are developed using Smart Start funding. Smart Start partnerships have implemented programs in three areas including childcare and education, family support and education, and health care and education. For example, resources provided through the Smart Start program help fund the Trinity Court and Pritchard Park Family Resource Center.

Childcare and Education. One of the goals of all partnerships is to make high quality child care available for all children who need it. Over 30% of Smart Start funds are used to assist families in purchasing childcare. Subsidies may be paid for care in any licensed childcare center or registered family childcare home which parents choose. Most Smart Start partnerships have raised the eligibility limit for subsidies to help poor working families afford child care, and additional spaces in child care programs are being added through a grants program. Smart Start projects also help to improve the quality of childcare, and teachers are being educated and given technical assistance to work more effectively with children who have disabilities.

Family Support and Education. Many Smart Start programs provide families with information, education, and other services to help their children prepare for success in school. Childcare resource and referral services offer a broad range of services to families, childcare providers, and businesses. Family Resource Centers (FRCs) have been established in targeted communities such as Trinity Court and Pritchard Park. Through Smart Start, family literacy programs help family members learn to read and encourage parents to read to their children. Finally, Smart Start partnerships fund ways to make transportation available to children and their families to increase their access to needed resources and services.

Healthcare and Education. Activities to improve health include preventive health care, treatment for particular health conditions, and health education. Communities provide immunizations in convenient locations. Outreach nurses care for children's health needs in childcare programs and include follow-up to assure that immunizations are given on time. Some local plans include health and developmental screenings - including vision, hearing, speech, developmental, and dental - in child care programs. First aid and CPR training, nutrition education, and training about infectious diseases are available to parents and childcare providers. Finally, educational programs are available to parents of newborns, including teen parents, to help them care for their newborns and learn about child development.

Shaping Orange County's Future Task Force. From October 1997 through February 1998, 23 different professionals, including members from the Orange County Health Department, Chapel Hill Police Department, and Orange Community Housing Corporation Board of Directors, met as part of the Human Services Health and Safety Committee. They formed the Shaping Orange County's Future Task Force to gather information on the quality of life of Orange County residents. The goals included the discussion of key issues and suggestions of strategies that will be submitted to the governing bodies to inform short-term and long-term policies and plans for the county. Input to the committee was given through a survey sent to 508 people on a mailing list, resulting in a 13% response rate. These data may be not be reliable because the response rate was so low.

One of the focus areas addressed by the Task Force dealt with public health. Issues identified by the community included the disparities between Caucasian and minority populations on most health indicators, but particularly substance abuse and illegal drug sales, teen pregnancy, sexual assault, AIDS awareness and education, poverty rates among minorities, and availability and use of preventive services, among others. The goals identified that relate to public health emphasize preventive health care (Orange County Health Department, 1998). The implications these suggestions have for the county and the housing communities of Trinity Court and Pritchard Park remain to be seen.

HEALTH SERVICES

Nearly 920,000 North Carolinians were without health insurance coverage in 1994, and only eight other states had higher numbers of uninsured residents (North Carolina State Center for Health Statistics, 1998). According to data covering state fiscal year 1994 through 1995, 7.7% of the total Orange County population was eligible for Medicaid coverage (North Carolina State Center for Health Statistics, 1998). Therefore, the need for free and low cost health care is especially important for North Carolinians. The state and county governments have addressed this need by providing many services free or by charging for services based on family income.

Orange County Health Department. The Orange County Health Department consists of four divisions. The Animal Control Division enforces state and local rabies control and animal cruelty laws, as well as local animal nuisance and protection ordinances. The Dental Health Division provides clinical services, focusing on preventive care with limited restorative services. Visits are by appointment only, and fees are based on income and family size. Services of the Environmental Health Division include inspecting and grading of food, lodging, and institutional facilities; designing and supervising the installation of individual on-site sewage disposal systems and water supplies; inspecting collective use swimming pools; and investigating general health-related complaints. The Personal Health Division provides a variety of clinic and community outreach services, which are described below (Orange County Health Department Brochure, 1998):

Family Planning. A complete physical exam, patient education, and counseling are provided. Birth control methods are available, and pregnancy testing is offered free of charge. Fees are based on income and family size.

Maternal Health. Complete prenatal care, patient education, and nutrition services are provided at no cost. Maternity Care Coordination and Maternal Outreach Worker services are available to those who qualify.

Child Health. Routine well child care, including physical exams, developmental screenings, parent education, home visits, Child Service Coordination, Health Check Outreach, and special health services are available at no cost to Medicaid eligible individuals from birth to age 21.

Immunizations. Routine childhood immunizations and those required by the state Immunization Law are offered free of charge to children and adults at walk-in clinics. Flu vaccines are offered for a fee each fall.

Adolescent Health. Non-emergency medical care is provided at clinics free of cost for youth ages 12 to 20 years old.

School Health. Nurses provide school health services in the Orange County and Chapel Hill - Carrboro City School Systems. Services include screening and observation, medical and dental referrals, health assessment, immunization review, and individual counseling.

Adult Health. Services are limited to certain screenings, monitoring, and referrals.

Breast and Cervical Cancer Screening. Screening and education are available for women ages 40 and older with limited incomes. Pap tests and mammograms are available at screening facilities for a sliding scale fee based on income and family size.

Communicable Disease. Services include education, surveillance, and follow up of reportable communicable diseases such as rubella, tuberculosis, rabies, and syphilis.

Sexually Transmitted Diseases. Free screening is available on a walk-in basis or by appointment.

Tuberculosis. Free screening is available without an appointment, and treatment is available free of charge by appointment.

HIV/AIDS. HIV counseling and testing services are provided free of charge.

Health Education. Educational activities and resources covering a wide range of health topics are available to individuals and groups in the community.

Nutrition Program. Services include individual assessment and counseling, classes on weight control, and infant feeding. In cooperation with Piedmont Health Services, the Orange County Health Department also provides the Women, Infant, and Children (WIC) program, which provides free food to pregnant women, mothers who are breast feeding, and children under age five. The Orange County Health Department office in Hillsborough is the closest WIC center.

Health Promotion. Services for businesses, churches, agencies, and other community groups to reduce risky health behaviors and promote health sustaining behaviors are available. Cholesterol, blood pressure, and other screening and health education services are also available.

The services described above are provided by the Orange County Health Department at area clinics located in Hillsborough, Carrboro, and a new clinic which recently opened in 1998 on Homestead Road in Chapel Hill. In addition, the Carrboro Community Health Center run by the Inter-Faith Council serves Orange County residents as well.

Student Health Action Committee (SHAC) Clinic. The Student Health Action Committee (SHAC) Clinic is a free clinic run by students pursuing advanced degrees in the University of North Carolina Schools of Dentistry, Medicine, Nursing, Pharmacy, Public Health, and Social Work. SHAC is sponsored in conjunction with the Orange County Public Health Department, United Way, and the UNC Schools of Medicine and Dentistry. Several nights per week, while the university is in session, students operate the clinic in the health department facilities at Carr Mill Mall in Carrboro. Some services are also offered at the Inter-faith Council in Chapel Hill. SHAC Clinic services are available free of charge to all people in and around Chapel Hill on a first-come, first-serve basis free of charge. Procedures performed at the clinic include primary care, reproductive health services, pediatric care, immunizations, and oral hygiene instructions (UNC Dentistry, 1998).

UNC Hospital Clinics. While the Orange County Health Department and area clinics offer many services at no cost or on a sliding scale fee, area hospitals generally charge for services. UNC Hospitals are the closest major hospital and emergency care centers to Trinity Court and Pritchard Park. UNC Hospitals are staffed by more than 650 primary care physicians and specialists (UNC Hospitals, 1998) and provide a family practice center, emergency room, pediatric clinic, and medical walk-in-clinic.

Dental Services. The Orange County Health Department, Piedmont Health Services, SHAC Clinic, and the UNC School of Dentistry (through the Smart Start Dental Program) all provide dental care and services to children at locations in the Chapel Hill area. Services offered by SHAC and Smart Start are free of charge for children.

Reproductive Health Services. With the vast majority of its residential population comprised of women of childbearing age, reproductive health is particularly important to the Trinity Court and Pritchard Park communities. Fortunately, several reproductive health services are available in the Chapel Hill area, including:

Planned Parenthood of Orange/Durham Counties (PPOD). Gynecological exams, and cancer screening for men and women are offered in addition to specialized gynecological care with an obstetrician/gynecologist. A clinical psychologist provides in-depth counseling for concerns about unplanned pregnancy, relationships, sexuality, and depression. Sexually transmitted disease screening and treatment, as well as confidential HIV testing are also available. Abortion services are not currently provided, but PPOD can make referrals to other abortion providers in the area. Prescriptions are available for all methods of birth control and emergency contraception. Services are on a sliding scale fee for high school and college students with valid school identification (Planned Parenthood Federation of America, 1998).

Horizons Program, Chapel Hill. A program is offered through the UNC Department of Obstetrics and Gynecology at UNC Hospitals. Comprehensive care to pregnant and postpartum women using drugs or alcohol is provided. The Horizons Program also provides substance use screening, assessment, counseling, and case management to pregnant and postpartum women (Orange County Partnership for Young Children, 1998).

Child Abuse and Family Violence Services. Because most households in Trinity Court and Pritchard Park consist of single mothers with young children, there are concerns that stress and lack of financial and social support may lead to neglect, child abuse, or family violence. A discussion of child abuse and neglect is found in Chapter Ten: Children - Providing a Strong Foundation. Appropriate services in the area include:

Child Protective Services - Orange County Department of Social Services, Hillsborough. Offers services to families where there has been substantiated abuse, and/or dependency of a child or children in the home. Services are provided to strengthen families and reduce the risk of further abuse, neglect, and/or dependency (Triangle United Way, 1997).

Guardian Ad Litem, Carrboro. Works with volunteers who follow court cases of abused and neglected children. Volunteers are paired with an attorney advocate who works to promote the best interest of the child (Triangle United Way, 1997).

Orange/Durham Coalition for Battered Women, Orange County. Operates a 24-hour crisis phone line responding to victims of domestic violence. Services include crisis intervention, support counseling, access and referral to shelters, court advocacy, short-term case management and group therapy (Triangle United Way, 1997).

Rape Crisis Center, Chapel Hill. Offers child sexual abuse prevention programs to groups and individual consultations with parents and/or children. A lending library is available containing books and videos that can be viewed at the office. Provides community education on the incidence and prevention of sexual violence, and provides information, support, advocacy, and referrals for victims, their families, and friends (Orange County Partnership for Young Children, 1998).

Mental Health Services. There are no existing data about access to or use of mental health services by residents of Trinity Court and Pritchard Park. For those residents with mental health concerns, services nearby include:

Mental Health Association (MHA) in Orange County, Carrboro. Support groups for people who have mental illness and for their family members. Different groups focus on suicide, depression, and bipolar disorders. Programs about dealing with general family problems and stress management are also available (Triangle United Way, 1998).

Orange-Person-Chatham Mental Health Center, Carrboro. Comprehensive services for children with developmental disabilities, mental health, and substance abuse. KidScope and Exceptional Child Programs are also offered (Triangle United Way, 1998). A 24-hour crisis line provides access to needed services (OPC Mental Health Center, 1998).

CONCLUSION

Residents of Trinity Court and Pritchard Park are predominantly minority women of childbearing age, children under 18 years, and include a few elderly residents. Their health concerns are comprised of reproductive health, infectious disease, and chronic disease issues. Many of the health disparities reported in this section are the result of preventable behaviors. Contributors to the ethnic disparities in health status are due to lifestyle, diet, physical activity, obesity, drug abuse, risky sexual behaviors, health care access barriers due to poverty, health insurance, cost, lack of awareness, cultural experiences through history, and transportation problems. Other contributors include racism, stress, a challenging environment, and cultural influences. It remains to be seen whether the specific health needs of residents of Trinity Court and Pritchard Park are being met by the services available in the Chapel Hill and Orange County area.

As mentioned earlier in this chapter, barriers to health care for Trinity Court and Pritchard Park may include one or more of the following: lack of transportation; lack of health insurance; cost barriers to those residents not covered by Medicaid; and a lack of health knowledge. Additionally, inconvenient hours of operation, inadequate or inappropriate services, lack of information about available services, and/or lack of coordination between providers, further complicate health conditions seen in Trinity Court and Pritchard Park. The state and county governments have set legislation and services in place to address the general needs of Orange County residents. However, special efforts must be made to ensure that the health needs of residents of the Trinity Court and Pritchard Park communities are met.

⁶The Department of Health and Human Services (DHHS) established the Healthy People 2000 Project as an effort to improve health status nationwide.
⁷Age being younger than 18 years of age or older than 34 years of age.
⁸Less than 12th grade completed

Chapter Five: Crime

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Chapter Six: Health Figures