Chatham County, NC
Home MenuSpotlight on Health Disparities in Chatham County - Fall 2020
The Chatham County Public Health Department - consistent with the American Public Health Association, the Centers for Disease Control & Prevention, and the World Health Organization - is committed to the pursuit of Health Equity in our community. The CCPHD's vision is: "A fair and inclusive Chatham County where all residents achieve their best physical, mental and emotional health and feel a sense of belonging." To achieve this aim, we seek to better understand the health disparities that exist in our community and the inequities in which they are rooted.
Health Disparities are preventable differences in health outcomes between groups in our society. Disparities occur across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation.
Many disparities in health are the result of the unjust, unfair, and uneven distribution of social and economic resources. These Health Inequities are rooted in social and economic policies and practices that create barriers to opportunity for marginalized groups, including racial and ethnic minorities, low-income populations and members of the LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual) community. The realities of structural racism, historical disenfranchisement, and discrimination have exposed these populations and others to a combination of factors such as poverty, violence, poor neighborhood conditions, and environmental health hazards that limit their ability to achieve optimal health.
The following provides a snapshot of documented health disparities in our county based on existing sources of data. This is not a complete representation of inequities in our county. As we continue our efforts to advance health equity in Chatham County, a leading priority for our Department is to develop a more comprehensive data-driven understanding of the health of all segments of our community. These efforts to provide data and context to health equity work build on previous work including CCPHD's 2010 Health Disparities report, the 2014 Chatham County Community Health Assessment, and 2018 Chatham County Community Assessment.
About Chatham County
Located between two of the state’s largest population and economic centers, Chatham County has experienced double-digit growth since 2010, but two-thirds of the 74,470 people living in Chatham County still live in rural areas. The overall racial composition of Chatham County is: 82.2% white, 12.4% Black/African-American and 5.4% other, including Asian and American Indian/Alaskan Native. Additionally, 12.1% of Chatham residents identify as Hispanic/Latinx. With a median income of $66,857, an unemployment rate of 3.9%, and poverty rate of 13.3%, Chatham County performs well when compared to other counties and the state as a whole. Additionally, the county ranks in the top 10 of North Carolina counties for life expectancy, health behaviors, and health outcomes.
However, there are notable economic and health inequities in the county. Black/African-American households are two times more likely and Hispanic/Latinx households are three times more likely to be living in poverty when compared to White non-Hispanic/Latinx households and life expectancy for members of the Black/African-Americans population is nearly 5 years shorter than White residents. Disparities can also be seen visually across Chatham when looking at a map. For instance, poverty rates in the northeast corner of the county are three to four times lower, and the median income is nearly two times higher, than in the southwest corner. Siler City, located in the western part of the county, has a median income under $35,000 and an unemployment rate of 9.8%. Taken together, these point to inequities across our community that coincide with well-documented outcomes across the state and country.
Sources: County Health Rankings & Roadmaps, Robert Wood Johnson Foundation, 2020; Chatham County, North Carolina, American Community Survey 5-year Estimates, 2013-2017
Social Drivers of Health
Social Drivers of Health are the social, economic, and physical conditions in the environments where people are born, live, learn, work, play, worship, and age. These conditions affect a wide range of health, functioning, and quality-of-life 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. The disparities in these measures point to the social and economic inequities that contribute to unequal outcomes for marginalized groups in our community.
Learn more: "Social Determinants of Health," Office of Disease Prevention and Health Promotion, HealthyPeople.gov
The percentage of children living in poverty in Chatham County is higher among Black/African-American and Hispanic/Latinx populations than White, non-Hispanic/Latinx populations.
The median household income* for White non-Hispanic/Latinx residents in Chatham County is higher than for Black/African-American and Hispanic/Latinx residents.
*2019 1-year estimates, 2019 inflation-adjusted dollars
A higher percentage of Hispanic/Latinx and Black/African-American residents in Chatham County live below the poverty line than White Chatham County residents.
Maternal & Infant Health
On many measures Chatham County’s population is healthier than North Carolina’s, but when it comes to infant health outcomes, Chatham County fares similarly or worse than the state. For instance, our 2014-2018 infant mortality rate was higher than the state’s (10.7 per 1,000 vs. 7.1) and our 2014-2018 low/very low birthweight rate (11.3%) and preterm birth rate (10%) were comparable to the state (9%). While these numbers are concerning, they do not communicate the full scope of the issue. In Chatham County, infant mortality rates are 2.2x higher for Black/African-American babies (18.7) than non-Hispanic/Latinx White babies (5.2). The low and very-low birthweight rate is also higher for African-American newborns (21.4%) and Hispanic/Latinx newborns (11.6%) when compared to non-Hispanic White newborns (9.3%).
Infant mortality rates per 1,000 live births are higher among Black/African-American Non-Hispanic/Latinx residents and Hispanic/Latinx residents than White Non-Hispanics/Latinx residents.
Non-Hispanic/Latinx Black women have a higher percentage of low/very low weight births*. Women in Chatham County have a higher percentage of low/very low weight births than North Carolina overall.
*Low birthweight is defined as <2500 grams; very low birthweight is defined as <1500 grams.
Poor and disparate birth outcomes for Black/African-American women and babies in Chatham County mirror well-documented inequities in birth outcomes across the country. The Center for American Progress states: "In the United States, Black/African-American women across the income spectrum and from all walks of life are dying from preventable pregnancy-related complications at three to four times the rate of non-Hispanic/Latinx White women, while the death rate for black infants is twice that of infants born to non-Hispanic/Latinx white mothers." Numerous studies have linked these disparate outcomes to the impacts of structural racism over the life course, with other instances connected to action or inaction at the time of care.
Learn more: "Eliminating Racial Disparities in Maternal and Infant Mortality," Center for American Progress, 2019
Youth Mental Health
In its 2018 report for the Siler City Building Integrated Communities group, The Latino Migration Project at UNC-Chapel Hill wrote that "Latino youth and their immigrant families face a number of stressful social conditions and barriers to socioeconomic advancement…Restrictive federal and state policies have been associated with negative health outcomes, such as decreased health care utilization, mental illness, poor maternal health, and food insecurity."
While data on specific mental illnesses is not available in Chatham County, data from the 2017 Youth Risk Behavior Survey indicate that a concerning proportion of Chatham County youth are suffering from prolonged feelings of sadness and hopelessness and a clear disparity exists between Hispanic/Latinx teenagers and their White peers.
A higher percentage of Hispanic/Latinx high school students in Chatham County have felt sad or hopeless almost every day for two weeks -- one of the primary symptoms of depression -- compared to White, non-Hispanic/Latinx students.
A higher percentage of Hispanic/Latinx high school students in Chatham County reported attempting suicide in the past 12 months compared to White, non-Hispanic/Latinx high school students.
Citing local mental health professionals who work with the Hispanic/Latinx youth population, the BIC report highlighted some of the unique experiences contributing to these disparities: "They shared that students they see talk about feelings of hopelessness and uncertainty about the future. They also spoke about the trauma of having a loved one in another country and the inability to see them because of the difficulty of traveling and obtaining visas... Participants also described some of the mental health issues of a particularly vulnerable group of children, unaccompanied minors who have migrated to the United States from Central American countries."
Screenings & Vaccinations
A lower percentage of Hispanic/Latinx Medicare female enrollees aged 65-74 in Chatham County get an annual mammogram screening compared to other Chatham County Medicare enrollees of the same age.
Screening mammography is an important tool in the early detection and treatment of breast cancer. According to cancer.gov, "Screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50." Disparities in mammography may exacerbate disparities in morbidity and mortality from breast cancer in Chatham County. According to the 2018 Chatham County Community Assessment, cancer is the leading cause of death in Chatham County, and Black/African-American residents in Chatham experience a higher rate of cancer diagnoses and deaths from cancer. Further, breast cancer rates are somewhat higher in Chatham County than the state average, making this a salient issue for Chatham County.
A lower percentage of non-White and Hispanic/Latinx Medicare fee-for-service enrollees in Chatham County had an annual flu vaccination compared to White Medicare enrollees.
Flu vaccinations are effective in mitigating risk of flu-related illness and death. The CDC estimates that "during 2018-2019, flu vaccination prevented an estimated 4.4 million influenza illnesses, 2.3 million influenza-associated medical visits, 58,000 influenza-associated hospitalizations, and 3,500 influenza-associated deaths." These benefits are particularly evident among older adults, for whom the flu vaccine has reduced flu-related hospitalizations by an average of 40%. A smaller percentage of non-White and Hispanic/Latinx Medicare enrollees in Chatham County get the annual flu vaccine compared to their White counterparts, putting them at higher risk of flu-related illness, hospitalization, and death.
It is important to note that this disparity may stem from a variety of reasons, including vaccine-related mistrust due to historic and continued instances of medical racism, such as the Tuskegee Syphilis Study (Freimuth, et. al., 2017). Ensuring equitable vaccine coverage requires not only the availability of convenient, low to no-cost vaccinations, but earning trust with all members of the Chatham community and ensuring that systemic racism and discrimination in health care are recognized and eliminated.
Sources: "Key Facts About Seasonal Flu Vaccine," CDC; County Health Rankings & Roadmaps, Robert Wood Johnson Foundation, 2020; "Determinants of Trust in the Flu Vaccine for African Americans and Whites," Freimuth, et al., 2017; "Racism and health service utilisation: A systematic review and meta-analysis," Ben, et al., 2017
Life Expectancy, Cancer and Heart Disease
While Chatham County ranks highly in North Carolina on the metric of life expectancy at birth (highest in the state, 2013-2015), persistent disparities between whites and Black/African-Americans remain. The 2016 Health of Chatham Report notes that the disparity of 6.8 years (2013-2015) was the highest in the state. Since then, this disparity has been reduced to 4.4 years, ranking fifteenth in the state (2015-2017).
This is a positive trend, but work must continue to highlight and remedy drivers of these disparities. Average life expectancies vary throughout the county and crucially, are correlated with economic and educational disparities.
Life expectancy (in years) is lower among the Black/African-American population than the White population in both North Carolina and Chatham County.
Age-adjusted rates
Sources: "Health of Chatham Annual Report 2016," Chatham County Public Health Department; "Chatham County Community Assessment," 2018
The rate of deaths from cancer per 100,000 is higher among Black/African-American, non-Hispanic/Latinx residents in Chatham County compared to White, non-Hispanic/Latinx residents.
Age-adjusted rates
Cancer is the leading cause of death in Chatham County, responsible for one quarter of all deaths. Overall, at 455 cases per 100,000 residents, Chatham’s cancer incidence rates rank among the lowest in the state at 79th. However, age adjusted cancer mortality rates vary greatly by sex and race. The cancer mortality rate among Black/African-American males in Chatham in particular is more than twice that of White women. The American Cancer Society notes, "African-Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers. The racial disparity has widened for breast cancer in women and remained constant for colorectal cancer in men, likely due to inequalities in access to care, including screening and treatment."
The rate of deaths from heart disease per 100,000 is higher among Black/African-American, non-Hispanic/Latinx residents in Chatham County compared to White, non-Hispanic/Latinx residents.
Age-adjusted rates
Heart disease, including conditions such as blood vessel diseases, arrhythmias, and congenital heart defects, consistently rank highly among leading causes of death in Chatham County. According to the 2018 Chatham Community Assessment, heart disease came second only to cancer, accounting for more than 17% of all deaths. While lifestyle factors such as poor diet and limited physical activity contribute to the risk of heart disease, the American Heart Association reports that “social determinants play a big role in heart health.” These factors affect people’s access to affordable healthy food stores, spaces to engage in physical activity, and consistent preventive healthcare.
Sources: "Health of Chatham Annual Report 2016," Chatham County Public Health Department; "Cancer Facts & Figures for African Americans," American Cancer Society; "Environment, culture, other social determinants play big role in heart health," American Heart Association, 2019
The COVID-19 Pandemic
Hispanic/Latinx individuals make up more than 50% of confirmed COVID-19 cases in Chatham County (as of Sept. 18, 2020), even though they make up around 12% of the county's population.
The coronavirus pandemic has disproportionately impacted Hispanic/Latinx individuals across North Carolina and Chatham County. While Hispanic/Latinx individuals make up 9.8% of the state’s population, Hispanic individuals were 36% of the state’s confirmed COVID-19 cases as of September 7. The disparity is similar in Chatham County. Hispanic/Latinx residents constitute 12.1% of the county’s population but 55% of the county’s confirmed COVID-19 cases as of September 18, 2020. Chatham County Interim Health Director Mike Zelek highlighted the disparity in a June press release, stating: "We remain concerned about the impact COVID-19 is having in Chatham County, and especially among the Latinx population and in long-term care facilities."
The CCPHD has also allocated considerable resources to creating and distributing Spanish-language information and updates and conducting direct staff outreach to tiendas and majority-Hispanic/Latinx churches in Chatham County. The State of North Carolina has also recognized this disparity. In June, N.C. Gov. Roy Cooper signed an executive order to direct state agencies to provide "targeted measures to help communities of color that have been affected by the pandemic." Gov. Cooper said in a statement that "COVID-19 is shining a light on disparities that have long existed in our health care and economic institutions for communities of color."
National and state data points to disparities in COVID-19 outcomes based on race, geography, and socioeconomic status as well. For instance, African-Americans comprise 31% of COVID-19 deaths in North Carolina but only 24% of the confirmed cases and 22% of the population. Learn more: https://d4bl.org/reports.html.
Sources: Quick Facts, Chatham County, North Carolina, U.S. Census Bureau; COVID-19 Cases Dashboard, N.C. Dept. of Health & Human Services; "Chatham County COVID-19 Dashboard Updated to Include Demographic Data," Chatham County, NC; N.C. Gov.: "Governor Cooper Signs Executive Order to Address Disproportionate Impact of COVID-19 on Communities of Color"
For more...
Learn more about disparities and inequities:
- "The Gardener" video: Camara Jones discusses the three levels of racism
- "Unequal Opportunity Race" video: A short educational video produced by the African American Policy Forum to demonstrate how inequality is built into the very framework of our society
Find Support:
All this information affects us differently. We understand that receiving information about negative health outcomes that seem to reflect your community can be burdensome and upsetting. If you are in need of support, here are a couple links to resources that may be helpful.