Davidson County Final Health Portfolio

Lexington, North Carolina

HEA-603, Professor McCoy

Kimani Burney, Carissa Crews, Chris Jacobs, Parris Mitchell

Introduction

For this particular

assignment, as a group,
we were assigned an
area in Davidson
County North Carolina.
From there we
canvassed and
researched the town of
Lexington, the second
largest town in
Davidson County after Thomasville. After interviewing community members and leaders, our
group learned about the strengths in the community in addition to what health and economic
disparities needed extra attention. Barbeque festivals, car shows, and rich community traditions
are some the aspects Lexington is known for. As with all things, there is always room for
improvement. Currently, there is a lack of jobs, high homeless and teenage pregnancy rates, and
a large socioeconomic status gap amongst residents. The Davidson County report below will
work as a tool to identify and hone in on those themes, plus more!
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Table of Contents

Introduction

Community Health Assessment Process…………………………………………………..2

Map of Neighborhood……………………………………………………………………..3

Description of the Community…………………………………………………………….4

Community Interviews…………………………………………………………………….6

Socio-Demographic Profile…………………………………………………….………….8

Health Profile……………………………………………………………………………...11

Discussion of Findings………………………………………………………………….....13

Appendices………………………………………………………………………………...16

References……………………………………………………………………………...….17

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Community Health Assessment (CHA) Process
The Community Health Assessment serves as a great resource to the residents of Davidson
County. The document allows persons to physically see what factors are affecting the community they
live in. Also the 2012 Community Health Assessment we referenced for this assignment includes several
tables and charts, which makes interpreting data a lot easier. Additionally, underneath some of the tables
and graphs there were bullet points, instead of paragraphs, interpreting what the table and or graph meant.
That technique is great considering some residents may be intimidated by lengthy paragraphs. The bullet
points in the assessment allow important, summarized information in an easy to understand format. The
assessments also provides information that may have not been accessible elsewhere. For instance, if a
resident wanted to know average household income rates, the assessment provides that information to
them. Residents may not have had access to that information, or knew where to find it. As far as
techniques used to collect primary data, participants putting together the 2012 assessments, conducted
door-to-door surveys as well as electronic surveys via “Survey Monkey”. These two survey methods
allow for a traditional way to collect data, going door-to-door and a technologically advanced method-
online survey taking. That way a person without access to a computer isn’t left out of taking the survey,
they can partake in the door-to-door version. The same works for if a person isn’t home, they can opt to
participate in the electronic version of the survey. It’s great that the creators of the 2012 Davidson County
Health Assessment were inclusive in their methods for collecting data. That particular characteristic helps
to reach populations in greater spans. Community forums were also conducted that included members
from the community as well as professional leaders. That method used to collect primary data is a
successful tactic in that different viewpoints and opinions were brought to the table.
To collect secondary data the assessment used several resources such as: the North Carolina State
Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS), Kids Count Data
Center, and a myriad of other informational databases (Davidson County Health Department, North
Carolina, 2012). How was all of the data analyzed? The data was analyzed in Cary, North Carolina with
weighted frequencies for each survey question. Qualitative data collected was summarized into
categorical variables. There were certain gaps in samples for quantitative data collection for populations
such as: African Americans, teenagers, Hispanics, pregnant women, senior citizens, uninsured
individuals, and persons with a history of substance abuse. Overall, the 2012 Community Health
Assessment process was very organized and well put together in a resource that can be used for reference
years to come.

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Map of Neighborhood

As shown by the map above, the area encompassed within the blue lines, was the area canvassed
by our group. Each different colored marker represents a community asset or resource. We decided to
categorize the resources into eight groups: churches, food/eateries, recreational, educational/historical
services, residences/houses, retail/shops, health-related services, and miscellaneous services (a day spa,
fire department, police department, cleaners, banks, etc.). For example, the red plus sign markers are
health-related services such as a dentistry, drug store, health department, chiropractor, and eye doctor. As
you can see, some of the red plus signs are outside of the blue line that marks the area we canvassed as a
group. That is one aspect, during the windshield tour and audit, that we noticed. So of the necessary
resources, like medical care, was further away and harder to access without transportation. Also, upon

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reading the community health assessment, there was a very low ratio of doctors and medical professionals
to actual patients in the area. According to Livability.com there is a ratio of 317 patients per one doctor,
three heart specialist in the area, and eight optometrists (“Doctors in Lexington, NC”). There may be a
need for additional medical professionals in the area so that residents can be served in a certain manner
and doctors aren’t overwhelmed by a high patient volume.

The burgundy cross symbols indicate a church or religious affiliation. Being that there are a
plethora of churches within a short radius, it is clear that churches play a key role in this community.
More specifically, the only homeless shelter in the entire Davidson County is religiously affiliated, Crisis
Ministries of Davidson County. As a group, we have mentioned throughout the entire semester how
important Crisis Ministries is to the Lexington community. Not only is it the only homeless shelter in the
area for miles, but it is also a food pantry, and a place that has services to assist residents in paying their
bills if they are needing additional help during the month. It goes without saying that Crisis Ministries,
and other religious organizations within the community, serve as positive beams of light throughout the
area and as helpful resources for a variety of needs.

Description of the Community

Lexington, NC is semi-rural, suburban area that has a small town feel to it. Its downtown is
relatively small, as it is concentrated on one street. Right outside of downtown there are several
abandoned buildings; many of them looking as if they have been closed for decades. There is a large
stretch of abandoned buildings and businesses that separates downtown Lexington from suburban
Lexington. It is very empty and gives a ghostly feel to the area.

In the neighborhood we conducted our tour on, there were several dilapidated homes. Paint was
chipping off of them, and the rust stains were becoming prominent. Many of the homes looked like as if
they had not been renovated or tended to in decades. The majority of the homes in the neighborhood had
all sorts of items sprawled throughout their front lawn and porch. One notable home had sinks, broken
down boxes, children toys that looked like they were bought in another decade, and other miscellaneous
items (reference image below).

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Figure 1.1
Image taken of House in Canvassed Neighborhood

Culturally and politically, Lexington is very conservative. At the center of downtown is the Davidson
County Republican Party headquarters. There were several “Trump-Pence Make America Great Again”
flyers sprawled throughout the city. There were several churches in a small radius; all of them Christian.
Church and religion play a large part in the culture of Lexington. Attending church is a part of their
weekly regimen. Their Christianity is at the center of their day-to-day practices, politics and lifestyle.

There are several health facilities. Surprisingly, Lexington offers nearly every specialty clinic that we
imagine that a community would need. A hospital, Lexington Medical Center – Wake Forest Baptist
Health is on the outskirts of town. There are specialty clinics such as: Lexington Healthcare Center
(physical rehab), Abbot’s Creek Center (drug rehab), The Eye Care Group (optometrist), and Wincare

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Chiropractic Center, to name a few. There are also pharmacies such as CVS, Walgreens, and Lexington
Drug.

There are over thirty different schools. They include pre-K, Kindergarten, Elementary, Middle, High,
Charter and Private schools. There were about a dozen churches that we saw; all of them Christian. A
select few were Baptist, Methodist, and Episcopalian. There were not many businesses at all, with many
of them being closed down. The biggest industry there were privately owned restaurants. Other notables
were insurance agencies- Allstate and Mountcastle. As far as organizations and agencies there were:
Davidson County GOP Headquarters, J Smith Young YMCA, Sapona Ridge Country Club, Lexington
Golf Club and the Lexington Health Department.

Access to facilities is a huge issue in Lexington. Many of the facilities are not in an immediate distance
that can be walked to. The majority of the residents live in the suburban area, which is at least a 15 minute
drive away from most of the facilities.

The neighborhood is served by public transportation that stops a block from where they live. The
bus runs from 7:00 a.m. until 5:00 p.m. Since lack of access and transportation is an issue in Lexington
they are served by this public transit. Also, Aldi, a grocery store is within walking distance, as is CVS,
and a laundromat. This makes their lives more convenient by not needing a car for these basic needs.

The most pressing need concerning the community is more businesses and industries. Lexington is
struggling economically. There is nothing that attracts jobs. This need will usurp any artistic gifts that the
individuals may have. For example, an arts center would not be appropriate in Lexington. A
business/industry that brings jobs would be more of a pressing need first.

Community Interviews

After going on a windshield tour of Lexington, North Carolina, conducting an audit and several
interviews it can be determined that there are three priority concerns of the community: (1.)
unemployment, (2.) homelessness and (3.) access to healthy food options.

A common theme within our interviews is unemployment, and subsequently the lack of jobs in
the area. In speaking to people in the community, unemployment seemed to be the most identified
dilemma of the area. The Director and Administrative Assistant of Crisis Ministries of Davidson County,
Officer Rose, and an employee we spoke with at Jojo’s Ice Cream Shop during our windshield tour all

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discussed the need for more jobs in the area. The Duracell factory closing in Lexington displaced a
number of families, however the community is attempting to fix their unemployment issues. As a result,
several businesses have recently opened to help accommodate those who lost work. The Director of Crisis
Ministries mentioned that an Amtrak Train Station is coming to the area soon that may potentially bring
more job opportunities. Though new jobs are becoming available, it is still difficult for many individuals
to obtain a position with no higher education; nonetheless the community still remains very hopeful that
times are changing slowly but surely.

The county’s high rate of homelessness could correlate with the county’s lack of jobs. In
surveying the area, and reading about poverty in the Davidson County Community Health Assessment,
homelessness seems to be a significant issue in the area. Currently, Crisis Ministries is the only homeless
shelter in Davidson County, which includes five towns. At the time of our windshield tour we saw the
homeless shelter administering shelter for several single men, women, families, and veterans. One
community member stated: “I see homeless people in the area all of the time. I bring my kids into this ice
cream shop every week, and driving around during the day I see a lot of homeless people loitering and
panhandling and it’s an eyesore. It seems like the homeless shelter must be overflowing!” (Community
Member Interview, 2016)

Our assessment of the community clearly indicates that there is a need for more jobs as well as an
additional shelter in the area. Funding that will be utilized in enhancing Crisis Ministries is also needed to
continue to provide a resource to the community that is well equipped to house a large number of
inhabitants that it is well off and functioning.

As a result of canvassing the community and the map assignment it became obvious that the
county lacks access to healthy food options. It can be assumed that much of Davidson County also has
this issue as well. During our windshield tour and audit of the community we did not observe any
farmer’s markets or healthy food stores or eateries beyond the typical grocery stores such as Food Lion
and Aldi. One interviewee mentioned her concern for proper access to healthier food options throughout
the community. She discussed how her and her husband travel to local farmers markets in Winston-Salem
and Greensboro to shop for healthier food options for themselves and their families. Improving access to
healthier food options at affordable prices seem to be a priority need in the community and could be a
potential strategy to helping decrease rates of obesity, high blood pressure, heart disease and diabetes.

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Socio-Demographic Profile

Just to give some background information about Davidson County: the total population is
currently 162,878 with a median age of residents being 40.3 years old (FactFinder). The distribution of
ethnicity is as follows: Whites, 84.3%, Black/African-Americans, 8.9%, American Indian/Alaska Native,
0.5%, Asian, 1.2%, some other race, 3.6%, and two or more races, 1.5% (FactFinder).

Figure 2.1
Race & Ethnicity

Davidson County is mostly made up of White residents, with a small percentage of other races and
ethnicities. Before looking at ethnicity percentages, our group observed that Lexington was majority
White. During our windshield tour we only encountered a couple of black people who were hanging out
in front of a Beauty Supply store downtown. Initially, the white people we saw gave us weird looks and
didn’t greet us in any manner. The black people we saw did at least wave and flashed us a warm smile.

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As a group we researched and provided information on the educational levels of the residents
living in Davidson County. 4.7% of individuals in the age range 18-24 received a Bachelor’s degree or
higher. While 21.2% of persons received a Bachelor’s degree or higher in the 25-34 year old age bracket.
The age range of 36-64, made up 39.8% of persons with a Bachelor’s degree or higher (FactFinder).

Figure 2.2
Education Levels

Many persons residing in Davidson County have a High School Diploma, but not a lot of individuals
decided to continue on their education and obtain a higher education degree. Upon interviewing the
Director of Crisis Ministries, Gayle Whitehead, we learned that many people living in Davidson County
depended on a trade instead of an education to make a living and provide for their families. For example,
the Duracell battery factory, where many residents were employed, shut down and the unemployment rate
went through the roof. Ms.Whitehead explained it to us like this- if no one has a job, then people don’t
make money, and thus lose their homes and assets, which leads to homelessness and poverty. This seems
to be the pattern currently in Davidson County with the average median household income in the area
being less than Guilford County and the state of North Carolina. One could describe this phenomenon as a

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Domino effect. If there are no jobs in the area, people lose homes, and slip into poverty and that
ultimately decreases person’s overall health outcomes. If a person’s basic needs are not being met such as
having shelter and a steady income, then they more than likely do not have additional funds to visit
physicians regularly in order to check in on their health.

Additional residents we interviewed mentioned a variety of resources already in the community

and what could be added to make it a more enjoyable place to live. For example, Parris interviewed the
Director of the local Senior Citizen Center and she mentioned that Lexington has a high senior population
and many of them enjoy the center and all that it has to offer. As a matter of fact, the Director, said that
there is usually a long waiting list for the seniors to participate in certain activities. The Director also
mentioned that many abandoned factories and buildings could potentially be renovated into affordable
homes for seniors. This ties directly into the Police Officer’s viewpoint, Kimani interviewed him. Officer
Rose, is his name, said that there is a plethora of rental properties in the area that are not well-kept and
manicured by property owners. What a coincidence! Those same rental properties Officer Rose
mentioned could be bought and rented out as a cheaper living arrangement for local senior citizens. As
one can see there are many determinants of health that were identified during our visits to Lexington.
Those needs could also be transformed into interventions in order to build a healthier, happier
community.

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Health Profile

In researching and collecting data for the Davidson County Health Profile, we discovered two
leading causes that accounted for about half of all deaths across all races, ages and gender. More
specifically, those causes are Cardiovascular Disease (CVD) and Cancer. In 2015, Cancer consumed 410
lives (22%), with CVD (19%) following close behind with 358 deaths (State Center for Health Statistics)

Figure 3.1
Leading Causes of Mortality in Davidson County

It is no secret that both Cancer and CVD consume many lives all over, not just in Davidson County and
the state of North Carolina. Moreover, initiatives can be taken to reduce the rate at which persons are
being diagnosed with CVD. Davidson County is known for its tradition in BBQ recipes, and interviewed
community members have mentioned that persons do not partake in a healthier diet that includes more
fresh produce. That lifestyle alone could be contributing to people in this community being diagnosed
with CVD.

In thinking more in-depth about Cancer rates, lung cancer has the highest prevalence with an
average of 85 persons per 100,000 as compared to much lower rates for colon, breast and prostate Cancer.

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In one of the interviews conducted, we received feedback on the idea that there is a need for tobacco
education in schooling. Because the population consists of mostly middle aged to elderly adults, habits of
smoking have more than likely persisted for years on end, resulting in the adverse effects of lung Cancer.
The rates also break down further into race. Though these rates are those of the state as a whole, we are
confident that they are not much different from that of Davidson County.

Figure 3.2
Cancer Rates by race across North Carolina

Between the Black, White, and Hispanic populations in Davidson County, Hispanics reported the lowest
rates of cancer incidences in all four major sites. Traditionally, cancer does not plague Hispanics as
severely as the Black and White populations, as their countries of origin are typically less susceptible to
Cancer than the United States. The most interesting finding about the other types of cancers is that fact
that Black men reported an astronomically higher rate of prostate Cancer than white or Hispanic men.
According the reports of the North Carolina State Center for Health Statistics, we concluded that black
men are routinely less likely to have prostate examinations than any other race. This may be due to
several factors: anxiety over the sensitive exam, apathy towards health care and routine check-ups, and/or
a greater propensity to the disease.

From this information, we have concluded that there is a lack of health promotion in Davidson
County. Community members are proud of their county for housing the BBQ capital of the state, however
the effects of this high-fat and high-sodium entree are negative and adverse. Indulging too frequently and
consistently more than likely results in high rates of Cardiovascular diseases. Also contributing to these
high rates are the lack of exercise areas and facilities, and the lack of accessibility to resources for fresh
fruit and vegetable options. These same factors may contribute to the county’s prevalence of Cancer.
Though we do not know what specifically causes Cancer, the lack of exercise, unhealthy diets, lack of

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access to hospitals and other necessary health care centers (displayed via our map), all contribute to the
likelihood of community members getting diagnosed with cancer.

Discussion of Findings
“I had a great time learning about Davidson County, during each trip made I learned more and
more about the area. I believe I was most shocked about the lack of homeless shelters in the area. I could
not digest the fact that there was only one homeless shelter in the entire county. The homeless shelter, to
me, is one of the biggest assets the community possesses. Not only do they provide shelter for individuals
and families, but there is also a food pantry, and additional resources such as a place to go if you can not
pay your bills for the month. Additionally, all of these many operations were ran by a small team of
people who are more than likely overworked and underpaid but share a true passion for helping others in
need. I commend those people, the work they do, and the difference they are making within their
communities- my heroes! With that being said, homelessness is obviously a huge issue in the area and
more shelters should be available. The Director of the homeless shelter mentions that it is stressful
operating one shelter for an entire county of people. I could sense how passionate Ms. Whitehead was
regarding this population, but she also sounded frustrated that other community leaders do not feel as
concerned as she does. Therefore, old, abandoned houses and buildings could potentially be turned into
residences for homeless persons. As far as what I noticed in secondary and primary data, income levels
and poverty rates went hand and hand. As mentioned earlier in the portfolio, one lack of a resource led to
many other aspects of life failing as well. For instance, if one has no job and there is no income coming
in, it makes affording life that much more difficult. I noticed poverty rates being higher in Davidson
County, that statistic sparked my knowledge of a major factory closing down- one of the only
employment opportunities that was offered to Lexington residents. Since the closing down of the factory,
poverty levels increased. Therefore, more job opportunities need to be brought to the area that cater to
residents’ skill set such as textile and factory-level jobs. ”
-Carissa C.
“The biggest revelation I came across was the increased need of aide for the homeless. The
homeless shelter, Crisis Ministries, is a tremendous help, but they are overcapacity. There needs to be an
additional homeless shelter working at the same level as Crisis Ministry. Another finding I came across
which may be more paramount than the former is the need for skilled trade. There is a low number of
college graduates and the battery factory that the residents depended on is long gone. In order to mitigate

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this, residents need to develop skill sets. Electricians, plumbers, and mechanics would be a welcomed
skilled labor to an underemployed town.”
-Chris J.

“Our time spent exploring around and researching about Davidson County allowed me to learn a
great deal about the area. I am new to North Carolina, and I always feel that I know nothing about the
state, however this opportunity gave me the chance to learn about more than what meets the eye.
Interviewing community members and community leaders allowed me to gain insight on the daily lives of
those who reside in Davidson County, and more specifically Lexington. I was able to better understand
the harsh reality homeless shelters face, having to turn away people because there is simply not enough
room to house the entire county. The fact of the matter is that many of the inhabitants are war veterans
and other people whom have simply lost their jobs due to the closing of a number of factories in the area.
I can only imagine opting out of school to learn a trade in order to support my family and myself, and then
after spending more than half of my life working in a factory being relinquished of all of my rights and
perks as a working person. In learning about all of the ins and outs of the homeless shelter, I could not
help but to empathize with the continued fight of Ms. Whitehead, the Director of the homeless shelter.
Because it is a non-profit organization, she is constantly faced with having to put herself on the front line
in order to fight for the rights of these people. In conducting a community health assessment, though this
was not the full process, I learned about the importance of partnerships within the community- this helps
in being able to advocate for the rights of others. I also learned the importance of gaining the perspectives
and concerns of community members themselves. At the end of the day, we are working to better serve
the communities in which we are accessing and because of this we are to value their input. I hope that
Davidson will move towards a more accessible community, offering an abundance of jobs to allow for
residents to get back on their feet and provide for their families, as well as eventually establish a line of
public transportation so that community members are able to reach places in which they need.”

-Kimani B.

“Overall, I really enjoyed conducting the windshield tour of Lexington. The city reminded me of
many other small towns in North Carolina. To my surprise the area we toured was not as rural as I
expected it be. Through my observation I realized that Lexington was not as homogenous as I initially
thought it would be either. Most of the residents were white, however I saw more blacks than I
anticipated. Although the community is rather small, there seemed to be a good variety of resources and
assets in the community, yet there are still many needs that should be addressed. As a result of our

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interviews, primary and secondary data, and exploring the community, I concluded that there is a need for
healthier food options, an additional homeless shelter, more jobs, and more affordable senior housing for
the growing senior population. Some of these issues were common concerns among our community
leader and community member interviewees. Addressing each of these issues will lead to significant
changes within the community, however each issue will definitely take time to accomplish and face many
challenges. Based on the windshield tour and knowledge of the community, I believe the residents of
community need to know more about the many resources in the area and the services they provide. There
is a good amount of resources and services in the area that many community members are likely unaware
about, such as the various services offered to older adults and their families through the Department of
Senior Services, which I learned about through my interview with the Director of the department, Thessia
Everhart-Roberts. While conducting my interview with Thessia, I realized how some of the information
she discussed overlapped with parts of the Davidson County Community Health Assessment. ”

-Parris M.

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Appendix

A.

Figure 1.1

Figure 1.1 shows an image we took of a house with a rather cluttered porch in the neighborhood we
canvassed.

Figure 2.1 Race & Ethnicity

The Race & Ethnicity table shows the race and ethnicity of residents in Davidson County, its peer
counties and the state of North Carolina.

Figure 2.2 Education Levels

This table shows the comparison of education attainment levels among different ages groups in Davidson
County, Rockingham County, Forsyth County, and North Carolina.

Figure 3.1 Leading Causes of Mortality in Davidson County

The pie chart shows the leading causes of mortality in Davidson County.

Figure 3.2 Cancer Rates by Race Across North Carolina

Figure 3.2 shows the comparison of cancer rates between African Americans, Whites, and Hispanics in
North Carolina.

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References

C. (n.d.). Doctors in Lexington, NC. Retrieved December 4, 2016, from

http://www.livability.com/nc/lexington/health/doctors

D. (2012, July). Davidson County 2012, Community Health Assessment, July 2012. Retrieved December
4, 2016, from http://www.dchdnc.com/Docs/HealthED/communityhealthassesmnets/2012 Community
Health Assessment.pdf

Google. (n.d.). Retrieved October 10, 2016, from https://www.google.com/maps/d/edit?mid=144wS-

3giXN2Vxl_Va5mRR2tQ9og&ll=35.808595134748 06%2C-80.26202825000001&z=13

Johnson, N. B., Hayes, L. D., Brown, K., Hoo, E. C., Ethier, K. A., & Centers for Disease Control and
Prevention (CDC). (2014). CDC National Health Report: leading causes of morbidity and mortality and
associated behavioral risk and protective factors—United States, 2005–2013. MMWR Surveill Summ,
63(Suppl 4), 3-27.

(n.d.). Davidson County, North Carolina. Retrieved November 9, 2016, from

http://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml#

N. (2015, October 9). Leading Causes of Death in North Carolina. Retrieved November 14, 2016, from
http://www.schs.state.nc.us/interactive/query/lcd/lcd.cfm

NC-DHHS State Center for Health Statistics, 2011-2015 North Carolina Resident Live Birth by County of
Residence. Retrieved November 9, 2016, from
http://www.schs.state.nc.us/data/databook.CD6A-B%20LBW%20&%20VLBW%20by%20race.html

SCHS. 2009-2013 Cancer Incidence Rates for Selected Sites per 100,000 Population Age-Adjusted to the
2000 U.S. Census. Retrieved November 9 2016, from
http://www.schs.state.nc.us/schs/CCR/incidence/2013/5yearRates.pdf

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