Substance abuse tops community concerns

May 4—Substance abuse is the top concern identified by the community in the 2022 Cumberland County Community Health Assessment. Poverty, youth tobacco and vaping, lack of affordable housing and mental health rounded out the top five issues identified through a survey.

The report, prepared every three years by Cumberland Medical Center, is developed through community surveys.

"The frustrating thing about the prevention of substance abuse is that just when you get a handle on something, something else comes around the back door," said Gary Young, with Covenant Health, during a presentation on the latest community health assessment April 12.

The data found that the number of opioid prescriptions written to Cumberland County residents had decreased 34.5% from 2019.

"There's some public policy behind that where they were tracking who was writing prescriptions, for what reason and for what amount," Young explained. "There was a lot of oversight that made an impact."

But a decline in opioid prescriptions is often followed by abuse of heroin or fentanyl. Representatives with the Cumberland Prevention Coalition said the original dose of naloxone, which reverses the effects of opioid overdose, was no longer effective in many instances, requiring more and more doses.

Crossville City Manager Greg Wood said city emergency personnel — law enforcement and the Crossville Fire Department — offer fast response to medical emergencies such as overdoses, and law enforcement is equipped with naloxone.

Young explained the health assessment is a requirement for nonprofit hospitals as part of their tax-exempt status with the federal government. It's required every three years — this is the fourth community health assessment for Cumberland County.

"The hospital facilitates this assessment. The community does the assessment," Young said.

About 600 people participated in the health assessment through surveys, focus groups and meetings. Steering committee participants represented the school system, local nonprofit organizations, representatives of the Cumberland County Health Department, emergency medical services, long-term care facilities and Cumberland County and the city of Crossville.

The report considers a variety of data, such as quality of life, social and economic factors, and clinical care. The leading causes of death in Cumberland County in 2020 were cancer, heart disease and chronic respiratory diseases.

The county reports a much lower number of mental health providers compared to the state or nation — about one provider for every 2,840 people compared to one for every 560 people in Tennessee.

But a centerpiece of the report are responses to a community survey which helps to identify health challenges faced by the community at this time.

"What are people living with and challenged with right now — not looking at data that is two or three years old," Young said. "If you're listening to community leaders who are living and breathing the challenges, they're in the trenches. They can tell you what's going on."

The survey data can also help fill in gaps in data which may not have been collected during the COVID-19 pandemic, Young said. Health care workers shifted their focus from outreach or other activities to handle the more immediate patient care needs.

The community health assessment provides good information that can be used to help leverage other resources through grant applications and decisions on programs.

While the health assessment is required every three years, Young explained that assessments can build on earlier efforts.

"We're dealing with some pretty big generational stuff that's not going to change very quickly," Young said.

The first assessment looks at the community overall. The next will look at the issues identified in that first assessment to see if those issues got better, worse or stayed about the same — and then to look at other factors that may have emerged in the past three years.

"In 2019, we looked at everything again. But in 2022, we built upon that last assessment," Young said.

In addition, the 2022 assessment also looked at the impact of the COVID-19 pandemic on the top issues, asking if the pandemic made the problem worse. Survey respondents said the pandemic most negatively impacted issues of substance abuse, poverty and mental illness.

"Because of COVID, our outreach for health education ceased," Young said. "Because of COVID, people were homebound, they were furloughed or they lost their jobs, their hours were cut. The kids were home ... if you didn't have mental health issues before COVID, you probably thought you might have issues by the end of COVID.

"It's not surprising the substance abuse worsened or that mental health was at higher demand but access was less."

The health assessment also helps identify potential future health concerns. Young pointed to the number of residents over the age of 65 in Cumberland County — 32%. The state average is closer to 17% of the population.

"Most of your health care delivery is going to come in the last decades of your life," Young said. "That's got profound implications for health care."

Heather Mullinix is editor of the Crossville Chronicle. She covers schools and education in Cumberland County. She may be reached at hmullinix@crossville-chronicle.com.