By Thomas Goldsmith

additional reporting by Rose Hoban

Looking for new locations where hunger hits the hardest, planners at Loaves & Fishes, a Charlotte-Mecklenburg County emergency food provider, used a sophisticated, layered mapping process born at UNC-Chapel Hill to find the right spots.

Last week, the state Department of Health and Human Services put online a statewide expansion of that mapping, developed by the North Carolina Institute for Public Health in Chapel Hill. The deeply interactive map showing a variety of social determinants for health is available from the Center for Health Statistics at DHHS.

“Access to medical services is crucial to being healthy, but research shows that more than 70 percent of a person’s overall health is driven by social and environmental factors outside the health care system,” Dr. Betsey Tilson, state health director and DHHS chief medical officer, said in a statement.

The layered state guide, called a “story map,” lets users track information from 10 county-based public health regions across the state. The data show the chief non-medical factors — residents’ economic status, social and neighborhood conditions, and housing and transportation access — that can have overriding effects on community health.

Lighting up

“We wanted to make sure that the pantries we operate and those we open are in the right location,” said Tina Postel, executive director of Loaves & Fishes in Charlotte. “One of our pantries that we opened was at Hope Covenant House. It’s in an area that we didn’t have a pantry, but it lit up bright green on the map.”

A look at the DHHS map shows that Region 4, Tract 45 of Mecklenburg County, where the community-development corporation Hope Covenant House is located, is home to 3,146 people. Almost three out of four have poor access to grocery stores, making it a natural market for a new food pantry, Loaves & Fishes decided in 2016, based on data from a pilot map.

shows a part of the social determinants map highlighted and indicating the lack of healthy food available in the area
Screen shot of the social determinants map showing poor food access in a region of northwest Charlotte.

“We’re taking these findings and data to a larger group of stakeholders to design interventions,” said John Wallace, a data analyst with the Institute for Public Health. “It’s not necessarily guiding the intervention.”

Low access to food was defined for the study as living more than a half mile from a large grocery store in an urban setting, or in a rural setting living more than 10 miles from a large grocery or supercenter.

In contrast to Tract 45 north of downtown Charlotte, everyone of the 2,285 people in Mecklenburg’s Region 4, Tract 58.29, had adequate access to grocery stores, according to state and federal statistics used by the mapmakers. The tract is about 16 miles south of Hope Covenant House, almost in South Carolina.

screen shot of a small segment of MEcklenburg where there were fewer social determinants of health factors that impede residents from being healthy
This segment of Mecklenburg County has no issues with access to fresh, healthy food, as shown on the new maps.

Another key number shown by the map is what’s called the z-score, the amount by which the combined social determinants in a given area, in this case a census tract, vary from the average in the region of counties. The z-score for the area where Loaves & Fishes placed the new pantry shows that the tract was among the region’s greatest deficiencies in the areas considered.

Locating and fixing such problem areas is the heart of the mapping effort, state officials said.

“No matter what our respective goals — to mitigate the opioid crisis, to ensure our children are healthy, safe and ready to learn, to increase employment or to drive economic growth — it all begins with healthy people,” Dr. Mandy Cohen, DHHS secretary, said in a statement.

Regional comparisons

A measure called the Social Determinants of Health Index combines indicators into three groups, each with equal weight in determining a final score. The individual and overall scores are compared to other counties in the same region, making statewide comparisons unrealistic.

“If you’re a coastal tract in Brunswick, you’re comparing yourself to every county in the state and it loses a lot of its usefulness,” said Matt Simon, a GIS analyst at the public health institute. “It makes more sense to compare it on a region-by-region basis.”

Still, it’s inevitable that users will find their own ways to use the map’s wealth of information, not all of it medical. Want to know the median income in Wake County? It’s $70,620, compared to $31,129 in Bertie County in Northeastern North Carolina.

Interested in the rate of people living below poverty levels in the west side of Lumberton, where Hurricane Matthew ripped up homes, churches and businesses? It’s 54.1 percent, compared to 10.6 percent living below poverty in a tract just west of booming Asheville.

Numbers such as these can suggest projects in the making for public, private and nonprofit interests.

“I think that that’s one way that the tool could be used, to figure out where resources are lacking,” Wallace said. “This is basically a conversation starter.”

The map has roots in a pilot project in which the public health institute combined forces with the Carolinas HealthCare System (now known as Atrium Health) to map a 10-county region including CMC’s own Charlotte campus. Another iteration of it is taking place in Raleigh under the auspices of the John Rex Endowment.

So far, there are no plans or funding to make the state map part of a longitudinal effort, such as the one seen the annual county assessments by the Robert Wood Johnson Foundation.

“We would love to say yes to that,” Wallace said. “We really want to do this long-term.”

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Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...