By Thomas Goldsmith

When leaders in Anson County looked at public health needs recently, childhood obesity emerged as one of the most troubling trends among the county’s 26,000 citizens.

Statistics show that more than a third of adults are obese in Anson, located about 60 miles southeast of Charlotte. And county health director Fred Thompson and his team wanted to ward off that fate for local youngsters: obese teens have an 80 percent chance of maintaining the condition in adulthood.

gold seal that says NC Local Health Department Accreditation Board
Local health departments that have received accreditation display this seal on their websites and in their facilities.

“The studies say that if the individual is obese between 9 and 13, you’ve lost them,” Thompson said during a recent telephone interview from the county seat of Wadesboro.

“About a third of our population here is obese and a lot of them are diabetic. A lot of it is education, because at the end of the day, it’s mom and dad who are responsible for what the kids eat and also for what mom and dad eat.”

The county’s health assessment and development of a plan — better eating, fewer screens, more movement — to address problems of obesity were part of Anson County Health Department’s process of gaining recognition from the North Carolina local health department accreditation program. The complex process requires ongoing planning as well as providing electronic and in-person evidence that each department has meet as many as 137 standards.

“The bottom line is that it’s a quality improvement effort to strengthen the public health department in every county in the state,” said Dr. Leah Devlin, professor of the practice at UNC Gillings School of Global Public Health.

NC led nation

Devlin was the state health director in 2006 when North Carolina became a national leader by passing legislation to require accreditation by its local health departments, 85 of them covering 100 counties. With local assessments leading to different focuses in each local department, accreditation has become not only a means of assessing agencies, but also a tool for leaders and staff to make sure they’re taking care of citizens’ needs.

shows the county health department building
Even small county departments, such as the one in Bertie County, with only about 20,000 residents, have received accreditation. Photo courtesy: Bertie County

“It was really a push by health directors to make sure their funders, their county commissioners, knew that they were accountable,” said Amy Belflower Thomas, technical assistance manager at the North Carolina Institute of Public Health and accreditation administrator for the state’s Association of Local Health Departments.

Accreditation reached a milestone in May, when all local departments in North Carolina achieved the reaccreditation that showed continued effort statewide. One of the state’s smaller departments, Anson was one of four to achieve reaccreditation with honors late last year for meeting all but one of its standards. (Catawba, Granville-Vance and Macon were the other honorees.)

“We have a total of 20 people and that includes the WIC program and environmental health,” Thompson said. “We had met 136 of the 137 activities required for accreditation.”

“Observe the configurations”

The county’s performance on precise standards are measured by both electronic and in-person evidence. For example, Activity 30.3 calls for departments to have “examination rooms and direct client service areas that are configured in a way that protects client privacy.”

A county has to provide both written clinical protocols and floor plans that ensure privacy. In addition, a site team checks the layout during a visit, then sends one member back to “observe the configurations and the manner in which they protect one’s privacy.”

In big-picture goals derived from the community health assessment, the focus on childhood obesity joined plans to prevent STDs and pregnancy among teens, as well as efforts to control hypertension.


“Because the current problems in the county have existed for decades, the community health assessment team understands that a culture change is necessary to have a true and lasting impact,” the team said in a statement.

To address the childhood obesity problem, Anson County performed an assessment of the county’s elementary schools and how they were addressing the problem. In addition, they adopted the 5-3-2-0 program, a modification of an approach by the National Initiative for Children’s Healthcare Quality.

“One of the things that we are seeing with young children is that they are spending so much time on social media, in front of a screen, whether it’s a video game, a television or a computer, it’s a screen,” Thompson said.

“We are seeing things like high blood pressure in younger and younger age cohorts. So, in the 5-3-2-0 program, we are promoting five servings of healthy food, not more than three hours of screen times, two hours of healthy activity, and zero sugary drinks.”

A seat at the table

Given the changing health care environment, county health departments are facing new demands based on what other players are offering and not offering. Accreditation and interactions with state officials give local departments more of a seat at the table as inevitable change comes on, said Thomas, with the state association of local health departments.

Related: Bill Could Change Look, Abilities of NC Public Health Departments

“In some counties there’s plenty of pediatricians who take Medicaid, so the health department may not have to provide primary care for children,” she said.

“They are all a little bit different. They may take Medicaid, they take people without insurance, and more and more they are taking private pay patients. It’s different in every single county.”

The 10 Essential Public Health Services require all departments to:

  •     Monitor health status to identify and solve community health problems,
  •     Diagnose and investigate health problems and health hazards in the community,
  •     Inform, educate, and empower people about health issues,
  •     Mobilize community partnerships and action to identify and solve health problems,
  •     Develop policies and plans that support individual and community health efforts,
  •     Enforce laws and regulations that protect health and ensure safety,
  •     Link people to needed personal health services and assure the provision of health care when otherwise unavailable,
  •     Assure competent public and personal health care workforce,
  •     Evaluate effectiveness, accessibility, and quality of personal and population-based health services, and
  •     Research for new insights and innovative solutions to health problems.

Source: North Carolina Association of Public Health Directors

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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...