Dec 13, 2017 in Medicine

The Health Crisis in Columbus County, North Carolina


Health sector plays a crucial role in any county or state. A healthy population means that economic production can continue without a stop. On the contrary, if the population is not healthy, it means that a lot of government resources will be spent on health care. It negatively affects the development agenda. In 2012, the foundation of Robert Wood Johnson released ranking on the state of health for different counties in North Carolina. It was noticed that while Wake County was the leading, Columbus County was the last. In other words, the latter was the unhealthiest county in the state. This is a clear indication that the county is in a crisis. The declining state of health in the county is not only a consequence of government health policy but also as a result of serious economic problems.

This research paper seeks to explore the health state in the county from a historical perspective. It is based on the assumption that its poor performance was not an overnight activity but a consequence of practices that were built up with time. Specifically, the research paper looks into the state of the county’s health in 2008, 2010 and 2012. Investigation of variables in those years will make it possible to offer an important insight into the trends that may have developed. The paper analyzes the specific determinants of health in relation to social policy in details. Finally, the paper outlines the implications for deteriorated health sector in the county.

Analysis of the Problem

Background Information

Columbus County is names after Christopher Columbus and was founded in 1808 (Columbus County Health Department 11). The County embraces such towns as Tabor City, Whiteville, Hallsboro, Cerros Gordo, Evergreen, Fair Bluff, Bolton Branswick, Riegelwood, Nakina, Lake Waccamaw and other incorporated townships. In terms of education, the county holds 19 schools ranging from elementary to high schools. There are also 4 city schools from elementary to high school and 1 charter school that teaches children from kindergarten to grade 8. There is a college owned by the community and 2 privately owned schools.

Columbus County is fairly populous. In 2000, the county had a total population of 54,749 inhabitants. By 2010, the population increased by 6.1% to 58,098 people. A closer look reveals that the county’s population structure is fairly balanced. The age-sex structure analysis shows that most residents (14.2%) are aged 50 to 59. The next age group in terms of numbers is 40-49, while the least amount of the population totaling 10.1% is aged above 69. In terms of race, Caucasians constitute 60.4% followed by African Americans at 30.3%, Native Americans at 3.1% and Asian Americans at 4.6% of the total population. According to the U.S Census 2012 statistics, the following pie chart represents the age distribution.

Other important issues concern housing and employment. According to 2010 statistics, home ownership rate was 72.0% representing 26,042 housing units. While per capita income preceding 2010 was 18,784 USD, a number of those below poverty line were 21.4%. 

The above analyses of population and education levels are important because they will inform the analysis of the findings. In essence, there is a strong relationship between education level and health status. In addition, age structure of a population has implications on the healthcare system. Furthermore, description of the races would be the basis of any social issues if heath inequalities were to be distributed in terms of racial grounds.

The Problem

There were a lot of reasons explaining why the Columbus healthcare system was problematic. First of all, people did not have the access to funds for insurance cover, medicine and other crucial health issues (CCDH 190). Second of all, when Columbus people were asked their opinions about local health, most of them gave an average score. The percentages were 38.36% (good), 31.27% (very good), 15.07% (fair) and 10.48% (excellent). Indeed, if most citizens of a country are sure that their health is neither excellent nor very good, then it is a problem.

There were other issues within the Columbus County health system. These could have contributed to the county being listed as the unhealthiest one in the States. One of them includes inadequate mental health services and facilities. Second of all, the county was very poor in provision of wellness health services. Thirdly, there were very few drug abuse or other rehabilitation services. Fourthly, the county administration did not offer enough recreational facilities which would otherwise reduce cases of depression or strain. Fifthly, the county did not have the required health education programs. The other problem had to do with where the people of Columbus County got their health information. It was established that most people (32%) got their information from doctors. Viewed from a critical angle, this is a problem because most people do not have regular visits to doctors. Counties that toped the ranking had more digital or electronic methods of accessing information on health status.

The problem of the county could be summarized in the bar graph below:

The health needs of Columbus County (Adapted from CCDH 36)

Findings and Analysis

According to the results of the opinion survey carried out by the Columbus County Health Department, the topmost killer diseases were cardiac diseases, cancer and stroke constituting 43.19%, 33.60% and 8.22% respectively. However, according to the 2008 survey, the top three killer diseases were cardiac (heart) diseases, cancer and diabetes. There was an upsurge of cases of stroke. In addition, it was established that the most burning health issue was that of chronic diseases at 46.6% followed by drugs and alcohol abuse at 21.35% and 12.56%. In 2008, the leading issues were drug or alcohol abuse, obesity and violence. When respondents were asked what mainly contributed to their quality of health, a whooping 75.45% cited economic factors. It was followed by education (7.99%) and age (6.24%). It should be noted that in 2008, economic factors were also the leading ones but at a far much lower percentage of 52%. It appears that the economic recession of 2008 had a significant impact on health care.

The study also undertook other dimensions. Respondents were asked what they would want done in order to improve health, 18% preferred job opportunities, 11% healthy foods and 10% additional health services. Regarding introduction of educational health programs, top three topics of concern were a combination of cholesterol, blood pressure and diabetes at 11% followed by cancer at 10% then substance abuse at 9%. This ranking did not differ from the 2008 survey in terms of order.

The findings of the study also showed that while 49% of the respondents had emergency supply kits, 47% did not, while 4% were not sure. This discrepancy must have largely contributed to the poor ranking. It means that almost a half of the population did not have emergency kits. Lack of this kit has other implications. The first one is that those families that do not have them lack basic first aid education. This is because the kits are set with some educational materials that would equip family members with the necessary information about some possible health outcomes. In times of emergency, people tend to choose the television as the source of information. This could have social implications. It could mean, for instance, that the inhabitants of the county are more individualistic; TV has been negatively associated with broken social bonds and increased addiction. This means that people are also likely to rely on TV even for getting that health information presented there may even be wrong.

Analysis of the county results compared to those of the state level shows that the county shows worse figures. Some rates are almost twice those of the state (Green and Klein 45). This means that the county contributes largely to the possible dismal performance of the state at the federal level. For instance, the rates for heart disease are 259.8 per 100,000 people in the county while that of the state is 184.9 per the same number of people. In addition, in the county, the rate for cerebrovascular disease is 69.9 per 100,000 while the state rate is 47.8. It means that if it were not for the county extreme figures, the state would have far lower rates. The same could be said about cancer rates. While those of the state are 183.1, those of the county are 204.3 per 100,000. With regard to diabetes mellitus, the rates per 100,000 are 22.5 and 32.4 for state and county respectively.

The table below summarizes the significant health issues in the county versus the state in relation to the thesis:



North Carolina

% uninsured 0-18 years



% adults without any form of healthcare



% adults who could not see a doctor in the last 12 months due to the cost of service



The findings leading to the classification of the county as the worst have several implications. The first one is based on the population structure. It was realized that the county mainly possesses an ageing population. It is a well-known fact that ageing people have more health problems than young people. It means that the county will continue to spend a lot more on delivery of healthcare services. If the population were not old, this money would be used for other developmental projects. Since it was established that economic factors mostly contribute to poor health, this implies that as long as the county government does not continue to create opportunities for the unemployed, the state of ill health will continue bedevil the county. With regard to housing, it implies that poor living conditions may continue to exacerbate the local health situation. All the town authorities are compelled to put efforts towards provision of better housing, sanitation, infrastructure and water.

A close analysis the health crisis in Columbus reveals a lot of health policy implications. For instance, with regard to age, it is expected that senior citizens consume more while they do not produce anything. This is because the government is obliged to provide healthcare to them. This imbalance leads to strain in government resources. In addition, the government must set aside a lot of funds for the care of the elderly. In terms of health, there are expected to be significantly more deaths including child mortality. This is partly because there is a smaller number of people who are born than those who die. Consequently, in order to avoid a lot of deaths at old age, the government must invest in quality and, hence more expensive care for the old. Furthermore, there are diseases that are associated with old age. These include, for instance, arthritis. In the case of Columbus, it means that such cases will continue to increase, thereby rising mortality statistics figures. Conversely, money that would have been used to expand healthcare is used to sustain the aged people. As expected, there are more cases of sickness among the old as opposed to the young or middle-aged people. In essence, the elderly may continue to fill Columbus hospitals in the near future.

Having established that the health crisis in Columbus has economic implications, it is also important to analyze the reverse case. Indeed, the economic challenges of the county have contributed a lot towards the failed health policy. From the survey, it was realized that most people attributed their health conditions to lack of job opportunities. In the same way, such people preferred economic empowerment as the first step towards achieving good health. There is no doubt that poverty leads to poor health. In each unhealthy society, poverty plays a major role in the state of overall health. Specifically, when people are economically challenged, they cannot afford paying for healthcare in qualified hospitals. As a result, diseases which ideally they should not catch lead to their possible death. In addition, lack of economic power results in inability to pay for insurance cover. This has a direct link to the deterioration of health since conditions persist in bodies for a long time. Furthermore, poor economic status means that people cannot afford balanced diets. This may lead to deficiency diseases. In addition, cheap fried foods are known to be among the causes of lifestyle diseases such as obesity and high blood pressure. It implies that as long as most Columbus people are not able to afford healthy food, such diseases will continue to bedevil them. Besides, poor economic status forces people to live in unhealthy environments that harbor diseases.

In the final analysis, policy makers in Columbus must recognize the reciprocal causality of health and economics. They do affect each other. In order to curb the negative relationship between economy and health, there must be policy interventions. These interventions could start from the provision of job opportunities to people subjected to the above stated problems. Furthermore, if there is a policy change in the domain of health, there will be massive economic dividends that could be channeled to other development projects. Otherwise, the ageing population would continue to pose both a health and economic challenge to the county. Other than provision of economic opportunities, another equally important policy intervention must be grounded on provision of free or subsidized insurance to the people of Columbus County. Additionally, the study implies that a lot of public education on health issues is required. These issues were established to be nutrition, exercise, safety, etc. This approach is based on the fact that health can be achieved through individual efforts other than exclusive reliance on government support. Although the ranking of the county as the unhealthiest was not restricted to purely health issues, the same parameters were used for other counties. Therefore, it is mandatory that the county develops policies that would see the ranking go up.

Conclusion and Recommendations

Columbus County ranks as the worst county in North Carolina in terms of health. These rankings by Robert Wood Johnson Foundation were elaborated together with CCDH’s findings upon conducting health surveys across the county. There is strong evidence pointing out towards the fact that economic difficulties have made people unable to afford healthcare services or individual healthcare kits. Moreover, Columbus’s healthcare crisis must be understood in the wider context of the demographic, economic, social and infrastructural ideals.

It is recommended that the county adopts a comprehensive education program on benefits of good health. This includes education on nutrition, alcohol use and exercise. However, this must be backed by enormous financial support not only from the county but also from the state. Furthermore, there is a need for the establishment to conduct screening and promotional programs. These could focus on oral hygiene, diabetes, cancer, blood pressure and other lifestyle diseases. Indeed, there is a positive correlation between health and economic status.

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