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viii Executive Summary Introduction Every 4 years, the Orange County Health Department and Healthy Carolinians of Orange County (HCOC) conducts a Community Health Assessment (CHA). Regular assessment of Orange County’s health enables public health officials to monitor trends in health status, determine priorities among health issues, and determine the availability of resources within Orange County to best protect and promote the public’s health. With the overall goal to address health disparities and identify needs of populations who are most disadvantaged, 799 survey households were randomly selected from census blocks, stratifying to ensure low-income communities were included. 279 addresses were attempted and 166 door-to-door surveys were completed. New to this CHA, a health opinion survey was placed online and was completed by 1,548 community residents. Combined, this created 1,714 total health opinion surveys answered, 5 focus groups conducted, and 4 community listening sessions held. Selected Priorities The results from community listening sessions were brought to HCOC’s Annual Meeting in December 2015 where participants prioritized issues on the basis of importance and changeability. The health priorities, as determined by Annual Meeting participants to be of greatest concern to the Orange County community, were 1) Social Determinants of Health with priority around Access and Poverty, 2) Mental Health & Substance Abuse, and 3) Physical Activity and Nutrition. Poverty Orange County has the highest Gini Coefficient of Income Inequality in NC (0.52). This means our county experiences high income dispersion, where fewer people hold a lot of capital and many people hold little capital. While the median income for households in Orange County is $57,261, 17% of residents are living in poverty, including 16% of children. Food insecurity and affordable housing are key areas of emphasis for mitigating the effects of poverty in Orange County. While Orange County’s median gross rent is $918 half of Orange County households (52.7%) who rent spend more than 30% of income on rent. 21% of children and 15.4% of the overall population (20,900 people) live in food insecure households in Orange County Access Approximately 21,000 Orange County residents, between 0-64 years of age are uninsured. Low income residents are twice as likely to be uninsured compared to the average county resident. In 2013 a higher percentage of low income youth under 19 years were uninsured in Orange County [15% (+/- 3.2%], and 31.8% of low income residents under 64 years were uninsured. Over 6,000 Orange County residents enrolled into the marketplace for 2015 coverage.