Madison County May 2023


County Seat

Median Income

Population Density Designation

“Doing fine and thriving are not the same thing.”

That quote from a meeting with community leaders in Madison County accurately describes the fundamental challenge facing this large, sparsely populated area of western North Carolina. These leaders are not content to simply maintain the status quo; they are determined to make life better throughout the region.

At Blue Cross NC’s Extra Miles Tour visit to Madison County, company officials gathered at the Mars Hill Anderson Rosenwald School in Mars Hill. The recently restored, century-old school was an appropriate place for our conversation, symbolizing the area’s determination to recognize its history while realizing ambitious plans for a brighter future.

One of the most immediate challenges in Madison County is the lack of childcare options. Simply put, there aren’t many – not even unaffordable options. With a relatively small population and a large geographic area, access to transportation is a very immediate problem. Public transit is limited, and many families have to use their only car to commute to work every day. That makes it difficult or impossible to ferry young children to and from school or to visits with a doctor.

With little access to childcare and transportation, parents are faced with difficult choices. Most of these parents are consumed with meeting the most immediate necessities of their families, starting with the need for a steady income. This is where the difference between “doing fine” and “thriving” comes into clear focus. Landing a job can get a family to the point of doing fine, but to truly thrive, that family needs a lot more.

And these folks are not looking for handouts, they’re looking for more choices. Madison County has only two grocery stores; imagine how far some people have to travel to buy groceries. The county doesn’t have a hospital and has no practicing OB-GYN, no doulas, no midwives, no services for high-risk pregnancies. There are three dental offices in the county, including the Health Department, which has a waiting list of three to four months for an appointment.

Access to mental health services is equally limited. The COVID-19 pandemic added to the already serious need for mental health care. In fact, the end of the national COVID emergency period will mean a reduction in federal funding for mental health services.

Madison County’s Health Department is focused on preventive care for mental health through early interventions and case management services. The local faith community is also part of the solution, with churches filling some social services gaps.

This is a community in the truest sense, where neighbors help one another simply because it’s the right thing to do. Yes, Madison County is doing fine. But thriving is within reach.

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U39702, 6/23