Conditions that Shape Thriving

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This section highlights several high-level conditions that shape economic well-being for women and girls, alongside key barriers identified through both data and community insight. Together, these measures look beyond income alone to consider how people get to work, how mental health affects daily life, and whether household resources are sufficient to meet basic needs. These are all measures that the Community Cohort identified as important indicators of or barriers to thriving across multiple sections in this report. Throughout this section, quantitative trends are paired with reflections from the Community Cohort to ground the data in lived experience. This combined approach helps illustrate not only where disparities exist but also how women, girls, and families navigate challenges with resilience amid structural constraints.

Key Findings from the Community Cohort

The Community Cohort (Cohort) is a group of local women and people whose lived experiences reflect womanhood—especially Black and Latine parents—who helped shape this report by sharing their real-life experiences, priorities, and interpretations so the data reflects what thriving (and struggling) actually looks like in our community.

The cohort expressed concern about the bus system, given how many people walk to work and how few people use the bus. They were particularly concerned about the percentage of older people who reported walking to work.

Frequent mental distress seems to be a relatively common experience across a fairly diverse geography, but females experience it more than males.

  • 19% of females report frequent mental distress, compared to 12% of males.
  • Residents between 35 and 44 seem to have had a recent increase in reports of frequent mental distress, and residents experiencing poverty have higher rates of frequent distress.
  • Renters report higher rates of frequent mental distress than homeowners, leading cohort members to observe, “I think everyone knows it, but your housing situation really changes how you feel about things,” and “If you don’t have a reliable place, it weighs on you.”

The rates of some kinds of Emergency Department visits for mental health concerns increased a lot around 2021 and 2022, particularly for youth.

  • This led cohort members to note, “It looks like our young folks, well they are not doing well,” and that they’re “becoming increasingly unwell over the years. Like, if you look at the 2017-2022 time frame, suicidal ideation has really went rampant.”

Females generally have higher rates of Emergency Department usage for mental health diagnoses, with the exception of suicidal ideation.

  • The cohort noted that women who are navigating the postpartum period may be at a particular risk for mental health challenges. “I know that there’s not a whole lot of education and support around postpartum depression and the way it manifests. I feel like that might be a helpful piece of the puzzle here.”
  • Non-Hispanic residents generally have higher rates of Emergency Department usage for mental health diagnoses than Latine residents.
  • Black and white residents generally have similar rates of Emergency Department usage for mental health diagnoses, but Black residents have higher rates of ED use for depression and trauma / stressors than white residents.
  • The cohort also noted that LGBTQ+ residents have higher rates of suicidal ideation and suicide, but sexual orientation and gender identity data were not included in the Emergency Department data.

When observing the high rate of residents who are income insufficient, the cohort noted that a lot of families make it work, even if the estimates indicate that they should not be able to, highlighting the resiliency of local community members.

  • They also raised concerns about the impact of student loans on financial security, even in households that appear to have sufficient income.
  • They also pointed out that older residents may have dramatically different experiences of income insufficiency by race/ethnicity.
Learn More About the Community Cohort

The 2026 Gender Lens Report

Glossary Terms from this Page

The 2026 Gender Lens Report

Glossary Terms from this Page

MEASURES ON THIS PAGE

Commuting to Work

Frequent Mental Distress

Mental Health Emergencies

Income Insufficiency

Commuting to Work

This indicator measures the percentage of workers who use various methods to commute to work.

The Community Cohort felt it was important to provide information about commute times by mode of transportation and whether or not workers have access to a vehicle in their household. A graph of median travel times to work by mode of transportation and vehicle access between 2019 and 2023 can be found below.

Please note that in some cases, the margins of error on this graph are high or could not be estimated, potentially due to small sample sizes. In this case, readers should use caution in interpreting the results. This graph also does not include students or other residents living in group quarters.

Data Visualization

Median Travel Times to Work by Mode of Transportation and Vehicle Access (2019-2023)

The cohort also raised questions about how TransAID users would be described in this measure. The survey this data comes from asks residents to describe their commute themselves using the categories provided, choosing from options that include “Car, Truck, or Van”, “Bus”, or “Other method”. Individual TransAID users may have selected different responses to this question.

Data Visualization

Percent of Residents Commuting to Work by Mode of Transportation (5-year Periods from 2015-2019 to 2019-2023)

Detailed Data Notes

Community Voices

Transportation further stretches her wages; without a car, she relies on ride‑shares and favors, explaining that she is “catching Ubers and Lyfts and everything else” just to manage daily life.

Frequent Mental Distress

This indicator measures the percentage of residents in the Piedmont Region of North Carolina who reported frequent mental distress. Residents were identified as having frequent mental distress if their mental health was “not good” for 14 or more days out of the past 30 days.

Respondents reporting that their mental health was not “not good” for 14 or more days answered the question: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”

The data in this measure describes the Piedmont Region of North Carolina, not just Forysth County. The counties included in this geography are: Alamance, Alexander, Anson, Cabarrus, Caswell, Catawba, Chatham, Cleveland, Davidson, Davie, Durham, Forsyth, Franklin, Gaston, Granville, Guilford, Iredell, Lee, Lincoln, Mecklenburg, Montgomery, Moore, Orange, Person, Randolph, Richmond, Rockingham, Rowan, Stanly, Stokes, Union, Vance, Wake, Warren, and Yadkin counties.

Data Visualization

Percent of Piedmont Region Residents Reporting Frequent Mental Distress (2018-2023)

Detailed Data Notes

Community Voices

Youth who have already experienced years of complex trauma are often then exacerbating their pre-existing trauma-induced mental health symptoms as they enter adulthood. Youth who have aged out of foster care report higher rates of depression, trauma exposure and behavioral health challenges than their peers who did not experience foster care. They may have had years of therapy to work through the healing process of previous traumas. Oftentimes, this state in life can reactivate the effects of earlier trauma. Threats of uncertainty, fear of failure, and mistrust of others can lead to chronic stress and hyperarousal of a number of physical and emotionally trauma induced symptoms. Questions such as, “Does anyone see me? Is anyone there for me? Where do I belong?” may echo in the deep corners of their minds even if they never say them outloud. Neurologically, their brains know it. Physically, their bodies can feel it. They may then react in ways that are unexpected, even for them. They may not know what they feel or why they respond the way they do. Their trauma responses are compounded during this critical developmental stage and emotional regulation and decision-making become extremely challenging.

Mental Health Emergencies

This indicator measures the number of emergency department visits for mental health-related conditions in Forsyth County per every 10,000 residents for all of the breakdowns except insurance. The insurance breakdown shows the percentage of visits paid for by each type of insurance. A visit is considered mental health-related if a patient presents with any of the following issues:

  • Anxiety
  • Depression
  • Self-Inflicted Injury
  • Suicidal Ideation
  • Trauma / Stressors

The Community Cohort had questions about what was included under the category of “Trauma / Stressors” and whether or not it included sexual assault. This category included severe stress in response to life events (e.g. Post-traumatic stress disorder), dissociative disorders in which a patient loses memories, awareness and/or control of their body, and disorders of social functioning. It is possible that sexual assault could trigger one of these responses, resulting in a diagnosis in this category, but the sexual assault itself would not be classified in this category.

The cohort also had questions about how race categories were assigned in the emergency department data. North Carolina state statute indicates that patients should report their own race and ethnicity, but it is not possible to know if this happens in practice. The researchers who created this dashboard also noted that the “other” category includes multi-racial residents as well as those from smaller racial and ethnic groups. They noted that this may not line up with how the population data they used to calculate rates assigned “other”, and that this may contribute to some of the data for “other” races looking unusual.

Lastly, the cohort requested information about the percentage of emergency department visits that are covered by different kinds of insurance as context. According to UNC’s Sheps Center for Health Services Research, across North Carolina, the percentage of emergency department visits by insurance type is as follows:

 

  • Commercial Insurance/HMO: 38%
  • Medicaid: 23%
  • Medicare: 14%
  • Other Government: 4%
  • Uninsured: 21%
  • Other: 1%

Data Visualization

Rate of Emergency Department Visits with Mental Health Diagnoses per 10,000 Residents (2017-2023)

Data Visualization

Percent of Emergency Department Visits with Mental Health Diagnoses by Insurance Type (2017-2023)

Detailed Data Notes

Community Voices

Experiencing mental health struggles at such a young age made me more aware of the silent battles others face. I became more compassionate, more patient, and more intentional about supporting people around me. I developed a heart for helping others with their mental health because I know what it feels like to be overwhelmed and misunderstood.

Now, at sixteen years old, I know that I want to become a therapist. This dream was born from my own experiences. I want to be the person who listens, who creates a safe space, and who reminds others that their feelings matter. I want to help break the stigma surrounding mental health, especially in the Black community, where these conversations are often avoided… My story is proof that strength and vulnerability can coexist, and that healing is not a weakness, but an act of courage.

LGBTQ+ people of color sit at the sharpest intersections of these realities.

They face the combined effects of racial inequity, economic precarity, and anti-LGBTQ+ discrimination. In Forsyth County, where racial disparities in wages, housing, and health outcomes are already well-documented, queer and trans people of color often experience the most severe consequences of policy gaps and institutional neglect. Job loss hits harder without generational wealth. Housing instability is more dangerous when racism shapes interactions with landlords or law enforcement. Mental health struggles deepen when affirming, culturally competent care is scarce or inaccessible.

These are not anomalies. They are predictable outcomes of systems that were not designed with LGBTQ+ lives in mind.

Income Insufficiency

This indicator measures the percent of the Forsyth County population who live in households that do not have enough income to meet their estimated annual living expenses (e.g., housing, health care, food, etc.). That is, the percentage of the population that is income insufficient. This measure compares the cost of these expenses for different families in Forsyth County and compares their income to these expenses. It is not based on a particular minimum or living wage standard.

In responding to how high these rates are in Forsyth County, the Community Cohort expressed admiration that so many families succeed in keeping their families fed and housed, even with limited resources.

The Asset Building Coalition of Forsyth County uses this measure to estimate a living wage for Forsyth County. In 2026, they are promoting $26 an hour as a living wage. They estimate that this is the hourly rate that would be needed to cover basic living expenses for at least 75% of working adults 18-65 in Forsyth County if they are working full-time, year-round.

Data Visualization

Percent of Residents with Insufficient Income (2023)

Detailed Data Notes

Community Voices

Queer, trans, and gender-expansive people often face extraordinary financial barriers to forming families: through adoption, fertility care, legal parentage, or simply securing safe housing and employment stable enough to imagine a future. These costs exist alongside persistent wage gaps, employment discrimination, and uneven access to benefits. What is framed socially as “choice” is often constrained by policy, price, and prejudice.

The result is a doubling of burden: lower wages paired with higher costs, fewer safety nets paired with greater risk.

For LGBTQ+ people, especially those who are single or not cohabitating, economic vulnerability may look different, but it is no less real. Survival often relies on chosen family, informal support networks, or navigating workplaces and housing markets where safety, dignity, and belonging are not guaranteed. Mental health, economic security, and housing stability become intrinsically intertwined when you are absorbing risk alone.

Across interviews, participants describe wages that sustain survival but not security. Income is consistently “just enough” to keep households afloat, but not enough to allow savings, rest, or recovery when life changes. No one blames themselves; women describe careful, disciplined budgeting nested inside systems that steadily absorb income through fixed costs, debt, caregiving demands, and workplace practices.

She and her partner “do everything right”—tight budgeting, strategic grocery shopping, avoiding extras, prioritizing debt—but still cannot see a path to savings. As she puts it, she doesn’t know “how anyone’s supposed to save” and feels that “everyone’s kind of bleeding dry at this point.” In her story, wage inadequacy is not about mismanagement; it is about systems that leave no margin for emergencies, rest, or future planning.

Across the dataset, women describe high‑interest car loans taken when credit scores were low, student loan payments that resume after forbearance, and medical or other debts that absorb what little flexibility their earnings might otherwise provide. Even when bills are technically paid, women ask how they are supposed to ever save.