We know that healthy children learn better, grow stronger and become more successful adults. Unfortunately, children in eastern North Carolina have traditionally suffered from disproportionately high rates of obesity, infant mortality, smoking and other health-related problems. Rather than closing the gap between eastern North Carolina and the rest of the state, the 2011-13 state budget will only make the disparity worse.
In an effort to improve the health and well-being of our children, federal, state and local governments have spent decades creating a broad infrastructure of health-related programs and services. While this infrastructure has never worked perfectly, it plays a crucial role in our continuing efforts to improve children’s health, particularly in areas suffering from a high concentration of poverty (in three eastern North Carolina counties, the childhood poverty rate tops 40% and in over a dozen others the rate exceeds 30%).
Some of the challenges to this infrastructure will start before the child is even born. North Carolina has a disgraceful history of high infant mortality rates and poor birth outcomes, and this problem is worse in the 41 counties that compose the East. Recent efforts by the state and local health agencies have achieved modest improvements (North Carolina no longer has the highest infant mortality rate in the country), though recent budget cuts threaten to undermine the progress that we have made.
Specifically, the legislature failed to renew funding for the East Carolina University High-Risk clinic for the relatively low amount of $325,000, which is less than .1% of the state’s overall budget. The ECU clinic has played a key role in preventing infant deaths in the East, where there is very little availability for specialized pre- and post-natal care. The budget cut has drastically reduced the capacity of the clinic, leaving many expecting mothers with a high risk of birth complications nowhere to go.
Later in life, care for these children and thousands of others will largely fall to the state’s over-burdened Medicaid program. Already, children in the East rely on Medicaid for health services at a disproportionately high rate due to the high concentration of poverty in the area.
As a result of recent budget cuts, fewer health care providers will be willing to serve children on Medicaid, particularly those needing intensive treatment. Here’s why: the Medicaid system operates on a reimbursement system for providers – when a provider treats a child on Medicaid that provider bills the state’s Medicaid program for services rendered.
The 2011-13 state budget reduces the rate at which providers are reimbursed for Medicaid services, and since no provider is required to serve Medicaid patients, many are closing up shop or are only seeing patients with private health coverage. This problem will be particularly severe in the east where there is dense poverty and high Medicaid enrollment.
Furthermore, the loss and weakening of public health programs will have a disproportionate impact on children in rural and eastern parts of the state. The Children’s Environmental Health Agency will be moved from the Department of Environment and Natural Resources (DENR) to the Department of Health and Human Services (DHHS), a move which will likely weaken the agency since it loses much of its regulatory power. This is particularly dangerous in eastern North Carolina, where there is a substantial amount of sub-standard housing and exposure to lead and mold.
Additionally, the elimination of the Health and Wellness Trust Fund, the state’s primary funder of obesity and smoking prevention programs, means that many children who are already lacking access to basic health care will be at a greater risk of becoming obese or starting smoking.
The story doesn’t end with the aforementioned examples – cuts to mental health care, Smart Start and even support staff in our schools will have a negative impact on the healthy development of children in eastern North Carolina. Right now, we don’t know exactly what the picture will look like five, ten or fifteen years from now, but we do know this: closing the health disparity that exists between children from the East and children from the rest of the state won’t be accomplished by eliminating services and resources from families and communities in need.
Sadly, state lawmakers have taken a bad situation and made it worse.
Rob Thompson is the Executive Director of the Covenant with North Carolina’s Children