[Editor’s note: The following is excerpted from the “For Children’s Sake” blog which is managed by the children’s advocacy organization, NC Child.]
This week NC Child and the NC Institute of Medicine release the 2018 Child Health Report Card, an annual assessment of key health indicators for North Carolina’s more than 2.2 million children. The focus of the 2018 Report Card is Financial Security, Opportunity, and Health.
Almost half of North Carolina’s children live in poor or low-income households (defined as income less than 200% of the federal poverty level). Across nearly every indicator of child health, there is a dramatic difference in health outcomes for children depending on their parents’ income levels. The good news is that most kids in North Carolina are in excellent or very good health – but this varies by income level. In non-low-income homes, 96.9% of North Carolina’s children are healthy. By contrast, only 81.5% of children in low-income homes are considered healthy.
Here’s a look at some of the points where the state is earning good marks for child health outcomes:
North Carolina received an A grade for Access to Care. The percent of uninsured low-income children (5.6%) continues to decline, falling 43% in North Carolina between 2012 and 2016. 95.5% of children in North Carolina had health insurance coverage in 2016, ensuring that they are better able to access preventive health care services. Medicaid and NC Health Choice have put otherwise unaffordable or unavailable health services within reach for children in low-income homes.
With CHIP (the Children’s Health Insurance Program) funded for another 10 years, we are optimistic that North Carolina will continue to receive strong grades for ensuring that all children, regardless of income level, have access to health care. Unfortunately, more than 100,000 parents in North Carolina don’t have health insurance because they earn too much to qualify for Medicaid, but not enough to purchase private health insurance. North Carolina’s leaders can seek more options to provide low- and middle-income families with health insurance coverage.
B in Teen Births, as rates continue to decline in North Carolina. Teen births are down 31% in North Carolina since 2012 thanks to increased access to family planning services and sexual education programs. Teen girls who have babies are more likely to live in poverty, and less likely to receive early prenatal care. While this decline should be celebrated, there are significant racial disparities. African American teens are twice as likely, and Hispanic/Latinx teens are almost three times as likely to give birth as their white peers. Additionally, the Trump Administration’s decision to cut funding for teen pregnancy prevention could slow future progress.
B in Postpartum Health & Breastfeeding. More mothers are meeting the recommended guideline of exclusively breastfeeding for six months (26.1% in 2016, up from 20.7% in 2012). Breastfeeding is associated with fewer infectious and chronic illnesses among children, reductions in child mortality, and health benefits into adulthood.
B in Environmental Health. Statewide, child blood lead levels continue to decline, with the percentage of children tested with elevated blood lead levels at 1.9% in 2016 (down from 3.6% in 2011). Rates vary widely by county and even by neighborhood. Because child lead poisoning is strongly associated with low-quality housing, children in low-income homes are much more likely to be affected. Even very low levels of blood lead are associated with reductions in IQ and reduced success in school. We hope these rates will continue to decrease as a result of the legislature’s passage of stronger lead testing and mitigation requirements in 2017.
Now we take a look at some of the worst grades…
F in Housing & Family Financial Security. Family financial security is one of the most impactful determinants of children’s health. Children who live in poverty, particularly during early childhood, are at risk of poor health outcomes throughout their lives. Children living in financially secure families are more likely to achieve educational success and grow to be healthy, self-sufficient adults. Almost half of North Carolina’s kids live in poor or low-income households (defined as less than 200% of the federal poverty level). 28% of children live in households spending over 30% of income on housing costs.
D for Birth Outcomes. NC ranks 42nd in the nation for infant mortality, with an infant mortality rate holding steady at 7.2 deaths per 1,000 live births. This number has hardly moved since 2010 (7.0 deaths per 1,000 live births).
D for School Health. Few school districts in North Carolina meet the recommended school nurse ratio of 1 nurse for every 750 children. Statewide, the average ratio is 1:1,072. School nurses are a particularly vital resource for students living in poverty, who often face barriers to managing chronic conditions or receiving preventive care.
D in Mental Health. 9.3% of North Carolina high school students attempted suicide in the past year, an increase of 86% from 2011. In North Carolina between 2011 and 2015, suicide was the 2nd leading cause of death for youth age 15 to 17.
D in Child Abuse & Neglect. 28 children in North Carolina died from child abuse in 2016, a number that has not moved since 2012. Investigations of child abuse are down somewhat since 2012, with 5.6% of children investigated for child abuse & neglect in 2016 (down 5.1% since 2012). Adverse childhood experiences such as abuse, neglect or poverty can negatively affect brain development and increase risk for physical and behavioral health problems later in life.
D for Children In Out-of-Home Care. The rate of children in foster care who exit to permanent homes within 24 months declined in 2016 to 65.2% (down 5.6% since 2012). Providing children with safe and stable homes, relationships, and environments can protect against the impact of adverse childhood experiences, improve health, and generate increased financial security.