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Report card: State's poor children suffer health disparities


Most children in North Carolina are in excellent or very good health, but this varies by income level. Nearly 97 percent of children not in low-income homes are healthy, compared with 81.5 percent healthy children in low-income families, according to a state report.


By Michael Abramowitz
The Daily Reflector

Sunday, February 25, 2018

An annual report card on the health of children in North Carolina released last week drew a stark connection to economic insecurity and poor health, giving the state low grades on health issues affecting its poorest residents.

The 2018 Child Health Report Card was released Monday by the N.C. Institute of Medicine and NC Child, a nonprofit child advocacy group. It compiles the leading indicators of child health and safety to help policymakers, health professionals, the media, and concerned citizens track child health, identify emerging trends, and plan future investments.

The report card presents data gathered mainly in 2015, the most current year available, and compares it with benchmark data from 2011. New county-level data will be released in March.

The latest report gives North Carolina an A for insurance coverage and Bs for environmental health, family involvement, health services utilization and immunization, postpartum health and breastfeeding and teen births.

But the state gets Cs for education, oral health, preconception and maternal health and support; Ds for birth outcomes, child abuse and neglect, children in out-of-home care, healthy eating and active living, mental health, tobacco, alcohol, and substance use and school health.

Most children in North Carolina are in excellent or very good health, but this varies by income level. Nearly 97 percent of children not in low-income homes are healthy, compared with 81.5 percent healthy children in low-income families, the report revealed.

The state received an F in housing and economic security, due to the high percentage of children living in low-income homes and neighborhoods.

That matters because children from families that are not financially secure fare worse in almost every indicator of health, including birth outcomes, access to care, health-risk behaviors, and mortality, according to the report led by Dr. Adam Zolotor, the institute’s president and CEO, and Whitney Tucker, research director for NC Child.

“Children’s health is largely determined by factors outside of the doctor’s office; rather, it’s determined by the environments in which children grow, play, and learn,” Zolotor said in comments accompanying the report. “That’s why addressing family financial security is a critical health intervention, and why we must focus on ensuring all children, regardless of race or ethnicity, have the opportunity to grow up in thriving families and communities.”

The report card highlights a number of ways in which family income intersects with other child health indicators. Children in low-income homes, for instance, have higher rates of childhood asthma and are more likely to be exposed to environmental triggers such as pollution and allergens, including cockroaches and mold, the researchers said.

“While the economic challenges facing North Carolina families are entrenched and challenging, evidence-based public policy interventions offer a way forward,” said Michelle Hughes, NC Child executive director. “Implementing refundable tax credits for working families, promoting affordable child care, and expanding access to health insurance are all proven strategies for ensuring family financial health.”

Almost half of North Carolina’s children live in poor or low-income (less than 200 percent of the federal poverty level) households, and one-third live in households that spend more than 30 percent of income on housing. In addition, 14 percent of children live in high-poverty neighborhoods. These children are more likely to be exposed to neighborhood violence and crime.

As with other health indicators, troubling racial and ethnic disparities exist in North Carolina children’s economic security data, according to the report. In 2015, African American children (67 percent) and Hispanic and Latino children (75 percent) were more than twice as likely to live in poor or low-income homes than white children (33 percent). 

The statewide infant mortality rate improved slightly in 2016, with 7.2 deaths per 1,000 live births, compared to 7.4 in 2012, the data showed. Premature births decreased from 11.5 percent in 201 to 10.4 percent in 2016. Low birth weights increased, however, from 8.8. percent in 2012 to 9.2 percent in 2016, according to the report.

First births among North Carolina’s teenage girls decreased from 31.8 per 1,000 in 2012 to 21.8 per 1,000 in 2016.

Health insurance coverage is necessary for accessing consistent preventive care and needed sick care for children and parents, the report’s authors said. The good news: More than 95 percent of state children had health insurance in 2016, compared with 92.4 percent in 2012. Among women aged 18-44, 80.6 percent had health insurance in 2015, compared with 73.6 percent in 2011. 

The child health report card project was supported by the Annie E. Casey Foundation, and the Blue Cross and Blue Shield of North Carolina Foundation. The report does not necessarily reflect their opinions.

Contact Michael Abramowitz atmabramowitz@reflector.com or 252-329-9507.