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Steps Forward, Back for NC Children’s Health


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This year’s Child Health Report Card finds improvement in many health indicators, but poverty-related problems impede improvement for many of North Carolina’s children.

By Rose Hoban

Twenty years ago, Tom Vitaglione got a phone call. At the time, he was leading the child health division at the North Carolina Department of Health and Human Services, and the guy on the other end, Gordon DeFriese, was the head of the North Carolina Institute of Medicine.

DeFriese asked Vitaglione about the idea to create a “report card” by gathering data on the health of children in North Carolina.

At the time, the state was ranked near the bottom of the country in children’s health outcomes; the state had one of the nation’s highest infant mortality rates; teen pregnancy rates were high, as were death rates for older kids.

Child Health Report Card Graphics

Information courtesy NC Child and N.C. Institute of Medicine

“This was pre-computers. If you wanted to know something, you had to go to a particular paper source to find out,” Vitaglione said, mimicking how he’d reach into a pile to retrieve a random piece of paper. He and DeFriese gathered those piles of paper, sat down over lunch and put together the first child health report card.

“Here we are 20 years later,” said Vitaglione, who noted that at the time of the first report card admitting “how crummy we were doing took a lot of guts.”

He recounted the story Monday afternoon at the Child Health Summit, held in the Hunt Library on the campus of NC State University. That’s where the 2014 Child Health Report Card was presented by leaders from the Institute of Medicine and NC Child, an advocacy organization that focuses on children’s health.

“”North Carolina has made substantial gains,” said Elizabeth Hudgins, executive director of the North Carolina Pediatric Society. “When we look at deaths of kids 1 to 14 … we have gotten ‘more better’ than the rest of the nation.”

Hudgins said that in national rankings of children’s deaths, “We used to be ranked in the 40s on that, now we’re ranked in the 20s on that.”

She said improvements in North Carolina’s children’s health has come from a combination of things, from an aggressive campaign to get kids enrolled in the state children’s health insurance program, called North Carolina Health Choice, to initiatives to get children into car seats and bicycle helmets.

But Hudgins, Vitaglione and others at the summit said there’s still work to be done.

Creating policy

In 1988, North Carolina had the worst infant mortality rate in the nation. That’s improved, but not enough, said Gerri Mattson, the pediatric medicine consultant for the state’s Division of Public Health.

Mattson talked about the need to create systems that drive change. She said a combination of state policies have helped to reduce the rate.

“Infant mortality is influenced by low birth weight, prematurity, and we used to have sudden infant death syndrome as one of the issues,” Mattson said.

She described the legislative Child Fatality Task Force‘s efforts to get the medication 17-P, 17-hydroxyprogesterone, covered by Medicaid. The drug is effective in helping a woman who has had one premature birth avoid giving birth too early in subsequent pregnancies. North Carolina was the first state to cover 17-P.

Mattson and others cited the task force’s use of data to create policies to reduce child deaths.

Vitaglione said legislative “champions” have also been key. But he bemoaned how policymakers have moved away from worrying about improved health outcomes and become more focused on savings.

“And so to get something done, you have to show that it’s going to create jobs,” he said. “People don’t talk about the health that’ll be improved; it’s about the hospitals that won’t close, it’s all that sort of thing.”

Big hurdles

The infant mortality rate in North Carolina is still too high, Mattson said. And other child health outcomes need improvement.

The state received Ds in the rate of obese kids, the use of electronic cigarettes and the number of adolescents who have attempted suicide.

“Public policies and public programs can really have an impact on all of these areas,” said James Perrin, former head of the American Academy of Pediatrics, the day’s keynote speaker. “These are not intractable problems.”

But Perrin said the biggest barrier to kids being healthy is poverty.

Laila Bell, director of research and data for NC Child presents findings from this year's Child Health Report Card. Photo credit: Rose Hoban

Laila Bell, director of research and data for NC Child, presents findings from this year’s Child Health Report Card. Photo credit: Rose Hoban

“Poverty does increase rates of most health conditions,” he said. “It does increase the severity of most conditions and it affects the response to treatment of most conditions.”

Perrin talked about “toxic stress,” the idea that adverse childhood experiences, especially in very young children, can lead to permanent changes in brain anatomy and hormone production. He described the kind of stress experienced by a toddler listening to parents argue about money.

“Forty-five percent of America’s families that have children in them have incomes below two times the poverty level” of $24,250 for a family of four, Perrin noted. And he argued that the health consequences of poverty are almost the same as those of adverse childhood experiences.

Among those he listed were “increases in infant mortality, low birth weight, all the chronic diseases, food insecurity, increased accidental injury and mortality, higher exposure to toxic stress, poorer educational outcomes, less positive social and emotional development, more problem behaviors and more likely to be poor as adults,” citing multiple studies to back up his assertions.

Policy recommendations

Perrin said one of the best interventions is high-quality early-childhood education. He cited data from the Abecedarian Project, conducted by researchers from UNC-Chapel Hill’s Frank Porter Graham Child Development Institute, that indicates children who get high-quality preschool have improved graduation rates, higher adult earnings and lower incarceration rates.

He also touted the successes of nurse home-visitation programs for young families and policies that result in well-paying jobs.

NC Child’s Rob Thompson said there’s an effort underway to educate lawmakers about these issues, and he was upbeat about convincing lawmakers to make important policy changes.

“The joint chairs of the HHS appropriations subcommittee said they want to use data and look at outcomes for children zero to 5 and determine how they’re going to be making funding decisions,” Thompson said. “That’s a really good thing.

“We think there’s a great opportunity this year to reorient the discussion of children’s health to focus on prevention and promoting long-term outcomes.”

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