A health-prevention report card shows that the state continues to fail in obesity and nutrition prevention, while the state’s tobacco-prevention grade worsened from a B to a C.

By Hyun Namkoong

North Carolina backslid, stagnated and failed to curb the effects of the top four preventable causes of death, according to the 2015 NC Prevention Report Card issued by Prevention Partners, an organization that helps businesses and schools change policies to promote healthier behavior.

The report card, released every two to three years, assesses how well or badly North Carolina does preventing sickness and early death from tobacco use, obesity, physical inactivity and poor nutrition.

The interactive 2015 report allows users to select indicators or explore databases used to estimate the state’s progress in meeting the Healthy People 2020 goals.

Prevention Partners looked at where North Carolina met the aims of Healthy People 2020, national health goals created in 2010 by the U.S. Department of Health and Human Services. The organization determined what grade the state would receive in each area relative to the progress North Carolina has made in reaching those goals, said Rachel Zucker, research and evaluation coordinator at Prevention Partners.

The grades, she said, “reflect that there’s a lot of work left to be done in North Carolina.”


Setbacks in tobacco control

In 2012, North Carolina received a B for tobacco-control efforts, the highest grade the state has ever achieved. But this year, the state was given a C.

Zucker said North Carolina was no longer making advances in tobacco-control and -cessation efforts.

“We haven’t provided extra funding for our Quitline. We haven’t increased our tobacco tax. We haven’t created tobacco-free spaces,” she said.

Zucker said the state made progress by banning indoor smoking in bars and restaurants in 2010, but that more needs to be done to ban tobacco use in other spaces such as day-care centers and entrances to buildings.

Infographic courtesy NC DHHS.
Infographic courtesy NC DHHS.

Tobacco-free spaces are important for limiting exposure to second-hand smoke, especially for children and workers, according to the Centers for Disease Control and Prevention. A growing body of research from states and countries that have banned indoor smoking in bars, restaurants and worksites shows reductions in hospital admissions for acute heart problems and improvements in overall lung health since the bans were enactment.

And contrary to a popular belief that a smoking ban hurts businesses’ bottom lines, there has been no negative impact on income or employment, according to the North Carolina Department of Health and Human Services.

“We always advocate for tobacco-free spaces,” Zucker said.

Failing nutrition

The state’s failing grade for nutrition was based on a number of measures such as percentage of babies that breastfeed at six months or the percentage of households that experience food insecurity.

More than 17 percent of all households in North Carolina experience food insecurity, meaning the families often don’t know where their next meal will come from. A state goal is to reduce that rate to 6 percent.

Research shows that food insecurity can lead to reduced academic performance and poor social functioning in children. Academic performance and education play a key role in total earnings in a lifetime, according to data from the American Community Survey, a part of the U.S. Census Bureau. Earned income in turn affects one’s ability to pay for health care services or purchase nutritious foods, exacerbating the cycle of poverty.

Eating five servings of fruits and vegtables each day remains a challenge for the majority of adult North Carolinians; just over 10 percent of them report eating the recommended amount.

Poor nutrition costs North Carolina more than $12 billion a year, according to Prevention Partners.

To reduce the costs of health care to employers and improve the overall health of the state’s workforce, Prevention Partners, the N.C. Department of Commerce, the N.C. Hospital Association and the Center for Healthy North Carolina joined to recruit 10 of the largest employers or worksites in each of the 100 counties in the state to make the workplace a healthier space by implementing policies around nutritious foods in the cafeteria or paying employees to exercise for 30 minutes.

“By reaching those places, we hope to reach 20 percent of the workforce in North Carolina by the year 2025,” Zucker said. She said she hoped to create a ripple effect because as people experience changes at work, they bring it into their homes and their communities.

“It’s a big goal, but it’s exciting,” Zucker said. “We’ve already accomplished this in 11 counties, so we only have 89 to go. We [have] 10 more years to do it.”

Another fail, obesity

For a state that proudly claims fried chicken, collards seasoned with pork and cornbread as staples, it’s little surprise that two in three adult North Carolinians are overweight or obese.

Zucker said obesity is intertwined with other health issues, so a coordinated effort is required to see changes in reducing the obesity rate.

“If we’re looking for things to tackle, we can tackle things in nutrition and we can tackle things in physical activity, and obesity follows suit,” she said.

More than 25 percent of high school students in North Carolina are overweight or obese, according to the report card.

Childhood and adolescent obesity carry significant risks for developing a number of health issues later in life such as heart disease or type 2 diabetes, according to the CDC. Medical costs for people who are obese are almost $1,500 higher annually than for people of normal weight, the agency has found.

Physical activity unchanged

North Carolinians of all ages need less screen time and more time outside breaking a sweat, according to the report card. Less than half of all adults in the state get the recommended minimum of 150 minutes of physical activity each week.

The outlook is worse for teens. Barely a quarter of all North Carolina high school students get the recommended amount of physical activity.

While a number of factors such as access to public parks and neighborhood crime affect the amount of physical activity people can get, the ubiquity of affordable computer products has made it more difficult for adults and children alike to unplug and get moving.

Findings from the Pew Research Center show that ownership of smartphones, tablets and computers has been steadily rising among American teenagers since 2011.

Zucker said Learn Healthy America, a school-health program from Prevention Partners, doesn’t directly address the issue of excessive screen time, but it does combine physical activity and health education to move children away from their smartphones.

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Hyun graduated from the UNC-Chapel Hill Gillings Global School of Public Health in the health behavior department and she worked as the NC Health News intern from Jan-Aug 2014.