Child Health Report Card Highlights Old and New Concerns

North Carolina’s children show progress across many health areas, while birth and mental health outcomes worsen.

By Liz Schlemmer

On many counts, the health of children in North Carolina improved in recent years. But even with gains, some areas such as infant mortality and suicide rates continue to be a concern.

That’s according to the 2016 North Carolina Child Health Report Card released Tuesday by the North Carolina Institute of Medicine and NC Child. For 20 years, the report has tracked health concerns from prenatal care and breastfeeding to teenage risk factors such as alcohol and substance abuse.

This year’s report shows improvement among most of the 40 health indicators it follows. Hospitalization rates for asthma received an “A” and progress in insurance coverage, teen births, immunization rates and dental health earned “B” grades.

Health areas that received a “D” include school health, weight and physical activity, tobacco use, substance abuse and mental health.

The indicators that showed decline are most closely associated with infants and teens. Prenatal care, infant mortality among Hispanic and American Indian babies, marijuana use and suicide rates worsened.

An area where both infants and teens benefited was births by teen mothers, which decreased between 2009 and 2013 from 19.9 births per 1,000 girls age 15 to 17 to 12.2 births.

Child health insurance

The most significant gain in the report is the increase in children with health insurance, according to Rob Thompson, senior policy advisor at NC Child, an advocacy group focused on children’s health. The uninsurance rate for children reached an all-time low of 5.2 percent in 2014, the latest year the report covers.

“It’s a sign of tremendous progress even though there’s still more work to do,” Thompson said.

The report’s authors draw attention to the continued lack of health insurance among parents.

Many North Carolina parents lack health insurance, and the report’s authors consider this an impediment to continued progress in children’s health.

According to Thompson, when parents get health insurance, they are more likely to enroll their children in programs for which they may already be eligible. It is known as “the welcome mat” effect.

Of the remaining 119,000 children who still don’t have insurance, about two-thirds are currently eligible for Medicaid or NC Health Choice.

Thompson also attributes the rise in kids insured to their parents getting insurance through the Affordable Care Act marketplace and discovering their kids’ eligibility for Medicaid.

“The more we can integrate families into the health system, the more we can ensure children will get enrolled,” said Thompson, referring to several hundred thousand North Carolinians who missed the opportunity to obtain insurance when the state legislature declined to expand Medicaid, as allowed for under Obamacare.

“If we can get half a million adults insured by closing the health insurance coverage gap, we’re also going to get more of their children insured,” Thompson said.

Infant mortality

“One of the biggest red flags that I see is the stall in the infant mortality rate,” Thompson said.

North Carolina’s infant mortality has historically ranked high nationally. In 1991, North Carolina had the highest infant mortality rate in the country. The state had been steadily improving, reaching an all-time low rate in 2010, but still scores poorly compared with other states.

And the rate has slowly ticked up in recent years. The health report card shows no significant increase in infant mortality since 2010 when combining all races. For minority groups, however, infant mortality is on the rise.

The number of deaths among white infants declined from 2010 to 2014, but African-American infants had a slight rise in infant mortality. Hispanic and American Indian infants had significant increases of 24 percent and 25 percent over the same period.

“We’ve had remarkable reductions in infant mortality until recently,” said Adam Zolotor, president and chief executive officer of the North Carolina Institute of Medicine and a family physician. “We haven’t made any reduction in the past three years. We’ve stalled.”

The percent of babies born to mothers who received inadequate prenatal care also increased significantly since the last benchmark year, from 5.4 percent to 7.2 percent.

Health indicators to watch

Over the years, the North Carolina Child Health Report Card has measured different health indicators in response to changing trends.

The past three report cards have included data on mental health outcomes for pre-teens and teens. The reports show an increase in suicide attempts among middle-schoolers and suicide treatment for high -choolers from 2011 to 2013.

Zolotor said the suicide data is an area of growing concern. Gov. Pat McCrory’s Task Force on Mental Health and Substance Abuse includes a workgroup on children, youth and family to address the rise.

This year’s report card also includes data on student use of emerging tobacco products such as e-cigarettes and nicotine lozenges. Kids who use e-cigarettes are more likely to smoke other tobacco products later. .

Almost a quarter of high-schoolers surveyed in 2014 had used emerging tobacco products in the last 30 days. This data will serve as a benchmark for the future.

“I think the most surprising finding in this report is the use of emerging tobacco products. It’s important to keep our eye on that,” said Zolotor.