Thank you, Tom and Gordon, and the Child Advocacy Institute and the Institute of Medicine, for your work on this North Carolina Child Health Report Card. It will be an invaluable tool for looking at the broad picture of children’s health in our state; for seeing the successes and identifying the areas for improvement. It will help all of us—state and local agencies, community-based organizations, child health advocates, policymakers, legislators—as we seek to improve the health and well-being of North Carolina children and their families.
Carmen Hooker Odom like to say a few words about some of those successes , as well as the areas where improvement is called for.
We’re proud of our grades in the children’s health insurance program. Close to 90,000 children are now enrolled in NC Health Choice. We asked communities to lead the effort in identifying and enrolling children at the grassroots level, so they could tailor messages specifically to local families. This has been tremendously successful. The state also worked hard to make these programs accessible, easy to apply for and family-friendly.
A large number of agencies, families, advocates and legislators have worked together to promote the Health Check and N.C. Health Choice Program for children—another key to success. Recently, I worked with the Institute of Medicine to develop a special task force to identify cost efficiencies and provide a means to ensure the maximum number of children can be enrolled through this program.
North Carolina has achieved its lowest infant mortality rate in the state’s history — 8.5 deaths per 1,000 births — but we still have a long way to go. Nationally, North Carolina is ranked 47th in the country — only three other states have a worse rate. Our biggest area of concern is the fact that infant mortality rates for African Americans and American Indians are more than twice that for whites, and there is no evidence that this gap is narrowing. This is unacceptable. We are greatly challenged to eliminate these disparities.
We can credit the hard work of Public Health and local communities for the gains that have been made so far. Three federal Healthy Start grants fund community-based initiatives in 14 counties to address disparities in infant health outcomes, particularly in African American and American Indian communities. Other programs are focusing on reducing unintended pregnancies and improving the overall health of women of childbearing age. Low birthweight continues to be an area of grave concern and a focus of a number of these programs.
North Carolina’s immunization rate of 87.5% for two-year-olds ranks among the best in the nation. This true success story is directly attributable to a decision by the General Assembly to make vaccines available to children at low or no cost, and to a statewide initiative that enjoys the participation of primary-care providers. Many vaccine-preventable communicable diseases — measles, tetanus, polio, diphtheria — have been virtually eliminated; mumps and pertussis have been markedly reduced. For the first time in several years, no cases of rubella were reported in 2001, which is a testimony to the work of local health departments in providing immunization education and services, particularly those focused onnew immigrant populations.
The numbers of newly reported cases of congenital syphilis and perinatal HIV/AIDS have dropped dramatically—another success story. Tuberculosis, however, is a communicable disease that will require more concentrated efforts. Over 50 percent of childhood TB cases in North Carolina are in immigrants from Latin America. Tuberculosis control measures will continue to be focused on this at-risk population.
Asthma, the number-one chronic childhood disease and a leading cause of school absences, disproportionately affects Native American, African American and poor children in this state.
North Carolina maintains a high level of active prevention efforts through community coalitions and the Asthma Alliance of North Carolina, a partnership of public and private organizations working together to reduce asthmaillness and death. In support of asthma management and awareness activities, the NC General Assembly allocated funds to the Division of Public Health for the next two years to develop and enhance community-based childhood asthma initiatives. In North Carolina, one-third of children entering kindergarten have had tooth decay. Community water fluoridation and preventive dental sealants are the two best ways to prevent decay.
Due to the successful public-private collaboration between private dental offices and the state, almost 90 percent of people on community water systems now receive the benefits of fluoridated water. Now, one of the Department’s top priorities is to increase the proportion of high-risk schoolchildren with preventive dental sealants. Since 1996, the proportion of North Carolina fifth-grade children with dental sealants increased from 28 to 37 percent. We want 50 percent of children to have dental sealants.
The Division of Public Health has taken the lead in an innovative collaborative program that is being observed nationally. Into the Mouths of Babes trains medical professionals to provide screenings and fluoride treatments for children up to age three, and educational services for caregivers in order to prevent tooth decay and encourage them to seek dental care when needed.
There is not much positive to say about the grade of F on access to dental care for school-age children. We have redirected our resources toward creating innovative ways to increase the proportion of low-income children receiving needed dental care. Over the last decade, we have helped counties increase the number of facilities where low-income patients can receive dental care from 7 to 62. But at the same time, access decreased by 8-15%. Adequate funding is the key to addressing this perplexing, ongoing problem.
About 8 percent of North Carolina’s very young children are at risk because of developmental or physical disabilities, developmental delays, chronic diseases or other conditions like low birthweight or prematurity. Early intervention services are one way we work to help these children get a good start in life. Last year, nearly 10,000 children from birth to age three were provided early intervention services through DHHS. That was a 19 percent increase over the previous year, earning us a “B.”
Still, we are striving to do more. We have developed a comprehensive plan to better coordinate resources, better involve the medical community, expand the network of providers, and partner more effectively in planning services at the state and local levels. We’re attempting to look at family needs more holistically, and to reach more young children in a more coordinated, efficient and accessible way.
It is good news that the child death rate in North Carolina has dropped more than 25 percent since 1988, to the lowest rate ever recorded in our state this year. We’ve gained a lot of ground in reducing the rate of child deaths, but that also means that we have a lot to lose. Budget and personnel cuts in state programs could turn that trend in a negative direction for the first time in a quarter century.Twenty-four children died as a result of child abuse homicide in 2001– killings by a parent or another caregiver. Though the trend in child abuse deaths is downward, the high numbers of cases of child abuse and neglect are completely unacceptable. DHHS divisions are working with other state, local and community agencies, groups, advocates and policymakers to find more effective ways to combat these heartbreaking problems. There is much work to be done.
The epidemic of overweight and obesity is one of the toughest public health issues facing the entire country. It is not an issue that can be solved by public health alone, but we can provide the leadership. The N.C. Healthy Weight Initiative, established by a grant from the Centers for Disease Control and Prevention, formed a 100-member task force and last month released their report, Moving Our Children Toward a Healthy Weight: Finding the Will and the Way. The statewide plan provides 12 recommendations for action that calls for individuals and families, business and industry, government and non-government organizations, and policy makers at all levels to work together. It’s a major step in the right direction.
An especially tragic problem for our children is the percentage of teens who are using and abusing tobacco, alcohol and drugs. Our grades in those areas are abysmal, in spite of the hard work of so many agencies, organizations, and communities. These are difficult problems, and will require ongoing efforts. There are no easy answers.
We’re improving in the area of teen pregnancy. In 2001, the pregnancy rate for girls ages 15 through 19 was the lowest rate reported for our state in over 20 years.
Since 1990, adolescent pregnancy rates have declined by more than 30 percent in North Carolina, due in great part to the hard work of the Adolescent Pregnancy Prevention Coalition of North Carolina, the Division of Public Health and others. However, the state still has the twelfth-highest birth rate for 15-19 year olds in the U.S. North Carolina also has the nation’s highest birth rate among Hispanic adolescents. All this in a country that has the highest teen birth rate in the industrialized world.
Unfortunately, due to budgetary constraints, DHHS funding has been eliminated this fiscal year for almost one-fourth of the local agencies that were funded last year to provide teen pregnancy prevention programs. We will closely monitor the short-term impact of these reductions.
So, in looking at the 2001 Child Health Report card, we have much to celebrate. We also have a lot more work to do, both to maintain the gains we have made and to improve in those areas where our grades are poor. Every improvement means better health for our children and a better outlook for our state. It will take all of us, working together, to raise this vitally important grade-point average. Our goal is a straight 4.0. Working together, we can get there.