The HNC 2030 Scorecard supports the North Carolina Division of Public Health's
2020, 2022 State Health Improvement Plan.
Local health departments and their partners link local scorecards to the state scorecard to reflect the collective impact occurring statewide on 21 population indicators.
The state health assessment, planning and improvement process uses a population health framework with a health equity lens and disparity focus.
Results-based accountability drives the decennial plan using data driven, disciplined thinking. While population level indicators are monitored at the state level, local health departments monitor program performance with three simple measures:
How much did you do?
How well did you do it?
Is anyone better off?
The plan can be viewed/downloaded from the N.C. State Center for Health Statistics website:
https://schs.dph.ncdhhs.gov/units/ldas/hnc.htm
Why Is This Important?
“The current scale of community development is insufficient to address the many complex causes of poverty and to ensure the vital conditions that shape health, wealth, and well-being are met for all Americans. Addressing poverty and meeting the vital conditions are in the direct interest of stakeholders beyond the field of community development, including government officials, businesses and business owners, educators, and healthcare providers and payers. New business models are needed to closely align the financial interests of those who benefit from a healthier, more productive population and those who create the conditions that promote human flourishing.”
“The nation’s dominant narrative, which states that people can achieve the American Dream of economic success through resilience and grit and by taking personal responsibility, causes great harm. We have stigmatized poverty with racist and misogynistic language, such as “welfare queens and deadbeat dads,” instead of acknowledging our history. This narrative perpetuates White privilege and tells those in stigmatized groups that opportunity is there if they seize it and work twice as hard. Working twice as hard to overcome systemic and structural barriers harms health. Evidence shows how disparities in health outcomes increase with education and income, which contradicts a narrative that emphasizes personal responsibility and hard work.” 2022 NC SHIP, pg. 28.
Story Behind the Curve
According to the North Carolina Justice Center, in 2019, the federal poverty guideline was $25,750 combined income for a family or household of four.
- 1.4 million North Carolinians, or about 1 in every 7 people in the state, lived in poverty
- 1 in 5 North Carolinians under 18, or over 430,000 children, lived in poverty
Higher rates of poverty among women are connected to the lack of support for working parents.
In 2019, the poverty rate among North Carolina women was more than 20 percent higher than for men.
- 786,000 women, or 14.9 percent, experienced poverty
- 600,000 men, or 12.2 percent, experienced poverty
Young children have the highest poverty rate of any age group. Many people were close to poverty before the COVID-19 pandemic began. Due to the impact of the COVID-19 pandemic, the Census Bureau changed the 2020 American Community Survey (ACS) release. Instead of providing the standard 1-year data products, the Census Bureau released experimental estimates from the 1-year data. One should not compare 2020 ACS data to any other data survey years. 2022 NC SHIP, pg. 30
Partners
Child Care Services Association (CCSA) |
https://www.childcareservices.org/ |
Communities in Partnership (CIP) |
https://communitiesinpartnership.org/ |
Cooperative Christian Ministry |
https://cooperativeministry.com/ |
Crisis Assistance Ministry |
https://www.crisisassistance.org/ |
End Poverty Durham |
http://endpovertydurham.org/ |
Equity Before Birth |
https://www.equitybeforebirth.com/ |
NC Raise Up |
https://www.ncraiseup.org/fed-up |
GreenLight Fund- Charlotte |
https://greenlightfund.org/sites/charlotte/ |
Latin American Coalition |
https://latinamericancoalition.org/ |
Mary Reynolds Babcock Foundation |
https://www.mrbf.org/ |
NAACP |
https://naacp.org/ |
NCCARE360 |
https://nccare360.org/ |
NC Early Childhood Foundation (NCECF) |
https://buildthefoundation.org/ |
North Carolina Community Action Association |
https://www.nccaa.net/ |
North Carolina Early Education Coalition |
https://ncearlyeducationcoalition.org/ |
NC DHHS Office of Economic Opportunity |
https://www.ncdhhs.gov/divisions/office-economic-opportunity |
North Carolina Justice Center |
https://www.ncjustice.org/ |
NC Coalition Against Domestic Violence |
https://nccadv.org/ |
North Carolina Department of Commerce |
https://www.nccommerce.com/ |
North Carolina Network of Grantmakers (NCNG) |
https://ncgrantmakers.org/ |
North Carolina Poor People’s Campaign- A National Call for Moral Revival |
https://ppc-nc.org/ |
The Duke Endowment |
https://www.dukeendowment.org/program-areas/overview |
Z. Smith Reynolds Foundation |
https://www.zsr.org/ |
What Works
- Advocate for universal basic income
- Advocate for universal health insurance/Expand Medicaid eligibility
- Bring back the infrastructure to support community & economic development at the state and federal level
- Focus economic development on well-paying jobs
- Improve third grade reading proficiency and high school graduation rates
- Increase paid medical leave
- Increase subsidized childcare
- Increase the state earned income tax credit
- Launch funds for minority businesses
- Raise the minimum wage to $15 per hour • Reduce incarceration
- Strengthen initiatives to prevent teen pregnancy
- Support and strengthen the community college system
Description of Indicator Data
American Community Survey (US Census)
Additional Data Needed at Local Level
- Economic Mobility: Job market (income); Savings rate; Ownership (home, business, investment)
- Study the Road to Zero Wealth - https://ips-dc.org/report-the-road-to-zero-wealth/
- Study Economic Mobility - https://scholar.harvard.edu/files/hendren/files/mobility_geo.pdf
- DHHS, in partnership with a diverse set of stakeholders, developed a standardized set of Social Determinants of Health (SDOH) screening questions.
- Food insecurity
- Housing instability
- Lack of transportation
- Interpersonal violence
https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/screening-questions
Why Is This Important?
Loss of income is linked to increased vulnerability to disease, unhealthy behaviors, and adverse health outcomes associated with poverty. Unemployment leads to disparities in health insurance coverage, limiting access to medical attention and medication. 2022 NC SHIP, pg. 32.
Story Behind the Curve
North Carolina needs a plan that “incorporates strategies to build a more resilient economy by focusing on rural communities and equitable, inclusive practices.”
“Typical state economic development plans traditionally focus on issues such as industry recruitment strategies, incentives to encourage business expansion and relocation, support for the development of industrial properties, and state tax policies – all very important activities…. Every business survey conducted – nationally and in-state – identifies acquiring and growing the right talent as a crucial factor. The ability to find high-quality employees is essential to a business’s success. It is also what enables individuals and communities to advance their economic situation – making it the single most important issue to ensure North Carolina’s competitiveness.”
“The North Carolina Department of Commerce outlines three goals to guide the state’s strategy:
1. Prepare North Carolina’s workforce for career and entrepreneurial success.
2. Prepare North Carolina’s businesses for success by growing and attracting a talented workforce.
3. Prepare communities across North Carolina to be more competitive in growing and attracting a talented workforce and businesses.”
2022 NC SHIP, pg. 34
Partners
Care4Carolina |
https://care4carolina.com/all-resources/ |
Green Opportunities (GO) |
https://www.greenopportunities.org/jobtraining/ |
Hinton Rural Life Center |
https://www.hintoncenter.org/ |
Just Economics of Western North Carolina (JE) |
https://www.justeconomicswnc.org/issues/living-wage/ |
NCCARE360 |
https://nccare360.org/ |
North Carolina Association of County Directors of Social Services (NCACDSS) |
https://www.ncacdss.org/ |
Open Integration Coalition (OIC), Inc. |
https://www.oic-inc.com/ |
Raising Wages NC |
https://raisingwagesnc.org/our-coalition |
The Broadband ReConnect Program |
https://www.usda.gov/reconnect |
What Works
- Access to broadband internet
- Address collective impact of structural racism
- Expand transit options in rural and low-income communities
- Focus on investing in businesses owned by women and people of color
- Improve educational outcomes/increase participation in post-secondary education
- Improve personal finance credit scores and access to financial capital
- Increase access to affordable personal vehicles
- Increase access to affordable childcare
- Increase percentage of jobs that pay a living wage: look at health careers
- Increase workforce development efforts - target those who need it most
- Invest in the entrepreneurial population
- Recognize that opioid epidemic contributes to people not passing employer drug screens
- Seek a national health insurance/service program: An Economic Bill of Rights for the 21st Century
- Shift funding from industrial recruitment to support of small businesses and social enterprises
- Support “fair-chance” hiring policies
- Support economic opportunities that provide full-time employment and grow local businesses
Description of Indicator Data
American Community Survey (US Census)
Additional Data Needed at Local Level
- Availability Job Training Programs
- Minority Owned Businesses
- Financial Counseling/Wealth Building for Minorities
- Child Care Subsidy Assistance
- Post-secondary education support
- Distribution of broad-band internet
Why Is This Important?
School disciplinary action is a strong predictor of student academic performance and high school completion. Less education can lead to fewer opportunities for high-paying employment that provides health insurance and access to other social support. 2022 NC SHIP, pg. 36.
Story Behind the Curve
“Trauma-informed school-wide interventions are associated with decreased office discipline referrals, physical aggression incidents, and out-of-school suspensions.” Suspensions are often linked to adverse childhood experiences (ACEs). Blodgett & Dorado (2016) reviewed the literature for trauma-informed school practice and alignment with educational practice.8 Communities with higher ACE scores had “higher rates of suspension and unexcused absences and lower rates of graduation from high school and progression to post-secondary school than communities with relatively low prevalence of ACEs.” 2022 NC SHIP, pg. 39
Partners
Center for Racial Equity in Education (CREED) |
https://www.creed-nc.org/ |
Color of Education |
https://colorofeducation.org/ |
Made in Durham |
https://madeindurham.org/ |
Public School Forum of North Carolina |
https://www.ncforum.org/ |
Racial Equity Institute, LLC |
https://www.racialequityinstitute.com/ |
Southern Coalition for Social Justice-Youth Justice Project |
https://southerncoalition.org/youth-justice-project/ |
The Center for Youth, Family, and Community Partnerships (CYFCP) |
https://cyfcp.uncg.edu/ |
Village of Wisdom |
https://www.villageofwisdom.org/ |
Working to Extend Anti-Racist Education (we are) |
https://www.weare-nc.org/ |
What Works
- Develop collaborative learning groups for schools to share best practices
- Develop statewide system of restorative justice programs
- Enhance recruitment and retention efforts for black and brown educators
- Include suspension rate in measures of school quality
- Promote non-exclusionary approaches to discipline
- Provide informational resources for schools on how to reduce disciplinary actions
- Train teachers, administrators, school resource officers, and others working with students on implicit bias
Description of Indicator Data
NC Department of Public Instruction
Additional Data Needed at Local Level
- Economic Mobility: Job market (income); Savings rate; Ownership (home, business, investment)
- Study the Road to Zero Wealth - https://ips-dc.org/report-the-road-to-zero-wealth/
- Study Economic Mobility https://scholar.harvard.edu/files/hendren/files/mobility_geo.pdf
- DHHS, in partnership with a diverse set of stakeholders, developed a standardized set of SDOH screening questions.
- Food insecurity
- Housing instability
- Lack of transportation
- Interpersonal violence
https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/screening-questions
Why Is This Important?
“People of color, notably African American men, are imprisoned at disproportionate rates and tend to face harsher punishment for similar crimes as their white counterparts. There are enormous health, social, and economic consequences of incarceration for both the imprisoned person, their families, and our communities.” 2022 NC SHIP, pg. 40.
Story Behind the Curve
According to SAMSHSA, an estimated 18% of the general population has a mental illness. However, an estimated 44% of those in jail and 37% of those in prison have a mental illness.
An estimated 11% of the 18–25-year-old population and 6% of those over 25 years old have a substance use disorder. The estimated prevalence of substance use disorder in jails is 63%, and 58% in prisons.
People with these disorders have challenges in getting appropriate treatment, and often incarceration exacerbates their symptoms. This can lead to individuals staying incarcerated longer than those without behavioral health concerns. Upon release from incarceration, people with behavioral health issues face many barriers to successful reentry into the community, such as lack of health care, job skills, education, stable housing, and poor connection with community behavioral health providers. These factors may jeopardize their recovery and increase their probability of relapse and re-arrest. 2022 NC SHIP, pg. 42
Partners
Durham County NC Criminal Justice Resource Center |
https://www.dconc.gov/county-departments/departments-a-e/criminal-justice-resource-center |
Growing Change, Inc |
https://www.growingchange.org/ |
Leading Into New Communities (LINC), Inc. |
https://lincnc.org/ |
National Council of Juvenile and Family Court Judges (NCJFCJ)-Trauma- Informed Courts |
https://www.ncjfcj.org/child-welfare-and-juvenile-law/trauma-informed-courts/ |
North Carolina Department of Public Instruction (NC DPI) |
https://www.dpi.nc.gov/data-reports/discipline-alp-and-dropout-data |
North Carolina Harm Reduction Coalition (NCHRC) |
https://www.nchrc.org/ |
North Carolina Judicial Branch- School Justice Partnership |
https://www.nccourts.gov/programs/school-justice-partnership |
North Carolina Justice Academy |
https://ncdoj.gov/ncja/ |
North Carolina Task Force for Racial Equity in Criminal Justice (TREC) |
https://ncdoj.gov/trec/ |
Wash Away Unemployment |
https://www.wash-away.org/ |
What Works
- Implement Medication Assisted Treatment (MAT) programs in correctional settings
- Implement standardized, evidence-based programs to reduce recidivism
- Improve access to treatment for substance use disorders, physical illnesses, and mental illnesses
- Improve conditions and programs in jails and prisons to reduce harmful impact and foster successful reintegration into community
- Improve educational outcomes, particularly for boys of color
- Increase employment opportunities and job training programs in disadvantaged communities
- Reduce intergenerational and neighborhood poverty
- Revise current criminal justice policies
Description of Indicator Data
US Bureau of Justice Statistics and NC Department of Public Safety
Additional Data Needed at Local Level
- Racial equity training for court system personnel
- Racial data in Administrative Office of the Courts reporting
- Policies of law enforcement agencies regarding
- use of force
- duty to report excessive use of force
- School-based offenses
- Mental Health and Substance Use Disorder Screening and care in jail health
Why Is This Important?
Numerous studies have found a consistently strong relationship between an increasing number of Adverse Childhood Experiences (ACEs) and poor health outcomes in adults. While the National Survey of Children’s Health does not capture the timing of ACEs or the onset of poor health outcomes, a similar dose-response relationship is found between ACEs and health outcomes in children. In 2017-2018, the percentage of children with complex or poor physical and social-emotional health increased as the number of parent-reported ACEs increased. For example, 14.3% of children with no ACEs had special health care needs, increasing to 43.5% among children with four or more ACEs. The same pattern was found between the number of ACEs and poorly rated physical health, difficulty making and keeping friends, behavior or conduct problems, anxiety, and depression. 2022 NC SHIP, pg. 44.
Story Behind the Curve
“Childhood adversity changes our biological systems – those with higher ACE scores have greater health risks over the course of a lifetime.”
Research consistently shows that ACEs are common.
“Historical and ongoing traumas due to systemic racism and discrimination or the impacts of multigenerational poverty resulting from limited educational and economic opportunities intersect and exacerbate the experience of other ACEs, leading to disproportionate effects in certain populations (Nurious, Logan-Greene, and Green, 2012, as cited in CDC, 2020).” 2022 NC SHIP, pg. 46
Partners
Center for Child & Family Health |
https://www.ccfhnc.org/ |
Kellin Foundation |
https://www.kellinfoundation.org/ |
NCCJ |
https://www.nccjtriad.org/programs/ |
NC DHHS Division of Child Development and Early Education |
https://ncchildcare.ncdhhs.gov/ |
North Carolina Academy of Family Physicians |
https://www.ncafp.com/ |
North Carolina Child Treatment Program |
https://www.ncchildtreatmentprogram.org/ |
North Carolina Homeless Education Program |
https://hepnc.uncg.edu/ |
North Carolina Infant and Young Child Mental Health Association (NCIMHA) |
https://www.ncimha.org/ |
North Carolina Judicial Branch- Chief Justice’s Task Force on ACEs |
https://www.nccourts.gov/commissions/chief-justices-task-force-on-aces-informed-courts |
North Carolina Area Health Education Centers (NC AHEC) |
https://www.ncahec.net/ |
North Carolina Pediatric Society |
https://www.ncpeds.org/ |
North Carolina Psychological Foundation |
https://www.ncpsychology.org/ |
Our Children’s Place of Coastal Horizons Center |
https://coastalhorizons.org/ |
Parenting Inside Out |
http://www.parentinginsideout.org/ |
The Impact of Racism on Child and Adolescent Health |
https://publications.aap.org/pediatrics/article/144/2/e20191765/38466/The-Impact-of-Racism-on-Child-and-Adolescent?autologincheck=redirected |
The National Child Traumatic Stress Network (NCTSN)- Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) |
https://www.nctsn.org/interventions/structured-psychotherapy-adolescents-responding-chronic-stress |
The North Carolina Partnership for Children, Inc.- Smart Start |
https://www.smartstart.org/ |
Together for Resilient Youth (T.R.Y.) |
https://try4resilience.org/ |
Wellness Recovery Action Plan (WRAP) |
https://www.wellnessrecoveryactionplan.com/wrap-can-help/youth-children/ |
Winer Family Foundation |
https://www.wffcharlotte.org/ |
What Works
- Expand community and domestic violence prevention initiatives
- Increase access to behavioral health treatment
- Increase access to evidence-based parenting, early intervention, and home visiting programs
- Increase minimum wage and employment opportunities
- Increase opportunities for traumainformed parenting support
Description of Indicator Data
Children’s National Health Survey
Additional Data Needed at Local Level
DHHS, in partnership with a diverse set of stakeholders, developed a standardized set of SDOH screening questions to address and acquire data on the following:
- Food insecurity
- Housing instability
- Lack of transportation
- Interpersonal violence
https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/screening-questions
Why Is This Important?
Children with low reading proficiency are more likely to drop out of high school, acquire low-paying jobs that limit access to health care, and have increased risks for numerous adverse health outcomes. 2022 NC SHIP, pg. 48
Story Behind the Curve
Dialogue from the 2022 NC SHIP Community Council Meeting and Symposia:
- Reading scores have been declining for over a decade
- Young children do not receive enough instruction in phonics to become fluent readers
- Fluency improves comprehension
- Reading is taught in a vacuum without giving students an opportunity to learn reading in science and history
- Home reading habits have deteriorated
- Cuts in spending for education generally mean cuts to personnel
“In 2019, results on national and international exams showed stagnant or declining American performance in reading and widening gaps between high and low performers. The causes are multifaceted, but many experts point to a shortage of educators trained in phonics and phonemic awareness — the foundational skills of linking the sounds of spoken English to the letters that appear on the page. The pandemic has compounded those issues.” 2022 NC SHIP, pg. 49
Partners
What Works
- Expand access to NC Pre-K, 4-, and 5-star early learning programs and other high-quality early childhood programs, particularly for children who are homeless, in foster care, are from immigrant families, or who have disabilities or other special healthcare needs
- Expand use of evidence-based literacy programs connected to health care (e.g., Reach Out and Read)
- Improve the rigor and responsiveness of birth through third grade teacher and administrator preparation programs
- Increase access to home visiting programs for young children
- Increase funding to public schools and early learning programs that serve children with the highest barriers to success, including children from low-income families and people of color
- Raise wages to attract, recruit, and retain highly qualified birth through third grade teachers
Description of Indicator Data
NC Department of Public Instruction
Additional Data Needed at Local Level
DHHS, in partnership with a diverse set of stakeholders, developed a standardized set of SDOH screening questions to address and acquire data on the following:
- Food insecurity
- Housing instability
- Lack of transportation
- Interpersonal violence
https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/screening-questions
Why Is This Important?
Exercise is essential for physical, social, and mental well-being. All North Carolina residents need equitable access to safe areas where they can be physically active. Equitable community environments support physical activity behaviors and provide safe exercise opportunities for the entire community. These spaces should be crime-free and accessible by public transit. They should also include safe and well-lit sidewalks, walking trails, greenways, and bike lanes.
Access to safe exercise space has been highly correlated to a community’s increased level of physical activity. Among adolescents, access has been shown to increase time spent in vigorous physical activity, and to lower obesity rates.
Regular physical activity decreases risk for premature morbidity and mortality. Regular exercise habits have been linked to improved brain health and balance in elderly populations. It can lower risk for obesity, depression, anxiety, and dementia. Conversely, lack of physical activity can lead to serious chronic diseases, including cancer, diabetes, and heart disease. To reduce risk of chronic disease, the Centers for Disease Control and Prevention (CDC) recommends that adults engage in 150 minutes of physical exercise/physical activity per week, and children engage in a minimum of 60 minutes of physical exercise per day. 2022 NC SHIP, pg. 52.
Story Behind the Curve
Multiple factors can impact individual access to exercise opportunities. These factors include income, race/ethnicity, geography, and disabilities. Low-income communities may have fewer parks and recreational facilities, in contrast to more affluent communities. People of color are less likely to live near parks. Compared to metropolitan populations, residents of rural areas face additional barriers to activity opportunities. Finally, parks and recreational facilities may lack appropriate accommodations for individuals with physical disabilities, rendering these areas inaccessible to this population.
Dialogue from the 2022 NC State Health Improvement Plan Community Council Meeting and Symposia
- How is equity defined, and how do you measure it?
- How is accessibility defined, and how do you measure it? Equity and access to be able to measure it?
- How is the impact of infrastructure, like walking trails, measured?
- There is a grading system for community parks that has a checklist and looks at who has access, is equipment ADA, are wheelchair swings available, safety and disrepair of the equipment, and the timing of those that are using the park.
Policies and investment are needed to support development and expansion of community parks, transit options, sidewalk improvements, and to increase the number of greenways, walking trails and bike paths.
Community partners such as childcare facilities, schools, churches, and workplaces provide essential services and infrastructure, in promoting access to physical activities. Supporting the efforts of these entities can improve access for all citizens. The COVID-19 pandemic affected physical access to facilities and interrupted the efforts of some community partnerships. Improved capabilities for partnering and providing for safe distancing will help to promote the reemergence and increased potential for robust equitable access to exercise opportunities for all. 2022 NC SHIP, pg. 54
Partners
American Association of Retired Persons (AARP) Livable Communities |
https://www.aarp.org/livable-communities/ |
Boys & Girls Clubs of North Carolina |
https://www.ncclubs.org/ |
Boy Scouts of America-East Carolina Council |
https://www.eccbsa.org/ *several councils across the state |
Brenner FIT®- WakeHealth |
https://www.wakehealth.edu/Specialty/b/Brenner-FIT |
Bull City Fit |
https://www.bullcityfit.org/ |
Children’s Healthy Weight Research (CHWR)- UNC Center for Health Promotion and Disease Prevention |
https://chwr.web.unc.edu/ |
Children Wellness Initiative Network (WIN)- Walk Cabarrus |
https://walkcabarrus.com/our-mission/ |
Durham Parks & Recreation (DPR) |
https://www.dprplaymore.org/ |
Eat Smart Move More North Carolina |
https://www.eatsmartmovemorenc.com/ |
Girl Scouts- North Carolina Coastal Pines |
https://www.nccoastalpines.org/ |
Go NAPSACC (Nutrition and Physical Activity Self-Assessment for Child Care) |
https://gonapsacc.org/ |
Kids in Parks- TRACK Trails |
https://www.kidsinparks.com/blog-topics/track-trails |
Lumber River Council of Governments |
https://www.lumberrivercog.org/ |
National Recreation and Park Association |
https://www.nrpa.org/ |
NC Council of Churches |
https://www.ncchurches.org/ |
NC State Design National Learning Initiative |
https://naturalearning.org/ |
NC State Extension- Faithful Families |
https://ncstepstohealth.ces.ncsu.edu/faithful-families/ |
North Carolina Department of Transportation- Great Trails State Plan, Safe Routes to School Program, Let’s Go NC! |
https://www.ncdot.gov/Pages/default.aspxhttps://www.ncdot.gov/divisions/bike-ped/great-trails-state/Pages/default.aspxhttps://www.ncdot.gov/initiatives-policies/safety/safe-routes-school/Pages/default.aspx |
North Carolina Recreation and Park Association (NCRPA)- |
https://www.ncrpa.net/ |
The North Carolina Partnership for Children, Inc.- Smart Start |
https://www.smartstart.org/ |
The Duke Endowment |
https://www.dukeendowment.org/ |
The Trust For Public Land |
https://www.tpl.org/ |
The Walking Classroom |
https://www.thewalkingclassroom.org/ |
Vision Zero Network |
https://visionzeronetwork.org/ |
What Works
- Adopt “Complete Streets” policies
- Expand transit services to provide access to places for physical activity
- Increase access to evidenced-based and informed interventions that support physical activity in childcare, schools, churches, workplaces and other community-based settings
- Increase number of biking trails and lanes, walking trails, and greenways
- Increase number of and access to community parks, particularly in rural areas
- Increase the number of joint use/open use policy agreements for school playground facilities
- Maintain safe and well-lit sidewalks
- Provide public access to municipal recreation facilities
- Support community walking clubs and public fitness classes
Description of Indicator Data
County Health Rankings and Roadmaps - Business Analyst, Delorme map data, ESRI, & US Census Tiger line Files *Should not compare ranked data from year to year
Additional Data Needed at Local Level
Work with the city and/or county planning department to identify locations in your community that are used for physical activity and select or create your own measure(s).
- Walk-ability/Bike-ability of any location - https://www.walkscore.com/
- How to assess your community’s environment, physical activity -https://activelivingresearch.org/toolsandresources/toolsandmeasures
Why Is This Important?
Access to foods that support healthy eating patterns contributes to an individual’s health throughout his or her life.
Healthy eating habits include controlling calories; eating a variety of foods and beverages from all the food groups; and limiting intake of saturated and trans fats, added sugars, and sodium. Healthy eating can help lower the risk for chronic disease.
Evidence also shows that poor nutrition and an unhealthy diet are risk factors for high blood pressure, diabetes, and cancer. According to the 2015—2020 Dietary Guidelines for Americans, healthy eating patterns include: a variety of vegetables; fruits, especially whole fruits; grains, at least half of which are whole grains; fat-free or low-fat dairy; protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), unsalted nuts and seeds, and soy products; and oils.
Some research has shown that increased access to healthy foods corresponds with healthier dietary practices. 2022 NC SHIP, pg. 56
Story Behind the Curve
- There are barriers to, and disparities in, the accessibility and availability of foods that support healthy eating patterns. Data from 2012—2013 show that the average distance from U.S. households to the nearest supermarket was 2.19 miles. Individuals without a vehicle or access to convenient public transportation or who do not have food venues with healthy choices within walking distance have limited access to foods that support healthy eating patterns.
- Transportation and distance to sources of healthy foods impact low–income and rural communities, especially older adults living in rural communities. Overall, for those who do not have access to a car or public transportation, the cost of travel time to find healthier options, in addition to out–of–pocket expenses, may be too high.
- Another barrier to the accessibility of healthy food choices is living in a food desert. In food deserts, food sources are lacking or limited, particularly in low-income areas that are more also likely to have a higher share of convenience stores and small food markets. These options tend to carry foods of lower nutritional quality compared to large chain supermarkets, which may have a wider variety of healthy options.
- Improving access to foods that support healthy eating patterns is one method for addressing health disparities and population health. Several strategies that aim to “improve diet by altering food environments” are being considered and implemented.
- For example, a study has shown that a small financial incentive increased the use of Supplemental Nutrition Assistance Program (SNAP) benefits in participating farmer markets – resulting in increased access to healthy foods.
- Several strategies have also been proposed to encourage more equitable access to healthy food choices, such as “attracting and opening supermarkets in underserved neighborhoods, selling healthy foods at reduced prices, and limiting the total number of per capita fast-food restaurants in a community.” 2022 NC SHIP, pg. 58
Partners
What Works
- Expand transit options in rural and lowincome communities
- Increase access to healthy foods in childcare, schools, churches, workplaces and other community-based settings
- Increase technological support for eWIC payments
- Increase technological support for SNAP EBT payments at food retailers
- Support nonprofit grocery stores working to meet the needs of residents of food deserts
- Support school-based meal programs
- Support tax-incentive programs designed to encourage grocery stores and farmers markets to move into food deserts
Description of Indicator Data
County Health Rankings and Roadmaps - United States Department of Agriculture (USDA) *Should not compare ranked data from year to year
Additional Data Needed at Local Level
DHHS, in partnership with a diverse set of stakeholders, developed a standardized set of SDOH screening questions to address and acquire data on the following:
- Food insecurity
- Housing instability
- Lack of transportation
- Interpersonal violence
https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/screening-questions
Why Is This Important?
Housing instability encompasses several challenges, such as having trouble paying rent, overcrowding, moving frequently, staying with relatives, or spending the bulk of household income on housing. These experiences may negatively affect physical health and make it harder to access health care.
Households are cost burdened if they spend more than 30% of their income on housing and severely cost burdened if they spend more than 50% of their income on housing. Cost-burdened households have little left over each month to spend on other necessities such as food, clothing, utilities, and health care. Black and Hispanic households are almost twice as likely as white households to be cost burdened. 2022 NC SHIP, pg. 60.
Story Behind the Curve
- Housing quality refers to the physical condition of a person’s home as well as the quality of the social and physical environment in which the home is located. Aspects of housing quality include air quality, home safety, space per individual, and the presence of mold, asbestos, or lead.
- Housing quality is affected by factors like a home’s design and age.
- Poor-quality housing is associated with various negative health outcomes, including chronic disease and injury, and mental health.
- The quality of a home’s neighborhood is shaped in part by how well individual homes are maintained, and widespread residential deterioration in a neighborhood can negatively affect mental health.
- Both home design and structure significantly influence housing quality and may affect mental and physical health.
- Steps, balconies, and windows are features of home design that may present a threat to safety, especially for individuals with physical disabilities. Breakable glass, low windowsills, and poorly constructed stairs may increase the risk of injury from a fall. 2022 NC SHIP, pg. 62
Partners
CASA (Court Appointed Special Advocates) |
https://www.casanc.org/ |
Crisis Assistance Ministry |
https://www.crisisassistance.org/ |
Episcopal Farmworker Ministry |
https://episcopalfarmworkerministry.org/ |
Habitat for Humanity of North Carolina |
https://habitatnc.org/ |
Legal Aid of North Carolina |
https://www.legalaidnc.org/ |
NC DHHS Housing and Home Improvement Assistance |
https://www.ncdhhs.gov/assistance/low-income-services/housing-home-improvement-assistance |
Neighborhood Assistance Corporation of America |
https://www.naca.com/ |
North Carolina Housing Coalition |
https://nchousing.org/ |
North Carolina Housing Finance Agency |
https://www.nchfa.com/ |
North Carolina Voluntary Organizations Active in Disaster- Long-Term Recovery Groups (LTRGs) & Community Organizations in Active Disaster (COADs) |
https://www.ncvoad.org/coads-ltrgs/ |
Reinvestment Partners-Hotel to Home |
https://reinvestmentpartners.org/https://reinvestmentpartners.org/what-we-do/hotel-to-home.html |
Center for Public Engagement with Science |
https://ie.unc.edu/cpes/https://nchealthyhomes.com/ |
UNC-Greensboro Center for Housing and Community Studies |
https://chcs.uncg.edu/ |
UNC Institute for the Environment |
https://ie.unc.edu/ |
What Works
- Consider regulatory change allowing trailers to be registered as homes, not vehicles
- Enforce fair housing laws
- Examine ways to reduce retaliation or rising rents on properties that have been repaired
- Implement “right to counsel” policies for times tenants need to take their landlord to court
- Improve access to social services and resources for affordable housing
- Improve inspection process for migrant farmworkers
- Increase education to community members about housing environmental issues like lead and mold
- Increase involvement of community members in decision-making
- Increase living wage employment opportunities
- Increase understanding of issues for clinical providers and create partnerships to address issues that are uncovered
- Provide education for Latinos on rights and how to file a complaint
- Support programs designed to increase home ownership for people of color
- Update housing standards (H2A housing) required by OSHA
- Update the NC Migrant Housing Act
Description of Indicator Data
County Health Rankings and Roadmaps - Comprehensive Housing Affordability Strategy (CHAS) *Should not compare ranked data from year to year
Additional Data Needed at Local Level
DHHS, in partnership with a diverse set of stakeholders, developed a standardized set of SDOH screening questions to address and acquire data on the following:
- Food insecurity
- Housing instability
- Lack of transportation
- Interpersonal violence
https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/screening-questions
Why Is This Important?
An average of nine North Carolinians died each day from a drug overdose in 2020, a 40% increase from the previous year. This stark increase during 2020 aligns with the increases experienced nationwide with the nation exceeding 100,000 deaths. In North Carolina, the number of drug overdose deaths — from illicit substances and/or medications — increased by nearly 1,000 deaths, North Carolina per 100,000 population, age-adjusted from 2,352 in 2019 to 3,304 in 2020. There were also nearly 15,000 emergency department visits related to drug overdoses in 2020. Provisional surveillance data suggest these increases continued through 2021. Both overdose deaths and the increases disproportionally affect historically marginalized populations. 2022 NC SHIP, pg. 66.
Story Behind the Curve
Prescription medications have been a major driver of the opioid epidemic, but illicit drugs (heroin and synthetic fentanyl) are also increasingly contributing to this problem. Additionally, North Carolina and many other states are identifying fentanyl and opioid analogs in other kinds of illicit drugs (including cocaine, methamphetamine and counterfeit pills). People using these substances may unknowingly be exposed to opioids and are at high risk of opioid overdose. Using harm reduction techniques for safer use and having naloxone on hand can help prevent fatal opioid overdose. 2022 NC SHIP, pg. 68
Partners
What Works
- Access and use the Opioid Action Plan
- Address the needs of justice-involved populations
- Adopt and support payment of evidenced-based interventions that prevent opioid prescribing
- Avert future opioid addiction by supporting youth and families
- Encourage/support mobile crisis units
- Expand Medicaid eligibility
- Expand peer support specialist programs
- Implement broader use of NC Controlled Substance Reporting System by health care providers and pharmacies
- Implement Medication Assisted Treatment (MAT) programs in correctional settings
- Implement needle exchange programs
- Improve access to drug treatment programs, including medication-assisted treatment
- Increase distribution of naloxone
- Increase the use of agonist therapies (methadone and buprenorphine)
- Increase training for health care providers on buprenorphine prescribing
- Increase training for health care providers on safe prescribing practices
- Meet basic needs of individuals like housing and employment
- Promote alternative treatments for pain that are nonpharmaceutical based (e.g., acupuncture)
- Reduce the supply of prescription and illicit opioids
- Support policies that decriminalize and promote treatment of substance use disorder
- Support training for health department staff about naloxone: they are a main access point for people who are uninsured
Description of Indicator Data
NC State Center for Health Statistics, Vital Statistics
Additional Data Needed at Local Level
- Food insecurity
- Housing instability
- Lack of transportation
- Interpersonal violence
Why Is This Important?
Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined — and thousands more die from other tobacco-related causes such as involuntary exposure to secondhand smoke, fires caused by smoking (more than 1,000 deaths/year nationwide) and smokeless tobacco use. 2022 NC SHIP, pg. 70.
Story Behind the Curve
- Almost half of all young people who have ever used a cigarette started with menthol
- Young people use e-cigarettes for social reasons and because they come in flavors
- 76% of youth under 21 who got their e-cigarettes from social sources got them from someone under 21
- 2 out of 3 young people who currently use e-cigarettes are seriously thinking about quitting
- 24% of young people who have never tried an e-cigarette are open to trying one in the next year
Although a majority of cigarette smokers make a quit attempt each year in the United States, less than one-third use evidence-based methods which include FDA-approved tobacco treatment medications and behavioral counseling to support quit attempts. Nationally, one of the largest disparities is in the behavioral health population. 2022 NC SHIP, pg. 73
Partners
What Works
- Fund comprehensive state tobacco control programs to levels recommended by the CDC
- Implement high-impact media campaigns that warn about the dangers of tobacco use
- Implement state and local tobacco-free and smoke-free air policies that include e-cigarettes
- Implement strategies to curb tobacco product advertising and marketing that are appealing to young people
- Increase access to standard-of-care tobacco use treatment
- License tobacco retailers to enforce youth access to tobacco laws
- Raise the age of tobacco product sales to 21 to comply with federal law
- Raise the price of tobacco products through a tobacco tax
- Remove state preemption of local government regulations on the sale, promotion, distribution, and display of tobacco products
- Restrict the sales of flavored tobacco products
Description of Indicator Data
NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS) NC Youth Tobacco Survey, Smoke-free/Tobacco free local regulations maps
Additional Data Needed at Local Level
- Data regarding sale and consumption of new and emerging tobacco products
- Data to understand health disparities regarding tobacco use and exposure to hazardous secondhand smoke and e-cigarette emissions.
- Data on the effectiveness of price policies to prevent initiation of e-cigarette use among young people
Why Is This Important?
Alcohol use is responsible for approximately 3,500 deaths annually among youth under age 21 in the United States, shortening their lives by an average of 60 years
Underage alcohol use occurs in a context of significantly problematic adult use nationwide. Approximately 95,000 individuals of all ages in the United States die from alcohol attributable causes each year, making excessive alcohol use the third leading preventable cause of death in the U.S. 2022 NC SHIP, pg. 76.
Story Behind the Curve
Alcohol consumption increased during the COVID-19 pandemic in 2020 in the United States. The increase could substantially increase the long-term alcohol-associated liver disease (ALD) and mortality. 2022 NC SHIP, pg. 77
Partners
Addiction Professionals North Carolina |
https://www.apnc.org/ |
Centers for Disease Control’s Community Guide on Preventing Excessive Alcohol Consumption |
https://www.thecommunityguide.org/topic/excessive-alcohol-consumption |
Forensic Tests for Alcohol- NC DPH Branch |
https://publichealth.nc.gov/chronicdiseaseandinjury/fta/index.htm |
Mothers Against Drunk Driving North Carolina |
https://www.madd.org/north-carolina/ |
National Alcoholic Beverage Control Association (NABCA) |
https://www.nabca.org/ |
North Carolina Area Health Education Centers (NC AHEC) |
https://www.ncahec.net/about-nc-ahec/statewide-work |
North Carolina Fetal Alcohol Syndrome Disorder (FASD) Informed |
https://ncfasdinformed.org/about-us/about-ncfasd-informed |
North Carolina Preventing Underage Drinking Initiative (PUDI)- Talk It Up. Lock It Up! |
https://www.ncpudi.org/https://www.ncpudi.org/resources/talk-it-up-lock-it-up/ |
North Carolina Substance Use Disorder Federation |
https://sudfederation.org/ |
Recovery Communities of North Carolina (RCNC) |
https://www.rcnc.org/ |
The Center for Alcohol Policy |
https://www.centerforalcoholpolicy.org/ |
The Center for Prevention & Counseling- Too Smart to Start |
https://centerforprevention.org/too-smart-to-start/ |
What Works
- Consider laws around beer and wine couponing
- Education for family practitioners about how to talk about alcohol consumption and resources for addressing excessive drinking
- Education for parents about securing alcohol at home
- Expand access to treatment through Medicaid eligibility
- Hold alcohol retailers liable for intoxicated or underage customers who cause injury to others
- Increase alcohol excise taxes
- Increase funding for compliance checks
- Increase number and access to programs like Fellowship Hall
- Integrate Screening, Brief Intervention, and Referral to Treatment (SBIRT) into medical settings
- Reduce density of alcohol retailers
- Reduce the days and hours designated for alcohol sales
- Screen adults for excessive drinking and conduct brief intervention for those that screen positive
- Support and maintain state-controlled alcohol sales
Description of Indicator Data
NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Additional Data Needed at Local Level
- Map of points of liquor sales in community
- Number of criminal offenders under the influence when crime was committed
- Number of emergency room visits for alcohol-related injuries and conditions
- Economic cost of alcohol-related injuries and conditions
- Availability of alcohol from illegal sales and practices
- Availability of inpatient and outpatient treatment and counseling programs
- Alcoholics Anonymous (AA) locations and meeting times
- Expand the NC Alcohol Data Dashboard
Why Is This Important?
Sugar-sweetened beverages (SSBs) or sugary drinks are leading sources of added sugars in the American diet. Frequently drinking SSB is associated with weight gain, obesity, type 2 diabetes, heart disease, kidney diseases, non-alcoholic liver disease, tooth decay and cavities, and gout, a type of arthritis. Limiting sugary drink intake can help individuals maintain a healthy weight and have healthy dietary patterns. 2022 NC SHIP, pg. 80.
Story Behind the Curve
• In 2011-2014, 6 in 10 youth (63%) and 5 in 10 adults (49%) drank an SSB on a given day. On average, US youth consumed 143 calories from SSBs, and US adults consumed 145 calories from SSBs on a given day.
• Among youth, SSB intake is higher among boys, adolescents, non-Hispanic Black youth, or youth in families with low incomes.
• Among adults, SSB intake is higher among males, young adults, non-Hispanic Black or Mexican American adults, or adults with low incomes.
• The prevalence of Americans who drink sugary drinks at least once per day differs geographically.
• For example, 68% of adults living in the Northeast, 67% of adults living in the South, 61% of adults living in the West, and 59% of adults living in the Midwest reported drinking SSBs one or more times per day.
• About 31% of adults in nonmetropolitan counties and 25% of adults in metropolitan counties reported drinking SSBs one or more times per day. • Americans drink 52% of SSB calories at home and 48% of SSB calories away from home.
2022 NC SHIP, pg. 81
Partners
Color Me Healthy (CMH) |
https://snapedtoolkit.org/interventions/programs/color-me-healthy-cmh/ |
Diabetes Management NC- DiabetesSmart NC |
https://diabetesmanagementnc.com/diabetessmart/ |
Duke Sanford World Food Policy Center |
https://wfpc.sanford.duke.edu/ |
Durham’s Innovative Nutrition Education (DINE)- Supplemental Nutrition Assistance Program Education (SNAP-Ed) |
https://snaped.fns.usda.gov/success-stories/durhams-innovative-nutrition-education-dine |
Eat Smart, Move More North Carolina |
https://www.eatsmartmovemorenc.com/ |
Eat Smart, Move More, Prevent Diabetes |
https://esmmpreventdiabetes.com/ |
Eat Smart, Move More, Weigh Less |
https://esmmweighless.com/ |
Go NAPSACC |
https://gonapsacc.org/ |
Healthy Eating Research- Healthy Drinks Healthy Kids |
https://healthydrinkshealthykids.org/ |
I Heart Water |
https://iheartwaternc.com/ |
NC Cooperative Extension- Eat Smart, Move More, Take Control |
https://richmond.ces.ncsu.edu/take-control-2/ |
North Carolina Area Health Education Centers (NC AHEC) |
https://www.ncahec.net/about-nc-ahec/statewide-work |
North Carolina Expanded Food and Nutrition EducationProgram (EFNEP) |
https://ncefnep.org/what-is-efnep/ |
UNC Center for Health Promotion and Disease Prevention |
https://hpdp.unc.edu/research/cardiovascular-health-obesity-diabetes/https://hpdp.unc.edu/research/nutrition-physical-activity/ |
North Carolina Council of Churches- Partners in Health and Wholeness (PHW) initiative |
https://www.ncchurches.org/programs/phw/ |
What Works
- Address targeted industry marketing to communities of color
- Consider multidisciplinary approach to reducing SSB consumption that includes oral health
- Create community coalitions to identify additional community strategies to reduce consumption
- Launch public awareness campaigns
- Limit sugary drinks through government and private sector procurement policies
- Limit the default beverages served with kids meals to milk, 100% fruit juice, or water
- Partner with schools and youth-oriented settings to remove or limit SSBs and their marketing
- Promote healthy restaurant meals
- Use SSB taxes and generated revenues to address equity issues
- Work with clinicians, medical practices, and insurance providers to add SSB screening questions to the electronic health record
- Work with retailers to improve offerings and create healthier store environments
Description of Indicator Data
Youth: NC Department of Public Instruction, Youth Risk Behavior Survey (YRBS) Adult: NC State Center for Health Statistics, Behavioral Risk Factor Surveillance System (BRFSS)
Additional Data Needed at Local Level
- School and Child Care Policies on SSB sales and consumption
- Early Childhood Programs participating in NAPSACC
- Water quality in community
Why Is This Important?
HIV can cause lifelong physical and psychological consequences. When left untreated, HIV can also be transmitted to sexual partners and unborn children. 2022 NC SHIP, pg. 84.
Story Behind the Curve
Thousands of people in the United States are diagnosed with HIV every year. Many people have HIV for years before they know it. Testing everyone ages 13 to 64 years for HIV at least once in their lifetime — and testing people at high risk for HIV at least once a year — can lead to early diagnosis and treatment.
People must feel safe when seeking health care. This means acknowledging the person respectfully – especially for transgender individuals. Good quality sexual health education across the lifespan helps to normalize and integrate sexual health as a standard component of overall health awareness. Clinical staff must receive training specific to clinical care for transgender people.
Non-traditional testing and notification systems are needed. These could include multiple ways for people to notify other people of exposure, such as a website for anonymous contact notification. Home based STI testing and virtual clinical visits could improve early detection. 2022 NC SHIP, pg. 88
Partners
Carolinas CARE Partnership |
https://www.carolinascare.org/ |
Duke PrEP Clinic For HIV Prevention |
https://www.dukehealth.org/locations/duke-prep-clinic-hiv-prevention |
Durham County Department of Public Health- Formerly Incarcerated Transitions (FIT) Program |
https://www.dcopublichealth.org/services/std-hiv-testing |
Equality North Carolina |
https://equalitync.org/issues/hiv_aids_work/ |
Getting To Zero Mecklenburg |
https://www.mecknc.gov/HealthDepartment/GettingToZero/Pages/Home.aspx |
NC Council of Churches- Growing Communities of Inclusion: A Faithful Response to HIV/AIDS |
https://www.ncchurches.org/growing-communities-of-inclusion-a-faithful-response-to-hiv/ |
NC DHHS HIV Care Program |
https://epi.dph.ncdhhs.gov/cd/hiv/program.html |
NC DHHS Medicaid Be Smart Family Planning Program |
https://ncgov.servicenowservices.com/sp_beneficiary?id=kb_article&sys_id=389050c51b5424906aacdb1ee54bcba8&table=kb_knowledge |
NC DHHS NC HIV/AIDS Prevention and Care Advisory Committee (HPCAC) |
https://epi.dph.ncdhhs.gov/cd/stds/programs/hpcac.html |
NC DHHS North Carolina Injury & Violence Prevention Branch- North Carolina Safer Syringe Initiative |
https://www.injuryfreenc.ncdhhs.gov/ |
North Carolina AIDS Action Network (NCAAN) |
http://www.ncaan.org/ |
North Carolina Area Health Education Centers (NC AHEC) |
https://www.ncahec.net/about-nc-ahec/statewide-work |
North Carolina Association of Pharmacists (NCAP) |
https://www.ncpharmacists.org/ |
NC Board of Pharmacy |
http://www.ncbop.org/ |
North Carolina Community Health Center Association (NCCHCA) |
https://www.ncchca.org/ |
North Carolina Harm Reduction Coalition (NCHRC)-Syringe Exchange Program |
https://www.nchrc.org/about/ |
NC Institute of Medicine (NCIOM) |
https://nciom.org/ |
North Carolina Sheriff’s Association (NCSA) |
https://ncsheriffs.org/ |
Regional AIDS Interfaith Network (RAIN) |
RAIN (carolinarain.org) |
Sexual Health Initiatives For Teens (SHIFT) |
https://www.shiftnc.org/ |
Society for Public Health Education (SOPHE) |
https://www.sophe.org/ |
Southeast STD/HIV Prevention and Training Center |
https://nnptc.org/locations/southeast-stdhiv-prevention-training-center |
The North Carolina Barbers Association |
https://www.ncbarbae.com/home |
The Task Force For Global Health- Coalition for Global Hepatitis Elimination |
https://taskforce.org/viral-hepatitis/ |
UNC Center for Health Equity Research (CHER)- TRANSforming the Carolinas Project |
https://www.med.unc.edu/cher/ |
What Works
- Address systemic issues of provider discomfort discussing HIV and sexual health especially with young people and LGBTQ populations
- Allow pharmacists to provide post-exposure prophylaxis
- Ensure availability of free condoms at health departments and community-based organizations
- Ensure people who are diagnosed are linked with appropriate care and receive behavioral interventions and other supports to decrease risk of transmission
- Harm reduction, such as needle exchange programs, housing programs
- Implement interventions that improve access to HIV treatment
- Increase access to PrEP (pre-exposure prophylaxis) for individuals at high risk for HIV transmission
- Increase education and access for formerly incarcerated populations
- Increase Medicaid eligibility
- Make testing easy, accessible, and routine
Description of Indicator Data
NC Division of Public Health, Epidemiology Section
Additional Data Needed at Local Level
- Availability of PrEP (pre-exposure prophylaxis) within community
- Social media platforms used by the at-risk community
- Community awareness of sexual health
- Access to care for sexual health
Why Is This Important?
Teenage mothers are more likely to face higher rates of pregnancy-related morbidity, are less likely to receive prenatal care, and experience greater hardships that negatively impact their children’s lives and their own. 2022 NC SHIP, pg. 90.
Story Behind the Curve
According to the National Campaign to Prevent Teen and Unplanned Pregnancy, teen childbearing costs taxpayers in North Carolina over $325 million annually, and nationally the annual cost is over $9.4 billion. Additionally, pregnancy and birth are significant contributors to high school dropout rates among girls, with only about 50 percent of teen mothers receiving a high school diploma by age 22, compared to 90 percent of women who do not give birth as a teen. Teen mothers are also more likely to rely on public assistance, be poor as adults, and more likely to have children with poorer health outcomes over the course of their lives than children born to older mothers. 2022 NC SHIP, pg. 92
Partners
Helping Each Adolescent Reach Their Spark (H.E.A.R.T.S) |
https://www.heartsnc.org/ |
NC DHHS Adolescent Pregnancy Prevention Program |
https://www.teenpregnancy.ncdhhs.gov/appp.htm |
NC DHHS Personal Responsibility Education Program (PREPare) for Success |
https://www.teenpregnancy.ncdhhs.gov/prep.htm |
North Carolina Area Health Education Centers (NC AHEC) |
https://www.ncahec.net/about-nc-ahec/statewide-work |
North Carolina School Health Training Center (NCSHTC)-ECU |
https://hhp.ecu.edu/ncshtc/ |
Nurse-Family Partnership |
https://www.nursefamilypartnership.org/ |
Sexual Health Initiatives for Teens (SHIFT) NC- Gaston Youth Connected |
https://www.shiftnc.org/initiatives/gaston-youth-connected |
Teen Health Connection |
https://teenhealthconnection.org/teens-and-tots/ |
What Works
- Engage community. Community input is essential to understanding what issues are impacting unintended pregnancy
- Ensure access to information and services for youth sexual health
- Examine school sex education policies to ensure they include information on how to avoid teen pregnancy and sexually transmitted infections (STIs)
- Increase access to educational programs for youth in juvenile justice and foster care systems on pregnancy and STIs
- Increase access to long-acting reversible contraceptives, such as IUDs and implants, as well as condoms
- Increase education for teen mothers to prevent second pregnancies
- Make contraceptives available on-site in schools
- Require medically accurate sex education
Description of Indicator Data
NC State Center for Health Statistics, Vital Statistics
Additional Data Needed at Local Level
- Number of organizations in community that have similar interest in teens and reproductive health
- Number of teens in community
- Demographic profile of teens in community
- Number of middle and high schools
- Location of contraceptive health services (public and private)
- Number of youth-serving businesses
Why Is This Important?
Access to quality health care services is critical to achieve and maintain health, prevent and manage disease, and achieve health equity. Lack of health insurance can make health care inaccessible and unaffordable. 2022 NC SHIP, pg. 94.
Story Behind the Curve
The 2021 NC State Health Improvement Plan Community Council Meeting and Stakeholder Symposia stimulated dialogue among attendees. Questions that the participants posed included:
- Is healthcare a right?
- What is the standard for high quality health care? Is there a living document?
- What does high quality mean? Standards of care have been established.
- Who shares the responsibility?
- Who benefits from high quality healthcare?
- Does the government bail out insurance companies by giving a certain amount of care but doesn’t address root causes or families getting the care that they need?
- Who owns this issue in the state?
- Who were the community caregivers? Are there enough of the other groups to meet the unmet need?
- Did the care of people fall to the community when we did not have health insurance 100 years ago?
- Does shared responsibility bring out the opportunity to do nothing?
2021 NC SHIP Stakeholder Symposia Participants
The same attendees expanded the story expanded about uninsured people with these collective statements:
“People need information about the different levels of insurance within plans.”
“Many people do not qualify for the subsidies and fall into a coverage gap.”
“Because North Carolina has a robust safety net, there is a philosophical and political bias against support for Medicaid expansion.”
“The safety net is an excuse not to expand Medicaid.”
“We may need new words to describe the problems and the solutions to avoid the pitfalls of bias in our public discourse.”
“The terminology we use for the uninsured can be stigmatizing.”
“The undocumented population doesn’t qualify for these services.”
“Implicit bias needs to be addressed to create change.”
“Paternal leave/care not offered by some employers.”
“Family care excludes father.”
2022 NC SHIP, pg. 96
Partners
What Works
- Expand Medicaid eligibility criteria
- Increase publicity and navigator funding for open enrollment
- Increase public education about insurance options
- Support bans or limitations on short-term health plans
Description of Indicator Data
US Census Bureau - Small Area Health Insurance Estimates (SAHIE) Program
Additional Data Needed at Local Level
- Impact of Covid-19 pandemic on employer sponsored insurance
- Estimates of underinsured/uninsured at the county level
- Major employer insurance benefits available in area
- Analysis of support/opposition by elected officials to Medicaid expansion
- Stories from consumers/residents and their experience
Why Is This Important?
Having a primary care provider (PCP) is important for maintaining health and preventing and managing serious diseases. PCPs can develop long-term relationships with patients and coordinate care across health care providers. Strategies like team-based care and innovative payment methods are promising approaches for improving access to primary care. 2022 NC SHIP, pg. 98.
Story Behind the Curve
Access to health services means “the timely use of personal health services to achieve the best health outcomes.” A lack of access to care can impact overall physical, social, and mental health. It can also affect someone’s quality of life and livelihood. Barriers to access typically include the high cost of care, inadequate or no insurance coverage, and a lack of available services (geographically or remotely), especially culturally competent care. These barriers can lead to unmet health needs, delays in receiving appropriate care, an inability to get preventive services, preventable hospitalizations, and financial burdens. Access to care often varies by race/ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location.
Participants in the 2021 NC SHIP Community Council Meeting and Stakeholder Symposia elaborated on the story of primary care in North Carolina with these comments:
• “Surprising that certified nurse midwives (CNMs) are weighted at 0.75 in primary care when an obstetrician (OB) is weighted at 0.25 and most CNMs work in OB.”
• “To the point regarding CNM vs OBs time splitting: CNMs do mostly deliveries, OB visits, and prescribing birth control, and annual exams are all primary care activities. OBs are mostly surgical, so actually, we under-valued CNMs in this regard.”
• “The correlation of good health outcomes in quality primary care is the level of continuity and comprehensiveness – it’s the longitudinal relationship and the understanding of all of the indicators and factors putting the puzzle together.”
• “We have a data problem in counting population per primary care practitioner – example in Chatham Co. Most of the physicians that work in Northern Chatham Co., have a primary practice in Orange County, but their ambulatory office may be in Chatham County.”
• “There are primary care physicians that have practices in one county, but they may go out to surrounding counties three days per week but are not counted in those counties.”
• “I am willing to accept that the data is not perfect and that this is all that we have, but it is bothersome that there is no sense of “parttime-redness”. Most physicians in academic health settings are going to be less than one-half clinical. In addition, you have people in various stages of retirement or family life cycle. This is a big impact on access that we have no way to estimate.”
• “This is also an AWESOME measure because it now includes advanced practice providers, whereas previously, it only captured primary care physicians. This is a huge advance and is really appreciated. No doubt it can still be refined, but it is still a great advance from what we had been using.”
2022 NC SHIP, pg. 102
Partners
College Foundation of North Carolina (CFNC) |
https://www.cfnc.org/ |
Community Care of North Carolina (CCNC) |
https://www.communitycarenc.org/ |
Duke Health’s Primary Care Preceptor Development Mini-Fellowship Program |
https://fmch.duke.edu/education-training/primary-care-preceptor-development-mini-fellowship |
Mountain Area Health Education Center (MAHEC) |
https://mahec.net/ |
Mountain Community Health Partnership (MCHP) |
https://www.mchp.care/ |
NC DHHS Office of Rural Health |
https://www.ncdhhs.gov/divisions/orh |
NC Medical Society |
https://www.ncmedsoc.org/ |
North Carolina Academy of Physician Assistants (NCAPA) |
http://ncapa.org/ |
North Carolina Alliance for Health Professions Diversity (NCAHPD) |
https://ncahpd.org/ |
North Carolina Area Health Education Centers (NC AHEC) |
https://www.ncahec.net/about-nc-ahec/statewide-work |
North Carolina Association of Free & Charitable Clinics (NCAFCC) |
https://ncafcc.org/ |
North Carolina Association of Local Health Directors (NCALHD) |
https://www.ncalhd.org/ |
North Carolina Community Health Center Association (NCCHCA) |
https://www.ncchca.org/ |
North Carolina Healthcare Association (NCHA) |
https://www.ncha.org/ |
North Carolina Health Occupations Students of America (NC HOSA) |
http://nchosa.org/ |
North Carolina Institute of Medicine (NCIOM) |
https://nciom.org/ |
North Carolina Medical Board |
https://www.ncmedboard.org/ |
North Carolina Public Health Association (NCPHA) |
https://ncpha.memberclicks.net/ |
North Carolina Nurses Association (NCNA) |
https://www.ncnurses.org/ |
North Carolina Pediatric Society (NCPeds) |
https://www.ncpeds.org/ |
Office of Rural Initiatives at UNC |
https://www.med.unc.edu/inclusion/ori/ |
The Cecil G. Sheps Center for Health Services Research at UNC |
https://www.shepscenter.unc.edu/ |
**Primary Care Advisory Committee (PCAC) Office of Rural Health |
|
What Works
- Ensure high speed internet access because it impacts telehealth, electronic health records and access to the controlled substance reporting system
- Identify rural provider champions
- Increase access and payment for specialist consults
- Increase residency positions in rural areas
- Increase rural health clinical rotations for physician assistants (PAs) and Advanced Practice Nurses (DNPs)
- Increase support for all primary care providers
- Increase telehealth primary care initiatives in rural areas
- Invest in rural economies
- Support increased funding for provider loan repayment programs that incentivize primary care providers to practice in medically underserved areas
- Support pipeline programs in rural areas to encourage high school and college students to pursue careers in medicine/primary care
Description of Indicator Data
Cecil G. Sheps Center for Health Services - Research analysis of licensure data from North Carolina Medical Board and North Carolina Board of Nursing
Additional Data Needed at Local Level
- Stories from consumers/residents and their experiences around access to primary care in their community
- Secondary and post- secondary opportunities to pursue careers in health care
- Telehealth availability
- Contact information for all health care providers serving residents
Why Is This Important?
Prenatal or antepartum care is care given to pregnant women by an obstetrician or midwife and increases the likelihood of a safe and healthy delivery. Components of prenatal care recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) include determination of gestational age, fetal ultrasound imaging, routine laboratory testing, immunizations, genetic screening, psychosocial risk screening and patient education. According to the National Institute of Health, engaging in prenatal care early and consistently in pregnancy is an essential preventative factor in reducing adverse pregnancy outcomes such as low birth weight. By addressing chronic diseases such as diabetes and hypertension associated with preterm birth, prenatal care has been found to reduce adverse birth outcomes. Assessment of prenatal care utilization is considered a critical step in improving prenatal care access and birth outcomes. 2022 NC SHIP, pg. 104.
Story Behind the Curve
Racial discrimination is a significant risk factor for adverse birth outcomes. To best understand the mechanisms by which racial discrimination impacts birth outcomes, and to inform the development of effective interventions that eliminate its harmful effects on health, longitudinal research that incorporates comprehensive measures of racial discrimination is needed. Healthcare providers must fully acknowledge and address the psychosocial factors that impact health outcomes in minority racial/ethnic women. 2022 NC SHIP, pg. 106
Partners
What Works
- Allow certified nurse midwives to practice under their full authority
- Encourage group prenatal care, childbirth education, and doula services are covered services by Medicaid
- Expand Medicaid eligibility
- Expand safe and reliable public transit options
- Provide education for local health & human services agencies on the importance of prenatal care.
- Public and provider awareness/education about ability to receive prenatal care services before receiving Medicaid card
- Strengthen workforce diversity and cultural humility in the delivery of prenatal care services
- Support quality improvement efforts to address provider bias
- Take advantage of the Children’s Health Insurance Program option to provide coverage for comprehensive prenatal care to undocumented immigrant women
- Use community health workers to provide outreach and education to women of childbearing age in underserved communities
Description of Indicator Data
NC State Center for Health Statistics, Vital Statistics
Additional Data Needed at Local Level
- Number of pregnancy care providers in the community
- Number of High-risk pregnancy care providers in the community
- Employer policies related to pregnancy care
- Number of community health care workers providing outreach and education
- Availability of public transportation to get to prenatal appointments
Why Is This Important?
Suicide rates increased 30% between 2000-2018 and declined in 2019 and 2020. Suicide is a leading cause of death in the United States, with 45,979 deaths in 2020. This is about one death every 11 minutes. The number of people who think about or attempt suicide is even higher. In 2020, an estimated 12.2 million American adults seriously thought about suicide, 3.2 million planned a suicide attempt, and 1.2 million attempted suicide. In 2020, suicide was among the top 9 leading causes of death for people ages 10-64. Suicide was the second leading cause of death for people ages 10-14 and 25-34. 2022 NC SHIP, pg. 108.
Story Behind the Curve
Some groups have higher suicide rates than others. Suicide rates vary by race/ethnicity, age, and other factors, such as where someone lives. By race/ethnicity, the groups with the highest rates were non-Hispanic American Indian/Alaska Native and non-Hispanic White populations. Other Americans with higher than average rates of suicide are veterans, people who live in rural areas, and workers in certain industries and occupations like mining and construction. Young people who identify as lesbian, gay, or bisexual have higher rates of suicidal thoughts and behavior compared to their peers who identify as heterosexual. 2022 NC SHIP, pg. 110
Partners
American Foundation for Suicide Prevention- North Carolina Chapter |
https://afsp.org/chapter/north-carolina |
Carolinas CARE Partnership |
https://www.carolinascare.org/what-we-do/mental-health/ |
Faith Connections on Mental Illness |
https://www.faithconnectionsonmentalillness.org/ |
National Alliance on Mental Illness- North Carolina Chapter |
https://naminc.org/ |
North Carolina Area Health Education Centers (NC AHEC) |
https://www.ncahec.net/about-nc-ahec/statewide-work |
North Carolina Governor’s Challenge to PreventSuicide |
https://challenge.ncgwg.org/ |
UCLA-Duke Center for Trauma-Informed Suicide,Self-Harm & Substance Abuse Treatment & Prevention ASAP Center |
https://asapnctsn.org/ |
What Works
- Continue to support the integration of physical and mental health
- Create trauma informed schools with access to mental health providers
- Expand access to tele-mental health services
- Expand Medicaid eligibility criteria to increase access to mental health services
- Implement policies targeted to decrease access to lethal means
- Improve access to social services and other supports
- Increase programs that provide mental health services and support for LGBTQ youth
- Increase programs that provide mental health services and support for veterans
- Increase state funding for mental health services provided through local mental health systems
Description of Indicator Data
NC State Center for Health Statistics, Vital Statistics
Additional Data Needed at Local Level
- Stories from survivors/families and their experiences with getting help for mental health/substance use disorders
- Enhanced death certificate review
- Inventory of all local/regional services for mental health care/substance use disorder
Why Is This Important?
Infant mortality is considered a key indicator of the overall health of the population, and both infant and maternal mortality are multifaceted problems impacted by factors such as access to care, poverty, systemic racism, and housing.
Racial disparities have long plagued the state’s infant mortality rate and many other health indicators, now including those associated with the current pandemic. And at the same time, as with COVID-19, we know how to prevent many infant deaths. Other states have prioritized addressing racial gaps in infant deaths and have moved to expand Medicaid, address the impacts of racism on birth outcomes, and implement a number of policies that improve family economic security. Here in North Carolina, it is beyond time to implement critical policy interventions that we already know will work to prevent unnecessary infant deaths. 2022 NC SHIP, pg. 112.
Story Behind the Curve
Participants in the 2021 NC SHIP Community Council Meeting and Symposia expressed the following thoughts about infant mortality:
• “It’s hard to understand the root causes.”
• “Physiological stress due to racism, adverse childhood experiences, and social determinants play a huge role.”
• “Many children who died in the first year of life had no father listed on the birth certificate.”
• “The father’s name not being on the birth certificate may be an important predictor of risk – what does it mean? Is there economic, emotional stress?”
• “There are barriers to getting the father added: access to a notary, transportation, affidavit of parentage is not easily found, cost of DNA test.”
• “Indicator rates for fertility suffer from small counts. Rates are sensitive to small counts and should be interpreted with caution. How do we navigate issues of equity if we can’t measure with small numbers?”
• “We need attorneys that understand statutes for adding father to the birth certificate.”
2022 NC SHIP, pg. 114
Partners
What Works
- Consider recommendations from the Perinatal Health Strategic Plan
- Improve access to, and use of, prenatal care, including group prenatal care and evidence-based home visiting programs
- Improve individual preconception routine medical check-ups and reproductive life planning counseling with a focus on intimate partner violence, substance use, immunizations, depression, body mass index, blood pressure, and diabetes
- Increase access to health insurance
- Reduce maternal obesity
- Reduce maternal tobacco use before, during, and after pregnancy
- Support training on health equity including implicit bias and determinants of health.
- Take advantage of the Children’s Health Insurance Program option to provide coverage for comprehensive prenatal care to undocumented immigrant women
Description of Indicator Data
NC State Center for Health Statistics, Vital Statistics
Additional Data Needed at Local Level
- Communities that participate in all aspects of the research process
- Research that leads to a better understanding of the drivers of health and well-being with attention to health equity/ health disparity issues
Why Is This Important?
Well-being is a complex, multifaceted, and multilayered concept. There are many different approaches to defining and measuring well-being, and the focus and terminology used to describe these measures vary. Concepts that fall within the category of well-being include psychological wellbeing, emotional well-being, quality of life, health-related quality of life, psychosocial functioning, thriving, flourishing, happiness, satisfaction, and others.
Life expectancy is one of those measures. It is also a proxy measure for the total health of a population. Disparities in life expectancy between populations point to where issues of health equity must be addressed. 2022 NC SHIP, pg. 116.
Story Behind the Curve
Participants in the 2021 NC SHIP Community Council Meeting and Symposia discussed the following:
• “It is difficult to focus on just a few programs because many programs/initiatives/policies impact the result we want. Life expectancy is just one measure.”
• “We should examine the way we look at this measure. Living a long time and being healthy can be quite independent of each other.”
• “We need help in figuring out how to deal with small numbers.”
• “We should consider bringing in statisticians who can assist with data modeling and impute data to get more precise estimates.”
• “We need to streamline the process of obtaining data.”
Several participants recognized this indicator as an opportunity to focus on community priorities identified by partnering agencies and organizations. Two areas of interest were brain health and radon exposure. Brain health was further linked to hearing loss and falls prevention.
2022 NC SHIP, pg. 118
Partners
American Civil Liberties Union |
https://www.aclu.org/ |
Area Agencies on Aging |
https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx |
Carolina Demography |
https://www.ncdemography.org/ |
North Carolina Coalition on Aging |
https://nccoalitiononaging.org/ |
NC DHHS Aging and Adult Services |
https://www.ncdhhs.gov/assistance/aging-and-adult-services |
North Carolina Institute For Public Health |
https://sph.unc.edu/nciph/nciph-home/ |
Southern Coalition for Social Justice |
https://southerncoalition.org/ |
What Works
- Increase access to health insurance
Description of Indicator Data
NC State Center for Health Statistics, Vital Statistics
Additional Data Needed at Local Level
- Impact of Covid-19 pandemic on life expectancy
- Continuing impact of opioid epidemic on life expectancy
- Continuing impact of infant mortality on life expectancy
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