Healthy North Carolina 2030 Scorecard

Why Is This Important?

Low income is a strong predictor of health disparities and instances of disease. Poverty is linked to restricted access to resources and opportunities for healthy living conditions. HNC 2030, p. 36

Story Behind the Curve

North Carolina ranks 39th in the nation for percentage of individuals below 200% Federal Poverty Level (FPL). The 5-year average percent of individuals below 200% FPL was 37% from 2013-2017 compared to 33% nationally. The 2019 200% FPL for individuals was $24,980. Ethnic and racial minorities are disproportionately affected by poverty with 52% of American Indians, 51% of African Americans, and 64% of Hispanic North Carolinians living below 200% of the FPL, compared to 31% of the white population. Over the past decade the percent of individuals below 200% FPL has been slowly decreasing across North Carolina. Current goals align with statewide 10-year targets to decrease the percent of individuals living below 200% FPL to 27% or to increase the rate of decline. HNC 2030 pp. 36-37

Partners

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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. HNC 2030, p. 38

Story Behind the Curve

The 5-year average for the unemployment rate for 2013- 2017 is at 7.2% for the state of North Carolina. Current unemployment rates among racial and ethnic groups are 11.7% for African Americans, 10.3% for American Indians, and 7.1% for the Hispanic population, compared to 5.7% for the white population. Unemployment is twice as prevalent in rural areas than in metropolitan areas (disproportionately affecting African Americans), and people who have been incarcerated have reduced access to employment opportunities that provide sufficient income. Unemployment and loss of income leads to loss of health insurance for 56% of the population. The 10- year goal is to decrease the unemployment disparity ratio found between the white population and other racial and ethnic groups. Current efforts are focused on initiating meaningful change at the state and county levels. HNC 2030 pp. 38-39

Partners

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. HNC 2030, p. 42

Story Behind the Curve

Across North Carolina exclusionary discipline (suspension and expulsion) is disproportionately higher for students belonging to racial and ethnic minorities than for white students. Although nearly half of the NC student population is white, it was found that for every 10 African American students there were on average 3 short-term suspensions compared to less than 1 short-term suspension for every 10 white and Hispanic students. African American and American Indian girls were more likely to be suspended than their white counterparts. Clear racial disparity exists for targets of exclusionary discipline despite studies showing that no inherent difference in student behavior can be attributed to race or ethnicity. Students in special education programs account for 24% and boys represent nearly 66% of all suspensions. Current 2030 goals are to reach a rate of 0.80 suspensions for every 10 students (the approximate rate for white and Hispanic students). Meeting this goal is largely dependent on eliminating the targeting of minority students. HNC 2030 pp. 42-43

Partners

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?

Communities with high rates of incarceration experience damaged social networks and family ties, reduced life expectancy, have greater instances of adverse health outcomes. HNC 2030, p. 44

Story Behind the Curve

North Carolina has the 21st lowest incarceration rate among US states with a rate of 341 people incarcerated in prison per 100,00 people in the population. Mental illness affects 17% of inmates in North Carolina. African Americans account for only 22% of the state population, yet make up 52% of the total incarcerated population. African Americans are 6.5 times more likely to be incarcerated for drug-related offenses although drug use among African Americans is lower than other racial and ethnic groups. Rates of trafficking are similar. Explicit targeting of people of color by law enforcement and harsher sentencing leads to jail and prison time. The 2030 state goal is to decrease the incarceration rate to 150 people incarcerated per 100,000 in the population or increase the rate of decline. Reducing the disproportionate incarceration of African Americans and American Indians will largely affect the success in meeting this goal. HNC 2030 pp. 44-45

Partners

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?

Children’s experiences of adversity and trauma can have lifelong impact by increasing the risk of poor physical and mental health during growth and increasing their health-related challenges in adulthood. HNC 2030, p. 46

Story Behind the Curve

North Carolina is ranked 32nd among US states for the number of children with two or more Adverse Childhood Experiences (ACEs) and is ranked 1st for the lowest percent of children with 2+ ACEs at 23.6% of children ages 0-17 (2016-17). In NC 18% of children ages 0-5 have experienced 2+ ACEs. A child’s living arrangements, household income level, care needs, and race and ethnicity can all effect the risk of ACEs. The statewide goal is to decrease the percentage of children with 2+ ACEs to 18.0% by 2030. Current work involves increasing trauma-informed practices and programs that support families and children to decrease their exposure to trauma and overcome the impact of ACEs. HNC 2030 pp. 46-47

Partners

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. HNC 2030, p. 48

Story Behind the Curve

The third grade reading proficiency rate in North Carolina for the 2018-19 school year was 56.8%. This amounts to 53,000 students not meeting third grade reading requirements each year. Performance by school district varied greatly. Twenty-three percent of children with disabilities, 27.7% of English learners, 32.8% of students experiencing homelessness, and 40% of economically disadvantaged students and children in foster care were proficient in reading. From 2018-2019, only 40% of African American, American Indian, and Hispanic third graders were meeting proficiency requirements compared to 70% of white students and 76% of Asian students. The current goal is to accomplish 80% third grade reading proficiency by 2030. Achieving this goal is largely dependent upon eliminating disparities in proficiency rates for African American, Hispanic, and American Indian students. HNC 2030 pp. 48-49

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?

Communities that provide spaces for physical activity have healthier people with less risk of chronic health conditions, poor cardiovascular health, and premature mortality. HNC 2030, p. 54

Story Behind the Curve

In 2019, 74% of the North Carolina population lived within half a mile from a park in any area, one mile from a recreational center in a metropolitan area, or three miles from a recreational center in a rural area. Among counties, the range was 6-100% among US states for percent of population with access to exercise opportunities. Low income communities, people of color, people with physical disabilities, and people living in rural areas have less access to recreational facilities and parks compared to affluent, white, and metropolitan communities. Statewide goals are to increase access to opportunities for physical activity to 92% of the population. HNC 2030 p. 54

Partners

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

County Health Ranking Map

Access to exercise opportunities

Percentage of population with adequate access to locations for physical activity.

The 2020 County Health Rankings used data from 2010 & 2019 for this measure.

CHR Link to County Level Data

Why Is This Important?

Good nutrition is essential for mental and physical health. Limited access to healthy food has been linked to obesity, cardiovascular conditions, nutritional deficiencies, and other preventable causes of disease and death. HNC 2030, p. 56

Story Behind the Curve

In North Carolina, 7% of people with low-income live more than one mile away from a grocery store in metropolitan areas or more than 10 miles away from a grocery store in rural areas (2015) making North Carolina ranked 26th among US states with limited access to healthy foods. More than 500,000 residents live in one of the 340+ “food deserts” or areas with limited access to healthy foods. Race and income level affect likelihood of living in a food desert and the grocery stores in those communities often have fewer options or higher prices for healthier foods compared to stores in wealthier areas. The current percent of the population with limited access to healthy food has remained steady at 7% for the last five years. The state goal is to reduce this to 5% within the next 10 years. HNC 2030 pp. 56-57

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

County Health Ranking Map

Limited access to healthy foods

Percentage of population who are low-income and do not live close to a grocery store.

The 2020 County Health Rankings used data from 2015 for this measure.

CHR Link to County Level Data

Why Is This Important?

Housing Quality is important for overall well-being affecting physical and mental health. Poor housing can increase risk of respiratory infections, psychological stressors, and other chronic conditions. HNC 2030, p. 58

Story Behind the Curve

With 16.1% of the population facing severe housing problems (2011-2016), North Carolina ranks at 28th among US states. One in six households in the state faces severe housing problems.4 This breaks down to 14,000 overcrowded households, 18,000 households with incomplete plumbing, 24,000 households with insufficient kitchen facilities, and severe cost burden affecting 500,000 households.4,5 Geographic location, race and ethnicity, education level, and income level are all factors in determining likelihood for facing severe housing problems. People who rent their home face higher costs and lack the ability to improve their housing conditions. Only 43.9% of African American residents and 43% of Hispanic residents live in a home they own compared to 71.2% of white residents. The goal for 2030 is to reduce the percent of the population with severe housing problems to 14%. HNC 2030 pp. 58-60

Partners

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

County Health Ranking Map

Severe housing problems

Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen facilities, or lack of plumbing facilities.

The 2020 County Health Rankings used data from 2012-2016 for this measure.

CHR Link to County Level Data

Why Is This Important?

Drug overdose is the leading cause of death due to injury in the United States. Drug use affects relationships, employment, physical and mental health, and contributes to the spread of diseases. HNC 2030, p. 66

Story Behind the Curve

Substance use disorders (SUDs) are chronic or recurrent conditions that, like other chronic illnesses, require ongoing care and treatment for individuals to regain health and maintain recovery. As with any chronic disease, prevention, identification, treatment, and recovery services and supports are essential to ensuring positive health outcomes. Effective treatments for SUDs and underlying mental and physical health problems exist; however, access to services and supports for SUDs varies greatly across the state. HNC 2030 pp. 66-67

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?

Far too many of the most vulnerable North Carolinians have suffered for too long from products that have been protected from regulation, yet are designed to addict, are promoted to young people, and are deadly. Until everyone is protected from addiction and exposure, we must keep working toward fairness and value-based services.

Story Behind the Curve

As of 2019, 27.3% of high school students in North Carolina report tobacco use, and 22.9% of adults report tobacco use. One of every five deaths in North Carolina is associated with cigarette smoking and for each death, 30 more people are sick or live with a disability. Cigarette smoking has declined for both youth and adults while electronic cigarette smoking and use of other tobacco products are increasing. Low income, low educational attainment, mental illness, and unemployment increase likelihood of tobacco use. LGBTQ individuals and people in rural communities are also more likely to smoke. American Indians have a higher prevalence of smoking, while African American tobacco users die from tobacco-related causes at higher rates. Goals for 2030 are to reduce youth tobacco use to 9.0% and adult use to 15.0%. HNC 2030 pp. 68-69

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 consumption is the third leading cause of preventable deaths in North Carolina. Excessive alcohol use causes poor health outcomes and has social and economic repercussions. HNC 2030, p. 70

Story Behind the Curve

In 2018, 16.9% of adults in North Carolina reported binge or heavy drinking. This placed North Carolina at 14th among US states. Men are twice as likely to report excessive drinking and it is most reported for adults 18-44, whites, Hispanics, and multiracial individuals. Individuals with higher income ($75,000+ annually) reported excessive drinking at 23% compared to 17.7% for lower income individuals ($25,000-$49,999 annually). Although the percentage of excessive drinking has been slowly increasing, the goal is to reduce this indicator to 12.0% over the next 10 years. Prioritizing reducing excessive drinking reported by men will help to reach this goal. HNC 2030 pp. 70-71

Partners

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 beverage consumption is the leading source of calories and added sugar in the American diet and is directly linked to greater instances of chronic nutrition-related conditions, heart disease, and dental problems. HNC 2030, p. 72

Story Behind the Curve

In 2017, 33.6% of high school students and 34.2% of adults in North Carolina reported consumption of one or more sugar sweetened beverages (SSBs) per day. Men, individuals in low-income households, individuals with low levels of educational attainment, and individuals that have parents with low levels of educational attainment report higher SSB consumption. Perception of tap water and targeted marketing to youth of color and low-income populations contribute to differences in SSB consumption across racial groups. The goal for the next 10 years is to decrease youth consumption of SSBs to from 33.6% to 17% and decrease adult consumption from 34.2 % to 20.0%. HNC 2030 pp. 72-73

Partners

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. HNC 2030, p. 76, revised

Story Behind the Curve

The North Carolina HIV diagnosis rate was 13.9 per 100,000 people in 2018. Significant racial and gender disparities exist, including higher rates of diagnosis within communities of color. For African American men and women, HIV diagnosis was 68.7 cases per 100,000 and 15.9 cases per 100,000, respectively. Hispanics were diagnosed at a rate of 17.7 cases per 100,000 people. The white population was diagnosed at only 4.9 cases per 100,000 people. HIV diagnosis is significantly higher among men who have sex with men and large disparities exist between African American, Hispanic, and white men within this group as well. Men who have sex with other men are 155 times more likely to contract HIV than men who have sex only with women. People with lower income, who lack health insurance, sex workers, and incarcerated individuals have higher rates of diagnosis and lack resources for prevention and treatment of HIV. The 2030 goals for this indicator are to reduce the rate of diagnosis to 6.0 cases per 100,000 people and reduce racial/ethnic disparities. HNC 2030 pp. 76-77, revised

Partners

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