The eighteenth annual North Carolina Child Health Report Card, recently published by Action for Children North Carolina and the North Carolina Institute of Medicine, is a compilation of important indicators of child health and safety in our state over the past five years. This year it is something in addition: it reminds us of the progress (or lack thereof) made under an outgoing administration, and sets the bar for the incoming administration.
This is not to say that the health status of children relies solely on government, for this awesome responsibility falls on all of us: executive agency and legislative leaders, parents, churches, advocates and the media. However, with its influence on the use of resources and its bully pulpit stature, each administration has an opportunity to set the tone for improvement in the lives of our children.
The 2012 Report Card includes several important messages:
1. Over and over again, research shows that family income is highly correlated with child health. With child poverty rates now exceeding 25%, child health is placed in jeopardy. Both jobs advocates and child advocates need to remember that an improved economy also means healthier children. In a dire economy, government plays a critical role not only by fostering job creation, but also in reducing stress at the lower rungs of the economic ladder by fostering solid unemployment insurance benefits as well as earned income tax credits.
2. The Report Card also shows that government can make a difference. More children in North Carolina now have access to health insurance despite the loss of jobs as well as the loss of job-related health insurance. However, the Perdue administration and the General Assembly joined to make public insurance programs – Medicaid and Health Choice – available for all children (as well as pregnant women) in low-income families. Insurance coverage helps assure access to preventive, primary and critical specialized care. Thus, even in an economic downturn, the Report Card shows improvements in infant mortality, dental health, care for asthma (the leading chronic illness in children), and lead poisoning prevention.
The McCrory administration and the new General Assembly have the challenge to continue this progress, which will include the best possible implementation of the national Affordable Care Act in our state. Done well, including an expansion of Medicaid and the establishment of an effective insurance market exchange, this could help assure improved child health in the years to come. This in itself is an awesome responsibility.
3. Education is also an important correlate of child health, so the news that the four-year high school graduation rate has improved to its highest rate ever (just over 80%) also bodes well for child health. Once again, this was a clear goal of the Perdue administration, the General Assembly and the State Board of Education. In the face of such success, combined with improvements in end-of –year test scores, the McCrory administration and the next General Assembly will be challenged to define how “education reform”, a theme of the recent campaign, will continue the progress of recent years.
4. It is important to recognize that child health outcomes tend to lag behind changes in investments. In the past two years, there have been enormous reductions in programs and services affecting children. Given past history, we would expect the negative effects on child health to become evident in the next two to three years. Thus, the McCrory administration begins at a great disadvantage, and will need to focus on strategic changes to mitigate the expected negative outcomes.
5. In the budget process of the last session of the General Assembly, a priority was placed on “direct service” over education. This is a fallacy that the McCrory administration and child advocates musk debunk. For example, the wonderful decline in the teen pregnancy rate is due not only to the availability of contraceptives, but primarily to enhanced health education in the schools regarding responsible behaviors. And prenatal care can effectively reduce infant mortality only when the problems of smoking, alcohol use, and obesity have been overcome, all of which can only be addressed by education.
Finally, the Perdue administration should be recognized for its role in improving child health during an awful economic period. One challenge it did not meet, which now falls to the McCrory administration, is the translation of business success into the improved welfare of children. On virtually every survey of a “business-friendly” environment, North Carolina ranks in the top five states nationally. In virtually all surveys of the welfare of children we rank between thirty and forty. Somehow, something is getting lost in the translation between successful businesses and successful families. Evening up this equation would be a legacy that any administration would be proud of.