Reflections on a children’s health check-up
North Carolina now ranks 9th among the states in population with 10.3 million people. Of them, 2.3 million are under 18 years old – which means that North Carolina has more children than the total population of 15 states.
A profile of the state’s children – sobering and challenging – emerges from the Child Health Report Card 2018, compiled by the North Carolina Institute of Medicine and the NC Child advocacy organization. The report serves as a powerful reminder that good health varies by family income, that schools influence children’s future health, and that healthy children do better in school.
“Children from low-income families fare worse in almost every indicator of health, including birth outcomes, access to care, health-risk behaviors and mortality,” says the report, which points out that nearly half of the state’s children live in lower-income households.
“These children are also often exposed to high levels of toxic stress, which can have an impact on cognitive development and learning, and can contribute to behavioral, social, emotional and health problems later in life. Children living in financially secure families are more likely to achieve educational success and grow to be healthy, self-sufficient adults.”
For the data assembled and A-through-F grades awarded by NC Child and NCIOM, turn to their websites here and here. Let me offer three reflections that flow out of the data:
1. Maybe, just maybe, the ripple effects of the school-safety debate, renewed by the shooting deaths of 17 people in a Parkland, FL, will lead to expanding the corps of school nurses and counselors. Some public officials apparently feel politically safer addressing “mental health’’ rather than “gun control.” This week, the Republican-majority Florida legislature approved new gun restrictions, a provision to arm and train “school marshals,’’ and funding for mental-health services.Whatever the rationale, the child-health report makes the case that North Carolina needs more trained health-related professionals in its schools – giving the state a “D’’ grade for its ratios of one nurse per 1,072 students, and one counselor per 384 students. The report says that a 2015 survey found 9.3 percent of high school students attempted suicide in the past year, and that 12.3 percent of adolescents had a “major depressive episode.”
2. The child-health report rightly points to families, homes and neighborhoods as critical components of children’s well-being. It reports 41 percent of families read daily to their toddlers, 72 percent of families eat together at least four times a week, while 14 percent of children live in high-poverty neighborhoods and 18 percent have asthma, often triggered by mold and cockroaches in their dwellings.
To address children’s needs arising from dilapidated housing and broken families requires a marshalling of the resources of civil society: not just government, but the involvement of businesses that offer jobs; nonprofits and religious organizations that organize people to provide mentoring, build houses, deliver food, and sponsor recreational activities; university scholars and think tanks that provide research; and journalists who inform a community of its conditions. The report confidently asserts that there are “many opportunities’’ for North Carolinians to identify “evidence-based solutions.”
3. Overall, nine out of 10 North Carolina children live in very good health – 97 percent of young people in middle-to-high income homes, 82 percent in low-income families. The single “A’’ awarded on the report card comes in the “insurance coverage’’ category. It reports that 95.5 percent of children have health insurance coverage – 43.5 percent by public health insurance.
“Medicaid, NC Health Choice, and the Affordable Care Act have led to gains in health insurance coverage for North Carolina,” says the child-health report. “The expansion of enrollment processes, greater outreach and increased coverage for parents have contributed to near total health insurance coverage for children in North Carolina.”
This finding offers a counterweight to the impulse to elevate individualism over civic institutions or to disparage and diminish government as inevitably mismanaged or intrusive. Creative public policymaking and budgeting can, and has, made a difference in elevating the life chances of young people.