North Carolina has struggled with some of the nation’s worst infant mortality rates for decades, and now it’s Democratic Gov. Roy Cooper’s turn to wrestle with the stubborn public health challenge.
Thirty years ago the state had plummeted to the nation’s second-worst infant mortality rate, prompting the creation of Smart Start and other government programs to reverse the trend. The state’s infant mortality rate has now improved from 12.6 deaths for every 1,000 live births to 7.2 deaths in 2016, but is still the 12th-worst rate in the country, according to the latest data available.
On Wednesday, Cooper issued an executive order, calling for an “action plan” that would set out goals on lowering infant mortality and improve related health measures by 2025.
The plan doesn’t specify what level of infant mortality would be acceptable; instead it sets a Nov. 1 deadline to issue proposals for public comment. The task of creating a road map is in the hands of the 25-member N.C. Early Childhood Advisory Council, with staff support from the N.C. Department of Health and Human Services.
“There’s some areas where we really have a lot of work to do to insure the health and wellness of our children and, frankly, the state’s prosperity,” Susan Perry-Manning, principal deputy secretary at the N.C. Department of Health and Human Services, said this week in a phone interview.
While white papers and committee reports are the standard fare of state government, will be the first attempt to create numerical targets to reduce infant mortality and the number children living in poverty, Perry-Manning said.
Whitney Tucker, research director at Raleigh nonprofit N.C. Child said the challenge largely comes down to improving the health of black children and black families. The infant mortality rate for white children is 5 deaths for every 1,000 live births, comparable to the national average. But the black infant mortality rate is 13.4 deaths, well above the national average of 11.4 deaths for every 1,000 live births.
“It’s really a black-white disparity, or a black and everyone else disparity,” Tucker said. “It’s not just whether or not we move the needle, but whether we close the gap.”
Tucker also noted that 48.2 percent of children in the state are low-income or living in poverty, a 2016 statistic referenced by Cooper’s executive order.
Broken down by race, the disparities follow a familiar pattern: About 31 percent of white children are living in households under 200 percent of the Federal Poverty Level in North Carolina. That compares to 64 percent of black children and 71 percent of Hispanic children living below the poverty level — all above the national average.
Tucker acknowledged that no report can magically erase the underlying issues that contribute to infant mortality and poor public health. Those factors include obesity, unemployment, lack of health insurance and, Tucker emphasized, structural racism that is borne out in the health metrics of black children. But she said the value of a plan, timetable and clear goals is that it can lead to measurable progress.
The action plan called into being by Cooper will cover such areas as food insecurity, low birth weight, infant mortality, foster care and family permanency, as well as early brain development, which can set the course of a person’s life, Perry-Manning said.
Early Childhood Advisory Councils have met in North Carolina since 2010, as required by federal law. They have advised governors on spending federal grants and tracked the spending and the programs they funded, including a program that sent nurses into the homes of low-income families.
This time, Perry-Manning said, the panel will create timetables and benchmarks to assess whether the state is succeeding or failing.
“We have to look together at what our targets are, and what resources — public and private — are already going into these things,” she said. “And where the needs are, and how we should prioritize our strategies and our investments.”