NC Budget and Tax Center

North Carolina’s budget and policy choices can improve health

Deeper and smarter investments in education, infrastructure, economic security, housing, and other areas can eliminate barriers to good health for low-income residents and communities of color, according to a new report from the Center on Budget and Policy Priorities (CBPP).

In addition to these and other public investments, North Carolina can remove obstacles to better health by:

  • Improving access to affordable health care, including by expanding Medicaid under the Affordable Care Act (ACA);
  • Leveraging Medicaid to improve access to other economic and social programs known to improve health, like case management and supportive housing;
  • Enacting social and economic policies known to improve health, like creating and expanding paid leave programs and raising minimum wages; and
  • Improving state and local tax systems by basing them on a taxpayer’s ability to pay and ensuring they raise enough revenue to maintain the quality of the places in which residents live, work, learn, and play.

Social, economic, environmental, and behavioral factors account for 80 percent of an individual’s health; health care access and quality are responsible for just 20 percent.

Opportunities to be healthy are not available to all North Carolinians. Where there is greater income and wealth inequality, there are also greater disparities in health. Income and wealth inequality and a history of structural racism have erected barriers to health for low-income residents as well as communities of color:

  • Black North Carolinians die more than three years earlier than white residents, on average.
  • Black babies born in North Carolina are nearly twice as likely as white babies to be born with low birthweight.
  • Black babies are also more than twice as likely as white babies to die before their first birthdays.

Generating revenue that will allow for investments in programs that help to ameliorate these deep disparities has been more difficult in North Carolina, due to changes to the state’s tax code starting in 2013. Findings from the CBPP report support the need for increased investments, including those strategies described above, in order to equip all North Carolinians with opportunities to be healthy.

Suzy Khachaturyan is a Fiscal Analyst with the Budget & Tax Center. 

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