NC Budget and Tax Center, What's Race Got To Do With It?

Racial and ethnic gaps in infant mortality have grown in North Carolina

Infant mortality data reveal longstanding economic and social disparities that exist along racial and ethnic lines — disparities that are actually getting worse in many cases. Overall infant mortality has declined from 1991 to 2016, as the number of deaths prior to age 1 per 1,000 live births in North Carolina declined from 12.2 deaths to 7.2 deaths. However, when disaggregated by race and ethnicity, the data tell a more complex story.

The infant mortality rate is declining more rapidly for white children compared to many communities of color. From 1997 to 2016, the rate declined 22 percent for white infants but only decreased by 14 percent for African-American and Black infants. Mortality among Hispanic and Latinx infants actually increased by 25 percent during the same time period.

The more rapid decrease in infant mortality for white infants has compounded disparities that already existed across groups. Deaths among Hispanic and Latinx infants have historically been closer to white infant deaths, though there has been an increase in the percentage of Hispanic and Latinx infant deaths from 1997 to 2016.

These changes equate to an increase from 2.2 to 2.68 times the number of African-American and Black infants, meaning that for each white infant that dies per thousand births, there are nearly three African-American and Black infants who die. For Hispanic and Latinx infants, these rates increased from 0.68 to 1.2 deaths for each white infant that dies per thousand births from 1997 to 2016. In addition, if the disparity gap were closed and the white infant mortality rate was reflected across all racial and ethnic groups, 238 fewer African-American and Black infants and 19 fewer Hispanic and Latinx infants would die each year.

These growing gaps in infant mortality are rooted in disparate access to economic opportunities and resources that impact health. While two leading causes of infant death in the United States are attributable to preterm births and birth defects, the underlying root causes point to social factors such as family income, access to health care and insurance, access to prenatal care, mother’s education, and experiences of discrimination and systemic racism. Addressing and eliminating racial barriers to economic opportunity is a vital step in protecting infants and giving everyone in North Carolina the chance to live full and healthy lives.

Suzy Khachaturyan is an MSW/MPH intern with the NC Budget & Tax Center.

NC Budget and Tax Center

African American infants now die at more than 2.5 times the rate of white infants in N.C.

[Note: As was explained earlier this month in a post entitled “North Carolina needs help to meet strategic health objectives by 2020,” North Carolina is at real risk of failing to meet a series of objectives identified in 2010 as part of the “Healthy NC 2020” initiative. This post is part of a summer series that is providing in-depth coverage of some of the focus areas in which we are falling short.]

In 2010, the state of North Carolina identified 13 major health focus areas and established 41 decennial health objectives and targets to meet by the year 2020. As part of the state’s ‘Healthy NC 2020’ improvement plan, the state identified Maternal and Infant Health as a focus area and developed three objectives through which to track progress.

Recently released data show that North Carolina has made some progress on two of its three maternal and infant health objectives since 2008, but has failed to make any progress in reducing the racial disparity that exists between whites and African Americans. Today, the state’s infant mortality disparity between white and African American infants is greater than it was in 2008, while the overall infant mortality rate and the percentage of women who smoke during pregnancy have reduced slightly.

In order to meet 2020 targets, North Carolina needs to do more for maternal and infant health.

Infant mortality – or the number of infant deaths before age 1 for every 1,000 live births – is widely recognized as an important indicator of a state’s overall health. This measure has long been a focus of public health work in North Carolina, and while the overall rate is improving, the worsening racial disparity between white and African American infants reflects poorly on our state. With African American infants dying at more than 2.5 times the rate of white infants, there is a great deal of work to do to address the inequities that lead to these dire outcomes.

Infant health is tightly connected to maternal health, and ensuring that women have the supports they need before and during their pregnancy is vital to making a long-lasting positive impact. As stated in this report by the North Carolina Institute of Medicine on the Healthy North Carolina 2020 Maternal and Infant Health objectives:

Maternal health is an important predictor of newborn health and well-being, and addressing women’s health is essential to improving birth outcomes. Many factors affect women’s health, including individual health behaviors, access to appropriate care, and socioeconomic factors. Focusing on the health of a woman before and during her pregnancy is essential to the reduction of poor birth outcomes such as low birthweight, pre-term birth, and infant death.”

Currently North Carolina is preparing for changes to how Medicaid services are delivered and is making plans to address social determinants of health. This transformation presents an opportunity to make a big impact by addressing inequities that lead to poor health and could lead to improvements in maternal and infant health, in addition to many other areas.

Suzy Khachaturyan is an MSW/MPH intern with the Budget & Tax Center, a project of the North Carolina Justice Center. 

immigration, NC Budget and Tax Center, Trump Administration

Too little, too late: Trump can’t fix damage already done to 2,000 children separated from families

President Trump may want people to believe he ended his devastating policy of separating children from their families at the US border, but his reversal (and subsequent back and forth confusion) doesn’t turn back the clock for those who have already been separated, and does not end the mistreatment of families seeking refuge through asylum in the United States. Trump’s order also fails to lay out a humane policy for how families and children will be treated going forward, an omission that will likely lead to even more trauma for immigrant families and ongoing legal wrangling. Most recently, 17 states including North Carolina filed a suit against the Trump administration, and, in a separate lawsuit, a U.S. district judge ordered that border authorities reunite children with their families.

Trump’s executive order is no act of heroism, but rather an insufficient response to a crisis created by his own administration’s cruel policies.

More than 2,000 children have been separated from their families at the border since the “zero tolerance” policy took effect in early May as part of the administration’s latest attack against immigrant families. Family separations drew widespread condemnation from professional groups, including the American Academy of Pediatrics, the National Academy of Sciences, the American Psychological Association, the National Association of Social Workers, and thousands of individual mental health professionals.

Health professionals point to a range of short- and long-term harms that family separation imposes on children. In the short term, serious cases of traumatic separation, reactive attachment disorder, and sustained toxic stress lead to a range of coping strategies, including aggression, withdrawal, self-harm, anxiety, depression, and sleep problems. These adverse childhood experiences (ACEs) can undermine long term health, increasing the risk of heart disease, diabetes, and substance use disorders, and inhibiting the formation of healthy relationships.

In addition to the events at the U.S.-Mexico border, families currently residing in the United States are being separated in ICE raids, most recently in Ohio, North Carolina, and Tennessee. These, too, result in families being torn apart, have a similar negative impact on children, and are issues of concern to medical professionals, teachers, social workers and more. These traumatic experiences will continue for children whose families face the daily fear of deportation, and for the thousands of children who have already been separated from their families.

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NC Budget and Tax Center, public health

Virginia votes to expand Medicaid for some. We can do better.

Last week, North Carolina’s northern neighbor, Virginia, voted to expand Medicaid coverage to 400,000 low-income residents, making it the 34th state to do so since the passage of the Affordable Care Act in 2010. If North Carolina wants to compete with our southern neighbors, as we so often hear in policy debates, now is the time for policymakers to move ahead with closing our state’s coverage gap.

They should do so for everyone, demonstrating their leadership by passing a more comprehensive coverage plan that doesn’t include red tape or exclusions.

Virginia’s state legislature voted to extend coverage to many uninsured Virginians. However, the inclusion of requirements that those eligible work a minimum number of hours each month will limit coverage for an estimated 50,000 individuals who would otherwise be eligible for coverage. It is a move that doesn’t acknowledge current labor market realities and is likely to cost the state more to implement. So-called “work requirements” create significant administrative burden for states, and will cost Virginia approximately $1.2 million in the next two years alone.

Furthermore, work requirements do not address the root causes of poverty, and they generally exacerbate the problem. Data show that almost all adult Medicaid recipients who do not work either have a disability, serve as a caretaker to family, attend school, are retired, or could not find work. These requirements hurt most enrollees, including the most vulnerable, such as children, adults with disabilities and those with substance use disorders, as enrollees wrestle with complex administrative requirements for reporting and documenting their work hours each month.

Let Virginia’s restricted expansion of health coverage be a signal for North Carolina lawmakers to enact better, evidence-based legislation that demonstrates their commitment to promote the health and well-being of all in our state.

Suzy Khachaturyan is an MSW/MPH intern with the Budget & Tax Center, a project of the North Carolina Justice Center. 

Commentary, NC Budget and Tax Center

Legislature considering changes to Medicaid that would pose a huge danger to mothers and infants

Early next week the North Carolina General Assembly is expected to release a budget that may include taking health coverage away from people who do not meet work requirements. Faced with unrealistic work hour quotas, these proposals will mean that many adults, such as new moms, will lose essential health coverage. Loss of coverage, and the decline in health that will result, will make employment and employment prospects more difficult and will push women and their families further into poverty. While it remains to be seen if CMS would approve such a harsh proposal, its potential impact would be felt throughout North Carolina.

These requirements would likely require new mothers to return to work 60 days after birth, at which time pregnancy Medicaid expires. In reality, many mothers do end up working; data show that 62% of parents on Medicaid work. Rushing new moms into the workforce is bad for infant health, and poor maternal-infant bonding is known to have lasting effects. Research shows that mothers’ early return to work has negative impacts on the duration of breastfeeding, infant vaccinations, and regular checkups, and may diminish maternal-infant bonding as a result of less time spent together and increased maternal stress. Studies show that children are more likely to receive the care they need if their parents have insurance coverage, suggesting that the health of low-income infants and children would decline as a result of work requirements for parents.

A rigid work requirement for moms and parents with low-income fails to account for the cost and difficulty of finding child care and job market realities.

And in the case of North Carolina, such a policy would create a cliff for many families where increasing work hours and income will push them into the coverage gap. For example, a single mother with two children who works 23 hours per week at minimum wage, earning only $667 per month, would be ineligible for Medicaid because their income is too high. With high-quality child care costing a median $832 per month per infant in our state in 2017, North Carolina mothers and families are already forced to make tough decisions about returning to work.

To protect maternal and child health in North Carolina, policymakers should be closing the coverage gap not pushing more people into it without the prospect of accessing the tools to live healthy and financially secure lives.

Suzy Khachaturyan is a MSW/MPH Intern with the N.C. Budget and Tax Center