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

Report: North Carolina’s latest state budget fails to effectively address N.C.’s existing and emerging needs

The NC Budget & Tax Center has released a report explaining the 2019 state budget that was passed this year by the state legislature and begins by pointing out North Carolina lawmakers approved a state budget “that falls short of helping all North Carolinians live healthy, prosperous lives.”

The report explains that the new $23.9 billion budget does not promote a long-term vision for an inclusive state, as it continues to under-invest in areas of great public need and doesn’t take into account upcoming federal budget cuts.

According to the report:

“The final budget that lawmakers enacted continues to limit a collective commitment to North Carolina, increasing spending by $881.7 million over 2018. To put that figure in perspective, this means that the final budget is just 1 percent above pre-Recession levels, despite the state’s population growth over that same period of 11 percent.”

The latest NC Budget & Tax Center report points out, among other things:

  • Total state spending for fiscal year 2019 marks 10 consecutive years that state spending has declined as a share of the state’s economy
  • Lawmakers left $561 million unappropriated
  • The legislature’s decision to leave in place tax choices from 2017 means roughly $3.5 billion less in revenue each year to fund community and voter priorities like protecting children from abuse, building healthy schools, serving seniors meals, protecting our water and air, and training the future workforce
  • Over two-thirds (71 percent) of new investments in the 2019 fiscal year budget are made up of ‘one-time’ funds, or non-recurring money

The report also explains that Governor Cooper and the legislature offered different visions for North Carolina in their 2019 budgets and provides a visual recap of their different tax and spending choices. Moreover, the report compares current funding to 2008 levels in various critical areas and answers relevant questions such as:

  • What percentage of the state budget goes to each core area (e.g., education, health & human services, public safety)?
  • Which agencies received the most one-time funding?
  • How much more would NC’s public schools need to receive to be funded at the same percentage as in 1970?
  • How much, on average, have Civil and Criminal Court costs & fees increased since 2008?

To find out the answers to these questions and see more graphs that explain our state’s 2019 budget you can access the latest NC Budget & Tax Center report here.

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center

Many North Carolinians continue to struggle to afford enough food, especially in households with children

“Food hardship is a serious national problem that requires a serious national response,” says the Food Research and Action Center (FRAC). Each year FRAC publishes a report on food hardship in America. Food hardship occurs when a household did not have enough money to buy food that they or their family needed over the past 12 months. Though the economy has continued to recover from the Great Recession, many states — including North Carolina – have struggled to create an inclusive economy. The shortage of high quality, high paying jobs, stagnant wages, and disinvestment in public programs that ensure households can access basic needs have contributed to the high food hardship rate in North Carolina.

In 2016-17, North Carolina was ranked 17th out of the 20 states in America with the worst food hardship rate. The combined food hardship rate for families with and without children was 16.4 percent— 1 in 6 households were unable to afford enough food at least one point in time during 2016-2017.  Households without children faced a slightly lower food hardship rate of 15.3 percent. Meanwhile, the food hardship rate for households with children was more than 3 percent higher — 18.6 percent — than households without children. Nearly 1 in 5 households with children in North Carolina struggled to afford enough food during 2016-2017, meaning that caretakers may have forgone eating to ensure that their children ate, or that the family lacked food all together.

At the local level, Greensboro-High Point was one of the 20 Metropolitan Statistical Areas (MSA) in the state with the highest food hardship rate, at 19.2 percent. Families with children in Winston-Salem had the 7th highest food hardship rate, out of the 20 MSAs with the worst food hardship rates for households with children.

The food hardship rates in North Carolina reflect state policies that fail to ensure all North Carolinians can access basic human needs. “The cost — in terms of damage to health, education, early childhood development, and productivity — is too high.” State leaders must take steps to ensure that all residents don’t have to make the choice between going hungry and paying for other basic needs by passing policies that reduce hunger and poverty:

  • Increasing full time employment for well-paying jobs,
  • expanding childcare and work supports for working parents,
  • increase the minimum wage,
  • and strengthen nutrition programs, among other proactive policies to lift struggling households.

Melissa Roark is an MPP Intern with the Budget and Tax Center, a project of the NC Justice 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. 

NC Budget and Tax Center, public health

Medicaid and Medicare mark 53rd anniversary by continuing to serve millions of North Carolinians today

Medicaid and Medicare were signed into law on July 30, 1965 – exactly 53 years ago this week.

President Lyndon Johnson signs the Medicare and Medicaid Bill (July 30, 1965). LBJ Library photo

Since these programs were created, they have given millions of people access to a doctor so they can maintain their health. Over the long-term, these programs have provided significant returns on investment, such as benefiting children into adulthood by lowering disability rates and increasing their earning income potential. Today, these two healthcare programs are worth celebrating and expanding even further as they continue to serve millions of Americans and North Carolinians each day.

In North Carolina, 2.3 million people receive comprehensive, affordable health coverage through Medicaid. Medicaid provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. Meanwhile, 1.8 million North Carolinians (18 percent of the population) are served by Medicare, which serves people over 65, younger people with disabilities, and dialysis patients.

At a time when some lawmakers in Congress and in our state’s General Assembly minimize the value of these critical healthcare programs and limit their potential, it is important to celebrate the 53rd anniversary of Medicaid and Medicare and recognize that their continued evolvement have helped transform the lives of millions of people in positive ways. In recognition of their 53rd anniversary, here are five facts and three charts that provide a quick glimpse into their reach, structure and impact.

Fact 1: North Carolina’s health insurance gap coverage gap needs to be closed: In 2016, North Carolina had the 9th-highest uninsured rate (16.2%) in the nation for ages 18-64. This is above the national average of 12.4 percent.

Fact 2: North Carolina’s legislature has rejected Medicaid expansion since 2013: If North Carolina expands Medicaid, over 600,000 more people in the state would receive healthcare coverage and $4 billion would be added to our state’s economy annually.

Fact 3: Medicaid is funded jointly by the federal government and the states: In North Carolina, the federal government pays for 66 percent of Medicaid’s costs, and the state pays the remaining 34 percent, resulting in a 2:1 federal “match.”

Fact 4: The Medicaid system is efficient: For every dollar spent on Medicaid, 94 cents is spent directly on health services. Furthermore, Medicaid’s costs increased at about one-fourth the rate of private insurance since 2007.

Fact 5: Women comprise 55 percent of Medicare beneficiaries in North Carolina: The average age of a Medicare beneficiary in our state is 71. In 2016, 1.5 million seniors and 321,600 people with disabilities in North Carolina were Medicare beneficiaries.

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.