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Budget cuts could undermine progress in child health care, The Duke Chronicle (11.16.2011)

The state of children’s health in North Carolina is better than ever before, but state budget cuts could set this progress back.

North Carolina has made strides in children’s health care this year, according to the 2011 Child Heath Report Card, commissioned by Action for Children North Carolina and the North Carolina Institute of Medicine. The report rated the state in 13 categories measuring child health—ranging from environmental health to breast-feeding statistics. But recent budget cuts to state health care programs, as part of the state budget approved in June, might lead to their decline in the future, experts said.

Cuts to state programs, such as early intervention services, oral health care and provider rates, may have a negative effect on child health in the future, said Laila Bell, director of research and data at Action for Children North Carolina. These budget cuts—particularly to early intervention programs—will cost more to society in the long run, Bell said. Trimming spending now will raise the cost of treating illnesses in the future.

“If [children] are not treated early, they will lose opportunities in terms of academics, achievements and educational outcomes,” she said. “We know in the long run, when there are less resources available, it’s the children that end up suffering.”

Budget cuts to child health care will invariably cause a decline to child health, said Elizabeth Vigdor, research scholar at the Center for Health Policy. She added that historically, state-funded health care programs increase health and school performance for children—particularly for those who come from low-income families.

“When cuts are made to these programs, health outcomes decline,” Vigdor said. “However, it’ll ultimately depend on which specific services are cut.”

The 2011-2012 state budget includes a 20 percent cut, which equals $37.6 million, to Smart Start funding. Smart Start is North Carolina’s chief early intervention children’s care, health and education program.

Although the full effects of the budget cuts are yet to be seen, a wide variety of organizations have been lobbying hard against the decline in funding, Vigdor noted.

“We have been stressing the importance of maintaining healthy and safe children to our state leaders,” Bell said. “The important thing is that we do not want to turn back the clock on these important gains.”

But child health leaders in the community are pleased with the success of child health care this year. North Carolina received “A” grades in the categories of early intervention, environmental health and incidence of communicable disease among children, according to the report, which compares data from 2008-2010 to data from the last five years.

The most significant improvement this year was in infant mortality, which decreased to seven deaths per 1,000 live births, a record low for the state, said Berkeley Yorkery, project director at the North Carolina Institute of Medicine.

“We are especially happy to see this decrease in infant mortality,” Yorkery said. “For years, we’ve been in the bottom 10 states for infant deaths, but these recent numbers are getting toward the national average.”

Another notable improvement is in environmental health. Since 2005, more children are being screen for elevated blood lead levels—about a 10 percent increase in children tested and a .5 percent decrease in children found with elevated levels of lead in their blood. In addition, the incidence of asthma among children has decreased to 16.8 percent from 17.8 percent since 2005, according to the report.

“In terms of environmental health, we are definitely moving in the right direction,” Bell said. “For example, the Community Care for North Carolina program has improved the early diagnosis of asthma and provided children with primary and preventive care.”

Despite these advances in child health, there is still need for improvement. North Carolina received a “D” grade in the category of alcohol, tobacco and substance abuse among high school students. A notable trend is the increase in adolescents taking prescription drugs illegally—a statistic that has grown from 17.1 percent to 20.5 percent within four years, Yorkery said.

“Prescription drugs is becoming a major issue among parents and legislators,” Yorkery said. “Students have reported to taking a range of prescription drugs, such as OxyContin, Vicodin, Adderall and Ritalin.”

North Carolina also received a “C” in the breast-feeding category. Since 2003, the percent of infants to be breast-fed has decreased from 71.7 to 67.3 percent since 2003.

“This decrease in breast-feeding was surprising to us,” Yorkery said. “Many N.C. hospitals are now engaged in efforts to increase breast-feeding by developing specific hospital practices. There is definitely still a lot of room to improve.”

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