Press Release: North Carolina Sees an Increase in Failing Grades for Kids’ Health in 2021

Biannual Child Health Report Card reviews 15 key indicators of children’s health

By: Fawn Pattison | February 2021

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Vikki Crouse, NC Child KIDSCOUNT Project Director & Policy Analyst: 919-726-6531
James Coleman, Research Specialist, NC Institute of Medicine: 919-780-7346 

RALEIGH — On February 16th, NC Child and the NC Institute of Medicine release the 2021 Child Health Report Card. Since 1997, this biannual report has presented 15 key indicators of child health. In 2021, North Carolina earned failing grades in several key areas, including Mental Health, Substance Use, Birth Outcomes, and Housing & Economic Security. The data sources for this release pre-date the current pandemic and associated economic downturn. However, the report card also highlights current data snapshots pertinent to children’s health, and the impact of the pandemic on children and families.

View the 2021 Child Health Report card at  

“Even before the pandemic struck, we had a long way to go to improve health outcomes for North Carolina’s children – especially some of our biggest challenges, like ensuring healthy births for families of all races and economic means,” said Kathy Colville, President and CEO of the NC Institute of Medicine. “We know our state has made great strides in areas such as children’s health insurance coverage and childhood immunizations. We want to apply the successful approaches in those areas to the other health issues facing our kids and families.” 

“Children have the best chance of thriving and living full lives when they have access to physical and mental health care, education, adequate nourishment, safe housing, and high-quality child care,” said Michelle Hughes, executive director of NC Child. “Our state’s leaders have a responsibility to make wise policy choices that support children and families at all times – and especially in times of crisis.” 

It’s not all bad news: The report card gives the state high marks for children’s health coverage. Overall, child health coverage gets an “A” in North Carolina – but the rates of child and parent coverage are declining. Those losses are expected to accelerate during the pandemic as many parents lose employer-sponsored health insurance. Health care coverage is critical for ensuring that children receive preventive care such as immunizations, well child visits, and dental cleanings. Latinx children are most likely to be without health coverage in North Carolina – and their families are among those who have been hit hardest by the pandemic.  

Falling Grades

Several grades have fallen since the previous Child Health Report Card was released in 2019:

  • Breastfeeding fell from a “B” to a “C”
  • Birth Outcomes – including infant mortality – fell from a “D” to an “F”
  • Substance Use fell from a “D” to an “F,” driven by the massive increase in youth vaping
  • Mental health fell from a “D” to an “F,” with youth suicide attempts continuing to climb, even pre-pandemic. 

North Carolina also received an “F” score for Housing & Economic Security. A family’s economic and housing stability are important drivers of health outcomes that have worsened for many families during the recent economic downturn. Even before the pandemic, almost half of North Carolina’s kids lived in poor or low-income households (defined as less than 200% of the federal poverty level). In 2019, 26% of children lived in households spending over 30% of income on housing costs.

Summary of Grades

Below is a summary of grades in this year’s report: 

  • A – Insurance Coverage
  • B – Environmental Health; Health Services Utilization & Immunization; Teen Births
  • C – Breastfeeding; Education; Oral Health; Preconception and Maternal Health & Support;
  • D – Child Abuse and Neglect; Healthy Eating and Active Living; School Health
  • F – Birth Outcomes; Tobacco, Alcohol, and Substance Use; Mental Health; Housing and Economic Security

Opportunities to Strengthen Children’s Health

As the state legislature convenes for the 2021 “long session,” policy-makers have several opportunities to address some critical points for children’s health in North Carolina highlighted in the Report Card. 

Strengthening health coverage as a crucial part of North Carolina’s public health response to COVID-19. Expanding access to affordable health coverage – for adults and children alike – is important to children’s physical, mental, and emotional health. When parents are insured, they are better able to stay healthy and care for their children. Likewise, their children are more likely to have health insurance and to use it. Hundreds of thousands of North Carolina caregivers have lost the health coverage they previously received through their employers. Without health insurance, it can be nearly impossible for parents and caregivers to get health care when they need it. Affordable health coverage has also been proven to be an important bulwark against economic hardship for families.  

Preventing long-term harm to kids by investing in the programs that are proven to insulate families against the harmful effects of poverty. Programs such as Medicaid, SNAP, WIC, and high-quality early childhood education are proven to boost school success and help keep kids healthy throughout their lives.

Expanding access to broadband internet. State legislators have an opportunity to get broadband internet to the estimated 200,000 homes with students in North Carolina that still have no internet access at home. Currently, these families don’t have the wi-fi access they need for their kids to attend class remotely. Without high-speed internet, families often cannot use telehealth services, search & apply for jobs, or apply for vital benefits like Medicaid or SNAP, particularly during the pandemic.

Read the full Child Health Report Card and recommendations, and find downloadable infographics, at



About the North Carolina Institute of Medicine

The North Carolina Institute of Medicine (NCIOM) is an independent, quasi-state agency that was chartered by the North Carolina General Assembly in 1983 to provide balanced, nonpartisan information on issues of relevance to the health of North Carolina’s population. Visit for more information.

About NC Child

NC Child builds a strong North Carolina by advancing public policies to ensure all children – regardless of race, ethnicity, or place of birth – have the opportunity to achieve their full potential. Visit for more information.