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'It’s not just health care': New state health improvement plan aims to promote health equity


The North Carolina Department of Health and Human Services Dorothea Dix campus, located in Raleigh, is pictured on Aug. 26, 2022.

The North Carolina Department of Health and Human Services released its 2022 State Health Improvement Plan (NC SHIP) in late August, which explains strategies to improve key indicators of health identified by the Healthy North Carolina 2030 report. 

The health improvement plan is meant as a "companion document" to Healthy North Carolina 2030, which utilizes a population health model in order to address "drivers" that impact health outcomes. 

These drivers include social and economic factors, physical environment, health behaviors and clinical care factors. In the Healthy North Carolina 2030 report, specific health indicators are described within each major factor.

NC SHIP also advances the NCDHHS 2021-2023 Strategic Plan and its objective to promote health equity.

According to Dr. Elizabeth Tilson, state health director and chief medical officer for NCDHHS, about 80 percent of factors that impact health are outside the realm of medical care. She said that determinants such as food security, poverty and housing instability are central drivers of health.

She said these factors outside of medical care must be addressed by many stakeholders. 

“It’s not just health care,” Tilson said. “It’s law enforcement, it’s business. The State Health Improvement Plan is really a framework that we can have many stakeholders, all involved, all collaborating on this common set of objectives.”

One of the indicators mentioned in NC SHIP is the incarceration rate in North Carolina. According to the plan, incarcerated individuals with mental illnesses and substance use disorders face challenges obtaining treatment, and incarceration can often exacerbate symptoms.

“We owe it to our community members who are incarcerated to get quality treatment and get stabilized while they are there,” Caitlin Fenhagen, criminal justice resource director for Orange County, said. “So that when they come out they have the opportunities to go back to their families healthy, and find employment, find housing and all the things that significant behavioral health issues can be a barrier to doing so."

NC SHIP outlines proposed policy initiatives for each health indicator. For the incarceration rate indicator, this includes ensuring access to behavioral and medical health care and stable housing for those returning from incarceration.

Fenhagen said that improving access to housing and transportation is crucial to decreasing the number of people in detention facilities.

“I think if we really want to serve everyone equitably, we have to do that multidisciplinary approach,” she said.

Another indicator mentioned in NC SHIP is third-grade reading proficiency.

According to the plan, the percentage of children who are proficient in reading at the end of third grade in North Carolina decreased between the 2018-2019 and 2020-2021 school years.

Tania Cruse, a third-grade teacher at Seawell Elementary School said that many of the effects of the COVID-19 pandemic on student learning couldn’t be seen until the 2020-21 school year.

“The homeschooling part kind of changed everything a little bit," she said. "It changed how instruction was delivered to the students."

According to NC SHIP, students with lower reading proficiency are more likely to not complete high school, get lower-paying jobs that “limit access to healthcare” and are at a higher risk for harmful health outcomes. 

Cruse added that third-grade reading sets up the foundation for what kind of reader a student is. 

“Of course, along the way you want to teach them to learn how to enjoy reading as a lifelong skill,” Cruse said. 

Tilson said the multidisciplinary approach of NC SHIP allows healthcare providers to intersect with education, law enforcement, housing and food service providers in a holistic way, without any one party feeling overwhelmed. 

She said the goals represented in the plan are overarching goals for the state, not just the NCDHHS.

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Lucy Marques

Lucy Marques is a 2023-24 assistant city & state editor at The Daily Tar Heel. She was previously a city & state senior writer. Lucy is a junior pursuing a double major in political science and Hispanic literatures and cultures.