Population health examines the health outcomes of groups and the disparities in health among subgroups. This issue of the NCMJ illustrates population health efforts in the areas of obesity prevention, tobacco cessation, and clean water. Articles in this issue also discuss community health needs assessments, integrated health improvement, social determinants of health, and the Healthy North Carolina 2020 program.
Healthy North Carolina 2020: Are We Making Progress Toward Our Objectives?
Healthy North Carolina 2020, the state’s health improvement plan, consists of 40 health-related objectives that the state is working to achieve during the current decade. In 2010 a group of subject matter experts established an aspirational yet achievable target for each objective . Since the Healthy North Carolina 2020 objectives and targets were published early in 2011, quarterly updates focusing on specific sets of objectives  and annual data reports have been published. This article consolidates information from several recent annual data reports [3-5] in order to show trends in the data.
One challenging aspect of tracking health measures over time is that data collection sources and methodologies may change. For example, the Behavioral Risk Factor Surveillance System, which is used to measure progress on several Healthy North Carolina 2020 objectives, changed its methodology in 2011 by adding cell phone numbers and by adopting an improved weighting method. Therefore the results of the surveys conducted in 2011 or more recent years are not comparable with results from previous years . In cases where the data source or data collection methodology has changed, objectives are being reviewed to determine whether updates to the targets are needed. Those potential changes have not yet been finalized, however, so this article considers only the 25 objectives for which consistent annual data are available.
To prepare this article, I reviewed each objective and determined how data for the past 3 years compared with the baseline value (see Table 1). If the most recent data for an objective reached or surpassed the target, then the objective is given the status of target met. If the values for all 3 years represent improvement (moving toward the target value), the status of the objective is moving in the right direction. If the values for all 3 years represent worse performance (moving further from the target value), the status of the objective is moving in the wrong direction. The remaining objectives are not labeled with a status; for these objectives, at least 1 value has fallen on each side of the baseline value in the past 3 years.
In just 3 years, North Carolina has already met the targets for 4 objectives: the homicide rate, the rate of new HIV infection diagnoses, the percentage of children aged 1–5 years enrolled in Medicaid who received any dental service during the previous 12 months, and the percentage of the population being served by community water systems with no maximum contaminant level violations. Nine objectives are moving in the right direction: the infant mortality rate, the percentage of traffic crashes that are alcohol-related, the percentage of air monitor sites meeting the current ozone standard of 0.075 ppm, the mortality rate from work-related injuries, the 4-year high school graduation rate, the cardiovascular disease mortality rate, the colorectal cancer mortality rate, average life expectancy, and the percentage of nonelderly uninsured individuals. Six objectives are moving in the wrong direction: the unintentional falls mortality rate, the percentage of pregnancies that are unintended, the percentage of positive results among individuals aged 15–24 tested for chlamydia, the percentage of individuals aged 12 years and older reporting any illicit drug use in the past 30 days, the rate of mental health–related visits to emergency departments, and the percentage of people spending more than 30% of their income on rental housing.
Progress toward achieving the Healthy North Carolina 2020 objectives will continue to be updated annually so that we can acknowledge improvements in health and identify the areas in which additional work may be needed.
Potential conflicts of interest. E.E.H. has no relevant conflicts of interest.
1. North Carolina Institute of Medicine (NCIOM). Healthy North Carolina 2020: A Better State of Health. Morrisville, NC: NCIOM; 2011. http://publichealth.nc.gov/hnc2020/docs/HNC2020-FINAL-March-revised.pdf. Accessed September 17, 2014.
2. North Carolina Division of Public Health (DPH). Healthy North Carolina 2020: A Better State of Health. DPH Web site. http://publichealth.nc.gov/hnc2020/index.htm. Updated June 20, 2014. Accessed July 18, 2014.
3. North Carolina Division of Public Health (DPH). Healthy North Carolina 2020: 2011 Annual Data Update. DPH Web site. http://publichealth.nc.gov/hnc2020/docs/HC2020-2011-AnnualReportWithLogo-1-12.pdf. January 2012. Accessed September 17, 2014.
4. North Carolina Division of Public Health (DPH). Healthy North Carolina 2020 Update: January 2013 Annual Data Report. DPH Web site. http://publichealth.nc.gov/hnc2020/docs/HealthyNC-2020-2012-AnnualDataUpdate-January2013.pdf. Accessed September 17, 2014.
5. North Carolina Division of Public Health (DPH). Healthy North Carolina 2020 Update: March 2014 Annual Data Report. DPH Web site. http://publichealth.nc.gov/hnc2020/docs/HealthyNC2020-UpdateMarch-2014-0324.pdf. Accessed September 17, 2014.
6. North Carolina State Center for Health Statistics (SCHS). BRFSS 2011 Annual Results Technical Notes. SCHS Web site. http://www.schs.state.nc.us/SCHS/brfss/2011/technical.html. Updated September 19, 2012. Accessed July 18, 2014.
Eleanor E. Howell, MS director, State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina.
Address correspondence to Ms. Eleanor Howell, State Center for Health Statistics, 1908 Mail Service Ctr, Raleigh, NC 27699 (Eleanor.Howell@dhhs.nc.gov).