Clinical care – the care received in medical settings or directed by medical providers – is what most of us think about when we think about “health.” Research shows, however, that clinical care contributes only about 20% to our health outcomes. Health behaviors (30%), social and economic factors (40%), and physical environment (10%) comprise the rest of the health factors that influence our well-being. Though not the bulk of what makes up our health, access to high-quality critical care is a vital piece of the puzzle, and it is challenged by income inequality and racial disparities.
The latest issue of the North Carolina Medical Journal dedicated to highlighting Healthy North Carolina 2030 health indicators and goals examines several clinical care indicators: insurance status, primary care provider ratio across the state, access to early prenatal care, and suicide rate.
Guest editor Dr. Adam J. Zolotor of the UNC School of Medicine and NC AHEC notes that, “Though many factors play into the ill effects of systemic racism on health, and the health care system can’t address them all alone, we must do better at owning our own implicit bias and creating policies and systems for change to address gaps in health equity.”
Zolotor and other authors in this issue argue that the keys to achieving this goal include broadening access to health insurance (especially through Medicaid expansion), improving primary care provider to population ratios across the state, increasing access to early prenatal care, and reducing suicide rates.
Click the links below to read each article in the issue. Connect with us on Twitter @NCMedJ for further discussion of this and other health policy issues in North Carolina.
Issue Brief: A System for Health, Not a Health Care System by Adam J. Zolotor, MD, DrPH, UNC School of Medicine Department of Family Medicine; NC AHEC; UNC Sheps Center
Primary Care Clinicians in Low-Access Counties by Adam J. Zolotor, MD, DrPH; Evan Galloway, MPS, UNC Sheps Center; Margaret Beal, MMS, PA-C, UNC School of Medicine; Erin P. Fraher, PhD, MPP, UNC Sheps Center
NC Nursecast: Understanding the Nursing Workforce in North Carolina by Emily B. McCartha, PhD, UNC Sheps Center
Uninsurance in North Carolina: Progress and Opportunities by Erica Palmer Smith, MA; Kathryn Horneffer, MPH; Peg O’Connell, JD of Care4Carolina
Supporting Community-Based Family Medicine Residency Training Programs in North Carolina and their Potential Impact on Healthy NC 2030 by Audy G. Whitman, MD, MS; Geniene N. Jones, MD; Danny Pate, MD; Herb G. Garrison III, MD, MPH; Alyson Riddick, MHA, ECU; Kim Schwartz, MA, BCC, Roanoke Chowan Community Health Center; Greg Bounds, PhD, Goshen Medical Center
A Path Toward Health Care Equity: System- Based Interventions for Change by Samuel Cykert, MD, UNC School of Medicine
What Will It Take to Reduce Suicide Among Transgender North Carolinians by 2030? by Ames Simmons, JD, Duke University School of Law
Instilling Hope for All North Carolinians: Reducing Our Suicide Rate by Carrie L. Brown, MD, MPH, NCDHHS
Preventing Suicide by Implementing Trauma-Informed, Resilience-Focused Strategies by Kelly N. Graves, PhD, Kellin Foundation
The Path to Insuring All North Carolinians: An Interview with Senator Joyce Krawiec
Accessing Care Across Language and Geographic Barriers in North Carolina featuring Laura Zapater, Centro Unido Latino Americano
En Español: Acceso a la asistencia a través de obstáculos lingüísticos y geográficos en Carolina del Norte
We Are Not OK: Safety Net Primary Care Access in a Non-Expansion State Amid COVID-19 by Deborah Morrison, BA; Kim A. Schwartz, MA, BCC; Leslie Wolcott, MA, Roanoke Chowan Community Health Center
COVID-19 Vaccination in North Carolina: Promoting Equity by Partnering with Communities and Health Care Providers by Charlene A. Wong, MD, MSPH; Carolina Alzuru, BA; Kody Kinsley, MPP; Ryan Jury, RN, MBA; Margaret L. Sauer, MHA; Tivi Jones, BA; Victor Armstrong, MSW, NCDHHS
Policy Review -Achieving Healthy NC 2030 Goals: Clinical Care
Letter: Perinatal Substance Use Care Coordination: The Need for One Care Plan
Examination of Behaviors and Health Indicators for Individuals with a Lifetime History of Traumatic Brain Injury with Loss of Consciousness: 2018 BRFSS North Carolina by Dana Waltzman, PhD; Kelly Sarmiento, MPH; Jill Daugherty, MPH, PhD, CDC; Scott Proescholdbell, MPH, NCDHHS
The Societal Cost of Excessive Drinking in North Carolina, 2017 by Katherine Gora Combs, MPH; Michael D. Fliss, PhD, UNC-Chapel Hill Gillings School of Global Public Health; Kendall B. Knuth, MPH, IQVIA; Mary E. Cox, MPH, NCDHHS; Pamela J. Trangenstein, PhD, MPH, Alcohol Research Group
Assessing Breast Cancer Risks to Improve Care for an Increased-Risk Population within Eastern North Carolina by Charles H. Shelton, MD; Christina Bowen, MD; Antonio Ruiz, MD, The Outer Banks Hospital; Bryan Jordan, MD, Eastern Radiologists; Leigh M. Boehmer, PharmD, Association of Community Cancer Centers; Christine B. Weldon, MBA; Julia R. Trosman, PhD, Northwestern University