The public health needs, inequities, and shortcomings highlighted by the COVID-19 pandemic have existed for many decades. In this context, it may feel counterproductive to look backward. But in the latest issue of the North Carolina Medical Journal, experts from across the state identify the lessons and successes of the past 50 years that can help us address our most pressing current and future challenges.

Guest editors Laura Gerald, president of the Kate B. Reynolds Charitable Trust, and Douglas Urland, director of the NC Institute for Public Health, write that even while we celebrate our achievements, North Carolina should use those accomplishments as motivation to meet the challenges ahead.

“When exploring our past and considering our future, it is imperative to identify the policies, programs, and initiatives that will make North Carolina a healthier place,” write Gerald and Urland. “To design and implement new strategies takes resources, both financial and human.”

Click the links below to read more about where we’ve been, and how we can get where we’re going in a healthier, more equitable way.

Introduction

The More Things Change… The More Urgent Change Becomes by Editor-in-Chief Peter Morris, MD, MPH, MDiv

In this issue of the journal, we bridge two centuries to look at 50 years of public health achievement, threat, and opportunity in our own state.

Issue Brief

Public Health in North Carolina by Laura Gerald, MD, MPH of Kate B. Reynolds Charitable Trust and Douglas Urland, MPA of the NC Institute for Public Health

Increased funding, sound policy, collaboration, and community engagement are needed to ensure a robust public health system that helps every resident thrive now and beyond the pandemic.

Commentaries & Sidebars

Creating a Healthy North Carolina: Developing and Reaching Goals for the 21st Century by Amy Belflower Thomas, MHA, MSPH, CPH, DrPH(c) of the NC Institute for Public Health and Kathryn Dail, PhD of NCDHHS

Now in its fourth iteration with a 2030 report and measures, the Healthy North Carolina decennial initiative has galvanized the state and its diverse public health partners to develop, work toward, and track progress on a common set of health objectives for North Carolina.

Combating Outbreaks in North Carolina: Lessons Learned by Kristina Simeonsson, MD, MSPH and Karin Hillenbrand, MD, MPH of ECU

A review of the public health response to outbreaks, with attention to the core public health functions of assessment, policy development, and health assurance, can illustrate best practices and identify areas for improvement.

Sidebar: Working to Eliminate HIV in This Decade by Jacquelyn M. Clymore, MS and Victoria Mobley, MD, MPH of DPH

In North Carolina, members of historically marginalized populations continue to be disproportionately affected by the HIV epidemic. Continued disparities in HIV outcomes point to the clear need to link persons living with HIV to care and the services necessary to support retention.

Maternal and Infant Mortality in North Carolina by Belinda Pettiford, MPH of NCDHHS

Infant mortality is considered a key indicator of the overall health of the population, and both infant and maternal mortality are multifaceted problems impacted by factors such as access to care, poverty, systemic racism, and housing.

Environment and Health at a Crossroads by Stan Meiburg, PhD of Wake Forest University and William Ross, JD of Brooks, Pierce, McLendon, Humphrey & Leonard LLP

The road behind has brought cleaner air, cleaner water, and better health, but also serious problems. The road ahead requires critical and urgent choices based on new understanding, increasing risks, and more complex problems.

Partners: Keys to Success and Meeting Challenges in Tobacco Control in North Carolina by Sally Herndon, MPH; Susan M. Kansagra, MD, MBA; Courtney Heck, MPH; Jim Martin, MS; Ann H. Staples, MA, MCHES; Joyce Swetlick, MPH; Jennifer Park, CHES, MPH; Stephanie Gans, LCAS, LCSWA; Luanna McCraw, MPH; and Alyssa Mouton, MPH, MPP of NCDHHS

What works in tobacco control is well known, yet lack of funding stability and preemption by state and local laws continue to be barriers. Strong partnerships and a focus on health equity are keys to greater gains.

In Search of Equity by Cornell P. Wright, MPA of NCDHHS

North Carolina initiatives, including the establishment of the Office of Minority Health and Health Disparities in NCDHHS, have the common goal of eliminating disproportionate mortality and other adverse impacts of social and economic drivers of health.

Sidebar: A Crisis of Opportunity: A Collaborative Approach to Oral Health Policy in North Carolina by Zachary Brian, DMD, MHA of FHLI

North Carolina isn’t used to bold initiatives in oral health policy. A new approach is gathering strength, however, emphasizing the importance of policy in addressing disparities and inequities in oral health and oral health care.

Learning from the Past to Shape the Future for North Carolina’s Youngest Children by Lucas Griffin, BS and Dorothy Cilenti, DrPH, MPH, MSW of UNC Gillings School of Global Public Health

Despite improvements across social determinants of health, North Carolina’s youngest residents still experience poor outcomes and significant racial disparities.

Sidebar: Public Health and Schools—Natural Partners by Ann O. Nichols, MSN, RN, NCSN of NCDHHS

The health and well-being of a community is reflected in its schools.

Baptism by Fire: How the COVID-19 Pandemic Advanced North Carolina’s Health IT Capabilities by Tom Wroth, MD, MPH of Community Care of North Carolina

Faced with the COVID-19 pandemic and the imperative to address health equity, North Carolina strengthened its health information technology capabilities and rapidly evolved in areas such as telehealth.

The Journey Upstream: Chronic Disease Prevention and Control Over the Years by Susan M. Kansagra, MD, MBA and Amanda Isac, PharmD, MPH of NCDHHS

Over the last several decades, the field of public health has moved upstream to better address the roots of chronic disease. Public health’s role has required collaboration across many community sectors.

Columns

Focus on Philanthropy: The Role Philanthropy Can Play in Advancing the Public’s Health as North Carolina Transitions to a Value-based Health Care System by Chris Collins, MSW of The Duke Endowment

As our nation increasingly focuses on building a value-based health care system, there is a renewed appreciation for the value of prevention. In order to improve the health of communities, there is a need to move upstream beyond clinical care and invest in actions that result in a healthy population.

Also in this issue:

Pediatric Refugee Health and Patterns of Health Care Utilization in Durham, North Carolina by Emily Esmaili, DO, MA, FAAP of the Duke Global Health Institute and Lincoln Community Health Center; Ishaq Winters, MD of Yale University; Rayan Kaakati, MD of the University of Michigan; and Arun Augustine, MA and Nathan Thielman, MD, MPH of the University of Wisconsin

Investigating Barriers to Vaccination Among Durham County’s Vulnerable Populations by Aditya Santoki, BS and Nathan Boucher, DrPH of Duke University