1. Joanne Rinker MS, RD, CDE, LDN Director of Training and Technical Assistance Center for Healthy North Carolina

2. NCIOM Prevention Task Force Prevention for the Health of North Carolina released on October 8, 2009 At the release, Gov. Beverly Perdue voiced her desire for NC to be the healthiest state in the nation by 2020. Goal - a Better State of Health! http://www.nciom.org/projects/prevention/prevention_report.shtml

3. America’s Health Rankings http://www.americashealthrankings.org/ North Carolina: A Better State of Health

4. North Carolina: A Better State of Health The Next Step in the Journey... We have the Prevention Action Plan, now what? Healthy North Carolina 2020 Objectives Governor’s Task Force for Healthy Carolinians asked NCIOM to help develop NC’s 2020 objectives and targets.

5. Healthy North Carolina 2020 Three primary steps in setting Healthy North Carolina 2020 objectives: –1) Identify appropriate focus (priority) areas, building off Prevention Action Plan. –2) Identify limited number of objectives –3) Identify appropriate targets

6. Healthy NC 2020 Focus Areas 1.Tobacco use 2.Nutrition and physical activity 3.Sexually transmitted infections/Unintended pregnancy 4.Substance abuse 5.Environmental risks 6.Injury 7.Mental health 8.Infectious disease/ Food-borne illness 9.Social determinants of health 10.Dental health 11.Maternal and infant health 12.Chronic disease 13.Cross-area measures

7. Healthy North Carolina 2020: Moving Ahead Focus on prevention and reducing risk factors that contribute to the leading causes of death in North Carolina We cannot measure everything that is important in public health work Identify a limited number of health objectives to work toward across the state –40 objectives: limited, manageable, concise –Allow for meaningful impact –Pull together to make progress

8. Healthy North Carolina 2020: 2013 Annual Report Results The NC Division of Public Health/NC State Center for Health Statistics produces annual reports measuring progress towards the targets of improving population health. For 2013, of the 31* objectives for which we have updated data, 7 are not comparable. Of the 31 that are comparable to the baseline, trends may indicate: –15 (48%) are moving in the right direction –1 (3%) stayed the same –15 (48%) are moving in the wrong direction All data provided by the NC State Center for Health Statistics *Not all data are available every year. Note: Total does not equal 100% due to rounding

9. Healthy North Carolina 2020 Tobacco Use BaselineCurrent HNC2020 TargetUS 1. Decrease the percentage of adults who are current smokers¹ 20.3% (2009) 20.9% (2012) 13.0%21.2% (2011) 2. Decrease the percentage of high school students reporting current use of any tobacco product 25.8% (2009) 22.5% (2011) 15.0%23.4% (2011) 3. Decrease the percentage of people exposed to secondhand smoke in the workplace in the past seven days¹ 14.6% (2008) 8.6% (2012) 0%Not available * Data for this indicator is collected only in odd numbered years. ¹ In 2011, the BRFSS methodology changed, so results are not directly comparable to previous years’ results.

11. Healthy North Carolina 2020 Physical Activity and Nutrition BaselineCurrentHNC2020 Target US 1. Increase the percentage of high school students who are neither overweight nor obese 72.0% (2009) 71.2% (2011) 79.2%71.8% (2011) 2. Increase the percentage of adults getting the recommended amount of physical activity ² 46.4% (2009) No update² 60.6%51.0% (2009) 3. Increase the percentage of adults who report they consume five or more servings of fruits and vegetables per day² 20.6% (2009) No update² 29.3%23.4% (2009) * Data for this indicator is collected only in odd numbered years. ² In 2011, the definition for recommended amount of physical activity and fruit and vegetable consumption changed. Therefore, comparable data for these measures are not available at this time.

13. Healthy North Carolina 2020 Injury BaselineCurrent HNC2020 TargetUS 1. Reduce the unintentional poisoning mortality rate (per 100,000 population) 11.0 (2008) 11.7 (2012) 9.910.6 (2010) 2. Reduce the unintentional falls mortality rate (per 100,000 population) 8.1 (2008) 9.6 (2012) 5.37.9 (2010) 3. Reduce the homicide rate (per 100,000 population) 7.5 (2008) 6.0 (2012) 6.75.3 (2010)

14. Healthy North Carolina 2020 Maternal and Infant HealthBaselineCurrentHNC2020 Target US 1. Reduce the infant mortality racial disparity between whites and African Americans 2.45 (2008) 2.50 (2012) 1.922.35 (2010) 2. Reduce the infant mortality rate (per 1,000 live births) 8.2 (2008) 7.4 (2012) 6.36.1 (2010) 3. Reduce the percentage of women who smoke during pregnancy³ 10.4% (2008) 10.6% (2012) 6.8%Not available ³ North Carolina implemented the revised U.S. Standard birth certificate in 2011. The methodology for collecting smoking data was modified, therefore values presented for 2011 are not comparable to prior years.

16. Healthy North Carolina 2020 Sexually Transmitted Diseases and Unintended Pregnancy BaselineCurrent HNC2020 TargetUS 1. Decrease the percentage of pregnancies that are unintended 39.8% (2007) 42.7% (2011) 30.9%Not available 2. Reduce the percentage of positive results among individuals aged 15 to 24 tested for Chlamydia 9.7% (2009) 10.8% (2012) 8.7%Not available 3. Reduce the rate of new HIV infection diagnoses (per 100,000 population) 24.7 (2008) 17.3 (2011) 22.216.3 (2010)

17. Healthy North Carolina 2020 Substance AbuseBaselineCurrent HNC2020 TargetUS 1. Reduce the percentage of high school students who had alcohol on one or more of the past 30 days 35.0% (2009) 34.3% (2011) 26.4%38.7% (2011) 2. Reduce the percentage of traffic crashes that are alcohol-related 5.7% (2008) 5.3% (2012) 4.7%Not available 3. Reduce the percentage of individuals aged 12 years and older reporting any illicit drug use in the past 30 days 7.8% (2007- 2008) 7.9% (2010- 11) 6.6%8.8% (2010- 2011) * Data for this indicator is collected only in odd numbered years.

18. Healthy North Carolina 2020 Mental HealthBaselineCurrent HNC2020 TargetUS 1. Reduce the suicide rate (per 100,000 population) 12.4 (2008) 12.9 (2012) 8.312.1 (2010) 2. Decrease the average number of poor mental health days among adults in the past 30 days¹ 3.4 (2008) 3.9 (2012) 2.8Not available 3. Reduce the rate of mental health-related visits to emergency departments (per 10,000 population) 92.0 (2008) 104.5 (2012) 82.8Not available ¹ In 2011, the BRFSS methodology changed, so results are not directly comparable to previous years’ results.

19. Healthy North Carolina 2020 Oral Health BaselineCurrent HNC2020 TargetUS 1. Increase the percentage of children aged 1-5 years enrolled in Medicaid who received any dental service during the previous 12 months 46.9% (2008) 57.3% (2012) 56.4%40.3% (2011) 2. Decrease the average number of decayed, missing, or filled teeth among kindergartners 1.5 (2008- 2009) 1.5 (2009- 10) 1.1Not available 3. Decrease the percentage of adults who have had permanent teeth removed due to tooth decay or gum disease 47.8% (2008) 48.3% (2012) 38.4%43.6% (2010)

20. Healthy North Carolina 2020 Environmental HealthBaselineCurrent HNC2020 TargetUS 1. Increase the percentage of air monitor sites meeting the current ozone standard of 0.075 ppm 62.5% (2007- 2009) 80.5% (2010- 12) 100%Not available 2. Increase the percentage of the population being served by community water systems (CWS) with no maximum contaminant level violations (among persons on CWS) 92.2% (2009) 97.4% (2012) 95.0%Not available 3. Reduce the mortality rate from work-related injuries (per 100,000 equivalent full time workers) 3.9 (2008) 3.7 (2011) 3.53.6% (2010)

21. Healthy North Carolina 2020 Infectious Disease Foodborne IllnessBaselineCurrent HNC2020 TargetUS 1. Increase the percentage of children aged 19-35 months who receive the recommended vaccines 77.3% (2007) 76.2% (2012) 91.3%77.0% (2011) 2. Reduce the pneumonia and influenza mortality rate (per 100,000 population) 19.5 (2008) 19.6 (2012) 13.515.1 (2010) 3. Decrease the average number of critical violations per restaurant/food stand 6.1 (2009) 6.5 (2011) 5.5Not available **Data update not available

22. Healthy North Carolina 2020 Social Determinants of HealthBaselineCurrent HNC2020 TargetUS 1. Decrease the percentage of individuals living in poverty 16.9% (2009) 17.2% (2012) 12.5%15.0% (2011) 2. Increase the four-year high school graduation rate 71.8% (2008-9) 82.5% (2012- 13) 94.6%Not available 3. Decrease the percentage of people spending more than 30% of their income on rental housing 41.8% (2008) 44.8% (2012) 36.1%49.3% (2011)

23. Healthy North Carolina 2020 Chronic DiseaseBaselineCurrent HNC2020 TargetUS 1. Reduce the cardiovascular disease mortality rate (per 100,000 population) 256.6 (2008) 237.2 (2012) 161.5234.2 (2010) 2. Decrease the percentage of adults with diabetes¹ 9.6% (2009) 10.4% (2012) 8.6%9.5% (2011) 3. Reduce the colorectal cancer mortality rate (per 100,000 population) 15.7 (2008) 15.1 (2012) 10.115.6 (2010) ¹ In 2011, the BRFSS methodology changed, so results are not directly comparable to previous years’ results.

24. Healthy North Carolina 2020 Cross-cuttingBaselineCurrent HNC2020 TargetUS 1. Increase average life expectancy (years) 77.5 (2008) 78.2 (2012) 79.578.7 (2010) 2. Increase the percentage of adults reporting good, very good, or excellent health¹ 81.9% (2009) 80.7% (2012) 90.1%83.1% (2011) 3. Reduce the percentage of non-elderly uninsured individuals (aged less than 65 years) 20.4% (2009) 18.9% (2011) 8.0%17.9% (2011) 4. Increase the percentage of adults who are neither overweight nor obese¹ 34.6% (2009) 34.2% (2012) 38.1%36.3% (2011) ¹ In 2011, the BRFSS methodology changed, so results are not directly comparable to previous years’ results.

26. County Health Rankings: 2014 North Carolina 1Wake 2Watauga 3Orange 4Union 5Camden 6Mecklenburg 7Davie 8Dare 9Cabarrus 10 New Hanover 91 Bladen 92 Lenoir 93 Martin 94 Swain 95 Bertie 96 Vance 97 Robeson 98 Scotland 99 Halifax 100Columbus Source: County Health Rankings and Roadmaps, 2014. http://www.countyhealthrankings.org/

27. Healthy North Carolina 2020: Moving Forward Where would we be if we met our HNC 2020 Goals? Objective Current RankingRank if 2020 Goal Met Diabetes Prevalence 3313 Immunization Rates221 High School Graduation321 Adult Tobacco Use3313 Cardiovascular Mortality 323 Infant Mortality4025 The individual state’s ranking and score was determined for each of these measures using the 2013 America’s Health Rankings. The Healthy NC 2020 goal for each measure was then compared to the current ranking and a new ranking was determined based on the goal score. Source: Personal email, Kelly Kimple, MD, MPH, UNC Preventive Medicine, Chief Resident, June 18, 2014.

28. Healthy North Carolina 2020: Moving Forward The Prevention Action Plan and the Healthy North Carolina 2020 objectives form the basis of a larger campaign to promote a “Better State of Health” in North Carolina. Community engagement Locally implemented, community appropriate, evidence based strategies

29. Establish CHA Team Collect Primary Data Collect Secondary Data Analyze and Interpret Data Determine Health Priorities Create CHA Documents Disseminat e CHA Documents Develop Community Action Plan The Center for Healthy North Carolina can provide technical assistance related to the identification, selection, implementation, evaluation and sustainability of evidence based strategies for community identified health priorities that relate to the Healthy North Carolina 2020 objectives. Adapted from North Carolina Division of Public Health Community Health Assessment http://publichealth.nc.gov/lhd/cha/ Community Health Assessment and Technical Assistance Continuum Technical Assistance from NC DPH Technical Assistance from CHNC

30. Stage I key partners form workgroup Stage II common priorities formal commitment to action Stage III strategic plan defined purpose/vision Stage IV active projects established structure Stage V projects maintained or transitioned QI/Evaluation component multiple sources of funding/support CHA Implementation plan with priorities Identify & select EBS Implement & evaluate EBS Coalition Development Population Health Initiatives Evaluation Sustainability Implementation Technical Assistance Action Plan EBS Awareness

31. Healthy North Carolina 2020: The Campaign Working to improve individual, environmental and policy changes that will have a meaningful impact on health in NC Increase public awareness and community support Increase community capacity Engage boards, organizations and community groups

32. Healthy North Carolina 2020: What Can You Do Today? Sign the Resolution in Support of Making NC a Healthier State: http://www.publichealth.nc.gov/hnc2020/re solution.asp http://www.publichealth.nc.gov/hnc2020/re solution.asp –Commit as an individual –Commit as an organization Ask for an HNC2020 presentation to your organization, board or community group

33. Credits/Thanks Thanks to the NC State Center for Health Statistics for providing the HNC2020 data Thanks to CHNC’s funder - The Duke Endowment

34. Healthy North Carolina 2020: How Can You Find Out More? Visit the HNC2020 website http://publichealth.nc.gov/hnc2020 Contact: Joanne Rinker 919-699-5886 Joanne.rinker@centerforhealthync.org