RALEIGH, N.C. (WNCN) — North Carolina received four failing grades on a report card issued by advocacy groups that gauge the health of children in the state.

The North Carolina Child Health Report Card, released biannually by NC Child and the North Carolina Institute of Medicine, measures 15 indicators of child health and how it is affected by policy decisions from federal and state lawmakers.

“Even before the pandemic struck, we knew that we had a long way to go to improve certain health outcomes for North Carolina’s kids,” said Vikki Crouse, a project director for NC Child. “Especially some of our biggest challenges, like ensuring healthy births for families of all races and economic means.

“But the pandemic has really put a harsh spotlight on the deeply embedded barriers that create massive racial and economic inequalities in our communities,” she added.

Perhaps more concerning, the data predates the COVID-19 pandemic that started in North Carolina last March, Crouse said.

“We see that for certain groups, the trends have been going in the opposite direction since that time, so they never got better, and that’s really what we should be paying attention to,” Crouse said. “And we know from the recent data from the pandemic that, in fact, we are seeing those drops in health coverage, anxiety and depression.”

Since the last report was issued in 2019, grades in three categories dropped from D to F: birth outcomes, substance use and mental health. The state received another F in housing and economic security.

And the lone A received by the state — 94 percent of children have health insurance coverage — comes with an asterisk: That rate dropped by a percentage point from the previous report, and it does not yet reflect the large number of parents who may have lost their employer-sponsored health care during pandemic-related job losses.

“We also know from research that when parents are covered, it’s more likely that kids are going to be covered,” Crouse said. “So it is a really concerning trend that a lot of parents have lost” their coverage, she added. 

Other key data points from the report:

— 44 percent of children live in poor or low-income households, defined as being more than 200 percent below the poverty line, up from 43 percent two years ago. That percentage is even higher for children who are Black (61 percent) or Latino (68 percent). 

— The infant mortality rate in the state is 6.8 deaths per 1,000 live births overall, and Black babies are more than twice as likely than white babies to die before their first birthday.

— More than 35 percent of high school students reported they currently vape, up from 22 percent in the previous report card.

— And the report showed higher percentages of high school students who attempted suicide and 12-to-17-year-olds who had a “major depressive episode” and who were treated for depression.

So, how can the state improve its grades?

Crouse says the groups are urging lawmakers to prioritize spending on ways to improve children’s health.

That includes expanding access to affordable healthcare coverage, spending on programs like Medicaid, SNAP, WIC and early childhood education, and improving internet access across the state, which would increase access to long-distance learning programs, job applications and Telehealth services.

“During the crisis, we need a lot better funding for programs that we know are effective,” Crouse said.