By Jaymie Baxley 

No matter where you went in the early months of 1947, the song “It’s All Up To You” was inescapable.

A recording of the song by Frank Sinatra and Dinah Shore played in heavy rotation on the state’s radio stations and jukeboxes. The swinging big band tune’s lyrics appeared on the front pages of local newspapers. Copies of the song’s sheet music were distributed to public schools, where students were required to learn and perform it.

Though largely forgotten today, “It’s All Up To You” was written to raise awareness of North Carolina’s poor health conditions. It was the centerpiece of a public education and public relations campaign that had a lasting effect on the state’s health care infrastructure.

Creating the Good Health Plan

Two years before the song’s release, the State Hospital and Medical Care Commission presented some troubling statistics to the General Assembly.

North Carolina had had the nation’s highest rate of draft rejections during World War II. More than half of the state’s conscripted men were deemed medically unfit for military service, with many of them suffering from hookworm, tuberculosis and other diseases.

By 1945, North Carolina had only 2,300 doctors for its 3.5 million residents. The shortage of physicians was so severe that a quarter of babies born in rural counties were delivered without a doctor present.

Thirty-nine of the state’s 100 counties lacked hospital beds for Black patients, who in the Jim Crow South were forced to seek care at segregated facilities. In 33 counties, there were no hospitals at all.

These and other issues contributed to the abysmal state of conscripts’ health.

At Gov. Joseph Broughton’s request, members of the commission developed a plan to improve the situation. Their proposal called for the construction of hospitals and clinics to provide “better distribution of facilities, medical care, and public health services for every citizen Irrespective of race, creed, or financial resources.”

They called it the “Good Health Plan.”

Calling on Kyser 

The commission knew it needed public support to persuade lawmakers to fund the $48 million plan.

In March 1946, the commission organized a meeting of 200 of the state’s “leading medical men and laymen” in Thomasville. From that gathering came the Good Health Association, a volunteer committee that sought to “educat[e] the people of North Carolina as to the desperate need” for more doctors and hospital beds. Isaac Greer, superintendent of the Baptist Children’s Homes orphanage, was named the association’s president.

Hoping to enlist a well-known North Carolinian to assist with the effort, Greer reached out to bandleader Kay Kyser. The Rocky Mount native had released several chart-topping swing records with his big band orchestra in the 1940s. He had also appeared in a string of successful Hollywood comedies, including “You’ll Find Out,” “Playmates” and “My Favorite Spy.”

Ol’ Professor of Swing Kyser needed little convincing. After learning about his home state’s health woes, the musician embarked on an impromptu tour of more than 30 counties to solicit funding for the education campaign. He also drew from his experience in show business to craft a marketing and publicity prospectus for the Good Health Association, which adopted the document.

Over the next few months, marketing from the plan was unavoidable. The association used dramatic billboards, brochures, news releases, displays in pharmacy windows, essay writing contests for school children and all manner of other media to extoll the benefits of the Good Health Plan.

But Kyser believed that many residents “would never read about the State’s bad health record, or listen to even the most eloquent speaker discuss startling statistics,” according to a report released by the association at the campaign’s conclusion.

“He felt that these people would, however, sit up and listen to a musical appeal.”

Spreading the ‘health alarm’

Kyser passed the assignment to arguably the second most successful songwriting duo, behind Rodgers and Hammerstein, on Tin Pan Alley.

Lyricist Sammy Cahn and composer Jule Styne were established hitmakers in New York, having first teamed up three years earlier for the Oscar-nominated “I’ve Heard That Song Before.” Their most enduring collaboration, the Christmas staple “Let it Snow! Let it Snow! Let it Snow!,” propelled crooner Vaughn Monroe to the top of the charts in 1945.

Cahn and Styne wrote the words and jaunty music for “It’s All Up To You” in less than 24 hours. They framed it as a call to action, urging North Carolinians to “spread the health alarm to every town and farm” across the state.

“We need vitamins and medicines and beds to spare

Places where the sick can go and get some care

Lots of new equipment to combat disease

Clinics where the poor can go for moderate fees”

The lyrics also reference Leonora Martin’s poem “The Old North State,” which would be recognized a decade later by the General Assembly as the official toast of North Carolina:

“If we do these things then we will be the state 

Where the weak grow strong and the strong grow great”

With the association’s “musical appeal” now on paper, Kyser set out to find singers who could make “It’s All Up To You” resonate with radio listeners. As luck would have it, he shared a record label with two of the country’s biggest rising stars.

Sinatra and Shore 

Frank Sinatra and Dinah Shore were among Columbia Records’ most popular acts in 1946.

Sinatra had released his first full-length album, the best-selling “The Voice of Frank Sinatra,” earlier that year. Though he was a New Jersey native, Sinatra had something in common with many men in North Carolina: He had also been rejected for military service during WWII.

Shore, a new signee to Columbia, was enjoying a successful run of singles that included “Laughing on the Outside (Crying on the Inside)” and “The Gypsy,” which peaked at No. 2 on the Billboard chart.

When Kyser approached Sinatra and Shore with “It’s All Up To You,” they agreed to sing it for free. They recorded their vocals with Kyser’s orchestra in about an hour at a studio in Connecticut, according to newspaper reports.

“It’s All Up To You” officially premiered in North Carolina on New Year’s Day in 1947 as part of a special program broadcast on every radio station in the state. More than 9,000 copies of the track were later sent to the stations to give out to listeners.

“Even after they had given away their allotment of the records, many radio stations continued to play ‘It’s All Up To You’ daily, and disk jockeys reported many requests for the number,” read a report published by the association.

Records were also sent to the superintendents of county and city school systems, along with printouts of the song’s sheet music. Some schools required students to perform “It’s All Up To You” during Good Health Week that February.

The track was provided to jukebox operators in the state’s largest cities. Displays promoting the song were placed in the windows of record stores. Stories about it ran in newspapers.

One article, published in The State Port Pilot of Southport, called the recording a “songsation.”

“Perhaps no single phase or feature of the never-a-dull-moment Good Health publicity campaign has clicked so decisively as this latest device,” the paper wrote.

Lasting impact

The Good Health Plan was approved that March by the legislature, which agreed to put $32 million — equivalent to roughly $440 million in 2023 — toward the initiative.

An additional $16 million came from the Hill-Burton Act, a federal measure signed into law the previous year by President Harry Truman to increase the nation’s supply of hospital beds.

Money from the act would eventually fund the creation of 230 health care facilities in North Carolina, according to the National Health Law Program.

In addition to its role in expanding the state’s hospital system, the Good Health Plan paid for the construction of a four-year medical school at the University of North Carolina in Chapel Hill.

The once-ubiquitous anthem that helped drum up support for the plan has faded into obscurity, but it hasn’t been lost to time. “It’s All Up To You” can be heard today on Spotify, Apple Music and YouTube.

The post Crooning for a Cure: The star-studded song that changed NC’s health care landscape  appeared first on North Carolina Health News.

By Rachel Crumpler

Mona Evans left prison on May 2, 2022, after almost five years spent behind bars.

She traded the clanging doors, constant supervision and sterile environment of Anson Correctional Institution in Polkton — a town about one hour east of Charlotte — for a quiet 13-acre farm in rural Alamance County.

Housing and employment awaited her on her first day back in the community at Benevolence Farm, a rural reentry program and social enterprise supporting women leaving incarceration.

When Evans set foot on the property for the first time, it was a breath of fresh air — literally. Surrounded by nature for the first time in years, she basked in the sunlight and rows of flowers and herbs in bloom.

When she entered her room in the three-bedroom farmhouse, she saw that staff had purchased crochet hooks, yarn and a journal for her — all in her favorite color purple. She had a cabinet in the kitchen stocked with her favorite snacks, like potato chips and chocolate doughnuts. She was handed a cell phone that she used for hours that first night talking to her kids.

Evans said she was refreshingly treated like an individual human again — something that had long been lost from the monotonous treatment in prison.

During that first week, she started getting paid to produce the farm’s body care and candle products, applied for state IDs, paid parking tickets and went shopping at Walmart.

Benevolence Farm provided a safe landing ground and solid foundation of support, Evans said, as she grappled with establishing her life in the community again — this time with the stigma of a criminal record.

“A lot of stuff that you stress about as far as coming home is provided for you within that first week with this program,” Evans said. “That took a lot of stress off of me, and it gave me the opportunity to focus more on setting my goals.”

After five months, she left Benevolence Farm, finding her own footing in the community.

Now, over a year and a half since her release from prison, Evans rents a house in Burlington where she is reunited with her three kids. She’s working as a caregiver and also as a staff member at Benevolence Farm, where she is helping other women navigate reentry challenges — particularly family reunification.

“Without this program, I wouldn’t be where I’m at today, especially not this fast,” Evans said.

Dire need for reentry support

Kristen Powers, Benevolence Farm’s executive director, said the nonprofit is helping fill a massive gap in housing, employment and other support for women leaving North Carolina prisons and jails.

Over the past four decades, the number of women incarcerated nationwide has ballooned by more than 525 percent, rising from a total of 26,326 in 1980 to 168,449 in 2021, according to The Sentencing Project. More than half of these women have a child who’s younger than 18.

However, Powers said there hasn’t been a corresponding increase in services for these women.

“I think they are often forgotten in the conversation about incarceration,” Powers said.

In North Carolina, women make up about 8 percent of the state’s total prison population, which is more than 31,000 people. In 2022, 2,714 women were released from North Carolina prisons, according to data from the Department of Adult Correction. However, on average, about one-third of women released from prison will be re-arrested within two years and 14 percent will be re-incarcerated, according to data from the North Carolina Sentencing and Policy Advisory Commission.

“We’ve basically stripped incarcerated people of everything that they had prior to going to prison or jail, and if you’re expecting people to resume normal, everyday activities, you need that infrastructure around them when they get out,” Powers said. “That’s not a reality for so many people coming home.”

Evans realizes how fortunate she was to land at Benevolence Farm. Staying with family wasn’t an option because she had none in North Carolina.

“If I didn’t go to Benevolence Farm or didn’t have a reentry program to go to, I wouldn’t have had anywhere to go,” Evans said. “I wouldn’t have got home from prison. That alone shows you why reentry programs are so important. So many formerly incarcerated individuals are homeless or go back to committing crimes right after release because they don’t have the resources that they need to survive.”

Since welcoming the first resident in December 2016, Benevolence Farm has served over 50 formerly incarcerated women. Unlike some other reentry programs, Benevolence Farm accepts women of all conviction types and allows them to stay up to two years, though most don’t stay the full duration.

The farm in Graham, funded primarily through individual charitable donations and major gifts, provides housing and work for up to six women at a time. Staff receive dozens of applications for the six slots, and some people with a 2028 release date have already applied, Powers said.

While Powers said she realizes that Benevolence Farm could serve more women if the allowed length of stay was shorter, she said the time given is part of what makes the program special and effective.

“We try to do long-term because there are so many peaks and valleys to the reentry process,” Powers said. “People have all the quick wins when they get home — an ID, a bank account, a driver’s license — and then things start to get harder or emotions start to get harder, and it helps to have community around to support you.”

Life at the farm

Returning to the community after incarceration is a big adjustment — mentally, socially, physically and economically. That’s why Benevolence Farm seeks to create a space where women can process, heal and prepare for what’s next, Powers said.

When a new resident arrives at the farm, a two-week onboarding process begins where staff help the person secure essential items like IDs, birth certificates and bank accounts as well as needed health care such as mental health and substance use services, Powers explained. Time is also given to rest and reacclimate, she said.

“When you’re in prison, you’re so used to being locked down behind metal doors all the time,” Evans said. “You don’t have the freedom to even go to the kitchen. I remember the first few days, I would just walk in the kitchen, open up the refrigerator and close it. I was just getting used to having nobody in my ear telling me what to eat, when to eat, when to get up. It took time getting used to having my freedom back.”

Navigating the transition surrounded by nature has its benefits, said Powers, who moved to a farm as a teenager and saw how the change in environment and pace affected her well-being.

Katie Anderson, a former resident who arrived on the farm in May 2020, agrees. She said the farm was a refreshing contrast to prison.

She went from being locked down in her cell during the COVID pandemic for months, when she said she wasn’t allowed outside at all, to absorbing all the time she could outside working in the fields.

“I just loved the sun,” Anderson said. “I just wanted to be outside. I wanted to smell the air and not have to be confined.”

Residents work three days a week earning $15 per hour as they make Benevolence Farm’s body care products and candles using flowers and herbs grown on the property like rosemary and lavender. Several of the products were pitched and designed by residents, such as the honeysuckle and turmeric soap and the charcoal face soap.

Last year, sales generated about $75,000 in revenue, which is used to help fund operations at the farm.

The other two days of the week and weekends are dedicated to each resident’s personal tasks and goals, Powers said. This includes doctor’s appointments, probation appointments and visits with family and friends. Five staff members — two of whom were formerly incarcerated — are available to help navigate challenges that come up.

Residents leave the farm at their own pace, Powers said, and only three residents have stayed the full two years.

Powers added that most residents have established successful lives in the community after leaving Benevolence Farm, achieving small and big milestones from getting off probation to promotions at work to securing house keys.

However, Powers said about 15 percent of former residents have returned to incarceration — mostly for technical violations regarding their probation or parole. For example, one person on the sex offender registry did not have a proper address, and another squatted in an abandoned house.

“Overwhelmingly, we’re showing what happens when you build community around someone and meet their basic needs and how that affects their life moving forward,” Powers said.

Scalable ideas

Powers is acutely aware that what Benevolence Farm provides only scratches the surface of the need among formerly incarcerated women. That’s why Benevolence Farm has expanded its footprint in recent years.

In May 2022, the nonprofit opened a Burlington home that can house up to four women at a time in their own rooms. That bumped the organization’s total housing capacity up to 10 women.

But housing remains a monumental barrier to successful reentry, Powers said. She’s seen many landlords reject people with criminal records or charge double the security deposit, which can often put housing out of reach. To help address this problem, Benevolence Farm launched its Housing First Fund this year. The pilot program, made possible by the Coastal Federal Credit Union Foundation, helps women — primarily formerly incarcerated mothers — move into safe and stable housing of their choosing by paying the security deposit.

Powers also has her sights set on establishing a tiny home community on the Graham property to serve more women. The goal is to build six tiny homes, and fundraising for the project is ongoing.

But she knows that Benevolence Farm, which was named one of nine U.S. innovation sites by the Rural Justice Collaborative in 2022, can never meet all the need. Doing so will involve other players — employers, housing agencies, nonprofits, municipalities, community members and government officials — stepping up to “holistically support” people coming home from incarceration, Powers said.

“Our ideas are scalable and lessons are scalable,” Powers said.

“I do think we’re onto something here,” she continued. “I’m hoping that more folks can see that and learn from it and continue to push North Carolina in a direction that is more welcoming to formerly incarcerated people and willing to make the bold moves to keep people in the community in the first place.”

The post Second chances for formerly incarcerated women grow on this farm in Alamance County appeared first on North Carolina Health News.

Advocates for residents say proposed federal staffing requirements for nursing homes are ‘a step in the right direction.’ Industry supporters say they aren’t attainable.

Do NC nursing homes have enough nurses? is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

By Jennifer Fernandez

North Carolina children insured through Medicaid will remain covered for another year as the state works its way through recertifications of everyone on the program.

Health experts praise the move, which they say should help protect children from losing coverage over procedural issues when they would otherwise still be eligible during the process known as the “unwinding,” where states have been disenrolling people who gained Medicaid during the pandemic.

In April 2020, Congress passed a policy preventing states from kicking people off of the Medicaid rolls for the duration of the national public health emergency. That mandate expired this spring.

North Carolina, which requested a waiver to extend eligibility for children on Oct. 31, is only the second state after Kentucky to be approved.

“We believe continuing health care coverage for children is not only in the best interest of North Carolina, but it will also help reduce the immediate workload of County DSS staff,” the North Carolina Department of Health and Human Services said in an email, referring to the county Department of Social Services offices, which are handling Medicaid unwinding alongside a massive Medicaid expansion that is expected to add 600,000 beneficiaries in the state.

The state is also seeking other waivers that would benefit North Carolina children by keeping younger kids continuously enrolled in the program through age 5 and older children enrolled for two years before needing recertification. Another waiver being sought would keep some children who have aged out of foster care enrolled in Medicaid through age 26. Those waivers are pending before the Centers for Medicare and Medicaid Services.

“The big picture in North Carolina right now is pretty good” when it comes to children and Medicaid, said Leo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.

‘Unwinding’ ends some children’s enrollment

As with adult enrollment, the number of children covered by North Carolina Medicaid in the state swelled during the pandemic. For kids, enrollment grew from 1,168,602 in March 2020, to 1,382,255 this May.

The continuous coverage requirement allowed beneficiaries to skip Medicaid’s renewal process for about three years during the pandemic. All participants, even those who no longer qualified for the program, were automatically re-enrolled during the period.

North Carolina began the process of “unwinding this excess enrollment,” in June. Before the waiver to extend enrollment was approved, children were subject to being disenrolled during the process.

Nationally, more than 2.8 million children have lost Medicaid coverage since states resumed eligibility reviews.

Through November, the number of children covered by North Carolina Medicaid has dropped by a little more than 53,000.

However, the reasons for children losing coverage are not always clear. Some may have lost coverage because the state determined they were no longer eligible, while others may have been disenrolled due to procedural issues, such as their parents not returning paperwork on time, even if they were still eligible.

“Federal researchers prior to this process beginning projected that three out of four kids who lose Medicaid would remain eligible. And that’s a much higher number than what’s expected for adults,” said Joan Alker, executive director and co-founder of the Center for Children and Families, during a November webinar on how unwinding is affecting children across the country.

Fewer uninsured children

The rate of uninsured children had been steadily declining in the country from 2008 through 2016 before it began rising again.

Advocates say the pandemic-era changes to Medicaid have improved health insurance coverage for children, who make up about half of all program participants.

North Carolina had the fifth largest decline in the number of uninsured children from 2019 to 2022, according to a recent report by Georgetown University’s Center for Children and Families that analyzed the U.S. Census Bureau’s 2022 American Community Survey.

The state’s rate of uninsured children improved from 5.8 percent to 4.8 percent in that time.

Nationally, the rate is 5.1 percent. The District of Columbia has the lowest rate of uninsured children at 1.4 percent. Texas has the highest rate at 10.9 percent.

Thirty-six states saw a decline in the number and rate of uninsured children.

“Unfortunately, this progress is likely short-lived” because of Medicaid unwinding, Alker said, adding that for children, Medicaid enrollment is “declining rapidly.”

Coverage dropping

During the pandemic, North Carolina’s Medicaid rolls grew from a total of 2.1 million beneficiaries in March 2020 to just under 3 million people qualifying for coverage in May of this year. Enrollment for children through age 18 grew by 213,653 beneficiaries during that time, state data shows.

Through October, DHHS reports 162,138 people in North Carolina have lost coverage as part of the redetermination process. The vast majority, about 87.5 percent, were disenrolled for procedural reasons, such as not returning paperwork.

It’s not clear how many of those are children.

As part of unwinding, states are required to share information on the process. However, only 21 states publicly break down disenrollments by age group, according to KFF, a foundation that focuses on health policy. North Carolina is not one of them.

In those states that do track by age, children accounted for about 4 in 10 disenrollments through Dec. 7, according to KFF’s analysis of data.

North Carolina does break down overall enrollment in Medicaid, including by age group. That dashboard shows there are about 53,000 fewer children covered under the program since unwinding began.

While North Carolina doesn’t track data on children disenrolled during unwinding, NC DHHS noted that “children historically retain coverage at recertification because income thresholds for them are higher and it is uncommon for their eligibility to change.” So, sometimes, even if a parent is not eligible for Medicaid, their children might remain in the program.

Before the COVID-19 public health emergency, “nearly 80% of children retained Medicaid coverage during the recertification process,” NC DHHS said.

One in four children disenrolled typically enroll again within 12 months, NC DHHS said, citing a 2021 study by the Duke Margolis Center for Health Policy.

The study’s authors added, though, that even short lapses in coverage, or “churn,” can have adverse effects on a child’s health.

The effects of ‘churn’ 

“Every day a child spends without coverage is a detriment to their well-being and a serious risk to their health,” pediatrician Valerie Smith said during the Center for Children and Families’ webinar last month.

Smith, who works at a clinic in Tyler, Texas, shared stories of families whose children have lost coverage already during unwinding. One boy newly diagnosed with attention deficit disorder could not get the medicine he needed. Medicaid had helped a young girl survive catastrophic acute kidney failure — but she recently lost coverage, and her mother doesn’t know what they will do if the daughter needs more care for her illness.

“We know that when someone is uninsured, they’re more likely to delay or go without the care they need,” Smith said. “This means that kids might be unable to get follow-up care for injuries and newly diagnosed chronic conditions, or they may be skipping doses of their medication.”

According to the Duke Margolis study, even short disruptions in insurance coverage mean children are “less likely to receive preventive care, and are more likely to seek emergency care for ambulatory conditions.”

Medicaid unwinding could also lead to wider racial and ethnic disparities in health insurance coverage, as children of color make up a disproportionate share of Medicaid enrollment and may face more barriers to staying covered, the Center for Children and Families said.

“It’s clear that when families have easier access to these programs, health outcomes for young people improve across the board,” Smith said.

Protecting children

In North Carolina, 9 out of 10 people who remain on Medicaid after going through redetermination have been approved through an “ex parte” process. In these cases, the state uses information from various programs to determine eligibility and automatically renews coverage.

The state is best in the nation for ex parte approvals, according to KFF.

That high rate helped minimize the impact on children being disenrolled through procedural determinations, where something as simple as not returning paperwork could lead to a coverage lapse, according to Cuello with the Center for Children and Families.

“Procedural determinations are much more harmful because you’re almost always terminating a kid who was eligible,” he said.

Cuello said the state is doing “a lot of things to reduce the harm.”

He also said the state should be commended for pursuing the various continuous enrollment options, which he called “the real long term solution to drive down the renewal termination rate.”

Alker also pointed to North Carolina as a good example for handling children during unwinding by extending their eligibility for another year.

“We hope more governors will think about doing that (to) protect children during the process,” she said.

The post NC pushes back Medicaid unwinding for kids appeared first on North Carolina Health News.

INFORME ESPECIAL: La muerte de José Arturo González Mendoza destaca problemas más amplios en el programa de visas H-2A para trabajadores agrícolas estacionales en Carolina del Norte.

La entrada Cosechando desigualdades: la realidad sistémica de los migrantes en los campos de Carolina del Norte se publicó primero en Enlace Latino NC.

By Will Atwater

Judging by recent developments, microplastics have risen to the status of supervillain. Reports about these new anti-heros read almost like celebrity sightings. The tiny particles are everywhere: in water, on land, on mountaintops, in humans and animals — and even in the clouds.

Microplastic compounds are defined as being less than 5 mm long, which is slightly larger than a sesame seed, but many microplastic particles are much smaller. These substances can last hundreds, even thousands of years in the environment. Globally, more than 430 million tons of plastic is produced annually. Some plastics break down into these microplastic particles, and a significant amount of them end up in the ocean, where marine animals swallow them and they enter the food chain, according to a report by the United Nations Environment Programme.

Chatter about the need for regulations to reduce the proliferation of this problem is growing louder by the day as reports about the adverse health and environmental impacts of microplastics have started piling up.

In November, researchers published studies suggesting more potential risks of microplastic exposure for humans, including a Duke-led study that suggests links between nanoplastic particles and a brain protein that may result in increased risk for Parkinson’s disease and some forms of dementia.

“Our study suggests that the emergence of micro and nanoplastics in the environment might represent a new toxin challenge with respect to Parkinson’s disease risk and progression,” said lead researcher Andrew West, from the Department of Pharmacology and Cancer Biology at Duke’s school of medicine. “This is especially concerning, given the predicted increase in concentrations of these contaminants in our water and food supplies.”

Previous studies have revealed that humans ingest about a credit card-size amount of microplastics weekly and suggested links between microplastic ingestion in people and Inflammatory Bowel Disease. There’s also some suggestion that microplastics alter how hormones function in the body.

Moreover, in October, the Guardian reported that Japanese researchers found microplastic particles in cloud formations around Mount Fuji and Mount Oyama. Researchers said that they found nine types of microplastics in cloud water, such as polyethylene (which composes plastic bags, food and drink containers), polypropylene (which makes up high heat tolerance plastics, cleaning products, pill bottles) and polyethylene terephthalate (PET/disposable drink bottles), among others.

The researchers said their “findings suggest that high-altitude microplastics particles influence cloud formation and, in turn, might modify the climate.”

One step forward, two steps back?

Environmentalists have sounded the alarm about the proliferation of single-use plastics for years and, to be fair, some government agencies and municipalities are making changes. In the United States, 10 states and Puerto Rico have banned single-use plastic bags.

As of June 2023, Surfrider, a nonprofit environmental advocacy organization that works to reduce the impact of plastic debris on beaches and oceans, “identified 491 U.S. local single-use bag ordinances.”

Additionally, the third meeting of the Intergovernmental Negotiating Committee (INC-3) took place in Nairobi, Kenya, earlier this month to continue work toward a treaty to reduce plastic pollution. A fourth round of talks (INC-4) is scheduled to take place in 2024.

“I am encouraged by the forward motion of the negotiations towards a treaty that ends plastic pollution,” said Inger Andersen, executive director of the United Nations Environment Programme, according to a release. He noted the INC’s “determination to get to the finish line and put us on course for a world where plastic pollution is a problem of the past.”

But not all attendees were as encouraged as Andersen.

Neil Tangri is the senior research fellow at the University of California-Berkeley Goldman School of Public Policy and the founder of GAIA, an environmental advocacy group working to promote zero-waste cities. Tangri was disappointed that microplastics “were hardly addressed” at INC-3, he said by email.

“There is a widespread recognition of the need to ban primary microplastics (e.g., beads in personal care products and detergents),” he said in an email to NC Health News. “This is really low-hanging fruit and beyond obvious; many jurisdictions have already done so, but we need a global ban. But some countries are arguing that plastic production is out of scope of the treaty — which would mean that we couldn’t ban particular products such as primary microplastics.”

“Of course, the vast majority of microplastics in the environment are the result of physical breakdown of plastic products — e.g., tire wear or macroplastic waste that breaks down in the marine environment. Again, if we exclude production from the scope of the treaty — meaning we can’t reformulate plastic products to minimize microplastic generation, or ban the items most likely to end up in the environment — we end up with a waste management treaty, and there is no effective waste management solution to microplastics.”

Is it enough to move the needle at home?

While work is underway to reduce plastic pollution, North Carolina has yet to establish any regulations on plastic bags — despite the efforts of environmentalists.

The momentum gained by North Carolina advocates working to curb the use of single-use plastic bags in Durham, Boone and Asheville screeched to a halt in September when a provision in House Bill 259 that prohibits local municipalities from establishing plastic bag ordinances became part of the state budget.

Efforts to establish a plastic bag ordinance have been a polarizing topic since 2009 when former Democratic state Sen. Marc Basnight of Dare County introduced legislation that called for a ban on single-use plastic bags in retail stores in Outer Banks communities. Basnight’s family runs a restaurant in Nags Head, and the late senator was deeply involved in the coast’s tourism industry.

The legislation passed, and a ban was set in place from 2009 until 2017, when a Republican-led legislature repealed it. Critics argued that the ban unfairly taxed merchants who had to offer $.05 cent refunds or other incentives for customers who shopped with reusable bags. They also argued that paper bags were worse for the environment than plastic.

More data, more awareness

In 2022, some North Carolina riverkeepers began installing trash traps in creeks and streams to count and categorize pollution that collects there. A public dashboard contains data on debris removed from 11 waterways across the state, according to dashboard producer Nancy Lauer, a Duke Environmental Law and Policy Clinic staff scientist. The dashboard is on the Haw River Assembly website.

“The trash traps are important because they physically trap trash before it moves downstream, but when we can also collect data on what the traps are capturing, we are better equipped to keep the trash out of the waterways to begin with,” Lauer said. “The data tells us what plastics are frequently getting into waterways and what the sources of those escaped plastics might be.”

For instance, volunteers removed nearly 40,000 pieces of litter from Durham’s Third Fork Creek from June 2022 to November 2023. Of that amount, 82 percent of the debris was Styrofoam fragments, followed by plastic bottles.

Data collected from Boone’s Winkler Creek from June 2021 to February 2023 shows that volunteers removed 8,000 pieces of debris, and Styrofoam fragments comprised 72 percent of the trash.

The amount of Styrofoam fragments found in the two creeks alone is a concern to West because, in the Parkinson’s disease study, he and colleagues discovered that polystyrene, the source material for Styrofoam, bonded aggressively with a brain protein known as alpha-synuclein.

“Charged polystyrene contaminants are among the most toxic in the biological systems we use to study these diseases,” West said.

“Whether it’s lead pipes or different types of toxins that we find out later do more harm than good, I could certainly imagine polystyrene being added to that list as we [discover] what these particles can do,” he said.

Barbara Doll, N.C. State University Agricultural Extension professor and professional engineer, co-authored a study that looked at the distribution and characteristics of microplastics found in the Neuse River Basin.

“When we looked at the microplastics [and] characterized them for type, our main microplastic components were polystyrene, polypropylene, and PET (plastic bottles),” Doll said. “There’s a link [between] the garbage and the microplastic types.”

One of Doll’s goals through her research is to raise awareness.

“I wanted to establish that [microplastics] are coming from the garbage that everyone is throwing out of their car window on the ground or is blowing out of trash cans — this incredible prevalence of plastic in our everyday lives,” she said. “[It’s like], ‘Hey, this is what’s getting washed in the streams, floating through small creeks, down the river and getting out into our food resource.”

The post From creeks to clouds: The invisible invasion of microplastics appeared first on North Carolina Health News.

La expansión de Medicaid en Carolina del Norte inicia hoy, ampliando la elegibilidad a cerca de 600,000 personas, de las cuales se estima 50,000 son hispanos o latinos.

La entrada Expansión de Medicaid en Carolina del Norte: impacto en la comunidad latina y zonas rurales  se publicó primero en Enlace Latino NC.

By Liz Carey,

The Daily Yonder

Rural residents as a group live farther from dialysis treatment facilities than their urban counterparts. Given that rural America generally scores lower on health care access, that’s not a surprise.

But there is some unexpected news in a new study of dialysis access. One of the chronically medically underserved populations in rural America, African American residents, on average live closer to dialysis facilities than white residents do.

Jan Probst, a researcher at the Rural and Minority Health Research Center in South Carolina, has spent a career in medicine. She says she remembers being part of medical boards that decided who got certain treatments like dialysis and who didn’t. Her latest research looked at where dialysis centers are located and who lives in those areas, then compares the findings to similar past studies.

Dialysis is used to clean the blood when kidneys fail, also known as end stage renal disease. Those failures can be caused by diabetes and high blood pressure, among other things. Patients come to dialysis facilities and spend hours hooked up to machines that remove the blood from their body, filters it through an artificial kidney, and returns it to the body.

In her latest study, Probst looked at who lived in the areas around dialysis centers. What she found was that rural residents have to travel farther to get to dialysis treatment facilities.

This isn’t unexpected, she said. In the rural Southeast and Southwest, greater distances between communities mean those residents have to travel farther to get to their treatments. Rural residents, on average, have to travel just over 14 miles to get to the nearest facility. In contrast, urban residents live about 4.5 miles from the nearest dialysis center.

That’s a vast improvement from the last time Probst did the same research in 2013. In that study, rural residents in general had to travel about 40 miles to get to a dialysis facility.

But, the research found, one group, rural African Americans, was closer to dialysis facilities than any other racial group. On average, rural African Americans were only about 10.5 miles from a dialysis facility, while rural white residents were about 16.6 miles away. The study found that nearly three quarters (70%) of rural African American residents live within 15 miles from a facility, while less than half of white residents do. Only 42% of rural Hispanic residents and 39% of rural American Indians or Native Alaskans live within 15 miles of a dialysis facilities.

Funding changes improve access

The increase in access to dialysis centers isn’t solely due to need, Probst said. Since her 2013 study, how dialysis is funded has changed. Now, federal policy requires Medicare and Medicaid to pay for dialysis treatments. And once Medicaid and Medicare guaranteed payment, Probst said, the market responded, shifting most dialysis care to for-profit chains who entered areas knowing they were going to get paid. So, for-profit dialysis treatment facilities started popping up in areas with higher concentrations of patients who need the services.

Dialysis is expensive, Probst said. At current levels, dialysis and treating ESRD takes up about 7% of the Medicare budget, she said. Even for people who are insured, if a patient or their spouse has a sufficient work history, Medicare covers dialysis (or a kidney transplant) starting the fourth month of treatment.

So, providers put dialysis facilities in areas with higher concentrations of patients, she said. But, because these areas also tend to have limited access to other health services, which affects their ability to manage the illnesses that can lead to ESRD like diabetes, they are more likely to need dialysis. Lacking care for diabetes, she said, is a reason many rural African American residents develop end-stage renal disease.

Barriers remain

Still, even with dialysis centers closer to rural residents than they were in the past, there are barriers to care that may prevent patients from gaining access to the treatment they need.

“Dialysis is three times a week, and you have to sit there for like three hours,” she said. “That is a big time commitment for the persons or for their family members who are driving them.”

Additionally, dialysis facilities usually don’t have evening and weekend hours, increasing the amount of time taken off work for patients and their care providers. The burden dialysis places on rural patients would make maintaining any kind of job extremely difficult, she said.

“I suspect that for most of these folks that is not feasible, and they probably also have multiple things to deal with,” she said. “They’ve lost their kidneys, but they still have to deal with their dialysis. There’s a lot going on.”

This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.

The post Public payment of dialysis treatment has changed the rural health care marketplace appeared first on North Carolina Health News.

By Taylor Knopf

Later this month, a new 54-bed youth psychiatric hospital in Butner will open its doors to help North Carolina’s children and teens struggling with mental health issues.

The UNC Hospitals Youth Behavioral Health facility will include specialized units for patients with co-occurring mental health and substance use disorders, as well as a unit dedicated to serving children with intellectual and developmental disabilities with mental health needs.

Additionally, hospital leadership say they intend to take a whole-family approach to treatment and will offer family therapy services.

Over the past year, UNC Health and the N.C. Department of Health and Human Services has repurposed and renovated a former state-run substance use treatment facility to serve the growing number of adolescents showing up at emergency rooms across the state in mental distress.

“It was just in December, when we announced this opportunity. And here we are less than a year later about to cut a ribbon. … That is wild fast,” DHHS Secretary Kody Kinsley said. “It is also in recognition of the great need that our state has.”

During the pandemic, hospital emergency staff across the state reported record numbers of children in need of mental health support, at times tripling pre-pandemic levels.

“Truly, the mental health of our children and adolescents is the most pressing issue for our state and its future health,” said Wesley Burks, CEO of UNC Health and dean of UNC School of Medicine, at a ribbon cutting ceremony for the new facility on Tuesday.

“It was a problem way before the pandemic started. But during the pandemic and now, it really has reached dire levels,” he said. “Today is only a first step in what we need to do to address these issues.”

While health experts and families agree that the E.R. isn’t the safest or best place for kids in need of psychiatric care, it’s where many parents — often as a last resort — bring their children. And sometimes the wait for an inpatient bed can end up being weeks, particularly if a child has more complex needs, such as a disability or co-occurring substance use disorder.

The new youth psychiatric hospital hopes to offer a space designed to treat those patients.

Specialized units

The facility will consist of four units: a general child and adolescent unit; one for patients with more severe mental health issues; a unit for patients with co-occurring substance use and mental illness; and a unit for patients with intellectual and developmental disabilities.

There are also therapists from several disciplines working at the hospital, including music therapy, art therapy, yoga movement therapy, activities therapy, occupational therapy and child-life therapy.

“With novel approaches, integrating cutting-edge research that will have recreational therapy, art therapy, music therapy, family therapy, we will be one of the only units in North Carolina — and very few in the country — that will have a dedicated unit for children and adolescents with neuro-behavioral psychiatric issues,” said Samantha Meltzer-Brody, UNC Department of Psychiatry chair.

Music therapist Ashley Taul said because music can be a huge part of kids’ identities, it is often a great way to connect with them.

“They get their phones taken away and their music taken away, so to be able to offer some sort of normalcy to these kids is really important,” Taul said, a guitar slung over her shoulder. “So I do a lot of music listening interventions. We’ll play some drums. We’ll do songwriting. We’ll do music listening. I love doing a good lyric discussion. All these different kinds of things you can work on through music.”

Occupational therapy is also part of every unit, with one-to-one and group sessions. The units have a “quiet room” filled with tools like fidget devices, rocking chairs, weighted blankets and noise canceling headphones. If a patient is feeling overwhelmed or struggling to regulate their body and emotions, the tools in these rooms are designed to help them cope.

Tyler Harrell, an occupational therapist and therapy supervisor at the hospital, said ideally patients will learn to recognize when they need these interventions and request them. Harrell came to the new facility from the state-run psychiatric hospital across the street, Central Regional. Before that he worked with children with autism in Wake County public schools.

He said he’s looking forward to the opening of the unit for kids with intellectual and developmental disabilities, adding that it will be the last to open due to the increased training those staff will receive and some of the unique sensory equipment the hospital plans to install on the unit. These are the patients who tend to wait in emergency departments the longest for inpatient psychiatric beds because health professionals in many facilities don’t have the skills or training to help them, he added.

“I’m really happy that we’re filling a gap and kind of filling the need,” Harrell said.

The family-integration piece will also be huge for this population, he said. He added that the child-life specialists will be working with parents and siblings to ensure that each child has the best possible transition home after hospitalization.

A promise to families

Over years of reporting on mental health issues, NC Health News reporters have often heard from families of children in crisis who feel as though they’re cut out of the treatment process.

Parents of children in inpatient psychiatric facilities have often said they want to be more involved and know what’s going on with their child’s care. Many have said they don’t feel as though they have a good plan for support and continued recovery when their child comes home from the hospital.

Leaders of the new youth psychiatric hospital promise to instead take a whole-family approach to treatment.

“It’s the individual and the parents that suffer terribly when they can’t get care. And that weighs very heavily on all of us,” Meltzer-Brody said. “We have taken great strides here to ensure family members will play a vital role in the treatment.”

The new facility will also include virtual and in-person family therapy, she said.

“So that every child has the best opportunity to return home safely, that their family is part of the treatment plan and that they can get better as quickly as possible,” Meltzer-Brody added. “To our families — we want you to be able to trust us that we will care deeply and safely for your child so they can learn critical coping skills and recover in a sustained way so they can return home to you and move forward for a bright future.”

UNC child psychiatrist Jim Bedford said family involvement during treatment and during the hospital discharge process is vital for a child’s mental health recovery.

“One of the things that can make an inpatient stay the most meaningful is if the rest of the community-based [mental health] system rallies around the child and says, ‘This child has tremendous support needs and and we need to reach out to the child and family and offer more resources when they come out of the hospital,’” he said.

“That helps to make it the forward path toward a sustained recovery and prevent rehospitalization.”

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