North Carolina Children's Environmental Health Profile

Did you know 13.9% of children under 18 in North Carolina have ADHD or ADD (compared to the National average of 8.9%) in 2019-2020? Or that 43% of children under age 18 live in counties that do not monitor ozone pollution? There are 2.3 million children in North Carolina, and approximately 20% of them live in poverty. Poverty is an important social determinant of health; poverty hurts children and their families. Children of color and young children are disproportionately poor and experience many issues that lead to adverse health outcomes. All children deserve a safe and healthy environment to grow and develop.

This profile highlights key North Carolina children's environmental health indicators, federal support received by the state for environmental health, health equity and climate and health programs, and a spotlight feature in a children's environmental health-related topical issues.

Continue reading to learn more about environmental hazards, children's exposures, and children's health outcomes in North Carolina, or click the blue button to download the profile as a PDF.

Key Children's Environmental Health Indicators for North Carolina

What is a Children's Environmental Health Indicator?

See Indicator References

Safe Drinking Water: 22% of public water utilities had drinking water violations (2020)
National average: 31%
Air Quality: 43% of children under age 18 live in the 68 (out of 100 total) counties that do not monitor ozone pollution (2021)
Warming Temperatures: 2.5 degrees F warmer in 2020 than in 1970.
National average 2.8 degrees F warmer
Toxic Chemical Releases: 55 million pounds of toxic chemicals were disposed of or released (2020).
United States 3.1 billion pounds
Asthma: 7.1% of children under age 18 have asthma (2018- 2019)
Nationwide: 7.7%
Pediatric Cancer: 172.8 cases of pediatric cancer per 1 million population (2005-2015)
Nationwide: 181.0 cases per 1 million
Blood lead levels: 1.2% of tested children under age 6 have elevated blood lead levels (2018).
Nationwide: 2.6%
Neurodevelopmental Disorders:

13.9% of children age 3-17 have ADD or ADHD (2019-2020).
Nationwide: 8.9%.

3.2% of children age 3-17  have Autism Spectrum Disorder (2019- 2020)
Nationwide: 2.9%

North Carolina Spotlight: 

Research shows that children today will face around three times as many climate disasters as their grandparents did, including wildfires, storms, floods and droughts. Aggressive reductions in greenhouse gas emissions are needed to protect children and future generations from the health effects of these impacts. A 2018 North Carolina executive order established climate and clean energy goals to achieve by 2025, including reducing statewide greenhouse has emissions to 40% below 2005 levels. According to the U.S. Solar Market Insight Report, NC ranks 3rd in the nation for total solar power as  of the end of the first quarter of 2021.

The North Carolina Department of Health and Human Services (DHHS)has listed impacts to children among the top priorities to be addressed in its statewide climate resilience strategy. The state has an Early Childhood Action Plan which outlies a cohesive vision, sets benchmarks for impact by the year 2025, and establishes shared stakeholder accountability to achieve statewide goals for young children from birth through age 8. As of March 2021, the NC DHHS has been working on an addendum to the Early Childhood Action Plan that would focus on assessing and addressing the impacts of climate change on young children through the lens of health equity.

Federal Support to North Carolina within the past 5 years (click to expand):

CDC-funded Climate-Ready States & Cities Initiative
CDC-Funded Lead Poisoning Prevention Program
ATSDR State Cooperative Agreement Program
CDC National Asthma Control Program
CDC-funded Environmental Public Health Tracking Program
CDC State Biomonitoring Cooperative Agreement Program

Children's Environmental Health Indicators Selection Criteria (click to expand):

Children's environmental health indicators (CEHIs) are measures that can be used to assess environmental hazards, exposures, and their resulting health outcomes in children. The below criteria are used when determining which indicators to utilize:
    • Relevance: Each headline indicator should be a clear, understandable indicator of children’s environmental health, with broad relevance for a range of audiences at the state level – with relevance to the national level.
    • Representativeness: The indicators as a package should provide a representative picture of children’s health and relation to the environment.
    • Traceability: Each indicator should be calculated using an agreed-upon (and published) method and accessible and verifiable data.
    • Timeliness: Each indicator should be calculated regularly (at least biennially), with a short lag between the end of the period and publication of the data.
    • Data adequacy: The available data needed for the indicator must be sufficiently robust, reliable and valid.
    • Universality: Indicators must be comparable across all or very nearly all 50 U.S. states.

Indicator Notes and References (click to expand):

Air Quality

Warming Temperature

Toxic Chemicals
  • Indicator Note: EPA's Toxics Release Inventory (TRI) tracks the management of certain toxic chemicals that may pose a threat to human health and the environment. Certain industrial facilities in the U.S. must report annually how much of each chemical is disposed of or released on and off site. Many of these chemicals are known carcinogens, developmental toxicants, and neurotoxicants, such as arsenic, lead and mercury, that adversely impact children's health.
  • Reference: Summary of 779 Toxic Release Inventory Facilities in North Carolina. Reporting Year 2020.

Neurodevelopmental Disorders


Pediatric Cancer

Blood Lead Levels
  • Indicator Note: Often the most vulnerable children are not tested, and not all who are tested get reported, so 1.2% is likely an underestimate of the true scope of children's elevated blood lead in North Carolina. There is no safe level of lead exposure for children. A potent neurotoxicant, lead reduces IQ and impairs other cognitive, behavioral and developmental functions. In 2021, the CDC lowered the BLL reference value from 5 to 3.5 µg/dL.
  • Reference: National Childhood Blood Lead Surveillance Data. 2018. Centers for Disease Control and Prevention..

All children deserve and need a safe and healthy environment to grow and develop. They need clean air to breathe, safe water to drink, nutritious food to eat, and healthy places in which to live, learn, and play. Early exposure to harmful agents can lead to acute and chronic adverse outcomes. Infants and children are especially vulnerable to environmental exposures because they breathe, eat and drink more, in proportion to their body size, than do adults, and because their bodies and brains are still developing.

A blueprint for Protecting Children's Environmental Health Network set out to identify a set of CEHIs that can be used to provide an understanding of children's environmental health at the state level. Through this process, CEHN found that robust, valid, and regularly updated state level data--that are comparable across most states--were not readily accessible. States need adequate funding and capacity to collect and make accessible reliable CEHI data in order to set goals and track progress towards improving children's health.

Children are our future - society has a moral obligation to protect them. Exposure to environmental hazards can and must be prevented. Prevention requires strong environmental regulations, fully funded and supportive public and environmental health programs and a robust workforce.

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