 Tending to a newborn baby in the UNC Charlotte Nursing Center (Karen Haar) |
Sexually Transmitted Diseases, Including HIV/AIDSInfant Mortality |
Two very different but geographically similar patterns of health care problems continue to plague North Carolina and can be placed into the general category of lingering social issues. The first of these problems is infant mortality. While tremendous progress has been made nationally as well as within North Carolina with respect to decreasing rates of infant mortality, North Carolina still has severe problems in this area. The second health issue of a social nature that will continue to burden North Carolina's health care system consists of sexually-transmitted diseases, including HIV/AIDS. While it initially may appear that these health problems are very different in nature, there are some striking geographical similarities due to associations of HIV/AIDS and other STI (Sexually Transmitted Infections) rates with lower income groups. Infant mortality has long been identified with populations at or below poverty levels.
North Carolina has historically had a higher rate of sexually transmitted diseases than other parts of the country, a phenomenon characteristic of much of the “Deep South.” These diseases include infections from congenital syphilis, primary and secondary syphilis, gonorrhea, and more recently, chlamydia and HIV/AIDS. While syphilis and gonorrhea rates in North Carolina have declined over the past decades, overall rates continue to be higher than the national average. Declines have been the most substantial for syphilis, but, North Carolina’s gonorrhea rate continues to be well above the national average. As in many other parts of the country, chlamydia rates are on the increase, especially among college age populations of all races. The distribution of significant sexually transmitted diseases, including HIV/AIDS, is shown within Figure 7. The heaviest concentrations of higher average reporting for the 1997-2001 period are clearly in the Coastal Plain, but there are many counties with higher than average rates reporting in the eastern Piedmont. Social conditions, especially poverty, have long been linked to sexually-transmitted diseases, and this circumstance seems to hold for North Carolina with the exception of many poorer Mountain counties with traditionally lower rates for these diseases.
As the dominant public perception of HIV/AIDS in the United States as a problem for persons living deviant, socially unacceptable lifestyles has abated, this disease issue has become an increasing focus for socially marginalized populations. While the risk of contracting the disease has spread out from earlier geographical clusters into virtually all strata of society, current concentrations indicate a health problem for the economically deprived. During the 1980s and mid-1990s, the disease progressed and then started to decline, while the linkage between HIV/AIDS and poor and socially disadvantaged people has become stronger. The spread of HIV/AIDS into and among disadvantaged populations came as no surprise to those familiar with the geography of disease and health care systems. The distribution of deaths from HIV/AIDS for the time period 1999-2001 (Figure 8) demonstrates the socioeconomic connection. Since the information contained within Figure 8 contains actual deaths rather than existing cases (prevalence) or new cases (incidence), as those combined with other STIs in Figure 7, the effects of poverty on HIV/AIDS deaths is unmistakable.
Infant mortality has long been considered a key indicator of social conditions. It is defined as the number of children who are born alive but who die within the first year. Infant mortality rates often are used as a general indicator of both health and socioeconomic conditions in a population since the rates are affected by a host of factors, including access to pre- and post-natal care. Within the United States there has been a direct relationship between lower income and education levels and higher rates of infant mortality. Consequently, regional differences in infant mortality patterns seem to endure because of differences in these socioeconomic conditions. In 1980, the infant mortality rate for North Carolina was 14.4 per 1000 live births, and by 2001 it had declined to 8.5. The national average continues to decline as well, and now the gap between North Carolina and the U.S. is about 2 infant deaths per 1000 as opposed to 4 two decades ago. Reasons for both state and national success in combating infant mortality include improved prenatal care, declining teen birth rates, less smoking during pregnancy and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Figure 9 displays patterns of infant mortality rates for 2001. Many of the counties with the highest infant mortality rates continue to be located in the Coastal Plain in conjunction with poverty pockets. Unlike HIV/AIDS, there are also scattered areas in the Mountains with high infant mortality rates. Many of North Carolina’s most urbanized areas report about average rates, while some of our more rural counties demonstrate lower than average rates.
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