📊 Middle-Tier Health Status

North Carolina ranks 30th in overall health among U.S. states according to America’s Health Rankings 2024, positioning it in the middle tier of American health outcomes. With a population of approximately 10.84 million (9th largest), the state shows mixed health indicators.

However, North Carolina’s life expectancy has declined significantly from 76.1 years in 2020 to 74.9 years in 2021 – a drop of more than a year that outpaced the national decline. The state now ranks 36th nationally in life expectancy.

💊 Drug Overdose Crisis

North Carolina is experiencing a severe drug overdose epidemic. From 2000-2023, more than 41,500 North Carolinians lost their lives to drug overdose. In 2024, an estimated 3,025 people died from overdoses – about 8 people per day.

The crisis has worsened dramatically, with an 89% increase in overdose deaths from 2018 to 2022 (from 2,301 to 4,339 deaths). The rate per 100,000 residents nearly doubled from 22.2 to 44.1 during this period.

This epidemic primarily affects younger populations and has significantly contributed to the state’s declining life expectancy. Overdose is the leading cause of death among people experiencing homelessness in North Carolina.

🤱 Maternal Health Crisis

North Carolina faces significant maternal mortality challenges. In the 2018-2019 period, mental health conditions were the leading cause of pregnancy-related deaths, comprising nearly one-third of all cases (31.6%).

Twenty pregnancy-related deaths were attributed to overdoses, with nearly all involving opioids (18 of 20), and fentanyl noted in 14 cases. For non-Hispanic Black individuals, increased pregnancy-related mortality was associated with a rise in pregnancy-related homicides.

More than half of pregnancy-related deaths occurred during pregnancy, delivery, or within 42 days postpartum.

✅ Health Strengths

North Carolina demonstrates several health advantages:

• Relatively low levels of frequent mental stress
• Low black/white residential segregation
• Good air pollution levels
• Strong physical environment ranking (9th nationally)
• Heart disease mortality below national average

⚠️ Ongoing Challenges

Despite improvements, North Carolina faces several persistent health challenges:

• High premature death rate
• Low supply of dental care providers
• High uninsured rate
• Above-average rates for stroke, kidney disease, and diabetes mortality
• Significant racial and geographic health disparities

⚠️ Insurance Recommendations

Given North Carolina’s health challenges, including elevated stroke, kidney disease, diabetes, and overdose rates, IBUSA typically recommends helping residents first qualify for term life insurance with no exam.

For those unable to qualify for no-exam policies, fully underwritten life insurance policies with top companies remain viable options.

Applicants with significant pre-existing conditions may need to consider guaranteed issue life insurance policies.

Due to North Carolina’s above-average vehicle death rate (15.3 per 100,000 vs national average of 11.9), residents should consider purchasing accidental death coverage to supplement traditional life insurance.

📍 Significant Health Inequities

North Carolina faces pronounced health disparities across racial and geographic lines:

• Infant Mortality: African American babies are 2.4 times more likely to die than white babies
• Diabetes Deaths: African Americans are 2.3 times more likely to die from diabetes than whites
• Geographic Variation: Life expectancy ranges from 73.1 years in Swain County to 82.1 years in Orange County
• Rural vs Urban: Significant differences in healthcare access and outcomes between rural and urban areas

🎯 Healthy North Carolina 2030

North Carolina has set an ambitious goal to increase life expectancy to 82.0 years by 2030. The North Carolina Department of Health and Human Services is focusing on three key priorities through 2024:

• Investing in behavioral health and resilience
• Supporting child and family well-being
• Building a strong and inclusive workforce

🏥 COVID-19 Update

North Carolina performed relatively well during the COVID-19 pandemic, with the 8th lowest death rate nationally in 2020. Through 2021, the state maintained rates about 30% below the national average. COVID-19 has since dropped from the top leading causes of death by 2024.

Data Sources

Centers for Disease Control and Prevention, National Center for Health Statistics, 2024-2025

America’s Health Rankings, United Health Foundation, 2024 Annual Report

North Carolina State Center for Health Statistics, 2023-2024 Vital Statistics

NC Department of Health and Human Services, Overdose Epidemic Data 2024

North Carolina Maternal Mortality Review Committee, 2024 Report

USAFacts, Leading Causes of Death Analysis, 2024

ncIMPACT Initiative, State of NC Health Report, 2024

U.S. Census Bureau, Population Estimates, 2024-2025

County Health Rankings & Roadmaps, 2024-2025