North Carolina General Assembly Research Articles

Assessing Local Public Health Governance in North Carolina Across Organizational and Governance Configurations.

Every county in North Carolina must include a board of health (BOH) with specific prescribed duties and powers. It is unclear how BOHs in North Carolina are currently exercising their governance ability. In 2012, the North Carolina General Assembly provided coun-ties with additional flexibility to select among different configurations for their local health department (LHD). The impact of this flexibility on the governance and service delivery of LHDs is yet to be explored. We conducted semi-structured interviews with LHD directors and BOH members to assess the strengths and weaknesses of BOHs within different local public health configurations across North Carolina. We employed conventional content analysis to derive themes from the interview transcripts. BOHs were largely described as an underutilized institution, with few BOHs noted to be active beyond satisfying their required legal duties. Strong BOHs were noted to fulfill three identities on behalf of the LHD: an advocate, a bridge, and an advisor. The majority of interviewees desired to work in a standalone county health department (as opposed to a consolidated human services agency) with an appointed (versus elected) board of health. This configuration was preferred because, according to participants, it is more likely to enable a structural focus on public health initiatives. Our sample frame did not control for the length of time an interviewee had been in the office nor the professional background of each BOH member. Wide variations exist in the exercise of BOHs across the state, partially due to how different LHD configurations structurally focus resources and attention on public health.

In North Carolina, Coastal Towns Face An Ethical Dilemma as To Who Shall Pay For Debt Service and Operating Expenses Of Their Sewer Systems

In North Carolina, coastal towns that need to generate additional enterprise revenue to pay debt service and operating expenses of their sewer systems face an ethical dilemma as to who shall pay. Certain North Carolina coastal towns, including the Town of Oak Island (“the Town”), have been delegated the authority by the North Carolina General Assembly to generate non-operating enterprise revenue by imposing a Sewer Treatment Fee/Tax against owners of parcels that “could or [do] benefit from the availability of sewage treatment.” SECTION 4 of S.L. 2004-96 (as amended by S.L. 2006-54). In the alternative, to generate additional operating revenue, Towns could raise the rates that sewer users of developed parcels pay to receive sewage collection and treatment services. In this case, the sewer user and the owner of a developed parcel have a different legal relationship, although they may be the same person. The sewer user contracts with a town for the receipt of sewer collection and treatment services. In contrast, owners of undeveloped parcels pay taxes, both ad valorem taxes and taxes for a local benefit. Similar to the owner of a developed parcel, the owner of an undeveloped parcel pays taxes, both ad valorem taxes and taxes for a local benefit. However, the owner of an undeveloped parcel cannot also be a sewer user because the undeveloped parcel generates no sewage and, as a result, cannot benefit from the receipt of sewage collection and treatment services.

Jim Crow in North Carolina: The Legislative Program from 1865 to 1920 by Richard A. Paschal

Reviewed by: Jim Crow in North Carolina: The Legislative Program from 1865 to 1920 by Richard A. Paschal Abel A. Bartley Jim Crow in North Carolina: The Legislative Program from 1865 to 1920. By Richard A. Paschal. (Durham, N.C.: Carolina Academic Press, 2021. Pp. xx, 297. Paper, $29.00, ISBN 978-1-5310-1771-3.) In Jim Crow in North Carolina: The Legislative Program from 1865 to 1920, Richard A. Paschal crafts an interesting narrative about how Jim Crow legislation impacted North Carolina. The book documents the way race-based laws constructed by the North Carolina General Assembly shaped race relations in the state from Reconstruction through 1920. Traditionally, North Carolina was viewed as a moderate southern state with decent race relations and abundant educational opportunities for African Americans. Paschal attacks that narrative, deconstructing North Carolina's exceptionalist claims by showing that North Carolina maintained a virulently racist system throughout the post–Civil War period. North Carolina's Jim Crow laws were not the foundation of the state's discriminatory system; they instead simply confirmed the established customs that buttressed the white power structure in the state. Paschal pulls no punches as he questions the various theories about the origins of segregation. He acknowledges that C. Vann Woodward, Joel Williamson, and Howard Rabinowitz each supply partial answers to the origins of segregation, but none answers all the questions. Paschal questions Woodward's theories espoused in his classic work The Strange Career of Jim Crow (3rd rev. ed.; New York, 1974). Woodward argued that segregation came about as a result of the Democratic redemption of the state and the desire to end the challenge from the Populist movement. Paschal says that segregation and discrimination were prominent features of North Carolina life even during slavery, although he acknowledges the power of the Populist movement in the state. White North Carolinians did not need new legislation to enforce their racist actions. They relied on violence, chicanery, and intimidation to ensure white dominance of the state. The end of slavery created new expectations about race and social etiquette in the South. Woodward suggested that African Americans and whites mingled freely in economic and political matters during Reconstruction. Legalized racial segregation was a relatively new aspect of southern life. White North Carolinians turned to chicanery when they realized they could not win at the ballot box. [End Page 400] Paschal utilizes lists of laws to make his argument that between 1865 and 1920 North Carolinians were busy codifying white supremacy in the state. To make his point, the author explores several areas of social life, from politics and voting to school segregation, asylums, lynching, and juries. Between 1898 and the 1900s, white Democrats used violence, intimidation, and discriminatory laws to finally drive African Americans from the ballot box. They used discriminatory screening to block African Americans from the jury box. The lack of jury representation wreaked havoc on African Americans trying to get justice in the courts or challenge the new legal realities. North Carolinians refused to fund insane asylums, but they monitored private funds to ensure African Americans and whites were housed in separate facilities. Paschal notes that until 1885, when it was outlawed, North Carolina utilized a dual taxing program to ensure that white schools had more funding than African American schools. Paschal has written a wonderful book, which is a must-read for those interested in how Jim Crow developed and spread in North Carolina. North Carolina clearly was no different from other southern states. Paschal's writing is engaging, and the scholarship is impeccable and very thorough. However, the list of laws can be tedious at times, but if the reader takes the time to study them, they add to the arguments. In conclusion, I strongly recommend this book to anyone interested in North Carolina's or America's complicated racial past. Abel A. Bartley Clemson University Copyright © 2022 The Southern Historical Association

From Research to Policy: Reopening K-12 Schools in North Carolina During the COVID-19 Pandemic.

School-aged children experienced substantial challenges to health and well-being as a result of school-building closures due to the coronavirus disease 2019 pandemic. In hopes of supporting equitable and safe school reopening for every student across North Carolina (NC) and improving child health, researchers from Duke University and the University at North Carolina at Chapel Hill established the ABC Science Collaborative (ABCs) in July 2020. The ABCs collected data related to in-school severe acute respiratory syndrome coronavirus 2 transmission and adherence to mitigation strategies. These data were presented to NC government officials, including the NC Department of Health and Human Services, the NC Department of Public Instruction, and Democratic and Republican representatives from the NC General Assembly. These data-sharing practices led to the implementation of in-person school legislation in early 2021 in which in-person school access for every student was required, the full-time in-person reopening of NC public schools was supported, and weekly reporting to the ABCs of coronavirus disease 2019 infections from >1 000 000 children and adults was required.

Youth Suicide Legislation in the 2019 Session of the North Carolina General Assembly.

Youth Suicide Legislation in the 2019 Session of the North Carolina General Assembly.

Legislative Gaps in Addressing Rural Women’s Access to Obstetric Care in the United States: A Case Study of the North Carolina Home Birth Freedom Act

Rural women in the United States face numerous barriers to accessing obstetric care. Hospitals and obstetric wards in rural areas are closing, and there is a shortage of rurally-located obstetric care providers. Recent experience in North Carolina provides insight into current legislative barriers to improving rural women’s access to obstetric care. In 2015, legislators in the North Carolina General Assembly unsuccessfully advocated for the Home Birth Freedom Act, which would have allowed certified professional midwives to practice in the state.While the Home Birth Freedom Act would have helped to address rural women’s access to care, it would not have been sufficient. This analysis describes why rural women’s access to obstetric care is limited and offers recommendations to expand access to care by providing certified nurse-midwives with more autonomy, appropriating funds to place obstetric care providers in rural areas, and improving Medicaid reimbursement rates.

NC BEACH AND INLET MANAGEMENT PLAN: AN EVALUATION OF A DEDICATED BEACH NOURISHMENT FUND

The North Carolina General Assembly started the process for the original NC Beach and Inlet Management Plan (BIMP) in 2000 (HB 1840 Section 13.9c), with completion of the document occurring in 2009. The General Assembly passed legislation to update the BIMP in 2015 (HB 97) to review new coastal and socio-economic data driven by policy changes created since the original document. The NC Department of Environmental Quality (NCDEQ) served as the managing agency for both the original and updated BIMP studies.

Does the United States Need a Coordinated National Energy Policy?

The question this work attempts to answer is, whether a single, Unified and Coordinated National Energy Policy would serve a better purpose or, having every state in the United States regulating its own regional energy policy, is the best economic and environmental way to regulate energy?The North Carolina Energy Policy Act created the Energy Policy Council, within Their Department of Commerce, to advise and make recommendations on Energy Policy to the State Governor and the North Carolina General Assembly and to serve as the state's central energy policy planning body. Here we see that the State of North Carolina regulating its own. Many states in the country are doing the same. This is not unusual as this work will show. Cases have been made for, and against a single, unified, nationally coordinated energy policy, as this work will show.What are the challenges we face in this quest for a nationally unified energy policy? What is the place for renewable energy sources? Does the United States give fossil fuel energy sources and industry preferential treatment, as we have seen here during the George W. Bush Administration, at the expense of the renewable energy sources? This work attempts to answer the above questions.This work can be of interest to Energy Lawyers, Oil & Gas Lawyers, Renewable energy industry management and personnel, Energy Law and Management students, Energy Law Professors, and Energy Law Students alike.

A Second Look at Georgia's Revised Intrastate Crowdfunding Rules

At the time of the earlier SSRN article about Georgia, it was not public knowledge of the role of NASAA, or the N. C. Secretary of State, in coordinating the political efforts across state and national boundaries. The N. C. Secretary of State had decided to keep her initiatives at NASAA secret, and hidden from the public, including the members of the North Carolina General Assembly, where she had attempted to pass her version of the bill in 2013, and again in 2015.Subsequent to those articles about Georgia, further examination of the laws adopted in 2014 and 2015, by 16 other state legislatures, revealed a common template, whose genesis was unknown to non-NASAA members. This was just like the research of the Jesus Seminar, whose investigators kept coming across text in the Biblical apocrypha of hundreds of unrelated documents that had the same basic language. All the state laws had exactly the same language and format as the template created by the North Carolina Secretary of State. All the other states relied on the defective North Carolina template, which incorporated into law, administrative rules that should have either been left to various state administrators, or left out entirely, from any rules. Putting the rules into the legislation subjected CEOs of companies to both civil and criminal prosecution for violation of any minor transgression, as interpreted by hundreds of state bureaucrats.

Coal Ash Disposal in North Carolina: The Road after Eden

Coal ash legislation came to North Carolina in the wake of two significant spills, one at the nearby Tennessee Valley Authority coal power plant in Kingston, Tennessee, and another at the Dan River Steam Station along the Dan River in the town of Eden, North Carolina. These two events, combined with an impending study by the USEPA, would galvanize the North Carolina General Assembly to pass Senate Bill 729 (the Coal Ash Management Act). This bill mirrors the federal system of prioritizing the different energy utilities based on their hazard potential and eventually terminating their use as power production and coal ash storage facilities. Additionally, the act created a coal ash management commission and the process for confirming members. In summation, this legislative step shows the North Carolina General Assembly taking concrete steps to address a problem in the handling of coal combustion residuals. In North Carolina, however, only time will tell if these measures are substantial enough to ward off another Eden.

Collective Bargaining 3.0

The first lesson network leaders learn in the Jobs With Justice training is never give your power away. While easier said in a workshop than in the North Carolina General Assembly, it does compel us to remember how change happens. While we need labor law reform, we should not wait for it to build a movement to expand the scale and scope of collective bargaining. Early industrial unions were bargaining long before the Wagner Act codified the practice, leveraging their ability to halt production when necessary. Only through exercising their power, and even breaking some rules, were they able to win the legal protections to back up workers’ ability to bargain equally with employers.

Brief Amicus of North Carolina Legislative Black Caucus in Dickson v. Rucho, 11-CVS-16940

This amicus brief is offered on appeal of a state trial court's decision to uphold district maps drawn by the Republican majority in North Carolina's General Assembly in 2011. The underlying complaint in the lawsuit alleges that the state's plan violates the 14th Amendment Equal Protection Clause's color blindness principles and ignores the state's constitutional directive that district lines keep county lines intact except when necessary. Under a gross misinterpretation of the Voting Rights Act, the challenged plan replaces a series of majority-white districts in which black-preferred candidates have successfully been elected with racial gerrymanders -- majority-black districts with bizarre shapes that are inexplicable without predominant attention to race. This amicus brief makes three arguments to show the error in the decision below: (1) the state's map drawers completely ignored existing federal voting rights law, by turning the doctrine on its head, (2) the evidentiary record of elections in North Carolina amply shows that legally significant racial polarization is the exception and not the norm, belying any basis for imposing a statewide race maximization plan, and (3) the strategy of maximizing black majority districts without need and contrary to the announced views of black citizens, illustrates an illegal intent to target black voters for the purpose of minimizing their political efficacy.

Sidebar: Community Leaders and Health Agencies Partner to Stop the Devastation of Diabetes and Hypertension Among African American Men in Hyde County

NCMJ vol. 73, no. 6 ncmedicaljournal.com ment toward making public places smoke-free began to take place. Representative Hugh Holliman introduced House Bill 76, legislation which would have made restaurants smokefree. The bill did not pass, but the good news was that a legislative champion had emerged: Holliman was a lung cancer survivor who was passionate about the smoke-free issue. Between the 2005 and 2006 legislative sessions, a statewide strategy to move North Carolina toward smoke-free work sites and public places was born. The 2006 legislative session accomplished additional incremental steps toward the long-range goal of making all work sites and public places smoke-free. Advocates focused on making the North Carolina General Assembly smoke-free as their first step. In June of that same year, the US Surgeon General’s Report provided incontrovertible evidence that there is no safe level of exposure to secondhand smoke [7]. From there, advocates were ready to pursue legislation that would further restrict smoking in public places. Representative Holliman introduced House Bill 259, which would have banned smoking in work sites and public places. The legislation made history by making it through committee and was voted on the floor of the House, where it was defeated narrowly, by 6 votes Community Leaders and Health Agencies Partner to Stop the Devastation of Diabetes and Hypertension Among African American Men in Hyde County

The General Assembly Giveth and the Courts Taketh Away: Procedural Due Process Rights of North Carolina Career State Employees Facing a Reduction in Force and what Practitioners Need to Know

Deficits and spending cuts have been a reality for the North Carolina General Assembly regarding the State’s budget for the better part of the 21st Century. The governor’s budget proposal for fiscal year 2010-2011 calls for state agencies to cut their spending between five and seven percent in the face of a projected deficit of $788 million. One common budget-reducing method an agency may choose is the elimination of employee positions, a process commonly referred to as a reduction in force (“RIF”). The North Carolina General Assembly has provided statutory protection against adverse employment actions for its career State employees. Section 126-35(a) of the North Carolina General Statutes (“section 126-35(a)”) prohibits a State agency from discharging, suspending, or demoting a career state employee “for disciplinary reasons, except for just cause.” Just cause for disciplinary action is defined as unsatisfactory job performance, unacceptable personal conduct, or a combination of the two. Prior to taking disciplinary action against a career State employee, section 126-35(a) specifies the procedure an agency must follow. The agency must provide the employee with written notice of the disciplinary action to be taken and the underlying reasons, followed by an opportunity to appeal to the head of the agency for an inter-agency review. If the inter-agency review does not achieve a satisfactory result, an appeal to the State Personnel Commission is permitted. Appeals to the State Personnel Commission are conducted in the Office of Administrative Hearings (“OAH”) by filing a petition for a contested case as provided in Article 3 of the North Carolina Administrative Procedures Act (“APA”) codified as Chapter 150B of the North Carolina General Statutes. Subject matter jurisdiction over contested case hearings is conferred upon OAH in section 126-34.1 of the North Carolina General Statutes (“section 126-34.1”).Section 126-35(c) of the North Carolina General Statutes (“section 126-35(c)”) requires agencies to treat RIFs in the same manner as disciplinary actions. The plain language of the statute provides “[f]or the purpose of contested case hearings under Chapter 150B, an involuntary separation (such as a separation due to a reduction in force) shall be treated in the same fashion as if it were a disciplinary action.” By implication, RIFs are to be supported by just cause in the same manner as disciplinary actions and are subject to the same procedural protections set forth in section 126-35(a). In University of North Carolina v. Feinstein, the North Carolina Court of Appeals held that section 126-34.1 did not confer OAH with jurisdiction over appeals from RIF terminations based on alleged lack of just cause and procedural violations. The holding of Feinstein was reaffirmed and applied in Jailall v. North Carolina Department of Public Instruction. The practical effect of Feinstein and Jailall is a significant reduction of the procedural due process rights of by denying career State employees the right to a hearing in the OAH, a fundamental step in the process of appealing a RIF to the State Personnel Commission. After Feinstein and Jailall, the only process due to career State employees is written notice and inter-agency review.This Comment explores the procedural due process rights of North Carolina’s career State employees facing an involuntary separation from employment due to a RIF. This will be accomplished by a thorough analysis of (1) the statutory framework of protection enacted by the General Assembly for career State employees; (2) identifying the constitutional rights and protections conferred upon career State employees under the constitutions of the United States and North Carolina; and (3) an in-depth exposition of the holdings and rationale of Feinstein and Jailall. Analysis of these sources supports the ultimate conclusion of this Comment – North Carolina’s career State employees subject to Chapter 126 of the North Carolina General Statutes are entitled to a hearing in the OAH. Because career State employees are entitled to a hearing, this Comment provides practitioners representing career State employees facing a RIF with recommendations about how to pursue a contested case hearing in the OAH, followed by recommendations for judicial and appellate review.

Using Master Settlement Agreement Funds to Reduce Prenatal/Postpartum Smoking in North Carolina:

he North Carolina Health and Wellness Trust Fund Commission (HWTF) was established by the North Carolina General Assembly in May 2000 to receive 25% of the state’s share of the Tobacco Master Settlement Agreement in order to address the health needs of vulnerable and underserved populations in North Carolina. The HWTF addresses its statutory mission by investing in programs and establishing partnerships that focus on critical health needs in four major areas: youth tobacco use, obesity, health disparities, and access to medications. Governed by an 18-member commission of health care experts drawn from a variety of professions, the HWTF has embarked on these four major initiatives, all designed to reduce the economic and human suffering from preventable diseases. To date, the Health and Wellness Trust Fund has awarded over 250 grants that build capacity in local communities to prevent and treat chronic health issues. These local grantees make up the infrastructure that has enabled each of the Health and Wellness Trust Fund’s preventive initiatives to reach its overall goals. To enhance the impact of local grant infrastructure and to have a more sustainable impact statewide, the HWTF also designs and implements mass media campaigns and works to effect policy change at the local and state levels. Independent evaluations of its grant programs are conducted on an ongoing basis to measure and increase the effectiveness of all these strategies. Although North Carolina’s infant mortality rate has decreased dramatically in recent years, it still remains well above the national average. In 2008 North Carolina ranked 44th in the nation with 8.2 deaths per 1,000 births compared to the national rate of 6.8 deaths per 1,000 births. 1 According to the State Center for Health Statistics, three of the top four causes of infant death in North Carolina are directly associated with either maternal smoking during pregnancy and/or infant exposure to tobacco smoke after birth. 2 Analysis of the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) found that 24.6% of women reported smoking before pregnancy, 13.8% during pregnancy, and 20.3% after pregnancy. And, of those who smoked before pregnancy and quit during pregnancy, roughly half began smoking again by the time they completed the PRAMS survey three to six months postpartum. 3 If it were possible to eliminate smoking entirely during pregnancy, the infant mortality rate for the state would drop an estimated 10% to 20%, with the most improvement coming in underserved and disadvantaged communities where women are more likely to smoke while pregnant. 4

Regulating Mortgage Loan Servicing

The home mortgage market has changed considerably in the past 15 years and as a result, loan servicing companies have become an important actor in the lending industry. The business function of loan servicers is to collect mortgage payments from borrowers and remit these payments to the owners of the mortgage. Borrowers have no input in deciding what company services their loan and consumer advocates have suggested that this has allowed some loan servicers to provide poor customer care or act unethically. In response, lawmakers have initiated efforts to regulate loan servicing practices. In 2007, the North Carolina General Assembly passed House Bill 1374 to regulate loan servicers operating in North Carolina. Through a literature review, content analysis of the statute, and interviews with stakeholders, I provide guidance for lawmakers who are considering similar legislation at the state and federal levels.

Research for North Carolina: The University Cancer Research Fund

In 2008 an estimated 40,000 North Carolinians will be diagnosed with cancer. This disease is the number one cause of death in our state and will claim more than 17,000 lives this year. North Carolina is swimming against a demographic tide of growth and aging that will bring 80,000 new cancer cases by 2050, despite continued improvements in cancer prevention, early detection, and treatment. By establishing the University Cancer Research Fund, North Carolina has taken a bold, nation-leading step forward toward improving the future health and well-being of its citizens. Research that creates new knowledge, turns that knowledge into advances in treatment, screening, and prevention, and then ensures delivery of those advances across the state-that research is the key that unlocks the doors to a new and better future. The Fund will make that research possible. As has often been the case, North Carolina was ahead of the national curve by creating the UCRF in July 2007. In November 2007, Texas passed a $3 billion bond referendum to provide $300 million annually to support cancer research over the next decade. In 2005, California passed a $3 billion bond referendum to support stem cell research. Perhaps noting the downturn in federal funding for biomedical research, other states are watching these states' investments to see if they improve their citizens' health and make researchers nationally competitive. We will rigorously evaluate the UCRF to show the nation that North Carolina has taken a bold and wise step. The North Carolina General Assembly and the people of North Carolina have presented the University of North Carolina at Chapel Hill, the UNC Lineberger Comprehensive Cancer Center, the North Carolina Cancer Hospital, and UNC Health Care with an astounding opportunity and responsibility. We embrace that opportunity and that responsibility and pledge ourselves to our shared vision of a better future for the citizens of North Carolina.

Legislating Character: Moral Education in North Carolina's Public Schools

This article analyzes the epistemological aims and justification of character education legislation passed by the North Carolina General Assembly. I take this specific state law as representative of the broader national trends in the character education movement. I primarily use the work of Richard Rorty as the theoretical lens for the analysis and critique. I conclude by commending aspects of the legislative effort, but I suggest that greater emphasis must be placed on strengthening students' ethics through democratic action inside and outside schools and not on a right-leaning, conservative, and didactic curriculum. Further, as social foundations educators, it is imperative to make strides in our classrooms to expose preservice teachers to the apparent and hidden contradictions of using character education as a tool of educational reform.

Chronic Kidney Disease in North Carolina

N C Med J May/June 2008, Volume 69, Number 3 n the middle of the last century, chronic diseases overtook communicable diseases as the leading causes of death in the United States. Public health campaigns and the scientific community have responded and developed national strategies to prevent and cure diseases including cancer, diabetes, HIV/AIDS, and hypertension. While the morbidity and mortality resulting from these diseases warrant this attention, other equally serious chronic diseases unfortunately receive less attention. One of these conditions is chronic kidney disease (CKD). Death from kidney failure, the most severe form of CKD, is more common than many of the most prevalent forms of cancer. (See Figure 1.) Chronic kidney disease encompasses various levels of kidney damage ranging from a relatively asymptomatic decline in kidney function to kidney failure. Chronic kidney disease, in all its stages, is estimated to affect 13% of the United States population. In North Carolina alone, almost 1 million people have CKD not including those with kidney failure. Despite the large number of people living with CKD, there is an overall lack of knowledge about the disease even among people who have it. Nationally, only about 25% of Americans diagnosed with CKD reported awareness of weak or failing kidneys. Among the general population, there is even less awareness. Preliminary data from a University of North Carolina at Chapel Hill (UNC) Kidney Center study shows that many people are unfamiliar with the risk factors for CKD. The combination of high disease burden and low public awareness warranted an in-depth study of how North Carolina can best act to lower the CKD disease burden in the future. In 2006 the North Carolina General Assembly asked the North Carolina Institute of Medicine to convene a task force to study chronic kidney disease (Session Law 2006-248). The task force was funded by the state of North Carolina through its annual appropriation to the North Carolina Institute of Medicine. Marcus Plescia, MD, MPH, chief of the Chronic

Creating a Culture of Wellness in Workplaces

NC Med J November/December 2006, Volume 67, Number 6 he North Carolina State Health Plan (SHP), a self-funded plan established by the North Carolina General Assembly, provides healthcare coverage for more than 615,000 active public sector employees, retirees, and dependents. Employee members of the SHP work in 225 organizations in approximately 3,000 worksites throughout the state. Seventy percent of the health plan’s medical and pharmacy costs are attributed to preventable chronic diseases related to poor nutrition/obesity, physical inactivity, tobacco use, and stress. In 2003, more than 164,000 SHP members were treated for one or more chronic diseases, an increase of 37% from 2000. In response to these findings, the SHP launched NC HealthSmart, a healthy living initiative for all eligible members in 2005. The initiative includes six components: health tracking, including a health risk assessment; centrally designed health promotion interventions; targeted disease management; health coaching services available 24/7; high-risk case management; and worksite wellness programs. NC HealthSmart delivers integrated services directly to the member via the Web, mail, telephone, worksite, and the healthcare community. These wrap-around services are designed to empower the members to play an active role in the management of their health. Wellness programs in the workplace have great potential to impact employees’ long-term lifestyle choices because the average employee spends 50 hours-a-week at work and eats one third of his/her meals at work. Long-term results of wellness programs include improved health outcomes, reduced absenteeism, improved employee morale and retention, and reduced healthcare costs. Successful worksite wellness programs are characterized by: