According to the NC Prevention report card, North Carolina residents are struggling to meet public health goals for tobacco use, nutrition, obesity and physical activity.

Rachel Zuker is the research and evaluation coordinator for the Chapel Hill-based nonprofit Prevention Partners. She says the state’s grades are not looking good.

“Right now, we’re not doing great,” says Zuker. “We have a C in tobacco, a D in physical activity and Fs in both nutrition and obesity, so there’s definitely work to be done.”

The report measures state progress on national public health goals set for 2020.

Tobacco use continues to be the leading cause of preventable death in the US, and here in North Carolina, residents are smoking at a higher rate than elsewhere.

Zuker says this year North Carolina earned a C for tobacco use, down from a B grade last year.

“In tobacco policies, other states have continued to make progress, whereas we’ve kind of stayed the same, so I think we’re seeing ourselves slide a little bit in tobacco, which is too bad, because previously we’d been at a B and we were seeing that as a great area,” says Zucker.

The report points to policy changes at the state and local levels that could lower tobacco use, including designating more smoke-free places and increasing funding for cessation support services.

When it comes to nutrition and obesity, the report suggests economic challenges are hitting families hard. Seventeen percent of North Carolina households face hunger. At the same time, two out of every three adults and slightly more than a quarter of  high school students are overweight or obese, and the problem is more significant for those with lower levels of education and income.

Zuker says obesity and poor diet go hand in hand, as it costs more to eat well.

“You can be malnourished and obese. There’s a difference between malnourishment and obesity.”

Compounding the problem, the majority of North Carolina’s adults are not getting the recommended weekly minimum amount of physical activity.

Zuker says when it comes to changing the state’s health grade, workplace programs can have a big impact.

“People spend so much of their daily lives at work, and so if we see workplaces passing policies to promote cheaper, healthy foods, time for physical activities or access to those facilities, helping employees to quit [smoking], we really see that as key.”

Prevention Partners is launching an initiative with some of North Carolina’s largest employers to try to change the workplace culture to support healthy lifestyles. Zuker says the plan, called Healthy Together North Carolina, could reach up to 20 percent of the state’s workforce.

You can read the full interactive report card here.