RALEIGH — North Carolina’s 2.3 million children are falling behind in some important benchmarks for health, such as the poverty rate, but they’re improving in other areas, including the number who have insurance, according to a report issued Monday.

The North Carolina Institute of Medicine and Action for Children released the 18th annual Child Health Report Card on Monday, analyzing data in 15 areas. North Carolina got two A’s and three D’s, compared with three A’s and one D in last year’s report. The reports compare health indicators from 2010 and 2011 with the same figures from years dating back to 2004.

The report card gives North Carolina A’s in environmental health and early intervention and D’s in child poverty, weight-related health issues and alcohol and substance abuse.

Some 9.4 percent of children up to the age of 18, or 216,000, have no health insurance, compared with 13.6 percent in 2006. The number of children who have public health insurance such as Medicaid grew to almost 1.1 million in 2011, compared with almost 865,000 in 2006, the report says.

Lack of insurance is the biggest barrier to accessing health care, the report says, although even having insurance doesn’t guarantee that children will receive preventive and primary care services. About four of every 10 children enrolled in Medicaid don’t receive the recommended levels of preventive care, even though it’s covered, the report says.

“Many chronic, costly health challenges North Carolina will face in the future have their roots in the early years of life,” the report says. “Reducing the incidence and prevalence of these conditions, or lessening their effects, could have large payoffs for the state’s future and health costs, in addition to improving health.”

Another good sign for children’s health is the improving high school graduation rate, which went from 69.5 percent in 2007 to 80.4 percent in 2012. But child poverty increased to 25.6 percent in 2011, up from 20.2 percent in 2006 for children up to the age of 18. Among children up to the age of 5 — which the report says is the group most susceptible to the effects of poverty — the rate was 30.3 percent, up from 23.6 percent.

And more children in grades ninth through 12th report taking a prescription drug without a doctor’s prescription at least once: 20.4 percent in 2011, up from 17 percent in 2007, but down slightly from last year’s figure of 20.5 percent.

“The relationship between high school graduation, household income and health (has) been well-documented,” the report says. “Graduating from high school improves individuals’ quality of life, reduces alcohol and drug abuse and has been associated with longer life spans. The experience of poverty, on the other hand, is associated with poorer health outcomes, including poor nutrition, obesity and higher mortality rates.”