Intolerable Disparities in Minnesota’s Child Well-Being

Minnesota treats children well, but not equally. New data about the status of Minnesotan children shows the state’s overall strengths, but the extent of racial disparities is intolerable. It is time for policymakers, teachers, and community leaders to pay better attention to kids of color.

Minnesota ranked fifth in the nation for children’s general well-being in the annual KIDS COUNT report, released July 22. Minnesota has landed in the top five states for overall child well-being for over a decade which definitely warrants a pat on the back.

In general, Minnesota's economy is flourishing, our schools succeed, and our healthcare systems save lives. Compared to much of the US, Minnesota’s children thrive. Still, many non-white kids do not.

“The report found the state has some of the worst disparities in the country, with nearly half of Minnesota’s black children living in poverty,” MPR’s Sasha Aslanian writes.

Individuals below the poverty line are more than double as likely to be non-whites in Minnesota. We cannot forget about the children in impoverished homes, the resources they lack, and their unfair future ahead if nothing changes.

Neighborhoods with high poverty levels often have higher pollution, more crime, and poorer-performing schools. As the amount of Minnesotan children in poverty increases, kids are at a higher risk for health problems and academic failure.

Research on education, healthcare, and family life shows startling racial gaps. Minnesota’s non-white students are less likely to be prepared for kindergarten and almost 40 percent of black and Hispanic students do not reach the 4th grade reading standard, according to the report.

This inequality is a pressing issue that cannot be solved fast enough. Citizens need to pressure their leaders to prioritize growth for children of color—now.

Minnesota must implement stable programs and infrastructure that address racial disparities among children. These changes should originate from local governments and state legislation, as well as school boards and community outreach organizations.

Every child deserves access to Minnesota’s top-ranked resources. By working to solve the current deep-rooted inequality, we can build a better future for all Minnesotans.

Posted in Health Care | Related Topics: Children's Health 

There are no Magic Bullets

If there is one thing that my Introduction to Global Health class taught me, it is that there are no magic public healthcare policy bullets. We simply cannot isolate issues to identify micro-solutions sufficient to overcome large scale, sytemic challenges.

Minnesota, compared to the rest of the United States, has an exceptional health care system. According to the United Health Foundation, Minnesota’s health care system ranks number three, with our strengths being a low prevalence of physical inactivity and diabetes, a strong high school graduation rate, and low rates of premature death and cardiovascular disease deaths. However, MPR’s recent reports that investigate Minnesota health disparities are revealing a disturbing trend. Marginalized individuals have higher rates of health discrepancies. This marginalization threatens the whole.

Marginalized Minnesotans' health disparities aren’t simply due to poor health care access although that certainly can play a role. Health disparities are often linked to external factors such as stress faced by discrimination, the proximity of one’s home to an interstate, and the home's condition.

Many, if not all, of our lifestyle choices impact our health. If we choose to smoke, we put ourselves at a higher risk for lung cancer. If we drink excessively, we put ourselves at a higher risk for liver damage. However, do we want to accept a Minnesota that allows for marginalized individuals to face higher health care costs for a lifestyle they do not choose but is forced upon by economic status?

Consider long-term health care cost to society. Kids going to the hospital for an asthma attack due to home location to hospital bills that the family may or may not be able to afford, undermining family economic stability. It also reduces the hospital space for people who endure non-preventable emergencies. A society ruled by stress, a notable health issue in the LGBTQ community, only increases our nation’s mental health epidemic and affects our society’s ability to be as productive, and happy, as we can be.

Resolving and improving these challenges won't be easy. There is no magic bullet. We can’t focus on health care and expect it to improve drastically just as we can’t simply focus on housing development or education. We can't lose sight of the big picture in our world of specialization. Seeing the forest is just as important as seeing each tree.

Posted in Health Care | Related Topics: Health Care Reform  Public Health 

Life-Saving Legislation: A New Law to Prevent Heroin Overdose Deaths

With more and more fatalities each year, heroin overdose has become a statewide epidemic. Minnesota’s heroin-related deaths in 2013 almost doubled from 2011 and the upward trend continues.

Addressing this problem, Minnesota's state policymakers created and passed life-saving legislation. Thanks to a law that takes effect this month, those who seek medical help for a person experiencing a drug overdose are immune from criminal charges, like possession or use of drugs. This protection encourages bystanders to call 911 and save a life, without fear of prosecution.

The Hennepin County Sheriff’s Office is the first department in Minnesota to implement the law’s second component which allows law enforcement to carry and administer an antidote for heroin overdose, starting August 1st.

Licensed physicians must authorize officers to use the drug, which can fully revive an overdose victim if it’s dispensed in time. Aiming to train at least 75 deputies, the Hennepin County program will cost about $12,000. The money will mainly come from the drug forfeiture and seizure fund, according to Sheriff Rich Stanek, quoted in a Minnesota Public Radio story.

Counties across the state are keeping an eye on the outcomes of Hennepin's new policy to determine a course of action. But as departments delay medical authorization, officer training, and resource management, lives are at risk.

When police in Hennepin County (and hopefully the rest of Minnesota) implement specific techniques to save lives from heroin overdose, the whole population benefits from community-centered law enforcement. With more tools and training programs like this one, police could soon find methods to cope with other challenges, such as mental health, street harassment, or additional substance abuse issues.

Minnesota lawmakers made incredible progress with this legislation and Hennepin County is courageously adapting its law enforcement strategies to prioritize people's needs and safety. Now, it is up to the rest of Minnesota's communities to follow suit.

Posted in Health Care | Related Topics: Community Safety  Public Health 

Let’s Talk About Sex (Well, Power)

Fresh faced, anxious, excited teens head off to college. Their energy fills the campus for the first few weeks. These kids are eager to grow but nervous to fail, unsure if they are truly prepared for what lies ahead. While most students worry about grades, social acceptance, and paying for school, something that typically doesn’t cross their minds looms on the horizon: sexual violence.

We’ve all seen the national headlines. The good news is campus sexual violence crimes are increasingly reported to the police. Minnesota is experiencing a 23% increase of victims reporting sexual assaults. However, despite the increased issue profile and police reports, 1 in 5 women attending a Minnesota higher education institution will be sexually assaulted while in college. The victims are frequently marginalized while perpetrators seem to escape responsibility. Complicating the situation, colleges act as both a police force and adjudicator. A recent New York Times story, like others published across the country, captures the problem's nature. American higher education is riddled with victim-blaming, lacks training and regularly commits procedural errors in dealing with cases.

We cannot stand for this treatment of victims of not only sexual assault, but a system that does not adequately protect them. So why does this happen? And how do we fix it?

Katie Eichele, Director of the Aurora Center, which serves victims, survivors, relatives of victims, and those who are concerned with sexual violence at the University of Minnesota, explains that these cases often arise from a lack of understanding of what sexual assault and rape are, as well as what it means to consent to sex or other intimate activities.

The center operates from an affirmative consent approach, which dictates that only a “yes” means yes: silence is not consent, and "no" does not mean one should pry further. 

Eichele says there are a number of pathways one can take to extinguish this issue. First and foremost there must be early education clarifying what consent, sexual assault, and rape actually mean as well as training that dispels sexual assault myths. Bystander training should also be available. This training has to take place before students step foot on a college campus as more than 40% of victims experienced sexual assault before age 18. Early training creates greater understanding of consent and abuse, leading to social adjustment that changes how institutions and individuals view sexual interactions and sexual assault as well as increasing men's engagement in speaking out against sexual assault. 

More specialized training also needs to be required for anyone dealing with sexual assault cases. This includes but is not limited to medical examiners, first responders, counselors, and police.  Improved and increased comprehensive training reduces misunderstood cues and heighten awareness of signs of sexual assault. 

Victims also must have access to confidential resources to learn more about what it means to file a police report and what options are available to them. As the process of filing reports for sexual assault can be personal, intrusive, and emotionally grueling victims need a support system that has the specialized means to aid them in the proceedings.

Lastly, we have to debunk the notions that rape is about sex and is typically commited by strangers. Rape is about power and nearly all rapes are commited by someone the victim knows, making it more difficult for victims to speak up and act against their perpetrator. And while changing process is easier than changing attitudes, it is an excellent place to start.

There are a slew of issues complicating this problem even further, ranging from how schools punish perpetrators to a victim-punishing slant in our society. However, it doesn't have to stay this way. 

Let's make some noise. Let's talk about how to fix our inadequate system. Let's prove that the arc of the moral universe does in fact bend toward justice.

Posted in Health Care | Related Topics: Higher Education  Racial Inequalities  Community Safety 

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Transportation and Health: Modes Matter

Two new scientific studies offer a nice complementary perspective on our transportation choices and their often ignored consequences. 

Start with a Minnesota Department of Health report on geographic concentrations of asthma. As summarized by Minnesota Public Radio, the worst place in the Twin Cities for the breathing disease is along Interstate Hwy. 94 in north Minneapolis.

While fumes from the freeway may not be the main cause of this finding -- dirty rental housing and higher rates of smoking among low-income residents of the area are also implicated -- tens of thousands of motor vehicles roaring by daily a short distance away certainly doesn't help. And for African-Americans and Native Americans, the Minnesotans most afflicted by asthma, claims of environmental racism in the routing of pollution-spewing highways gain strength.

Now consider an unrelated study from Salt Lake City, where concern over periodic choking air inversions along the Wasatch mountain front helped spur rail transit development in a conservative region on a scale that puts the progressive Twin Cities to shame. University of Utah researchers found that the TRAX University light rail line significantly reduced auto traffic, congestion and air emissions along a major city thoroughfare.

These outcomes occurred despite increased development in the corridor since the light rail launched in 1999, the researchers noted. "Without the University TRAX line, there would be at least 9,300 more cars per day ... and possibly as many as 21,700 additional cars," said the study leader, Prof. Reid Ewing. "The line avoids gridlock, as well as saves an additional 13 tons of toxic air pollutants [per day]. This is important knowledge for shaping future transportation policies."

Ewing also warned that his study "cannot guarantee that light rail transit would have the same effect on traffic at other locations." That said, the Utah line resembles the new Twin Cities Green Line in two important respects: serving a major university campus along a busy urban street corridor. Since its June 15 opening, the Green Line is showing strong ridership, increasing by 4,500 a day over the first week, when free rides were offered. Its projected 40,000 daily boardings by 2019 may be reached long before then.

Right now, we can only guess the effect on auto traffic along University and Washington Avenues linking the St. Paul and Minneapolis downtowns. But I'm betting the air beside the tracks is already easier and healthier to breathe.

Posted in Transportation | Related Topics: Public Transportation  Clean Air  Public Health  Traffic Congestion 

Hobby Lobby Isn’t The Issue; Our Employers Are

The US Supreme Court's recent Hobby Lobby decision has prompted a lot of discussion regarding gender imbalances in our society. However, the Hobby Lobby decision is also a distraction from more important issues creating the initial conflict leading to a court challenge. It's a problem of how our health care system functions because our health insurance is tied to employment.

Historically speaking, at the time this trend began just after World War II, it made sense. The family provider, usually male, earned for the family and also typically stayed with their first employer for the entirety of his life. Today, we expect that Millennials and future generations will have 15-20 jobs throughout their adult life. Clearly, the employer-provided health insurance model is no longer working for my generation and it likely won't work for the next.

Minnesota has a forward thinking, effective, nonprofit health care system. Even before the federal Affordable Care Act passed, Minnesota worked to reduce the number of Minnesotans without health insurance through a state-subsidized, sliding fee scale state insurance program. As a state that prides itself on its progressive thinking, particularly with regard to health care, Minnesota must pioneer the next change in how we think about health care. Minnesota does great but we can still do better, confident that the nation will follow. 

In fact, as it turns out Minnesota health insurers are already troubling Minnesota businesses that wish to take advantage of the Hobby Lobby ruling. The owner of Stinson Electric, Inc. in Minneapolis, Paul Archambault, spoke to CityPages earlier this month and revealed that while his company can legally refuse to provide certain birth control methods to employees, Minnesota insurance companies are refusing to provide this insurance for a company that only employs 15 people as creating this type of insurance plan simply is not profitable in a more progressive state, such as Minnesota, because so few employers want to purchase it.

The Hobby Lobby decision has confused our state's health care policy, creating an abyss between employers, employees, and Minnesota health insurance companies. Thankfully, the resolution to this problem is staring us in the face and while it will not be a simple process separating employers from health care is possible. It can be done through a voucher system, through the expansion of Medicaid, or through some entirely new single-payer policy reform. The Hobby Lobby case reminds us of our current healthcare insurance system's shortcomings and helps make the case for change to a single-payer framework.

Posted in Health Care | Related Topics: Health Insurance  Courts & Justice  Workers' Rights 

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Cigarette Tax Increase Succeeds in Reducing Tobacco Usage

One of the reasons for increasing Minnesota’s cigarette tax was to incentivize current smokers to “kick the habit.” It appears that the cigarette tax increase is already having the desired effect. According to information from ClearWay Minnesota, “Quit attempts by Minnesotans have increased dramatically since the cigarette tax increased by $1.60 per pack on July 1, 2013. During the first two weeks of July 2013, QUITPLAN® Services received 256 percent more calls than in the first two weeks in July 2012, and saw a 289 percent increase in visits to quitplan.com."

Long term, ClearWay projects that the tobacco tax increase enacted in 2013 will lead to a 47,800 reduction in the number of children who become addicted, a 16 percent reduction in youth smoking rates, incentivize 36,600 Minnesotans to quit smoking, and a 25,700 reduction in premature smoking related deaths.

A reduction in tobacco usage was incorporated into projections of how much revenue the 2013 tobacco tax increase would generate. As a result, the tobacco tax increase is generating about as much new revenue as it was expected to. According the most recent economic update from Minnesota Management & Budget, net tobacco tax collections are within three percent of their projected target since the tax increase took effect (through March 2014).

It is true that tobacco taxes are regressive, falling most heavily on low income households. However, the long-term health effects of the tobacco tax increase outweigh concerns over regressivity. After all, the positive health effects of the tobacco tax increase will likely be concentrated among low income smokers, since they are most sensitive to cigarette price increases and will be most incentivized to quit as a result. There are many ways we can change the tax code to help low income households; giving them access to cheap carcinogens should not be one of them.

Posted in Fiscal Policy | Related Topics: Public Health  Sales Tax 

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Baby Steps Forward: New Law for Pregnant Inmates

As of July 1, the marginalized lives of pregnant prison inmates are now featured center stage. Minnesota’s new law protecting incarcerated pregnant women went into effect this month.

About 4,200 pregnant women are arrested in Minnesota each year, according to the Children’s Defense Fund of Minnesota. These women are at a high risk for poor birth outcomes that cause emotional and financial distress.

Research shows that children of inmates are five to six times more likely to end up in jail. To break this cycle, we must address the needs of pregnant, incarcerated women as a component of empowering healthy families.

Minnesota’s new policies restrict the use of restraints on pregnant women. Correctional facilities are now required to offer pregnancy and STD tests to inmates, in addition to prenatal, childbirth, and parenting materials. Mental health treatment must also be accessible to inmates during and after pregnancy.

Another major component of the law is the access to certified doulas in prisons. Doulas provide emotional guidance, group-based programs, and wellness advice to pregnant women.

When the nonprofit program Isis Rising began providing doula care at the Shakopee correctional facility, the number of babies born to inmates by cesarean section dropped by 60 percent in two years, and none of those babies were born preterm or at a low birth weight. 

Visitors are not allowed in the hospital room when inmates give birth. A doula provides support for the mother during the procedure and when she is separated from the newborn 48 to 72 hours later.

But limits on the ruling may lead to obstacles. A prisoner can only use a doula if there are no costs for the prison. The funds must come from the woman herself or elsewhere.

Most inmates cannot afford the service, so Isis Rising covers the costs. But as the doula program expands with the new legislation, a shortage of funds could obstruct the program's reach. With this risk, it is clear that the state has only begun its work toward sustainable improvements.

A new committee will discuss future changes in the fall, which offers hope for more progress. Policymakers cannot ignore remaining issues like incarcerated women’s abilities to breastfeed, quality prison nurseries, and stricter standards for prenatal care.

The health and safety of the next generation relies on the health and safety of its mothers. By ensuring better beginnings for at-risk mothers and children, Minnesota is on track toward equal opportunity and communal stability.

Posted in Health Care

Gender Perspectives in Mental Health Policy Largely Unrecognized

Mental illness is both a widespread problem and a complex challenge for health care policy. Gender is an important factor in mental healthcare but gender perspectives are often overlooked when addressing the population’s mental health needs.

Women deserve specific attention from mental health care policy. The new Status of Women and Girls Report shows that the female population constitutes the largest proportion of those who experience mental health issues. “41% of Minnesota’s women college students report a diagnosed mental-health condition at some point in their life,” the report reads.

While biology and genetics influence mental health, psychosocial factors in women’s lives play a main role in contributing to their higher risk for mental illness.

The National Alliance on Mental Illness (NAMI) in Minnesota reports that women are more vulnerable to mental health problems due to common social stressors on the female population, such as “multiple work and family responsibilities, sexual and physical abuse, sexual discrimination, lack of social supports, traumatic life experiences, and poverty.”

Socio-economic gender inequality produces disastrous ramifications on the mental health of girls and women. Discrimination in the workplace, sexual harassment in schools, and gender biases in family life pile on risks for mental illness. Studies by NAMI indicate that greater social equity likely leads to more equal rates of depression in women and men.

Harvard professor Mary-Jo DelVecchio Good promotes mainstreaming gender perspectives in mental health policy. “Healthy policies for women are supported by state gender ideologies that enhance the cultural, political and legal status of women by legitimizing equitable public investment in and protection of females as well as males,” she writes

As the state moves forward in working to defeat gender inequality, Minnesota can in turn improve overall mental health.

Effective mental health care must consider gender needs. Men and women often cope with different mental health problems, according to The Status of Women and Girls Report. Men are more likely to have externalizing problems that are destructive to others while women are more likely to have internalizing problems that are self-destructive.

Many young girls struggle with these internalized problems, such as feelings of depression or loneliness. Unfortunately, Minnesota lacks resources to help. The state ranks 49th in the nation for school counselor-to-student ratios in a 2009 Minnesota 2020 report.

Minnesota must invest in accessible, quality mental health services and educate communities about available resources. By centralizing gender perspectives in mental health policymaking, Minnesota can empower a healthier and more equal society.

Posted in Health Care | Related Topics: Higher Education  Mental Health  Gender Inequalities 

Getting Insurance is Just the Start

Good news from MNsure: in the first seven months of its operation, Minnesota’s uninsured rate has dropped by 40 percent. That represents over 180,500 more people with health insurance. The majority of these enrollees have signed up for expanded public insurance programs, but many others have purchased private coverage. (Many people who previously had coverage have also switched to more affordable MNsure options.) Minnesota’s uninsured rate is currently just 4.9 percent, which is our state's lowest rate ever and the second-lowest in the nation.

As impressive as this accomplishment is, it’s not the end of our efforts to help people access affordable healthcare. Not only do we still have five percent of Minnesotans left to reach, approximately 260,000 people, but we need to make sure that those who have gained health insurance continue to stay insured. That’s the true test of our success, and it will require ongoing effort on a few fronts.

Many, many people don’t fully understand how their health insurance works (even my own husband needs my help to comprehend his). They avoid seeking medical care because they’re not sure how much it will cost them. They find doctors’ bills confusing (as most of us do). If they make a costly mistake, such as using an expensive out-of-network provider, they might be hesitant to use their insurance in the future for fear of another unexpected expense. If we’re truly going to improve health and lower costs, we need to help people use their insurance wisely and confidently.

We also need to make sure that people keep the health insurance in which they’ve enrolled. I often meet clients who tell me, “I used to have insurance, but the renewal paperwork was confusing and I missed the deadline to send it in,” or, “I couldn’t afford my insurance anymore and I didn’t think there was anything more-affordable out there.” Whether due to a life change, a missed payment, or a paperwork error, it’s not hard to lose coverage. Insurance exchanges and providers need to make it easy for people to understand what is required to maintain coverage and easy to make changes to their insurance when their life circumstances merit it (one major weak point for MNsure at present).

People also need to want to keep their insurance. One year’s worth of big publicity around enrolling in insurance isn’t enough to convince everyone that they should always be covered. We need ongoing education about the value of insurance, the affordability of insurance, and the cost of not having insurance. Consumers will need to believe that their insurance is worth having, or they might not renew it--penalties nonwithstanding.

One last note. We also need to keep expanding affordable coverage. There are still people left out of the new marketplace, such as people with certain immigration statuses who are not eligible for insurance. There are also people whose coverage still strains their budget (as I’ve written about here and here). Lowering our uninsured rate is going to require some serious conversations about serving these populations.

This year has been the start of something very promising for Minnesota. But, it’s only the start. We can’t stop working together to keep our state healthy and vibrant.

Posted in Health Care | Related Topics: Health Insurance 

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