Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Linkage to Community Resources

Summer 2004

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Size of the Problem

Minnesota is the twenty-first largest state in the United States. According to the Children’s Defense Fund Minnesota [1], the per capita income in 2001 was $33,059, the ninth highest in the country. The 2002 unemployment rate was 4.4% compared to the national rate of 5.8%. Minnesota also ranks high in terms of positive health indicators and outcomes in comparison to other states.

However, there are many pregnant women, mothers, and infants who do not have their basic needs (for adequate food, shelter, clothing, and health care) met. Homelessness, hunger, lack of affordable housing, lack of access to health care, and unemployment are some of the problems faced by Minnesota families.

Seriousness

Housing is an important determinant of health, and substandard housing is a major public health issue [2]. Poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health problems [3].

According to the Wilder Research Center’s Report, Homeless in Minnesota 2003 [4], shelter providers counted 7,015 homeless people in October of 2003 living in emergency shelters and transitional housing programs. An additional 796 homeless people were identified who were not staying in any formal shelter or housing program, for a total of 7,811. These numbers are thought to be an undercount of homeless people because it is not known how many individuals are living on the street or in other non-shelter arrangements. Adding these individuals could bring the total count of MN homeless people to over 20,000 individuals.

Of the 7,811known homeless individuals, 2,257 were women and 2,862 were children with their parents. Of the 2,862 children who were homeless with their parents in 2003, 44% were age 5 or younger and 82% were with their mother or female caretaker only. Among the parents whose children were with them, 16% had at least one child with a chronic or severe physical health problem, 6% had been unable to obtain needed health care, 16% could not get needed dental care, 7% said their children skipped meals because of lack of money to buy food, and 23% said that at least one of their children had an emotional or behavioral problem, about four times the rate for the overall population.

In addition to the above issues, many of the homeless adults reported chemical dependency problems, physical and mental health problems, long-term unemployment, criminal backgrounds, lack of affordable housing, and lack of a high school diploma.

Lack of affordable housing has been linked to inadequate nutrition, especially among children. Relatively expensive housing may force low-income families to use more of their resources to obtain shelter, leaving less for other necessities such as food. A recent MDH publication, The Effects of Hunger on Children’s Health [5], reports the following: 1) Good nutrition is essential for normal brain development; 2) Hunger is associated with poorer health status; 3) Children in households experiencing hunger are more likely to have frequent doctor visits and require special education services; 4) Hunger during pregnancy may predispose the baby to obesity later in life; and 5) Young children in families whose welfare benefits are decreased have a 50% greater risk of being hungry [6]. In 2002, one out of ten households in the U.S. had experienced hunger during the previous year [7]. Minnesota data shows that in the years 2000-2002, 7.1% of households experienced hunger/food insecurity and that food insecurity is increasing in Minnesota’s inner-city young children [8].

In the most recent national KIDS COUNT data book, which used 2000 data, Minnesota ranked first in the nation on a set of ten indicators of child well being. However, as the economy weakened, so did some conditions for children. The needs increased for free or reduced school lunch and food support. Other findings from the Data Book include: one in 11 Minnesota children lived below the poverty line in 2000; one in 12 children received food support; one out of every 16 babies was born at low birth weight; one in five Minnesota two year olds are not fully immunized; and about 10,000 children every year have a substantiated report of child abuse and neglect, and another 5,300 enter the child welfare system through a new “alternative response” program [1].

In addition to the above child health indicators, a common indicator for measuring the well-being of children is the number of children who receive early and periodic well-child health care, called the Minnesota Child and Teen Check-up (C&TC) Program. The MN Department of Human Services report that the C&TC participation rate for Federal FY 2003 for the state of Minnesota was 60%. This leaves 40% of MN children on Medicaid who do not receive ongoing well-child health care.

It is difficult to estimate the cost/benefits of interventions to provide linkage and referrals to families to meet their basic needs. However, results of three Minnesota home visiting programs demonstrate that 1) Linkage to community resources was identified as a major role of public health nurses and other home visitors in promoting healthy behaviors and economic self-sufficiency; 2) Problems related to lack of employment, finances, education, housing, transportation and child care were major barriers to achieving goals to improve family health and well-being and to achieve economic independence; and 3) Families with more home visits, more staff hours, and more than 12 months of services fare the best. It can be expensive to provide services to families in need but is more costly in the long run not to assist families to meet their basic needs.

Disparities
Exposure to substandard housing is not evenly distributed across populations. People of color and low income people are disproportionately affected. For example, Blacks and families with low-incomes are 1.7 times and 2.2 times more likely, respectively, to occupy homes with severe physical problems compared with the general population. People with low income are more likely to live in overcrowded homes [9].

There have been some gains in racial disparities among numbers of homeless adults. However, Black, American Indian, and Hispanic people continue to make up the majority (about 57%) of the adult homeless population, while they made up just 6 percent of the total adult population in Minnesota in 2003.

Interventions

Effective interventions include: 1) Early identification and referral to community resources for problems related to meeting basic needs of food, shelter, clothing and health care; 2) Need for collaboration and cross-department planning (i.e. public health, housing, human services); and 3) Awareness of the importance of social determinants of health.

In Minnesota, almost all of the 87 counties and 11 tribal governments have family home visiting programs to promote health and well-being of families with pregnant women or young children. Services include assessment of needs and linkage/referral to community resources to assist with meeting the family’s needs. Results of the three-year (2000-2003) MDH Family Home Visiting report show these
positive outcomes for families served more than 13 months: 1) 96% of children ages birth-6 years had health insurance and 94% had well-child exams; 2) 91% of the mothers had health insurance; 3) 82 % of the mothers achieved one or more goals related to economic self-sufficiency and 92 % of the mothers did not have a subsequent birth within 18 months of the previous birth.

Status

The public health community has grown increasingly aware of the importance of social determinants of health (including housing) in recent years. Elected officials and communities alike recognize that substandard housing is an important social justice issue that adversely influences health [10].

The political and economic climate in Minnesota is likely to have an impact on families, especially low-income and racially and ethnically diverse families. Local public health agencies and tribal governments recently experienced a decrease in public funding. However, state and federal dollars are still available at a reduced level to provide services to families in need. The Local Public Health Association and Minnesota’s Community Health System is tracking the impact of the recent budget cuts and has identified the following effects on citizens: 1) fewer family home visits, including prenatal and new baby home visits; 2) decreased WIC and nutrition education; and 3) reduced or eliminated prevention and early intervention services for families [11]. Local public health agencies have had to prioritize their services and target populations that are most at risk as well as maximize other sources of funding to meet the needs of families in their communities.

References

1. Minnesota Kids: A Closer Look 2004 Data Book, Minnesota Kids Count, Children’s Defense Fund MN.
2. Sharfstein J, Sandel M. eds. Not Safe at Home: How America’s Housing Crisis Threatens the Health of Its Children,, Boston, Mass: Boston University Medical Center, 1998.
3. Krieger J, Higgins D. Housing and Health: Time Again for Public Health Action. Am J Public Health. May 2002, pp 758-768.
4. Homeless in Minnesota 2003, Wilder Research Center, St. Paul, MN.
5. Ellaway A, Macintyre S, Fairlye A. Mums on Prozac, Kids on Inhalers: the need for research on the potential for improving health through housing interventions. Health Bull. 2000; 54:336-339.
6. MDH, The Effects of Hunger on Children’s Health, 1/10/03.
7. Nord M, Andrews M, Carlson S. Household Food Security in the United States 2002. ERS Food and Assistance and Nutrition Research Report No. 25.
8. Cutts DB, Geppert JS, Levenson S, Meyers AF, Zaldifar N, Frank DA , Casey PH, Cook JT, Black MM, Berkowitz C, and the C-SNAP Study Group. Housing instability and hunger. 2001. Paper presented at Pediatric Academic Society Annual Meeting, Baltimore, MD.
9. US Census Bureau. American Housing Survey 1999. Accessed February, 2002.
10. Marmot M, Wilkinson R. Social Determinants of Health. New York, NY: Oxford University Press, 1999.
11. Local Public Health Association 2004, St.Paul, Mn.