Center for Health Equity Newsletter
Greetings from the Center for Health Equity
The Center for Health Equity is proud to share its second quarterly newsletter with our many colleagues, friends and partners across the state. We are also excited to announce that the job posting for the Director of the Center for Health Equity is now open, and we will be accepting applications through March 3, 2017. Please share widely with friends and colleagues to help us fill an important leadership position in Minnesota’s health equity efforts!
We also recognize that this newsletter comes at a time when many are feeling increased tension and uncertainty. We remain committed to making Minnesota a safe and welcome place for all who call it home.
As Lieutenant Governor Tina Smith said in a statement last week, “We will face many challenges in the days ahead, as a state, as a nation and as Minnesotans. But as Americans, we will keep working to enhance understanding, expand opportunity and protect the rights of every person in this country. In doing so, we make Minnesota and the nation even stronger.”
Continuing the Community Conversation
On Nov. 14, 2016, nearly 300 leaders and learners, clinicians and politicians, teachers and students, non-profit workers and government employees sat shoulder-to-shoulder around small round tables. As participants in the Minnesota Department of Health’s Community Conversation, these folks gathered to share stories, experiences and ideas for advancing health equity in Minnesota.
The goals of this event were to (1) provide an update on MDH’s efforts to advance health equity, (2) to provide a forum for community-based organizations and others to share stories of their efforts to advance health equity and (3) to continue a dialogue about the challenges facing our collective efforts, in order to engage in collaborative problem-solving. To continue this conversation, the Center for Health Equity is excited to announce many of the initial follow-up actions and efforts that are taking place.
Results of the Nov. 14, 2016 table conversations
For part of the Community Conversation event, about 30 tables of attendees had small-group discussions around nine different topic areas relating to health equity. These small-group discussions generated over 100 pages of notes and addressed a wide range of health equity advances, challenges and suggestions. These notes were then condensed into group discussion highlights and trends and individual question highlights and were posted on the CHE website.
The Center for Health Equity is using the feedback and information from this event to help shape actions and communication on steps that MDH is taking to advance health equity. MDH is also using this information to help develop work objectives for its healthy equity strategic plan and to facilitate internal staff conversations on health equity early in the year as described below.
Communicating with MDH staff
On Jan. 23 and 31, 2017, MDH staff met to discuss how feedback from the Community Conversation might impact the work of the agency. Over these two days, nearly 100 staff members sat in groups to review the notes, think about how the feedback relates to the work that they do and consider ways to incorporate the feedback into their current and future work.
Join the conversation
Planning is currently underway for two additional Community Conversations in 2017. The exact agendas, dates and times will be determined by a planning group made up of community members and MDH staff. Updates about the Community Conversations will be sent to the November event attendees and through the Center for Health Equity GovDelivery list. To stay up to date with CHE events and how you can get involved, subscribe to Center for Health Equity updates, which includes our quarterly newsletters.
Teaming Up to Reduce Infant Mortality
Helen Jackson Lockett-El and her team at the Center for Health Equity are working on a new project to combat one of the most devastating health disparities in the state – infant mortality. Each year in Minnesota approximately 350 babies die before their first birthdays, with rates significantly higher among babies of color and American Indians. This project is focused specifically on Hennepin County, the area with the highest concentration of African Americans in the state, where the infant mortality rate among U.S.-born African Americans is more than three times higher than Whites.
To address this inequity, the team is using a community engagement model that brings together the perspectives and expertise of the community to identify and address factors contributing to the disparity. The project acknowledges that the difference in the infant mortality rate may be explained not only by variations in maternal characteristics, behaviors and access to health care, but also by other factors including social issues and individual and family circumstances.
“Our work needs to be community driven,” Jackson Lockett-El said. “Every step will be based on shared decision-making, input and insight so that whatever we do will be beneficial to the community and culturally appropriate.”
From her very first day, Jackson Lockett-El and her team at CHE began forming a community Leadership Team to oversee every step of the project. They recruited community members who have worked on infant mortality in the past or who have a passion or interest in the issue. Acknowledging the wide range of social and economic factors that contribute to maternal and infant health, they also reached out to community members with experience in areas of education, employment and housing and from academia.
The Leadership Team held its first meeting on Nov. 26, 2016, where 19 participants discussed the available data on infant mortality in Hennepin County and the purpose for the project. A smaller community-based working group was then recruited from within the Leadership Team. The working group is responsible for working out more of the specific details for the plan, and organizing possible action steps. They then take their conclusions back to the larger Leadership Team, where everyone votes on what do to next.
A follow-up meeting was held on Jan. 25, 2017, where the team reviewed the successes and struggles of their November action steps, continued to define roles and responsibilities and planned the program launch to the community.
“It’s sometimes hard to bring government and community together, and we hope that this Leadership Team can act as a bridge,” Jackson Lockett-El said. “I know what it’s like to work in the community and have people say they are working with the state, but there is never really follow up. It’s important to involve those who are most impacted from the very beginning, work as teams and report the results or findings to the rest of the community.”
For more information about the project, visit the Infant Mortality Among African Americans Project webpage.
Equity in Action
Health equity work is happening across many different areas of MDH – not just inside the Center for Health Equity! This section features different health equity projects, leaders and partners in other areas of MDH and the state of Minnesota.
Building authentic community partnerships
To advance health equity in Minnesota, it is critical that the Minnesota Department of Health (MDH) works collaboratively and authentically with the communities most impacted by health inequities. One example of this work can be seen in the partnership between the Health Economics Program within the Division of Health Policy at MDH and Voices for Racial Justice (VRJ), a Minneapolis-based nonprofit organization dedicated to advancing racial, cultural, social, and economic justice in Minnesota. Together, these groups are working to break down data disparities in the health care system.
Data about race, ethnicity, language, disability and many other influencers of health is often incomplete, inadequate and inequitable in the health care system. In 2014, the Minnesota Legislature formally recognized that there is not enough meaningful data about how social and economic factors may affect the quality of care a patient receives. In response to the work of community advocates, the Legislature asked MDH to share recommendations on how to add these factors of health to the Quality Reporting System – a standard set of health measures recorded by health care providers across the state.
To help meet this goal, the Health Economics Program at MDH contacted VRJ. But at first, VRJ was hesitant to help. Community organizations like VRJ had been advocating for more standard and meaningful data collection for many years, yet little progress had been made. Many organizations conducted valuable research and reports, but never saw them used or put into practice.
“Community organizations started to feel discouraged,” said Mónica Hurtado, Racial Justice and Health Equity Organizer at VRJ. “And members of the community felt unheard and used.”
After talking through these concerns, the Health Economics Program and VRJ agreed to work together – as long as the program promised to honor VRJ’s Authentic Community Engagement Principles (PDF) in order to create a transformational, rather than transactional, relationship.
Together, VRJ and the Health Economics Program identified strategies for effectively and appropriately gathering data about social, cultural and economic factors of health. They also explored strategies for giving that data back to the communities disproportionally impacted by health disparities for their own use. To inform the project, VRJ recruited community Health Equity Champions, who conducted one-on-one interviews with community members and representatives of community-based organizations.
VRJ used this information to write the report Advancing Health Equity by Making Racial, Ethnic and Socio-Demographic Disparities Visible in Minnesota’s Health Care Quality Measurement System (PDF), which helped inform MDH’s report to the Legislature, Stratifying Health Care Quality Measures Using Socio-demographic Factors (PDF).
Although this work was a step in the right direction, the narrow focus of the project did not address some of the broader issues that members of the community shared in their interviews with VRJ. This was a challenging moment in the partnership, and VRJ expressed their frustration in the limitations of the report.
Using the Authentic Community Engagement Principles, the Health Economics Program and VRJ worked to navigate through this tension. Their discussions provided a platform to share feedback on the broader topic of government data and led to a second project. Later this month, VRJ and the Health Economics Program will publish a report on this topic, Advancing Health Equity by Sharing Data from the Minnesota Statewide Quality Reporting and Measurement System. The report will be posted on the VRJ and MDH websites.
“We need to grow – both MDH and the community – in how we do these partnerships,” Hurtado said. “We will make mistakes, and we will have tensions, but if we are open and courageous about that then we can use those moments for growth.”
Advancing health equity is complex work that requires partnerships across organizations, agencies, and sectors. This section features tools and resources that can be used to advance health equity.
Surveying students to document disparities
From January to May 2016, thousands of fifth, eighth, ninth and 11th graders across Minnesota sat with computer mice and No. 2 pencils in hand, ready to fill in another list of bubbles. But unlike typical exams or standardized tests, the results from their responses did not go toward a grade or academic measure. Instead, their answers provided important information about their individual health, the health of their schools and health equity across the state.
These students participated in the Minnesota Student Survey (MSS). One of the longest-running youth surveys in the nation, the MSS is administered every three years in classrooms across Minnesota. Survey questions range from demographics to drug and alcohol use to connections with school and family – with dozens of other topics in between. In 2016, 85 percent of public school districts agreed to participate in the survey, producing a rich view on the health of young people and health equity in Minnesota.
This year, for example, the MSS found that fewer students reported engaging in unhealthy behavior overall. However, the survey also shows that social and economic conditions continue to shape how we experience health. MSS data indicates that students who are American Indian, African American, Hispanic, low-income, lesbian, gay, bisexual, transgender, queer (LGBTQ) and/or experiencing homelessness and food shortages are more likely to have worse outcomes for several health indicators.
“The survey can point out which groups are less likely to experience good health and gives hints about why – but that’s the beginning,” said Pete Rode, a research scientist who works on the MSS at the Minnesota Department of Health’s Center for Health Statistics. Next, people have to find meaningful ways to use the information.
Multiple divisions within MDH are already starting to think about how these results could influence the work that they do. For instance, the Community and Family Health Division is working with the Minnesota Department of Education to identify education and health challenges among students in at risk populations, such as English-language learners and LGBTQ. Additionally, the Office of Statewide Health Improvement Initiatives plans to look into disparities in physical activity, healthy eating and obesity. But results from the MSS won’t stop there.
“Data is used most effectively if community advocates and health planners know about the data and can get access to it,” Rode said. “These are the folks who keep their communities informed and go to the foundations, legislature, county boards and city councils. This is the kind of organizing we need, and the data can help support it.”
To help get important data in the hands of advocates, planners and policymakers, MDH will share MSS data in a few different ways in the coming months. Staff are currently working to create a health equity spreadsheet that will be posted online, a report on MSS trends from 1992-2016 and a report comparing results in Minnesota to national results.
For more information about the Minnesota Student Survey, and to view current reports from the MSS, visit the Minnesota Student Survey webpage.
Meet one of the people behind the survey: Pete Rode!
Pete Rode is a research scientist at the Minnesota Department of Health’s Center for Health Statistics. Rode is part of an interagency team that helps coordinate every detail of the MSS – from drafting the questions through collecting responses. In addition to serving on this team, Rode is also responsible for cleaning and analyzing MSS survey data in order to make it usable and accessible for schools, communities and anyone else who wants to see it.
Before coming to MDH in 1999, Rode worked for the Urban Coalition in Minneapolis. During his time there, he began to realize that surveying students could be a key strategy for learning about broader inequities. To address this issue on the state level, Rode began working with the University of Minnesota to develop a large-scale student survey – the precursor to the MSS. He then moved to the Minnesota Department of Health, where he has worked with the MSS for 17 years.
The Center for Health Equity is happy to congratulate Pete on his upcoming retirement, and thanks him for his tireless commitment to students and health equity in Minnesota. You will be missed, Pete!
Events and Opportunities
Apply for the Culture of Health Leaders Program!
Are you highly motivated? Is collaboration across professions important to you? Do you have a strong record of leadership experiences (formal or informal)? Do you have the desire to deepen your leadership experience? If yes, consider applying for the Culture of Health Leaders program. Applications are due Feb. 15, 2017. Learn more at Culture of Health Leaders.
Apply to be the Director of the Center for Health Equity
The Minnesota Department of Health is seeking a Director for the Center for Health Equity! This position will direct the development, implementation and evaluation of efforts to advance health equity in Minnesota. To learn more about the position and how to apply, visit the Center for Health Equity Director job posting.