Center for Health Equity Newsletter
In this newsletter:
Greetings from the Center for Health Equity
Message from the Director
Continuing the community conversation in Bemidji
Welcoming the first members of the HEAL Council
Grantees reconnect at Community Health Conference
Equity in Action: CHWs in Ramsey County
Equity Toolbox: Statewide Health Assessment
Xiaoying Chen retires after 11 years at MDH
Updates and Opportunities
Greetings from the Center for Health Equity
Ever wonder what we do at the Center for Health Equity (CHE)? Are you looking for new tools or wanting to learn about other work going on to advance health equity in the state? In this newsletter, we cover a few of the recent events we’ve hosted, including a community conversation in Bemidji and a grantee gathering in Breezy Point; we welcome new members to the MDH Health Equity Advisory and Leadership Council; we highlight the work of community health workers in Ramsey County; we dive into the new 2017 Statewide Health Assessment; and much more.
But first we would like to give a warm welcome to our new intern, Ellis Raduenz, a sophomore at the University of Minnesota studying psychology and public health. Ellis has been busy helping us with a range of tasks—from entering evaluation data, to supporting the infant mortality project, to helping roll out a health equity learning tool among MDH staff. Welcome, Ellis!
Message from the Director
Over the last six months, the Center for Health Equity been wrestling with the ideas of trust and belonging. As I mentioned in the last newsletter, our June Community Conversation focused on building trust between community and government. This theme continued into our September Community Conversation in Bemidji, hosted in partnership with the Northwest Indian Community Development Center. The event was a reminder that when we as a government agency go into communities that have been historically marginalized and oppressed, we must do so with humility and knowledge of historical trauma as we begin to (re)build relationships and trust. We must also honor the importance of cultural and indigenous wisdom and healing.
In October, hundreds came together for the Community Health Conference in Breezy Point, Minn. for the Community Health Conference, where we discussed the power of our stories in creating health. I witnessed the cracking open of courageous conversations on race, power and privilege. These dialogues can be difficult but are necessary in order to experience breakthroughs in understanding, healing and belonging – which is exactly what our country and our communities need right now.
Lastly, this month MDH released the 2017 Minnesota Statewide Health Assessment, which talks about health inequities and the living and working conditions that shape health. It moves us to a model grounded in resilience that looks at how opportunity, nature and belonging create health. This approach allows us to focus our efforts on what creates health.
In today’s political environment, if we are not explicit that all Minnesotans are welcome and belong in our communities, we risk perpetuating exclusion and divisiveness. This then pushes people out of communities, resources or support networks, which foster and promote health. We all play a role in creating the health of our communities. How will you create greater trust between you and the communities you serve? How can you foster a greater sense of belonging amongst you and your neighbors? I invite you to consider these questions, as CHE also grapples with what they mean for us and for MDH.
Read on to learn more about the Statewide Health Assessment!
Continuing the Community Conversation in Bemidji
Earlier this fall we had the privilege of joining many American Indian community members in conversation at the Northwest Indian Community Development Center in Bemidji. Commissioner Ehlinger and CHE Director Bruce Thao shared updates on the agency’s progress in advancing health equity while also hearing from community members and leaders about their needs and concerns. We heard stories that attest to both the pervasiveness of inequities within the American Indian community and the enduring resilience of community members through generations of trauma. We also heard community members say that the challenges to achieve health and wellness cut across not just health systems, but also transportation, employment, housing and mental health, and that indigenous traditions, medicine and practices are key to healing.
We would like to extend a sincere thank you to our friends at the Northwest Indian Community Development Center for inviting us into your community space and for co-hosting the event. More detailed notes from the conversation can be found on the Community Conversations on Advancing Health Equity webpage.
Welcoming the first members of the HEAL Council
The Center for Health Equity is proud to welcome the first members of the MDH Health Equity Advisory and Leadership (HEAL) Council who were appointed this week by Commissioner Ehlinger. The new advisory council will provide guidance on how to advance the health of communities across the state that are most impacted by persistent health inequities.
“I am excited to work with this talented and passionate group of leaders from across the state,” said CHE Director Bruce Thao. “They represent the rich diversity of our state and will play a critical role in helping MDH advance the health of all Minnesotans.”
The HEAL Council was created as part of a broader effort by the Minnesota Department of Health to address Minnesota’s disparities in health status – particularly those persistent disparities across various ethnic, racial and regional groups. The HEAL Council was designed to consist of members representing the many communities most severely impacted by health disparities across the state, including racial and ethnic minority groups, rural Minnesotans, Minnesotans with disabilities, American Indian tribes, LGBTQ community members, refugees and immigrants. For a list of members, please visit the HEAL Council webpage.
The council will assist the Minnesota Department of Health in carrying out the efforts outlined in the department’s strategic plan and its Advancing Health Equity report, including advising on specific MDH policies and programs. The council will also assist MDH in developing strong performance measures related to advancing health equity. We look forward to hosting the first council meeting in early 2018.
Grantees reconnect at 2017 Community Health Conference
The Eliminating Health Disparities Initiative (EHDI) grantees came together once again this September for a half-day grantee gathering and the annual Community Health Conference in Breezy Point, Minn. Staff from the 32 grantee organizations gathered in Breezy Point the day before the conference to learn from one another’s successes and challenges and build a stronger grantee learning community.
“This year’s grantee gathering lifted my spirit and added fuel to my (bon)fire for health equity!” said grantee Jacki Trelawny of Family Tree Clinic. “Authentic relationships are not built solely over email or professional collaborations; getting together and getting to know the person behind the work is where lasting trust is planted. It is these relationships that break borders and create new ideas or practices to advance health equity.”
Jacki was one of six grantees who served on this year’s Community Health Conference planning work group, along with grant managers Bridget Roby and Mohamed Hassan. Representatives from seven grantee organizations also presented their work at conference during different concurrent sessions. This year’s conference theme centered around listening and learning from one another's stories, while also acknowledging our different perspectives and what makes us unique.
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.
Community Health Workers: Building bridges to health equity
Community health workers (CHWs) are a growing profession. The Minnesota Community Health Worker Alliance defines CHWs as “trusted, knowledgeable frontline health personnel who typically come from the communities they serve. CHWs bridge cultural and linguistic barriers, expand access to coverage and care and improve health outcomes.”
CHWs are becoming more common in Minnesota. In 2005, Minnesota became the first state to implement a CHW certificate program through the state college system, and in 2007, the Legislature approved reimbursement of specific CHW services through Medicaid. According to a 2016 report, “CHW Toolkit: A Guide for Employers,” there were as many as 2,000 paid and unpaid CHWs in Minnesota.
Ramsey County Public Health was an early and enthusiastic adopter of the CHW model. Some of their CHWs work under the job classification “Health Education Program Assistants” and are therefore known as “HEPAs.” Child and Teen Checkups (CT&C) is one of Ramsey County’s programs that has embraced the role of CHWs in expanding access to care and reducing health disparities.
Child and teen checkups are routine health visits for low-income youth up to age 21 who receive Medical Assistance (MA). The C&TC program works with families and health professionals to make sure that kids are getting all of their checkups so they can grow to their full potential. A federal program makes funding available for every MA-enrolled child to participate in C&TC. In 2016, there were about 80,000 eligible kids in Ramsey County.One reason that Ramsey County C&TC program employs HEPAs is that C&TC services are underutilized. Some reasons include:
- Not knowing about the program or its benefits
- Lack of trust in the government and/or the health care system
- Language or cultural barriers to accessing care
- Lack of transportation to access care
- More urgent, day-to-day, family needs
To help counteract these barriers, the CT&C program employs seven HEPAs. For this story, we interviewed three of them: Hibat Sharif, Say Say Eh and Glenda Harris.
Hibat Sharif grew up in Maine after coming to this country from Somalia as a little girl. Hibat explains that, as HEPAs, she and her colleagues spend a lot of time on the phone. They do “intro calls” to all families with children newly enrolled in MA. Every new enrollee receives a letter welcoming him or her to the program, but the HEPAs also reach out by phone to provide a more personal touch. They also do calls to clients reminding them to get their yearly checkups – a requirement of the program. The HEPAs do calls in their native languages as well as in English. They help set appointments and arrange for transportation and interpreters.
Say Say Eh is a member of the Karen community. Born in Burma, Say Say grew up in a refugee camp in Thailand. She sees the value of her work to the Karen community every day. She explained that because her community is new to the U.S., they need a lot of help navigating the system. Some in her community do not trust the government or health care system. She shared the following example of the value of her involvement: “When we send information to people in my community, they might just throw it into the garbage. So it’s really good that I do this work and can explain it to people.”
Even though many in St. Paul’s African-American community have lived here for generations, Glenda Harris said that people in her community may still need help knowing what services are available to them, like which dental clinics will accept their insurance. “I feel like for my community,” she said, “due to [structural inequities] many people are still not as connected as they could be. There is also limited quality health care within some neighborhoods.”
The HEPAs see themselves as bridge builders, connecting people to community resources. They visit nearly every agency that provides direct services for refugees and people with low incomes. They offer incentives and program information. They talk with people about the many available services in their counties. Sometimes their work is less directly about getting people to check-ups and more about helping them meet their basic needs first. They may help people find resources, like food shelves or help them apply for SNAP [Supplemental Nutrition Assistance Program]. “We are everywhere in the community,” Hibat said with a smile.
It is clear that Say Say, Hibat and Glenda love and believe in the work they are doing. “To me, it is such an honor and privilege to work for the community I am personally connected with,” said Glenda. “Because we are a part of the community, we understand it and can work in a culturally appropriate way without wasting time or resources…which sometimes happens when others come in to try to help.”
All three HEPAs had some thoughts on what made them successful in their jobs: they are self-motivated, resourceful, good listeners and thick-skinned. Perhaps the best and most honest advice came from Say Say: “Be loving and patient,” she said. “And if you don’t love your community, don’t come to this job.”
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.
Statewide Health Assessment: A critical step in examining health inequities
The long-awaited 2017 Minnesota Statewide Health Assessment was released in early November. Collaboratively developed by the Healthy Minnesota Partnership and MDH, the Statewide Health Assessment tells a story of health in our state.
“This 2017 Minnesota Statewide Health Assessment is a frank look at the challenges to health in Minnesota,” said Commissioner Ehlinger. “[It] is a critical step in examining Minnesota’s inequities by race and ethnicity, gender, age, sexual orientation, geography and disability so that we can work together for change.”
The purpose of this assessment is to clarify the association between the conditions in which we live and our health and to reveal the sources of health inequities experienced by many people in Minnesota. It is organized into three sections that reflect what all people need to be healthy:
- Opportunity: Health is related to opportunities for education, employment, income, housing and transportation.
- Nature: Health is shaped by connections to and interactions with the natural environment – including the impact our actions have on the air water and soil – and the places we live, learn, work and play.
- Belonging: Inclusion in the community and connections to other people enhance or weaken health, from early childhood and continuing throughout the lifespan.
In each section of the report, data on social, economic and environmental conditions have been linked to rates of disease or health behaviors in order to strengthen understanding of and model a new narrative around what really creates health.
For example, instead of rehashing the old narrative that teen substance use is about individual risk-taking behaviors (and a normal part of the teen experience), the assessment looks at root causes. It examines factors that may influence a teen’s sense of belonging. Using Minnesota Student Survey data, it highlights a correlation between self-reported substance use among 11th graders and the number of Adverse Childhood Experiences (ACEs)*. It shows that teens who have experienced four or more ACEs use painkillers, binge drink or use marijuana at a much higher rate than their peers who haven’t experienced such traumas. The assessment further notes that these traumas are not randomly distributed; rather, certain populations of children are more likely to experience adversity because of the stressors experienced by their families and communities.
We encourage health systems and our county, nonprofit, tribal and other partners to use the assessment to support your organization’s health improvement efforts. Completing a statewide health assessment every five years is a requirement of maintaining accreditation through the national Public Health Accreditation Board for MDH. More importantly, it sets the stage for action through the development of Healthy Minnesota 2025: Statewide Health Improvement Framework. Under the direction of the Healthy Minnesota Partnership and MDH, the 2025 framework will guide collective efforts to achieve the vision that “All people in Minnesota enjoy healthy lives and healthy communities.”
To learn more about the assessment and download a copy, please visit the Statewide Health Assessment website.
*Nine different types of Adverse Childhood Experiences (ACEs) have been studied: physical abuse, sexual abuse, verbal abuse, mental illness of a household member, problematic drinking or alcoholism of a household member, illegal street or prescription drug use by a household member, divorce or separation of a parent, witnessing domestic violence towards a parent and incarceration of a household member.
Xiaoying Chen retires after 11 years at MDH
Xiaoying Chen retired in October after many years of state service as the Asian health coordinator for the Office of Minority and Multicultural Health (OMMH), and most recently as a community engagement planner for the Center for Health Equity. As OMMH evolved over the years and eventually became part of the new Center for Health Equity, Xiaoying quickly adapted, responded to new challenges and willingly took on new and changing responsibilities. Xiaoying managed many EHDI grants, served as the MDH representative on numerous cultural and health coalitions and committees and consistently served as a voice of underrepresented communities. Her accomplishments and contributions are too many to name.
“Xiaoying was a strong collaborator partner for Asian communities and all of the populations of color,” said longtime colleague Rosemarie Rodriguez-Hager. “She was a fierce advocate for populations of color and never tired of working to help improve the conditions of health for all Minnesotans.”
Thank you Xiaoying, for your voice of wisdom and your years of service!
Updates and Opportunities
Director Bruce Thao interviewed on A Public Health Journal
CHE Director Bruce Thao sat down with Commissioner Ehlinger earlier this fall to discuss health equity in Minnesota on the Commissioner’s long-running cable TV show, A Public Health Journal. The weekly show features public health professionals, thought leaders, policymakers and community activists and airs Wednesdays at 8 p.m. on MCH Channel 6. Program episodes are also available on the A Public Health Journal YouTube channel.
Follow Bruce on Twitter!
Congratulations Anne Walaszek at the American Indian Cancer Foundation
Congratulations to one of our EHDI grantees, Anne Walaszek, recent recipient of the Lou Fuller Award for Distinguished Service in Eliminating Health Disparities! This award is given annually at the Community Health Awards Ceremony in Breezy Point, Minn. to an individual or organization who demonstrates an outstanding commitment to eliminating health disparities in populations of color and American Indians. Anne currently works as the clinic and community health program manager for the American Indian Cancer Foundation and is part of the organization’s EHDI-funded efforts to reduce the burden of cervical cancer in American Indians.
Congratulations to our MDH colleague Whitney Terrill
Congratulations to our colleague Whitney Terrill, whose photo submission was selected to be featured in the National Academy of Medicine's Visualize Health Equity online gallery. The community art show is designed to promote understanding what people across the country see as the most important health challenges and opportunities facing their communities. Whitney currently works as a planner in the Community Integration and Practice Transformation Unit of the Health Policy division of MDH.