Priority Health Areas of the Eliminating Health Disparities Initiative
On this page:
Breast and cervical cancer
HIV/AIDS and STIs
Teen pregnancy prevention
Violence and unintentional injury
Other related resources
Minnesota’s Sage Screening Program provides FREE breast and cervical cancer screening at 475 clinics throughout Minnesota. Individuals can call 1-888-6- HEALTH (1-888-643-2584) to find out if they are eligible and make an appointment.
Breast cancer is the most common form of cancer in Minnesota women and the second leading cause of cancer deaths. Survival from breast cancer is directly related to the stage of the disease at the time of diagnosis.
Approximately 98 percent of women who have had their breast cancer detected in the earliest stages survive.
The proportion of survivors drops to 23 percent for women whose breast cancer is diagnosed when it has spread to other organs.
Among the racial/ethnic groups in Minnesota, African American women have a breast cancer mortality rate that is 24 percent higher than that of white non-Hispanic/Latina women, despite incidence rates that are 22 percent lower. A greater proportion of African American women have their breast cancers diagnosed at a later, less treatable stage. The other racial and ethnic minority groups have breast cancer mortality rates that are similar or significantly lower than that of white non-Hispanics.
In order to reduce deaths from breast cancer, all women age 40 and older should get regular mammograms and clinical breast examinations. It is important to discuss with your provider what the optimal screening interval should be for the individual woman. Women cite economic, social and cultural barriers to screening referral, and treatment. Cost, lack of adequate health insurance, poor access to health care, lack of physician recommendation, language, and cultural beliefs and practices, fear, and knowledge gaps as reasons for not getting screened. Lack of time and inconvenience has also been reported as barriers.
Approximately 140 women (down from 170 women) develop invasive cervical cancer and ~ 40 women die from it every year in Minnesota. Thousands more develop pre-cancerous changes of the cervix that can progress to cancer if left untreated. Virtually all cervical cancer occurrence and deaths are preventable through:
Regular cervical screening with Pap tests and prompt treatment of pre-cancerous cervical changes.
African American, American Indian, and Asian American women have cervical cancer incidence rates that are two or more times as high as the rate for non-Hispanic white women. Deaths due to cervical cancer also occur at significantly higher rates among Asian Americans and African Americans compared to non-Hispanic white women.
All women who are age 21 to 65 should undergo regular cervical screening with Pap tests and prompt treatment of significant pre-cancerous lesions. Barriers to screening and treatment of cervical lesions include lack of health insurance, cultural beliefs and practices, and lack of knowledge about the need for on-going screening after childbearing years.
Breast and cervical cancer resources:
- SAGE Minnesota's Free Breast and Cervical Cancer Screening Program
Sage provides FREE breast and cervical screening at 475 clinics throughout Minnesota. Individuals can call 1-888-6-HEALTH (1-888-643-2584) to find out if they are eligible and make an appointment.
- Breast Cancer, Centers for Disease Control and Prevention
- Cervical Cancer, Centers for Disease Control and Prevention
- American Cancer Society
Gay Lynn Richards, DNP RN MPH
Heart disease and stroke (or cardiovascular disease) refers to a wide variety of heart and blood vessel diseases and conditions, including coronary heart disease, stroke, high blood pressure, high blood cholesterol, and rheumatic heart disease.
Arteriosclerosis (hardening of the arteries), the underlying disease process of the major forms of heart disease and stroke, begins in childhood and slowly progress throughout a person’s lifespan. Arteriosclerosis is associated with several modifiable risk factors, including high blood pressure, high blood cholesterol, cigarette smoking, physical inactivity, diabetes, obesity, and poor diet. Control of modifiable risk factors at the population and individual level is key to preventing heart disease and stroke and their complications.
Heart disease and stroke are the second and third leading causes of death in Minnesota. Combined they are the largest cause of death, responsible for 26 percent of all deaths statewide in 2007.
Current information related to disparity:
Mortality rates for Minnesotans overall are lower than the nation as a whole; however, for certain segments of the population, including American Indians, African Americans, and Asian American men, age-adjusted mortality rates for heart disease or stroke are higher than the overall state population rates. American Indian heart disease and stroke death rates from 2000 through 2007 were 45 and 29 percent higher than those for whites. Data from the Indian Health Service from 1999 through 2001 estimated the mortality from heart disease in the Bemidji district to be the highest of all IHS districts (61 percent higher than the national rate). African Americans died from stroke at a rate 44 percent higher than that for whites during the same time period. Asian American men living in Minnesota are more likely than other population groups to suffer from stroke. Individuals experiencing a heart attack or stroke are immediately at much higher risk of suffering the same event again, becoming permanently disabled, or dying from complications in the months and years that follow.
In conjunction with disparities in heart disease and stroke mortality rates by race in Minnesota, some racial groups experience a higher burden of disease at younger ages. Years of potential life lost (YPLL) measures premature mortality (defined as a death occurring before age 65). The YPLL rate due to heart disease and stroke differs dramatically by racial and ethnic groups in Minnesota. The burden of early death due to heart disease and stroke in African Americans (1,302 YPLL per 100,000) and American Indians (2,104 YPLL) is 64 percent to 165 percent higher than for whites (792 YPLL). YPLL rates for Asian Americans and Hispanics/Latinos in Minnesota are even lower at just 398 and 378 per 100,000, respectively. These disparities indicate that African Americans and American Indians die from heart disease and stroke at much younger ages than whites, Asian Americans, and Hispanics/Latinos.
Heart disease and stroke incidence and mortality rates are higher among people of lower socioeconomic (SES) status. The greatest declines in heart disease and stroke mortality over time have been among those at the highest income and educational levels. These differences have been attributed to the greater prevalence of risk factors (e.g., obesity, lack of exercise, high blood pressure, smoking) within lower SES populations and to the effects of neighborhood socioeconomic status.
Heart disease and stroke resources:
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit
- Take Heart Minnesota
- American Diabetes Association
- American Stroke Association
Stanton Shanedling, Ph.D., M.P.H
Supervisor, Heart Disease and Stroke Prevention Unit
Diabetes mellitus is a group of serious, lifelong diseases affecting nearly 24 million Americans. All forms of the disease are caused by higher than normal levels of blood sugar, which is a result of the body not producing or properly using insulin. Insulin is a hormone that converts food into energy needed by the body. Diabetes can lead to serious complications that can affect most every part of the body and cause early death if blood sugar, blood pressure and cholesterol are not kept under good control. The most common forms of the disease are:
- Type 1 diabetes – an autoimmune disease most often seen in children, but can happen at any age. People with type 1 diabetes must take insulin daily to live.
- Type 2 diabetes – the most common form of diabetes found in 90-95 percent of people with diabetes. Here the body gradually stops using insulin appropriately, so many people have no symptoms at first. Previously associated with aging, type 2 is now being seen in children and young adults due to obesity and other risk factors.
- Gestational diabetes – a condition where blood sugar levels are higher than normal during pregnancy, but return to normal after giving birth.
- Pre-diabetes – occurs when blood sugar levels are higher than normal but not yet high enough to be diagnosed as diabetes. Pre-diabetes can develop into type 2 diabetes, but is thought to be reversible with modest lifestyle changes.
Diabetes is the sixth leading cause of death in Minnesota, and the leading cause of blindness, kidney failure, and lower-limb amputations. In Minnesota, glaring racial and ethnic disparities in diabetes exist that are reflected in the disease’s prevalence, complication and death rates, and preventive care received by those who have diabetes. African Americans, Hispanics/Latinos and American Indians in Minnesota had diabetes as an underlying cause of death (diabetes-related death) 2-5 times greater that Asian Americans and non-Hispanic whites. However, the diabetes death rate among Asian Americans is increasing faster than any other racial or ethnic group. Among people with diabetes: kidney failure is 2-5 times greater in populations of color; lower limb amputations are 4 times greater in American Indians; and eye disease is 2 times greater in Hispanics/Latinos, and 40-50 percent greater in African Americans.
In Minnesota, diabetes is the leading medical risk factor during pregnancy. Both gestational diabetes mellitus (GDM) and pre-existing type 1 or type 2 diabetes may create complications during pregnancy and result in poor outcomes for both the mother and infant. Women who have had GDM are more likely to develop type 2 diabetes later in life. Pre-existing or gestational diabetes during pregnancy increases the risk of birth defects by over 70 percent and triples the risk of the infant dying after birth. Pre-existing diabetes-complicated births are 2.1 times greater in African Americans, 2.4 times greater in Hispanic/Latinos and 7.6 times greater in American Indians when compared to Asian Americans who have the lowest prevalence. Gestational diabetes-complicated births are 2 times greater in Hispanic/Latinos and almost 3 times greater in American Indians when compared to non-Hispanic white population who has the lowest prevalence. Pregnancy complicated by diabetes is increasing faster among Hispanics/Latinos, American Indians, and Asian Americans than among whites. These groups are also at greater risk of receiving less than adequate prenatal care.
One in every 3 children born in the U.S. after 2000 will develop diabetes. For Hispanic/Latino children the number is 1 out of every 2. In Minnesota, populations of color and American Indian children ages 10-19 years diabetes prevalence is 4-6 times higher than seen in the non-Hispanic white population.
One in four people in Minnesota have pre-diabetes, including 92,000 children. Most of these people (78%) are overweight or obese, 42 percent have high blood pressure, 38 percent have high cholesterol and 16 percent currently smoke. People with pre-diabetes are 5-15 times more likely to develop type 2 diabetes than those without the condition. However, studies show that diabetes may be prevented or delayed if people with pre-diabetes lose at least 7 percent of their body weight and engage in moderate physical activity (such as walking) at least 150 minutes per week. Some diabetes medications can also work, but lifestyle interventions are the most effective way to prevent diabetes for people with pre-diabetes of all ages.
Racial and ethnic disparities in diabetes complications and diabetes-related deaths are made worse by a variety of factors, including poor access to diabetes medicines, supplies, and preventive care. Lack of culturally and linguistically appropriate diabetes education materials and support systems, and lack of culturally diverse or culturally competent health care providers further impede effective diabetes management in these populations.
Obesity is a major risk factor for developing pre-diabetes and type 2 diabetes. Approximately 80 percent of people with type 2 diabetes are obese at the time they are first diagnosed. Other risk factors include a high-fat diet; physical inactivity; high blood pressure; high cholesterol; having a family history of type 2 diabetes (parents, siblings or children); and women having had gestational diabetes, given birth to a baby weighing 9 pounds or more, or having polycystic ovarian syndrome. The risks for diabetes and its complications are exacerbated by smoking, poor dental care and having other chronic conditions.
- National Diabetes Education Program (NDEP)
Multilingual, multicultural information on diabetes, pre-diabetes and behavior change for individuals, health professionals, community organizations, schools and businesses
- The National Diabetes Information Clearinghouse
- Centers For Disease Control and Prevention - Diabetes Public Health Resources
- American Diabetes Association
- Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003)
- Institute of Medicine. Guidance for the National Healthcare Disparities Report
- Rainbow Research. Minnesota's Eliminating Health Disparities Initiative – Reports 1-6, 2008
- MDH - Refugee Topics
Includes cultural competence, language access, social services and refugee program information.
The 2015 HIV/AIDS Surveillance Report can be found on the MDH website at HIV/AIDS Surveillance. It shows there were 294 newly reported HIV/AIDS cases in 2015, compared with 306 in 2014. A total of 11,007 cases have been reported to MDH since the epidemic began in the state in 1982. An estimated 8,215 people in Minnesota are living with HIV/AIDS. “We are seeing higher HIV infection rates in communities with limited access to HIV testing and prevention programs due to longstanding social, medical or income disadvantages,” said Minnesota Commissioner of Health Dr. Ed Ehlinger. “We can reduce these rates by improving access to services through expanded partnerships for HIV prevention, testing, treatment and care within these communities.”
For those at substantial risk of getting HIV, a daily prevention pill is now available by prescription from a health care provider. This is referred to as pre-exposure prophylaxis or PrEP. Among those who would benefit from PrEP are injection drug users and those who have multiple sexual partners. Individuals can talk about getting PrEP with their health care provider; those who don’t have a health care provider can contact the Minnesota AIDS Project (MAP) AIDSLine for assistance.
An all-time high of 25,986 sexually transmitted Infections (STIs) were diagnosed in Minnesota in 2015. The number of STIs increased by 6 percent from 2014 and by 33 percent from five years ago when 19,547 STDs were reported. The STIs which health care providers are required to report to MDH include chlamydia, gonorrhea and syphilis. The MDH report also shows higher infection rates for chlamydia and gonorrhea among communities of color and American Indians when compared to whites. Higher syphilis infection rates were seen among American Indian and African American women, and men who have sex with men of all races.
Factors that directly increase the risk of HIV and STI transmission include the following:
- Susceptibility of the uninfected individual
- Infectiousness of the infected individual
- Sexual behaviors
- Drug use behaviors
- Health care behaviors
HIV/AIDS and STIs resources:
- Minnesota Department of Health STD and HIV Section
- CDC Division of HIV/AIDS Prevention
- CDC Division of Sexually Transmitted Diseases
- American Social Health Association
The need for immunizations spans a person’s entire life, as a baby, child, adolescent, and as an adult. Immunizations protect us from vaccine-preventable diseases that can cause serious illness, or even death. To be fully protected, babies need to be immunized in the first two years of life then before kindergarten, and again as adolescents. Everyone six months and older needs a yearly flu immunization. Many adults also need immunizations against diseases they are susceptible to because of age, chronic medical problems, or conditions at their work.
Immunization has reduced in the levels of some diseases to historic lows. But the numbers of people getting immunized in some groups in Minnesota are too low to prevent the spread of disease. Barriers to immunization can include:
- Access to routine health care
- Limited health insurance coverage or no health insurance at all
- Language barriers with medical providers
- Concerns over immunization safety
- Low awareness about importance of immunizations
The Minnesota Department of Health Immunization Program offers resources to help address some of these barriers:
- Minnesota Vaccines for Children Program offers free or low cost shots for eligible children 18 years of age and younger.
- Uninsured and Underinsured Adult Vaccine Program offers certain vaccines for free or at low cost to adults without health insurance coverage for vaccines (19 years and older).
- Minnesota Immunization Information Connection (MIIC) a statewide immunization system that stores immunization records to help make sure Minnesotans get the right vaccines at the right time.
- MDH - Immunization Program – Information on vaccines and the diseases they prevent. Some documents are available in other languages. Many printed materials can be ordered for free.
Infant mortality is defined as the death of a live-born infant from any cause before the infant's first birthday. Infant deaths are usually expressed as rates that represent the number of infant deaths per 1,000 live births. Infant mortality rates (IMRs) are an important indicator of the health and well-being of families and communities. Minnesota's IMR for 2009-2013 was 4.8 infant deaths per 1,000 live births. Although Minnesota has one of the lowest state rates in the nation, the overall state rate masks longstanding disparities in infant mortality experienced by some of Minnesota's populations. African American and American Indian infant death rates have improved since the onset of the Eliminating Health Disparities Initiative but remain significantly higher than those of white infants. Infant mortality is a summary statistic reflecting multiple conditions and causes. Poverty, poor housing, less education, no health care insurance coverage prior to pregnancy, racism and chronic race-related stress, and the absence of social support networks including a caring partner-all are associated with increased rates of infant mortality.
The populations experiencing this and other disparities have many strengths and traditions to draw upon for solutions. In the African American community, churches provide connections and leadership on community issues. For American Indians, restoring cultural traditions such as native foods, cradleboards, and sacred use of tobacco could improve infant health. Hispanic/Latino and Asian communities have similar traditions around family, nutrition, and healing practices that promote healthy pregnancy, birth, and infancy. MDH’s role is to educate communities about disparities, facilitate community engagement, and provide support to empower communities to take action.
Infant mortality resources:
- MDH - Infant Mortality Reduction Plan for Minnesota (Part One)
- MDH - Infant Mortality Reduction Initiative
- MDH - Disparities in Infant Mortality Report (PDF)
- MDH - Community Engagement: Multicultural Community Resources
- Minneapolis Healthy Start
- MDH – Text4Baby or Text4Baby
- Minnesota Perinatal Organization
- March of Dimes, Minnesota Chapter
- US Office of Minority Health
Every day in Minnesota, approximately 10 teens become pregnant and the vast majority of these pregnancies are unintended. Even though the greatest number of adolescent births in Minnesota is to white females, Minnesota youth of color have significantly higher birth and pregnancy rates than their white counterparts. In 2014, the adolescent birth rate for white females ages 15-19 was lower than the national average. However, all other racial and ethnic groups in Minnesota have higher rates than the national figures.
While some adolescent females continue to excel despite a pregnancy, research shows that adolescent females who become parents are less likely to graduate from high school and are more likely to remain unmarried, live in poverty, have large families, and receive welfare than women who become parents beyond adolescence. Pregnant adolescents are also less likely to receive timely and consistent prenatal care than women who become pregnant at an older age. The most serious consequences of adolescent childbearing are on the children. Children of adolescent parents are more likely to have unfavorable outcomes such as premature birth, low birth weight, lower cognitive development, more behavioral problems, and poorer educational outcomes. Other research indicates that daughters born to adolescent parents have an increased risk of becoming adolescent parents themselves and sons born to adolescent parents are more likely to become incarcerated.
Adolescent pregnancy and childbearing also affect the economy and society as a whole, in addition to the social costs, there are monetary costs associated with teen pregnancy and childbearing. According to the National Campaign to Prevent Teen and Unplanned Pregnancy (2012), the cost of teen childbearing for Minnesota taxpayers was at least $146 million in 2010. The estimated cumulative costs to taxpayers associated with the 103,902 teen births in Minnesota between 1991 and 2010 are $4.0 billion over that period. Had it not been for significant declines in the teen birth rate in recent years, the costs to taxpayers would have been even higher. Minnesota has seen a 40 percent decline in the teen birth rate between 1990 and 2010. The progress Minnesota has made in reducing teen childbearing saved taxpayers an estimated $141 million in 2010 alone compared to the costs they would have incurred had the rates not fallen.
Teen pregnancy is a critical public health issue that affects the health, educational, social, and economic status of adolescent parents and their children. Program planners, public health professionals, and community based organizations have the benefit of years of research on risk and protective factors and rigorous program evaluation to help the field implement effective strategies that make a difference in young peoples’ lives.
Teen pregnancy prevention resources:
- MDH - Center for Health Statistics - Minnesota Student Survey
- Advocates for Youth
- Child Trends
A non-profit organization that conducts research and evaluation studies in teenage pregnancy and childbearing and in issues related to parenting, family structure, and family processes, including fatherhood and male fertility.
- University of Minnesota, Healthy Youth Development, Prevention Research Center
- MN Adolescent Sexual Health Report
- Resource Center for Adolescent Pregnancy Prevention Program (RECAPP)
Provides practical tools and information to effectively reduce sexual risk-taking behaviors. Provides up-to-date evaluated programming materials to help those working with teens.
Mrs. Gabriel McNeal
Injury and violence are great problems in our communities, resulting in death, hospitalization, lost time from work and school, and in long-term disability. The problems of injury and violence in Minnesota are not shared equally. American Indian males aged 18 and 19 have suicide rates six times higher than in any other age or population group. African American youth aged 15 - 24 have firearm injury (FRI) mortality rates eight times greater than all males 15 - 24 in Minnesota, and 15 times greater than the rates for all ages, races and genders combined. African Americans and American Indians in Minnesota have rates of Traumatic Brain Injury (TBI) more than four times higher than among the rest of the population. African American, American Indian, and Hispanic/Latino children have rates of child maltreatment five, three and two times greater, respectively, than Asian/Pacific Islander and white children in Minnesota. African American, American Indian and Hispanic/Latino students in grades six to twelve report sexual abuse more often than white or Asian youth. All minority groups in Minnesota report higher rates of domestic violence compared to white Minnesotans.
Violence and unintentional injury resources:
- Minnesota Department of Health Injury and Violence Prevention
- Minnesota Department of Health Sexual Violence Prevention Program
Place to Start: A Resource Kit for Preventing Sexual Violence
A Health Promotion Kit that contains information on assessment, community coalition building and partnerships, program planning and implementation, evaluation, and sustaining the effort.
- Community Engagement Web site
Basic tools and worksheets to help plan meetings and build partnerships.
- US Department of Justice - Office on Violence Against Women
- Safe Kids Minnesota
- Minnesota Coalition Against Sexual Assault
MDH - Adolescent Health Web site
Mental health/Family Home Visiting
Mary Jo Chippendale
Injury and violence prevention
MDH - Injury and Violence Prevention Unit
MDH - Overweight and Obesity