Priority Health Areas of the Eliminating Health Disparities Initiative


On this page:
Breast and cervical cancer
Cardiovascular disease
Diabetes
HIV/AIDS and STIs
Immunizations
Infant mortality
Teen pregnancy prevention
Violence and unintentional injury
Other related resources

Breast and cervical cancer

Minnesota’s Sage Screening Program provides free breast and cervical cancer screening at 430 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 their breast cancer detected in its 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 annual mammograms and clinical breast examinations. Women cite economic, social, and cultural barriers to screening, referral, and treatment, such as cost, lack of or inadequate health insurance, poor access to health care, lack of physician recommendation, language, 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 170 women develop invasive cervical cancer and 45 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 death are preventable through:

  • regular 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 white women. Deaths due to cervical cancer also occur at significantly higher rates among Asian Americans and African Americans compared with white non-Hispanics.

All women who are age 21 and older should undergo regular screening with Pap tests and prompt treatment of significant pre-cancerous lesions. Barriers to screening for 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:

Heart disease and stroke

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:

MDH Contact:
Stanton Shanedling, Ph.D., M.P.H
Supervisor, Heart Disease and Stroke Prevention Unit
651-201-5408
stanton.shanedling@state.mn.us

Diabetes

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.

Contributing Factors

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.

Diabetes resources:

HIV/AIDS and STIs

In 2009, the number of newly reported cases of HIV among persons of color (180) nearly equaled the number of newly reported cases among whites in Minnesota (189), even though communities of color make up approximately 10 percent of Minnesota's population. African-born men and women have the highest annual rates of newly reported HIV/AIDS infections.

Gonorrhea and chlamydia infections are the most common reportable diseases in Minnesota with nearly 16,500 cases reported in 2009. Infection with these STIs can cause infertility in women and increases the chances of spreading HIV. Communities of color are also disproportionately affected by STIs, accounting for 42% of reported cases. Among Minnesotans in 2009, African Americans had the highest rates of gonorrhea and chlamydia.

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
- Prevalence

HIV/AIDS and STIs resources:

Immunizations

A person's need for immunizations is life long. Children need protection against at least 14 serious vaccine-preventable diseases. To be fully protected, babies need five shot visits throughout the first two years of life in order to receive about 27 vaccinations, another visit for additional immunizations before kindergarten, and again as adolescents. Adults also need shots: tetanus-diphtheria-pertussis boosters, influenza, and pneumococcal vaccine. Medical conditions, environmental conditions, and work situations are other reasons for additional vaccines such as hepatitis B and hepatitis A for many adults. The use of vaccines has resulted in the lowest levels of vaccine-preventable disease ever reported, but the immunization rates of children in certain socioeconomic groups and adults in both socioeconomic and racial/ethnic groups remain low. These low immunization rates can lead to disease outbreaks at any time. There are a number of factors that contribute to low immunization rates in people of color and American Indians in Minnesota. These factors include, but are not limited to the following: income, lack of provider and community awareness of special vaccine recommendations, common barriers to immunizations (transportation, lack of health insurance, lack of a medical home, need for interpreters, lack of knowledge of the importance and safety of immunization, and lack of clinic reminders when shots are due), and misperceptions regarding influenza and pneumococcal vaccines.

The Minnesota Department of Health Immunization Program has information on diseases such as measles, diphtheria, pneumonia, whooping cough, hepatitis B, influenza, and more. They have materials available in Spanish, Hmong, Somali, Russian, and other languages. The program has resources on vaccines that infants, children, adolescents, and adults need to be safe from diseases. They also have videos, posters, brochures, magnets, etc. All of these resources can be ordered from the MDH Immunization Program for free.

For more information, call the Minnesota Immunization Hotline at 800-657-3970 or 651-201-5503.

Immunization resources:

Infant mortality

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 2004-2008 was 5.1 infant deaths per 1,000 live births, just slightly improved from 1999-2003’s rate of 5.4. 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:

Teen Pregnancy Prevention

Every day in Minnesota, approximately 20 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 2007, 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.  From 1991-2004, the estimated public cost of teen childbearing in the United States was $161 billion dollars.  In 2004 alone, adolescent childbearing cost the United States approximately $9.1 billion dollars, including the cost to Minnesota taxpayers (federal, state, and local), which was approximately $142 million.

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 Contact:
Jennifer O'Brien
651-201-3627
jennifer.obrien@state.mn.us

Violence and unintentional injury

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 weight of injury and violence in Minnesota is 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:

Other related resources

Adolescent Health
MDH - Adolescent Health Web site

MDH Contact:
Jennifer O'Brien
651-201-3627
jennifer.obrien@state.mn.us

Center for Health Promotion
MDH - Center for Health Promotion

MDH Contact:
Don Bishop
651-201-5402
don.bishop@state.mn.us

Center for Health Statistics
MDH - Center for Health Statistics

MDH Contact:
Melanie Peterson-Hickey
651-201-5949
Melanie.Peterson-Hickey@state.mn.us

Chronic Disease Risk Reduction Unit
MDH - Chronic Disease Risk Reduction Unit

MDH Contact:
Martha Roberts
651-201-5492
martha.roberts@state.mn.us

Community Engagement
MDH - Community Engagement

MDH Contact:
Gail Gentling
651-201-3875
Gail.Gentling@state.mn.us

Mental health/suicide prevention
MDH - Mental Health Promotion
MDH - Suicide Prevention

MDH Contact:
Phyllis Brashler
651-201-3586
health.suicideprevention@state.mn.us

Injury and violence prevention
MDH - Injury and Violence Prevention Unit

MDH Contacts:
Jon Roesler
651-201-5487
jon.roesler@state.mn.us

Mark Kinde
651-201-5477
mark.kinde@state.mn.us

Nutrition
MDH - Nutrition

MDH Contact:
Donna McDuffie
651-201-5493
donna.mcduffie@state.mn.us

Obesity Prevention
MDH - Overweight and Obesity

MDH Contact:
Chris Kimber
651-201-5497
chris.kimber@state.mn.us

Physical Activity
MDH - Physical Activity

MDH Contact:
Amber Dallman
651-201-5494
amber.dallman@state.mn.us

Social Determinants
MDH Contact:
Dorothy Bliss
651-201-3871
dorothy.bliss@state.mn.us

Tobacco
MDH - Tobacco Prevention and Control

MDH Contact:
Paul Martinez
651-201-3663
paul.martinez@state.mn.us


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Updated Tuesday, 16-Nov-2010 12:31:55 CST