Report Blames Structural Racism for MN Health Disparities
In a bold move by the Minnesota Department of Health (MDH), state officials are blaming structural racism for Minnesota’s significant health disparities, which have been a point of concern in the state for decades. The accusation is front and center in a new report to the Legislature called “Advancing Health Equity,” which was released Monday. In it, the MDH attempts to identify and explain the persistence of poor health outcomes among certain groups in Minnesota, which are expressed most starkly along racial lines.
Of course, other segments of the population experience persistent health inequities, including women, children, LGBT people, people with disabilities, people with mental illness, those who live in rural areas, and those who live in certain urban or suburban neighborhoods. Yet in composing the new report, the MDH decided to “lead with race” to meet the challenge of health equity, because “disparities by race/ethnicity in Minnesota persist across socio-economic factors, environmental conditions, health behaviors, and health outcomes; in many cases these disparities are growing.”
The report explores several areas in which structural racism contributes to poor health outcomes – even in areas where a connection to health may not seem immediately evident. One example is the racial disparity in homeownership rates between whites and people of color that are largely attributed to discriminatory practices (such as redlining). Those who don’t own homes because they can’t afford to often live in older housing as renters – and older homes can present threats to health (such as lead based paint, mold, and asbestos). The homeownership rate among whites in Minnesota is 75%; in comparison, the homeownership rate for Native Americans is 47%, Asians 54%, Hispanics 45%, and blacks 21%.
Housing is only one example of the kind of “persistent, significant, and socially-determined differences in the conditions that create health and the opportunity to be healthy for certain populations in Minnesota.” Other factors explored in the report include the frequency with which 9th graders change schools, high school graduation rates, poverty, unemployment, incarceration, and per capita income, along with more intuitively-related markers such as a lack of health insurance or underinsurance.
The documented disparities in these areas along racial lines are significant, as are several related disparities in health outcomes. Particularly illustrative are two examples: mortality rates for African-Americans and Native Americans in Minnesota are two to three times higher, respectively, than for whites at earlier ages, and African American women have a 24% higher breast cancer mortality rate than white women – despite the fact that the incidence of breast cancer among the former is 18% lower than the latter.
Taking into account the range of “social determinants of health” – the living and working conditions that influence individual and population health – the MDH argues for a systems-based approach to advancing health equity, wherein systems are in place that ensure every person has:
1) access to political, economic and educational opportunity;
2) the capacity to make decisions and effect change for themselves, their families and their communities;
3) social and environmental safety in the places they live, learn, work, worship and play; and
4) culturally competent health care available when the need arises (MDH, 2014: 3)
Identifying deficiencies in all of these areas may help to explain the disproportionately higher rates of autism spectrum disorder (ASD) accompanied by intellectual disability within Minneapolis’ Somali community that were documented in a University of Minnesota study last month. That study was prompted out of concern that there seemed to be a disproportionate percentage of Somali children enrolled in Minneapolis Public Schools’ preschool special education program for ASD. While researchers found no overall difference in the number of Somali and white children diagnosed with ASD (rates were found to be lower among black and Hispanic children), the likelihood that ASD will be accompanied by an intellectual disability in Somali children is significantly higher. The study’s authors did not offer an explanation for the discrepancy, but their recommendations for addressing it include adopting the kind of systems-based approach the MDH advocates.
Because it purports to address the socially-determined conditions that lead to disparities in health outcomes (and thereby produce health inequities), an authentic systems-based approach to health will require that Minnesotans confront the many racial disparities that have plagued the state. Talking about structural racism – let alone actually doing anything about it – is often a challenge. However, the authors of the new MDH report rightly point out that “having explicit conversations and creating clear intention to talk about race and racism and the relationship of race to the structural inequities that contribute to health disparities is necessary to advance health equity in Minnesota.” The authors note that all Minnesotans should take an interest in overcoming these disparities, because in societies with significant population-based inequities that result in compromised health outcomes, everyone’s health is diminished through “generalized tension and a diminished sense of overall security.”
A systems-based approach to health requires substantial leadership support and cultural shifts. The MDH has taken an important step in highlighting the way structural racism produces system-wide inequities that translate into poor health outcomes. Health care providers must also show a willingness to overcome an organizational culture that is often fragmented, driven by profit, and focused on individual rather than collective health if there is any hope of achieving more comprehensive, collaborative, and culturally-competent health care delivery in Minnesota.