January 26, 2018

Quick quiz: where is an infant more likely to die, in Bulgaria or north Minneapolis?  The correct answer, sadly, is the latter.  In fact, if the black population of Minnesota were its own country, it would rank 80th in the world in infant mortality, around the same as Thailand and Croatia.  White Minnesota would be about the same as Denmark.

Minnesota children of color lag behind white Minnesota children in many measures of health.  While our state consistently ranks among the best for children overall, it also has among the biggest health disparities.  Infant mortality, immunization rates, poverty, school readiness – all are worse for children of color, in some cases by an order of magnitude.

To draw attention to this problem, Gov. Dayton declared January Health Equity Month.  While it’s great to raise awareness, eliminating health disparities will require action, bold action.  Only 20% or less of health outcome is related to medical care.  The remainder is affected by environmental, social, and behavioral factors.  The health disparities we see in Minnesota (and frankly the rest of the country – they’re just more marked here) are due to deep underlying issues around poverty and inequality.  Issues that are so deep it can seem impossible to fix them.  What can those of us who care for kids do?  One thing Children’s Minnesota has done is to begin to focus on all those social determinants of health in our patients.  Our Community Connect program, launched in our St. Paul primary care clinic in 2017 and now rolling out to other areas, screens patients and families not only for medical issues like immunizations and allergies, but also non-medical ones such as poverty, housing and food insecurity, joblessness, and immigration issues, all of which have a direct impact on a child’s health.  When needs are identified, we can refer families to community resources for help.  So far we have screened nearly 2000 families.  Unfortunately, insurers don’t generally see this as a billable medical expense, but our program has been generously supported by philanthropy, including grants from the Children’s Hospital Association and U Care, among others.

We also need to take a hard look at ourselves.  While social issues predominate, racial and ethnic disparities in medical care itself have also been identified.  For example, children of color with appendicitis are less likely to receive pain medication than their white counterparts.  When we saw a similar issue in our own emergency department we implemented education and guidelines to help correct it.

But just as with patient safety, we need to look at the root causes.  Health disparities arise from the same issues of historical oppression and systemic racism that underlie a host of other issues.  Referring people to food banks and educating doctors about pain protocols is like giving ibuprofen to someone with an infection; it treats the symptom, not the disease.  If our children of color are to thrive as much as our white children, we need to dig far deeper, and advocate for real change.  January is a start, but it’s going to take much more than a month.

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