On February 4th, 2014 the Minnesota Senate Committee on Health, Human Services and Housing met with Dr. Edward Ehlinger, the Commissioner of the Minnesota Department of Health (MDH), and other members of the community to discuss the health disparities gap that persists in Minnesota and programs that can help alleviate these disparities. (Watch the hearing here.) MDH recently published the Advancing Health Equity in Minnesota Report which highlights these disparities; for example:

  • In Minnesota, the infant mortality rate for African American and American Indian children is twice that of White children.
  • Children of color and American Indian children in Minnesota are less likely to receive dental sealants to prevent cavities and are more likely to have untreated cavities than white children.
  • American Indian, Hispanic/Latino, and African American youth have the highest rates of obesity.

This report lists several contributing factors to the presence of health disparities among communities of color. One substantial contributing factor is the historical oppression of both the African American and American Indian communities (p. 73). For example, structural racism and oppression has made it difficult for African Americans to own property, and in neighborhoods where home ownership is low and schools are funded through property taxes, race-based inequities are reinforced. MDH notes that “

[t]his current reality was shaped by past public and private policies and practices, such as residential segregation, ‘redlining’ by financial institutions, and employment discrimination” (p. 25).

Poverty is also a major contributing factor to health disparities: According to the report, “over 60 percent of children under age six living in poverty are children of color/American Indian” (p. 72). Poverty limits a person’s ability to make healthy decisions in terms of nutrition, employment opportunities, and access to housing, among others.

An important message that Dr. Ehlinger stated during the meeting was that there is a perception that in order to be healthy, you need to have good health care. However, MDH’s report points out that there are many factors that contribute to a person’s health, and each of these mechanisms interact with each other in a positive or negative way. For example, income is strongly associated with health, but in ways that may not seem obvious. Income is not only related to the ability to pay for health care, but also is generally a product of employment, which allows for opportunities for training and education, which leads to socialization and various social connections.

Addressing Health & Child Welfare Disparities through Education

Like health disparities in Minnesota, disparities in Minnesota’s child welfare system overwhelmingly affect communities of color. The Minnesota Child Welfare Report 2012 shows that:

“American Indian, African American/Black, and children of two or more races are respectively 14.3, 4.4 and 3.6 times more likely than a White child to be placed out-of-home. In 2011 the respective statistics were 13, 5, and 4 times more likely, meaning that disparities for American Indian children increased in 2012 while there was a slight reduction in disparities for African American/Black children and children of 2 or more races.”

One strategy to potentially address both health and child welfare disparities among communities of color is through education. The MDH report notes that education is a key predictor of healthy outcomes (p. 33). Specifically, education during the primary years is directly related to future educational attainment, including high school graduation and college attendance, as well as future income.

Research has shown that children who are in out-of-home-placement are likely to be further behind educationally as compared to their counterparts. This is often due to the fact that these children have gaps in attendance due to being removed from their home or experiencing disruptions in placements. If a child is placed in a new school district, there may be delays in enrolling children or in records being transferred, or even issues with credit conversion.

H.F. 2397 (S.F. 1889), recently introduced in the Minnesota legislature, includes a provision that will enable children who have been placed in out-of-home-placement to stay in their home school. If passed, this bill would work to help mitigate the effect that out-of-home-placement has on a child’s educational stability, which will in turn improve the overall well-being of children who are in the child welfare system.

Addressing Disparities through The Affordable Care Act

Another impactful policy that will most likely help address health disparities among children in child welfare is the Affordable Care Act (ACA). With the passage and implementation of the ACA, youth who age out of the foster care system (approximately 26,000 youth each year) are now eligible to receive Medicaid until they are 26 years old. The language of the ACA also states that these youth will not be denied coverage due to pre-existing health conditions. In addition, preventive care (such as well-child exams and physicals) will be completely covered with no deductible. For children who are in the child welfare system, this will presumably make it easier for each child to access care.