I recently attended the Health Disparities Roundtable at the University of Minnesota, Economy and Health: What is the Role of Public Health? I’ll focus here on some of the thought-provoking highlights from the presentation by Paul Mattessich and Melanie Ferris, both of Wilder Research, on Health Inequities in the Twin Cities: Can We Close the Gap?
They reported on data from a 2010 report commissioned by the Blue Cross Blue Shield of Minnesota Foundation (which was prepared by Wilder Research).
While Minnesotans on average enjoy very good health (as we are often reminded), that status is not spread evenly throughout the population. In particular, African Americans, Native Americans, Southeast Asian immigrants, the poor and residents of neighborhoods where poverty is most concentrated experience significantly lower than average life expectancy and mortality rates. For example, there is a difference of 7-8 years in life expectancy between residents of the Twin Cities’ highest income and lowest income neighborhoods.
On the other hand, it’s interesting that certain ethnic groups (Latinos, Africans) have lower rates of diabetes and heart disease than other groups, and even lower than the average. This is attributed in part to new immigrants bringing a healthy lifestyle with them to their new home (however, this so called “immigrant advantage” doesn’t necessarily continue over generations).
How to close the gap? That’s where things get challenging. According to the presenters, access to and quality of medical care and healthy behaviors, such as tobacco use and diet and exercise, are only 50% responsible for our health. The other half of the equation relates to social and economic factors (e.g., income, education, family and social support) and the physical environment (e.g., environmental quality and housing). These latter influences are referred to in the jargon as “upstream” determinants of health.
As our population continues to become more diverse, as the weak economy impacts the poor the hardest (and the longest), and as the population ages, the situation only becomes more serious. A few suggestions for change which were offered:
- Build infrastructures which will better enable minority and low-income communities to tackle these issues.
- Create an environment where evidence-based approaches can have a chance; in other words, funders should support projects which may not show results after one, or even two, years. Obviously, these issues are complex and can not be solved in the short-term.
- Cultivate collaborations and partnerships; create incentives which will operate over long periods of time, not just when funding opportunities become available. Cooperative relationships can take years to develop.
Great ideas, all. I’d be interested in hearing about models or experiences that shed any light on how improvements can be made. Please comment!