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Published on Monday, April 11, 2016

Public Health Issue Number 1: Health Inequity

The following article was written by St. Louis County Public Health Nurse Josh Gorham. It was originally published in the Duluth Budgeteer on April 10, 2016.

This past week has been National Public Health Week. It’s a time to raise awareness of the work of Public Health professionals and talk about the most challenging public health issue of the 21st century.

Your health is determined by a variety of factors: genetics, personal habits, access to quality and timely healthcare, and the environments in which you live, work and play. Think of environment in a broad sense; it could be the air in your home, the water you drink, access to goods and services such as food or healthcare, and even access/opportunity to living wage jobs.

Dr. Ed Ehlinger, Minnesota’s Commissioner of Health, has recognized that although Minnesota is one of the healthiest states in the nation, we also have some of the largest differences in health outcomes by income, race, sexual-orientation, and mental health status. 

Here are some facts from the Minnesota Department of Health’s 2014 “Advancing Health Equity” report to the legislature that highlight the disparity in health among specific populations:

  • African American and American Indian babies die in the first year of life at twice the rate of white babies. While infant mortality rates for all groups have declined, the disparity in rates has existed for over 20 years.
  • American Indian, Hispanic/Latino, and African American youth have the highest rates of obesity.
  • Intimate partner violence affects 11 to 24 percent of high school seniors, with the highest rates among American Indian, African American and Hispanic/Latino students.
  • Gay, lesbian and bisexual university students are more likely than their heterosexual peers to have struggles with their mental health.
  • Persons with serious and persistent mental illness die, on average, 25 years earlier than the general public.

The root cause of these differences in health outcomes among populations is likely found in differences in economic and social conditions, which are strong predictors of health. Consider the following facts, also found in the Minnesota Department of Health’s report, which correlate with different health outcomes for various populations:

  • Poverty rates for children under 18 in Minnesota are twice as high for Asian children, three times as high for Hispanic/Latino children, four times as high for American Indian children, and nearly five times as high for African American children as for white children.
  • Unemployment is highest among populations of color, American Indians, and people who live in rural Minnesota.
  • African Americans and Hispanic/Latinos in Minnesota have less than half the per-capita income of the white population.
  • Lesbian, gay, bisexual, and transgender youth are at increased risk for bullying, teasing, harassment, physical assault, and suicide-related behaviors compared to other students.
  • Low-income students are more likely to experience residential instability.
  • American Indian, Hispanic/Latino, and African American youth have the lowest rates of on-time high school graduation.
  • African Americans and American Indians are incarcerated at nine times the rate of white persons.

These differences in health outcomes are also reflected in St. Louis County’s 2013 community health status report “Health is more than Healthcare.” Significant differences in life expectancy, as high as ten years, were found among ZIP codes within St. Louis County. There was strong correlation between life expectancy, education attained, neighborhood environment, and income. 

Health is not always determined by personal choices, genetics, or even just access to healthcare. We are seeing that some populations are experiencing circumstances beyond their control, and unfortunately, it is having a ripple effect on their health and well-being. This reality is not unique to St. Louis County or the State of Minnesota – it is a reality across the country. 

During National Public Health Week, I challenge us all to examine what we can do to support change that will lead to the elimination of the health disparities in our communities. 

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Dana Kazel 
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