MINNESOTA






 

 
MINNESOTA
Minnesota Office of Minority and Multicultural Health
Prepared by National Association of State
Offices of Minority Health (NASOMH)
 
Jose L. Gonzales
Office of Minority and Multicultural Health
Minnesota Department of Health
Freeman Building, 5C
625 N. Robert Street-P.O. Box 64975
St. Paul, Minnesota 55164-0975
Phone: (651) 201-5818
Fax: (651) 201-5801
 Email: jose.gonzalez@state.mn.us
 
Organizational Structure/History
 
The Minnesota Department of Health’s first public recognition of the problem of racial and ethnic health disparities occurred in 1987, with the publication of Minority Populations in Minnesota – A Health Status Report by the MDH Center for Health Statistics, which detailed for the first time the demographics and health status of the state’s populations of color. In 1993, the Commissioner of the Minnesota Department of Health, created an Office of Minority Health (OMH). The office is part of the organizational structure of the Minnesota Department of Health (MDH) Community and Family Health Promotion Bureau and changed its name in 2001 to the Office of Minority and Multicultural Health to reflect the growing racial and ethnic groups and the vast cultural factors in Minnesota.
 
Purpose/Mission Statement
 
The mission of the Office of Minority and Multicultural Health is to strengthen the health and wellness of racial/ethnic, cultural and tribal populations of the state of Minnesota by engaging diverse populations in health systems, mutual learning and actions essential for achieving health parity and optimal wellness.
 
 
 
 
 
Program Focus/Activities
 
In 1995 the OMH Advisory Committee and OMH staff created the office’s first strategic plan, which identified health disparity barriers and proposed a number of projects to eliminate these barriers. One of the office’s primary strategies was to increase awareness of racial/ethnic disparities through improved documentation of the problem. The 1997 Populations of Color in Minnesota – A Health Status Report, documented the extent of the state’s health disparities and identified factors that contributed to the poor health of these communities. The 1997 Populations of Color report provided the groundwork for the program and policy recommendations published in OMH’s January 1998 Minority Health Legislative Report: Current Status of Information Related to Minority Health Issues.
 
This report outlined a 12-point plan for expanding the collection and reporting of standardized racial/ethnic health data. The report called for: the elimination of racial/ethnic data collection barriers;
 
  • the clarification of legal issues related to data collection, reporting and information sharing;
  • the holding of health entities accountable for the collection and reporting of minority health data;
  • the improvement of the racial/ethnic coding of the state’s vital statistics data;
  • improved tracking of racial/ethnic morbidity data through existing surveillance systems; the adoption of federal racial/ethnic data reporting rules;
  • the inclusion of populations of color in the state’s Behavioral Risk Factor Survey;
  • the authorization and allocation of state funds for disparity reduction grant programs; and
  • the placement of the OMH office into state statute.
 
An array of potential partners was identified in the report, including business associations, health plan companies, major health providers, American Indian centers, public and private schools, institutions of higher learning, job training programs, community-based organizations, and local public health agencies.
 
In 1998, the Office of Minority Health hosted a statewide conference, Minority Health Data Collection: Implications for Improving Health Outcomes for Populations of Color, to demonstrate the importance and utility of collecting and reporting racial/ethnic and socioeconomic health data. The conference provided a forum for raising statewide awareness of the strengths and limitations of the state’s existing data, and for discussing potential strategies for improving the routine collection of standardized racial/ethnic health data.
 
In 2000, the MDH Office of Minority Health continued its strategy of documenting health disparities by awarding grants to six rural community health boards and one grant to the Twin Cities’ seven-county metropolitan area. The purpose of the grants was to conduct local minority health needs assessments. The assessments were conducted in rural areas with new immigrant populations, including Goodhue, Olmsted, Otter Tail, Rice, Todd, and Winona counties.
 
The Goodhue Report focused on health care access issues (language barriers, lack of dental care and need for insurance), community issues (the need to dispel racial/ethnic myths, celebrate differences, and respect others) and on health related disparities (including high rates of unemployment and uninsurance).
 
The Olmsted Assessment focused on social and economic factors (poverty, segregation and racism). The report also identified health disparities across the life span (in the areas of pregnancy, birth, prenatal care, alcohol and tobacco use during pregnancy, infant immunization, child abuse and neglect, HIV/AIDS prevalence, STI incidence, and years of potential life lost).
 
The Todd and Rice County Assessments focused on their Latino populations, while the Winona County assessment surveyed both Latino and Hmong groups. The Otter Tail assessment made several recommendations, including: incentives to encourage people of color to enter the health professions, brochures and other health education materials
translated into additional languages, resource centers to help people to access health services, and new ways to lower the cost of health insurance for low-income people.
 
The Metro Local Public Health Association (MLPHA) conducted the needs assessment for the Twin Cities seven-county metro area. In 2001, a summary report was published which included policy recommendations, a health disparity data book, and an immigrant/refugee study.
 
Gaining Credibility
OMH pursued a parallel strategy to increase the importance and visibility of the health disparity issue both inside and outside MDH. In 1998, MDH published a set of 18 statewide goals, Healthy Minnesotans: Public Health Improvement Goals 2004.
 
OMH advocated for other work units inside MDH to focus on minority health as part of their ongoing work. For example, OMH and MDH infant mortality staff to obtain a planning grant from the Reach 2010 program, a federal health disparities initiative administered by the Centers for Disease Control and Prevention (CDC). The MDH infant mortality project was aimed at reducing infant mortality rates among the state’s American Indian and African American communities.
 
In January 2001, legislative sponsors introduced the Eliminating Health Disparities Initiative (EHDI) legislation in the Minnesota Senate and House of Representatives. The OMH, Family Health Division (Maternal and Child Health), and MDH administrative and legislative policy staff worked to mobilize legislative and community support for the EHDI legislation.
 
In January and February 2001, during the early weeks of the session, the results of the local minority health needs assessments were published and publicized, identifying racial and ethnic disparities throughout the state. The results of the metro area minority health needs assessment were released in a capitol press conference, attended by senators and representatives from across the state, several of whom spoke in support of the proposed EHDI legislation.
 
Community groups organized rallies in support of the EHDI legislation. Asian American, Latino/Hispanic, and African American rallies were held on the capital steps, attended by hundreds of community members. Community members actively lobbied their respective legislators, pressing for the passage of the bill. As one legislator later explained, “It was politically difficult to go against the interests of the Governor, MDH leadership, and community members on this legislation.”
 
 
 
The Office of Minority and Multicultural Health is also involved in the following
program activities:
 
▪           Technical Assistance to 52 grantees throughout Minnesota
                        Capacity building
                        Community asset development
                        Data analysis training
                        Logic model development
 
Eliminating Health Disparities Statewide Initiatives
 
The 10-year mission of the Eliminating Health Disparities Initiative is to support culturally appropriate public health programs designed and implemented by racial and ethnic communities. The success of these programs is built on community assets, and grounded in the cultural beliefs, practices, and traditions of communities. The EHDI is administered through the Minnesota Department of Health Office of Minority and Multicultural Health.
 
This statewide initiative focuses on Africans/African Americans, American Indians, Asians, Latinos and Tribal Nations in eight health disparity areas: breast and cervical cancer, cardiovascular disease, diabetes, healthy youth development, immunization, infant mortality, HIV/AIDS and sexually transmitted infections, and unintentional injury and violence.
 
2009: Eliminating Health Disparities Version 2.0
 
Minnesota has had more than a 15-year commitment to eliminating health disparities in its Populations of Color and American Indians, starting with the establishment of the Office of Minority Health in 1995 and with the State Legislature’s biennial appropriation in 2001 of $10 million to:
·         reduce by 50% the health disparities in infant mortality and adult and childhood immunization rates by 2010 and
·         to reduce the disparities in breast and cervical cancer, diabetes, cardiovascular disease, HIV/sexually transmitted infections, teen pregnancy prevention, violence and unintentional injury. . 
At the 8 year mark in these grants, progress has been made in reducing the disparities some of these health areas, but the legislative goals have not been fully met. 
 
As a result of analyzing the progress made in eliminating health disparities in 8 targeted health areas, Minnesota’s Commissioner of Health charged the Office of Minority and Multicultural Health with designing the next “version” of Eliminating Health Disparities, which is being referred to as “Version 2.0”.
 
This charge is to address some identified challenges, including:
·         The need to accelerate the State’s progress in reducing health disparities.
 
Through the EHDI grants awarded to 42 community organizations and 10 tribes, community leadership and capacity building have occurred to address health disparities. Most grantees have achieved success in engaging their communities to address targeted health issues through individual and community-based interventions.
 
While the individual and community-based interventions are of great importance, it is time to strategically move more “upstream” to address root causes of disparities.
 
·         The need to better integrate the work of the Office of Minority and Multicultural Health (OMMH) within the other programs of the Minnesota Department of Health (MDH)
 
Over time, with both leadership and staff changes occurring within the Executive Office, the Office of Minority and Multicultural Health, and within the MDH as an agency, the original commitment to assure close connections between OMMH and the other programs of the department has waned. In 2008, MDH leadership charged a work group with developing an integrated model for eliminating health disparities within the department. Through this integrated model, there would be a value and expectation for close alignment between those program staff with cultural expertise and public health content expertise. Cultural perspectives and approaches need to be closely wed to scientific and technical public health programs and approaches. 
 
The services of a consultant were secured to do an analysis of other State Offices of Minority Health, to determine what the “best practices” were for structurally and programmatically achieving efficiency and effectiveness in the use of staff expertise and resources to advance the work of eliminating health disparities.
 
·         The need to develop the next Request for Proposals (RFP) for eliminating health disparities grants to be awarded ($10 million biennially) to eligible community organizations and agencies.
 
Plans are currently underway to define the principles, key decision-points and standards for Eliminating Health Disparities, Version 2.0 grants. Community input will be sought to help shape the foundational values and principles for awarding these grants, with the goal of achieving a broader reach in the grantees’ activities to impact health disparities within their respective communities.
 
·         The need for MDH leadership with other state agencies, major health and human service systems, and foundations to develop strategic directions for mobilizing the existing resources toward common goals for reduction in social, educational and health disparities and for addressing social determinants of health.
 
The MDH is positioning itself and its Office of Minority and Multicultural Health to provide the necessary system-wide leadership to address foundational, systemic contributors to the continuation of health disparities in Minnesota’s Populations of Color, American Indians and other affected populations.
 
 
 
 
 
 
 
 
Level of Funding Sources
 
 

Year
 
Federal
State
Private
FY 2005
$2,000,000
$3,800,000
 
FY 2006
$2,000,000
$3,800,000
$50,000
FY 2007
$2,000,000
$3,800,000
$25,000
FY 2008
$2,000,000
$3,800,000
 

 
 
Resources/Staffing
 
            Personnel
Director (1FTE) - Oversee policy impacting health disparities, legislative interface for American Indian and Populations of Color health issues; represent Commissioner of Health on health disparity issues. Coordinate with other state agencies on disparity issues. Staff management. Cultivate and nurture relationships across all government, health provider, community and other groups as appropriate to raise awareness of Minnesota’s health disparity and seek solutions to eliminate these disparities.
 
Office Administrator (1 FTE) - Manage all administrative aspects of the office. Includes: project management, vendor negotiator, online purchasing, information management, meeting planner, travel planner, intern student orientation, office equipment oversight, etc.
 
Tribal Indian Liaison (1 FTE) – Manage, facilitate and evaluate statewide effort to improve health and emergency preparedness among Minnesota’s American Indian tribes. Develop goals for MDH tribal relations and the development of a
framework for planning and implementation of a process that researches and identifies MN tribal resources, needs, and appropriate intervention for each of Minnesota’s tribal communities.
 
Urban American Indian coordinator (1 FTE) - To provide liaison to, community with, and contribute to the health related efforts of specific populations. Mobilize and organize members of the community to address health issues. Meet with community representatives and host community meetings. Plan health-related activities. Provide quantitative and qualitative information on health-related issues to community members and leaders. Provide leadership, education, support, and consultation to assigned grantees of the Eliminating Health Disparities Initiative (EHDI) so that the goals of the Initiative are met. Review and evaluate applications for funding administered by MDH divisions, as requested. Review and assist in the development of policies, reports, etc. Participate in and provide OMMH perspectives to agency division meetings, workgroups, committees, etc.
 
1 Latino coordinator, 1 African American coordinator and 1 Asian coordinator (see roles above). In addition, the office is supported by 2-3 Summer interns from Macalester College - Primary work involves Preventative Block Grant activities, Event planning, etc.
 
 
 
Recent Publications
(Support of MDH Health Statistics Department)
 
·         2007 Populations of Color Health Data Report
·         2007 Legislative Report
 
2009 Update for Publications:
·         Minnesota’s Eliminating Health Disparities Initiative – Report 1: Overview and History, April 2008
·         Minnesota’s Eliminating Health Disparities – Report 2: A Model and Method for Identifying Exemplary Program Practices to Eliminate Health Disparities, April 2008
·         Minnesota’s Eliminating Health Disparities – Report 3: Exemplary Program Practices in Action, April 2008
·         Minnesota’s Eliminating Health Disparities – Report 4: Programmatic Results Achieved by EHDI Grantees, April 2008
·         Minnesota’s Eliminating Health Disparities – Report 5: Building Capacities among Individuals, Organizations, Communities and Systems
·         Minnesota’s Eliminating Health Disparities – Report 6: Grantee Case Studies
·         Immunization and Health Disparities Report
·         Disparities in Infant Mortality
·         American Indian Infant Mortality Report
·         Populations of Color Health Status Reports
·         Eliminating Health Disparities – Report to the Legislature, January 2009
·         Eliminating Health Disparities – Report to the Legislature – January 2009, Appendices