January 20, 2016 Neighborhood House Planning Committee: Tikki - PowerPoint PPT Presentation

January 20, 2016 Neighborhood House

Planning Committee: Tikki Brown- Department of Human Services/ Office of Economic Opportunities Sue Letourneau- Blue Cross Blue Shield/Center for Prevention MN Amy Lopez- Greater Twin Cities United Way Donna McDuffie- Minnesota Department of Health Aimee Pappenfus- Allina Health Joe Newhouse- Matter Patty Wilder- Minnesota Hunger Initiative

INCREASED UNDERSTANDING OF: • the impact of access to healthy food on healthy equity. • creating a culture of health in Minnesota. • local promising practices to improve health equity. • how to increase engagement and investments in health equity initiatives.

I. WELCOME II. HEALTH EQUITY IN MINNESOTA Melanie Ferris, Wilder Research Center Allison Liuzza, Minnesota Compass III. KEYNOTE SPEAKER: CREATING A CULTURE OF HEALTH Dr. Dwayne Proctor, Robert Wood Johnson Foundation IV. TAKING ACTION IN MINNESOTA Commissioner Ehlinger, Minnesota Department of Health Q & A Session: Commissioner Ehlinger & Dr. Proctor V. PROMISING PRACTICES SHOWCASE VI. CALL TO ACTION Assistant Commissioner Anne Barry Minnesota Department of Human Services

Melanie Ferris, MPH Wilder Research Center Allison Liuzzi, MPH Minnesota Compass

Wilder Research Food access and health equity Demographic trends and efforts underway Wilder Research January 20, 2016

Wilder Research How are Minnesota demographics changing?

We are getting older . www.mncompass.org

2014 2014 35 counties where at least 1 in 5 residents are age 65+ @MNCompass

2020 2020 61 counties where at least 1 in 5 residents are age 65+ @MNCompass

2030 2030 87 counties where at least 1 in 5 residents are age 65+ @MNCompass

We are getting more racially and ethnically diverse .

For every 100 residents in Minnesota, 18 18 are persons of color. @MNCompass

Population of Color is growing faster here than in the U.S. 38% 18% Population of Color more than tripled in Minnesota @MNCompass

Growth among all populations of Color, but especially among… Asian and Black populations TRIPLED Hispanic population QUINTUPLED @MNCompass

Asian population by county, 2014 Ramsey 14% @MNCompass

Black population by county, 2014 Hennepin 13% @MNCompass

American Indian population by Mahnomen county, 2014 42% @MNCompass

Hispanic population by county, 2014 Nobles 26% @MNCompass

Minnesota’s high quality of life does not extend to all residents.

Minnesota is home to one of the lowest poverty rates in the nation, but… Individuals below the poverty level Minnesota and U.S., 2014 26% 23% Minnesota 16% U.S. 12% 11% 8% All residents White (non-Hispanic) Of Color @MNCompass

One in three Black and American Indian residents live below poverty 32% 38% 12% @MNCompass

Individuals below poverty Koochiching 15% by county, 2014 Mahnomen St. Louis 20% 15% Wadena 16% 18% Todd Winona 16% @MNCompass

Wilder Research Why do these changes matter to health?

There are pervasive Anoka County health inequities in Minnesota Life expectancies at birth, Washington County by census tract Hennepin County (2005-09) Ramsey County Carver County Dakota County Scott County

Health outcomes tend to be worse for residents who live in poorer neighborhoods Life expectancy by poverty rate group of census tracts Twin Cities 7-county metro (2005-09) Average life 83.1 82.4 expectancy 81.8 79.3 81.0 76.5 20.0% or 10.0% - 4.0% - 2.0% - Less than higher 19.9% 9.9% 3.9% 2.0% Percentage of households living below poverty

Structural racism is a leading factor contributing to health inequities Age-adjusted mortality rates per 100,000 residents (adults age 25-65) 1,000 800 White (Non-Hispanic) African American 600 American Indian 400 Asian Hispanic (All Races) 200 0 Less than $35,000- $45,000- $60,000- $75,000 $35000 $44,999 $59,999 $74,999 or higher Median household income groups of census tracts Sources: Minnesota Department of Health mortality data (2005-2009), American Community Survey (2005-2009)

Racial and socioeconomic inequities impact health for residents of all ages  Infant deaths for African American and American Indian babies are twice the rate of white babies  Obesity rates are highest among American Indian, Hispanic/Latino, and African American youth  9 th grade students who receive free/reduced-price lunch are less likely to report their health as “very good” or “excellent”  On multiple measures of health, outcomes are poorer for residents in rural Minnesota counties

What contributes to these inequities? Programs Health Health and policies factors outcomes Social and Physical Clinical Health economic environment care behaviors factors 10% 10% 20% 20% 30% 30% 40% 40% Social determinants of health www.mncompass.org Source: University of Wisconsin Population Health Institute

Health inequities are unjust and avoidable Health inequities are avoidable differences in health between groups of people that result form systematic differences and social conditions and processes that determine health. Health inequities are avoidable, unjust, and therefore actionable. Health equity is achieved when every person has the opportunity to realize their health potential – the highest level of health possible for that person – without limits imposed by structural inequities.

Structural racism contributes to inequities  Structural inequities: Decisions that benefit one population at the expense of others  Structural racism: The normalization of an array of dynamics – historical, cultural, institutional, and interpersonal – that routinely advantage white people while producing cumulative and chronic adverse outcomes for people of color and American Indians Source: Minnesota Department of Health

Wilder Research What does it mean to improve food access using a health equity lens?

Food insecurity in Minnesota  Impacts 25,000 Minnesotans (~10% of households)  Often, occasional and episodic  Tends to be more common in households: – With lower annual household incomes – With children – Headed by a single parent – Headed by a Black or Hispanic adult – Located in rural (non-metropolitan) areas Source: United States Department of Agriculture, 2014

Supplemental Nutrition Assistance Program (SNAP)  The number of SNAP-eligible has increased – 281,674 in 2006  554,940 in 2013  395,552 eligible for SNAP* in 2014 – 41% children – 21% adults age 60+  66% eligible for SNAP are enrolled, an increase from 46% in 2008 Source: Minnesota Department of Human Services, 2015 * SNAP-only (excluding MFIP-eligible)

Examples of efforts to reduce food insecurity  Expanded utilization of SNAP by: – Better outreach to SNAP-eligible households – Increased acceptance of SNAP benefit at farmer’s markets; incentive programs – Expansion of SNAP eligibility requirements  Food pantries at schools, health care clinics  State policies that increase affordable housing options, livable wage jobs, affordable childcare options, post-high school education options

Percent consuming each type of food one or more times per day in last 7 days, by income: grades 5, 8, 9 and 11 50 46.5 42.5 45 39.1 40 34.3 35 30 26.3 Percent 24.2 25 20 15 8.5 10 4.1 5 0 100% fruit juice fruit vegetables fast food Low-income Middle-upper income

Examples of efforts to improve food access  Improved quality of food available at food shelves  Changes to city park and recreation/school lunch, vending, sponsorship policies  Changes to convenience store inventory  Location of grocery stores, farmers markets – City zoning decisions, co-located grocery stores – Local farmers markets, Twin Cities Mobile Market

Questions to ask  What information does your organization need to initiate discussion and encourage action to advance health equity? Is there a common language and shared vision within the organization?  In your community, what are the systems in place that impact food access? Who benefits? Who is negatively impacted?

Questions to ask  How are impacted populations involved in shaping actions to improve food access and advance equity?  Who are your partners? How can you foster cross-sector collaboration?

Dr. Dwayne Proctor Senior Adviser to the President/Director, Health Equity Portfolio Robert Wood Johnson Foundation

Building a Culture of Health in America Dr. Dwayne Proctor The Robert Wood Johnson Foundation @drdwayneproctor

CULTURE OF HEALTH ACTION FRAMEWORK ACTION AREA ACTION AREA 1 2 MAKING FOSTERING CROSS-SECTOR HEALTH A COLLABORATION TO SHARED IMPROVE WELL-BEING VALUE OUTCOME IMPROVED POPULATION EQUITY EQUITY HEALTH, WELL- BEING, AND EQUITY ACTION AREA ACTION AREA 3 4 CREATING HEALTHIER, STRENGTHENING MORE EQUITABLE INTEGRATION OF COMMUNITIES HEALTH SERVICES AND SYSTEMS

Examples of RWJF Equity Principles A future in which everyone in America has the realistic hope and ample opportunity for the healthiest life possible remains a bold and audacious dream.