Going Upstream to Solve Health Disparities
All Minnesotans do not have equal access to health care. Nor do all Minnesotans share the positive health outcomes that make our state rank among the healthiest in the United States.
Many rich data sources point to unacceptable disparities between health conditions and outcomes for whites compared with those of other racial and ethnic groups, between suburbs and urban core neighborhoods, and among rural, tribal, and urban populations.
You can look this up yourself. The Minnesota Department of Health maintains the Minnesota Center for Health Statistics, with data drawn from medical professionals.
In Hennepin County, the Shape survey that’s administered every four years asks residents to self-report their health status, including physical and mental health indicators. Minnesota Compass, the Wilder Foundation’s trove of demographic research and data, is another information-rich source for exploring our region’s health outcomes.
Whether you ask doctors to share data, or ask individuals—the patients themselves—the results are comparable. To be poor; to be American Indian, Black, Hispanic, or Asian; or to be female means that your health outcomes are worse than those of white male Minnesotans.
Reviewing only breast cancer data, for example, Black women in Minnesota have the highest rate of the most serious and deadly subtype, and Minnesota’s American Indian women have the highest mortality rate. Yet this is a cancer for which many women have access to routine screening and early detection, increasing the likelihood that the disease can be successfully treated.
Fortunately, a strong cohort of nonprofits in our region are working to provide equitable access to health care in the form of neighborhood- and community-based health centers.
The Minnesota Association of Community Health Centers has 17 members operating clinics in 80 locations across the state. In 2022 they served more than 160,000 patients, nearly half of whom were uninsured, and more than half of whom were people of color.
Many of these nonprofits focus on culturally responsive approaches that are welcoming to our region’s increasingly diverse population, offer an integrated set of services that include prevention, vaccinations, and wellness activities, and are located in neighborhoods designated as “medically underserved.”
A defining characteristic of these centers is that they are governed by their patients. At least 51% of their boards of directors are patient representatives. They also accept all forms of payment (including none), openly stating that no one will be turned away.
These centers also are increasingly going “upstream” to focus not only on treating diseases and conditions but also on activities that foster health and well-being. Commenting on their increased recognition of the importance of community-based nonprofits is Penny George, co-chair of the George Family Foundation.
The Minneapolis-based foundation focuses a portion of its grantmaking on whole-person health and well-being. “The health care system in this country is, unfortunately, really a sick-care system,” George says. “We need excellent disease care, of course—but equally important is care that helps us stay well or live optimally with chronic illness. There are leaders in medical systems who are committed to changing the current paradigm, including changing a financial model that incentivizes procedures, not health.
“In the meantime, however, there is a fundamental, unmet need—and community-based organizations are increasingly stepping up and refocusing their efforts to truly support whole-person health and well-being. This work is particularly important and needed for people with limited means or whose cultural, racial, or ethnic background is not well served by current systems.”
The George Family Foundation has pivoted toward greater financial support of nonprofits, “moved by the unique positioning of community organizations to ensure choice, expand access, and empower people to take charge of their own health and well-being.”
Which nonprofits are investing in health and well-being? George cites the YMCA of the North and its George Wellbeing initiative, the Cultural Wellness Center, Family Tree Clinic, the Irreducible Grace Foundation, and Annex Teen Clinic. They provide programs and services, from exercise, meditation, and nutrition activities to health screening, family planning services, mentoring, job training, and counseling.
Independent community-based, non-medical nonprofits have long played a role in the health ecosystem. A growing spotlight on disparities in health outcomes has increased the recognition of their important role.
