ASk A Researcher

October 2010

Unequal distribution of health in the Twin Cities

The Minnesota Compass research team of Craig Helmstetter, Susan Brower, and Andi Egbert recently assembled a report entitled The unequal distribution of health in the Twin Cities. The report was commissioned by the Blue Cross and Blue Shield of Minnesota Foundation and released at an October 7th event called Revealing socioeconomic factors that influence your health. The report received prominent coverage by the Star Tribune, Pioneer Press, Minnesota Public Radio, and MinnPost, among others.

What were your hopes when the Blue Cross and Blue Shield of Minnesota Foundation asked the Compass team to look at health inequities in the Twin Cities?

I was hopeful that we wouldn’t find any health inequities in our region. After all, the Twin Cities region is ranked among the best of the nation’s 25 largest major metro areas on a wide variety of indicators that relate directly or indirectly to health, including:

What did you actually find?

My hopes were not borne out. As Paul Mattessich stated at the release of the report, instead of being able to say, “fortunately there are no health inequities in the Twin Cities,” we had to conclude “unfortunately there are notable health inequities” in our region.

In honesty, although I might have hoped we wouldn’t find health inequities through this project, I knew we would. We were already tracking some notable racial disparities for specific health outcomes in our region, including diabetes rates, obesity rates, and rates of low-weight births. Additionally, we know that there are significant racial disparities in our region in some of the socio-economic factors associated with health, including poverty rates and educational attainment.

So were there any surprises?

Have you ever heard of the immigrant paradox? Many immigrants face multiple barriers including limited English language skills, difficulties finding employment, and generally lower incomes. In addition, the Twin Cities metro is second home to a lot of refugees who’ve fled civil war or left behind dismal refugee camps. On the surface you might guess that health outcomes are worse for immigrants than native-born Americans. Paradoxically, however, health outcomes are generally better for newly arrived immigrants.

Our study finds support for the immigrant paradox as well. For example, foreign-born Black residents of the Twin Cities have a mortality rate roughly one-third that of US-born Black residents, and Hispanics – 40 percent of whom are immigrants in our region – have lower mortality rates than non-Hispanic whites.
These findings drive one of the reports main conclusions: that we all stand to learn from the health-promoting cultural practices of our region’s newest arrivals

Is this all about race and ethnicity?

Not at all. Through a series of maps and graphs the report shows that average income of residential areas in the Twin Cities is strongly related to the health of residents. Marin Krause, an intern who assembled some data for the report, first calculated what came to be one of the study’s main take-aways: “The relationship between an area’s income and mortality is so striking that, on average, every $10,000 increase in an area’s median income appears to buy its residents another year of life.”

In the end we concluded that, in addition to race and ethnicity, income, education, and place all matter when it comes to health in the Twin Cities.

What else did you learn through this project?

We convened a stellar advisory group to help us on the project, which offered crucial insights (they are listed on the report’s acknowledgements page). In addition, I was thoroughly impressed by the panel that that Blue Cross and Blue Shield of Minnesota Foundation assembled for the event. Here is just a sampling of what they had to say about the topic:

Atum Azzahir, President and Executive Director of the Cultural Wellness Center talked about the importance of reclaiming culture as a way to promote health, especially for the region’s populations of color. She specifically noted a project they have started in St. Paul’s Maxfield Elementary School which brings elders into the school building.
Patrick Geraghty, President and CEO of Blue Cross and Blue Shield of Minnesota, underscored how health can and should be embraced by all sectors of our community. He gave the example of the gardens at their corporate headquarters, which not only get their employees out and moving in the fresh air, but also grow produce which is donated to a local domestic violence program.
Justin Huenemann, President and CEO of the Native American Community Development Institute, mentioned the importance of looking at the issue from an asset basis. He senses a renaissance among the Native American population and encouraged those present to seek solutions from among the local community. The NACDI-led cultural corridor along Franklin Avenue is an example of how this can be done.
Dane Smith, President of Growth and Justice, spoke most directly to public policy and encouraged the audience to consider the issues raised by the report when voting this fall. He cited a book called The Spirit Level (by Wilkinson and Pickett, 2009), which posits that greater inequality leads to poorer health, even for those with the highest incomes. He also advocated for setting the goal that by 2020 at least 75 percent of adults Minnesota have a credential beyond a high school diploma.

The Blue Cross and Blue Shield of Minnesota Foundation has published reaction papers from all of these panelists, and four others (Family Housing Fund’s Tom Fulton, Greater Minnesota Housing Fund’s Warren Hanson, the Institute for Agriculture and Trade Policy’s David Wallinga, and the Minnesota Budget Project’s Nan Madden). You can find the papers here.

How many M&Ms were in that big jar?

Those of you who were at the event may remember a big jar of M&Ms at the sign-in table. Ninety-two people guessed at the amount. The average of all those guesses? 3,263. Only 140 off of the actual 3,123! The Blue Cross and Blue Shield of Minnesota Foundation put this exercise together as a real-life illustration of the wisdom of crowds—which is the title of a 2005 book by James Surowiecki. By extension, this suggests that we will all do better to address health inequities if we all join in.

Share your thoughts! Let us know if you have reactions to the report or thoughts on what we as a region might do to address health inequities: Contact us.

Craig Helmstetter, consulting scientist at Wilder Research, is the lead researcher on the Twin Cities Compass team. He holds a master's degree in community and regional planning and a Ph.D. in Sociology from the University of Oregon.