For discussion

October 2010

Working together to improve health “upstream”
By Marsha Shotley, Blue Cross and Blue Shield of Minnesota Foundation

Marsha Shotley

The Unequal Distribution of Health in the Twin Cities, a new Wilder Research study commissioned by Blue Cross and Blue Shield of Minnesota Foundation, reveals some surprising socioeconomic factors that may influence health in the region. Marsha Shotley talks about the findings and how Blue Cross and Blue Shield of Minnesota Foundation is working to address them.

Where we live, work and play has a lasting impact on health. That’s why the Blue Cross and Blue Shield of Minnesota Foundation focuses on “upstream” influences on health — the social, economic and environmental factors that determine health.

Good health requires individuals to make responsible personal choices, but it requires a societal commitment to remove the obstacles preventing too many people from making healthy choices. At the Blue Cross Foundation, we believe that all Minnesotans should have the opportunity to live a long, healthy life, regardless of their income, education or ethnic background.

The Unequal Distribution of Health in the Twin Cities study was commissioned by the Foundation to ask a very important question: “Is there a connection between socioeconomic status and health in the Twin Cities?” — something that has been demonstrated through a growing body of national and international research.

The results of the Wilder Research study suggest that our area is certainly not immune. Here, as elsewhere, health is connected to median area income, education, race and neighborhood conditions.

Over the last five years the Blue Cross Foundation has focused on making a healthy difference in people’s lives by addressing “upstream” factors that determine our health. We know that treating illness is important, but this report by Wilder Research and other research show that living in a healthy home and neighborhood, accessing high-quality early childhood care and learning, and being socially connected to others in the community are key to human health. Many of our most serious health problems could be prevented if we went after their root causes, instead of merely waiting for people to get sick and then responding.

So, why is a health company like Blue Cross interested in this kind of work? We believe the reason is well laid out in a chart recently developed by the University of Wisconsin Population Institute. It states that 20 percent of an individual’s health is determined by access to quality health care. That’s important. Another 30 percent of health is influenced by lifestyle choices and behaviors. That’s also important. But a full 50 percent is determined by socioeconomic and environmental factors. That, we believe, is critically important. As a health company, Blue Cross and its foundation have an impact on all of these three of these areas that influence health.

What we’re doing: grantmaking and beyond

As part of a health company, the Blue Cross Foundation has a unique opportunity to use the information from the report as we continue our work to reduce health inequities in the Twin Cities and throughout Minnesota. The data are relevant for our two grantmaking initiatives:Growing Up Healthy: Kids and Communities and Healthy Together: Creating Community with New Americans.

The first initiative focuses on the health of pregnant women and children birth to five years. Funded projects work in some of the lowest income areas of the state to nurture the healthy growth and development of young children by addressing housing, early childhood development, the physical environment and their impact on health. The latter initiative focuses on the mental health and social adjustment of immigrants and refugees, many of whom also live in the lowest income neighborhoods statewide.

In addition to grantmaking — $28 million since 1986 — the Foundation works in two other primary areas

Public awareness and policy support — Building public awareness and policy support for the social, environmental and economic conditions that promote health, through commissioned research, media partnership and policy forums.
Leadership — Recognizing and supporting extraordinary community leaders and their organizations, developing collaborative leadership across our state to create healthier communities and providing a forum to share lessons, successes and results.

What we can do together

We believe that it takes many sectors working together to improve the community conditions. We also believe that upstream policies and interventions will lower costs, prevent disease and premature death, and reduce health inequities. Our policy decisions need to take health into account — everyone’s health. We are challenged as a community … challenged to ensure that all Minnesotans have an equal opportunity for good health and a chance to live a long, healthy life.

Other regions throughout our country and other countries have better health as a result of a more integrated, health-focused approach and we can study and emulate them. Places such as Seattle, Finland, Switzerland and Sweden are modeling policies and community actions that make a difference.

We can do that too. The Twin Cities area and Minnesota are poised to be leaders in closing the health equity gap. Together, we can change the pathway that has led to health disparities.

The Blue Cross Foundation is a catalyst for the work still to be done. We wanted a sound study that grounds future decisions in a common reality, creates unity and guides smart progress. Our hope is that policy makers, communities, businesses and education leaders and all of us who volunteer and vote will speak loudly to help plot a future where everyone has an equal opportunity to be healthy. We will all be healthier when we focus on improving the social factors that play a powerful role in determining health.

Marsha Shotley is vice president of board and community relations at Blue Cross and Blue Shield of Minnesota, and president of Blue Cross and Blue Shield of Minnesota Foundation.For 23 years, she has worked for Blue Cross in several areas of the organization, including provider relations, finance, and health improvement.

She serves as a board officer and staff liaison for the Blue Cross board of trustees and its governance committee. The Blue Cross Foundation addresses significant social, economic and environmental influences that are beyond the traditional reach of the health care system.

Shotley also oversees the advancement of Blue Cross' social responsibility values through the corporate community affairs department, which promotes employee volunteerism and community involvement efforts for the corporation. In addition, she provides strategic leadership to the Minnesota Institute of Public Health, which provides public health prevention research and programming services to communities through grant projects

Opinions in the For Discussion columns are the authors' alone and do not necessarily reflect the views of Minnesota Compass. Compass welcomes a range of views about issues pertaining to quality of life in Minnesota.