Stacey Millett is a senior program officer at Blue Cross Blue Shield of Minnesota Foundation. She currently manages their work on health equity and social connectedness, and is organizing an upcoming “Equity in Action” event for the Foundation’s grantees. She talked to Minnesota Compass about the Foundation’s equity work and how the Foundation is responding to the impending arrival of health care exchanges.
Q: Minnesota has some significant racial and class disparities in the areas of education, income, safety, and employment. What is the Blue Cross and Blue Shield of Minnesota Foundation doing on health equity right now?
A: We have two major initiatives in the Health Equity Program. First, we fund health programs in public libraries. The Bill and Melinda Gates Foundation did a study on the critical importance of libraries for low-income people who go there for digital access. A subset of that report talked about why people were going to libraries, and it turns out people are often looking for health information. So the library is not dead. We thought, why not support health programming in the libraries?
The other program is Health Impact Assessments. We are actually funding The Pew Charitable Trusts, and they have a partnership with the Robert Wood Johnson Foundation called the Health Impact Project. This project helps communities assess the impact of their programming on health. There are about 300 Health Impact Assessments across the United States, several in Minnesota.
Q: Where does the equity piece come in?
A: When I talk about health equity I’m zooming out a little. We know that a person’s health outcomes are determined by more than just their genes and their behavior. The ZIP code where you live, learn, work, and play makes a huge difference. It’s a matter of life and death. We know from The unequal distribution of health study that people living a few miles away from each other, and with different ethnicities, have a huge difference in life expectancy.
Through Minnesota Compass, and other sources such as County Health Rankings and America's Health Rankings, we know that factors such as income, education and employment can affect whether you have access to healthy food and healthy choices.
I think that because more people are doing these studies and rankings—my goodness, all these numbers!—there’s more recognition that health equity is really a bigger topic than individuals modifying their behaviors.
This doesn’t mean it’s unsolvable, but it requires new players beyond the traditional health care system, which is focused on access to care and behavior at the individual level.
Q: You are planning on gathering your grantees together in the fall for a workshop called Equity in Action. What do you hope to achieve?
A: Well, we have four major programmatic areas: Health equity, early childhood development, social connectedness, and health care access. We decided to bring our grantees together to talk about equity, not as a program area, but also as a theme that cuts across all of our work.
We want people to meet each other because a lot happens when people get together. No funder is ever going to dream up all the things that can be done, though we can guide things. But ideas come from the people who are doing the work in the locations we fund, and that’s the community practitioner in me speaking. We want to to illustrate how our grantees are addressing equity and to ask them about ideas for future gatherings and issue areas.
Q: The MNsure website is rolling out health care exchanges in October. How will this affect the work of the Blue Cross Foundation?
A: Yeah, there are big changes coming. But there are many people who have no clue that there are major changes in October, or (like me) don’t necessarily understand the implications of the changes, because they are complex.
Our Access to Coverage program is a newer area that we started last year, partly as a response to federal and state changes in health care coverage. We thought, well, access to coverage is really a financial matter. If someone doesn’t get access to coverage because they are uninsured or in bankruptcy, they might have options for better coverage that they don’t even know about. So, how do you connect people to the opportunity to get access to coverage?
We wanted to support organizations that are already helping connect people to better health care access and information. If someone can get coverage and they couldn’t get coverage before, then maybe they’ll be able to get better health outcomes.
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