The State We're In

Advocacy groups across the country are calling 2021 a record-breaking year for legislation that seeks to attack the rights of the transgender and nonbinary community. To date, 33 states have introduced more than 100 bills that would limit transgender people's rights – and primarily impact transgender youth. These bills include efforts to ban participation in youth sports, limit education on LGBTQ issues and restrict gender-affirming health care treatment. Blue Cross remains committed to serving the transgender and non-binary community. Part of this commitment includes uplifting the work and voices of community leaders who are improving the health and well-being of the transgender and nonbinary community every day. In a special two-part episode of The State We're In podcast, Ani Koch, leader of Blue Cross' Gender Care and Service initiative, sat down with Blue Cross' Gender Services Consultant Alex Jackson Nelson, Ejay Jack of M Health Fairview, Dr. Angela Kade Goepferd of Children's Minnesota, Nathalie Crowley of Family Tree Clinic and Ms July 23rd, owner and founder of Goddess Electrolysis.

Advocacy groups across the country are calling 2021 a record-breaking year for legislation that seeks to attack the rights of the transgender and nonbinary community. To date, 33 states have introduced more than 100 bills that would limit transgender people's rights – and primarily impact transgender youth. These bills include efforts to ban participation in youth sports, limit education on LGBTQ issues and restrict gender-affirming health care treatment. Blue Cross remains committed to serving the transgender and non-binary community. Part of this commitment includes uplifting the work and voices of community leaders who are improving the health and well-being of the transgender and nonbinary community every day. In a special two-part episode of The State We're In podcast, Ani Koch, leader of Blue Cross' Gender Care and Service initiative, sat down with Blue Cross' Gender Services Consultant Alex Jackson Nelson, Ejay Jack of M Health Fairview, Dr. Angela Kade Goepferd of Children's Minnesota, Nathalie Crowley of Family Tree Clinic and Ms July 23rd, owner and founder of Goddess Electrolysis.

On May 25 of this year, George Floyd was murdered by Minneapolis police in South Minneapolis. The protests and ensuing unrest shined a local spotlight on the trauma of police brutality that Black people have endured for far too long and of which Black men have been the primary target. Black men have endured the multigenerational effects of slavery, lynching, family separation, Jim Crow, poverty, mass incarceration and systemic oppression. The relentless threat to Black bodies – especially Black male bodies – takes its toll on Black men's physical and mental health, leading to higher rates of suicide, disease and homicide. The life expectancy for Black men in America is 71.9 years, while White men, on average, live 76.4 years. At the same time, the topic of mental illness, mental health and trauma has been taboo in the Black community. Pleasant Radford, Jr., formerly of the Center for Prevention and now Health Equity Officer at UCare, facilitated this barber-shop style discussion with four Black Minnesota men to talk about mental health, racial trauma and the importance of talking about these issues. Many thanks to Pleasant Radford, Cedrick Frazier, Vernon Rowland, Sam Simmons and Jalen Travis for their contributions to this special two-part episode.

On May 25 of this year, George Floyd was murdered by Minneapolis police in South Minneapolis. The protests and ensuing unrest shined a local spotlight on the trauma of police brutality that Black people have endured for far too long and of which Black men have been the primary target. Black men have endured the multigenerational effects of slavery, lynching, family separation, Jim Crow, poverty, mass incarceration and systemic oppression. The relentless threat to Black bodies – especially Black male bodies – takes its toll on Black men's physical and mental health, leading to higher rates of suicide, disease and homicide. The life expectancy for Black men in America is 71.9 years, while White men, on average, live 76.4 years. At the same time, the topic of mental illness, mental health and trauma has been taboo in the Black community. Pleasant Radford, Jr., formerly of the Center for Prevention and now Health Equity Officer at UCare, facilitated this barber-shop style discussion with four Black Minnesota men to talk about mental health, racial trauma and the importance of talking about these issues. Many thanks to Pleasant Radford, Cedrick Frazier, Vernon Rowland, Sam Simmons and Jalen Travis for their contributions to this special two-part episode.

At the Center for Prevention we support active transportation — biking, walking, and rolling — because we know it leads to better health. Transportation also is what connects us to critical needs like education, jobs, housing, food, and medical care. A good transportation system gives people the ability to go where they want easily and safely. In the past weeks and months, we've seen the tragic reminders that it's not just car traffic that make streets unsafe. To advance health equity in transportation we must acknowledge the violence and trauma that Black, Indigenous, and people of color are often exposed to in the streets, and how racism undermines safety. Improving our transportation system for everyone is one aspect of tackling the racial, economic, and environmental inequities in Minnesota that continue to make the COVID-19 pandemic deadlier for low-income and nonwhite families. For this episode of the State We're In Jill Chamberlain, Center for Prevention senior program manager of community health and health equity, hosted a conversation with two advocates who are committed to making the transportation system in Minnesota better for all of us.

We bring you a special episode on declaring structural racism as a public health crisis, in the backdrop of the COVID-19 pandemic and the murder of George Floyd. Whether at the hands of police or because of pervasive inequities built into the fabric of our society, Black and brown people are dying at disproportionately high rates compared to white people. Systemic and structural racism in housing, health care, employment and healthy food access is resulting in Latinos and Blacks being three times as likely to be infected with COVID-19 as their white counterparts and twice as likely to die of the virus as white people. We spoke with three community leaders on why naming structural racism as a public health crisis is crucial and what comes after the acknowledgement.

We bring you another special episode in our series on COVID-19 on growing food and community connections. There is a growing need for healthy foods in Minnesota, especially during the COVID-19 pandemic. Minnesota is home to sizeable food security disparities. The pandemic has not only exacerbated these gaps, but also shown how food insecurity can be correlated with stress, anxiety, and fear. This episode focuses on some of our partners— farmers, gardeners and community leaders —who improve our local food system, build strong communities, and share their knowledge about growing food.

We bring you a special episode on coping and mental health in the times of COVID-19. This pandemic is forcing us to change our lives in ways we never imagined. Supporting and caring for one another is more important than ever, and we're doing it in new ways. Everyone reacts to stressful situations differently. We had the opportunity to get some advice from community leaders, teachers, and behavioral health professionals about strategies for coping and taking care of each other during this time.

As the vaping epidemic continues in Minnesota, we bring you a preview of our upcoming video documentary: stories from the people on the front lines of this fight against big tobacco. The 2019 Minnesota Student Survey found more than a quarter of Minnesota 11th-graders and 11 percent of 8th-graders used an e-cigarette in the past month. From 2016-2019, the 8th-grade vaping rate nearly doubled. The commercial tobacco industry uses flavors to attract these kids. Two thirds of current high-school tobacco users in Minnesota reported using a flavored product. The deliberate marketing tactics used by the tobacco industry have made vaping popular among youth. The Minnesota Student Survey also found that Eighty-eight percent of Minnesota high-school students are exposed to e-cigarette ads. Investigations have revealed e-cigarette maker JUUL targeted kids as young as eight with marketing including a summer camp, school programs and social media influencers. The state of Minnesota has sued JUUL Labs for illegally advertising to youth and engaging in deceptive practices. Flavored tobacco products are driving the youth nicotine epidemic, which has erased nearly two decades of progress to reduce youth tobacco use. The alarming rise of youth vaping goes hand-in-hand with the insidious impact of predatory marketing the commercial tobacco industry has targeted at marginalized communities – including African Americans, American Indians, and LGBTQ people. In the podcast we'll hear from  Laura Smith,  Senior Public Affairs Manager at ClearWay Minnesota. Will Gitler and Claire Hering share their personal experiences with vaping. These experiences led them to join local action and advocacy work to reverse this epidemic and protect the health of all Minnesotans. Watch for more on vaping epidemic in our upcoming documentary, where we continue with these conversations. We'll also explore how vaping is impacting Native American youth from the Lower Sioux Indian Community and how tribal leaders are addressing the problem. We'll learn more about the serious health impacts of vaping from Dr. Brook Moore, a pediatric pulmonologist at Children's Hospitals and Clinics of Minnesota.

This episode focuses on the great work of Healthy Together Willmar, and their mission to help create a future where all members of the Willmar, MN community have access to the resources and opportunities needed to achieve their best possible health. In Willmar, achieving good health is met with considerable barriers, which are often experienced most by an increasingly diverse and aging population. To address some of these barriers, the Healthy Together Willmar initiative launched the Idea Fund, creating an opportunity for community members to submit ideas to affect change.  Now in its second round of funding, more than $264,000 was awarded to community groups in Willmar to offer support and solutions related to physical, mental and behavioral health, community connections, access to dental care, the availability of culturally based childcare and more. The Idea Fund process kicked off in the fall of 2018, with residents attending a “progressive dinner,” community meals at homes throughout Willmar, where they engaged in conversations about how to address the community's barriers to health. From there, ideas were submitted to the Willmar Community Table, which is comprised of diverse residents who have firsthand experience facing barriers to health. Find more information about Healthy Together Willmar and the idea fund here.

At the Center for Prevention we are funded from the proceeds of Blue Cross' historical settlement with the commercial tobacco industry, and we use these resources to help fight health inequities in Minnesota. Addressing the harms caused by commercial tobacco is core to our work. While the overall smoking rate in Minnesota has dramatically decreased, commercial tobacco use remains one of the leading causes of death and disease. Marketing of these products continues to cause more destruction for communities of color, American Indians, immigrants and refugees. Throughout its history, the commercial tobacco industry has been misrepresenting and appropriating American Indian traditions, values and beliefs to market and sell their products. It's a direct assault on American Indian culture, traditions and practices. We have had the privilege to work with tribal communities to help reduce harm caused by commercial tobacco, and we are grateful for what we've learned along the way. Understanding the difference between commercial tobacco and sacred tobacco is critically important for shifting the dominant narrative around Tribal communities and their health.  In the next three episodes of the State We're In, we'll explore how honoring sacred tobacco and cultural traditions can lead to healing for Anishinaabe and Dakota people in Minnesota. These episodes are inspired by dedicated leaders who are doing this work. Over the summer we've had opportunities to have several conversations about sacred tobacco, healing from addiction, and health in Minnesota's American Indian Communities. We begin our series with conversations with Chris Matter, Senior Program Manager at Blue Cross and Blue Shield of Minnesota, and CoCo Villaluz, Senior Community Development Manager for ClearWay Minnesota, to get some background on how mainstream organizations and Native American communities are working together to reduce commercial tobacco use.

In part 2 of our series on Sacred Tobacco, we'll talk about “Tradition versus Addiction” for American Indian tribes in Minnesota. There are 11 federally recognized tribes in Minnesota, comprised of seven Ojibwe federally recognized reservations, and four Dakota communities,  all with their own sovereign governments: Bois Forte, Fond du Lac, Grand Portage, Leech Lake, Lower Sioux, Mille Lacs, Prairie Island, Red Lake, Shakopee Mdewakanton, Upper Sioux, and White Earth.  Ojibwe and Dakota people in Minnesota have tobacco traditions that were passed down for generations, for centuries before the arrival of Europeans. Using Native tobacco in a sacred manner is not a health risk. Teaching youth about their power and spirituality allows them to see tobacco differently, as a protective factor against harmful behaviors. We had the honor to sit down with Sharon Day and Suzanne Nash from the Indigenous People's Task Force to talk about sacred tobacco traditions that were passed down to them as Ojibwe people, and how they are sharing these practices across generations in their community.

In part 3 of our series on Sacred Tobacco, we'll talk about “Healing Generations" in the Lower Sioux Indian Community. Throughout these conversations we've learned that “culture is prevention.” Cultural practices and traditions, including the use of sacred tobacco play an essential role in healing and wellness. We hear from Mat Pendleton, Lower Sioux Youth Recreation Director, reflecting on sacred tobacco traditions that he has learned and shares through his work. We also hear from Darin M. Prescott, CEO of the Lower Sioux Health Care Center about how traditional practices inform and transform conventional medical practices. Lastly, we hear from Kara Siegfried, Assistant Tribal Planner/Grant Writer for Lower Sioux, reflecting on the holistic approach to health at Lower Sioux.

Minnesota is one of the healthiest states in the country, but it has some of the worst health disparities.  A primary driver of health and chronic disease starts in people's social and physical environments. This could be transportation, education, childcare settings, or their housing. All communities can experience poor health outcomes, but due to systemic inequities and the racial hierarchy on which the United States was built., they disproportionately occur in communities of color and the American Indian community. In this episode we take a closer look at what we mean by “systemic inequities,” and talk with two people deeply engaged in this work in two large health institutions in Minnesota: Vayong Moua, Health Equity Director at Blue Cross, and Maria Sarabia, Racial and Health Equity Administrator at Ramsey County. They both serve on the Cultural and Ethnic Communities Leadership Council in the state of Minnesota's Department of Human Services (DHS). DHS is the state's largest agency and provides or administers a variety of services to help people meet their basic needs and live as independently as possible. The agency makes up approximately 42 percent of state spending and approximately 80 percent of the agency's $18.65 billion fiscal year 2019 budget is devoted to health care and related services. DHS is working to implement equity practice and capacity within its core functions, through implementing a health equity policy, and the formation of the Cultural and Ethnic Communities Leadership Council, that serves to track equity, accountability, and systems change throughout the agency.

One of the key messages guiding the Center for Prevention's mission to tackle the leading causes of preventable disease is around the importance of community. A thriving community is made up of people who care for and about each other; people who depend on one another. The dominant health narrative says that health is about individual choices and behaviors. However, because of inequities built into our systems, policies and environments, not everyone has the opportunity or access to make healthy choices. We need to work together to change the systems and structures that hold us back from our full potential as healthy thriving communities. In this episode, we invited LaTrisha Vetaw and Jill Chamberlain to have a conversation about the roles of individuals and of community, the importance that lived experiences and seeing yourself as a part of your community play in shifting the narrative around health – especially physical activity, access to healthy spaces such as parks and walking paths. LaTrisha has over a decade of experience serving her community, both as Health Policy and Advocacy Director at NorthPoint Health and Wellness Center and most recently as a Minneapolis Park Commissioner At-Large. Jill is passionate about supporting policy and systems change work around active living, serving as Senior Community Health and Health Equity Program Manager at the Center for Prevention.

Stories surround all of us, and the way they are told shapes how we make decisions in both conscious and unconscious ways. What influences the stories we see and hear?  Whose voices are heard the most and who is being left out? In this episode we examine these questions through the work of ThreeSixty Journalism, a nonprofit that uses principles of strong writing, reporting and media production to help diverse Minnesota youth tell the stories of their lives and communities. For the second year in a row, during the summer of 2018, ThreeSixty and the Center for Prevention partnered together to conduct a one-week TV Broadcast Camp for high school students. The theme was health equity, with the goal of inspiring more active participation in creating more equitable, healthier communities. This work illustrates how changing the narrative, who is telling stories and how they are created, is an integral part of this goal.

Minnesota is one of the healthiest states in the U.S., yet we have some of the worst health disparities. The factors that play the greatest role in these health disparities — race, income and ZIP code — require community-led changes and solutions. It's changes at this level, through workplaces and policies, along with communitywide change, that will lead to long term, sustained health improvement. In this special edition of the State We're In podcast, Anika Ward, Director of the Center for Prevention, has a conversation with her brother, Saint Paul Mayor Melvin Carter, about his leadership in Saint Paul, and the City's role in the health of its residents. They talk about bringing all voices to the table, especially those who have been excluded, to undo the policies and systems that have created the gaps we see in health, wealth, and education, and what it will take to create healthy and strong communities for generations to come. The conversation continues with health advocates throughout Minnesota who talk about their different approaches to this work.

In this episode we're focusing on Trauma and Repair: how trauma threatens health and wellbeing for individuals and communities. It's an important issue for us at the Center for Prevention, as it feeds into the health disparities we see in Minnesota.  It's not an exaggeration to say that unaddressed trauma generates lifelong consequences that can end in early death. We'll talk with people in Minnesota who are working in their communities to address and prevent trauma, along with rebuilding and healing from trauma, as we consider what it means to be trauma-informed when addressing the health equity in our state. Understanding the current and historical context in which we all live is a key component to advancing health equity, especially as it relates to historical and collective trauma inflicted on African Americans and indigenous communities. The adverse effects of past violence carried down from generation to generation is known as historical trauma. Collective Trauma happens to large groups of individuals and can be transmitted through generations and across communities. Collective and historical trauma affects people in countless ways: manifesting in the lack of access to housing, safe spaces and healthy food; community violence; people coping through addictive behaviors like smoking or drug use; and the resulting chronic health conditions that many families and communities face. Addressing root causes means knowing that both racism and oppression are embedded in American culture, and realizing how this, along with massive historical traumas, continue to shape the lives of individual children, families, and communities. Through the conversations in this episode, we hope to support learning, growth, and understanding of historical and collective trauma, racial justice and how to foster community healing. We had the chance to sit down and talk with a few dedicated individuals who work for this change every day. It's not quick or easy, and it requires coming together with openness and persistence to shine a light on these issues to create the opportunities for better health for all of us.

In this episode we explore Belonging and Othering, and what it means to belong to a community, to a society, to one another, inspired by the work of John A. Powell from the Haas Institute for a Fair and Inclusive Society, and author of the book Othering and Belonging. We'll have frank conversations about what it means to feel ‘othered,' and the health implications for when systems are created and perpetuated to other groups of people, and how this leads to the serious gaps in access to health and wellbeing in the state of Minnesota. And what we can do to build connections in our communities to start to alleviate these gaps.

The factors that play the greatest role in Minnesota's heath inequities – race, income and ZIP code – reflect the policies, systems and environments in place that prevent people from taking care of themselves. Looking at these influences and creating solutions is critical to creating healthy, strong and thriving communities for generations to come. In our first episode we examine how health is shared from generation to generation. The episode combines conversations, reflections, and art to explore themes around how we learn about and come to understand health.