Improving health by addressing inequity
A healthy community includes access to healthy, affordable foods; safe, walkable and bike-friendly neighborhoods; and spaces free of commercial tobacco. Without these and other characteristics of healthy environments, many communities experience significant health inequities—especially Black communities, Indigenous communities and other communities of color. This is not due to biological predisposition, but because of the structures in place that create systemic disadvantages. These circumstances existed prior to the emergence of COVID-19, but the pandemic has exacerbated them and laid bare significant barriers to health.
Minnesota, where the killing of George Floyd in May sparked international protests and a re-examination of racial justice as well as health disparities, is seeking to move to a healthier and more just future. Blue Cross and Blue Shield of Minnesota, particularly through its Center for Prevention and alongside the Blue Cross and Blue Shield of Minnesota Foundation (Blue Cross Foundation) is leaning into the challenge.
We recently spoke with Dr. Mark Steffen, Chief Medical Officer at Blue Cross and Blue Shield of Minnesota to learn more about the company’s work and how it is seeking to improve the health of Minnesotans by addressing inequity.
Now, more than ever, there is an increased focus on health and racial inequity and how social conditions can impact the distribution of resources and effect overall health and well-being. How are communities across Minnesota being affected by health inequities, particularly amid the COVID-19 pandemic?
The roots of these inequities are grounded in structural differences that have led to differences in how people are impacted by social determinants, which ultimately determine as much as 80 percent of overall health. These determinants include where people live and their physical environment, as well as socioeconomic factors like education, employment and family/social support. They also include behaviors like tobacco use, diet and physical activity.
When we look at who is disproportionately affected by COVID-19, we see that, by and large, it is Black people, Indigenous people, people of color, the LGBTQ+ community, those living in poverty, the elderly and the uninsured. We see how their health outcomes are shaped by deep-rooted patterns in our structural, environmental and policy decision-making, including systemic racism upstream and downstream in direct health care. This often shows up as a lack of access to health care, which fosters underlying health conditions such as diabetes and asthma, which, in turn, make them more vulnerable to a number of health issues including COVID-19.
These communities have also been disproportionately displaced or impacted by redlining and, more recently, gentrification. Residents of these communities are more likely to live in food deserts, rely on public transportation and work in essential jobs, creating a greater risk of exposure. This is one tangible way that COVID-19 has revealed existing health inequities in very stark terms.
How has Blue Cross and Blue Shield of Minnesota worked to address these issues recently?
Through our Center for Prevention and working with the Blue Cross Foundation, we’ve worked to eliminate health inequities for years by providing funding, resources and support to communities working to improve social determinants of health.
Recently, this support has taken many forms. At the outset of the pandemic, we quickly committed $750,000 to Second Harvest Heartland’s COVID-19 effort to increase food security across Minnesota via this food bank services.
The Blue Cross and Blue Shield of Minnesota Foundation was also swift to provide community support by creating an $825,000 COVID-19 rapid response fund, contributing $100,000 to both the Headwaters Foundation for Justice’s Communities First Fund and the Minnesota Disaster Recovery Fund, granting $100,000 to the Coalition of Asian American Leaders (CAAL) to support a campaign to address anti-Asian racism heightened by COVID-19, and more.
In the long-term, it is imperative that we build health equity into our public health, but moreover all our infrastructure, taking a “health equity in all policies” approach. This will require more leaders and organizations to name social and racial inequity as a problem – and commit to improving the social determinants of health that cause them.
What should our new normal look like?
As we look for a new normal, first it is imperative that we acknowledge that racial health inequities have been our “normal” for generations. We cannot go back. As a doctor and a passionate public health advocate, I believe we have an opportunity and an obligation to leave behind these rampant health inequities that have existed for so long.
We must continue addressing the health inequities that have been magnified by COVID-19 within our immediate response and then within our health care system and other societal institutions over the longer term.
As an organization, we know we have so much more to do—today and in the days to come. We are willing to do the work. I believe that with the strength of our state, its leaders, communities and people, we will make it through the pandemic. My hope is that we can work as one community, now and in the future, to eliminate inequities and create a more just and equitable “normal.”