The killing of George Floyd on May 25, 2020 sparked weeks of ongoing protests against police brutality, bringing racial justice to the national forefront and inspiring companies, universities and local governments to take action. On June 29, 2020, the Hennepin County Board of Commissioners passed a resolution that declared racism a public health crisis.
Racism is a pervasive, insidious force in U.S. healthcare systems. For starters, African-Americans have never had access to safe, affordable health care in the United States. Before the late 1800s, most communities were tended by a town doctor; if a slave owner/human trafficker was unwilling to pay for a slave's care, they would not receive medical treatment. During the Jim Crow era, white and Black patients and practitioners were separated into different facilities. Today, access is largely determined by health insurance, which can mandate where a patient can go, how many visits they can have and how much it costs them. If someone is uninsured, healthcare expenses often result in bankruptcy. 
Access to health care forms the bedrock of equity in the medical industry - and that bedrock is layered with racism. Public health strives for equity by relying on a form of metrics called "social determinants of health" comprised of the environmental conditions in which people are born, live, learn, work, play, worship and age. "These conditions directly affect a wide range of health, functioning, and quality-of-life outcomes and risks," according to the Minnesota Department of Health. Ultimately, society attains health equity if all citizens have access to the same positive outcomes in the conditional environments of their daily lives. Unfortunately, the U.S. faces a long road to achieving genuine health equity.
A lack of entry to the healthcare field also creates a snowball effect of negative outcomes in medicine. For instance, if you only research symptoms or diseases in white bodies, students may not learn how to recognize symptoms or diseases experienced by BIPOC bodies (Big Think). Most often, a greater diversity of representation among medical practitioners proves to be the catalyst for expanding research and new medical practice among non-dominant populations.
According to the Association of American Medical Colleges, only 5% of licensed, practicing doctors identify as Black or African-American as of 2018, whereas 56.2% identify as white/Caucasian.
Similarly, a 2017 study revealed that only 6.2% of registered nurses identify as Black or African-American compared to the whopping 80.8% of nurses who identify as white/Caucasian. Today, almost 60 years after the Civil Rights Movement started, Black Americans still barely see themselves reflected in health care.
Naming racism as a public health crisis is an important first step so that communities can strategically respond, but there are also lesser-known grievances that negatively impact the way that Black and African-American patients experience health care. In particular, most patients who identify as Black, Indigenous or People of Color see their care significantly impacted by the implicit biases of doctors, nurses, receptionists and other medical personnel. Implicit bias is complicated because it is couched in unconscious behaviors, such as reacting favorably or unfavorably to embedded cultural stereotypes and assumptions about a group of people. A 2015 study by the Kirwan Institute for the Study of Race and Ethnicity helpfully identified some of the key characteristics of implicit biases:
Implicit biases are pervasive. Everyone possesses them, even people with avowed commitments to impartiality such as judges.The implicit associations we hold do not necessarily align with our declared beliefs or even reflect stances we would explicitly endorse.Implicit biases are malleable. Our brains are incredibly complex, and the implicit associations that we have formed can be gradually unlearned through a variety of de-biasing techniques.As a direct result of discrimination and implicit bias, people of color in the United States face disparities in access to health care, the quality of care received, and health outcomes. "The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities," write University of North Carolina, Chapel Hill researchers. For now, researchers know three things:
Racial discrimination is known to yield poorer health outcomes for Black patients.Implicit bias influences why institutional racism persists in health care.Federal and state funding allocations will determine how and if Black patients' experiences improve.Naming racism is an important first step. A public health crisis begets funding to fix the problem and to address a lack of access, lack of representation and personnel's implicit biases. Where will financial support come from for these efforts? Will government agencies, hospitals or insurance companies pay for public health programs aimed at ending racist practices?
The answers remain murky. But one thing is clear: The world is ready for healthcare practices that build equity, create space for compassion and empathy across difference, and ensure that all who need medical treatment feel seen and heard.
Twin Cities PBS is here for you at every stage of learning. Read on to learn how Black Americans are navigating and challenging systematic racism in health care. This month's resources are brought to you by artists, educators, researchers, and illustrators. 

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Building Health Equity: Appetite for Change
“I had lost my sixteen-year-old son the previous year to gun violence… I was pulled to do something in the garden related to food, hearing that the universe would do healing for me there.”
Watch time: 6 minutes
Queer Women of Color Ask Who Cares and Who Gets Care?
Whether doctors use abusive language, refuse to acknowledge a patient’s chosen pronouns on medical intake forms or ignore the specific needs of LGBTQ+ patients, normative gender/sexual orientations still abound in the healthcare industry, leaving many with a difficult question: Should I even go to the doctor?
Watch time: 9 minutes
Inequity Is A Matter of Life and Death
Not being white in Minnesota is literally hazardous to your health. Startling gaps in outcomes by race and gender prove that a healthcare system designed by and for one culture isn't working well for others. Public-health experts dive in to understand why, and work with communities to change outcomes and create new possibilities for the future.
Watch time: 6 minutes
How Race Shapes Our Scientists And Our Science
Now a cognitive neuroscientist, Jonathan Jackson has achieved his dream of studying the disease for a living. But he said being a Black scientist has also pushed him down paths he wasn't expecting...“There is some currency in my Black skin for everyone but me," he says.
Read time: 10 minutes
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COLOR & REFLECT
 
Coloring offers space to reduce anxiety, create focus and bring about more mindfulness. Take time to reflect on what you learned. What surprised you? How do you feel? What questions do you have?
Click here to download this month's coloring page featuring Dr. Rebecca Lee Crumpler. 
 
This educational resource is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.


How Do We Know If Health Care Is Racist?

Diana Fraser

Racism is not reserved to bad run-ins with police.
Since long before the word was said in 1902, racism has persisted in access to health care, poverty and in opportunities for Americans of color. These barriers to opportunity have created gaps between races that still exist today, but a growing tide of data has revealed where these disparities exist and what solutions can begin to solve them.
Allison Liuzzi, a Research Manager at the nonprofit Wilder Foundation, spoke about how such data is exposing racial disparities and why it is important for society to progress.
This story is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.
"The events of 2020 opened many people’s eyes to deep and rooted inequities that are an undercurrent in this country and the world. In the context of Minnesota the issue is magnified due to the Minnesota Paradox: the phenomenon that Minnesota ranks as one of the best places to live in the nation, but only if you are white. If you are Black, Native American or a person of color, it ranks as one of the worst. Information like this flies around like hot summer mosquitos: pesky reminders that won’t catch a hint." Writer and public-health educator Hadija Steen Mills looks at how we can collectively do better in a post-2020 world.
On January 28, 2021, the Twin Cities PBS digital storytelling project Racism Unveiled hosted a live Zoom panel titled “Flight, Fight and Flow: Self Healing” aimed at examining the ways in which Black Minnesotans are affected by trauma, and how we can begin or continue our healing journey. Packed with insight and guidance, discover the six key takeaways illuminated by the event.
Black people and people of color in America have been subjected to centuries of medical experimentation and abuse, a history that has spurred mistrust of the healthcare industry for generations. Discover how some Black doctors are addressing the legitimate concerns of their patients of color who are deeply skeptical of the COVID-19 vaccines. 


How Do We Measure Racial Disparities?

Kyeland Jackson

Between a global pandemic and police violence against people of color, 2020 underscored long-standing issues of racism as a public health crisis in America. Photo by Obi Onyeader via Unsplash.Have you ever had a cut in the most inconvenient place? One of those places that you continually bump and re-aggravate? That is the current backdrop of the United States, a festering set of wounds that are in the most used places of the collective body. There is a shared yearning for healing to mend the wounds that keep reopening. But healing does not mean there are no scars. It means altered tissue is rejoined into a new landscape. Moving toward a new future requires letting go of the pre-2020, because we can do better than before. 
The events of 2020 opened many people’s eyes to deep and rooted inequities that are an undercurrent in this country and the world. 
In the context of Minnesota the issue is magnified due to the Minnesota Paradox: the phenomenon that Minnesota ranks as one of the best places to live in the nation, but only if you are white. If you are Black, Native American or a person of color, it ranks as one of the worst. Information like this flies around like hot summer mosquitos: pesky reminders that won’t catch a hint. 
This is an oppressive environment that strips communities of their power and aggressions, both big and small, one that belittles and hurts. A new future requires naming the infections of oppression that fester in the wounds. 
Words like “public health” and “racism” have been launched into the realm of dinnertime conversation topics. In the last year, I have been asked for a definition of public health, whether or not something is racist, or what racism and public health have to do with each other. Although public health is a relatively young field, it is very much in a relationship with social inequities. 
Public health focuses on the prevention of negative health outcomes. Current systems have created an inequitable world where differences in the ability to access services and the way people are treated directly contribute to disease and unequal outcomes. 2020 was the year racism was declared a public-health crisis. It was a call for mobilization and movement toward a new future. 
A new future requires reattaching the severed pieces into a unified system. It requires harnessing the collective power. Minneapolis and Saint Paul make up the Twin Cities. They have their unique characteristics, but the major dividing line between these two locations is the mighty Mississippi River. Minneapolis is part of Hennepin County and Saint Paul is situated in Ramsey County, and all of that is a portion of Minnesota. So what does this all mean? It means there are five different systems to navigate: Minneapolis, Saint Paul, Hennepin County, Ramsey County and the State of Minnesota, all holding unique pockets of services and information, without working as a cohesive unit of support. 
The uncooperative, disjointed nature of these five different systems have been felt in the response to the pandemic; we have five different agencies that cover the same stolen land, that are fractured and that do not work together for the betterment of its citizens. This is not unique to the Twin Cities or the COVID-19 pandemic. It is echoed across the nation.
The reverberating impact of a severed system creates barriers. In the landscape of COVID-19, it looks like barriers to equitable care, testing and vaccines. The barriers to services have tangible outcomes. Currently in Minnesota, Latinx people are testing positive for COVID at three-times the rate of their white counterparts, and Black Minnesotans are testing positive at two-times the rate of white Minnesotans. A new future requires barriers to be lowered and responses to be accessible to the most vulnerable communities. 
The declaration of racism as a public health crisis is an opportunity. An opportunity to accept that there isn’t a before to go back to, to name the deep infection sickening us all, reattach systems into a cohesive unit and eliminate barriers. The motto of Minnesota is “L'Étoile du Nord” - the Star of the North. As a state with such different lived experiences and health outcomes, this is the chance to be a leader, a lodestar guiding the ship toward a more just future.
A post 2020 future requires us to dig deep, to that point between our belly button and tailbone - to the place that gets uncomfortable when we think about how much we must change to make the world better. This will not be our last crisis, and a new future deserves a reevaluation and reinvestment in how we will respond to that call for change. 
We need to blur the focus and allow the new future to come into view. What does it smell like, look like, taste like, feel like? Who is fed, who is safe? 
We must scratch that spot and aggravate it, get uncomfortable and work backwards toward the present. We must work toward eliminating the barriers that exist - not just throwing another bandaid on the problem because the wound will still bleed.
Hadija Steen Mills [they|she] was born and raised on Dakota land commonly known as Minneapolis. They received a Bachelor’s in Science from the University of Minnesota in sexual health with a focus on reproductive justice and health disparities. She has always been passionate about the creation of a world free of inequities and advocates for autonomy for the most systematically oppressed populations. Hadija’s work stems from a Healthcare Reparations ideology that pushes for unifying, creative and anti-oppressive approaches to a new world where Community Care elicits health. 
This story is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.
On January 28, 2021, the Twin Cities PBS digital storytelling project Racism Unveiled hosted a live Zoom panel titled “Flight, Fight and Flow: Self Healing” aimed at examining the ways in which Black Minnesotans are affected by trauma, and how we can begin or continue our healing journey. Packed with insight and guidance, discover the six key takeaways illuminated by the event.
Black people and people of color in America have been subjected to centuries of medical experimentation and abuse, a history that has spurred mistrust of the healthcare industry for generations. Discover how some Black doctors are addressing the legitimate concerns of their patients of color who are deeply skeptical of the COVID-19 vaccines. 
Whether doctors use abusive language, refuse to acknowledge a patient’s chosen pronouns on medical intake forms or ignore the specific needs of LGBTQ+ patients, normative gender/sexual orientations still abound in the healthcare industry, leaving many with a difficult question: Should I even go to the doctor? Four queer women of color, including Hadija Steen Mills, discuss barriers to LGBTQ+ women’s health care and share affirming ways to combat systems of oppressions through health education.


Responding to Disparities: A Look at a Post-2020 United States

Hadija Steen Mills

Rev. Alfred Babington Johnson is a community leader, convener and CEO of the Stairstep Foundation who has an ear bent to Black church leaders across the state. So he sees firsthand how congregations are living and dying during the pandemic - and he knows African Americans are less likely than their white neighbors to have health insurance or a primary-care physician. With such a direct line to both congregants and church leaders in all corners of Minnesota, he not only understands, but witnesses, the ways in which the COVID-19 pandemic has disproportionally affected the Black community. From his perspective, the Black church plays an equally vital role in improving the health of the community as it does in spiritual matters.
Passionate about the role that Black churches play in congregants' physical and spiritual health, Babington Johnson helped spearhead Discovered Truth, a 2019 Twin Cities PBS documentary that examines the history of how Black churches have provided for their communities from within and how the Affordable Care Act carved a path that allowed more African Americans to gain access to potentially life-saving health care.
CAN BLACK CHURCHES HELP?
In terms of their relationship with the medical industry, a troubling history has created a legacy of mistrust between Black Americans and U.S. medicine. Between the Tuskegee Study, which allowed Black men to die from syphilis, and the case of Henrietta Lacks, whose cancer cells were used by researchers and drug companies for years without her consent, it's no wonder that Black communities mistrust physicians and medical institutions. That turbulent history is also why many Black men and women are skeptical of the government's push to vaccinate against COVID-19.
A pastor has a trusted voice. Can the right messenger ease fears and improve trust in order to help stem the spread of the virus? Aside from the medical issues associated with the pandemic, many people are hurting. They have lost their jobs, they grapple with loneliness, and they feel scared.
Religious services - and the community within - provide care and support during trying times. If you lose a job, a church community will step up and provide. If a family member dies a church community is there for you. A topsy-turvy world can be righted, if just for an hour, by worshiping together.
BLACK CHURCHES PICK UP THE SLACK AND ADAPT
This 2019 documentary Discovered Truth explores the mutual-aid societies created within Black churches.
 
While it may take years to unpack the long-term impact of all that 2020 threw at Black communities, Black Americans have born the brunt of health and wellness issues sparked by a global pandemic, police violence and systemic racism within the healthcare industry. So we reached out to Rev. Babington Johnson to learn a bit more about how the Black church has provided shelter within so many storms.
Rev Alfred Babington Johnson before the congregation at Mount Olivet Baptist Church in Saint Paul (April, 2019). Photo courtesy of the Mount Olivet Baptist Church Facebook page.How is the Black church able provide support since the pandemic has made gathering in-person groups impossible? 
Babington Johnson: It's always a wonderful thing to be able to be in close human contact, but more important is the intentionality and the sense of connection. This causes you to look for new tools to implement these connections. We are using Zoom, computers and social media at levels that will continue to change the ways we relate to one another.
The core issue is about the intentionality. If my brother is on the West Coast and facing a medical crisis, I will call him much more often now than I would under normal circumstances, and he is going to feel my concern because my concern is genuine. It is really about the commitment to connection, which nothing can stop. We yearn for the time when the hug can replace the virtual contact, but we recognize intentional connection is a vital part of healing.
The important [question] is: Are we committed to one another? Do I want to find out how you're doing? Am I going to be intentional about the outreach? The church is doing that, and we have found ways to collaborate with the state in that regard.
How have Black churches in the community been a part of the action plan set by the state? 
Alfred Babington JohnsonOur church network, His Works United, made an agreement with the Department of Health in March 2020. Since then, we have created what we call, Community Beacons, made up of over 40 Pastors from across the state. The Beacons create Care Trees to intentionally reach out to their congregations and into their communities to get and provide accurate information about the coronavirus. We can then encourage the kinds of behaviors that can minimize the coronavirus impact. Beyond these behaviors like washing hands and social distancing, we can intentionally raise the profile of the churches into the very heart of the situation.
The churches have been a part of the solution by conducting dozens of testing events and through working with the State of Minnesota. We worked with Fairview M Health and Black Nurses Rock and, again, with the State, churches identified a location within the community where we can test. We had church members involved. The Black Nurses Rock did the testing, and the State of Minnesota did the registration. It was a team effort.
It is important for the church to be involved, not just in a public relations way, but in as tangible a way as possible because it is important to keep the church's trusted voice at the center of the conversation.
Why is it important to have the trusted voice of Black churches help deliver the message?
There's a lot of skepticism in the African-American community around institutional medicine and around government. In critical times such as these, it is important to intentionally engage as a church community, and it is important for the state and federal government to recognize the importance of this collaboration - to support it, resource it and trumpet it.
The messenger matters in this case?
Absolutely. You have to realize that the way you do things is as important as the thing you are doing.
Being fully aware of the history and skepticism that lives in the Black community, how are the vaccines being talked about?
With all of the historical issues, it is important for the community to take a look at these vaccines. It is important for the government to be at the table early on and not just asking us to get the people to come in. We have continued to press the Governor and his staff to have our community involved in the design of the outreach and implementation, just as we were involved in the testing. We continue to be assertive with the Governor and others that we need to be a part of this dialogue and communicate to our folks the efficacy or the danger around the vaccine.
Through partnerships with Black nurses and with African-American doctors in Minnesota, we are working together to help our community understand. We help them understand the dangers and the appropriate kinds of strategies with testimony from our own community. We are a part of the message, we are not not just taking whatever comes over the wire.
We are making statements. We have had several of our pastors and doctors who have taken the vaccine in public because the danger of COVID is greater than the recognizable dangers associated with the vaccine.
We have a real commitment to bringing the accurate information to our community.
Will the relationships formed with the likes of Black Nurses Rock and the African-American doctors last longer than the pandemic? 
The primary goal is community building. Crises come. There will be a new crisis at some point - they will always be before us. The idea of building a robust community that believes in one another and is accountable to one another and has a willingness to show up for one another - that's the real prize that we continue to seek.


Even if COVID-19 didn't trigger a global pandemic, 2020 would have been a trying time for all churches, perhaps especially for Black churches. Has the inability to gather presented new opportunities for churches to provide care and wellness for their congregants?


We have had to develop new approaches and learn things that our children and grandchildren know. We have had to work with the technology. This is okay because, at the core of it, the question is: What are our motivations? If you have to find new approaches, you will. In the midst of this, we need to connect and we will find a way to connect.


How do churches reach out to the family that has never crossed the threshold into a church, but is hurting, mourning or facing unemployment?


With the Black church, there are a lot of people going to the church for the services, but who don't necessarily go to the church for the service. This has always been the case. The  fact that there are people who are hungry is a dilemma. The fact that there are people who have lost jobs is a dilemma. There are people who are in relationship disarray - this, too, is a dilemma. These dilemmas are a part of life that gets exacerbated in these times of crisis. From that comes both the challenge and the opportunity.


Because of our relationship with the Department of Health, [church leaders] have been able to field calls from people all of the time who are in crisis. Whether it is about their mortgages, or about how to find testing sites, or whatever it may be. This crisis is allowing a higher profile of service into the community.


So many of our African-American churches are stepping up, doing food distribution and delivering food to the elderly, that I feel, coming out of this, there will be a great sense of communion and collaboration with our community around all kinds of issues like education, health and political power.


We are going to use the experiences of this very difficult season to advance the cause of community.


This story is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.
"I know that nothing changes unless people change it. And the people who usually have to make it happen are those who are most at risk from the system. It’s a conundrum I haven’t worked out in my mind or heart. No Black parent has. And yet, here we are." Writer Shannon Gibney contemplates what defunding the police means to her as a Black mother and to the future she envisions for her son.
Rates of inequity in Minnesota fall below national standards and show how historical divides have created ongoing consequences for people with darker skin. Some disparities are driven by historical and racist practices like redlining. Others are escalated by the wealth and success of white residents. Data Reporter Kyeland Jackson takes a close look at how Minnesota compares to the rest of the nation when it comes to racial disparities.
Along with other urban centers across the country, the Twin Cities have a history of racially discriminatory housing covenants that prevented people of color from buying homes in certain neighborhoods. That history ripples in the present-day affordable housing crisis: By limiting opportunities for home ownership, people of color were stripped of one key way to build equity over time. Discover more in “Mapping the Roots of Housing Disparities in Minneapolis.”


Black Churches Heal Many Wounds in a Turbulent Year

Luke Heikkila

For just about everyone living in the United States, healthcare costs can skyrocket, even for seemingly routine procedures.
The costs of visits, prescription medications and healthcare premiums – for those who are insured – have all steadily risen for decades. According to data from the Kaiser Family Foundation, health spending on a per capita basis has increased over 31-fold in the last four decades, with health spending growth outpacing the growth of the nation’s economy.
And while the number of insured Americans has grown since the Affordable Care Act (the ACA) passed in 2010, insurance coverage alone cannot always prevent medical debt for low- and moderate-income families. In a 2016 report on medical debt, an estimated 26% of U.S. adults said they or someone in their household had difficulty paying a medical bill within the past 12 months.
“First and foremost, we have a healthcare system in the United States that is based on capitalism, productivity and profit,” said Family Tree Clinic Executive Director Alissa Light. “And there’s amazing people within that healthcare system who really care about the health and wellbeing of people, but the healthcare system isn’t set up to be working toward health and wellness; it’s disease-oriented and it’s profit-driven.”
While Minnesota has a long history of high-quality health care – at least for those who can afford it – access to basic and preventative services and health outcomes can vary widely based on one factor: identity.
A community organization in Saint Paul, Family Tree Clinic reaches an estimated 22,000 people a year through its sex education programming and clinical services. Their patients come from all over the Upper Midwest and even, at times, from Canada, largely because of Family Tree’s gender-affirming hormone clinic and focus on LGBTQI+ health care.
“Because there are so many barriers to insurance,” said Light, “to getting care that honors, respects or even sees your identity in any sort of way – and just the economic realities that health care is really, really expensive and usually pretty inadequate… When we launched our LGBTQ health initiative in 2010, we just learned very quickly that the need was really, really, really profound because of all of those things.”
Bias in the System
Christy Hall is a litigator with Gender Justice whose work often intersects with health care. Hall uses the law and policy to combat discrimination, including for LGBTQ Minnesotans. While Hall cites access to health insurance as a major barrier, she acknowledges the bias of providers as another major challenge her clients face.
“For example, we had a client who was trans and who was seeking access to in-patient mental health treatment,” said Hall, “and because [the provider] was trying to figure out if they belonged on the men’s floor or the women’s floor - they haven’t figured out that piece of it - so she just didn’t get access to health care.”
Amelia Schlossberg, a healthcare advocate working in Vermont, uses a patient advocacy approach to help people get coverage they need, finding gaps in coverage around things like gender-affirming care and gender-affirming surgery. Schlossberg considers their work in getting Vermont’s Medicaid program to update their gender-affirming care coverage a major victory. For Schlossberg, though, options based on income remain a significant source of frustration.
“Generally, your access to health care depends on who is paying for your health care,” says Schlossberg. “And if your income goes up, or if it goes down, you have limited options. Sometimes even just having $10 more per year can really limit your options.”
In Minnesota, for example, low-income adults may qualify for either Medical Assistance (Minnesota’s Medicaid Program) or MinnesotaCare. While both programs have income guidelines for participants, choices may vary significantly between them; as Schlossberg notes, choice can have major implications for patients’ health outcomes.
“Oftentimes, if you have more income, you have more choice,” said Schlossberg. “And something that’s been really important for the people that I’ve worked with is being able to find a doctor or a provider that really works well with you…  And the difference in the doctor that you’re just kind of putting up and they’re just putting up with you, versus a doctor that you really click with and that really is your advocate as well as your medical provider, that can make a difference between okay medical care… and someone really pushing to help you get the diagnosis, or get the medication or help you navigate that system.”
“Multiply or Deepen"
The 2020 COVID-19 pandemic has brought to light many of the challenges of our national healthcare system, including some of the vast inequities that exist for people of color. As the U.S. reckons with myriad racial injustices, those in health care can have particularly dire effects.
“There’s still a dynamic among LGBT folks that means that health problems will often multiply or deepen if the individual is a person of color,” said Phil Duran, the Director of Policy and Research at JustUs Health. “And so we’re really supportive of the fact that Hennepin County and others have been moving to call racism a public health issue, and that’s a conversation that we continue to need to engage in. Because you can take some of these specific conditions off the table, but that one is still going to be there.”
Alissa Light of Family Tree Clinic agrees.
“It’s interconnected and inexorably linked,” said Light, “so that the more identities you hold that fall outside that really narrow focus that the healthcare system is designed for – which is really white, cis[gender], assumed heterosexual men, usually – not only are you less and less seen, represented, believed and treated with dignity, but also because of compounding factors of deep structural and systematic racism [that are] rampant throughout every system in the United States and oppression based on other identity, including queerness, trans-ness, non-binary, the factors are compounded.”
Duran sees the need to dig far deeper into health disparities throughout the COVID-19 crisis and beyond, noting that as LGBTQ+ Minnesotans age, they face yet additional challenges, including isolation.
“Among LGBT older adults,” said Duran, “you see a disproportionate number of people who don’t have spouses or partners at that stage of their life. They don’t often have children or grandchildren who are there. Many older adults will turn to a faith community… and there has been historic tension between many faith traditions and the LGBT community, so people don’t have access to that. And so isolation is a real concern.”
Moving Forward with Hope
Alissa Light, Christy Hall, Amelia Schlossberg and Phil Duran all support the idea of some version of universal health care. They share the hope that, someday, all Minnesotans will be covered no matter how much money they make or how they identify. Even as access to insurance and high-quality, gender-affirming care continues to pose challenges for LGBTQ+ Minnesotans, they see opportunity to move forward in new and innovative ways. And they all feel hopeful about the healthcare conversations they are having locally and hearing nationally.
“I always have to be hopeful,” said Light, laughing. “I feel like there is no option, although I feel hopeless many minutes and hours of many days… It’s like we’re going to do everything we can to not go back and to really design the world we want to live in. And that’s what it’s going to take. And I do feel hopeful that we can keep building towards that.”
Writer Lindsay King-Miller shares her journey to parenthood with her trans husband and asks the question, "Why is the road to parenthood full or perils for LGBTQ+ folks?"
Whether doctors use abusive language, refuse to acknowledge a patient’s chosen pronouns on medical intake forms or ignore the specific needs of LGBTQ+ patients, normative gender/sexual orientations still abound in the healthcare industry, leaving many with a difficult question: Should I even go to the doctor? Four queer women of color discuss barriers to LGBTQ+ women’s health care and share affirming ways to combat systems of oppressions through health education.
Queer women are not statistically “safe” when seeking health care, but there are medical spaces that have been crafted so that they can be treated with the same dignity as any other patient. The documentary film Patient No More explores the barriers LGBTQ+ women navigate across healthcare systems, and how the never-ending hunt for affirming care affects their lives.


Why Is It So Tough for LGBTQ+ Folks to Get the Care They Need?

Alauna Yust

Minnesota consistently ranks as one of the healthiest states in the nation, often taking the top spot. And as the home to the world's first Mayo Clinic, Minnesota is known worldwide for its innovative solutions in health care. However, as the conversation around racial disparities and social inequities has risen to the forefront, research shows that Minnesota's portrayal as the home to healthy residents only paints half the picture. 
Census data shows that Minnesota's population is more than 80% white and just 7% Black. Despite this vast difference in population size, Minnesota's Black community is overrepresented in chronic health issues when compared to their white counterparts. 
Black men in Minnesota have a higher mortality rate from cardiovascular disease than white men. Black women die of breast cancer at a 24% higher rate than white women, although their incidence rates - how frequent a disease occurs in a population - are 22% lower. The difference in health outcomes between white Minnesotans and Minnesotans of color is so pervasive that it can be pinned down to a zip code. 
And the COVID-19 pandemic has exposed more healthcare inequities. According to state data, Black and Hispanic Minnesotans are testing positive at higher rates than the overall population. When adjusted for age, Black and Asian residents have the highest COVID death rates. 
These racial disparities in health are not unique to Minnesota, and are indicative of a systemic issue that is plaguing the nation.
To address these inequities, universities and healthcare institutions have begun to redefine their roles in training and educating healthcare professionals.  
One such institution is the University of Minnesota's medical school — the leading producer of physicians in the state which manages several hospitals and clinics across Minnesota. 
University students and faculty at several medical schools have called on their administrations to create programs that address racial inequities that have caused disparities in health, pointing to inequality in care, racial bias among physicians and the lack of representation found in their study material. 
Making a Change in How Race is Addressed in the Classroom
Constructing a racially and culturally inclusive curriculum has become a focal point for medical schools across the country as the classroom serves as the introduction to medicine for students. What students learn in their first few courses in medical school may influence their practice for years. 
To change their approach to educating future physicians, the University of Minnesota Medical School recruited Dr. Ana Núñez to head their inaugural office of Diversity, Equity, and Inclusion (DEI). Dr. Núñez serves as a Vice Dean in the medical school and was brought on after last summer's civil unrest sparked by the Minneapolis police murder of George Floyd. 
"One of the things that actually impressed me about coming here in the first place was how many had actually started doing the work," Dr. Núñez said.  
The medical school's curriculum has been a focal point in making institutional changes. Knowing this, administrators have brought medical students in on the process to give their input as they work to reconstruct their education. 
"As we talk about curriculum, what really matters is: What are the student's experiences when they come to us," Dr. Núñez said.  
"Because that's how you get it right in terms of that engagement piece, because people sitting in a little conference saying, 'This is how we're going to change stuff,' without the voice of the lived folks just never get it right." 
Medical students like Sally Jeon and Tegan Carr have worked to fix the medical school's approach to education. Both have served as their class DEI officers and are a part of the UMN Medical Education Reform Student Coalition (MERSC) that formed as a response to the police murder of George Floyd.  
"That was the straw that broke the camel's back," Carr said. 
Carr helped lead the Task Force for Change, a student group on the medical school's Duluth campus aimed at reforming the medical school's approach to racial inequity, which later coordinated with student groups like White Coats for Black Lives in the Twin Cities. This cooperation would create the MERSC.  
Members of this coalition met with the medical school's administration, faculty and staff after sending a letter that listed what changes they'd like to see in response to the nation's racial awakening. Those changes include emphasizing an equity-based curriculum, establishing plans for faculty development in health equity instruction, removing race as a biological indicator in medicine, diversifying their standard patients and strengthening ties with communities of color. 
You can read the full list of demands here. 
Though medical students want to be a part of this change, their studies and time reserved for clinical work off campus limits how much they can do.
"For me as a first-year coming in, I had a sense that maintaining sort of the momentum of this could be a challenge," UMN medical student Sally Jeon said. "While it is absolutely crucial to have student voices centered through this experience, students cannot do this alone."  
That's where school faculty comes in. 
Both Jeon and Carr have commended Dr. Núñez and Dr. Mary Owen, director of the Center of American Indian and Minority Health, for doing the work from within the institution that goes beyond school hours. Much of DEI's work in health care or other industries has been seen as a sort of caveat or add-on to the work, but Dr. Núñez believes that it should be integral to how medicine is taught going forward.
"In the course of the year that I've been here, we've sort of built infrastructure," Dr. Núñez said. 
All the school's medical departments now have committees and key individuals in DEI roles. Specialists like pediatricians and anesthesiologists must now have some understanding of equity in their practice.  
Medical school faculty have also received racial bias and microaggression training to recognize how prejudice can appear in their practice.  
"There is no area that is exempt from health disparities," Dr. Núñez said. "Not a one." 
Most Patients That Medical Students Serve Are White
To gain an accurate perspective on how they will practice medicine in the future, medical students have asked for more diversity in their material and the patients they encounter while in school. Areas of medicine like dermatology rarely include how skin diseases will show up on people who are not white, for example. 
"Students have voiced: How are we supposed to relate to each other and diverse patients if every standardized patient that we see, or community teacher that we interact with, is a white person?" Carr said. "We were only seeing white skin. In our lectures and pathology books. I mean I probably couldn't diagnose Lyme disease on my own skin." 
If there was representation or mention of other races, it often came with misinformation which saw race as a biological factor. 
"We know that race is a social construct. It is not a biological construct, and a lot of medicine was built in a faulty way — we also know that we can't just eliminate it," Dr. Núñez said. "Because people's lives are different based on who they are, where they live and their access to health."
Black individuals suffer kidney failure at three times the rate of white individuals and represent a third of patients in the U.S. receiving dialysis. For decades, physicians approached illnesses and diseases relating to kidney function with the racist notion that Black individuals have more muscle mass than other races. Muscle mass is relevant because it breaks down into nitrogen that taxes the kidneys, but medical institutions had internalized this racist trope from slavery and incorporated it into their care. The National Kidney Foundation recently announced the removal of race from estimating kidney function. 
Since being diagnosed with a chronic illness relating to her kidneys, Carr has experienced the dismissive attitude that harms other patients of color seeking treatment. She said that questions about her race were brought up at the start of many of her doctor's visits.  
While change is essential within educational institutions, it's also important to incorporate more racially conscious approaches to public health policy. 
Dr. Rachel Hardeman is the director of the Center for Antiracism Research for Health Equity at the University of Minnesota and was named the first Blue Cross Endowed Professor of Health and Racial Equity at the university's School of Public Health. Dr. Hardeman's work aims to collaborate with colleagues across the university on developing curricula, fostering community engagement and developing policy work. Though Dr. Hardeman's conversations with Blue Cross and Blue Shield began before Floyd's murder, she believes there is even more reason to commit to this work now. 
"My research, broadly speaking, focuses on the impact of racism on health outcomes and healthcare delivery for Black populations, but specifically for Black moms and babies," Dr. Hardeman said. "Minnesota is often ranked as the healthiest state in the nation, but when you start to pull back the layers and understand a little bit more about what's going on here, we actually start to fall towards the bottom of the list when we look at health outcomes by race."
Seeing those disparities in health outcomes firsthand when her grandmother's health deteriorated, Dr. Hardeman decided to pursue a career in health to help close that disparity and to provide everyone with high-quality care.
Black maternal and infant mortality rates are some of the most significant examples of health disparities between Black and white individuals.  
"What we know when it comes to public health is that infant mortality is a critical marker for community health and wellbeing," Hardeman said. "Black women are four times more likely to experience maternal mortality (meaning death during pregnancy, childbirth, or year following childbirth) in comparison to their white counterparts despite their socioeconomic status." 
And the U.S., Dr. Hardeman stated, is the only industrialized nation that has a rising maternal mortality rate. 
"Even when you adjust for education and income level, you're still seeing these disparities," Dr. Foster said. "A lot of time when you talk about solutions, they want to point to social determinants of health and resources are crucial in achieving health equity." 
The history of malpractice and mistreatment of Black women is rife in medical history. One offender was the "Father of Modern Gynecology," James Marion Sims, who experimented on many female slaves without anesthesia. For some people, the treatment of Black women in that era parallel how they are treated today. 
"While folks can say, 'That's in our past, that's our history.' We haven't actually sat down and reconciled with that history and really struggled with what that means on how implicit bias and racism show up in current clinical encounters," Dr. Hardeman said. 
Dr. Foster said that other issues within health care appear when looking at the cross-section of race and gender. 
"Black women were typically offered hysterectomy as the only option or it was presented as the best option," Dr. Foster explained.  "I know many women who had their uteruses removed in their 30s or 20s because of a few benign tumors. 
Dr. Hardeman recently received an appropriation from the state to develop an antiracism training curriculum for perinatal care providers in Minnesota. This preventative care is provided in the form of checkups, nutrition assistance, and monitoring any biological changes. The Dignity in Pregnancy and Childbirth Act aims to reduce these racial disparities impacting Black mothers and babies and has allocated nearly $300,000 to the Center for Antiracism Research and Health Equity.  
States across the country have begun to implement similar changes which focus on creating implicit bias and antiracism training while expanding in areas such as midwifery. 



What Medical Schools Can Do to Fix Systemic Issues in Health Care

Abdi Mohamed

Waqoo talks about coded language, racism and bias as an African and Oromo immigrant before he explains how a long bike trip helped him discover what conservative white America really thinks of him.


That Got Weird: A True Story of Bias and Injustice Against Africans

Sergio Rapu

As frontline public health workers, community health workers are becoming increasingly important. Community health workers are passionate individuals who help to bridge the cultural and linguistic barriers between the communities they serve and the healthcare systems. In partnership with the Masonic Cancer Center, University of Minnesota.
We partnered on three additional videos together that you can view below.
The Minnesota Cancer Clinical Trials Network
Cancer Fighters
Cancer 101
 
 
 
 
 
 
 
 


How Community Health Workers Impact Cancer

The budget forecast shows a $1.3 billion projected surplus - and Minnesota is also outperforming the nation and region, especially when it comes to the number of workers now moving into communities across the entire state, reversing a long-term trend that continues to plague other Midwestern states. Laura Kalambokidis, the State Economist, explained that Minnesota's economy is more diverse than surrounding states, adding that, while we don’t do entrance or exit interviews to know for sure, the state is buoyed by greats jobs and wage growth.
Budget officials celebrated the result, which saves $2.3 billion and allows the state to reach the finish line in its budget reserve target. In response to the news, Democrats who control the House expressed caution, saying that the twelfth surplus in 13 years without inflation factored in is a fictional dream - and they offered a sobering counterpoint. "The state is dealing with racial disparities, unaffordable healthcare, childcare," said DFL House Majority Leader Ryan Winkler.
Republicans who run the Senate say an income tax cut worked and they want to give the surplus back to taxpayers. “This is actually really, really good news, " said GOP Senate Majority Leader Paul Gazelka. "It shows 4 years of growth.”
Republican House Minority Leader Kurt Daudt added, “Last election, the number-one issue was healthcare costs, and next election it will be healthcare costs."
For his part, Rep. Daudt called for a complete repeal of the healthcare provider tax, which got a big no from the governor. “The provider tax… Really?" retorted DFL Gov. Tim Walz. “Do not talk about the provider tax this year." That's after a big fight to stop the automatic full repeal of the of the tax on healthcare providers.
Overall, the governor expressed enthusiasm at the prospect of $1 billion in forecasted surplus dollars. The news is evidence of several positive trends sweeping the state, including a dramatic increase in household formations and the number of people moving to Minnesota to fill job vacancies. “This is a state that works and values everyone," he said.
Stay tuned to Almanac, which airs on TPT2 on Fridays at 7 pm and on Sundays at 9:30 am, for ongoing coverage of what lawmakers decide to do with the $1.3 billion surplus.
As the Minnesota legislature put the finishing touches on the state's budget earlier this year, Almanac's David Gillette offered this illustrated essay on what did and did not make it into the budget.
One of the wettest years on record, floods wreaked havoc on Minnesota communities in 2019. Almanac reporter Mary Lahammer recently visited Henderson, Minn., a town turned into an island due to floodwaters this year. She investigates how the town would use some much-needed bonding money as state lawmakers tour projects around the state in need of investment.
In the wake of news about the state's budget surplus, one issue remains true: Minnesota's infrastructure is aging, and several projects across the state could benefit from bonding money. Mary Lahammer accompanied lawmakers on a trip to southern Minnesota to learn more about the area's needs.


Minnesota has a $1.3 billion budget surplus. Now what?

Mary Lahammer

When it comes to mental health in Black communities, we know a stigma exists. For some of us, we mistrust the medical community after centuries of being misdiagnosed, mistreated or manipulated. For others, we’ve developed or inherited a survivor mentality that believes seeking help is a sign of weakness. Whatever the reason, it’s important for us to overcome our apprehension. There are many societal factors that are out of our control, but our own healing is one area that we have influence over - and one step in that journey may be seeking the help of a therapist.
To demonstrate the healing power of therapy, Sanni Brown-Adefope agreed to attend a recorded session and explore the trauma that has affected her life. Dr. Sheila Sweeney, of Peaces ‘n PuzSouls, partnered with Sanni to take her through a healing reflection of her past. Dr. Sweeney is a psychotherapist with a special interest in the mind, body and soul connection. In this session, she demonstrates a multitude of ways that connection emerges as someone is allowed to speak their own story.
There is no one path on the journey to healing, and it may take several attempts to find the methods that work best for us. But if we stay persistent about taking care of ourselves, we begin to mend, not only our own wounds, but those of generations before us and the generations to follow.
This story is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.
On January 28, 2021, the Twin Cities PBS digital storytelling project Racism Unveiled hosted a live Zoom panel titled “Flight, Fight and Flow: Self Healing” aimed at examining the ways in which Black Minnesotans are affected by trauma, and how we can begin or continue our healing journey. Packed with insight and guidance, discover the six key takeaways illuminated by the event.
In a year that has proved to be a turbulent challenge for so many Minnesotans, the Black church has continued to serve the spiritual and health needs of its congregants of color. The Stairstep Foundation’s CEO Rev. Alfred Babington Johnson shares some of the ways in which the state’s Black churches are working together to provide shelter in what has been an onslaught of storms. 
Black people and people of color in America have been subjected to centuries of medical experimentation and abuse, a history that has spurred mistrust of the healthcare industry for generations. Discover how some Black doctors are addressing the legitimate concerns of their patients of color who are deeply skeptical of the COVID-19 vaccines. 


WATCH: One Woman Finds Healing in Therapy

Bobby Edwards

Dayana Bella-Marie Campbell was loved on the night that she died.
It was an average day, and Dayana’s parents poured time into their first-born. Her mom, Stephanie Pollard, sat down to watch cartoons with her. A favorite was Princess and the Frog, a story about a Black woman struggling to be human again. Pollard bathed Dayana, washing her full head of hair, which had amazed doctors. And as the night ended, Pollard put Dayana in her father’s hands, kissed her and said, “I love you.” It was the last thing Pollard told her daughter. Pollard woke the next day to find that Dayana died in her sleep. She was three months old.
Dayana CampbellDoctors could not explain how Dayana died. They said she was healthy. One coroner said sudden infant death syndrome could be the cause. Whatever the reason, Pollard is now one of hundreds of Minnesotans whose child died before their first birthday. Many of them are Black.
African-American infants are dying at twice the rate of white infants, reflecting decades of health inequity that has been drawn by racial lines. The COVID-19 pandemic is bringing new challenges to the issue, and erasing that disparity means addressing systemic racism that has derailed the lives of countless families.
“A Horrible Bond”
The morning that Pollard found Dayana, she begged God to take her instead. When that didn’t happen, Pollard changed. She cried for days. Holding children felt unbearable, and even news of missing children reminded her of Dayana.
The pain is still there, but Pollard has found comfort in other mothers who also lost their infant children. Although their children passed in different ways, they share a history of being discriminated against.
“We get looked at a lot differently than some moms that lost their child [in] different ways. Sometimes people just want to come and hear the story and see if you did anything to your child,” Pollard said. Her second daughter, Ivory Campbell, cooed as she spoke. “It’s a horrible bond to have… But losing your child, it does help you create a bond with other moms that have lost their child as well.”
In Minnesota, most of those moms are people of color.
Data from the Minnesota Center for Health Statistics shows that infants of color are up to 2.6 times more likely to die than white infants. The highest rates are among Native American people, who make up just 1% of this state’s population. 
Minnesota Infant Mortality DataWith disparities in health care driving these unequal rates, many people have turned to doulas - professionals trained to support mothers before, during and after their pregnancy. Akhmiri Sekhr-Ra has been a doula here for decades and now works as a Chief Family Development Officer for the Cultural Wellness Center in Minneapolis. A lot has changed since Sekhr-Ra started practicing in the 80’s. But one thing remains the same: Few doulas are people of color.
“You’re more comfortable in your skin if somebody who looks like you is there. You don’t feel like you’re isolated and alone,” Sekhr-Ra said. “There needs to be more people who look like us in the field.”
Akhmiri Sekhr-Ra of the Cultural Wellness CenterJennifer Almanza, a certified midwife and clinician at University of Minnesota Physicians, has found that racial consistency in health care can halve the chances of Black babies’ deaths. Yet 90% of midwives in the U.S. are white.
“The U.S. is the only developed country with a rising maternal mortality rate. We know that many of these deaths and injuries can be prevented,” Almanza said. “We will not bridge the gap in maternal outcomes until we are able to fully address racial disparities in health.”
Jennifer AlmanzaCOVID-19 has worsened those disparities. More people of color in Minnesota are filing for unemployment, going hungry, and contracting and dying from the disease. Fewer have been vaccinated or have health insurance to help them.
Worse yet, Sekhr-Ra said COVID guidelines are separating more mothers of color from doulas and support systems that are vital to their babies’ health. Closing the gap in infant deaths means addressing what causes these disparities. Some experts say that the root cause is racism.
An Old Problem With New Solutions
Stephanie Pollard had heard horror stories of women dying or being misdiagnosed while pregnant, but she was not prepared to lose her daughter. Pollard journals to Dayana every day and says that her thoughts on the healthcare field have changed. She is more cautious now and feels that people should focus on the issue instead of sweeping it under the rug.
“Be more open-minded to treating African-American women and children a little bit better in the healthcare field and not just being like, ‘Since your family had cancer or diabetes, this is what’s most likely going to happen,’” said Pollard. “It doesn’t have to happen.”
Dr. Rachel Hardeman might agree. Hardeman studies reproductive health equity at the University of Minnesota and said that gaps in infant death rates persist, even when you account for healthcare access and risks such as smoking.
“At the crux of why we’re seeing these racial disparities, these racial inequities in infant mortality, is structural inequity and structural racism,” Hardeman said. “It’s not a coincidence that the two populations that have been historically oppressed, historically marginalized throughout our history - indigenous folks and Black folks -  have the worst infant mortality rates and the worst health outcomes.”
The proof is in and around the healthcare field.
Racial segregation points to infant mortality, Hardeman said, because the chances for an early, riskier birth increases. Minnesota is one of the most segregated states in the country, thanks in part to racial covenants that stopped people of color from buying homes. She also found that more run-ins with the police increase the chances for an early birth, which puts over-policed communities of color at greater risk.
The gap is so huge that Duke University says Black women with a PhD are more likely to lose their infant than white women who haven’t finished high school. It makes the issue personal for Hardeman, who has a 7-year-old daughter.
Hardeman believes that policies which target housing disparities, public safety and racial bias can address the gap in infant deaths. There has been some progress on that front: A bill that proposes to study maternal health and require anti-racism training is moving through Minnesota’s House of Representatives. Still, Hardeman has her doubts. 
“The fact that we have been tracking infant mortality rates since the 1800s or even earlier and we still see this gap makes me wonder, ‘What will it take?’” Hardeman said. “We have a responsibility to care for and protect our young and our vulnerable… If we can decide that every Black infant that comes into this world is valued, and make sure that we’re doing all that we can to ensure that they have a life where they get to be healthy and thrive and grow up in a safe place in a safe environment - and have what they need to thrive - that’s community health and wellbeing for everyone.”
Pollard is doing what she can to make that kind of change. She supports other friends and mothers who lost their children, and shares her story with them. She hopes that people find peace in hearing about her journey, and realize that they are not alone in this. 
 
Stephanie Pollard“Some people, they lost their child[ren] to SIDS twice. And some people lost their children to miscarriages,” Pollard said. “You’re not the only African-American woman. You’re not the only mother that has lost a child. If I could do it, I believe that you can do it.”
It’s now been two years since Pollard lost Dayana. Through therapy, doulas and support from others, she has been healing. Now when people look at Ivory’s full head of hair and say she looks just like her sister Dayana, Pollard can smile. It's likely that many mothers in Minnesota cannot do the same. 
This story is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.
In a year that has proved to be a turbulent challenge for so many Minnesotans, the Black church has continued to serve the spiritual and health needs of its congregants of color. The Stairstep Foundation’s CEO Rev. Alfred Babington Johnson shares some of the ways in which the state’s Black churches are working together to provide shelter in what has been an onslaught of storms. 
Black people and people of color in America have been subjected to centuries of medical experimentation and abuse, a history that has spurred mistrust of the healthcare industry for generations. Discover how some Black doctors are addressing the legitimate concerns of their patients of color who are deeply skeptical of the COVID-19 vaccines. 
To demonstrate the healing power of therapy, Sanni Brown-Adefope agreed to attend a recorded session and explore the trauma that has affected her life. Dr. Sheila Sweeney, of Peaces ‘n PuzSouls, partnered with Sanni to take her through a healing reflection of her past. Dr. Sweeney is a psychotherapist with a special interest in the mind, body and soul connection. In this session, she demonstrates a multitude of ways that connection emerges as someone is allowed to speak their own story.


Racism Is Killing Twice As Many Black Babies in Minnesota

Story published: May 4, 2020
Nurse practitioner Jennifer Murphy sees a patient through a video screen at Open Door Health Center in Mankato, Minn. The check-up would normally happen in person, but because of the pandemic and shelter-in-place orders, the clinic and the patient are instead using telehealth options.
"Good to see your face. Have you had a sore throat before in the last couple months? Murphy asked.
"No," replied the patient, who requested anonymity because of healthcare privacy.
"Any fevers, chills or night sweats?" Murphy prodded.
"A little bit," the patient answered.
Visits like this now make up about half of all care currently being administered through Open Door, a federally-funded safety net clinic that offers services on a sliding fee scale. Offering telehealth services was something the clinic had planned to research this year and perhaps start in 2021.
"But the problem was, because of the pandemic, our behavioral health team said, 'Whoa, these patients have to be seen, we’re going to have to figure out telehealth now,'" said Mandy Gault, a spokesperson for Open Door.
And in less than a month, they did. It was by no means easy, especially for a clinic that runs on federal and state funding, as well as private donations. And then there was the issue of whether patients, many of whom were low-income, had the devices needed for telehealth visits.
"Is this going to be a barrier for patients? Are patients going to be comfortable with the smartphone, the tablet? And we found in all cases that, yes, they are ready," Gault said.
Telehealth has been around for about 25 years, though it had primarily been used in rural settings to deliver specialty care. Funding came with restrictions, and not many patients took advantage of it overall. For example, in 2016, less than one percent of Medicare patients had ever utilized a telehealth visit, according to the Medicare Payment Advisory Commission. At nearby Mankato Clinic, they weren't doing it at all.
"The way it was governed by Medicare, Medicaid and CMS, a patient would have to go to an originating site for a telehealth visit. So if they wanted to have a visit with a specialist, they would have to get out of their house, drive to a clinic, check in to that clinic, go to a room with a  computer, and through their computer they would then see their specialist. And patients didn’t really want to do that," said Dr. Andrew Lundquist, chief medical officer of Mankato Clinic.
Editor’s Note: As the COVID-19 crisis unfolds in Minnesota, certain details in our stories about the impact of the virus may become outdated within hours, days or weeks of our publication. For the most up-to-date information about the coronavirus in Minnesota, please visit the websites for the Office of Governor Tim Walz and Lt. Governor Peggy Flanagan or the Minnesota Department of Health.
The pandemic has changed the equation. Restrictions were loosened to allow payer reimbursements to equal an in-patient visit. And healthcare providers such as Mankato Clinic quickly ramped up their telehealth capabilities. Lundquist reported that, in one week, all 180 of the providers at the clinic were trained and ready to go. He said telehealth now makes up 45 percent of all visits at the clinic.
"Physicians and nurses really like it also, it’s a great way to see a patient without having to see them - I mean that in a good way. It’s something that our patients are seeing a quicker response from us, they call us with a problem, and we can see them in 30 minutes, and they don’t have to leave their house," he said.
But one question remains: For how long with telehealth last? The payment structure is set to continue for only as long as the pandemic and various states' stay-at-home orders last.
"Once the genie is out of the bottle, we don’t know if we can put it back in," Lundquist said.
Jonathan Neufeld leads the Great Plains Telehealth Resource and Assistance Center at the University of Minnesota. He said the rapid conversion to telemedicine will leave a lasting imprint on how health care is practiced in the future.
"We don’t know how long this will last, and there may be resurgences of Covid-19 and other pandemics and that’s something we’re going to need to be prepared for going forward," he said.
Telehealth has also played a role in keeping healthcare providers afloat. Healthcare systems everywhere have struggled under bans on elective procedures and a spike in fears that some have over going into clinics. At Mankato Clinic, revenues are down by 70 percent, and some staff have already been furloughed. Despite telehealth replacing many in-person visits, Lundquist said that there are still a lot of people going without healthcare services.
"We do 200 mammo screenings a week, and we will diagnose breast cancer once every week. In the four weeks we’ve stopped, there may be four people with cancer out there who don’t know it," he said.
Diagnosing and treating patients with the novel coronavirus comes with different challenges for rural and regional healthcare systems located outside major metropolitan areas. One Greater Minnesota reporter Kaomi Goetz interviewed Essentia Health’s Chief Medical Officer Dr. Peter Henry to find out more about how rural healthcare providers are getting ready for an influx of coronavirus cases. 
As the approximately 6 million pregnant women in the U.S. face uncertainty due to COVID-19, one Twin Cities PBS producer plans to chronicle her story and that of others along the way. Check out Pregnancy in the Time of Coronavirus.
As Minnesotans looks for ways to show their support for healthcare workers on the front lines of the COVID-19 pandemic, we took a look back in time to celebrate the contributions that four women – all named Ruth – made to the state’s public health system. 


Minnesota Puts a Rush on Ramping Up Telehealth During a Pandemic

Kaomi Lee

On January 1 2019, Medicare Cost Plans will no longer be available in the Twin Cities and across much of the state. Currently, Minnesota accounts for 62% of the Cost Plan total, while the remaining 38% are shared between 14 other states.
This change will affect the 370,000+ Minnesotans who are currently enrolled in a Cost Plan, but not all enrollees will be affected in the same way. Different healthcare providers have different Costs Plans, so enrollees are advised to seek out more information - through any of the options highlighted in the video - before making a decision.


Medicare Changes in 2019

A COVID-19 vaccine pop-up clinic at Morning Star Baptist Church in Boston | Credit: Boston Medical CenterThis article was originally published on NextAvenue.org.
Parents, siblings, grandparents and children: They are among more than 600,000 Americans killed by COVID-19 since it was first detected in the U.S. nearly two years ago. The coronavirus has been particularly devastating for people 65 and older. They represent a sixth of the population, but are among those hardest hit by the virus and its complications.
New data from the Centers for Disease Control and Prevention (CDC) show that the virus hits older Black, Indigenous and people of color (BIPOC) even harder. The CDC was able to collect race and ethnicity data on 83% of all COVID-related deaths, as of August 25, 2021. Of that, 1 in 4 were 65 and older BIPOC, according to a Next Avenue analysis of the data.
There are many reasons why. In Illinois, for example, some Black and brown Medicaid customers lived in understaffed nursing homes or in nursing homes with four other people in their rooms. This led to an increase in mortality compared to white Medicaid customers.
Others have been affected by structural racism, which can contribute to "poorer health outcomes for racial and ethnic minorities and other populations who experience health disparities," according to the National Institutes of Health
But experts and healthcare officials say one of the biggest reasons is the wealth and income gap. Generations of racist policies have stoked inequality in the BIPOC community and many in it cannot catch up to their white counterparts. The pandemic has intensified these challenges. And for many, overcoming those gaps is now a matter of life or death.
The Cost of Racism
More than 100 years before the U.S. was founded, African people were enslaved, brought to North America and used for labor. Harvard Kennedy School professor Khalil Muhammad has traced the roots of racial disparity to that colonization period, explaining that European settlers took Indigenous peoples' land and prevented Africans from participating in the economy. When African Americans were freed from slavery, new obstacles shackled them.
Jim Crow laws limited the education, jobs and housing opportunities that the BIPOC community could choose from. Many who opposed those rules would face fines, jail time or violence. The 1965, the Voting Rights Act marked an end to most Jim Crow laws, but racism lives on, taking many different forms.
Explore how racial covenants in Minneapolis continue to have an impact on access to affordable housing today in the documentary Jim Crow of the North.
Black students are disciplined at more than twice the rate of white students. Black college students are the most likely to struggle financially from student loan debt. Applicants with "distinctively Black names" receive fewer callbacks for a job interview. And Black people are denied home loans at more than twice the average rate.
Preparing COVID-19 vaccines at the Morning Star Baptist Church pop-up clinic | Credit: Boston Medical CenterWhen It Comes to Wealth, Little Has Changed
A report by the Federal Reserve Bank of Minneapolis found that racial wealth gaps have persisted for 70 years, and white families' wealth now averages at more than $118,000. Black families' average is $13,947.
"This country has racialized poverty," said Denny Chan, directing attorney for the nonprofit Justice in Aging - a nonprofit advocacy organization fighting poverty among aging adults.  "[Class and race] aren't proxies for each other, but they also are so deeply intertwined that you can't talk about one without talking about the other."
According to a May 2021 report by the federal Administration on Aging, Black people who are 65 and older now hold the highest rates of poverty among their peers.
Less generational wealth means fewer dollars to save for retirement or for the costs of prescription drugs and other healthcare-related needs throughout life. These disparities in health and health care even extend to dementia care and the ability to get a diagnosis, for example.
In March, the Alzheimer's Association released a report detailing how those disparities played out. It found that older Black and Hispanic people are more likely to have Alzheimer's disease or another dementia, and compared to older white people, were more likely to have a missed diagnosis. The survey also found that roughly 50% of Black people who were surveyed have experienced healthcare discrimination; two in five unpaid caregivers said that race made it harder to get excellent care.
"The decades of racism and discrimination and intergenerational poverty — it builds up on one another so that the disparities are particularly massive among Black or Latinx older adults, and other older adults of color, compared to white older adults," Justice In Aging Staff Attorney Gelila Selassie said. "It really baffles me because this is a generation that fought for civil rights, that lived through Jim Crow, that saw all these racist policies of the sixties, seventies and beyond. So for this to be how they advance in age, how the end of their life is, is really heartbreaking."
At-home care could improve aging adults' health, but Selassie said that many members of the BIPOC community cannot afford it. A national survey by Genworth supports Selassie, finding that yearly rates for at-home care can cost more than $54,900.
Nursing homes can be safety nets for families who qualify for Medicaid. But as we saw during the pandemic, these types of settings may exacerbate decades of inequality. And without enough savings or long-term care insurance, being able to afford a private room in an assisted living community or other long-term care setting may be out of reach.
An Improved System That Needs Reform
Wendy Cappelletto believes that the healthcare industry needs to change.
Cappelletto is a member of the National Association of Elder Law Attorneys and works for the Office of the Public Guardian of Cook County in Illinois. She said racial disparities can be found in the quality of care that nursing homes offer, and even in where the facilities are located.
"[Nursing homes] don't pay well. [There are] transportation issues to get to that place. If people don't have cars, you're not going to want to take a bus in the middle of the night," Cappelletto said. "The pandemic really brought it to the forefront, but there's been disparities before this. They just weren't as obvious."
And volumes of research show those disparities in long-term care settings have gone on for years.
A Workforce Made Up of Women and People of Color
A report by PHI, an organization working to create quality jobs for the direct care workforce, found that direct care workers' median hourly wage in 2020 is $12.80. That has barely increased in the past decade. Another report by PHI found 48% of all direct care workers are women of color and one out of five live in poverty. This workforce is also more likely to rely on public benefits.
The report concluded by saying, "Unfortunately, direct care jobs do not provide economic stability to women of color and their families."
Ironically, PHI projects that the long-term care sector will need to fill 6.9 million jobs in the next decade.
But as Cappelletto said, healthcare disparities were a concern even before the pandemic. A 2005 report cited by the American Bar Association found that BIPOC patients were less likely than white patients to get "appropriate cardiac care, to receive kidney dialysis or transplants." It also found they were less likely to receive the "best treatments" for conditions like stroke or cancer.
Those kinds of barriers and health inequities have led us to where we are today. And the pandemic has exposed all of it for the world to see. But change is starting to happen — at the local level.
Investing In Future Generations, Now
Earlier this year, Boston Medical Center's Dr. Sabrina Assoumou reviewed her hospital's COVID-19 vaccination rates. She nearly jumped for joy.
Assoumou had worked closely with the medical center to reach more people in Massachusetts, where research shows that five communities with the highest COVID-19 infection rates in the state are home to a majority of BIPOC residents.
Assoumou said that many Black Americans are hesitant to trust healthcare providers. Some may recall stories of the Tuskegee Experiment, in which Black men were knowingly infected with syphilis by the U.S. government.
Although penicillin was available at the time, participants were not offered that treatment. As a result of living with untreated syphilis, many lost their vision, experienced neurological damage or died. With that history in mind, Assoumou knew she would have to take a different approach.
Assoumou made televised appeals, acting as a trusted voice who assured people the vaccine is safe and effective. Then, the Boston Medical Center decided to bring the vaccine to the people. The center joined many local senior centers and community organizations in launching pop-up clinics where BIPOC could easily access them.
After the center launched the pop-up clinics earlier this year, Assoumou looked at the data: 40% of the people vaccinated at the medical center were Black. For context: Less than a tenth of the state is Black.
"When you bring the vaccine to people and you make it convenient for them, you can see changes," Assoumou said.
Though it's still important to address generations of health inequities, Assoumou said the community outreach is critical. That's because members of the BIPOC community face barriers besides the wealth and income gap, which can keep them from receiving quality health care.
"Start with social determinants of health, which describe the milieu of where a person is born, lives and grows up," Assoumou said. "[That] impacts the trajectory and impacts [the] access to opportunities, to education — access to wealth."
And all of that, she said, affects one's access to quality health care.
Data on coronavirus rates highlights how those social determinants may be affecting communities of color. Said Assoumou: "It didn't matter where you were in the U.S., but the curves always looked the same: where Black people, Latinx people and Indigenous people were disproportionately impacted by the pandemic."
Research organizations like the National Institute on Aging have recognized the effects social factors can have on communities' health. Those factors have hurt people for generations, but Karyne Jones says that could change.
Jones is president and CEO of the National Caucus & Center on Black Aging, a nonprofit focused on quality of life for aging people of color. It has worked to inform aging Black communities for decades, and now functions as a connector to other programs and resources.
Jones said people today have more health information at their fingertips and can benefit more from that knowledge compared to previous generations. But spreading health awareness is just one piece of the puzzle, she said.
It's also important to build a productive and healthy society, but that means getting everyone to invest in it, she noted.
"COVID was horrible to communities of color, both in the health aspect and financially. And that is because there has not been the kinds of attention and investment in ensuring that these fellow Americans deserve quality of life," Jones said. "We can't continue to think that we can keep the system that we have, and still try to get out of this situation where we have an unhealthy society."
This article was originally published on Next Avenue as part of The Future of Elder Care series, made possible through funding from The John A. Hartford Foundation.


The Racism Unveiled digital storytelling project is funded by grants from the Otto Bremer Trust, HealthPartners and the Saint Paul & Minnesota Foundation.


How COVID-19 Exacerbated Inequalities in Health Care for the BIPOC Community

It's an open seat in a swing district. Voters here backed Presidents Bush, Obama and Trump. It's fiercely independent and hard to predict. Minnesota's First Congressional District has the attention of the nation. Control of Congress could be decided in this agricultural area of southern Minnesota that also boasts booming regional centers such as Rochester's world famous Mayo Clinic and the ever expanding college town of Mankato.
Republican Jim Hagedorn whose father represented the district has run and lost two times before, but he thinks three times is the charm and knows the seat could be a big pick up nationally for the GOP that's bringing "more money, more attention."  Democrat Dan Feehan is a teacher with a military background just like Democrat Congressman Tim Walz who's vacating the seat to run for governor, for Democrats to take over Congress he says "you have to hold on to what you have."
The candidates are approaching President Trump completely differently. Hagedorn says "I'm a conservative Republican that wants to keep the country moving in the right direction, so we offer the opportunity to stand with our president." Feehan responds "We're presenting a pretty clear choice, you can vote for an extension of the Trump administration or you can vote for an independent voice."
Agriculture and healthcare are the issues dominating the district and they're related. Farmers have struggled with healthcare costs and soybeans dot the prairie whose producers aren't sure about the global market for them. The last congressional race here decided by less than one percentage point, that makes this one to watch.
This story was published September 17, 2018.


First Congressional District: Top National Target

On Memorial Day, shocking live videos surfaced on social media, showing a white Minneapolis police officer kneeling on the neck of a handcuffed black man – George Floyd – for 8 minutes and 46 seconds, while Floyd laid face down on the pavement and repeatedly said, “I can’t breathe.” Three other officers on the scene stood by without intervening. Instead, they prevented bystanders from interfering. Floyd was pronounced dead shortly after.
In the wake of the police killing of George Floyd, widespread protests and uprisings unfolded across the world, with Minnesota at the epicenter. These demonstrations are part of the larger Black Lives Matter movement, which addresses America's history of systemic racism and police brutality, particularly against the African-American community.
What is unique about this occurrence is that the world has also been gripped in a pandemic since March. The coronavirus (which causes the disease COVID-19) is highly contagious, and experts recommend that individuals wear a face mask and maintain a distance of at least six feet from others in an effort to prevent the virus from spreading. But with these mass gatherings, many people were unable to maintain a safe and healthy distance. And many people did not wear masks.
In response, the Minnesota Department of Health (MDH) officials recommend that those individuals who have attended protests, community cleanups, volunteer events and other mass gatherings should get tested for COVID-19. They’ve also advised healthcare providers to increase testing capacity. Though uncertainty remains over whether or not these recent mass gatherings will trigger a surge in COVID-19 cases, many health experts predict a second wave as the outcome.
Editor’s Note: As the COVID-19 crisis unfolds in Minnesota, certain details in our stories about the impact of the virus may become outdated within hours, days or weeks of our publication. For the most up-to-date information about the coronavirus in Minnesota, please visit the websites for the Office of Governor Tim Walz and Lt. Governor Peggy Flanagan or the Minnesota Department of Health.
As someone who has attended these gatherings, Twin Cities PBS producer Susan Thao (Sinclair) documented her experience with COVID-19 testing. After spending a morning at a drive-thru test site, she got her results back in 12 hours.
Wondering what to expect? She shares her tips on what to expect when testing for COVID-19:
Make an appointment, preferably through a healthcare provider. If through a healthcare provider, it's beneficial to have an online account for quicker access to test results.Drive-thru test sites are great for maintaining confidentiality.Bring tissues if you're uncomfortable with a nasal swab.Try not to get stressed out about the results. There are instructions for both positive and negative diagnoses.If you're uneasy with the results, retest! MDH actually recommends taking another test 12 to 14 days after attending an event (or 5 to 7 days after the first test).Since the start of the pandemic in March, testing in Minnesota has ramped up considerably - good timing given the thousands of individuals who have marched, volunteered and attended events in recent weeks, and who may now seek out answers to the question: "Do I have COVID-19?"
During a time when musicians and performers of all stripes are offering musical interludes from balconies and porches, revisit a time in history between the world wars when local communities gathered in Minneapolis parks to sing together in unison.
Many pregnant people during this time of pandemic have had to make some unexpected decisions about their original birth plans. Meet two women who chose to forgo hospital births for other options that made them feel more comfortable during this uncertain time.
Diagnosing and treating patients with the novel coronavirus comes with different challenges for rural and regional healthcare systems located outside major metropolitan areas. One Greater Minnesota reporter Kaomi Goetz interviews Essentia Health’s Chief Medical Officer Dr. Peter Henry about the challenges that rural medical facilities face during a pandemic.


What to Expect When Testing for COVID-19 in Minnesota

Susan Thao

When the city of St. Paul, Minnesota, proposed developing apartment buildings and retail space on an empty industrial site, an opinion piece in Growler Magazine compared the proposed development to a metal shredder.
"Rather than conserving and improving the neighborhood's qualities and characteristics," Charles Hathaway writes. "The redevelopment endorsed by the city's plan disregards the neighborhood's unique characteristics and diminishes its quality."
The site has sat empty in St. Paul's Highland Park neighborhood since the 86-year-old Ford Motor Company Assembly Plant closed a decade ago.
Developer Ryan Companies purchased the site, with plans to build 3,800 housing units, 20 percent of which will be designated affordable housing.
But opponents say development would ruin the "character" of the neighborhood, a place they say has a small town feel amid a mid-sized city.
This isn't just a common phrase; it's literally written right into the language of the city's zoning code for conditional use:
"The use will not be detrimental to the existing character of the development in the immediate neighborhood or endanger the public health, safety and general welfare."
But what counts as "neighborhood character," and who gets to define it?
In many cities, it's wealthy, white homeowners who have lived there for decades.
"A common tactic is to use zoning for single family homes or large lot zoning that requires the single family homes to have a significant amount of land around the structure," said Lance Freeman, a professor at the Columbia University Graduate School of Architecture, Planning and Preservation.
"Things like that make it difficult to construct multifamily housing. So clearly that would serve to keep out certain types of housing that would be more affordable."
Racist zoning laws
Zoning laws in the United States have a racist history. The earliest weren't just implemented to control land use, but also for social control, an effort to keep wealthy neighborhoods from becoming slums.
Though they were intended to improve the environment, they were also used to keep out "undesirables," namely poor people, people of color and immigrants.
While wealthy communities were able to use zoning to their advantage — preserving their property values, and controlling development of schools and businesses, poor communities of color are often burdened by what's called "expulsive zoning," living next to industrial and hazardous waste sites and landfills, and without access to public parks and grocery stores.
We don't just see this in St. Paul. We also see it in cities like Charleston, South Carolina, which is facing an affordable housing crisis but has blocked further development in the center of the city, in the name of historic preservation.
Last year, St. Paul's neighbor, Minneapolis became the first major city to end single-family housing restrictions, instead allowing multi-family housing to be built anywhere in the city.
But across the river in St. Paul, the battle over density is still happening.
What's considered 'character?'
Tom Basgen, 32, is a renter in St. Paul who has been going to public meetings about the former Ford plant site for a decade. He's lived in the city since 2009.
"They couldn't say, you know, this is Highland Park. We don't want poor people living here," he said.
"They would say, how will this affect the character of our wonderful neighborhood? And it is a wonderful neighborhood. My contention was that as a renter now and a renter then, you know, I like to think I pick up trash, I contribute to that good character of the neighborhood."
Basgen said there's a belief that renters are tumbleweeds, just blowing through a neighborhood with no real commitment to it.
But with rising home prices and stagnant wages, homeownership is increasingly out of reach for many Americans. There are more U.S. renters today than there have been at any point since at least 1965.
In St. Paul, most residents are renters.
But the voices in community meetings are often long time homeowners.
Many homes in the Highland Park neighborhood were historically bound by racial covenants, as Michael Daigh writes for Streets.mn, barring people of color from purchasing them.
Racial covenants haven't been enforceable for decades. But it doesn't mean they didn't have a lasting effect on what we consider "character."
"If a Baby Boomer purchased their Highland home 30 years ago, it is a statistical likelihood that they purchased in the 1980s from another longtime resident who intentionally bought a home that was 'protected' by racial covenants," Daigh writes.
"...It is also reasonable to surmise that, in the twilight of legal racial covenants, homeowners still made intentional choices about whom they sold to."
Representation for renters
There is change happening in St. Paul. Basgen worked to elect Mitra Jalali to the St. Paul City Council two years ago.
Basgen and Jalali have been described as YIMBYs ("Yes in my backyard") for fighting the neighborhood's NIMBYs ("Not in my backyard").
Historically, renters haven't had a voice in St. Paul. Jalali made headlines as the first renter and youngest member on the council.
"People who use coded language like 'neighborhood character' and 'historic preservation' are participating in structural white supremacy that has historically and presently mostly valued white 'character' and white 'history' at the expense of everyone else," Jalali said.
"We don't need to discard maintaining historic significance or physical structures in our city, but we do need to discard blocking any and all positive change in the name of one narrow segment of the population's definition of 'history' and 'character.'"
Jalali recently pushed to rezone another area of the city to allow three-story apartment buildings, saying the move would benefit public transit, young people and people of color.
She said the city needs to take a racial equity lens to all urban planning, land use and engagement decisions going forward, to empower communities of color who have been disproportionately affected by racist urban planning. And she says there's more St. Paul could do to improve and expand its zoning code, like eliminating parking minimums.
Last week, the St. Paul City Council passed a set of renter protections that included limiting security deposits to one month's rent. The protections also require landlords to provide written justification when they do not renew a tenant's lease.
"I think the bellwether of whether this fight is over," Basgen said. "Is whether or not we have homeless people in this town."
This article originally appeared on Rewire.
© Twin Cities Public Television – 2020. All rights reserved.
Saint Paul's neighborhoods of color have a disproportionate number of vacant buildings than areas primarily occupied by white residents. That fact has a direct impact on crime rates, public-health risks and quality of life. Data reporter Kyeland Jackson examines the links between vacant properties and the city's racial disparities.
Along with other urban centers across the country, the Twin Cities have a history of racially discriminatory housing covenants that prevented people of color from buying homes in certain neighborhoods. That history ripples in the present-day affordable housing crisis: By limiting opportunities for home ownership, people of color were stripped of one key way to build equity over time. Discover more in "Mapping the Roots of Housing Disparities in Minneapolis."
When Twin Cities PBS Producer Kevin Dragseth was a teenager, he was mesmerized by the Living Colour song "Open Letter (To a Landlord)." Years later, the song impacted his documentary Sold Out: Affordable Housing at Risk. Aiming to learn more about the song's origins, he reached out to one of the songwriters, Tracie Morris, who sheds light on the roots of the New York City housing issues it addresses.


How Discussions of 'Neighborhood Character' Reinforce Structural Racism

Gretchen Brown

Neighborhood activism has been central to fighting environmental racism.When people first hear the term "environmental racism," they may wonder how ecology and bigotry intersect, especially in Minnesota. It can take many forms, but one common version looks like this: Decades of intentional housing discrimination concentrated generations of Black and brown families in less desirable, less safe locations without parks and streetlights and speed limits, and closer to health hazards like industrial zones, railways, freeways and polluted waterways. 
Redlining and racially-restrictive covenants persisted legally for decades, creating and reinforcing low-opportunity zones with poorer schools, lower-paying jobs, higher crime rates, poorer health and lower life expectancies, not to mention bleaker prospects for the futures of children. Undereducated and unhealthy children are less likely to land high-paying jobs, continuing the cycle over generations. These racist practices effectively prevented Black homeownership in these areas, and with it the generational wealth that would have transformed the future prospects of countless families of color. Our entire community is poorer as a result, and the reasons why were buried and forgotten. Racism doesn't need to be overt bigotry to cause deep harm. 
The Civil Rights Movement put an end to those racist housing practices in our legal code when the landmark Fair Housing Act was signed in 1968. But the inequity created by those practices still exists, and still plays out in the lives of generations of Minnesotans of color. A drive through Minneapolis neighborhoods like Hawthorne and Phillips reveals a vital, diverse tapestry of cultures and people, tight-knit communities, bustling schools, and small-business entrepreneurship like nothing the suburbs could imagine. Somehow, they thrive. Despite decades of under-investment and over-policing, despite the red lines and the white flight, they live and find joy and meaning and belonging.
Racism is lethal, and not only when it's violent
In the same way that racist redlining and covenants decades ago have left our whole community poorer in every respect, environmental racism hurts all of us. Casual business decisions and government policies have life-and-death impacts that are easy to miss if your community is not the one paying the greatest price. But we will all pay eventually. 
Perhaps things are changing. More white Minnesotans are seeing the connections that their Black and brown neighbors have known and described for decades. They are recognizing the links between the myriad large and small racially yoked events and environments at work as a landscape of injustice rather than isolated incidents, flukes in an otherwise just world. Moreover, racism is now being framed not only as a justice issue, but also a health issue.  Minnesota's House of Representatives and the City of Minneapolis recently adopted resolutions declaring racism a public health crisis, a drain on our healthcare systems and taxpayer dollars. 
That can sound a bit impersonal and abstract, especially if it doesn't reflect your own lived experience. So Twin Cities PBS followed two community members whose lives have been profoundly impacted by environmental racism. They have been called into activism because their communities needed brave warriors to protect them from the lethal dangers we've put into our air, water and soil, and the barriers to justice and equity we've put into our systems. 
In My Experience: Cassandra Holmes
An aerial view of the East Phillips neighborhood in South Minneapolis, with a former pesticide plant site on the bottom right.At the eastern edge of the vibrant Phillips neighborhood in South Minneapolis, a pesticide plant once dumped vast amounts of deadly arsenic into the air and soil for decades. Millions of dollars of EPA  Superfund cleanup paid for the replacement of 50,000 tons of soil around homes and businesses. But for generations of families in the area — particularly the Indigenous community centered in the Little Earth housing complex just blocks from the former plant — the human cost is very real, and the damage and injustice is ongoing. 
In this video, meet Little Earth community member and activist Cassandra Holmes to discover why she fights against environmental racism and where she draws strength from to keep fighting.
Sources: EPA, Wilder Foundation/Blue Cross Blue Shield, MPCA, WHO, Little Earth Urban Farm, Shield 1 Foundation
In My Experience: Roxxanne O'Brien
An industrial zone in North Minneapolis, with the Hawthorne neighborhood to the right.In North Minneapolis, a long, narrow strip of the Mississippi River shoreline is occupied by heavy industry. To the west is the vast, multicultural Hawthorne neighborhood. These industrial facilities are held to strict pollution control measures, with varying degrees of success. One such facility regularly made news headlines for a decade, and not in a good way. Northern Metals Recycling operated a metal shredder that failed to meet emissions limits essentially from day one. Perhaps destined to fail from the start, Northern Metals requested a 900% increase in their toxic emissions cap. When word of this reached one particular community activist, she spent the next 10 years of her life fighting both the polluter itself, but also (in her view) uncooperative city leaders and departments more interested in preserving the status quo than in protecting the health and wellbeing of its residents.
In this next video, meet Northside activist Roxxanne O'Brien and learn how her upbringing prepared her to become a tireless voice for justice, both against the lethal impacts of racism on Black and brown bodies, and for a community-led vision for development and investment in the Northside.
Sources: MPCA, Star Tribune, MN Center for Environmental Advocacy, CMEJ
There is growing awareness of the astonishingly deep roots of our racism that it's built into our neighborhoods, language, health care, education, law enforcement and religion. Our most pernicious racism is not overt and personal, but covert and institutional. 
It took the likes of Dr. King and millions of civil rights activists marching for years to force white leaders to make some of our overt racism illegal. What kind of movement will call white Minnesotans to account for our lethal covert racism?
With additional reporting by Kyeland Jackson, and research and videography by Sergio Rapu.


Racism Is In the Air We Breathe

Kevin Dragseth

"Leading Through the Pandemic" is a series focused on Twin Cities leaders and their reflections on the year of living during a pandemic and leading their teams into new ways of working.
In April 2021, we spoke with six Twin Cities leaders from various sectors - health care, independent business, nonprofit organizations, and education and religious institutions - about their experiences in decision-making, staff management and service to their audiences, patients and members during the last year of COVID-19 and civil unrest. Without a doubt, 2020 tossed countless challenges at any semblance of stability, but the topsy-turvy year also inspired these leaders' renewed hopes for a more sustainable future, one they might not have imagined without first grappling with so much unexpected turbulence.
Dr. Roli Dwivedi is an Assistant Professor of Family Medicine and Community Health, and Chief Clinical Officer at the Community-University Health Care Center (CUHCC) at the University of Minnesota, which provides primary care services to children and low-income families in South Minneapolis. She received her medical training in India and completed her residency in family medicine at the University of Minnesota. Before that, she served as the medical director for an organization serving the underserved in northern India. She is involved with several leadership and quality committees all across Minnesota, and serves as director-at-large within the executive committee of Minnesota Academy of Family Physicians (AFP). Serving and improving the health of minority populations is her personal mission. Her interest in education includes global health and culturally sensitive care, improving health disparities, and mentoring medical students and residents.
In her own words, she describes the obstacles, successes and opportunities for experimentation presented by the last year.
IN-PERSON, ONLINE AND HYBRID APPROACHES
At CUHCC, we serve over 11,000 patients a year through nearly 60,000 visits annually. We have several service lines that include medical, dental, mental health, including psychiatry, therapy, case management and Adult Rehabilitative Mental Health Services (ARMHS), along with domestic and sexual assault victim advocacy programs. Patients seeking these service lines have different needs, so we needed to create different models for them. For medical, we are providing 70% in-person and 30% telemedicine visits. Dental is fully in-person, whereas psychiatry and therapy are 20% in-person and 80% telemedicine. Our other services are also functioning in a hybrid model.
INITIAL COVID-19 PLANNING: PATIENTS COME FIRST
In mid-March, as the COVID-19 pandemic took hold in Minnesota, we needed to completely pivot all aspects of clinical, administrative and operational life at CUHCC. First thing that came to my mind was my patients, who have so many barriers when it comes to accessing care. A lot of our patients don’t speak English and many do not have the internet or smart devices, or even enough phone minutes to complete a telehealth visit. A lot of patients that we serve experience homelessness, and scheduling an appointment is a barrier for them. They prefer to walk in. While other organizations were very quickly able to pivot to only telemedicine, we needed to design our care delivery to have adequate in-person access all the time. We never were 100% remote and we always had 40% in-person visits. We also needed to make sure that we had enough access for our patients and resources to run the clinic in terms of Personal Protection Equipment (PPE), infection control, interpreter access, etc. We did not have telemedicine services before COVID, though we were thinking of launching it in September 2020. But when COVID hit us, we literally launched, trained staff and started practicing telemedicine within a week. The second thing that I was worried about was my staff - not only their physical health and safety, but also their emotional health.
COVID-19 testing at CUHCC.PROVIDING CONSISTENCY THROUGH THE UNEXPECTED
It was very hard back in March 2020 and still is, as sometimes we need to implement things with just hours’ notice - to ensure the continuation of quality care while keeping patients and staff safe. We needed to change our COVID testing site several times, starting from implementing the testing both inside and outside the clinic, then when winter hit, creating a mini indoor testing site in a trailer, and finally when we started opening up bringing the testing outside again. We needed to change our Personal Protection Equipment (PPE) guidance several times based on regularly changing PPE recommendations from the Center for Disease Control (CDC).
CUHCC's winter COVID testing site.The twin pandemics of COVID and racism and resulting civil unrest has focused attention on the broken trust that many communities have historically experienced with healthcare providers. We used this moment to create care models and partnerships that improve health outcomes and patient satisfaction as steps to rebuild that trust. One of these models uses a community-based care approach which began with pop-up COVID-19 testing events. We did several testing events which were community-informed. We collaborated with the City of Minneapolis and its public housing division to bring testing to high-rises. We also did a two-day testing even at Phelps Park near Mr. Floyd’s murder site.
As it was obvious from the beginning that there are disparities in COVID testing among BIPOC populations, I was given the responsibility of leading a task force, which is a University of Minnesota-wide collaboration with Minnesota health departments, local and regional healthcare systems, and communities to increase COVID testing, care and prevention in diverse communities. The Disparities in COVID Response Task Force is working to reduce gaps in treatment and care by coordinating and disseminating resources through mobile care and immunization events. The group also partners with community members to educate and engage around COVID-19 using culturally-appropriate tools to discuss its impact, and the importance of testing and vaccination. During the civil unrest in May/June of 2020 caused by the tragic death of Mr. George Floyd, I helped lead CUHCC staff through virtual and socially distant healing practices; joined “White Coats for Black Lives” in nine minutes of silence on the University of Minnesota Twin Cities campus honoring Mr. Floyd; helped organize and distribute food, medicine and care products in CUHCC’s parking lot for any in need in the midst of the civil unrest; and continued to lead clinical care - allowing CUHCC to remain open (even if only for virtual care) during the entire time of unrest.
Our most recent effort has been in mobilizing the vaccination efforts in Somali and East African communities and Hispanic communities. I worked with religious faith leaders and hosted an event at CUHCC where we collaborated with 16 imams from all over both rural and urban Minnesota who came to CUHCC and received their shots and helped educate the community in increasing vaccine confidence. It was a great coming together of health, religion, faith. Community and education together. Currently we are hosting mobile vaccination events to vaccinate as many people as community want before Ramadan celebrations.
CUHCC's Imam event.PATIENT-CENTERED CARE
One story that I remember that is very near and dear to my heart is about a patient of mine who is in her 90s and was affected by severe COVID, but wanted to stay home rather than being in the hospital. She was a non-English speaker but with the help of her family, we were able to bring multiple family members from different locations into a Zoom consult a few times a week and they all had different roles in her care: Some were directly providing her care; some interpreting; some responsible for medication pick-up, etc. The best part is that she survived and received patient-centered care.
HEALING AND MOVING FORWARD
Last year has been overwhelming and tiring, not only physically, but also socially and emotionally. We have tried different things for and with staff to keep everyone engaged and informed. We launched daily staff-wide huddle meetings every morning where we do quick updates on sociopolitical changes and clinical updates. We had previously been regularly holding a staff-wide meeting every month or two months, in which we typically started with a mindfulness practice like meditation before jumping on to data, numbers, productivity, finances, expectations, etc. A lot of our providers are engaged in advocacy and antiracism work. We have added moments of silence for the lives we lost to COVID and civil unrest, including eight minutes of silence to honor George Floyd’s life. We together have lit a candle for spiritual healing. I strongly believe food brings healing, and so we have provided breakfast, lunch and snacks as a thank-you gift for our providers’ continuous hard work. We have celebrated together with online baby showers, retirement celebrations, birthdays, and the like. But the biggest support I could and can continue to provide to them is a schedule that will work for them and their personal needs and challenges during all of this, including changing child-care requirements and at-home schooling.
Racism is the root cause of all inequities. The power of public health and antiracism work play important roles in improving the health of all. I have always walked every step of my life with my personal mission of advancing health equity, and though last year has been very emotional and challenging, I see a ray of hope as more and more people are uniting to do the antiracism work together.
On January 28, 2021, the Twin Cities PBS digital storytelling project Racism Unveiled hosted a live Zoom panel titled “Flight, Fight and Flow: Self Healing” aimed at examining the ways in which Black Minnesotans are affected by trauma, and how we can begin or continue our healing journey. Packed with insight and guidance, discover the six key takeaways illuminated by the event.
Black people and people of color in America have been subjected to centuries of medical experimentation and abuse, a history that has spurred mistrust of the healthcare industry for generations. Discover how some Black doctors are addressing the legitimate concerns of their patients of color who are deeply skeptical of the COVID-19 vaccines. 
Whether doctors use abusive language, refuse to acknowledge a patient’s chosen pronouns on medical intake forms or ignore the specific needs of LGBTQ+ patients, normative gender/sexual orientations still abound in the healthcare industry, leaving many with a difficult question: Should I even go to the doctor? Four queer women of color, including Hadija Steen Mills, discuss barriers to LGBTQ+ women’s health care and share affirming ways to combat systems of oppressions through health education.
