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. 
