MN VOICES | Addressing health inequities in Minnesota takes engagement from regular people | Twin Cities Daily Planet – 12/24/12
By Andrea Parrott, TC Daily Planet
December 24, 2012
Health disparities implies something that is just there, Doran Schrantz explained. Health inequities, on the other hand, implies a societal structure that produces inequality. “We need a structure that brings more equity,” Schrantz said as she described the differences in terms.
Doran Schrantz is the executive director of ISAIAH, a faith-based nonprofit organization. ISAIAH is a partnership of around 100 congregations throughout Minnesota that advocate for racial and economic equality. Schrantz values people and organizations working together toward a main goal: the wellbeing of people regardless of race and across all areas of life, including economic, education, and health. Her efforts towards such a goal and the efforts of ISAIAH gained recognition in October when Schrantz became one of ten people to receive the Robert Wood Johnson Foundation’s Young Leader Award: Recognizing Leadership for a Healthier America.
Twin Cities Daily Planet spoke with Schrantz about health inequities in Minnesota and how people can help. The edited text of the interview is below.
What are the main health inequities facing Minnesota?
Doran Schrantz: Our work on health inequities comes out of the framework of the social determinants of health … racial and economic inequality creates health inequities… It’s not about access to health care; it’s about access to opportunity and quality of life.
There was a PBS series called inequality is making us sick, and it focused on income, race… African American women are almost two times as likely to have a stillborn than white women and in some places it can be three to four times. That’s regardless of income or access to healthcare. The research that people have done on this is that there is a health cost, living in a society in which you experience the daily stress of racism. They’ve looked at that kind of thing on like being poor, or income levels, or what happens to your health if you lose your home. If you’re unemployed and you lose your job, you’re much more likely to have a heart attack or stroke…
For public health, how do you create the quality of life in which the color of your skin, or your class, how much income you have, is not a determinant of your health or life expectancy?
…We began to partner more with public health officials – work in transportation, education, housing, jobs; we work at the intersection of those issues… Right now we’re getting ready to work on education and the academic achievement gap. One of the recommendations, number one things they could do to reduce health inequities is to close the academic achievement gap.
We’re partnering with an organization to do a health impact assessment. The health impact of segregation in our schools… A health impact assessment is a formal tool for looking at the health impact of how the impact of programs and decisions are made in the public… We did a health impact assessment on the Central Corridor zoning. We gave recommendations on what people’s experience was.
What are some of the health inequities?
Schrantz: If you look at the research in Minnesota, there are indicators—life expectancy, rates of asthma, rates of diabetes, obesity, mental health—on every indicator that you look at in MN, there is an enormous disparity between whites and people of color… If you disaggregate the data, you can see variations, but there’s still a gap on people of color’s health compared to white people.
Poor people are less healthy than more well off people. What are the interventions? How do you, over the course of a long period of time, intervene to reduce those health inequities? It’s not just one thing; it’s going to be housing, jobs, economic development…
Health inequities are a sign and a symptom that we’re not making the decisions we need to make to invest in our future… Part of what health inequities are is a sign and symptom of lack of capacity of a community to advocate for the conditions it needs to advocate for its health…
It’s not just access to health care or personal choices. Do people in the community have the capacity to ensure the conditions… The building of community power to increase the capacity for people, increases peoples capacity to ensure the conditions to be healthy… Am I safe when I go to school? Is my home safe? Do I have even access to fresh and healthy food? Is there a grocery store nearby that’s affordable? These are the conditions – they’re collective solutions. The idea of community organizing is that that begins to build people’s capacity to demand what they need…
What is the role of community organizations, like ISAIAH, in addressing health issues in the state?
Schrantz: The role of the field of organizing, building democracy, is that that work is essential to creating the conditions in which people can be healthy, and the more that people are in the field of organizing, like community, safe place, labor, community advocacy, the more we see our work as connecting and working together and having a specifically health inequity and racial equity lens on our work, the more effective we will be… We see our work as part of the larger goal of reducing racial, economic, and health inequities.
How can people use their power to solve the problems that they are facing?
Schrantz: [For example] the question about the housing question in St. Paul. If there’s going to be a four billion dollar investment in light rail, how can that be a catalyst for economic development and benefit those living along the community?
There’s a whole set of policy decisions… keeping people in their homes [is one]. Policy decisions around inclusionary zoning so that the Central Corridor remains mixed income. The city and state play some role in ensuring that people can negotiate in keeping their homes… Mechanisms for evaluating schools, teachers, and superintendents for how they are actually improving the practices in the school…
Let’s agree that we’re navigating toward the goal of a healthy community with reducing the achievement gap, and we’re all partnering to meet that goal…That’s not the goal that ends up being met. The interest of the well being of people is often not at the top of the list.
There’s no silver bullet policy. The better question is, what’s the goal we are collectively trying to achieve and how do we make that the most important thing: city, community, schools? We’re going to navigate towards that goal and there’s accountability for are we achieving more equity or less and if it’s less then we have to change.
What can ordinary citizens do to help improve health in their communities?
Schrantz: I think what people can do is get engaged. There’s multiple vehicles for people to get engaged – that can be through your block club or through, like in St. Paul many people are engaged in local councils or church… We do need more and more people actively engaged and not just leaving it to the experts, or that the civic responsibility is just to vote…
We do need more vehicles through which people can be engaged. My experience organizing is that it is only when the regular person, with other regular people, get engaged that things really transform and change… People themselves by getting engaged—it’s transformative for them. We have hundreds of people who are deeply active in their church and ISAIAH and they stay in it because it’s rewarding…
You meet amazing people. You get to take all these risks that you didn’t even know you could do. Often people start with small things: write a letter, attend a meeting, go with someone to meet their senator… People build confidence and courage by taking small action steps
Schrantz’s concluding remarks:
What’s happened in the last five years is an incredible awareness built—increasing awareness, throughout a lot of levels, from decision makers, to advocates… I think what I feel hopeful about is people are starting to turn a corner in levels, state department to try some things – the transportation has made a lot of progress in hiring people in construction jobs and the numbers are improving; there’s a long way to go. It’s less about who’s to blame and it’s more we’re all responsible; we’re all part of the problem and so we all have to be part of the solution.