DGH Live Blog: Keynote, Commissioner Dr. Edward Ehlinger – “The State of Disparities in Health in Minnesota”

Dr. Edward Ehlinger, the commissioner of the Department of Public Health in Minnesota addresses the DGH General Assembly.  

 

The line dividing good and evil cuts through everyone, the idea of the “Trinity Test”, which comes from language around the creation of the atomic bomb, is one of conflict within ourselves. We all have some degree of culpability in the problems that we face, and can be part of the solution.

 

Though Minnesota is one of the healthiest states by many metrics, we know that those statistics are worse for people of color and Native Americans. Overall infant mortality in Minnesota is lower than many other states in the region, however the disparities between whites and US born Black women, are among the greatest in the nation.

 

The population of the state is rapidly changing, there are many more people of color now than there were 30 years ago, including Somalian, Nigerian, Hmong, Mexican. If Minnesota has a large health disparities and an increasingly diverse population, there is a large social justice problem.

 

Though Dr. Ehlinger has been working hard to improve rates of infant mortality and improve disparities in the state, black infant mortality in 2011 (11.4%) had still not reached the level of white infant mortality in 1980 (10.8%). In the late 70s, health disparities started to increase and has gone up since. When these disparities started to increase, our overall health ranking among other countries in the world started to decrease. Disparities therefore had a profound impact on our overall health.

 

We need to change how we do our work. We need to re-define the unacceptable. We can’t tolerate disparities in infant mortality. We can’t tolerate disparities in incarceration rates of black v. white males.

 

Liberation medicine is about humility and equality. We have to be humble that we don’t know everything. Working within the context of community, there is a strong moral bond and collective responsibility. The philosophy behind public health is social justice. No one should benefit at the expense of someone else. We need to change our our approach to the triple aim, and call it the triple aim of health equity: Implement health in all policies, strengthen community capacity, and expand the understanding of health. We need to strengthen the capacity of communities to create their own healthy future.

We need to expand our understanding of what creates health. Clinical care is only about 10% of what predicts good health. Behavior is 30%. Societal and economic factors are 60%! Sometimes the healthy choice is not possible. So what really affects people are the systematic policies that define the socio-economic factors of a community. It is about the conditions in which people live. Therefore, the biggest public health interventions are increasing minimum wage, providing universal paid maternity leave. Liberation Medicine and Public Health are partners in advancing health equity.

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