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Excerpted from: Susan R. Weisman, Ayah Helmy, Vayong Moua and Julie Ralston Aoki, Changing Hearts, Minds, and Structures: Advancing Equity and Health Equity in State Government Policies, Operations, and Practices in Minnesota and Other States , 44 Mitchell Hamline Law Review 1230 (2018) (323 Footnotes) (Full Document)


Susan WeismanThe population of Minnesota is rapidly becoming more racially, ethnically, and culturally diverse. People of color (those self-identifying as one or more races other than white and/or Latino) who made up 14 percent of the population in 2005 will increase to 25 percent by 2035, adding more than 500,000 people of color between now and 2035. “Census data from 2000-2014 indicates that the rate of growth among populations of color (74 percent) in Minnesota far outpaced that of the state's white population (2 percent).” Similar demographic changes are occurring throughout the nation. However, in Minnesota and other states, the structural components of how public and private entities operate day-to-day do not yet fully reflect and embrace the population's diversity with regard to race, ethnicity, culture, gender, gender identity, sexual orientation, individuals with disabilities, veterans, and others. Customary ways of doing business--hiring, retention, advancement practices, contracting and procurement, and civic engagement--have failed to keep pace with, and be responsive to, the needs of the state's diverse population.

Community representatives, philanthropic foundations, public policy and public health advocacy groups, policymakers, andAyahHelmy government officials have called for structural, comprehensive changes in governmental and private processes to reduce and eventually eradicate structural racism. Structural racism and inequities stand in the way of a truly representative democracy where all individuals can thrive and achieve their full potential. A growing body of evidence demonstrates the harmful effects of racism on health outcomes. This research examines the costs to individuals and society of failing to implement changes that can reduce disparities and eliminate inequities in access to government services and in health and well-being outcomes. State government leaders and policymakers have responded with a rising sense of urgency by introducing a mix of legislated and non-legislated structural approaches to eliminate disparities.

This article describes policy and programmatic approaches in four states, with a focus on a landmark equity policy recently adopted by the Minnesota Department of Human Services (DHS).

vayong mouaSection I provides an overview of recent pioneering state-level efforts to embed consideration of health equity and equity in government processes and decision-making.

Section II offers a detailed case study of the development and early steps toward implementation of the DHS Policy on Equity in Minnesota.

Section III describes policy and programmatic approaches taken in the states of California, Washington, and Vermont.

Lastly, in Section IV, we offer recommendations, drawing from our research, to inform future work and to stimulate discussion throughout the country.

. . .

Opportunities to advance equity and health equity, reduce health disparities, and eliminate inequities are abundant in all Julie Ralston Aokistates and at the federal level. The urgency of prioritizing this work cannot be understated. Structural changes that match the magnitude of the inequities they address are essential to eliminate those inequities and to ensure our nation's future productivity, health, and well-being. No matter how well or poorly resourced, all states can take steps to something, do more, do better. We appreciate this opportunity to elevate pioneering work underway and to encourage forums for sharing and expanding progress in the field.

Susan R. Weisman, J.D., Senior Staff Attorney, Public Health Law Center.

Ayah Helmy, J.D., Assistant County Attorney, Office of the Ramsey County Attorney (at the time this article was written, Ms. Helmy was a Staff Attorney at the Public Health Law Center).

Vayong Moua, M.P.A., Director, Health Equity Advocacy, Center for Prevention at Blue Cross and Blue Shield of Minnesota.

Julie Ralston Aoki, J.D., Director of Healthy Eating and Activing Living, Public Health Law Center.