A new story of health equity in Minnesota

Using a public work approach highlighted new facts about vital health conditions

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Jeanne Ayers, director of the Center for Public Health Education and Outreach of the University of Minnesota’s School of Public Health, studied community organizing, public work and the citizen professional concept at the Humphrey Institute for Public Affairs (now Humphrey School) and was energized by the idea that she could integrate her passion for racial and social justice, growing from her Catholic faith, with her public health career.

After helping to lead a healthy community initiative that connected the planning process for the light rail train between Minneapolis and St. Paul to other key considerations such as the need for local groceries, employment opportunities, schools, and affordable housing in low income and minority communities, she became Assistant Commissioner at the Minnesota Department of Health (MDH) in 2011.

At the Department, Ayers took the lead in creating a “Heathy Minnesota Partnership” that emphasized the “social determinants” of health beyond simply provision of health care. Social determinants included birth and early childhood conditions, education, transportation, work, housing, and a community’s sense of self-efficacy. In 2014, building on the partnership, her team involved more than one hundred MDH staff in developing a report on health in the state. Their planning process engaged more than one thousand civic and community leaders and health professionals across Minnesota. The story they developed highlighted problems of structural racism for the first time in state health discussions. What helped people to take it seriously was that the facts emerged from hands-on study conducted by diverse actors, not from an imposed 

framework. Distinguishing between structural racism and a narrower focus on individual bias and intentional racist acts, they involved health workers, the broader public and legislators in talking about health from different angles. This collaborative research – a good example of what we call “public work” – revealed gaps and inequities that had not previously been understood as causes of poor health. The project created a new story of health that had not been told before. Sometimes the process involved people recognizing how their own practices disadvantaged minorities. For instance, staff members of the environmental health unit in the MDH analyzed their radon testing program from the vantage of race. Ayers

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remembers that one said, “Oh my God, we’ve designed the whole radon program around home ownership. Seventy-five percent of white people in the state own their own homes, but only twenty-one percent of African Americans do. That’s structural racism!”

Jeanne Ayers had long been attentive to a multi-dimensional view of power, different than “power over." She understood power as the capacity for communities to act effectively, and believed this involved, crucially, the stories communities tell about their past, present and future. Through all her work at MDH, she constantly asked the question – almost never posed in government bureaucracies – how can this policy or approach provide resources to increase communities’ capacities to act on the challenges they identify? The process of developing a new story of health in Minnesota focused centrally on expanding communities’ own awareness of their power to take action.

The report to the legislature, Advancing Health Equity in Minnesota, was widely acclaimed as making a national contribution to health equity work in the nation. In Minnesota, it created the basis for major changes in policies on grantmaking and evaluation for American Indian tribes and minority communities  in local public health departments.