Minnesotans Underestimate Social Determinants’ Powerful Health Influence

EAGAN, MINN. (April 29, 2019) – Minnesotans are commonly portrayed as egalitarian, fair-minded people. Indeed, those values were partially reinforced by findings from a recent poll conducted by the Center for Prevention at Blue Cross and Blue Shield of Minnesota, in which 83 percent agreed that everyone deserves to live healthy, safe lives.

But while the vast majority supported the idea of health equity, far fewer acknowledged the everyday barriers that stand in the way of well-being for some Minnesotans. Almost half of the respondents did not identify critical items such as safe neighborhoods (42%), living wage (45%) or safe, affordable housing (45%) as positive influences on health.

The need to expand our Minnesota ‘nice’ to better respond to those that experience discrimination
Poll respondents did not see discrimination based on race/ethnicity and cultural alienation as strong negative influences on an individual’s health (42 percent and 41 percent, respectively). Discrimination based on sexuality or gender identity was even lower (38 percent and 36 percent, respectively). These results underestimate social determinants’ powerful health influence, particularly when it comes to discrimination. They also contradict reports of discrimination by members of the LGBTQ community, including recent survey findings by the Rainbow Health Initiative.

“Our positive outlook on the world can sometimes cloud the reality that poor health can come from discrimination,” said Dr. Craig Samitt, president and CEO of Blue Cross and Blue Shield of Minnesota. “But the fact is, discrimination and exposure to trauma are very real, and social inequities have great impacts on our state’s health disparities — from infant mortality to cancer and suicide rates.”

As an example, in Minnesota, African-American and American-Indian babies die in the first year of life at twice the rate of white babies, Samitt said. He added that increasing numbers of adverse childhood experiences — from physical abuse to witnessing violence — have strikingly direct correlations to higher rates of smoking, physical inactivity and unhealthy eating.

While the Minnesotans polled underestimated the health impacts of inequity, many did recognize the negative health effects of trauma: 62% perceived exposure to trauma or abuse as one of the top negative influences on individual health.

The “bootstrap” mentality still prevails
The survey elicited some of its strongest responses when Minnesotans were asked to identify the top positive influences on an individual’s health: 65% said that individuals have sole responsibility for their health — perhaps reflecting our state’s cultural heritage of self-determination.

But those attitudes contrast strongly with findings from the World Health Organization (WHO) and the Centers for Disease Control and Prevention, for example, which link a wide variety of social, economic and physical factors to significant impacts on individual and population health. A WHO special commission reported that global health inequities are “killing people on a grand scale.”

Health disparities stubbornly persist in Minnesota as well. Although the state continues to be touted as one of the healthiest in the nation overall, it is also home to some of the worst health inequities. According to the most recent Statewide Health Assessment, “If we are able-bodied, gender-conforming, Judeo-Christian, and of European descent, we likely enjoy advantages that help us to be healthy, [while others] face daily obstacles, particularly those of us who are of American Indian, African, Hispanic/Latino, and Asian descent, who have different religious beliefs and practices, sexual orientations or gender identities, or who are disabled.”

Coming to terms with health inequities – together
Only 28 percent of Minnesotans surveyed agreed that programs aimed at reducing discrimination would have a strong impact on improving the health of the community.

What solutions could help Minnesota eliminate health inequities? One in 3 Minnesotans believe that addressing the social determinants of health must be a combined effort across many parties — from individuals to the government. Over half (53 percent) see a role for health insurance providers. Dr. Samitt agrees.

“We’re strongly committed to bringing people, communities, and health systems together to improve health for every Minnesotan,” he said. “To make this a reality we are taking action across the state, informing Minnesotans about the widespread health impacts of inequity and rallying support for policies and funding that assure access to the resources, health care services, education and social supports needed to live a healthy life.”

Blue Cross and Blue Shield of Minnesota is dedicated to addressing social determinants of health (SDoH) at the community level. One example is the Blue Cross and Blue Shield of Minnesota Foundation’s recent five-year effort to increase access to insurance coverage across the state that profoundly impacted tens of thousands of Minnesotans and their families. Another is the Center for Prevention’s partnership with Minnesota Communities Caring for Children, to increase awareness in American Indian communities about the link between trauma and adverse health outcomes.

Blue Cross continues to integrate equity-centered best practices in its own business policies and practices and works to advance health equity — throughout Minnesota communities and within its commercially insured markets.

About the Poll
The public-opinion online poll was commissioned by the Center for Prevention at Blue Cross and Blue Shield of Minnesota and conducted by SMS Research Advisors on March 5 – 13, 2019.  It consisted of 500 Minnesota residents, ages 18 and over. Results were weighted a priori (through survey sampling) and ad hoc (applied weights) to be representative of state population for geography and ethnicity, with additional monitoring to ensure representation on gender, income and sexual orientation. All statistical tests were performed at a 5% risk level.

About the Center for Prevention
Funded through proceeds from Blue Cross’ historic lawsuit against the tobacco industry, The Center for Prevention at Blue Cross and Blue Shield of Minnesota (centerforpreventionmn.com) delivers on Blue Cross’ long-term commitment to make healthy choices possible for all Minnesotans. By tackling the leading causes of preventable disease—commercial tobacco use, physical inactivity and unhealthy eating—we advance health equity to transform communities and create a healthier state where Minnesota can achieve their full health potential.

About Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of Minnesota (bluecrossmn.com), with headquarters in the St. Paul suburb of Eagan, was chartered in 1933 as Minnesota’s first health plan and continues to carry out its charter mission today as a health company: to promote a wider, more economical and timely availability of health services for the people of Minnesota. Blue Cross is a not-for-profit, taxable organization. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, headquartered in Chicago.