The killing of George Floyd on May 25, 2020 sparked weeks of ongoing protests against police brutality, bringing racial justice to the national forefront and inspiring companies, universities and local governments to take action. On June 29, 2020, the Hennepin County Board of Commissioners passed a resolution that declared racism a public health crisis.
Racism is a pervasive, insidious force in U.S. healthcare systems. For starters, African-Americans have never had access to safe, affordable health care in the United States. Before the late 1800s, most communities were tended by a town doctor; if a slave owner/human trafficker was unwilling to pay for a slave's care, they would not receive medical treatment. During the Jim Crow era, white and Black patients and practitioners were separated into different facilities. Today, access is largely determined by health insurance, which can mandate where a patient can go, how many visits they can have and how much it costs them. If someone is uninsured, healthcare expenses often result in bankruptcy. 
Access to health care forms the bedrock of equity in the medical industry - and that bedrock is layered with racism. Public health strives for equity by relying on a form of metrics called "social determinants of health" comprised of the environmental conditions in which people are born, live, learn, work, play, worship and age. "These conditions directly affect a wide range of health, functioning, and quality-of-life outcomes and risks," according to the Minnesota Department of Health. Ultimately, society attains health equity if all citizens have access to the same positive outcomes in the conditional environments of their daily lives. Unfortunately, the U.S. faces a long road to achieving genuine health equity.
A lack of entry to the healthcare field also creates a snowball effect of negative outcomes in medicine. For instance, if you only research symptoms or diseases in white bodies, students may not learn how to recognize symptoms or diseases experienced by BIPOC bodies (Big Think). Most often, a greater diversity of representation among medical practitioners proves to be the catalyst for expanding research and new medical practice among non-dominant populations.
According to the Association of American Medical Colleges, only 5% of licensed, practicing doctors identify as Black or African-American as of 2018, whereas 56.2% identify as white/Caucasian.
Similarly, a 2017 study revealed that only 6.2% of registered nurses identify as Black or African-American compared to the whopping 80.8% of nurses who identify as white/Caucasian. Today, almost 60 years after the Civil Rights Movement started, Black Americans still barely see themselves reflected in health care.
Naming racism as a public health crisis is an important first step so that communities can strategically respond, but there are also lesser-known grievances that negatively impact the way that Black and African-American patients experience health care. In particular, most patients who identify as Black, Indigenous or People of Color see their care significantly impacted by the implicit biases of doctors, nurses, receptionists and other medical personnel. Implicit bias is complicated because it is couched in unconscious behaviors, such as reacting favorably or unfavorably to embedded cultural stereotypes and assumptions about a group of people. A 2015 study by the Kirwan Institute for the Study of Race and Ethnicity helpfully identified some of the key characteristics of implicit biases:
Implicit biases are pervasive. Everyone possesses them, even people with avowed commitments to impartiality such as judges.The implicit associations we hold do not necessarily align with our declared beliefs or even reflect stances we would explicitly endorse.Implicit biases are malleable. Our brains are incredibly complex, and the implicit associations that we have formed can be gradually unlearned through a variety of de-biasing techniques.As a direct result of discrimination and implicit bias, people of color in the United States face disparities in access to health care, the quality of care received, and health outcomes. "The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities," write University of North Carolina, Chapel Hill researchers. For now, researchers know three things:
Racial discrimination is known to yield poorer health outcomes for Black patients.Implicit bias influences why institutional racism persists in health care.Federal and state funding allocations will determine how and if Black patients' experiences improve.Naming racism is an important first step. A public health crisis begets funding to fix the problem and to address a lack of access, lack of representation and personnel's implicit biases. Where will financial support come from for these efforts? Will government agencies, hospitals or insurance companies pay for public health programs aimed at ending racist practices?
The answers remain murky. But one thing is clear: The world is ready for healthcare practices that build equity, create space for compassion and empathy across difference, and ensure that all who need medical treatment feel seen and heard.
Twin Cities PBS is here for you at every stage of learning. Read on to learn how Black Americans are navigating and challenging systematic racism in health care. This month's resources are brought to you by artists, educators, researchers, and illustrators. 

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Building Health Equity: Appetite for Change
“I had lost my sixteen-year-old son the previous year to gun violence… I was pulled to do something in the garden related to food, hearing that the universe would do healing for me there.”
Watch time: 6 minutes
Queer Women of Color Ask Who Cares and Who Gets Care?
Whether doctors use abusive language, refuse to acknowledge a patient’s chosen pronouns on medical intake forms or ignore the specific needs of LGBTQ+ patients, normative gender/sexual orientations still abound in the healthcare industry, leaving many with a difficult question: Should I even go to the doctor?
Watch time: 9 minutes
Inequity Is A Matter of Life and Death
Not being white in Minnesota is literally hazardous to your health. Startling gaps in outcomes by race and gender prove that a healthcare system designed by and for one culture isn't working well for others. Public-health experts dive in to understand why, and work with communities to change outcomes and create new possibilities for the future.
Watch time: 6 minutes
How Race Shapes Our Scientists And Our Science
Now a cognitive neuroscientist, Jonathan Jackson has achieved his dream of studying the disease for a living. But he said being a Black scientist has also pushed him down paths he wasn't expecting...“There is some currency in my Black skin for everyone but me," he says.
Read time: 10 minutes
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COLOR & REFLECT
 
Coloring offers space to reduce anxiety, create focus and bring about more mindfulness. Take time to reflect on what you learned. What surprised you? How do you feel? What questions do you have?
Click here to download this month's coloring page featuring Dr. Rebecca Lee Crumpler. 
 
This educational resource is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.


How Do We Know If Health Care Is Racist?

Diana Fraser

Minnesota consistently ranks as one of the healthiest states in the nation, often taking the top spot. And as the home to the world's first Mayo Clinic, Minnesota is known worldwide for its innovative solutions in health care. However, as the conversation around racial disparities and social inequities has risen to the forefront, research shows that Minnesota's portrayal as the home to healthy residents only paints half the picture. 
Census data shows that Minnesota's population is more than 80% white and just 7% Black. Despite this vast difference in population size, Minnesota's Black community is overrepresented in chronic health issues when compared to their white counterparts. 
Black men in Minnesota have a higher mortality rate from cardiovascular disease than white men. Black women die of breast cancer at a 24% higher rate than white women, although their incidence rates - how frequent a disease occurs in a population - are 22% lower. The difference in health outcomes between white Minnesotans and Minnesotans of color is so pervasive that it can be pinned down to a zip code. 
And the COVID-19 pandemic has exposed more healthcare inequities. According to state data, Black and Hispanic Minnesotans are testing positive at higher rates than the overall population. When adjusted for age, Black and Asian residents have the highest COVID death rates. 
These racial disparities in health are not unique to Minnesota, and are indicative of a systemic issue that is plaguing the nation.
To address these inequities, universities and healthcare institutions have begun to redefine their roles in training and educating healthcare professionals.  
One such institution is the University of Minnesota's medical school — the leading producer of physicians in the state which manages several hospitals and clinics across Minnesota. 
University students and faculty at several medical schools have called on their administrations to create programs that address racial inequities that have caused disparities in health, pointing to inequality in care, racial bias among physicians and the lack of representation found in their study material. 
Making a Change in How Race is Addressed in the Classroom
Constructing a racially and culturally inclusive curriculum has become a focal point for medical schools across the country as the classroom serves as the introduction to medicine for students. What students learn in their first few courses in medical school may influence their practice for years. 
To change their approach to educating future physicians, the University of Minnesota Medical School recruited Dr. Ana Núñez to head their inaugural office of Diversity, Equity, and Inclusion (DEI). Dr. Núñez serves as a Vice Dean in the medical school and was brought on after last summer's civil unrest sparked by the Minneapolis police murder of George Floyd. 
"One of the things that actually impressed me about coming here in the first place was how many had actually started doing the work," Dr. Núñez said.  
The medical school's curriculum has been a focal point in making institutional changes. Knowing this, administrators have brought medical students in on the process to give their input as they work to reconstruct their education. 
"As we talk about curriculum, what really matters is: What are the student's experiences when they come to us," Dr. Núñez said.  
"Because that's how you get it right in terms of that engagement piece, because people sitting in a little conference saying, 'This is how we're going to change stuff,' without the voice of the lived folks just never get it right." 
Medical students like Sally Jeon and Tegan Carr have worked to fix the medical school's approach to education. Both have served as their class DEI officers and are a part of the UMN Medical Education Reform Student Coalition (MERSC) that formed as a response to the police murder of George Floyd.  
"That was the straw that broke the camel's back," Carr said. 
Carr helped lead the Task Force for Change, a student group on the medical school's Duluth campus aimed at reforming the medical school's approach to racial inequity, which later coordinated with student groups like White Coats for Black Lives in the Twin Cities. This cooperation would create the MERSC.  
Members of this coalition met with the medical school's administration, faculty and staff after sending a letter that listed what changes they'd like to see in response to the nation's racial awakening. Those changes include emphasizing an equity-based curriculum, establishing plans for faculty development in health equity instruction, removing race as a biological indicator in medicine, diversifying their standard patients and strengthening ties with communities of color. 
You can read the full list of demands here. 
Though medical students want to be a part of this change, their studies and time reserved for clinical work off campus limits how much they can do.
"For me as a first-year coming in, I had a sense that maintaining sort of the momentum of this could be a challenge," UMN medical student Sally Jeon said. "While it is absolutely crucial to have student voices centered through this experience, students cannot do this alone."  
That's where school faculty comes in. 
Both Jeon and Carr have commended Dr. Núñez and Dr. Mary Owen, director of the Center of American Indian and Minority Health, for doing the work from within the institution that goes beyond school hours. Much of DEI's work in health care or other industries has been seen as a sort of caveat or add-on to the work, but Dr. Núñez believes that it should be integral to how medicine is taught going forward.
"In the course of the year that I've been here, we've sort of built infrastructure," Dr. Núñez said. 
All the school's medical departments now have committees and key individuals in DEI roles. Specialists like pediatricians and anesthesiologists must now have some understanding of equity in their practice.  
Medical school faculty have also received racial bias and microaggression training to recognize how prejudice can appear in their practice.  
"There is no area that is exempt from health disparities," Dr. Núñez said. "Not a one." 
Most Patients That Medical Students Serve Are White
To gain an accurate perspective on how they will practice medicine in the future, medical students have asked for more diversity in their material and the patients they encounter while in school. Areas of medicine like dermatology rarely include how skin diseases will show up on people who are not white, for example. 
"Students have voiced: How are we supposed to relate to each other and diverse patients if every standardized patient that we see, or community teacher that we interact with, is a white person?" Carr said. "We were only seeing white skin. In our lectures and pathology books. I mean I probably couldn't diagnose Lyme disease on my own skin." 
If there was representation or mention of other races, it often came with misinformation which saw race as a biological factor. 
"We know that race is a social construct. It is not a biological construct, and a lot of medicine was built in a faulty way — we also know that we can't just eliminate it," Dr. Núñez said. "Because people's lives are different based on who they are, where they live and their access to health."
Black individuals suffer kidney failure at three times the rate of white individuals and represent a third of patients in the U.S. receiving dialysis. For decades, physicians approached illnesses and diseases relating to kidney function with the racist notion that Black individuals have more muscle mass than other races. Muscle mass is relevant because it breaks down into nitrogen that taxes the kidneys, but medical institutions had internalized this racist trope from slavery and incorporated it into their care. The National Kidney Foundation recently announced the removal of race from estimating kidney function. 
Since being diagnosed with a chronic illness relating to her kidneys, Carr has experienced the dismissive attitude that harms other patients of color seeking treatment. She said that questions about her race were brought up at the start of many of her doctor's visits.  
While change is essential within educational institutions, it's also important to incorporate more racially conscious approaches to public health policy. 
Dr. Rachel Hardeman is the director of the Center for Antiracism Research for Health Equity at the University of Minnesota and was named the first Blue Cross Endowed Professor of Health and Racial Equity at the university's School of Public Health. Dr. Hardeman's work aims to collaborate with colleagues across the university on developing curricula, fostering community engagement and developing policy work. Though Dr. Hardeman's conversations with Blue Cross and Blue Shield began before Floyd's murder, she believes there is even more reason to commit to this work now. 
"My research, broadly speaking, focuses on the impact of racism on health outcomes and healthcare delivery for Black populations, but specifically for Black moms and babies," Dr. Hardeman said. "Minnesota is often ranked as the healthiest state in the nation, but when you start to pull back the layers and understand a little bit more about what's going on here, we actually start to fall towards the bottom of the list when we look at health outcomes by race."
Seeing those disparities in health outcomes firsthand when her grandmother's health deteriorated, Dr. Hardeman decided to pursue a career in health to help close that disparity and to provide everyone with high-quality care.
Black maternal and infant mortality rates are some of the most significant examples of health disparities between Black and white individuals.  
"What we know when it comes to public health is that infant mortality is a critical marker for community health and wellbeing," Hardeman said. "Black women are four times more likely to experience maternal mortality (meaning death during pregnancy, childbirth, or year following childbirth) in comparison to their white counterparts despite their socioeconomic status." 
And the U.S., Dr. Hardeman stated, is the only industrialized nation that has a rising maternal mortality rate. 
"Even when you adjust for education and income level, you're still seeing these disparities," Dr. Foster said. "A lot of time when you talk about solutions, they want to point to social determinants of health and resources are crucial in achieving health equity." 
The history of malpractice and mistreatment of Black women is rife in medical history. One offender was the "Father of Modern Gynecology," James Marion Sims, who experimented on many female slaves without anesthesia. For some people, the treatment of Black women in that era parallel how they are treated today. 
"While folks can say, 'That's in our past, that's our history.' We haven't actually sat down and reconciled with that history and really struggled with what that means on how implicit bias and racism show up in current clinical encounters," Dr. Hardeman said. 
Dr. Foster said that other issues within health care appear when looking at the cross-section of race and gender. 
"Black women were typically offered hysterectomy as the only option or it was presented as the best option," Dr. Foster explained.  "I know many women who had their uteruses removed in their 30s or 20s because of a few benign tumors. 
Dr. Hardeman recently received an appropriation from the state to develop an antiracism training curriculum for perinatal care providers in Minnesota. This preventative care is provided in the form of checkups, nutrition assistance, and monitoring any biological changes. The Dignity in Pregnancy and Childbirth Act aims to reduce these racial disparities impacting Black mothers and babies and has allocated nearly $300,000 to the Center for Antiracism Research and Health Equity.  
States across the country have begun to implement similar changes which focus on creating implicit bias and antiracism training while expanding in areas such as midwifery. 



What Medical Schools Can Do to Fix Systemic Issues in Health Care

Abdi Mohamed

Between a global pandemic and police violence against people of color, 2020 underscored long-standing issues of racism as a public health crisis in America. Photo by Obi Onyeader via Unsplash.Have you ever had a cut in the most inconvenient place? One of those places that you continually bump and re-aggravate? That is the current backdrop of the United States, a festering set of wounds that are in the most used places of the collective body. There is a shared yearning for healing to mend the wounds that keep reopening. But healing does not mean there are no scars. It means altered tissue is rejoined into a new landscape. Moving toward a new future requires letting go of the pre-2020, because we can do better than before. 
The events of 2020 opened many people’s eyes to deep and rooted inequities that are an undercurrent in this country and the world. 
In the context of Minnesota the issue is magnified due to the Minnesota Paradox: the phenomenon that Minnesota ranks as one of the best places to live in the nation, but only if you are white. If you are Black, Native American or a person of color, it ranks as one of the worst. Information like this flies around like hot summer mosquitos: pesky reminders that won’t catch a hint. 
This is an oppressive environment that strips communities of their power and aggressions, both big and small, one that belittles and hurts. A new future requires naming the infections of oppression that fester in the wounds. 
Words like “public health” and “racism” have been launched into the realm of dinnertime conversation topics. In the last year, I have been asked for a definition of public health, whether or not something is racist, or what racism and public health have to do with each other. Although public health is a relatively young field, it is very much in a relationship with social inequities. 
Public health focuses on the prevention of negative health outcomes. Current systems have created an inequitable world where differences in the ability to access services and the way people are treated directly contribute to disease and unequal outcomes. 2020 was the year racism was declared a public-health crisis. It was a call for mobilization and movement toward a new future. 
A new future requires reattaching the severed pieces into a unified system. It requires harnessing the collective power. Minneapolis and Saint Paul make up the Twin Cities. They have their unique characteristics, but the major dividing line between these two locations is the mighty Mississippi River. Minneapolis is part of Hennepin County and Saint Paul is situated in Ramsey County, and all of that is a portion of Minnesota. So what does this all mean? It means there are five different systems to navigate: Minneapolis, Saint Paul, Hennepin County, Ramsey County and the State of Minnesota, all holding unique pockets of services and information, without working as a cohesive unit of support. 
The uncooperative, disjointed nature of these five different systems have been felt in the response to the pandemic; we have five different agencies that cover the same stolen land, that are fractured and that do not work together for the betterment of its citizens. This is not unique to the Twin Cities or the COVID-19 pandemic. It is echoed across the nation.
The reverberating impact of a severed system creates barriers. In the landscape of COVID-19, it looks like barriers to equitable care, testing and vaccines. The barriers to services have tangible outcomes. Currently in Minnesota, Latinx people are testing positive for COVID at three-times the rate of their white counterparts, and Black Minnesotans are testing positive at two-times the rate of white Minnesotans. A new future requires barriers to be lowered and responses to be accessible to the most vulnerable communities. 
The declaration of racism as a public health crisis is an opportunity. An opportunity to accept that there isn’t a before to go back to, to name the deep infection sickening us all, reattach systems into a cohesive unit and eliminate barriers. The motto of Minnesota is “L'Étoile du Nord” - the Star of the North. As a state with such different lived experiences and health outcomes, this is the chance to be a leader, a lodestar guiding the ship toward a more just future.
A post 2020 future requires us to dig deep, to that point between our belly button and tailbone - to the place that gets uncomfortable when we think about how much we must change to make the world better. This will not be our last crisis, and a new future deserves a reevaluation and reinvestment in how we will respond to that call for change. 
We need to blur the focus and allow the new future to come into view. What does it smell like, look like, taste like, feel like? Who is fed, who is safe? 
We must scratch that spot and aggravate it, get uncomfortable and work backwards toward the present. We must work toward eliminating the barriers that exist - not just throwing another bandaid on the problem because the wound will still bleed.
Hadija Steen Mills [they|she] was born and raised on Dakota land commonly known as Minneapolis. They received a Bachelor’s in Science from the University of Minnesota in sexual health with a focus on reproductive justice and health disparities. She has always been passionate about the creation of a world free of inequities and advocates for autonomy for the most systematically oppressed populations. Hadija’s work stems from a Healthcare Reparations ideology that pushes for unifying, creative and anti-oppressive approaches to a new world where Community Care elicits health. 
This story is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.
On January 28, 2021, the Twin Cities PBS digital storytelling project Racism Unveiled hosted a live Zoom panel titled “Flight, Fight and Flow: Self Healing” aimed at examining the ways in which Black Minnesotans are affected by trauma, and how we can begin or continue our healing journey. Packed with insight and guidance, discover the six key takeaways illuminated by the event.
Black people and people of color in America have been subjected to centuries of medical experimentation and abuse, a history that has spurred mistrust of the healthcare industry for generations. Discover how some Black doctors are addressing the legitimate concerns of their patients of color who are deeply skeptical of the COVID-19 vaccines. 
Whether doctors use abusive language, refuse to acknowledge a patient’s chosen pronouns on medical intake forms or ignore the specific needs of LGBTQ+ patients, normative gender/sexual orientations still abound in the healthcare industry, leaving many with a difficult question: Should I even go to the doctor? Four queer women of color, including Hadija Steen Mills, discuss barriers to LGBTQ+ women’s health care and share affirming ways to combat systems of oppressions through health education.


Responding to Disparities: A Look at a Post-2020 United States

Hadija Steen Mills

Racism is not reserved to bad run-ins with police.
Since long before the word was said in 1902, racism has persisted in access to health care, poverty and in opportunities for Americans of color. These barriers to opportunity have created gaps between races that still exist today, but a growing tide of data has revealed where these disparities exist and what solutions can begin to solve them.
Allison Liuzzi, a Research Manager at the nonprofit Wilder Foundation, spoke about how such data is exposing racial disparities and why it is important for society to progress.
This story is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.
"The events of 2020 opened many people’s eyes to deep and rooted inequities that are an undercurrent in this country and the world. In the context of Minnesota the issue is magnified due to the Minnesota Paradox: the phenomenon that Minnesota ranks as one of the best places to live in the nation, but only if you are white. If you are Black, Native American or a person of color, it ranks as one of the worst. Information like this flies around like hot summer mosquitos: pesky reminders that won’t catch a hint." Writer and public-health educator Hadija Steen Mills looks at how we can collectively do better in a post-2020 world.
On January 28, 2021, the Twin Cities PBS digital storytelling project Racism Unveiled hosted a live Zoom panel titled “Flight, Fight and Flow: Self Healing” aimed at examining the ways in which Black Minnesotans are affected by trauma, and how we can begin or continue our healing journey. Packed with insight and guidance, discover the six key takeaways illuminated by the event.
Black people and people of color in America have been subjected to centuries of medical experimentation and abuse, a history that has spurred mistrust of the healthcare industry for generations. Discover how some Black doctors are addressing the legitimate concerns of their patients of color who are deeply skeptical of the COVID-19 vaccines. 


How Do We Measure Racial Disparities?

Kyeland Jackson

For just about everyone living in the United States, healthcare costs can skyrocket, even for seemingly routine procedures.
The costs of visits, prescription medications and healthcare premiums – for those who are insured – have all steadily risen for decades. According to data from the Kaiser Family Foundation, health spending on a per capita basis has increased over 31-fold in the last four decades, with health spending growth outpacing the growth of the nation’s economy.
And while the number of insured Americans has grown since the Affordable Care Act (the ACA) passed in 2010, insurance coverage alone cannot always prevent medical debt for low- and moderate-income families. In a 2016 report on medical debt, an estimated 26% of U.S. adults said they or someone in their household had difficulty paying a medical bill within the past 12 months.
“First and foremost, we have a healthcare system in the United States that is based on capitalism, productivity and profit,” said Family Tree Clinic Executive Director Alissa Light. “And there’s amazing people within that healthcare system who really care about the health and wellbeing of people, but the healthcare system isn’t set up to be working toward health and wellness; it’s disease-oriented and it’s profit-driven.”
While Minnesota has a long history of high-quality health care – at least for those who can afford it – access to basic and preventative services and health outcomes can vary widely based on one factor: identity.
A community organization in Saint Paul, Family Tree Clinic reaches an estimated 22,000 people a year through its sex education programming and clinical services. Their patients come from all over the Upper Midwest and even, at times, from Canada, largely because of Family Tree’s gender-affirming hormone clinic and focus on LGBTQI+ health care.
“Because there are so many barriers to insurance,” said Light, “to getting care that honors, respects or even sees your identity in any sort of way – and just the economic realities that health care is really, really expensive and usually pretty inadequate… When we launched our LGBTQ health initiative in 2010, we just learned very quickly that the need was really, really, really profound because of all of those things.”
Bias in the System
Christy Hall is a litigator with Gender Justice whose work often intersects with health care. Hall uses the law and policy to combat discrimination, including for LGBTQ Minnesotans. While Hall cites access to health insurance as a major barrier, she acknowledges the bias of providers as another major challenge her clients face.
“For example, we had a client who was trans and who was seeking access to in-patient mental health treatment,” said Hall, “and because [the provider] was trying to figure out if they belonged on the men’s floor or the women’s floor - they haven’t figured out that piece of it - so she just didn’t get access to health care.”
Amelia Schlossberg, a healthcare advocate working in Vermont, uses a patient advocacy approach to help people get coverage they need, finding gaps in coverage around things like gender-affirming care and gender-affirming surgery. Schlossberg considers their work in getting Vermont’s Medicaid program to update their gender-affirming care coverage a major victory. For Schlossberg, though, options based on income remain a significant source of frustration.
“Generally, your access to health care depends on who is paying for your health care,” says Schlossberg. “And if your income goes up, or if it goes down, you have limited options. Sometimes even just having $10 more per year can really limit your options.”
In Minnesota, for example, low-income adults may qualify for either Medical Assistance (Minnesota’s Medicaid Program) or MinnesotaCare. While both programs have income guidelines for participants, choices may vary significantly between them; as Schlossberg notes, choice can have major implications for patients’ health outcomes.
“Oftentimes, if you have more income, you have more choice,” said Schlossberg. “And something that’s been really important for the people that I’ve worked with is being able to find a doctor or a provider that really works well with you…  And the difference in the doctor that you’re just kind of putting up and they’re just putting up with you, versus a doctor that you really click with and that really is your advocate as well as your medical provider, that can make a difference between okay medical care… and someone really pushing to help you get the diagnosis, or get the medication or help you navigate that system.”
“Multiply or Deepen"
The 2020 COVID-19 pandemic has brought to light many of the challenges of our national healthcare system, including some of the vast inequities that exist for people of color. As the U.S. reckons with myriad racial injustices, those in health care can have particularly dire effects.
“There’s still a dynamic among LGBT folks that means that health problems will often multiply or deepen if the individual is a person of color,” said Phil Duran, the Director of Policy and Research at JustUs Health. “And so we’re really supportive of the fact that Hennepin County and others have been moving to call racism a public health issue, and that’s a conversation that we continue to need to engage in. Because you can take some of these specific conditions off the table, but that one is still going to be there.”
Alissa Light of Family Tree Clinic agrees.
“It’s interconnected and inexorably linked,” said Light, “so that the more identities you hold that fall outside that really narrow focus that the healthcare system is designed for – which is really white, cis[gender], assumed heterosexual men, usually – not only are you less and less seen, represented, believed and treated with dignity, but also because of compounding factors of deep structural and systematic racism [that are] rampant throughout every system in the United States and oppression based on other identity, including queerness, trans-ness, non-binary, the factors are compounded.”
Duran sees the need to dig far deeper into health disparities throughout the COVID-19 crisis and beyond, noting that as LGBTQ+ Minnesotans age, they face yet additional challenges, including isolation.
“Among LGBT older adults,” said Duran, “you see a disproportionate number of people who don’t have spouses or partners at that stage of their life. They don’t often have children or grandchildren who are there. Many older adults will turn to a faith community… and there has been historic tension between many faith traditions and the LGBT community, so people don’t have access to that. And so isolation is a real concern.”
Moving Forward with Hope
Alissa Light, Christy Hall, Amelia Schlossberg and Phil Duran all support the idea of some version of universal health care. They share the hope that, someday, all Minnesotans will be covered no matter how much money they make or how they identify. Even as access to insurance and high-quality, gender-affirming care continues to pose challenges for LGBTQ+ Minnesotans, they see opportunity to move forward in new and innovative ways. And they all feel hopeful about the healthcare conversations they are having locally and hearing nationally.
“I always have to be hopeful,” said Light, laughing. “I feel like there is no option, although I feel hopeless many minutes and hours of many days… It’s like we’re going to do everything we can to not go back and to really design the world we want to live in. And that’s what it’s going to take. And I do feel hopeful that we can keep building towards that.”
Writer Lindsay King-Miller shares her journey to parenthood with her trans husband and asks the question, "Why is the road to parenthood full or perils for LGBTQ+ folks?"
Whether doctors use abusive language, refuse to acknowledge a patient’s chosen pronouns on medical intake forms or ignore the specific needs of LGBTQ+ patients, normative gender/sexual orientations still abound in the healthcare industry, leaving many with a difficult question: Should I even go to the doctor? Four queer women of color discuss barriers to LGBTQ+ women’s health care and share affirming ways to combat systems of oppressions through health education.
Queer women are not statistically “safe” when seeking health care, but there are medical spaces that have been crafted so that they can be treated with the same dignity as any other patient. The documentary film Patient No More explores the barriers LGBTQ+ women navigate across healthcare systems, and how the never-ending hunt for affirming care affects their lives.


Why Is It So Tough for LGBTQ+ Folks to Get the Care They Need?

Alauna Yust

A COVID-19 vaccine pop-up clinic at Morning Star Baptist Church in Boston | Credit: Boston Medical CenterThis article was originally published on NextAvenue.org.
Parents, siblings, grandparents and children: They are among more than 600,000 Americans killed by COVID-19 since it was first detected in the U.S. nearly two years ago. The coronavirus has been particularly devastating for people 65 and older. They represent a sixth of the population, but are among those hardest hit by the virus and its complications.
New data from the Centers for Disease Control and Prevention (CDC) show that the virus hits older Black, Indigenous and people of color (BIPOC) even harder. The CDC was able to collect race and ethnicity data on 83% of all COVID-related deaths, as of August 25, 2021. Of that, 1 in 4 were 65 and older BIPOC, according to a Next Avenue analysis of the data.
There are many reasons why. In Illinois, for example, some Black and brown Medicaid customers lived in understaffed nursing homes or in nursing homes with four other people in their rooms. This led to an increase in mortality compared to white Medicaid customers.
Others have been affected by structural racism, which can contribute to "poorer health outcomes for racial and ethnic minorities and other populations who experience health disparities," according to the National Institutes of Health
But experts and healthcare officials say one of the biggest reasons is the wealth and income gap. Generations of racist policies have stoked inequality in the BIPOC community and many in it cannot catch up to their white counterparts. The pandemic has intensified these challenges. And for many, overcoming those gaps is now a matter of life or death.
The Cost of Racism
More than 100 years before the U.S. was founded, African people were enslaved, brought to North America and used for labor. Harvard Kennedy School professor Khalil Muhammad has traced the roots of racial disparity to that colonization period, explaining that European settlers took Indigenous peoples' land and prevented Africans from participating in the economy. When African Americans were freed from slavery, new obstacles shackled them.
Jim Crow laws limited the education, jobs and housing opportunities that the BIPOC community could choose from. Many who opposed those rules would face fines, jail time or violence. The 1965, the Voting Rights Act marked an end to most Jim Crow laws, but racism lives on, taking many different forms.
Explore how racial covenants in Minneapolis continue to have an impact on access to affordable housing today in the documentary Jim Crow of the North.
Black students are disciplined at more than twice the rate of white students. Black college students are the most likely to struggle financially from student loan debt. Applicants with "distinctively Black names" receive fewer callbacks for a job interview. And Black people are denied home loans at more than twice the average rate.
Preparing COVID-19 vaccines at the Morning Star Baptist Church pop-up clinic | Credit: Boston Medical CenterWhen It Comes to Wealth, Little Has Changed
A report by the Federal Reserve Bank of Minneapolis found that racial wealth gaps have persisted for 70 years, and white families' wealth now averages at more than $118,000. Black families' average is $13,947.
"This country has racialized poverty," said Denny Chan, directing attorney for the nonprofit Justice in Aging - a nonprofit advocacy organization fighting poverty among aging adults.  "[Class and race] aren't proxies for each other, but they also are so deeply intertwined that you can't talk about one without talking about the other."
According to a May 2021 report by the federal Administration on Aging, Black people who are 65 and older now hold the highest rates of poverty among their peers.
Less generational wealth means fewer dollars to save for retirement or for the costs of prescription drugs and other healthcare-related needs throughout life. These disparities in health and health care even extend to dementia care and the ability to get a diagnosis, for example.
In March, the Alzheimer's Association released a report detailing how those disparities played out. It found that older Black and Hispanic people are more likely to have Alzheimer's disease or another dementia, and compared to older white people, were more likely to have a missed diagnosis. The survey also found that roughly 50% of Black people who were surveyed have experienced healthcare discrimination; two in five unpaid caregivers said that race made it harder to get excellent care.
"The decades of racism and discrimination and intergenerational poverty — it builds up on one another so that the disparities are particularly massive among Black or Latinx older adults, and other older adults of color, compared to white older adults," Justice In Aging Staff Attorney Gelila Selassie said. "It really baffles me because this is a generation that fought for civil rights, that lived through Jim Crow, that saw all these racist policies of the sixties, seventies and beyond. So for this to be how they advance in age, how the end of their life is, is really heartbreaking."
At-home care could improve aging adults' health, but Selassie said that many members of the BIPOC community cannot afford it. A national survey by Genworth supports Selassie, finding that yearly rates for at-home care can cost more than $54,900.
Nursing homes can be safety nets for families who qualify for Medicaid. But as we saw during the pandemic, these types of settings may exacerbate decades of inequality. And without enough savings or long-term care insurance, being able to afford a private room in an assisted living community or other long-term care setting may be out of reach.
An Improved System That Needs Reform
Wendy Cappelletto believes that the healthcare industry needs to change.
Cappelletto is a member of the National Association of Elder Law Attorneys and works for the Office of the Public Guardian of Cook County in Illinois. She said racial disparities can be found in the quality of care that nursing homes offer, and even in where the facilities are located.
"[Nursing homes] don't pay well. [There are] transportation issues to get to that place. If people don't have cars, you're not going to want to take a bus in the middle of the night," Cappelletto said. "The pandemic really brought it to the forefront, but there's been disparities before this. They just weren't as obvious."
And volumes of research show those disparities in long-term care settings have gone on for years.
A Workforce Made Up of Women and People of Color
A report by PHI, an organization working to create quality jobs for the direct care workforce, found that direct care workers' median hourly wage in 2020 is $12.80. That has barely increased in the past decade. Another report by PHI found 48% of all direct care workers are women of color and one out of five live in poverty. This workforce is also more likely to rely on public benefits.
The report concluded by saying, "Unfortunately, direct care jobs do not provide economic stability to women of color and their families."
Ironically, PHI projects that the long-term care sector will need to fill 6.9 million jobs in the next decade.
But as Cappelletto said, healthcare disparities were a concern even before the pandemic. A 2005 report cited by the American Bar Association found that BIPOC patients were less likely than white patients to get "appropriate cardiac care, to receive kidney dialysis or transplants." It also found they were less likely to receive the "best treatments" for conditions like stroke or cancer.
Those kinds of barriers and health inequities have led us to where we are today. And the pandemic has exposed all of it for the world to see. But change is starting to happen — at the local level.
Investing In Future Generations, Now
Earlier this year, Boston Medical Center's Dr. Sabrina Assoumou reviewed her hospital's COVID-19 vaccination rates. She nearly jumped for joy.
Assoumou had worked closely with the medical center to reach more people in Massachusetts, where research shows that five communities with the highest COVID-19 infection rates in the state are home to a majority of BIPOC residents.
Assoumou said that many Black Americans are hesitant to trust healthcare providers. Some may recall stories of the Tuskegee Experiment, in which Black men were knowingly infected with syphilis by the U.S. government.
Although penicillin was available at the time, participants were not offered that treatment. As a result of living with untreated syphilis, many lost their vision, experienced neurological damage or died. With that history in mind, Assoumou knew she would have to take a different approach.
Assoumou made televised appeals, acting as a trusted voice who assured people the vaccine is safe and effective. Then, the Boston Medical Center decided to bring the vaccine to the people. The center joined many local senior centers and community organizations in launching pop-up clinics where BIPOC could easily access them.
After the center launched the pop-up clinics earlier this year, Assoumou looked at the data: 40% of the people vaccinated at the medical center were Black. For context: Less than a tenth of the state is Black.
"When you bring the vaccine to people and you make it convenient for them, you can see changes," Assoumou said.
Though it's still important to address generations of health inequities, Assoumou said the community outreach is critical. That's because members of the BIPOC community face barriers besides the wealth and income gap, which can keep them from receiving quality health care.
"Start with social determinants of health, which describe the milieu of where a person is born, lives and grows up," Assoumou said. "[That] impacts the trajectory and impacts [the] access to opportunities, to education — access to wealth."
And all of that, she said, affects one's access to quality health care.
Data on coronavirus rates highlights how those social determinants may be affecting communities of color. Said Assoumou: "It didn't matter where you were in the U.S., but the curves always looked the same: where Black people, Latinx people and Indigenous people were disproportionately impacted by the pandemic."
Research organizations like the National Institute on Aging have recognized the effects social factors can have on communities' health. Those factors have hurt people for generations, but Karyne Jones says that could change.
Jones is president and CEO of the National Caucus & Center on Black Aging, a nonprofit focused on quality of life for aging people of color. It has worked to inform aging Black communities for decades, and now functions as a connector to other programs and resources.
Jones said people today have more health information at their fingertips and can benefit more from that knowledge compared to previous generations. But spreading health awareness is just one piece of the puzzle, she said.
It's also important to build a productive and healthy society, but that means getting everyone to invest in it, she noted.
"COVID was horrible to communities of color, both in the health aspect and financially. And that is because there has not been the kinds of attention and investment in ensuring that these fellow Americans deserve quality of life," Jones said. "We can't continue to think that we can keep the system that we have, and still try to get out of this situation where we have an unhealthy society."
This article was originally published on Next Avenue as part of The Future of Elder Care series, made possible through funding from The John A. Hartford Foundation.


The Racism Unveiled digital storytelling project is funded by grants from the Otto Bremer Trust, HealthPartners and the Saint Paul & Minnesota Foundation.


How COVID-19 Exacerbated Inequalities in Health Care for the BIPOC Community

Republican Lieutenant Governor candidate Donna Bergstrom and DFL Lieutenant Governor candidate Peggy Flanagan debated healthcare, housing, #MeToo movement and shared who their political heroes are. They also discussed the historic nature of the 2018 Election - Minnesota's next Lt. Governor will be an Ojibwe woman, regardless of who is elected Governor.
 


Lieutenant Governor Candidates Debate

When it comes to mental health in Black communities, we know a stigma exists. For some of us, we mistrust the medical community after centuries of being misdiagnosed, mistreated or manipulated. For others, we’ve developed or inherited a survivor mentality that believes seeking help is a sign of weakness. Whatever the reason, it’s important for us to overcome our apprehension. There are many societal factors that are out of our control, but our own healing is one area that we have influence over - and one step in that journey may be seeking the help of a therapist.
To demonstrate the healing power of therapy, Sanni Brown-Adefope agreed to attend a recorded session and explore the trauma that has affected her life. Dr. Sheila Sweeney, of Peaces ‘n PuzSouls, partnered with Sanni to take her through a healing reflection of her past. Dr. Sweeney is a psychotherapist with a special interest in the mind, body and soul connection. In this session, she demonstrates a multitude of ways that connection emerges as someone is allowed to speak their own story.
There is no one path on the journey to healing, and it may take several attempts to find the methods that work best for us. But if we stay persistent about taking care of ourselves, we begin to mend, not only our own wounds, but those of generations before us and the generations to follow.
This story is part of the digital storytelling project Racism Unveiled, which is funded by a grant from the Otto Bremer Trust.
On January 28, 2021, the Twin Cities PBS digital storytelling project Racism Unveiled hosted a live Zoom panel titled “Flight, Fight and Flow: Self Healing” aimed at examining the ways in which Black Minnesotans are affected by trauma, and how we can begin or continue our healing journey. Packed with insight and guidance, discover the six key takeaways illuminated by the event.
In a year that has proved to be a turbulent challenge for so many Minnesotans, the Black church has continued to serve the spiritual and health needs of its congregants of color. The Stairstep Foundation’s CEO Rev. Alfred Babington Johnson shares some of the ways in which the state’s Black churches are working together to provide shelter in what has been an onslaught of storms. 
Black people and people of color in America have been subjected to centuries of medical experimentation and abuse, a history that has spurred mistrust of the healthcare industry for generations. Discover how some Black doctors are addressing the legitimate concerns of their patients of color who are deeply skeptical of the COVID-19 vaccines. 


WATCH: One Woman Finds Healing in Therapy

Bobby Edwards

On July 21, 2020, Twin Cities PBS hosted a virtual panel to discuss how LGBTQ+ health care and coverage might be changing in the United States. 
Panelists dove into the details of President Trump’s ACA rule reversal, the recent Supreme Court ruling on LGBTQ+ employee rights, and shared what business leaders, non-profits, HR departments and employees need to know so they are following the letter of the law.
Moderated by Almanac's David Gillette (he/his), the conversation featured:
Christy Hall (she/her), a Senior Staff Attorney at Gender Justice, where she represents clients challenging gender discrimination.
Nathalie Crowley (she/her), Associate Executive Director at Family Tree Clinic, a regional leader in LGBTQ healthcare, evidence-based comprehensive sex education, and culturally responsive care.
Casey Nolan (she/her), Chief Human Resources Officer at HealthPartners.
Writer Lindsay King-Miller shares her journey to parenthood with her trans husband and asks the question, “Why is the road to parenthood full or perils for LGBTQ+ folks?”
Queer women are not statistically “safe” when seeking health care, but there are medical spaces that have been crafted so that they can be treated with the same dignity as any other patient. The documentary film Patient No More explores the barriers LGBTQ+ women navigate across healthcare systems, and how the never-ending hunt for affirming care affects their lives.
While Minnesota has a long history of high-quality health care – at least for those who can afford it – access to basic and preventative services and health outcomes can vary widely based on one factor: identity. A very real tension exists between health care and health insurance coverage in Minnesota and beyond, so we wondered: Why is it so tough for LGBTQ+ folks to get the care they need?


Are LGBTQ+ Healthcare Rights Changing in the U.S.?

Anita White“The pandemic hit so quickly, didn't it? I mean, I think we're all still a little traumatized,” comments artist Anita White as she pulls out a sketchbook.
“Initially, I started poking fun at coronavirus and doing drawings, like, 'I used to draw a lot, but now all I do is wash my hands!'" White holds the sketch up to the computer screen, revealing one of the first drawings she made during the pandemic.
White has been drawing her way through life since she was a child. Her parents were both artistic and encouraged her to pursue art school. After art school, she had a 28-year career teaching art to children and, all the while, retained a regular routine of sketching.
Zorongo Flamenco, Anita WhiteIn her sketchbook, she captures the world around her, whether it be her travels, flamenco dancers (a common theme as she used to frequent Zorongo Flamenco performances), or simply capturing moments with family members and friends.
“Well, drawing is really interesting because it helps me pay attention to beauty or pathos. And it's been a navigational tool for me.”
White’s late husband of 39 years, Josh, had many ailments throughout his life, which increased in his final years. Hospital stays became a consistent part of their lives and, as a way to cope, she pulled out her sketchbook. Turning an extra chair into a makeshift easel, “I drew my way through all the medical challenges,” she says. She’s also quick to explain that this was in the “Way Back Time,” referring to a pre-pandemic world in which visitors were allowed in hospitals.
Diagnosis in Bite-Size Pieces, Anita WhiteShe’d sketch his latest diagnosis in an effort to grasp the gravity it had on their lives and to mitigate anxieties of the unknown. “Drawing just helped me get through because, otherwise, I would have been emotionally a lot more stressed out.” And when possible, she’d try to find the humor in the moment. “Humor does a lot for healing as well.”
She also turned her attention to the healthcare staff that floated in and out of the room, changing tubes, changing the garbage or changing the food trays. “People are basically kind of shocked to be drawn. And I usually ask them [for permission]. I try not to be too secretive…. It's a way of honoring and it's a fun way of connecting.”
The act of someone drawing your likeness (with permission, of course) holds a powerful allure: It means that they are paying attention to you. They see you.
All of her sketching led to a creative relationship with Hennepin Healthcare, where her husband received treatment. Working with Patient Advocate Sheila Moroney, Arts Program Coordinator Wenda Ballinger and Chief Academic Officer Dr. Meghan Walsh, White had an art show in 2017, “Drawing Through Crisis with Courage and Humor.” She then worked on the project “A Day in the Life of Hennepin Healthcare” from March 2018 until June 2019, by following various staff members around the hospital and documenting moments of their days.
“I followed an Ethiopian woman around in the medical ICU as she cleaned. I'd met a doctor, and so I did one called 'Doctor's Rounds'…. I ran with people, let's put it that way. I ran, ran with the guy who did translations as he ran from one place to another. I ran with Rosie, who greets people.”
Straddling roles as both a caregiver and an artist at Hennepin Healthcare offered a unique perspective on the people - the patients and the medical staff - who populate a bustling hospital. She was touched by the talent, care and the big hearts of all those who serve the public there.
“Anita has a unique gift of capturing a scene with keen observation and gentle humor. One of the comments I received from a member of our staff states, 'As both an employee and recent patient, I truly appreciate [Anita’s] whimsical, honest artwork. 'Love Me Just the Way I Am' particularly hit home as often when we are ill, people expect us to be how we were.  Thank you for so generously portraying the patient and family perspective so beautifully,'" relays Ballenger.
"Love Me Just the Way I Am" Anita WhiteWhite's husband, Josh, uttered the words, "Love me just the way I am," in a late-night farewell during a particularly challenging hospital stay - and they reflect his realization that life takes on a new shape when confronted by continual health challenges.
In the final weeks of her husband’s life, she noticed that her drawings became very symmetrical. “I drew very symmetrical, balanced drawings based on William Morris designs. And this really helped me because things were anything but balanced, anything but symmetrical.”
When her husband died in April 2019, “[I] drew my way through his death and actually have been drawing my way through my grief journey, too. So drawing is really interesting because it's like a key that opens the door, and it just helps me see and it helps me feel, it helps me empathize, in other very different ways.”
White's work revolves around empathizing with and honoring people that might not ordinarily be celebrated. She was ready to embark upon another project with Hennepin Healthcare in the spring of 2020, but the pandemic took hold and, for safety reasons, the hospital closed to most visitors. To lift the staff’s spirits, she sent weekly drawings from her previous projects. In more recent months, she has shared her interpretations of Hennepin Healthcare’s Stories from the Field, another documentary project by the hospital that focuses on staff experiences during COVID-19. The stories are poignant and heartbreaking, but show the resilient spirit of healthcare workers in this unrelenting time.
Now that she's spending far more time at home, her sketchbook reflects a more interior life. She captured her cats and window views of construction crews working on her street (she has, of course, learned the names of the crew and shared copies of her drawings with them to honor the work they are doing). She also doesn’t mind drawing what's on television, whether it be an address from the Governor or another program that moves her, like Twin Cities PBS's own Hippocrates Cafe: Reflections on the Pandemic.
And certainly her sketchbook carries a continuation of the grief she experiences due to her husband's death and the new grief of the life COVID-19 has bestowed on the world. “It's just one rollercoaster ride after another. Our sense of normal is really disturbed. There's just really a lot of grief and unexpressed grief. I'm really lucky because I've got my creative life,” she says, lifting up her sketchbook. She wonders how others are processing - or not processing - these important times.
Length of Grief, Anita WhiteIn a moment of reflection, she notes that her sketchbook now has symmetrical drawings in it, too, just as it did in the final days of her husband’s life. These are an expression of craving balance in an unbalanced time.
For White, drawing offers many things. It’s a way to process, a way to navigate, a way to honor and document those around her. It’s a way to process grief, anger and joy, and share in life’s journey. It’s been a way of life, a creative habit.
Credits: “A Day in the Life of Hennepin Healthcare” was curated by Wenda Ballinger, commissioned by Hennepin Healthcare and funded by Hennepin Healthcare Foundation’s Fallon Fund for Humanism. "Drawing Through Crisis with Courage and Humor" was curated by Wenda Ballinger and funded by Hennepin Healthcare Foundation’s Fallon Fund for Humanism.
 
This story is made possible by the Arts and Cultural Heritage Fund and the citizens of Minnesota.
If the wintertime scarcity of outdoor performances has left you with the blues, never fear: We have seven Pandemic Performances from local musicians that will bring a spring to your step.
For only a year and a half, the hardcore music scene in the Twin Cities rippled with exuberance, creative innovation and a healthy dose of grit. Check out the docu-series Minnesota Hardcore, which chronicles the short-lived, but pivotal, influence of hardcore music and the subculture that formed around it. 
When COVID-19 first showed up in the U.S., G. Phillip Shoultz III, like many Americans, had no idea what was ahead. “All of us naively thought this is just going to be a few weeks and we’ll get back to our lives,” he reflects. But the director of the VocalEssence Singers of This Age youth choir quickly realized that wouldn’t be the case. So the choir got creative and performed this rousing choral tune on a downtown rooftop.
