Many MPHA 2024 Conference attendees have asked for the reading of President Dr. Antonia Wilcoxon's remarks. Please read the full article here:

Dreams Of A Beloved Public Health: Confronting White Supremacy In Our Field

By Ryan J. Petteway, Oregon Health and Science University (OSHU), published February 9, 2021 on Health Affairs.org website.

June 5th is celebrated internationally as World Environment Day to call individuals and communities to reflect and take action. This year’s theme, Only One Earth calls for “collective, transformative action on a global scale to celebrate, protect and restore our planet.” Following shortly after our 2022 Annual Conference Together, for Planet and Community, we wanted to shine a spotlight on the #OnlyOneEarth Practical Guide to living sustainably in harmony with nature. Take a gander today!

The COVID-19 pandemic is beginning to expose the vast disparities present within the United States. While the recent outrage is warranted, it’s something that many public health and medical professionals have been warning about for weeks. In an article from CNN published yesterday, Dr. Monica Peek an internist at the University of Chicago Medical Center is quoted saying:

"What pandemics, natural disasters, economic disasters do is uncover the everyday lived experiences of these structural inequities that communities live with all the time.”

It’s important that amidst all of the current chaos and confusion, all efforts to combat the pandemic are done so through a health equity lens. As a report from the NAACP on Ten Equity Implications of the outbreak reminds us, our government (bolding is my own)“… must ensure necessary policies and practices are in place so that needed information, training, resources, and care are available equitably and reach all people in all communities.”

Images from those on the frontlines of fighting this virus are terrifying and unforgettable. Patients lining up in hallways. Medical professionals with bruises on their faces from their masks, overrun with emotion. Organized chaos. Or maybe just chaos in some places. But as many remind us, it’s important that we look toward to the future. That we have hope; hope is something that can help us get through this. Hope for an effective treatment. Hope for a vaccine.

However, as groups around the world race to find these treatments and vaccines, we can’t forget that clinical trials are another area where racial disparities are rampant.  In a review of over 200 trials supporting FDA oncology drug approvals from July 2008 to June 2018, Blacks represented only 3% of trial participants and Hispanics only 6%. The disparities are even more evident in genomic studies that seek to find associations between genetic variations and certain diseases. As of a review in 2018, 78% of people who participated in those studies were of European descent with only 10% being of Asian descent, 2% African descent, and 1% Hispanic descent.

Distrust among these populations is not unwarranted- remember! it was only in 1972 that the Tuskegee Syphilis Experiment was finally stopped after 40 years. But it’s important to push for the inclusion of diverse study populations because there are instances where medications don’t work as effectively in certain groups of the population.

Instead of sweeping the lack of diversity in research studies “under the rug”, I have seen more researchers are calling for this to end. And what’s great is that it’s not just young researchers (who are often more diverse themselves). Instead, it’s researchers who are well-known in their fields. This has been incredibly heartening as an early-stage researcher myself.

One effort underway to improve diversity in research is the All of Us research program. The goal of the program is to strive for better health for all of us. It’s a national effort to build one of the most diverse health databases in history through a historic effort to collect and study data from one million or more people living in the United States. Not only can you sign up and participate in the study, but there are also opportunities for researchers (traditional and nontraditional) to get involved. You can learn more at https://allofus.nih.gov/.

It is up to all of us - researchers, public health professionals, medical professionals, and the general public - to push towards greater inclusion. Studies that include diverse individuals - whether that be race, ethnicity, sex, socioeconomic status, or other characteristics - will ultimately be required to better understand the world around us. How can we learn what will protect all of us if studies don’t include people who look like all of us? And these studies might be more important now than ever before as we fight against this virus. We need to continue to push for inclusion in research studies. If we don’t, it’ll only serve to widen the disparities that are already present. 

Written by Kristin Moore, PhD MPH, Cancer Disparities Postdoctoral Fellow, Program in Health Disparities Research, University of Minnesota Medical School.

This blog post is for the Minnesota Public Health Association's National Public Health Week (NPHW) 2020 activities.

I consider my working situation during the COVID-19 pandemic as low stress: I’m working from home with no added responsibilities of caring for loved ones or children (besides a giant black lab). Working in health promotion for a large healthcare system, my focus has turned toward the health and well-being of the employees, the majority of whom are still working onsite in clinics and hospitals. These colleagues are working long hours without breaks, in sometimes traumatic situations. I’m also supporting colleagues who have been sent home to work on desk set-ups that are most definitely not ergonomically sound, while teaching their kid fourth grade at the same time. 

However, even though I am grateful for my situation, I can still feel the intense, tumultuous energy of living and working through a pandemic. Our work in public health feels more important than ever, and even harder to step away from. Hours blurs together into one big day/night/workday/weekend. Maintaining work/life balance is…hard.

In public health, we are constantly thinking about the health and well-being of others. However, unless we remember to “put on our own oxygen masks first,” it will be impossible to serve the public in meaningful ways without burning ourselves out. Creating boundaries around our “work” and “life” spheres—and protecting those boundaries—allows us space to ensure we are meeting our own needs in order to continue to show up for others.

Here are some things I’ve found helpful in maintaining those boundaries:

• If you’re working from home, stick to a regular schedule. Setting dedicated work hours will help you relax during your downtime. Discuss the schedule with others, not just your supervisor and colleagues but family and friends as well. It will set everyone’s expectations around when you do and don’t work—including your own.
• Create a morning routine to establish a sense of normalcy. It can be as easy as shower, teeth, coffee, eggs. Knowing what will happen next, even for one hour, is very comforting when other things around you feel uncertain or chaotic.
• Take breaks, if you can, at home and at work. Go outside, read a book, listen to a meditation. Even ten minutes can help restore vital energy and focus. One perk of working from home is the ability to step away to stretch or put your legs up the wall for a few minutes without anyone seeing. If you’re working onsite, download a free meditation app like Headspace or Insight Timer, which provide special content for COVID-19-related stress and anxiety.
• Create a ritual around the end of your workday as well. Give yourself something to look forward to each day when work is over.
• If you’re working from home, put a physical stop to your workday: close your computer, put your work in a drawer, change your clothes, leave the room and close the door.
• If you’re working onsite, find a moment of calm and self-care before you switch into home mode. Run through this checklist: 1. Acknowledge one thing that was difficult today, and then let it go. 2. Be proud of the work you did today. 3. Think of three things that went well today. 4. Check in with your colleagues, are they doing OK? 5. Check in with yourself—what support do you need? 
• Add an activity you enjoy: go for a run, walk the dog, take a virtual yoga class, or find a kickboxing video on YouTube. Elizabeth Gilbert has a great, 5-minute activity for grounding in the present moment, rather than spinning into an unknown future or ruminating on the past eight hours.
• Take it easy on yourself. When life is upended, your level of productivity may be affected—and that’s OK. It’s completely normal to feel scared, sad, angry, grateful and hopeful, sometimes all at once. Remember to give yourself and others grace as we all make our way through this together.

Written by Claire Fleming Sivongsay, MPH, On-Site Well-Being Program Manager, HealthPartners.

This blog post is for the Minnesota Public Health Association's National Public Health Week (NPHW) 2020 activities.

Many people will be surprised to know that nearly 10% of Minnesotans have some form of disability, whether physical, intellectual or developmental.

For those whose disabilities are serious enough to qualify for supportive services, most of them receive financial benefits through Minnesota's Medicaid program, which is funded through both federal and state dollars. The federal agency known as the Center for Medicare and Medicaid Services (CMS) sets the parameters for states to follow to administer their Medicaid programs, but there is still quite a bit of flexibility, each state’s Medicaid program is different.

CMS has established a series of waivers to allow States to operate certain provisions of their Medicaid programs outside the normal parameters. For people that are aging or have disabilities, there are Home and Community Based Services (HCBS) waivers that make it possible for those who would otherwise qualify for the levels of care provided by institutional settings such as hospitals, nursing homes or intermediate care facilities, to receive supportive services so they can live in home-like settings in the community. Approximately three-quarters of Minnesotans with significant disabilities receive support through HCBS waivers.

These supportive services can be delivered in a person's family home, in a day setting that is different than the person's home, or in a residential setting like a group home or foster home. Delivering these services requires a large number of direct support professionals (DSPs), whose job duties are incredibly variable, complex, and in some cases intimate. Depending on the needs of the person receiving supports, their DSP's responsibilities may include dressing, feeding, toileting, medical care, transferring from bed to wheelchair and back, shopping, driving and escorting to activities.

It may be surprising to learn that these caring professionals are paid very low wages - less than $13.00 per hour on average. With the rate of job growth and unemployment we were enjoying in the US prior to the current pandemic, there was a staffing crisis in Home and Community Based Services. Recruitment and retention of DSPs was very challenging, with half of new DSPs leaving their jobs in less than 1 year (fast food restaurant and retail positions typically paid more). Coupled with the extensive training requirements and regulations providers must follow, and the fact that their reimbursement rates are set by the state legislature, the workforce situation has had provider organizations operating in crisis mode for years.

Enter the coronavirus!

In less than a month's time, an industry that was already in crisis is now unsure of its viability through the next 3 months. Staffing has become even more challenging because many DSPs are either afraid to come to work out of fear of being exposed, or because they may have been exposed themselves and are self-isolating.

That means remaining staff have to work longer hours, including overtime, and in some cases work 24-hour shifts. Day programs, where people would go for services for several hours a day, have been forced to suspend their operations, which means the people are now in their residential programs 24 hours a day, adding to operating expenses, food budgets, and staff time. Shortages of cleaning supplies and personal protective equipment for medical care have hit these programs hard as well.

Where will our state's most vulnerable citizens go if these programs don't survive?

There have been some helpful actions taken at the state and federal levels, and some additional funding has been temporarily made available. But the future is still uncertain. The DSPs are not consistently included in lists of essential employees, so some benefits don't apply. Some benefits that have been instituted to support businesses don’t apply to these provider organizations.

The biggest concerns right now at the federal level are that it is not certain that any of the $100 billion Congress appropriated for emergency health and human services as part of the $2 trillion CARES Act is meant for Medicaid-funded providers. And there is still not a final opinion as to whether DSPs are considered health care workers under the Families First Coronavirus Response Act (FFCRA) and would therefore be exempt from expanded family and medical leave and paid sick leave due to COVID-19.

At the state level, while providers are following the Governor’s executive orders and recommendations from the CDC and Minnesota Department of Health, the biggest need is for an emergency rate increase to help HCBS providers keep up with increased costs of doing business related to the pandemic.

In times of uncertainty and high anxiety, Minnesota is known as a resilient state.

I hope we can all work together to see through this crisis and emerge as a stronger community on the other side. Advocacy organizations in the state, such as the Association of Residential Resources in Minnesota (ARRM), the Minnesota Organization for Habilitation and Rehabilitation (MOHR) and The Arc are working hard together to secure the necessary resources through legislative action. And in Washington, DC, the American Network of Community Options and Resources (ANCOR) is doing the same with Congress.

We ask the public health community to support us in these activities

Written by Ken Bence, MHA, MBA, Director of Research, Analysis & Policy, AARM (Association of Residential Resources in Minnesota) and MPHA Past President.

This blog post is for the Minnesota Public Health Association's National Public Health Week (NPHW) 2020 activities.