Call for the Minnesota Public Health Association (MPHA) to support policy and advocacy efforts to increase voter registration and voting participation, which leads to healthier communities.

MPHA Members approved by electronic vote on September 22, 2022

 

Whereas, the Robert Wood Johnson Foundation’s Culture of Health action framework and the American Public Health Association Healing Through Policy Initiative have identified voting participation and voting rights protection as important measures of health and racial equity^1,2 and

Whereas, high levels of community engagement help people recognize their own agency and ensure they are connected with each other, which improves neighborhood cohesion, health outcomes, and community resilience³; and people who value community health are more likely to translate those values into civic engagement; which includes involvement in civic organizations, participation in advocacy and voting, and other actions to change laws or policies, bring about systemic change and produce healthy communities³; and

Whereas, a positive relationship exists between civic engagement and physical and mental health, health behaviors, and well-being^3,4; while social isolation, marginalization, lack of trust in institutions, poor health, and the burden of chronic disease result in lower voting participation rates and less civic engagement. This creates a reinforcing feedback loop where people who have good health participate more, reinforcing their good health, and people with poor health participate less, reinforcing their poor health^3,4,5;and conversely, participation in voting is more likely among those who enjoy good health⁶; and 

Whereas, a study of 44 countries, including the United States, found that voter participation is associated with better self-reported health, even after controlling for individual and country characteristics^,7; 

Whereas, regardless of political party, a plurality of likely voters consider health care issues extremely important, with voters’ values, beliefs, and concerns about issues such as health care costs, insurance coverage, and benefits influencing both candidates’ campaigns and legislators’ votes; and policy issues about health and health care influencing a majority of voters’ choices when voting for candidates⁸, and ballot initiatives³; and

Whereas, public health can be politicized, such as the compromising of public safety during the COVID-19 pandemic by state legislators enacting partisan measures that limit the power of governors, local elections officials, and the authority of public health officials in at least 26 states⁹; and

Whereas, public health considerations should be the guiding factor in health policy decisions, individual legislators within political systems craft legislation that affects population health, opening the possibility for political ideologies and partisan agendas to influence essentially apolitical public health interventions or guidelines^10,11,12; and

Whereas, public policies can affect voter participation, such as increased voter turnout associated with increased Medicaid enrollment as a result of the Affordable Care Act’s Medicaid expansion¹³; and 

Whereas, because of the COVID-19 pandemic, primaries were postponed, election laws were changed, and emergency powers were invoked in dozens of states to give election administrators more time and resources to conduct elections safely, yet high levels of civic engagement continue to be threatened by the ongoing COVID-19 pandemic and an increase in legislation and policies restricting access¹⁴; and

Whereas, people experience barriers to registering to vote and casting a ballot for many reasons, including many that intersect with barriers to receive healthcare. These reasons include the lack of identification documents¹⁵, frequent changes in home address¹⁶, limited English proficiency¹⁷, misconceptions about the rights of people with disabilities to vote and issues of accessibility ¹⁸,a combination of poor health and low income¹⁹, and voter registration office closures due to emergencies like COVID-19²⁰; and 

Whereas, voters of color and American Indians and Alaska Natives face heightened barriers when it comes to voting and participating in our democracy.²¹ Voters of color are more likely to experience longer polling lines, are disproportionately burdened by stringent voter identification laws, and have fewer polling locations per capita than their white counterparts. American Indian voters also face unique barriers to voting by mail on reservations²²; and

Whereas, the Cost of Voting Index ranks Minnesota #15 among the states on accessibility to voting, and in 2020 83% of those eligible to register to vote did register, and 80% of those registered cast a ballot²³; and  

Whereas, Minnesota Statute 201.162 requires that state agencies, as well as community-based public agencies and non-profit corporations that contract with a state agency to carry out obligations of the state agency, shall provide voter registration services for employees and the public²⁴; and  

Whereas, disparities exist with a negative correlation between those enrolled in Medicaid and voter registration. Currently, 13 states have laws that allow Medicaid-based registration which combats these disparities ²⁵;

Whereas, civic participation and voter registration were included as measurable objectives with the Social Determinants of Health - Healthy People 2020 and voting metrics were initially omitted from the Healthy People 2030^26,27; and

Whereas, an easier transition in the development of a voting habit, and an interest in politics more broadly, happens through the presence of resources⁵; and

Therefore, be it resolved, the Minnesota Public Health Association (MPHA) shall:

1. Support legislation, policies, and practices that encourage state and local agencies who administer health and social service programs to integrate voter registration opportunities for applicants who are U.S citizens, eligible to vote, and at least 18 years old on Election Day.
2. Support legislation, policies and practices that encourage all health-related organizations, including public health, health systems and health plans, to include voter registration and education in their programs and services. 
3. Support efforts that make compliance with Minnesota Statute 201.162 by state agencies, community-based public agencies, and nonprofit corporations a routine practice; and 
4. Support policies and practices that allow for those who are 16 and 17 years old to pre-register to vote, when they will reach voting age and then be eligible to vote.
5. Support policies and initiatives that increase voter registration and voting for American Indians/Alaskan Natives and people of color.
6. Support policies and practices that allow people with disabilities to fully participate in the political process, including ensuring the accessibility of polling locations and through promoting the availability of accessible voting technology.²⁸ 
7. Support policies and practices that increase the number of eligible Minnesotans who both  register to vote and cast a ballot in elections and increase awareness of these policies and practices, through the creation of an even lower cost to vote by making elections more accessible across the state, including considerations for people with varying literacy and/or abilities. These include: 
   1. automatic and same day registration;
   2. early voting; 
   3. vote-by-mail;
   4. no-excuse absentee voting; 
   5. convenient voting locations and hours 
   6. physical accessibility of polling sites, and assistance with equipment, languages, and awareness of assistance methods for casting a ballot.
8. Oppose policies and practices that create barriers - or discourage, suppress, or restrict the ability of eligible voters to either register to vote and/or cast a ballot in free and fair elections. These include but are not limited to: 
   1. partisan or otherwise biased redistricting
   2. requiring identity verification or other additional documentation requirements at the polls after the person has already established their eligibility to vote
   3. unnecessary registration deadlines
   4. prohibiting online registration
   5. requiring an approved excuse for early voting
   6. minimizing poll locations or hours of operation
   7. restricting voting by mail
   8. disallowing nourishment in voting lines
   9. policies and initiatives that reduce voter participation of American Indians/Alaska Natives and people of color
9. Support the inclusion of civic participation and voter registration as a measurable objective for public health agencies and initiatives, including the Healthy People-2030 initiative. 
10. Encourage its members and other stakeholders to promote the health of communities by reminding them of upcoming elections and to vote in every election in which they are eligible to vote, while making the connection of how voting impacts their health and improves health equity, and
11. Provide members and other stakeholders with opportunities to learn about issues that will shape policy and encourage members and other stakeholders to support elections and to be civically engaged, by serving as election workers or volunteers and by participating in town halls and other public meetings.
12. Provide its members and other stakeholders with information on how public health experts can play a larger role in helping election administrators manage safe options for voters to cast their ballots; including voters who may have active COVID-19 infections, those who are particularly vulnerable to a host of other health concerns, or those who are not familiar or comfortable with absentee or vote-by-mail options.

References 

References are available for download.

Climate change is one of the greatest threats to public health and requires renewed efforts to expand policies that increase actions to reduce harmful health and ecological impacts. Climate change threatens the very foundations of human health and wellbeing, with the Global Risks Report registering climate change as one of the five most damaging or probable risks every year for the past decade¹.

WHEREAS, beyond the obvious forms of climate change—from, extreme heat, hurricanes, drought, wildfires, and tsunamis to biological threats such as vector-borne diseases—the effects of climate change are pervasive and impact the very food, air, water, and shelter society depends on, extending across every region of the world¹; and

WHEREAS, climate change is worsening stark and persistent health inequities which interact with existing social, environmental, and economic inequalities¹; and

WHEREAS, those who disproportionately bear the health impacts of climate change in Minnesota include: children, seniors, pregnant women, low-income communities, communities of color, , people with disabilities and people with chronic disease^{2 3}; and

WHEREAS, atmospheric influences such as increases in greenhouse gas emissions, ambient temperatures, precipitation, and humidity cause disruptions in human environment that threaten the health and vitality of human communities⁴; and

WHEREAS, in Minnesota, the most concerning impacts of climate change include injury and death from extreme weather events including heat waves and floods, disease from changing tick and mosquito populations, illness from drinking or swimming in contaminated water from increased runoff and floods, respiratory and cardiovascular impacts from increases in wildfires, ozone, fine particulate matter, pollen, and mold, and mental health impacts from experiencing an extreme weather event or from a loss of sense of place⁵; and

WHEREAS, climate change stresses our health care infrastructure and delivery systems . There is a pressing need to prepare for potential health risks^{6 7}; and

WHEREAS, extreme weather patterns destabilize communities, increase economic stress and poverty, reduce access to essential healthcare, and increase risk for mental health concerns, such as Post Traumatic Stress Disorder (PTSD), depression, anxiety, aggressive behavior, and relationship and social unrest^{8 9 10}; and

WHEREAS, the Intergovernmental Panel on Climate Change (IPCC) recommends a global goal of net zero carbon emissions by 2050 to prevent the worst effects of climate change, which include increases in heat-related morbidity and mortality and ozone-related mortality, as well as, increases in vector-borne disease and heat waves amplified by urban heat island effects¹¹; and

WHEREAS, as public health professionals, we are best poised to prevent, detect and manage the health implications of climate change. We need to be the leading voice in advancing climate change strategies and interventions that have co-benefits for all¹².

THEREFORE, BE IT RESOLVED, that the Minnesota Public Health Association:

1. Calls on policy makers and state and local leaders to integrate climate change solutions and climate justice into all relevant federal, state, and local public health systems and programming and to adopt policies and programs to create an equitable and just transition to a 100% carbon-free economy by 2050; and
2. Urges for a just transition away from the use of coal, oil, and natural gas to clean, safe, and renewable emergency and energy efficiency; and
3. Supports leadership by the Minnesota Department of Health, the University of Minnesota system schools, and other entities to study, analyze, provide data and recommendations, training, technical assistance, and funding in support of efforts to address the negative impacts of climate change on state and local communities; and
4. Take bold and timely action to promote awareness of environmental injustices that harm historically oppressed communities, undermine tribal sovereignty, disadvantage poor neighborhoods, and worsen the effects of climate change; and
5. Supports the funding of climate-health risk assessments, expanded disease surveillance systems, early warning systems, and research on climate and health to strengthen Minnesota’s capacity for an effective health response to climate threats; and
6. Adopts an interdisciplinary and inter-professional approach to addressing climate change, including collaborations with other scientific, professional, and community organizations in Minnesota based on scientific evidence and public health expertise; and
7. Pledges to help its members and other stakeholders readily access resources regarding climate change from credible sources, including the American Public Health Association, the Centers for Disease Control and Prevention, as well as organizations named above.

1. Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Beagley, J., Belesova, K., Boykoff, M., Byass, P., Cai, W., Campbell-Lendrum, D., et al. (2021). The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. Lancet (London, England), 397(10269), 129–170. https://doi.org/10.1016/S0140-6736(20)32290-X
2. Voskoboynik, D. (2019). A Guide to Climate Violence. The World at 10C. Accessed 2/12/2021 at: https://worldat1c.org/a-guide-to-climate-violence-4cfbc5a7648f
3. Minnesota Declaration on Climate and Health. (2021). Accessed 2/15/2021 at: https://drive.google.com/file/d/1ggWbqIH937RF4zTxbfkBR7ydzged0Bmd/view
4. Minnesota Department of Health. February 2015. Minnesota Climate and Health Profile Report 2015: An 4 Assessment of Climate Change Impacts on the Health and Well-being of Minnesotans. Accessed 3/30/2021 at: hAps://www.health.state.mn.us/communiCes/environment/climate/docs/mnprofile2015.pdf
5. Minnesota Department of Health Climate & Health Strategic Plan: An update on program successes and next 5 steps. April 2019. Accessed on 3/30/2021 at: https://www.health.state.mn.us/communiCes/environment/climate/ docs/progressreport.pdf
6. National Institute of Environmental Health Sciences. (2021). Accessed 3/22/2021 at:  https://www.niehs.nih.gov/ 6 research/programs/geh/climatechange/index.cfm
7. Centers for Disease Control and Prevention. Accessed 3/22/2021 at: https://www.cdc.gov/climateandhealth/ 7 policy.htm
8. Minnesota Department of Health. Minnesota Climate Change Vulnerability Assessment. Accessed 2/15/2021 at: https://www.health.state.mn.us/communities/environment/climate/docs/mnclimvulnsummary.pdf
9. Clayton, S., Manning, C. M., & Hodge C. (2014). Beyond storms and droughts: The psychological impacts of climate change. Washington, DC: American Psychological Association and ecoAmerica.
10. Clayton, S., Manning, C. M., Krygsman, K., & Speiser, M. (2017). Mental health and our changing climate: Impacts, implications, and guidance. Washington, D.C.: American Psychological Association and ecoAmerica. https://www.apa.org/news/press/releases/2017/03/mental-health-climate.pdf
11. IPCC, Special Report Global Warming of 1.5°C, Summary for Policymakers. hAps://www.ipcc.ch/sr15/chapter/ spm/
12. American Public Health Association (APHA). Climate Changes Health: #ActOnClimate. Accessed 3-30-2021 at: hAps://www.apha.org/Topics-and-Issues/Climate-Change/Act-On-Climate

WHEREAS, race is a social construct with no biologic basis¹; and

WHEREAS, society is built on racial hierarchies, established through colonization, that pervade structures, histories, politics, and, ultimately, minds; and

WHEREAS, racism is a social system with multiple dimensions, including individual racism, which is internalized or interpersonal¹; and

WHEREAS, systemic racism, which is institutional or structural, is a system of structuring opportunity and assigning value through the social interpretation of one’s race²; and

WHEREAS, the cumulative result of these racist systems and structures has contributed to an environment that is persistently unhealthy and unsafe for Black communities, American Indian communities, Latinx, and Asian communities³; and

WHEREAS, studies show moderate to strong positive relations between racism and trauma. Black, American Indian, and People of Color are unfairly burdened with the responsibility of coping with the painful existence of those oppressive experiences⁴; and

Whereas, racism in all its forms causes persistent discrimination and disparate outcomes in many areas of life, including housing, education, health, employment, public safety and criminal justice5. And it is amplified during this pandemic as communities of color face inequities in everything from a greater burden of COVID-19 cases to less access to testing, treatment and care^{5 6 7}; and

WHEREAS, a multitude of studies connect racism to inequitable health outcomes for Black, American Indians, and People of Color, including cancer, coronary heart disease, asthma, diabetes, hypertension, mental health, high infant and maternal mortality rates demonstrating that racism is the root cause of social determinants of health^{8 9 10 11}; and

WHEREAS, racism is killing Black Americans—both by fueling police violence against them and by propelling adverse socioeconomic conditions that contribute to serious health issues. George Floyd’s death at the hands of Minneapolis police officers is a visceral reminder of the reality Black Americans know all too well: Racism is a public health crisis¹²; and

WHEREAS, the Minnesota Public Health Association (MPHA) recognizes that Africans were forcibly brought to this country, enslaved, and after the Emancipation Proclamation, citizens of this country perpetuated Anti-Black racism through violence, mass incarceration and Anti-Black policies, including redlining, and that the social construction of race was used to justify their enslavement as well as the removal of American Indian peoples off their land pushing them onto land deemed less desirable¹³; and

WHEREAS, Minnesota—which received its name from the Dakota [Sioux] word for Mississippi’s major tributary in the state, the Minnesota River, “Sky-Tinted Water”¹⁵—is largely built upon Ojibwe [Anishinaabe] and Dakota homelands. American Indians have lived upon this land and waters since time immemorial, and the land and water itself carries historical trauma, and that genocidal policies have aimed to strip tribal nations not only of land, but of culture, language, and family systems¹⁴; and

WHEREAS, MPHA also recognizes that the long-standing persuasive anti-immigrant sentiment and treatment works against the well-being of Latinx peoples—whether an immigrant or born in the U.S. Viewed as an alien and low status, many continue to be scapegoated and targeted for mistreatment¹⁶; and

WHEREAS, the COVID-19 pandemic is not the first public health crisis for racist policies and political rhetoric targeted Asian-Americans. During the bubonic plague in 1900, public health officials quarantined Chinese residents in Chinatown and during the SARS outbreak in the early 2000’s East Asians experienced stigmatization worldwide. Today, Asians and people of Asian descent around the world continue to be subjected to attacks and beatings, violent bullying, threats, and discrimination linked to the current pandemic¹⁷; and

WHEREAS, anti-racism means actively participating in dismantling racist systems and institutional practices, as well as addressing personal and interpersonal acts of racism; and

WHEREAS, embodied anti-racism acknowledges the historical roots and contemporary manifestations of racial prejudice and discrimination that lives in bodies today⁸; and

WHEREAS, unfair and race‐based inequities will continue unless we undertake the uncomfortable but necessary work to dismantle the institutions and systems that perpetuate racism, violence, poverty, and injustice¹⁸; and

WHEREAS, MPHA membership is committed to ending racism and building an active, anti-racist culture across the organization and community;

NOW, THEREFORE, BE IT RESOLVED that upon adoption of this resolution, by the MPHA:

That by declaring racism a public health crisis, MPHA will recognize the severe impact of racism on the well-being of Minnesotans and actively engage in racial equity in order to name, reverse, and re- pair that harm done to American Indian and People of Color in Minnesota, including the following actions:

1. Assert that racism is a public health crisis affecting our entire society
2. Honor the Dakota and Anishinaabe people, ancestors, and descendants, as well as the land and water itself
3. Center the voices, work, and leadership of the communities most affected by racism
4. Reshape our discourse and agenda and commit to recognizing personal biases, educating ourselves to understand the structures and behaviors that propagate racism, listening to and speaking up for those who are affected by racism so that all MPHA workgroups, membership and our overall work and strategic plans actively engage in anti-racism.
5. Continue to advocate locally for relevant policies that improve health in American Indian communities and communities of color, and support local, state, regional, and federal initiatives that advance efforts to dismantle systemic racism
6. Further work to solidify alliances and partnerships with other organizations that are confront- ing racism and encourage other local, state, regional and national entities to recognize racism as a public health crisis.

1. Krieger N. (2000). Refiguring "race": epidemiology, racialized biology, and biological expressions of race relations. Int J Health Serv. 30(1):211–216.
2. Jones, C. P. (2002). Confronting institutionalized racism. Phylon (1960-), 7-22.
3. Krieger N. The science and epidemiology of racism and health: racial/ethnic categories, biological expressions of racism, and the embodiment of inequality—an ecosocial perspective. In: Whitmarsh I, Jones DS, editors. What’s the use of race? Genetics and difference in forensics, medicine, and scientific research. Cambridge, MA: MIT Press; 2010. p. 225–55.
4. Krieger N. Discrimination and health. In: Berkman L, Kawachi I, editors. (2000). Social epidemiology. Oxford: Oxford University Press; pp. 36–75
5. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. (2020). COVID-19 and Racial/Ethnic Disparities. JAMA; 323(24):2466–2467. doi:10.1001/jama.2020.8598
6. Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429—445.7 Minnesota Compass. Disparities by Race. http://www.mncompass.org/disparities/race#1-9538-g. Accessed on August 9, 2020.
7. Krieger N. (2001). A glossary for social epidemiology. Journal of epidemiology and community health, 55(10), 693–700. https://doi.org/10.1136/jech.55.10.693
8. Institute of Medicine. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. https://www.nap.edu/read/10260/chapter/2#7. Accessed August 9, 2020.
9. Minnesota Department of Health. Advancing Health Equity Executive Summary. https://www.health.state.mn.us/communities/equity/reports/aheexecutivesummary.pdf. Accessed August 9, 2020.
10. Link BG, Phelan JC. Understanding sociodemographic differences in health--the role of fundamental social causes. Am J Public Health. 1996 Apr;86(4):471–473.
11. Merelli, A. (May 2020). “Black people are at the center of two public health crises in the US: Covid-19 and police brutality.” Retrieved August 9, 2020 from https://qz.com/1862403/black-people-are-at-thecenter-of-two-public- health-crises-in-the-us-covid-19-and-police-brutality/
12. Gee, G. C. (2008). A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. American journal of public health, 98(Supplement_1), S48-S56.
13. Dunbar-Ortiz, R. (2015). An indigenous peoples' history of the United States.
14. Encyclopaedia Britannica. Minnesota. https://www.britannica.com/place/Minnesota. Accessed on August 9, 2020
15. Blakemore, Erin. (August 2018). The Brutal History of Anti-Latino Discrimination in America. https://www.history.com/news/the-brutal-history-of-anti-latino-discrimination-in-america Accessed on August 9, 2020. 
16. Gover, A. R., Harper, S. B., & Langton, L. (2020). Anti-Asian Hate Crime During the COVID-19 Pandemic: Exploring the Reproduction of Inequality. American Journal of Criminal Justice, 1–21. Advance online publication. https://doi.org/10.1007/s12103-020-09545-1
17. Krieger N, Birn AE. (1998). A vision of social justice as the foundation of public health: commemorating 150 years of the spirit of 1848. Am J Public Health. Nov;88(11):1603–1606. 

WHEREAS, millions of Americans live in households that struggle against hunger and in Minnesota 13.7 percent of children live in food-insecure households¹ and that number has likely increased significantly as families have lost jobs and wages due to the economic impact of the COVID-19 pandemic; and

WHEREAS, hunger has been shown to reduce academic achievement as children experiencing hunger are more likely to have repeated a grade, received special education services, or received mental health counseling, than low-income children who do not experience hunger;² and

WHEREAS, hunger creates barriers to learning as children experiencing hunger are more likely to be hyperactive, absent, and tardy, in addition to having behavioral and attention problems more often than other children,³ and

WHEREAS, the National School Lunch Program and the National School Breakfast Program play an important role in reducing childhood hunger by providing a nutritious breakfast and lunch every school day; and

WHEREAS, school meals support struggling families trying to stretch their limited resources and provide children with a significant portion of the daily nutrition they need to be healthy; and

WHEREAS, school breakfast and lunch provide students the nutrition they need in order to learn and have success throughout the school day; and

WHEREAS, the National School Lunch Programs work hand-in-hand with other federal nutrition programs such as the Child and Adult Care Feeding Program (afterschool snacks and meals) and the Summer Food Service Program to create a nutritional safety net for low-income children throughout the year.

Therefore, be it resolved that the Minnesota Public Health Association:

1. Supports state and federal policies that seek to protect, strengthen, and expand access to the National School Lunch Program, the National School Breakfast Program, the Child and Adult Care Feeding Program (afterschool snacks and meals) and the Summer Food Service Program.
2. Encourages work at the school-district, state and federal levels to reduce barriers to participation in the programs; to eliminate stigma associated with program participation; to implement innovative models that improve program participation such as breakfast in the classroom and “grab and go” breakfast stations and to enhance the nutritional quality of food served.
3. Stands in support of providing free and nutritious meals to every student that needs one, regardless of income eligibility, so that all students have the nutrition they need to learn and grow.

1. Food Research and Action Center analysis of 2014-2016 Current Population Survey-Food Security Supplement (CPS-FSS) data.
2. Kleinman, R. E., Murphy, J. M., Little, M., Pagano, M., Wehler, C. A., Regal, K., & Jellinek, M. S. (1998). Hunger in Children in the United States: Potential Behavioral and Emotional Correlates. Pediatrics, 101(1),E3.
3. Murphy, J. M., Wehler, C. A., Pagano, M. E., Little, M., Kleinman, R. F., & Jellinek, M. S. (1998). Relationship Between Hunger and Psychosocial Functioning in Low-Income American Children. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 163-170.

WHEREAS, the largest proportion of the population of the United States of America is composed of people whose ancestors immigrated to this country from other lands¹;

WHEREAS, immigrants to the United States, categorized as foreign-born in the U.S. Bureau of the Census reports, are a diverse group including both documented and undocumented individuals who make up 13.5% of the current population². Immigrants and their U.S born children constitute 86.4 million people, or 27% of the overall U.S population. The population of foreign-born children has decreased by 21% between 2000 and 2016, from 2.7 million to 2.1 million³.

WHEREAS, Minnesota's first large groups of immigrants arrived from Europe, primarily Norway, Sweden, Ireland, and Germany. Today, the majority of Minnesota's immigrants arrive from Mexico, India, Laos, and Somalia. Between 2010 and 2016, Minnesota has had a 20% increase in immigrant population growth3. About 8% of Minnesota's residents are immigrants, and 7% are native-born U.S citizens with at least one immigrant parent⁴.

WHEREAS, the experience of immigration has immediate implications for the psychological, health and social well-being of individuals and families⁵ which are especially intense for children, people of color, people of the impoverished socioeconomic classes¹, as well as women⁷, lesbian, gay, and bisexual persons⁸, and individuals with disabilities;

WHEREAS, as of May 2018, over 10,000 immigrant children have been separated from their parents and/or family members as part of the current immigration policy towards undocumented individuals entering the US at the border. Of those, almost 1,500 have gone missing from the homes of their caregivers. Instead of detaining families together, ICE has been mobilized to separate children from families;

WHEREAS, separating children from their parents exposes them to trauma and toxic stress that can have lifelong negative impacts on their mental and physical health. As noted by the American Academy of Pediatrics (AAP), exposing children to traumatic events and prolonged or toxic stress such as separation from a parent disrupts a child’s healthy development and can lead to physiologic changes that result in short- and long-term negative effects on physical, mental, and behavioral health^9-19;

WHEREAS, detention, for even brief periods, has short- and long-term negative effects on the health of parents and children. Studies show high levels of psychiatric distress, including depression and post-traumatic stress, among detained asylum seekers, even after short detention periods, and that symptoms worsen over time^{20, 21};

WHEREAS, the separation of a child from his/her/their parent or family member/caregiver, constitutes an Adverse Childhood Experience, or a significant trauma experienced by an individual before the age of 18. Adverse Childhood Experiences, or childhood trauma, has been shown in numerous studies to substantially increase the risk of mental, emotional, and physical health outcomes long term^10-19;

WHEREAS, Adverse Childhood Experiences have been strongly correlated to increased levels of mental health outcomes (depression, suicide, addiction and substance abuse), chronic health conditions (obesity, diabetes, stroke, heart disease), and significant effects on economic potential (educational attainment, lost productivity, future income growth)^22-23;

THEREFORE, BE IT RESOLVED that the Minnesota Public Health Association urges the government of the United States to revoke and reverse the current policy of separating migrant, undocumented, or immigrant children from their parents. Regardless of how they come into the United States of America, they are first and foremost children, and human beings, deserving of care, dignity, and respect.

1. Fix, M., & Passel, J. S. (1994). Immigration and immigrants: Setting the record straight. Washington, DC: The Urban Institute.
2. Census Bureau's 2010 and 2016 American Community Survey (ACS)
3. Jeanne Batalova and Elijah Alperin, "Immigrants in the U.S. States with the Fastest-Growing Foreign-Born Populations," Migration Policy Institute, (July 10, 2018).
4. Immigrants in Minnesota Fact Sheet, 2017, American Immigration Council. https://americanimmigrationcouncil.org/sites/default/files/research/immigrants_in_minnesota.pdf. Accessed on 10/14/2018.
5. Beiser, M. (1988). After the door has opened: Mental health issues affecting immigrants and refugees in Canada. Ottawa: Health and Welfare Canada.
6. Board on Children and Families, Commission on Behavioral and Social Sciences and Education, National Research Council, Institute of Medicine (1995). Immigrant children and their families: Issues for research and policy. The Future of Children, 5, 72-89.
7. Yee, B. W. K. (1997). The social and cultural content of adaptation of aging among Southeast Asian elders. In J. Sokolovsky (Ed.), The cultural context of aging, 2nd Edition, New York: Greenwood Publishers.
8. Espin, O. (1997). Crossing borders and boundaries: The life narratives of immigrant lesbians. In Greene, B. (Ed.), Psychological perspectives on lesbian and gay issues: Vol. 3. Ethnic and cultural diversity among lesbians and gay men (pp.191-215) Thousand Oaks, CA: Sage.
9. Colleen Kraft, MD, MBA, FAAP, “AAP Statement Opposing the Border Security and Immigration Reform Act,” American Academy of Pediatrics, (June 15, 2018), https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAPStatementOpposingBorderSecurityandImmigrationReformAct.aspx Accessed 7/19/2018. 
10. Center on the Developing Child, NGA Center for Best Practices, and National Conference on State Legislatures, In Brief: The Impact of Early Adversity on Children’s Development, (Cambridge, MA: Center on the Developing Child, Harvard University, 2015), https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp- content/uploads/2015/05/inbrief-adversity-1.pdf; Hillary A Franke, “Toxic Stress: Effects, Prevention and Treatment,” Children 1 (2014):390-402;
11. Sara B Johnson, Anne W Riley, Douglas A Granger, and Jenna Riis, “The Science of Early Life Toxic Stress for Pediatric Practice and Advocacy,” Pediatrics 131, 2 (February 2013):319-327
12. Jack P Shonkoff, Andrew S Garner, et. al., “The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” Pediatrics 129, 1 (2012):e232-e246;
13. Committee on Psychosocial Aspects of Child and Family Health, et. al., “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science into Lifelong Health,” Pediatrics 129, 1(2012):e224-e231
14. National Scientific Council on the Developing, Child Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9, (Cambridge, MA: National Scientific Council on the Developing Child, 2010), http://www.developingchild.net
15. Jack P Shonkoff, W Thomas Boyce and Bruce S McEwen, “Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention,” Journal of the American Medical Association 301, 201 (2009):2252- 2259
16. Jennifer S Middlebrooks and Natalie C Audage, The Effects of Childhood Stress on Health Across the Lifespan, (Atlanta, GA: Centers for Disease Control and Prevention (CDC), 2008), http://health- equity.lib.umd.edu/932/1/Childhood_Stress.pdf
17. Stanley D Rosenberg, Weili Lu, Kim T Mueser, et. al., “Correlates of Adverse Childhood Events Among Adults with Schizophrenia Spectrum Disorders,” Psychiatric Services 58, 2 (2007): 245- 253
18. Shanta R Dube, Robert F Anda, Vicent J Felitti, et. al., “Childhood Abuse, Household Dysfunction, and the Rise of Attempted Suicide Throughout the Life Span: Findings from the Adverse Childhood Experiences Study,” JAMA 286, 24 (December 2001): 3089-3096;
19. Vincent J Felitti, Robert F Anda, Dale Nordenberg, et. al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 14, 4 (1998):245-258.
20. Janet Cleveland, Cecile Rousseau, and Rachel Kronick, The harmful effects of detention and family separation on asylum seekers’ mental health in the context of Bill C-31,” April 2012, https://csssdelamontagne.qc.ca/fileadmin/csss_dlm/Publications/Publications_CRF/brief_c31_fin al.pdf; Julie M. Linton, Marsha Griffin, Alan J. Shapiro, and Council on Community Pediatrics, “Detention of Immigrant Children,” Pediatrics, March 13, 2017,; http://pediatrics.aappublications.org/content/early/2017/03/09/peds.2017-0483,
21. Wendy Cervantes, Family Detention: The Harmful Impact on Children, (Washington, DC: First Focus, December 8, 2015), https://firstfocus.org/resources/fact-sheet/family-detention-the- harmful-impact-on-children.
22. U.S Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2018). Retrieved from: https://www.samhsa.gov/capt/practicing-effective- prevention/prevention-behavioral-health/adverse-childhood-experiences.
23. Schilling, E., Aseltine, R., & Gore, S. (2007). Adverse childhood experiences and mental health in young adults: A longitudinal survey. BMC Public Health, 7, 30.

WHEREAS, On Tuesday, September 5, 2017, President Donald Trump ordered an end to the program known as Deferred Action for Childhood Arrivals, or DACA.¹ Congress is being given six months to determine the legal status and ultimate fate of 800,000² immigrants, known as “Dreamers”, who were brought into the United States as children, and who are eligible, under the existing DACA program, to apply for temporary residence in the United States; and

WHEREAS, A compromise devised by the Obama Administration after Congress failed to pass the bipartisan Development, Relief and Education for Alien Minors (DREAM) Act, which would have offered eligible immigrant children the chance of permanent legal residency in the United States, the DACA program, established by Executive Order on June 15, 2012, offers temporary residence status to these children, and protection from immediate deportation, if certain conditions are met: and

WHEREAS, An undocumented immigrant is eligible to claim DACA status if, as of June 15, 2012, the individual was under the age of 31, came the United States before turning age 16, lived continuously in the United States for five years since June 15, 2007; and either has a high school diploma or GED certification, or has been honorably discharged from the military or is currently enrolled in school.³ Applicants for DACA status are fingerprinted and rigorously vetted by the Department of Homeland Security for any criminal history or threat to national security. If the applicant passes the vetting, action to deport the person is deferred for a period of two years, with an opportunity to renew the deferral, and the individual becomes eligible for basics such as a driver’s license, college enrollment or work permit; and

WHEREAS, To date, 800,000 individuals have qualified for DACA status. As President Obama put it when he signed the Executive Order creating the DACA program: “These are young people who study in our schools, they play in our neighborhoods, they’re friends with our kids, they pledge allegiance to our flag. They are Americans in their heart, in their minds, in every single way but one on paper. They were brought to this country by their parents – sometimes even as infants – and often had no idea that they’re undocumented until they apply for a job or a driver’s license, or a college scholarship”; and

WHEREAS, In an act of faith and trust in America’s promise of hope and opportunity, “Dreamers” came out of the shadows and gave their names, addresses and telephone numbers to the United States Government in order to participate in the DACA program; and

WHEREAS, deportation and threat of deportation affect not only undocumented people, but also their children and family members who are often legal residents, anyone perceived to be an immigrant based on skin color or other factors, other people with whom they share communities or schools, and our broader society⁴; and

WHEREAS, fear of deportation makes communities less healthy. People are afraid to drive, afraid to use parks and exercise outdoors, afraid to use public health services like clinics, and afraid to participate in their communities⁵; and

WHEREAS, deportations and threat of deportations impact children and lead to poorer child health, poorer child behavioral outcomes, poorer child educational outcomes, and poorer adult health and shorter lifespan.⁵

WHEREAS, an increase in risk of deportation is associated with a decrease in Medicaid use and mental health services. The implications of this outcome have tremendous impacts for health service providers and policy makers interested in preventing and reducing health disparities in complex family structures^{6, 7}; and

WHEREAS, The mission of the Minnesota Public Health Association is to create a healthier Minnesota through effective public health practice and engaged citizens; DACA has provide many immigrants the opportunity to join the health field to work towards improving the health of Minnesotans. “Majority of DACA recipients are still students and 17 percent are pursuing an advanced degree. By contrast, most recipients of H-1B visas are between 25 and 34 and hold either a Bachelor's Degree or a Master's Degree. In short, they appear to be a close reflection of what DACA recipients will look like a few years from now as they complete their educations." DACA recipients are relatively well-educated, meaning they are highly skilled workers who benefit the rest of the nations' workers in the long term.⁸

WHEREAS, During the difficult days ahead, the Minnesota Public Health Association wants all of its Dreamers to know that: “You are welcome here in Minnesota and in our schools.”

THEREFORE, BE IT RESOLVED that the Minnesota Public Health Association Urge the Governor of Minnesota and the Minnesota Legislature:

1. To establish a Minnesota Dreamers Bill of Rights to ensure that the State of Minnesota is doing all it can to remain a welcoming place for the more than 6,000⁹ Dreamers that live, work and study in our great State.
2. To amend State law to allow Dreamers to obtain the licenses and certifications they need to enter additional professions, such as health care, education, social work and real estate, and to remain in those professions after their DACA work permit expires.
3. To establish a statewide legal protection fund to assist residents in navigating the immigration process.
4. To strongly prohibit cooperation or communication with Immigration and Customs Enforcement (“ICE”) with respect to Dreamers.
5. To disallow local governments from exempting themselves from these new Dreamer protections.

1. Memorandum on Rescission Of Deferred Action For Childhood Arrivals (DACA).https://www.dhs.gov/news/2017/09/05/memorandum-rescission-daca. Accessed 9/15/2017.
2. Pew Research Center, DACA has shielded nearly 790,000 young unauthorized immigrants from deportation, http://www.pewresearch.org/fact-tank/2017/09/01/unauthorized- immigrants-covered-by-daca-face-uncertain-future/. Accessed 9/15/2017
3. American Immigration Center. https://www.us-immigration.com/deferred-action-application-I-821D.jsp. Accessed 9/15/2017.
4. Public Health Actions for Immigrant Rights: A Short Guide to Protecting Undocumented Residents and Their Families for the Benefit of Public Health and All Society. https://unafraideducators.org/wp-content/uploads/2017/04/PHAIR_guide_2017.01.27.pdf. Accessed on 11/20/2017
5. Human Impact Partners. June 2013. Family Unity, Family Health: How Family-Focused Immigration Reform Will Mean Better Health for Children and Families. Oakland, CA. https://humanimpact.org/wp-content/uploads/2017/09/Family-Unity-Family-Health-2013.pdf. Accessed on 11/20/2017.
6. Vargas, Edward D., Immigration enforcement and mixed-status families: The effects of risk of deportation on Medicaid use, Children and Youth Services Review. Volume 57, October 2015, Pages 83–89.
7. The Lancet. Health consequences of the US Deferred Action for Childhood Arrivals (DACA) immigration programme: a quasi-experimental study. March 2017.
8. “Characteristics of H-1B Specialty Occupation Workers,” Fiscal Year 2014 Annual Report to Congress (Washington: U.S. Citizenship and Immigration Services, February 26, 2015),https://www.uscis.gov/sites/default/files/USCIS/Resources/Reports%20and%20Studies/H- 1B/h-1B-characteristics-report-14.pdf. Accessed on October 17, 2017.
9. U.S. Citizenship and Immigration Service.

WHEREAS, Tobacco industry documents show that the tobacco industry used targeting strategies intentionally tailored to market menthols to African Americans, Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) communities, and youth at disproportionate rates.^1,2 Documents also revealed Lorillard Tobacco Company characterized high-school students as “the base of our business” for menthol cigarettes,³ and

WHEREAS, a 2013 U.S. Food and Drug Administration (FDA) report showed that menthol cigarettes increase youth smoking initiation, lead to a greater addiction and decrease successes in quitting smoking.⁴ A study demonstrated that menthol levels in cigarettes were deliberately manipulated by the industry to broaden the appeal of cigarettes to youth.⁵

WHEREAS, eighty-three percent of African American youth smokers⁶ and 71 percent of LGBTQ youth smokers report smoking menthol cigarettes.⁷

WHEREAS, African Americans in Minnesota smoke at a rate of 22.3 percent.⁸ Tobacco use is the top cause of preventable death and disease among African Americans. Among adult African American smokers, 88 percent smoke menthols, compared to 26 percent of adult white smokers.⁹ Eight out of every 10 (83 percent) African American youth smokers smoke menthols.¹⁰ African Americans have the highest death rate and shortest survival rate from most cancers.¹¹

WHEREAS, members of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) communities smoke menthol cigarettes at higher rates than the general population. The smoking rate for lesbian, gay and bisexual persons in Minnesota is 25.7 percent.¹² More than 36 percent of LGBTQ smokers smoke menthol cigarettes, with LGBTQ female smokers smoking menthols at an extremely high rate (42.9 percent).¹³

WHEREAS, menthol tobacco use is a specific problem for Minnesota with 25.1 percent of smokers report smoking menthol cigarettes,¹⁴ half of Minnesota teen smokers (44.3 percent of high-school student smokers) smoke menthol cigarettes,¹⁵ and smoking-related disease rates among American Indians are at epidemic levels, and 30 percent of American Indian smokers smoke menthol cigarettes.¹⁶ 

WHEREAS, policies that regulate or restrict menthol tobacco products have potential to reduce tobacco addiction and improve health. Research suggests that if menthol were banned in the U.S., 39 percent of menthol smokers, including 47 percent of black menthol smokers, would quit smoking.¹⁷ Among Minnesota menthol smokers, approximately half reported they would quit smoking if menthol cigarettes were banned.¹⁸

WHEREAS, on 2016, the National Association for the Advancement of Colored People (NAACP) Board of Directors ratified a resolution to support efforts at local and state levels to restrict the sale of flavored and menthol tobacco products.¹⁹

WHEREAS, the a ban of menthol from cigarettes is supported by several public health entities, including the Truth Initiative (American Legacy Foundation), the American Cancer Society, ClearWay Minnesota, the American Heart Association, the American Lung Association, the Campaign for Tobacco-Free Kids, the National African American Tobacco Prevention Network, the American Academy of Pediatrics, the American Public Health Association, the Center for American Progress and the Delta Sigma Theta sorority.

THEREFORE, BE IT RESOLVED, that the Minnesota Public Health Association:

1. Supports the rights of state and local governments to regulate menthol to the extent it is legally permissible. Potential regulatory options include restricting the sale of menthol tobacco products and restricting point-of-sale advertising.
2. Supports a federal ban on menthol in cigarettes and in all other tobacco products to reduce the impact on the public’s health.
3. Support funding communities most impacted by menthol to organize from within the community and support practice-based evidence strategies that respect community tradition and knowledge.

1. Yerger VB. Menthol's potential effects on nicotine dependence: A tobacco industry perspective. Tobacco Control. 2011;20(Suppl. 2):ii29-ii36.
2. Reynolds R. Project SCUM. December 12, 1995.
3. Achy TL. Tobacco industry product information. 1978; http://legacy.library.ucsf.edu/tid/nlt13c00.
4. Food and Drug Administration. Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol versus NonMenthol Cigarettes. 2013; http://www.fda.gov/downloads/ScienceResearch/SpecialTopics/PeerReviewofScientificInformationa ndAssessments/UCM361598.pdf.
5. Kreslake J, Wayne G, Alpert H, Koh H, Connolly G. Tobacco Industry Control of Menthol in Cigarettes and Targeting of Adolescents and Young Adults. Am J Pub Health. 2008;98(9):1685- 1692.
6. Substance Abuse and Mental Health Services Administration (SAMHSA). The NSDUH Report: The Use of Menthol Cigarettes. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; November 19, 2009.
7. National Youth Advocacy Coalition. Coming Out about Smoking: A Report from the National LGBTQ Young Adult Tobacco Project. 2010.
8. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System. Minnesota data; http://www.cdc.gov/brfss/, 2015.
9. Giovino GA, Villanti AC, Mowery PD, et al. Differential trends in cigarette smoking in the USA: is menthol slowing progress? Tob Control. 2015;24(1):28-37.
10. National Youth Advocacy Coalition. Coming Out about Smoking: A Report from the National LGBTQ Young Adult Tobacco Project. 2010.
11. Society AC. Cancer Facts & Figures for African Americans 2016-2018. Atlanta: American Cancer Society;2016.
12. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System. Minnesota data; http://www.cdc.gov/brfss/, 2015.
13. Fallin A, Goodin AJ, King BA. Menthol Cigarette Smoking among Lesbian, Gay, Bisexual, and Transgender Adults. Am J Prev Med. 2014.
14. ClearWay Minnesota, Minnesota Department of Health. Minnesota Adult Tobacco Survey: Tobacco Use in Minnesota: 2014 Update. February 2015.
15. Minnesota Department of Health. Teens and Tobacco in Minnesota, 2014 Update - Results from the Minnesota Youth Tobacco Survey. November 2014.
16. American Indian Community Tobacco Projects. Tribal Tobacco Use Project Survey, Statewide American Indian Community Report. 2013.
17. Hartman AM. What Menthol Smokers Report They Would Do If Menthol Cigarettes Were No Longer Sold. Paper presented at: FDA Tobacco Products Scientific Advisory Committee MeetingJanuary 10-11, 2011.
18. D’Silva J AM, Boyle RG. Quitting and switching: Menthol smokers’ responses to a menthol ban. Tobacco Regulatory Science. April 2015;1(1):54-60.
19. NAACP Board ratifies resolution to support State and Local Restrictions on the Sale of Flavored Tobacco Products. Accessed July 20, 2017.

WHEREAS, more than 1 billion pounds of pesticides are used annually in the United States, of which 680 million pounds are used in agriculture¹; and

WHEREAS, all children are exposed to pesticides via residues on food and pesticide applications in homes, schools, and parks; and children in rural and agricultural communities are additionally exposed to agricultural pesticides that travel from nearby fields and contaminate water supplies, air or dust²; and

WHEREAS, children are particularly vulnerable to the impacts of pesticide exposure as they take in more air, water and food per pound than adults, and exposure to synthetic chemicals like pesticides—even at low doses—can have significant effects during critical windows of prenatal and childhood development^{3 4}; and

WHEREAS, rates of childhood cancer continue to rise, as do rates of autism spectrum disorder, attention deficit hyperactivity disorder and other developmental disabilities⁵, and some birth defects; and

WHEREAS, a growing body of evidence links prenatal or childhood pesticide exposure to increased risk of childhood cancers, including leukemia and brain tumors^{6 7 8}; and

WHEREAS, prenatal proximity to agricultural fields where pesticides are applied is linked with increased risks of developmental disabilities and changes in neurodevelopment, including autism spectrum disorders, ADHD, and lowered IQ^{9 10 11}; and

WHEREAS, the American Academy of Pediatrics,¹² the President’s Cancer Panel,¹³ and the American Congress of Gynecologists¹⁴ have highlighted the link between pesticide exposure and harms to human health, and called for reducing exposure to pesticides to protect human health; and

WHEREAS, six of the top eight pesticides most commonly sold in Minnesota are carcinogens, three are linked with birth defects or developmental harms, and six are suspected endocrine disruptors^{15 16 17}.

THEREFORE BE IT RESOLVED, that the Minnesota Public Health Association:

1. Calls on policy makers and state leaders to minimize children’s exposure to pesticides by setting ambitious targets for pesticide use reduction in agriculture; creating protective buffers around sensitive sites like schools and daycares; phasing out the use of pesticides most harmful to children’s health and development; and creating incentive programs to support farmers to reduce pesticide use; and
2. Urges policy makers, state agencies including the Minnesota Department of Agriculture, and the University of Minnesota to collect and release additional data on pesticide sales and/or use in Minnesota, including creating a publicly searchable pesticide use database; and
3. Calls on policy makers to improve tracking of illnesses related to pesticide exposure by making pesticide-related illness and injury a reportable disease, and allocating funding to create a Department of Health Pesticide Illness Monitoring and Prevention Program to do surveillance and outreach; and
4. Encourages its members, partners, individual health professionals and health professional associations to become familiar with the identification, treatment and reporting of acute and chronic illnesses linked to pesticide exposure; to educate patients on the health effects of pesticide exposure and encourage reduction of pesticide use in the home; and to report incidents of pesticide-related illness to state agencies and encourage patients to do the same.

1. Grube A, Donaldson D, Kiely T, Wu L. Pesticides Industry Sales and Usage, 2006 and 2007 Market Estimates. U.S. EPA. February 2011.
2. Marquez EC, Schafer KS. Kids on the Frontline, How Pesticides are Undermining the Health of Rural Children. Pesticide Action Network of North America. May 2016.
3. Landrigan P, Mattison DR, Babich HJ, Boardman B et al. Pesticides in the Diets of Infants and Children. National Academy Press, Washington DC,1993.
4. Grandjean P, Landrigan P. Neurobehavioural effects of developmental toxicity. The Lancet Neurology. 2014;13(3):330-38.
5. U.S. EPA. America’s Children and the Environment: Measures of Contaminants, Body Burdens, and Illnesses. Washington, DC. 2011.
6. Lafiura KM, Bielawski DM, Posecion NC Jr, Ostrea EM Jr, et al. Association between prenatal pesticide exposures and the generation of leukemia-associated T(8;21). Pediatr Blood Cancer. 2007;49(5):624-8.
7. Emerenciano M, Koifman S, Pombo-de-Oliveira MS. Acute leukemia in early childhood. Braz J Med Biol Res. 2007;40(6):749- 60.
8. Infante-Rivard C, Weichenthal SJ. Pesticides and childhood cancer: an update of Zahm and Ward's 1998 review. J Toxicol Environ Health B Crit Rev. 2007;10(1-2):81-99.
9. Marquez EC, Schafer KS. Kids on the Frontline, How Pesticides are Undermining the Health of Rural Children. Pesticide Action Network of North America. May 2016.
10. Shelton, Janie F., Estella Marie Geraghty, Daniel J. Tancredi, Lora D. Delwiche, Rebecca J. Schmidt, Beate Ritz, Robin L. Hansen, and Irva Hertz-Picciotto. “Neurodevelopmental Disorders and Prenatal Residential Proximity to Agricultural Pesticides: The CHARGE Study.” Environmental Health Perspectives, June 23, 2014. doi:10.1289/ehp.1307044.
11. Bennett D, Bellinger DC, Birnbaum LS, Bradman A, Chen A, Cory-Slechta DA, Engel SM, Fallin MD, Halladay A, Hauser R, Hertz-Picciotto I, Kwiatkowski CF, Lanphear BP, Marquez E, Marty M, McPartland J, Newschaffer CJ, Payne-Sturges D, Patisaul HB, Perera FP, Ritz B, Sass J, Schantz SL, Webster TF, Whyatt RM, Woodruff TJ, Zoeller RT, Anderko L, Campbell C, Conry JA, DeNicola N, Gould RM, Hirtz D, Huffling K, Landrigan PJ, Lavin A, Miller M, Mitchell MA, Rubin L, Schettler T, Tran HL, Acosta A, Brody C, Miller E, Miller P, Swanson M, Witherspoon NO. 2016. Project TENDR: Targeting Environmental Neuro-Developmental Risks. The TENDR Consensus Statement. Environ Health Perspect 124:A118–A122; http://dx.doi.org/10.1289/EHP358.
12. American Academy of Pediatrics Policy Statement, Pesticide Exposure in Children. Pediatrics. 2012;130(6):e1757-63.
13. U.S. DHHS, NIH, National Cancer Institute. 2008-2009 Annual Report, President’s Cancer Panel. Reducing Environmental Cancer Risk What We Can Do Now. April 2010.
14. American College of Obstetricians and Gynecologists Committee Opinion, Exposure to Toxic Environmental Agents. October 2013, Number 575, reaffirmed 2016.
15. MN Department of Agriculture sales data, http://www2.mda.state.mn.us/webapp/lis/chemsold_default.jsp.
16. Pesticide Action Network, Pesticide database http://www.pesticideinfo.org
17. Guyton, Kathryn Z et al. Carcinogenicity of tetrachlorvinphos, parathion, malathion, diazinon, and glyphosate. The Lancet Oncology, 2015;16(5):490-91.

WHEREAS, a large and growing body of scientific evidence demonstrates adverse effects on neurodevelopment among children with blood lead concentrations above 5 μg/dL, including lower IQ, reduced cognitive ability and academic aptitude, as well as attention deficit/hyperactivity disorder (ADHD)andconductdisorder(CD)^{1 2 3 4 5 6 7 8 9 10 11};and

WHEREAS, an alliance of 48 leading scientists, health professionals and advocates agree that environmental toxins, including lead, are putting children at risk for adverse effects on neurodevelopment¹²; and

WHEREAS, MPHA’s 2009 resolution entitled Protecting Children from Harmful Effects of Lead in the Environment presents the scientific evidence for adverse effects on brain development and behavior at blood lead levels of 5 ug/dL and supports policies that set a blood lead level of concern at 5 ug/dL to protect the health and brain development of children; and

WHEREAS, the Centers for Disease Control and Prevention (CDC)¹³ and the Minnesota Department of Health (MDH)¹⁴ now recognize 5 ug/dL as a reference blood lead level to identify children whose blood lead levels are higher than most children; and

WHEREAS, 1.1 % of Minnesota children tested by 3 years of age had blood lead levels of 5 ug/dL or higher¹⁵ and African-American children as a group and children from lower-income families (of any racial or ethnic background) are subject to disproportionately high exposures¹⁶; and

WHEREAS, lead is still found in the soil, especially in urban areas, and in paint in 75% of the homes built before ^{17 18 19}; and

WHEREAS, lead in drinking water can be a significant source of exposure for children due to the presence of lead in older (pre-1930) water pipes, lead-based solder and brass components in pre-1985 plumbing¹⁸; and

WHEREAS, lead is also found in recycled waste tires used as playground mulch and synthetic turf athletic field infill¹⁹, exposing children and athletes when they play; and

WHEREAS, MDH has identified lead as a priority chemical under the Toxic Free Kids Act, indicating a key exposure for children²⁰; while the U.S. Consumer Product Safety Commission bans lead in most toys and child care articles for younger children, it is still found in many consumer products, including imported pottery and candy, antique or imported toys, crafts and jewelry materials, wheel weights, and fishing tackle, batteries, and some products for older children and pets; and

WHEREAS, lead-based ammunition is one of the greatest unregulated sources of lead discharged into the environment and the second largest annual use of lead in the U.S., accounting for over 60,000 metric tons in 2012, and lead-based ammunition poses significant health risks to humans, especially gun users and people who consume wild game,^{21 22 23 24 25} including pregnant women and children;^{26 27}and

WHEREAS, banning lead in ammunition reduces wildlife²⁸ and human exposure to lead for people who consume wild game^{29 30} and banning lead in paint and gasoline has resulted in significant reductions in blood lead levels³¹: These interventions demonstrate the value of public policy in reducing human exposure to lead; and

WHEREAS, investment in lead exposure prevention can yield great economic returns: Decades after the phase-out of lead from gasoline and paint, children‘s lead exposure from other sources still costs the U.S. economy an estimated $50.9 billion per year in lost productivity when children become adults of working age³²; MDH estimates the cost in Minnesota alone is $1.9 billion in 2014 dollars³³.

THEREFORE, BE IT RESOLVED, that the Minnesota Public Health Association:

1. Urges state and federal regulators to restrict the remaining uses of lead in consumer products and urges businesses to eliminate lead from their supply chains and products.
2. Recommends that health professionals integrate knowledge about all sources of lead exposure into patient care and public health practice.
3. Urges policymakers to accelerate the clean-up of past uses of lead, such as in paint and water pipes and better regulate industrial uses of lead to prevent future discharges.
4. Recommends a moratorium on new uses of recycled waste tire mulch and crumb rubber in playgrounds and athletic fields to prevent children’s exposure to lead and other toxicants.
5. Recommends a comprehensive approach to reducing the use of lead-based ammunition and fishing tackle - including public policy and education - to reduce risks to humans and wildlife.

1. Canfield RL, Henderson CR Jr, Cory-Slechta DA, Cox C, Jusko TA, Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 μg/dL. New England Journal of Medicine. 2003;348(16):1517-26.
2. Jusko TA, Henderson CR, Lanphear BP, Cory-Slechta DA, Parsons PJ, Canfield RL. Blood lead concentrations <10 μg/dL and child intelligence at 6 years of age. Environmental Health Perspectives. 2008;116(2):243-8.
3. Lanphear BP, Hornung R, Khoury J, Yolton K, Baghurst P, Bellinger DC, Canfield RL, Dietrich KN, Bornschein R, Greene T, Rothenberg SJ, Needleman HL, Schnaas L, Wasserman G, Graziano J, Roberts R. Low-level environmental lead exposure and children's intellectual function: an international pooled analysis. Environmental Health Perspectives. 2005;113(7):894-9.
4. Surkan PJ, Zhang A, Trachtenberg F, Daniel DB, McKinlay S, Bellinger DC. Neuropsychological function in children with blood lead levels <10 μg/dL. Neurotoxicology. 2007;28(6):1170-7.
5. Téllez-Rojo MM, Bellinger DC, Arroyo-Quiroz C, Lamadrid-Figueroa H, Mercado-García A, Schnaas-Arrieta L, Wright RO, Hernández-Avila M, Hu H. Longitudinal associations between blood lead concentrations lower than 10 μg/dL and neurobehavioral development in environmentally exposed children in Mexico City. Pediatrics. 2006;118(2):e323-30.
6. Lanphear BP, Dietrich K, Auinger P, Cox C. Cognitive deficits associated with blood lead concentrations <10 μg/dL in US children and adolescents. Public Health Reports. 2000;115(6):521-9.
7. Miranda ML, Kim D, Galeano MA, Paul CJ, Hull AP, Morgan SP. The relationship between early childhood blood lead levels and performance on end-of-grade tests. Environmental Health Perspectives. 2007;115(8):1242-7.
8. Braun JM, Kahn RS, Froehlich T, Auinger P, Lanphear BP. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environmental Health Perspectives. 2006;114(12):1904-9.
9. Chiodo LM, Covington C, Sokol RJ, Hannigan JH, Jannise J, Ager J, Greenwald M, Delaney-Black V. Blood lead levels and specific attention effects in young children. Neurotoxicology and Teratology. 2007;29(5):538-46.
10. Nigg JT, Knottnerus GM, Martel MM, Nikolas M, Cavanagh K, Karmaus W, Rappley MD. Low blood lead levels associated with clinically diagnosed attention-deficit/hyperactivity disorder and mediated by weak cognitive control. Biological Psychiatry. 2008;63(3):325-31.
11. Braun JM, Froehlich TE, Daniels JL, Dietrich KN, Hornung R, Auinger P, Lanphear BP. Association of environmental toxicants and conduct disorder in U.S. children: NHANES 2001-2004. Environmental Health Perspectives. 2008;116(7):956-62.
12. Project TENDR: Targeting Environmental Neuro-Developmental Risks. The TENDR Consensus Statement. Environ Health Perspectives 2016;124(7):A118-A122.
13. Centers for Disease Control, Update on Blood Lead Levels in Children https://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm accessed July 26, 2016.
14. Minnesota Department of Health, Blood Lead Screening Guidelines for Pregnant and Breastfeeding Women in Minnesota (August 2015) http://www.health.state.mn.us/divs/eh/lead/guidelines/ accessed July 26, 2016.
15.  Minnesota Department of Health, https://apps.health.state.mn.us/mndata/lead_level accessed July 26, 2016.
16. U.S. Environmental Protection Agency, Office of Children‘s Health Protection. America’s Children and the Environment: Measures of Contaminants, Body Burdens, and Illnesses, 2nd Edition. EPA Pub. No. 240-R-03-001. Washington, DC, February 2003.
17. Minnesota Department of Health, http://www.health.state.mn.us/divs/eh/lead/homes/ accessed July 26, 2016.
18. Minnesota Department of Health, http://www.health.state.mn.us/divs/eh/lead/fs/common.html#food accessed July 26, 2016.
19. Brown DR, Artificial Turf - Exposures to Ground-Up Rubber Tires, Environment & Human Health Inc., 2007.
20. Minnesota Department of Health, Toxic Free Kids Act Priority Chemicalshttp://www.health.state.mn.us/divs/eh/hazardous/topics/toxfreekids/priority.html#chemicals accessed July 26, 2016.
21. Bellinger DC, Bradman A, Burger J, Cade TJ et al. Health Risks from Lead-Based Ammunition in the Environment – A Consensus Statement of Scientists. Environ Health Perspectives 2013;121:A178-A179.
22. Pain DJ, Cromie RL, Newth J, Brown MJ et al. Potential hazard to human health from exposure to fragments of lead bullets and shot in the tissues of game animals. PLoSOne. 2010;5(4):e10315.
23. Grainger Hunt W, Watson RT, Oaks JL, Parish CN et al. Lead bullet fragments in venison from rifle-killed deer: potential for human dietary exposure. PLoS One. 2009;4(4):e5330.
24. Iqbal S, Blumenthal W, Kennedy C, Yip FY et al. Hunting with lead: association between blood lead levels and wild game consumption. Environ Res. 2009;109(8):952-9.
25. Meltzer HM, Dahl H, Brantsaeter AL, Birgisdottir BE et al. Consumption of lead-shot cervid meat and blood lead concentrations in a group of adult Norwegians. Environ Res. 2013;127:29-39.
26. Taylor CM, Golding J, Emond AM. Intake of game birds in the UK: assessment of the contribution to the dietary intake of lead by women of childbearing age and children. Public Health Nutr. 2014;17(5):1125-9.
27. Green RE, Pain DJ. Potential health risks to adults and children in the UK from exposure to dietary lead in gamebirds shot with lead ammunition. Food Chem Toxicol. 2012;50(11):4180-90.
28. Legagneux P, Suffice P, messier JS, Lelievre F et al. High risk of lead contamination for scavengers in an area with high moose hunting success. PLoS One. 2014;9(11):e111546
29. Mateo R, Vallverdu-Coll N, Lopez-Anita A, Taggart MA et al. Reducing Pb poisoning in birds and Pb exposure in game meat consumers: the dual benefit of effective Pb shot regulation. Environ Int. 2014;63:163-8.
30. Couture A, Levesque B, Dewailly E, Muckle G et al. Lead exposure in Nunavik: from research to action. Int J Circumpolar Health. 2012;17:18591.
31. Centers for Disease Control http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5608a1.htm#tab1
32. Trasande L, Liu Y. Reducing the staggering cost of environmental disease in children, estimated at $76.6 billion in 2008. Health Affairs 2011;30(5):863-70.
33. Minnesota Department of Health, The Economic Burden of the Environment on Two Childhood Diseases: Asthma and Lead Poisoning in Minnesota, December 2014. http://www.health.state.mn.us/tracking/pubs/BurdenReport.pdf

WHEREAS, firearm injuries and the use of firearms in violent acts are a threat to the wellbeing of Minnesota residents across the state; and,

WHEREAS, 410 firearm fatalities occurred in 2015 in Minnesota¹; and,

WHEREAS, between 2010-2014, there were 1,559 firearm suicide deaths reported in Minnesota²; and,

WHEREAS, it is estimated that about 500 Minnesota residents are hospitalized or receive emergency care as a result of firearm injuries each year³; and,

WHEREAS, fatal and non-fatal gun injuries cost Minnesota $764 million per year in healthcare costs, criminal justice expense, employer costs, and lost income⁴; and,

WHEREAS, this cost increases to an estimated $2.2 billion per year with the addition of reduced quality of life caused by pain and suffering⁴; and,

WHEREAS, a study by the Urban Institute found that one less gun homicide in Minneapolis in a given year was associated with the creation of 80 jobs and an additional $9.4 million in sales across all businesses in the following year⁴; and,

WHEREAS, the cost of gun violence in Minnesota is equal to 11% of the state’s yearly general fund spending⁴; and,

WHEREAS, firearm related death rates are seven times higher in the states with the highest rates of household gun ownership when compared to states with the lowest rates of household gun ownership⁵; and,

WHEREAS, people who live in a home with a gun are more likely to die by suicide than those without access to a firearm²; and,

WHEREAS, In the United States, approximately 1.7 million children live in a home with access to an unlocked, loaded gun⁶; and,

WHEREAS, a 1996 congressional appropriations bill stipulated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control.” Similar restrictions were extended to other agencies (including the National Institutes of Health), although the legislation does not ban gun-related research outright^7,8; and,

WHEREAS, in two places in Minnesota state law there are prohibitions against the collection of data regarding guns, which prevents essential public health research from taking place⁹; and,

WHEREAS, states that require background checks for all gun sales report a lower rate of suicide¹⁰, domestic violence homicide¹¹, and police killed with handguns¹²; and,

WHEREAS, in Minnesota, no background check is required to purchase through a private sale or transfer, which makes it easy for those who are prohibited from possessing a gun under federal and state law, to obtain a firearm⁴; and,

WHEREAS, three laws most strongly associated with reduced homicide-specific firearm mortality are universal background checks for firearm purchase, background checks for ammunition, and firearm identification¹³; and,

WHEREAS, laws requiring firearm identification are associated with reduced suicide-specific firearm mortality¹³; and,

WHEREAS, devising an effective public health approach for Minnesota must recognize both the health impact of the misuse of firearms and the right of law-abiding citizens to own and use firearms; and,

WHEREAS, previous MPHA gun violence prevention resolutions have supported state and federal legislation that would: (1) limit the access to handguns and high-powered assault pistols; (2) maximize the ability to limit firearm permits to only those who are legally permitted to own one; (3) minimize the number of permits to carry loaded, concealed weapons; (4) limit the purchase of handguns to a maximum of one per month; (5) prevent firearms from entering the illegal gun market; and (6) maximize the ability of law enforcement to identify and penalize those who provide firearms to young people and others who are prohibited from possessing them.

THEREFORE, the Minnesota Public Health Association resolves that:

First, funds should be allocated to conduct surveillance for all forms of violent injury and research regarding the role of firearms in violence, and the effectiveness of different types of firearm laws and prohibitions in Minnesota state law against collecting gun-related data should be overturned so that date can be collected for the sole purpose of public health research and policy development;

Second, firearm owners should store guns unloaded and locked, with ammunition locked separately, to reduce unintentional injury and suicide risk.

Third, background checks should be implemented universally, including firearm purchases and exchanges, coordinated with national efforts to close all loopholes in the current system, including online, gun show, and individual firearm sales;

Fourth, firearms sellers should be held accountable by law enforcement and statute when selling to prohibited purchasers;

Fifth, all agents selling and exchanging firearms should be licensed and tracked; in the event that a non- licensed seller wishes to sell a firearm, it should take place at a Federal Firearm Licensee location;

Sixth, ammunition purchases should be taxed to fund firearm injury prevention efforts; Seventh, “military-style assault weapons” with magazines in excess of ten rounds should be banned because of the potential of these firearms to be used in mass shootings; and

Eighth, MPHA opposes the carrying of concealed and non-concealed firearms in public places, except those carried by law enforcement.

1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2014) Available at: http://www.cdc.gov/injury/wisqars/index.html.
2. Brady Center to Prevent Gun Violence. The Truth About Suicide & Guns. Available at: http://www.bradycampaign.org/the-truth-about-suicide-guns
3. Minnesota Department of Health, Injury and Violence Prevention Unit. Web-based Minnesota Injury Data Access System (MIDAS) [online]. (2016) Available at: http://www.health.state.mn.us/injury/midas/violence/index.cfm
4. Minnesota Coalition for Common Sense. The Economic Cost of Gun Violence in Minnesota: A Business Case for Action. (2016). Available at: http://americansforresponsiblesolutions.org/files/2016/12/The-Economic-Cost-of-Gun-Violence.pdf
5. Harvard School of Public Health: Harvard Injury Control Research Center. Homicide – Suicide – Accidents – Children and Women. Boston: Harvard School of Public Health. (2009). Available at: http://www.hsph.harvard.edu/research/hicrc/firearms-research/guns-and-death
6. Brady Center to Prevent Gun Violence. The Truth About Kids & Guns. Available at: http://www.bradycampaign.org/the-truth-about-kids-guns
7. Kellermann AL, Rivara FP. Silencing the science on gun research. JAMA. 2013;309(6):549-550.
8. Rubin R. Tale of 2 agencies: CDC avoids gun violence research but NIH funds it. JAMA. 2016;315(16):1689-1691.
9. MN Statute 144.05 and 625.714
10. Everytown for Gun Safety. State Background Check Requirements and Suicide. Available at: http://every.tw/1Aj9CVz 11
11. Everytown for Gun Safety. State Background Check Requirements and Rates of Domestic Violence Homicide. Available at: http://every.tw/1Aj9HZj
12. Everytown for Gun Safety. State Background Check Requirements and Rates of Firearm Homicide Against Law Enforcement. Available at: http://every.tw/1Aj9JAy
13. Kalesan, Bindu et al. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Te Lancet, 2016;387(10030):1847–1855