With the election behind us, COVID vaccines rolling out and the state's legislative session about to begin, it's time to start planning for life after the pandemic.
Minnesotans need to be healthier — physically, mentally and civically. We must commit to the vision of a state whose people and communities thrive.
Health and well-being are declining in our state on many fronts, including poor birth outcomes (especially for rural, Black and Indigenous Minnesotans), rising suicide, obesity and addiction rates, and declining mental health. COVID and the death of George Floyd in police custody have helped bring inequities into stark relief.
Once Minnesota, overall, was the envy of the country, rating among the top three healthiest states for more than a decade. Now, we rank seventh on UnitedHealth's respected list and may lose further ground in the coming years. The United States, meanwhile, is near the bottom of the list among developed nations. Why?
The answers boil down to this: Relative to the rest of the developed world, America invests little in the "upstream" social, behavioral and economic factors that create the conditions for the health and well being of its people. Worse, for decades we have created conditions that assure non-whites and people marginalized for other reasons are deprived of equity in education, health, social support and employment. Discrimination costs all of us through lost productivity, wasted lives and violence.
Solutions lie upstream in factors such as public policies, the environments we live in, social and economic conditions, and behaviors influenced by our social and community context. We need livable, equitable and connected communities, in other words. Yet we spend most of our money on sick care and "containment" of social problems downstream.
Consider the disparate budgets of the state Department of Health — which emphasizes preventive health policy — and the Department of Human Services, which primarily spends on "downstream" health services and long-term care. The health department's budget totals less than 2% of that of the Human Services Department.
Other countries have learned that spending "upstream" lowers the cost of downstream fixes. But in the U.S. and Minnesota, we have narrowed our focus to a small area of the relevant landscape. We are expecting less and paying more for it. And our lack of preparedness for a predicted pandemic has made this worse.