Before she reaches her first birthday, a black child in Minnesota is more than twice as likely to die as a white child.

An American Indian high school student is twice as likely to have suicidal thoughts as his white classmate.

And Hispanic Minnesotans are three times as likely to be uninsured as their white neighbors.

These and other stark racial gaps in the health of Minnesotans are documented in a new report prepared for the Legislature, with health officials warning Friday that Minnesota must tackle deep-seated problems if it is to close what are some of the widest racial health disparities in the nation.

In unusually blunt language, state Health Commissioner Dr. Edward Ehlinger laid part of the blame on "structural racism," which, he said, all Minnesotans must confront in order to bridge the gap.

"Everybody is damaged by health disparities," Ehlinger said in an ­interview on Friday.

As one example of deep institutional health barriers, Ehlinger cited the Health Department's own radon testing program. It educates homeowners to test their houses for the chemical, which can cause lung cancer. But only one-fifth of black residents own their own homes in Minnesota — compared to 75 percent of white residents — meaning that blacks were less likely to be reached by the program and, as renters, less likely to be able to install radon remediation systems where they live.

The report suggests ­far-reaching reforms, which could include such measures as raising the state minimum wage — because health is linked to poverty — and changes in state education, housing and transit policies.

"It's an issue that cannot be resolved just by the medical care system," Ehlinger said.

'Health equity'

In addition to presenting their findings to legislators, health officials plan to establish a Health Department ­center focusing on "health equity" and to meet with stakeholders throughout the state. The Health Department will even evaluate itself for structural racism, and work to recruit and hire more people of color, the report said.

Whether the report will lead to action at the Legislature remains unclear. Rep. Jim Abeler, an Anoka Republican who is a leading voice on health policy, said he agrees the state needs to do more to reduce its health disparities, but said blaming structural racism is misguided.

"They would rather study a problem than to do anything about it," he said. "… It's not [about] creating new ­programs. There's a lot of programs; you've just got to make sure that they're directed toward the greatest needs."

Infant mortality

Lacretia Larson has seen the complexity of one health problem — infant mortality — close up.

Larson is a health division manager for the Leech Lake Band of Ojibwe, which received a $140,000 state grant last year to improve infant health.

Tribal leaders are using the money to train educators so they can teach families parenting techniques like the importance of healthy food, nonviolence and reducing stress. Home visits make the program more effective, Larson said, because the farthest houses on the reservation can be up to 50 miles from the clinic.

Ehlinger said the issue is ultimately a complex one that won't have a simple solution.

"This is not a one-year program," he said. "This is changing how we do business from this point on, and everybody has a role in it."

Rebecca Harrington is a University of Minnesota student reporter on assignment for the Star Tribune.