In their 2019 state of the state speeches, 13 governors addressed social equity, acknowledging that reducing inequities and improving opportunities for all residents improves lives and health outcomes. Two of them — Indiana and Minnesota – offer examples of how states are orchestrating their legislative and administrative efforts to reduce health disparities and promote social equity.
Of the many factors that influence health, 80 percent occur outside of the health care system, such as access to safe and affordable housing, high-quality education, and employment opportunities. Across the nation, health disparities persist where racial and ethnic discrimination, gender inequities, class distinctions, and other barriers systemically keep certain people from the opportunities and resources needed to live long and healthy lives.
These health disparities can be observed and tracked by state, county, zip code, or neighborhood. Indiana and Minnesota state policymakers are using budget appropriations, executive orders, and legislation to improve social equity.
Gov. Eric Holcomb and a group of Indiana state leaders are tackling disparities in infant mortality under the umbrella of health equity. Their goal is to lower the state’s rate of infant mortality across all zip codes by improving services for expecting mothers.
In May, Gov. Holcomb signed a bill to address infant mortality and establish a perinatal navigator program. The program engages pregnant women in evidence-based, early prenatal care to improve outcomes regardless of where a woman lives by providing referrals for wraparound services and community-based, home-visiting programs. There is an evidence base to support the positive impact on birth outcomes of community-based programs like these that address social determinants of health. The new law also establishes a program to provide more nurse partners and community health workers to coach, care for, and educate young women during pregnancy.
Across the United States, African Americans experience a higher infant mortality rate than any other racial group — and this is true in Indiana as well. From 2013 to 2015, Indiana’s infant mortality rate averaged 7.13 per 1,000 live births, compared to the 2015 national average of 5.90 per 1,000 live births. The non-Hispanic black population infant mortality rate in Indiana was much higher, at 13.26 per 1,000 live births. Indiana’s plan to boost resources for pregnant women and to engage women sooner in supportive care is designed to make pregnancy outcomes — and overall health outcomes — more equitable for all.
In Minnesota, Gov. Tim Walz and state leaders are using a variety of levers to address the structural components of inequity. The initiatives proposed in the budget or enacted through executive orders are designed to reduce disparities in educational achievement and hiring experienced by racial minorities in Minnesota. Though not directly tied to health, these disparities can lead to income inequality and other stressors that are strongly associated with poor health outcomes — so Minnesota’s upstream approach has the potential to improve health across the state.
Minnesota’s state budget, approved in late May, included a 2 percent increase in per-pupil funding to public schools, which is part of Gov. Walz’s plan to reduce disparities in educational achievement by improving school resources across the state. He also proposed a Community Solutions Fund in his budget that would provide local groups with grants to help them address children’s health care issues in a flexible way.
Gov. Walz also issued an executive order at the beginning of his term creating the Diversity, Inclusion and Equity Council. Headed by Chris Taylor, the state’s new Chief Inclusion Officer, the council will focus in part on diversifying the state workforce as another strategy to address historic structural inequities. The council’s long-term approach to address disparities is designed to level Minnesota’s economic and social playing fields and improve social equity and health outcomes for all.
The approaches taken by Minnesota’s and Indiana’s governors demonstrate how state leaders can push for social equity with targeted or broad systemic changes to improve overall social conditions. As more policymakers adopt an upstream approach to health and address inequities, they can reduce economic, social, and discrimination-based obstacles to generate better health outcomes for all.