By Charles N. Oberg, MD, FAAP, Program Director of Maternal and Child Health at the University of Minnesota’s School of Public Health and pediatrician at Hennepin County Medical Center…
Minnesota prides itself on being one of the finest places to raise a family and has frequently been ranked as one of the healthiest states in the country. In 2004, the Annie E. Casey Foundation ranked Minnesota first overall in the well-being of its children using 16 measures of child well-being in the four major domains of economics, education, health, and family. But in its 2013 report, Minnesota had slipped to fourth overall and 15th in the health of children category. This decline in our state ranking is resulted in part to persistent disparities in health outcomes for minority children in Minnesota. Infant mortality and immunizations are two health outcomes that epitomize these disparities.
The Infant Mortality Rate or IMR is considered by many as a pre-eminent marker of the overall health of a community. Minnesota’s IMR is 4.61 infant deaths per 1,000 live births–better than the national average of 6.39. But this is largely the result of Minnesota’s IMR for non-Hispanic, white-infants, which is at is 4.14. For African Amerian infants, Minnesota is worse than the national average–at 7.44. Minnesota is similarly worse than the national average for American Indian children–at 8.6.
Minnesota’s overall high ranking also holds true for immunization. Overall, Minnesota ranked seventh in the nation among children fully immunized at 19-35 months old. But stark differences in Minnesota’s immunization rates emerge based on a child’s race and ethnicity. The percent of children fully immunized was 85 percent for white, non-Hispanic toddlers but only 73 percent for American Indians, 66 percent for Asian/Pacific Islanders, 65 percent for Hispanics, and 63 percent for non-Hispanic African Americans.
These are just two of the measures. Others similarly demonstrate the disparities in health care across the state varying by race and ethnicity.
Minnesota pediatricians take pride in the access and quality of care we deliver to our children and their families. However, there is a danger when we, as Minnesotans, consistently see the overall health of our children held up as an example to the rest of the nation. We must celebrate the success but realize that the gradual slippage of our overall state as well as persistent disparities indicate that there is still work to be done.
First, we must continue to be cognizant of persistent disparities and translate that knowledge into action. This includes the ongoing promotion of “Back to Sleep,” smoking cessation, and breast-feeding in our practices as primary prevention strategies to reduce infant deaths. We know that the adoption of these strategies are not evenly utilized by communities of color due to access, poverty, non-financial barriers, and cultural differences.
With regard to immunizations, we must remain vigilant in the promotion of the efficacy of vaccines for children. We must also encourage participation in the Vaccines for Children program as well as Medicaid, MinnesotaCare, and MNSure. It will be through such efforts that we will be able to achieve the equity we as pediatricians strongly embrace.
