José L. González Office of Minority and Multicultural Health 625 Robert St. N P.O. Box Saint Paul, MN

The Office of Minority and Multicultural Health The purpose of the Office of Minority and Multicultural Health is to provide leadership within MDH to strengthen the health and wellness of Minnesota’s communities by engaging populations of color and American Indians in actions essential to eliminate health disparities and achieve health equity. Lou Fuller

The Minnesota Department of Health Mission: To protect, maintain, and improve the health of all Minnesotans MDH Goal: To eliminate health disparities and achieve health equity “Minnesota has one of the highest rates of health disparities for populations of color and American Indians in the country, and that is unacceptable.” Edward P. Ehlinger, MD, MSPH Commissioner of Health

WHAT’S NORTH OF LAKE GENEVA, WI?

Minnesota Population Change: Racial/Ethnic Group Percent Change African American 94,944171,731274, American Indian 49,90954,96760, Asian 77,886143,947216, Hispanic 53,884143,382250, White 4,130,3954,400,2824,524, % Non-White5.6%10.6%14.7% Total Population 1 4,375,0994,919,4795,303, Source: US Census, the population for Census data is from 100-percent data based on single race categories 1 The added value of each population group does not add up to “Total Population” because Hispanic, who can be any race are not counted in the total and because “Some other race alone” and “Two or more races” are not shown.

Immigrants living in Minnesota, 2010 Racial/Ethnic Group Foreign-born Population Percent Foreign-born Population African American 4,92976, American Indian Asian 76,771131, Hispanic 49,66496, White 113,039131, Source: US Census, Race Alone

Laws Guarantee Access  Title VI of Civil Rights Act of 1964 “No person in the United States shall, on ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal assistance.”  Minnesota Statutes 1995 (15,441) “Every state agency that is directly involved in furnishing information or rendering services to the public and that serves a substantial number of nonEnglish-speaking people shall employ enough qualified bilingual persons in public contact positions, or enough interpreters to assist those in these positions to ensure provision of information and services…”

Cultural Competency Proficiency Culture influences an individual’s health beliefs, practices, behaviors, and even the outcome of medical treatments. What is Cultural Competency Proficiency? “The ability of individuals and systems to respond respectfully and effectively to people of all cultures, in a manner that affirms the worth and preserves the dignity of individuals, families, and communities.” Why “Proficiency?” 1) The learning never stops and it operates on a continuum 2) The learning and teaching should be a two-way process (Integration)

Bicultural Continuum *Marilyn Vigil, Eustolio Benavides, Joan Velasquez

Six Steps Towards Cultural Competence Proficiency 1) Involve patients in their own health care 2) Learn more about culture; starting with our own 3) Speak the language; or use a trained interpreter 4) Ask the right questions and look for answers 5) Pay attention to financial issues 6) Find resources and form partnerships

A Competent Interpreter 1) Introduces self and explains role 2) Positions self to facilitate communication 3) Accurately and completely relays the message between patient and provider 4) Uses the interpretation mode that best enhances comprehension 5) Reflects the style and vocabulary of the speaker 6) Ensures that the interpreter understands the message to be transmitted 7) Remains neutral 8) Identifies and separates personal beliefs from those of other parties 9) Identifies and corrects own mistakes 10) Addresses culturally based miscommunications when necessary

An Ethical Interpreter 1) Maintains confidentiality 2) Interprets accurately and completely 3) Maintains impartiality 4) Maintains professional distance 5) Knows own limits 6) Demonstrates professionalism

The Larger Challenge More than half of a person’s health is driven by social factors –Income: each additional $10,000 in an area’s median household income is associated with a full year gain in life expectancy –Education: Life expectancy is nearly 5 years less for those with the lowest levels of education; compared to those with a high degree of post-secondary education attainment –Race: Life expectancy in the Twin Cities swings widely from 83 years for Asians to 61.5 years for American Indians –Neighborhood: Children born into the highest income areas live 8 years longer than those born into our poorest communities “Revealing socioeconomic factors that influence your health,” supplement to The unequal distribution of health in the Twin Cities. BCBS Foundation of MN/Wilder Foundation, October 2010

The Easier Challenge Use trained interpreters/cultural brokers Use trained Community Health Workers (CHWs), Community Health Representatives (CHRs), Doulas From the Community Take at least one annual training, seminar, workshop to increase your cultural awareness and to help you be more culturally responsive Be Brave