The unequal distribution of health in the Twin Cities

Oct 2010

The following is an invited response by Nan Madden, Minnesota Budget Project director, to a report released by the Blue Cross and Blue Shield Foundation of Minnesota, The Unequal Distribution of Health in the Twin Cities.

The disparities existing today in health outcomes and income should be a concern for all in our region. Income inequality, with persistent disparities between whites and people of color, contradicts our most deeply held values. Minnesotans believe that hard work should pay off, that people who work full-time should be able to support their families, and that everyone who is willing to work should have the opportunity to succeed. Gaps like those in the Twin Cities today make people distant from each other. That distance undermines our sense of shared destiny. It weakens trust in our public institutions.

The economic future and quality of life in the Twin Cities depend on everyone having access to opportunity. That means quality jobs, a good education and all the things that make for a healthy life. Deep economic and racial disparities that exist today in incomes and health outcomes are an obstacle to this goal.

That’s why making progress in closing the gaps in health and in income is so important. They will have a powerful effect in improving people’s lives. This is critical not only for the sake of justice, but also to ensure our region’s economic success.

The report found that “income is the single most important social determinant of health in the Twin Cities.” So, making sure all Minnesotans have access to quality jobs is just as important — if not more so — than health care policies. Good jobs mean a significant improvement in income, which, in turn, will help eliminate health disparities.

Unfortunately, the Twin Cities’ income and employment disparities are as stark as those found in health. The median household income for African Americans in the Twin Cities is less than half that for white non-Hispanics. In fact, blacks in Minneapolis are 3.1 times more likely to be unemployed than whites, according to a recent study by the Economic Policy Institute (EPI). That is the widest level of disparity among the 50 largest metropolitan areas in the United States.[1] As my colleague Christina Wessel wrote, “it is already widely known that Minnesota has one of the largest educational achievement gaps in the nation. But the gaps in educational attainment don’t explain the wide disparities in unemployment. EPI found that among blacks and whites with similar levels of education, blacks were still much more likely to be unemployed in Minneapolis. It’s likely the unemployed are finding it difficult to get adequate and appropriate job training, lack the social connections that are so important in job hunting during a recession and are coming up against prejudice during the hiring process.”[2]

We can make choices about what kind of economy we have. Those choices should take into account that economic prosperity in our region depends on all Twin Cities residents having the chance to reach their fullest potential in education and employment. Policy choices that help reduce income and employment disparities ensure that all people in our region have access to opportunities for education and a good job.

A number of state investments help parents access and maintain employment and earnings, and also improve opportunities for their children’s success. Affordable, quality early childhood education, for example, helps children enter kindergarten ready to learn and at the same time frees their parents to work. Finding an affordable place to live is also crucial; it provides greater stability for children — and that stimulates higher school achievement.

Much still needs to be done so that all children receive a quality K-12 education that gives them the skills needed to earn the post-secondary credentials or degrees essential for good jobs. And higher education needs to be affordable and accessible not just to recent high school graduates, but also to current workers seeking to improve their skills.

Barriers to Reducing Inequalities in Minnesota

But Minnesota has been reducing its investments in all of these key areas. A decade of the state receiving less in revenues than what would be required to meet growing needs has taken its toll.

State funding for schooling from early childhood through grade 12, child care assistance, higher education, and affordable housing and homelessness prevention did not keep up with inflation from 2003 to 2009, the Minnesota Budget Project found in a report called, The Lost Decade: Taking a Closer Look at Minnesota’s Public Investments in the 2000s.[3] In addition, our analysis shows:

  • Minnesota lost ground compared to other states. In 2006, Minnesota had fallen to average levels in education spending and below average in higher education.
  • In-state tuition rose by 55 percent at our Minnesota State Colleges and Universities and 68 percent in the University of Minnesota system from 2000 to 2007. At the same time, average state grants for students trying to pay the higher tuition decreased.[4]
  • 11,000 fewer children received child care assistance after dramatic funding cuts in 2003.
  • The number of Minnesota households spending more than half of their income on housing more than doubled between 2000 and 2006.

What Policies Could Reduce Inequalities

Through the public investments it makes in a wide range of areas, state government needs to be a partner with the nonprofit sector, the business community and Minnesota’s residents in building a state with a high quality of life where everyone has the opportunity to succeed. Public investments help those who face more serious challenges attain a decent standard of living for their families. That makes Minnesota’s economy and quality of life stronger. But Minnesota’s inadequate responses to fiscal challenges in this decade have eroded the state’s commitments to these public investments.

Quality jobs — needed to close the income gap in the Twin Cities — don’t just “happen.” Government has a role to play, through policies like increasing the state minimum wage to reward work, giving working men and women access to paid time off for sick days and directing economic development, employment and training efforts toward disenfranchised communities. A recent policy success in promoting economic equity noted by the Organizing Apprenticeship Project is promoting hiring equity in green jobs.[5]

Investments worth making don’t always come cheap. Improving Minnesota’s standard of living and making it a more attractive place to build a business and raise a family means confronting the failures of the state’s tax system. Minnesota needs a state and local tax system based to a greater degree on ability to pay, where the richest households and most profitable businesses contribute their fair share.

Clearly, our region faces stark challenges. But that need not be cause for dismay. We also have significant resources to draw on. The most important of these are the strengths of low-income communities and people of color themselves. They must be an important part of the planning and implementation of initiatives to address health and economic disparities. We should also seek to address both kinds of disparities — health and income — in our initiatives.

For example, addressing health disparities by increasing the number of health care facilities would create new jobs. Setting up farmers’ markets where residents can buy fresh foods, and building and staffing new recreation centers — these all are ways of combating both health and income disparities at the same time.

In the end, The Unequal Distribution of Health in the Twin Cities provides more numbers and details that demonstrate what we’ve suspected for some time. The Twin Cities is in danger of becoming two distinct communities — one where people have good jobs and limitless opportunity, and one where people who want to work and provide for their families face more hurdles than many can conquer.

It’s our job now to use these findings as a road map to plot a future of growth that leaves no one out. When we’ve accomplished that, the Twin Cities truly will be a prosperous region, in every sense of the word.

[1] Economic Policy Institute, Uneven Pain: Unemployment by metropolitan area and race, June 2010.
[2] Christina Wessel, “Minneapolis unemployment rates show highest racial disparity in the nation,”
[3] Minnesota Budget Project,
The Lost Decade: Taking a Closer Look at Minnesota's Public Investments in the 2000s, December 2008.
[4] Both tuition and financial aid figures have been adjusted for inflation.
[5] Organizing Apprenticeship Project,
2009 Legislative Report Card on Racial Equity.