Racial and health equity initiatives

To combat racism and enact lasting change, Blue Cross donated $5 million to the University of Minnesota School of Public Health to establish the Center for Antiracism Research for Health Equity (CARHE). Rachel Hardeman, associate professor and Blue Cross Endowed Professor of Health and Racial Equity, created the vision for the center and will serve as its founding director.

CARHE develops education and training on structural racism and health inequities; fosters authentic community engagement to address the root causes of racial health inequities and drive action; seeks to change the narrative about race and racism to one that does not hold up whiteness as the ideal standard for human beings; and serves as a trusted resource on issues related to racism and health equity. Most critically when it comes to long-term change, the center intends to be a leader in antiracist health research.

A disturbing statistic that racism lays bare is that one in every 1,000 Black men will die at the hands of law enforcement, with police violence is a leading cause of death for Black men ages 25 to 29. These stats and the 2016 murder of Philando Castile and 2020 murder of George Floyd by police officers during routine stops brought the need for a solution that Jazz Hampton, Esq., Andre Creighton and Mychal Frelix have created through their app TurnSignl.

The innovative app provides on-demand live legal advice connecting the user to an attorney specifically trained to de-escalate interactions between police, driver, and passengers if they are stopped by law enforcement. The goal is to de-escalate encounters between motorists and law enforcement and ensure that drivers have their rights protected, and that everyone, including law enforcement, feels safe. Blue Cross funded TurnSignl as part of a five-year engagement strategy with the city of Brooklyn Center to improve racial and health equity citywide.

Together with Minnesota State University – Mankato we funded 24 Blue Cross Presidential Scholarships over seven years to support the next generation of Minnesota’s workforce. The funding supports students studying all majors in education; pre- law; criminal justice; political science; social work; cultural and multi-ethnic studies; nursing; health science; health informatics; and biochemistry. The aspiration is for these scholarships to help build more career pathways for BIPOC health care practitioners, culturally competent care providers, and future changemakers across all our communities.

Trauma and systemic racism threaten the wellbeing of individuals and communities and have a direct impact on the health inequities we see in Minnesota particularly as it relates to mental health. Breaking down barriers for those seeking mental healthcare, and providing therapy that puts culture and lived experience first, are the first steps to building a strong community that can thrive even as it faces many challenges.

Unfortunately, traditional forms of therapy are not designed with cultural humility in mind and can perpetuate systemic barriers to accessing mental healthcare for Black, Indigenous, and communities of color. Blue Cross worked with Hurdle Health to provide culturally responsive therapy that places culture and the lived experiences of clients at the forefront, offering a model of therapy that equips therapists with the skills needed to effectively address issues of race, ethnicity, class and culture. The work focused on Brooklyn Center, provided residents of the city with free culturally responsive and trauma informed mental healthcare virtually to increase access and reduce the stigma of receiving mental healthcare.

Equitable and inclusive access to safe places for physical activity is a key aspect of maintaining health and wellness. However, many communities lack access to health and wellness infrastructure, having few safe spaces, or other social or environmental supports, to promote physical activity. This lack of access is often a result of disinvestment and policies that were designed in a system that historically omitted BIPOC and underserved populations.

Blue Cross is working with the National fitness campaign to create 10 free, outdoor Fitness Courts® for communities across Minnesota with locations in BIPOC and underserved communities—investing in equitable access to outdoor exercise programs to positively impact deeply embedded inequities.

Already, Willmar, Shakopee, the University of Minnesota, and Moose Lake Township have been completed and are open to the community. All courts will integrate community artwork from local artists to add culturally appropriate and enriching visuals. The courts will also develop engagement modules, accessible through QR codes at the sites so that participants can access workouts, specific exercises for therapy, and sequenced movements that aid in culturally relevant wellness.

The Breast Cancer Gaps Projects is part of a multi-year effort to address inequities in breast cancer rates for Black women. The breast cancer mortality for Black women is 41 percent greater than for white women. To address the barriers identified, the Breast Cancer Gaps Project created a video series to educate, relieve anxiety, and dispel any falsehoods that may be circulating about mammograms.

Through our collaboration, Blue Cross wants to close breast cancer mortality gaps, rebuild trust in healthcare, and center the needs and lived experiences of Black women. Particular focus will be on increasing breast cancer screening rates, reducing equity gaps in breast cancer screening rates, and sharing information about existing inequities, tools, and knowledge available to address the barriers with providers, members, and community.

Healthcare for Black, Indigenous and other women of color have long been a source of significant health inequities. Compared to white women, Black women are less likely to be insured, face greater financial barriers to healthcare, and also experience higher rates of preventable diseases and chronic health conditions such as diabetes, cardiovascular disease, and hypertension. Additionally, they are more likely to have their concerns dismissed, their pain under-treated, and are referred less frequently for specialty care. Connecting BIPOC women with culturally competent care can help by centering culture and community to empower BIPOC women to find a trusted healthcare provider that understands their lived reality and live healthier lives.

To address this, we collaborated with Health in Her HUE- an independent company that connects Black women and women of color with culturally sensitive health care providers and resources. The initiative sort to engage and provide mental wellness support for Black women and women of color via culturally relevant education, community discussions and access to a curated network of culturally relevant providers. Health in Her HUE also partners with the Center for Antiracism Research for Health Equity at the University of Minnesota to research and report out on the current state of healthcare for BIPOC women in Minnesota.

The devastating impact of boarding school experiences on Native Americans has had far-reaching consequences in the social, emotional, spiritual, cultural, and health realms. Research estimates that approximately 500 (15 in Minnesota alone) government-funded Indian day and boarding schools operated in the United States during the 19th and 20th centuries. During this time Indigenous children were forcibly taken from their families by the government and sent hundreds of miles away to these schools. If they spoke their Native languages, they were punished with beatings, starvation, and other forms of abuse. This trauma continues to reverberate through generations, and addressing the impacts is crucial to healing, repair, and long-term health.

By focusing on culturally based treatment and healing through a collaboration with the National Native American Boarding School Healing Coalition, we are partnering on complex work aimed at meeting urgent mental health needs—providing resources for survivors of Indian boarding schools and their families. The work includes building a ‘Healing Trauma Resources’ directory for community members seeking support. Hosting ‘Healing Circles’, providing safe spaces for elders to understand their trauma and get healing support, virtual healing events, and ‘Healing Voices’ – to honor elders stories, and providing survivors with a care package with culturally relevant products to support wellbeing, break down isolation, and connect them to community.

Investing in the cultural competency of healthcare professionals is essential to ensuring equitable care for all members of our communities. Blue Cross has a longstanding commitment to fostering diverse career paths for individuals from Black, Indigenous, and People of Color (BIPOC) backgrounds, nurturing culturally competent providers, and empowering future leaders who will champion positive change within our communities.

The Hennepin Healthcare Talent Garden project combines on- campus events with healthcare mentorship programs that foster long-term connections between BIPOC youth and clinicians, while building interest and providing support to pursue healthcare careers. The white coat events create spaces for learning through hands-on activities and facilitate peer mentorships enabling greater connection and sense of inclusion and belonging. This includes summit events for Black women, American Indian, Latine and Black Men. The program also provides tangible on the job learning opportunities with support for 22 summer internships for aspiring BIPOC healthcare professionals. The hope is that these participants will continue their aspirations in the field resulting in better culturally concordant care for all communities in the future.

Minnesota has welcomed 1,300 Afghan evacuees since September 2021, as part of the federal Operation Allies Welcome program. The work starts with housing and stocking homes with specific cultural and religious items to bring comfort to our new neighbors. And while having a place to live holds immense importance for displaced people, the feeling of home requires familiarity, connection, and joy.

To help those families establish a life and envision a future in Minnesota, Blue Cross collaborated with Alight as they created a community program for Afghan women and youth called the Welcome Home Initiative. Through community informed focus groups, the initiative sought to address Afghan women struggling with isolation and loneliness. One solution to foster social connection was the formation of a sewing social club—creating a safe place for conversation, to sew, and forge friendships.

Alight’s youth programming brings Afghan teens together on weekends to play in sports leagues, take part in other structured activities, and simply have fun with their peers.

The program includes ongoing programming to either directly provide or partner with organizations that offer ESL programs, computer literacy training, financial literacy sessions and access to healthcare. This critical support will act as wraparound services to focus on community building and access to social capital.

Accessing and consuming healthy foods can be a significant challenge, especially when healthy food options are scarce or prohibitively expensive. This issue particularly impacts low-income communities, where residents face numerous barriers to accessing nutritious foods, including lack of full-service grocery stores and/or a high prevalence of convenience foods. These barriers create an environment where less healthy choices are made, which further exacerbates health inequities and contributes to a cycle of poor health outcomes.

One solution to increase access to healthy foods is integrating farmers’ markets into communities. Farmers markets offer budget-friendly options, with 60 percent of shoppers in low-income neighborhoods across the U.S. reporting better prices on produce at the farmers market than the grocery store.

To address this, Blue Cross was a sponsor for the Lakeview Terrace Farmer’s Market, which held 18 markets between May and September of 2023. The location is in Robbinsdale, near the border with North Minneapolis, in a food desert. Funding also supports Behind the Menu events. The markets also included health and wellness activities such as fitness classes, live cooking demonstrations, and live music, helping to create a vibrant space for the community, while addressing the racial and health equity of food accessibility.

NMDP (formerly known as Be the Match®) is a community of health care professionals, marrow donors, volunteers, researchers, and financial contributors who save lives by connecting patients with a matching donor for a life-saving blood stem cell or marrow transplant. For thousands of patients diagnosed with a blood disease, a bone marrow or blood stem cell transplant is their best or only hope for a cure. A patient’s likelihood of finding a fully matched bone marrow donor or cord blood unit on the NMDP registry ranges from 29% to 79% depending on ethnic background. The inequity on the NMDP registry particularly affects BIPOC patients.

Blue Cross funded a recruitment Coordinator, and two multicultural recruitment positions to help educate, engage, inspire, and ultimately increase the diversity of the donor list—reducing equity gaps. Working in multiple diverse communities, the new roles are connecting with people to add more people to the registry, improving the odds to ensure every patient has a chance at finding their lifesaving donor and live their healthiest life.

In 2022, 1,239 ethnically diverse Minnesotans were added to the NMDP registry. This is a 114% increase compared to the previous year. With that number growing in 2023 to 1,590 members added, a 128% increase compared to the previous year.

To address access to physical activity, food insecurity, and create equitable learning environments for BIPOC students Blue Cross funded the Sanneh Foundation. Their work included the Conway Community Center OST program that engages BIPOC young people at Conway Community Center from various racial, ethnic, and national origins through high- quality and consistent youth development activities. The Dreamline program, a culturally relevant and responsive mentoring program that provides direct instruction in social emotional learning and academic interventions for under-performing students in Minnesota schools, K-12. And finally, the Sanneh Nutrition Services that packages and distributes meals containing a mixture of fresh produce, robust proteins, and culturally specific items six days a week to help close the food insecurity gap for families in the Twin Cities.

This collaboration centers diversity, equity, and inclusion throughout each program helping to create more equitable physical activity opportunities, food access, and learning environments for BIPOC youth and low-income families.

Mental health is a critical issue for everyone, regardless of where you live. According to the Centers for Disease Control and Prevention (CDC) 1 in 5 adults in the U.S. experiences mental illness each year.

However, those numbers can become far starker for people who live in rural areas. In rural Minnesota lack of access to providers is one of the biggest issues with a National Alliance for the Mentally Ill (NAMI) report showing that there are only 10 psychiatrists per 100,000 people. This shortage makes it difficult for people in rural areas to find a mental health provider who is accepting new patients, coupled with often being spread over a large geographic area with limited public transportation, and access is even more magnified.

To address these challenges and close those care gaps in rural Minnesota, Blue Cross collaborated with Minnesota State University, Mankato to establish the ‘Blue Cross and Blue Shield of Minnesota Center for Rural Behavioral Health at Minnesota State University, Mankato.’ The partnership and investment will allow the Center, as one of the first rural behavioral health centers in the nation, to develop and disseminate best practices on building the behavioral health workforce, aiming to address the lack of providers and practitioners and also support the expansion of the pipeline of behavioral health professionals in Northern Minnesota and with Tribal Nations and Tribal Colleges.

Trauma and systemic racism threaten the wellbeing of individuals and communities and have a direct impact on the health inequities we see in Minnesota particularly through a primary care context. Breaking down barriers for those seeking primary healthcare, and that centers culture and lived experience first, are vital steps to building a strong community that can thrive even as it faces many challenges. As traditional primary care is not designed with cultural humility in mind, it can perpetuate systemic barriers to access for Black, Indigenous, and communities of color.

Blue Cross is working with Spora Health, an independent company that provides virtual-first primary care which is culture centered, to better serve Black, Indigenous, and other peoples of color. This manifests in the form 50 primary care providers specially trained to listen and deliver respectful care to all people in need of quality healthcare that aligns with a person’s experiences and cultural needs. Those providers are trained to deliver easy-to-understand care plans based on health history and lifestyle, meet a patient’s specific needs, and empower them to work toward their goals. Whether a patient has short or long-term needs, using virtual primary care and virtual walk-ins that is relevant, appropriate, and accessible to individuals from diverse cultural backgrounds is a core focus. The collaboration also gives people the flexibility to work with a personally selected provider throughout their health care journey or explore a different provider each visit ensuring each visit is designed to maximize the opportunity for health.

Traditional healing is diverse, global, and emphasizes relational understandings of health and healing, recognizing that taking care of a person extends beyond physical health. It includes understanding the mind, body, and spirit as interconnected. For thousands of years, traditional Indigenous medicine has been used to promote health and wellbeing. However, Indigenous cultural practices have been systemically dismantled or suppressed.

Today, Indigenous communities are working to reclaim their health by integrating tribal wisdom and Cultural practices that are central to restoring and improving the health of Indigenous peoples’ alongside western medicine. Collaborating in that work, Blue Cross partnered with community and healthcare providers and co-developed a new benefit to ensure members have access to equitable care. This Traditional Healing Services Benefit reimburses providers dedicated to serving Indigenous communities for proving access to those traditional forms of healing, culturally based care, and cultural wellness activities.

Despite significant advancements in understanding the unique healthcare needs of transgender and nonbinary individuals, a large gap persists in knowledge and awareness among healthcare professionals and decision-makers. This knowledge deficit poses serious challenges, leading to the delivery of inadequate care, the formulation of misinformed policies, and the perpetuation of exclusionary practices. These issues collectively contribute to the exacerbation of existing health inequities experienced by transgender and nonbinary individuals, impeding their access to quality healthcare and leading to compromised health outcomes.

Recognizing the critical need to address this gap, the World Professional Association for Transgender Health (WPATH) provided specialized training to over 130 Blue Cross associates.

The training program empowers and helps associates gain insights into the fundamental principles of gender-affirming care, and encompassing a range of medical, psychological, and social considerations. With this knowledge, they are now better equipped to make informed clinical decisions that prioritize the holistic well-being of transgender and nonbinary individuals.

While cancer mortality rates have declined overall in the US, Black individuals continue to face a disproportionately high cancer burden, encountering significant obstacles in prevention, detection, treatment, and survival compared to other racial/ethnic groups. They endure more illness, poorer outcomes, and premature death compared to their white counterparts, with Black men experiencing particularly elevated cancer incidence and mortality rates.

Addressing racial inequities in treating complex illnesses such as cancer necessitates solutions to alleviate the financial burden associated with the substantial costs of treatment. Especially for families in lower income brackets, the need for financial assistance as medical bills accumulate alongside monthly expenses are crucial. Blue Cross is collaborating with the Angel Foundation, which provides relief to adults with cancer and their families through financial aid, educational resources, and social and emotional support. The funding further adds to emergency financial assistance and addresses social determinants of health needs in underserved communities, while also promoting educational endeavors focused on health equity, cancer care, and mitigating financial toxicities.

Stark racial inequities in maternal and infant health in the U.S. have persisted for decades despite continued advancements in medical care and are often symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination. Following the COVID-19 pandemic the maternal mortality rate for Latine birthers rose significantly.

To help address these health inequities and identify other gaps that impact the health of Latine mothers, Lakewood Health System launched “Todd County Promotores,” an initiative to integrate a collaborative community health worker (CHW) into a multi-sector community team. This initiative delivers culturally competent practices and interventions to improve health and social outcomes for Latine mothers and their children. The CHW is part of a team of bilingual and bicultural community professionals – who primarily serve this rapidly growing Spanish-speaking patient population.

Children living in poverty are more likely to experience adverse childhood events that can manifest as trauma, altering brain development. This issue impacts our Black, Indigenous and neighbors of color at four times the rate of white people in our community, and the ripple effect of this trauma can lead to intergenerational poverty. With 80 percent of brain growth occurring before a child’s third birthday, there is a critical need for trauma-sensitive preschool care to buffer the harm of adverse experiences on children, so their innate resiliency can flourish.

Through our support of the Greater Twin Cities United Way (GTCUW) and its ‘80×3: Resilient From the Start’ initiative, we are helping to ensure every child in our state has high-quality care in this critical stage. GTCUW has brought together an advisory group, consulting partners and funded eight childcare centers to create a systems change approach for facilitating trauma-informed care for children ages 0-5 Minnesota’s littlest learners. A big part of the funding will go towards supporting 200 hours of mental health care for childcare providers and parents in the 80×3 network. This trauma-informed care provides the best education for youngest learners caring for their mental health and their spirit.