Tuesday, September 29, 2015

African American Income and Poverty in Minnesota – “No change” should motivate us

“Black household income dipped severely; black poverty has increased. So, we need to take action.” News articles since the release of the most recent findings from the Census Bureau have expressed this theme in one way or another. Advocacy groups have vocalized it and have demanded action in response.

But did the trends in black income and black poverty really take an alarmingly sudden and significant wrong turn? Should a one-year change in black household income and black poverty trends cause us to take action? If so, what would we do?

Wilder Research staff member, Allison Liuzzi, explained to Minnesota Public Radio that the black poverty rate moved from about 33% to 38% from 2013 to 2014 in Minnesota, representing 20,000 more people reported in poverty in just one year. However, Allison and her fellow Minnesota Compass staff members have emphasized that in the previous year the poverty rate among blacks had declined by 5 percentage points. The recent change brought the rate back to its high mark for most of the past 10 years. That’s the news that she and others want us to understand.

Blips in the statistical trend lines, whether up or down, should not divert our attention from the real story, namely, that one in three black Minnesotans lives in poverty. Even though some numbers shifted back and forth, really “no change” has occurred, and that should disturb us. We must acknowledge the stark and serious fact that the economic status of the black residents of our communities remains dismally low.

So, what do we do? Implore the Governor to mobilize state policymakers and staff? Perhaps, but also recognize that no Governor or Government has succeeded at producing more than incremental change on these issues, and typically only slowly. Disrupt public transportation and public events? That activity achieves headlines and might work in certain situations. But, in my opinion, unless such demonstrators acquire the skills of the civil rights and peace activists of the days of Martin Luther King, such action runs the risk of being counterproductive, and might even divide rather than connect us.

If I had the perfect answer, I would share it. Yet I am certain that the route to the answer requires change at the molecular level of our hearts and the structural level of our society and economy. A “strategic plan” to address economic disparities that have the potential to destroy us should include steps at both of these levels.

At the level of the heart, we need to acknowledge our common humanity. Reasonable people can understand that the features we share outweigh the features that differentiate us. Extreme bigots may deny that premise, but most of us can be brought to accept it. Martin Luther King, Jr. dreamt of the day when “little black boys and black girls will be able to join hands with little white boys and white girls as sisters and brothers.” As a first strategic step, we need to hold hands, literally and figuratively, in order to address economic disparities and ultimately improve the economic status of all.

We need a combination of research analysis and genuine soul-searching to understand what lies at the roots of the disparities we see in our state and how we strike at those roots. Why do differences exist in the poverty rates of whites and blacks? Yes, racism plays a role; yes, disparities in education lead to disparities in acquisition of wealth; yes, social determinants of health influence educational achievement, disease and disability rates, with resulting decreased earnings for certain groups.

But at the same time that Minnesota enjoys a relatively high overall standard of living, analysis reveals that, relative to the other 49 states, we have some of the largest social and economic disparities among racial groups. Why? If we don’t answer that question, we might have the misfortune of spinning our wheels with unproductive solutions to our challenge. Our strategic plan will create a failing strategy.

In fashioning solutions, role clarification becomes extremely important. What can we expect government to do? What must individuals do? What must communities do for their members? Educational success for young people depends, for example, on the combined efforts of communities, families, and schools. The educational system alone cannot produce success. Yet too many proposals for improving the education of persons of color ignore the necessity of involving all three of these elements of our society.

And, at the level of our overall society and economy, job creation stands out as crucial. No amount of improvement in education, no change in attitudes among the majority population, and no legislation will produce an increase in the economic status of blacks if jobs do not exist for people to fill and earn a livelihood. Our strategy needs to include government and the private sector in roles which attract and retain black workers in adequately paying jobs.

Lower economic status for our black residents should precipitate a clamor for intervention. All of us have a role in that intervention. I’m confident that, with increased understanding, hope, and a genuine commitment, we can act to move the line on the graph unswervingly in a positive direction.

Thursday, August 27, 2015

Summer Reading from Wilder Research

For a bit of summer reading this year, I perused some of the most recent Wilder Research reports and took time to reflect on them. The past couple of months contain just a sampling of the more than 200 reports that we produce each year – all of them intended to enhance people’s lives by sharing relevant, actionable information that can improve our communities.

While research isn’t beach reading for everyone, I encourage you to think about this as a back-to-school reading list, spanning a variety of topics and issues. Below you will see some of the things that you can learn from our recent reports. I encourage you to explore the links and see what else these reports contain.

From our Big Picture Project, one report which reflects our research on the Central Corridor, intended to document how the construction of a new light rail line affects the urban neighborhoods through which it passes: “The Green Line has been up and running for one year, and change is evident for all parts of the corridor.” The number of new housing units has increased, as have advertised rents. Unique relative to national counterparts, the Central Corridor initiative has focused efforts to increasing park space along the rail line; no other city has yet to develop goals or metrics for the amount of parkland in a transit corridor.

From our Central Corridor Tracker, another report on the effects of the new Green Line: Along the Central Corridor, single family housing values are rising. The business mix, defined by type of business, has not changed. However, the mix defined by size of business has begun to change – with the smallest businesses declining, and mid-size businesses making gains.

From an infographic developed by our study of children with incarcerated parents, providing details on the chemical use behaviors of youth with incarcerated parents: Such youth “face more chemical health concerns than youth who have not experienced parental incarceration.” One in 10 youth with an incarcerated parent, who has used alcohol or other drugs, reported becoming violent or acting violently while they were intoxicated (versus 1 in 100 youth who has not had an incarcerated parent).

From our study, Families with Young Children Who Are Deaf and Hard of Hearing in Minnesota: Some of the most common needs for parents of young children who are deaf and hard of hearing are: Emotional support; connections with similar families; role models that their child can look up to; hope for the future; American Sign Language capability; and information about assistive technology, such as cochlear implants and hearing aids.

From an essay on early childhood policies to prevent inequities: “Social, economic, and educational inequities and their lifelong adverse consequences are preventable…Reaching the goal of optimal healthy development for all children requires concerted, interconnected policy efforts across public and private sectors and disciplines and in partnership with families. The disadvantaged families affected by inequities must help shape and sustain the policies and community-led practices to strengthen themselves and their children within a cultural context.” Richard Chase explains the rationale for this conclusion in this short position paper – calling for government, schools, and other organizations to act, but also for families to take action on their own behalf.

From a report on the early childhood program, Invest Early: Invest Early is having county-wide impacts, serves higher-risk and underserved populations, and has convincingly demonstrated that it prepares low-income students for success.

From a report on a pilot study of Signs of Safety, a strengths-based, safety-organized child protection intervention strategy: The study offered insight into the process of delivering service. “Good communication and giving parents a voice are critical in working with families.” The study also identified some of the results. For example, caseworkers who respect and listen to parents increase the satisfaction levels of parents. With a formal network ready to help, parents feel more confident in asking for help with difficult aspects of their lives. The study also says, “Reliance on safety planning diminishes over time, but families find it helpful.” This seems to indicate that the strategy empowers families to act on their own.

Our website, www.wilderresearch.org, contains information on these studies, and hundreds more. We welcome the opportunity to work with any organization, large or small, to improve the lives of individuals, families, and communities.

Friday, June 12, 2015

Be healthy, be happy; U.S. needs to get wise

According to the World Health Organization, someone born in the United States will not, on average, live as long as someone born in England, Sweden, Spain, Norway, Malta, Netherlands, France, Finland, and other countries, even though we spend more than they do on health care.

In fact, we spend more than any other country on health care, but rank at the very bottom among the wealthiest countries on the quality of our health care system. (The United Kingdom, ranked in first place, spends only about 40% of what the United States spends, yet achieves such better health for its population.)

We’re not the happiest country, either – with a rank of 17 in a 2013 United Nations report. Interestingly, the countries where people live the longest also tend to have the highest levels of happiness.

How can our bodies and our spirits get into better shape?

In thinking about health, we often jump immediately to health care. However, effective health care probably only accounts for about 20 percent of the reasons why we are healthy (or not). Our health depends on much more. The condition of our bodies, the illnesses that afflict us, and even how long we live depend largely on the social determinants of health. These social determinants include our housing, our income, our education, the availability of nutritious food, air quality, the level of crime in our neighborhood, facilities to promote physical activity, and other aspects of our environment. In short, many of the factors that lead to illness, or promote good health, lie outside of the health care system.

The President of the Robert Wood Johnson Foundation recently invited me to attend a meeting, to discuss how we can transform thinking and action in this country to promote health. The Foundation has worked intensively on a major initiative to “build a culture of health” in the United States They have traveled the country, delivering lectures and participating in meetings, including three, annual Healthy Communities conferences in Minnesota, organized by Wilder Research and the Federal Reserve Bank of Minneapolis.

The movement to build a culture of health predicates itself on the premise that promotion of health, in the words of the Robert Wood Johnson Foundation, “must place well-being at the center of every aspect of American life.” The movement focuses on “the key influences of factors found in communities, business and corporate practices, schools, and the many other spheres of everyday life.”

Think about it. The sick leave policies of our nation’s businesses directly enable us to achieve better health by offering the opportunity to rest and to fight an illness that strikes us. Indirectly, those policies keep us healthier by enabling sick people to stay home and recover rather than feeling compelled to work and coincidentally to infect us. Government decisions to create or protect space for physical activity enable us to maintain a healthier lifestyle. Sick leave policies and greenspace policies strongly influence our health, yet neither falls into “health care policy” in the traditional sense.

So, we will likely see the culture of health movement take action in four areas.

For one, we’ll see increased emphasis on making health “a shared value.”
That means developing a public mindset about health as a fundamental building block of our communities. Developing such a mindset will require education, attitude shifts, and social interaction to motivate our population to want to improve health on their own and with others.

We will see increased emphasis on fostering cross-sector collaboration to improve health.
That means that members of the traditional health care system – doctors, hospitals, health plans, etc. – will collaborate more with people and organizations outside of health care. Health departments might work with banks who want to finance preschool education facilities and community health clinics. Units of state government such as transportation, housing, and natural resources will take action jointly with the state health department to shape policies and programs which promote health. Ed Ehlinger, Minnesota’s Commissioner of Health stands out as a national leader in terms of promoting collaboration and infusing “health into all policies.”

We will see increased energy and resources devoted to changing our environments.
Even the best motivated, most well-intended individuals cannot ensure optimal health on their own. Without access to healthy food, people cannot provide suitable nutrition to themselves and their families; without affordable housing, some families cannot achieve stability and ensure good education for their young members; without feeling safe on the street, individuals cannot engage in health promoting activities, plus they have greater likelihood of suffering injury or death.

Finally, in the movement to promote a culture of health, we will see efforts to strengthen and integrate the system of health care services on which we rely.
We will see action taken to improve the access of people to health care, to improve patients’ experience, to contain costs without compromising quality, to improve outcomes for all, and to focus on prevention.

Can we achieve the levels of health and happiness of other major nations? Can we eliminate the disparities in health which now exist among groups in the United States? Focusing attention on building a culture of health, including work in the above four action areas of interest to the Robert Wood Johnson Foundation, can hopefully move us in that direction.

Wednesday, May 06, 2015

Effectiveness, and the Case of Dr. Oz

Dr. Oz became famous on Oprah, then developed his own TV show. Millions of people who seek health and medical information hang on his every word. But can we believe him?

A group of doctors publicly called for Columbia University to fire Dr. Oz. Their accusations?
“Dr. Oz has repeatedly shown disdain for science and for evidence-based medicine … he has manifested an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.”

The controversy focuses attention on evidence-based practices. So, what do we mean by evidence? What constitutes credible information that a treatment works or that a specific behavior promotes good health?

In human services, the meaning of the term, evidence-based practice, has achieved some consensus, at least in a general sense. Most people would agree that, to meet the standard of evidence-based, a treatment, service, or policy must have multiple rigorous studies which support it. Rigorous usually means either some form of experimental design or at least a very strong comparative effectiveness study. Comparative means that information exists to show that people who received a service achieved an outcome to a higher degree than people who did not receive that service. The Substance Abuse and Mental Health Services Administration, for example, has established criteria, as have some other organizations.

Oftentimes, the fact that a practice has appeared in a scientific journal becomes accepted as proof of adequate strength to demonstrate effectiveness. However, in the field of medicine, many practices with early promise of effectiveness, as reported in credible medical journals, actually turn out not to work during later years of testing.

We can’t let a similar-sounding term, best practice, confuse us. It sees a variety of uses, one of which unfortunately constitutes a bad use: as a synonym for evidence-based practice, but without any evidence! Sometimes, a so-called best practice is a new service approach that seemed to produce positive outcomes in one situation, perhaps only for a limited period of time, and now it attracts other providers to incorporate it into their operations. However, no sound research has demonstrated the effectiveness of that new approach. If an approach appears promising, evaluation researchers can work in unison with practitioners to determine its effectiveness by creating a sound base of evidence.

So, what should we do?

·         We should move forward with a combination of hope and humility, using the best information available to make informed choices about what services to deliver. Strong evidence of effectiveness means that a specific service, delivered as intended, will produce positive outcomes for many or most of those who receive it. Keep in mind, though, that nothing’s perfect. If we go with the evidence, we maximize the chances of taking the best possible action using our current state of knowledge, even though we will not produce our desired outcomes 100 percent of the time.

·         Let’s remember that science is just science. It never reaches the final “truth”; it always searches to discover more. New evidence inexorably supplants current evidence, sometimes changing the way we think and act. In addition, our environment changes; our communities change. Science strives to keep up and provide the best answers at any given point in time, acknowledging for example, that actions by individuals and government that worked effectively to produce strong communities in 1915 might not work in 2015.

·         The fact that science has imperfections and we may never achieve absolute certainty should not compel us to ignore the best evidence and put all of our trust in self-proclaimed experts and authorities. From blood-letting during the Middle Ages to quack remedies of today, many “experts” have had no basis for the approaches they use to treat the illnesses of individuals and the social problems of communities.

Effective service delivery requires blending the latest evidence, the wisdom of practitioners, and the preferences (cultural, personal, etc.) of an individual or group who receives a service. Over time, we continually refine our knowledge and competence so that human service practitioners, policy makers and others can shape services, programs, and policies optimally to meet the needs of our ever changing communities.

What does this all mean for Dr. Oz? Dr. Oz speaks as one, fallible physician; hopefully, he uses research evidence wisely. The conflict of interest that his accusers charge might, or might not, exist. But I’m willing to let others fuss over the fate of him and other celebrities, while we work on improving the future of our communities!

Thursday, March 26, 2015

From Selma to the Present -- Some Progress

Commemorative events in Selma during this past month brought to mind events of the 1960s. I vividly remember hearing the junior high principal announce the assassination of President Kennedy. I remember TV coverage of the Selma march to Montgomery and newspaper coverage by the New York City papers of the rationale for the Civil Rights Act of 1965.

Have we made progress during the past 50 years? In advocating for the passage of civil rights legislation, President Kennedy asserted that a number of inequities existed in the United States:

The Negro baby born in America today, regardless of the section of the State in which he is born, has about one-half as much chance of completing a high school as a white baby born in the same place on the same day, one-third as much chance of completing college, one-third as much chance of becoming a professional man, twice as much chance of becoming unemployed, about one-seventh as much chance of earning $10,000 a year, a life expectancy which is 7 years shorter, and the prospects of earning only half as much.

Where do we stand today?

Drawing valid comparisons, for our nation as a whole, across the span of a half century presents challenges, but evidence definitely points to elements of progress related to most, but not all, of Kennedy’s concerns. We have not met Kennedy’s goals, but we have moved in a positive direction.

  • A black young person today is 80% as likely as a white young person to complete high school – up 30 percentage points from the “half as much chance” cited by Kennedy. 
  • A black young person has about two-thirds of the likelihood of a white young person to complete college – so double the probability from Kennedy’s era. 
  • Regarding the “one-third as much chance of becoming a professional man” which Kennedy noted, contemporary statistics show about 30% of black workers classified as employed in “management, professional, and related occupations,” compared with 39% of white workers. That significantly boosts the likelihood from Kennedy’s “one-third as much chance” to a current “75% as much chance.”
  • A 1965 income of $10,000 equates to about $75,000 today. Among black households, 20 percent have income above that mark, compared with 37% of white households. So, we see movement from Kennedy’s “one-seventh” to the current “one-half.”
  • The lifespan gap has improved, from 7 years difference between blacks and whites to about 4.
  • The unemployment rate for blacks remains about twice the rate for whites; so no change from when Kennedy did his assessment.

Moving forward, we must ask ourselves how we can reduce even more the social and economic differences which Kennedy identified. We know that some of these differences result from social and environmental conditions outside of the control of any single individual. So, no matter how well you eat and exercise, aspects of your surroundings partially influence how long you will live. However, individual choice also makes a difference; what you eat and drink, what lifestyle you lead – those things add and subtract years from your life.

We need to determine what we can meaningfully achieve through our formal government and community institutions and what we must encourage individuals to do on their own to improve their lives.

As Dr. Martin Luther King, Jr. stated (in one of his many quotes which I love): “In a real sense, all life is inter-related. All men are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.” Those words provide a rationale for action – that the inability of any one person in our society to achieve good health and prosperity detracts from the health and well-being of all. The words also bring us to recognize that progress on social issues requires changes in the habits, customs, systems, and activities of all of us, with the ultimate consequence of a better life for everyone.

(By the way, if you have additional interests regarding social disparities, consult Minnesota Compass.)