Category Archives: Social & Family Issues

Feds fund effort to tie medical services to social needs

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Young woman holds an older woman's handBy Julie Rovner
KHN

The federal government has announced a $157 million project to help hospitals and doctors link Medicare and Medicaid patients to needed social services that sometimes have a bigger impact on their health than medical interventions.

Public health experts have known for decades that even with medical care easily available, patients are often limited in their ability to get better or maintain good health if they lack stable housing, access to healthy food, or the ability to get to and from medical appointments.

The goal of the project is to find better ways to identify patients’ non-medical needs and connect them to available services in their communities.

The goal of the “Accountable Health Communities” project is to find better ways to identify patients’ non-medical needs and connect them to available services in their communities.

The social services to be linked include those related to housing, food, personal safety, inability to pay utility bills and transportation. The project will fund up to 44 separate experiments over five years.

Applications are being accepted by the Centers for Medicare & Medicaid Services and announcement of the winning proposals is expected later this year. Continue reading

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Learning soft skills in childhood can prevent problems later

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Pat-a-cake,_pat-a-cake,_baker's_man_1_-_WW_Denslow_-_Project_Gutenberg_etext_18546 (1)By Lynne Shallcross

Academic learning is usually in the spotlight at school, but teaching elementary-age students “soft” skills like self-control and how to get along with others might help to keep at-risk kids out of criminal trouble in the future, a study finds.

Duke University researchers looked at a program called Fast Track, which was started in the early 1990s for children who were identified by their teachers and parents to be at high risk for developing aggressive behavioral problems.

The students were randomized into two groups; half took part in the intervention, which included a teacher-led curriculum, parent training groups, academic tutoring and lessons in self-control and social skills.

The academic skills turned out to have less of an impact on crime and delinquency rates than did the soft skills, which are associated with emotional intelligence.

The program, which lasted from first grade through 10th grade, reduced delinquency, arrests and use of health and mental health services as the students aged through adolescence and young adulthood, as researchers explained in a separate study published earlier this year.

In the latest study, researchers looked at the “why” behind those previous findings. In looking at the data from nearly 900 students, the researchers found that about a third of the impact on future crime outcomes was due to the social and self-regulation skills the students learned from ages 6 to 11.

The academic skills that were taught as part of Fast Track turned out to have less of an impact on crime and delinquency rates than did the soft skills, which are associated with emotional intelligence. Soft skills might include teaching kids to work cooperatively in a group or teaching them how to think about the long-term consequences when they make a decision. Teaching physics is an example of a hard skill.

“The conclusion that we would make is that these [soft] skills should be emphasized even more in our education system and in our system of socializing children,” says Kenneth Dodge, a professor of public policy and of psychology and neuroscience at Duke who was a principal investigator in this study as well as in the original Fast Track project. Parents should do all they can to promote these skills with their children, Dodge says, as should education policymakers. Continue reading

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Baby boomers set another trend: More golden years in poorer health

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240px-Peace_sign.svgBy Lisa Gillespie
KHN

After the last of the baby boomers become fully eligible for Medicare, the federal health program can expect significantly higher costs in 2030 both because of the high number of beneficiaries and because many are expected to be significantly less healthy than previous generations.

The typical Medicare beneficiary who is 65 or older in 2030 will more likely be obese, disabled and suffering from chronic conditions.

such as heart disease and high blood pressure than those in 2010The typical Medicare beneficiary who is 65 or older then will more likely be obese, disabled and suffering from chronic conditions such as heart disease and high blood pressure than those in 2010, according to a report by the University for Southern California’s Schaeffer Center of Health Policy and Economics. Continue reading

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Violence abroad and at home – Viewpoint

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DuchinThe following is a message from Public Health – Seattle & King County’s Health Officer Dr. Jeff Duchin to the agency’s staff. The agency decided to share the message with the public because it thought “the message will resonate with those inside and outside of our agency.”

Dear Colleagues,

On Friday, I spent the day with others from Public Health – Seattle & King County and regional local health departments, Washington State Department of Health, and the University of Washington at a conference organized by the Northwest Center for Public Health Practice to help find solutions to the problem of injury and violence in our communities.

It was therefore especially ironic and sickening to hear the news of the Paris terrorist attacks on the car radio as I returned from the meeting.

Many of us, including myself, feel overwhelmed trying to fathom the reasons for, and solutions to, the type of mindless killing that has been routinized by repeated violent terrorist attacks happening around the world, most recently in Paris, Beirut, Nigeria, Somalia, Cameroon, Turkey, Israel and Gaza, Iran, and elsewhere.

Here at home, we are struggling with many incarnations of violence in our own communities and country, including intentional violence from suicide, gun violence, intimate partner and domestic violence, adverse childhood experiences and other emotional trauma, and multiple causes of unintentional injury and death.

As public health professionals we share a common purpose: Improving the health of communities through prevention. Accordingly, we bring our public health approach to addressing the wicked problems of violence and injury.

I sincerely hope that in addition, this most recent abomination in Paris will motivate not only public health professionals but all of us, including governmental, business and community leaders across the country to acknowledge all types of violence – even terrorist violence– as a public health problem – a disease – and treat it accordingly.

Although we will not be able to easily solve the problem of global terrorist violence through our actions here at home, redoubling our efforts to end the ongoing devastation of violence of all types in our communities would be a meaningful start.

I’m optimistic that with the same perseverance, dedication, and intelligence that we used to put a man on the moon, conquer smallpox and polio, and harness the energy of the atom, we can make real progress in reducing violence from all causes in our communities, our country, and the world.

Sincerely,

Jeff

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States look for help with bilingual mental health

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From a string of public suicides in Alaska to assimilation anxiety among young Hispanics in Cleveland, states are faced with the need for more bilingual and culturally sensitive mental health care professionals

Illustration of the skull and brainBy Tim Henderson
Stateline

The U.S. is grappling with a severe shortage of mental health professionals. But the situation is particularly dire for some minority communities, where barriers of language and culture can make it hard to seek and get help.

Most good mental health care requires subtle, intimate conversation with patients. But too often, mental health experts say, professionals lack the language skills needed to serve those who struggle with English.

The greatest mental health needs are often in remote, rural areas with scattered populations.

“It’s difficult to trust that translation will capture nuances in the soul-baring process of mental health treatment,” said Sita Diehl, director of state policy at the National Alliance on Mental Illness (NAMI).

The greatest mental health needs are often in remote, rural areas with scattered populations. Continue reading

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In L.A., community health workers are part of the medical team

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By Anna Gorman
KHN

Month after month, Natalia Pedroza showed up at the doctor’s office with uncontrolled diabetes and high blood pressure. Her medications never seemed to work, and she kept returning to the emergency room in crisis.

Doctor Janina Morrison speaks with patient Jorge Colorado, 49, and daughter Margarita Lopez about Colorado’s diabetes on Thursday, October 8, 2015 at the Los Angeles County-USC Medical Center (Photo by Heidi de Marco/KHN).

Doctor Janina Morrison speaks with patient Jorge Colorado, 49, and daughter Margarita Lopez about Colorado’s diabetes on Thursday, October 8, 2015 at the Los Angeles County-USC Medical Center (Photo by Heidi de Marco/KHN).

Walfred Lopez, a Los Angeles County community health worker, was determined to figure out why.

Lopez spoke to her in her native Spanish and, little by little, gained her trust. Pedroza, a street vendor living in downtown Los Angeles, shared with him that she was depressed. She didn’t have immigration papers, she told him, and her children still lived in Mexico.

Then she mentioned something she hadn’t told her doctors: She was nearly blind.

Pedroza’s doctor, Janina Morrison, was stunned. For years, Morrison said, “people have been changing her medications and changing her insulin doses, not really realizing that she can’t read the bottles.”

Health officials across the country face a vexing quandary – how do you help the sickest and neediest patients get healthier and prevent their costly visits to emergency rooms? Los Angeles County is testing whether community health workers like Lopez may be one part of the answer.

Lopez is among 25 workers employed by the county to do everything possible to remove obstacles standing in the way of patients’ health. That may mean coaching them about their diseases, ensuring they take their medications or scheduling medical appointments. Their help can extend beyond the clinic walls, too, to such things as finding housing or getting food stamps.

(L) The Los Angeles County-USC Medical Center is the county’s biggest and busiest public hospital. (R) Walfred Lopez, a community health worker at the Los Angeles County-USC Medical Center, sits in small cubicle in the clinic looking over a patient’s health record on Oct. 14, 2015. (Photo by Heidi de Marco/KHN)

(L) The Los Angeles County-USC Medical Center is the county’s biggest and busiest public hospital. (R) Walfred Lopez, a community health worker at the Los Angeles County-USC Medical Center, sits in small cubicle in the clinic looking over a patient’s health record on Oct. 14, 2015. (Photo by Heidi de Marco/KHN)

The workers don’t necessarily have a medical background.  They get several months of county-sponsored training, which includes instruction on different diseases and medications, as well as tips on how to help patients change behavior. They are chosen for their ability to relate to both patients and providers. Many have been doing this job for friends and family for years – just without pay.

“By being from the community, by speaking their language, by having these shared life experiences, they are able to break through and engage patients in ways that we as providers often can’t,” said Dr. Clemens Hong, who is heading the program for the county. “That helps break down barriers.”

For now, they work with about 150 patients, many of whom have mental health issues, substance abuse problems and multiple chronic diseases. The patients haven’t always had the best experience with the county’s massive health care system.

“They tell us, ‘I am just a number on this list,’” Lopez said. “When you call them by name and when you know them one-on-one … they receive that message that I care for you. You are not a number.”

By spring, Hong said he hopes to have hundreds more patients in the program.

Walfred Lopez, a community health worker at the Los Angeles County-USC Medical Center, visits patient Maria Rivera, 48, at her home in La Puente, California, on Friday, October 9, 2015. Rivera says she depends on Lopez to understand what is happening with her health (Photo by Heidi de Marco/KHN).

Walfred Lopez, a community health worker at the Los Angeles County-USC Medical Center, visits patient Maria Rivera, 48, at her home in La Puente, California, on Friday, October 9, 2015. Rivera says she depends on Lopez to understand what is happening with her health (Photo by Heidi de Marco/KHN).

Community health workers have been used for decades in the U.S. and even longer in other countries.  But now officials in various counties and states — including Massachusetts, Pennsylvania and Oregon —  are relying on them more as pressure grows to improve health outcomes and reduce Medicaid and other public costs, experts said.

“They are finding a resurgence because of the Affordable Care Act and because health care providers are being held financially accountable for factors that occur outside the clinical walls,” said Dr. Shreya Kangovi, assistant professor of medicine at the University of Pennsylvania and director of the Penn Center for Community Health Workers.

Community health worker Walfred Lopez checks the patient’s medicine to make sure she is up-to-date during a home visit in La Puente, California, on Friday, October 9, 2015 (Photo by Heidi de Marco/KHN).

Community health worker Walfred Lopez checks the patient’s medicine to make sure she is up-to-date during a home visit in La Puente, California, on Friday, October 9, 2015 (Photo by Heidi de Marco/KHN).

Kangovi said community health worker programs, however, are likely to fail if they don’t hire the right people, focus too narrowly on certain diseases or operate outside of the medical system. They also need to be guided by the best scientific evidence on what works.

“A lot of people think… they can sort of make it up as they go along, but the reality is that it is really hard,” she said.

Hong, who designed the program based on lessons learned from other models, said Los Angeles County is taking a rigorous approach. It is conducting a study comparing the costs and outcomes of patients in the program against similar patients without assigned workers.

The patients are chosen based on their illnesses, how often they end up in the hospital and whether doctors believe they would benefit.

To Lopez, 43, the work is personal. A former accountant from Guatemala, Lopez has a genetic condition that led to a kidney transplant. Like some of his patients, including Pedroza, he is now on dialysis.

He tries to use his experience and education to get what patients need. But even he runs into snags, he said. One time, he had to argue with a clerk who turned away his patient at an appointment because she didn’t have identification.

Walfred Lopez informs patient Maria Rivera that she is a candidate for bariatric surgery, but needs to lose some weight before the procedure (Photo by Heidi de Marco/KHN).

Walfred Lopez informs patient Maria Rivera that she is a candidate for bariatric surgery, but needs to lose some weight before the procedure (Photo by Heidi de Marco/KHN).

“The hardest part is the system,” Lopez said. “Trying to navigate it is sometimes even hard for us.”

Lopez and his fellow community health worker, Jessie Cho, sit in small cubicles in the clinic at Los Angeles County-USC Medical Center, the county’s biggest and busiest public hospital.

Throughout the day, they accompany patients to visits and meet with them before and after the doctor does. They also visit patients at home and in the hospital, and give out their cell phone numbers so patients can reach them quickly.

Cho said the patients often can’t believe that somebody is willing to listen to them. “Nobody else on the medical team has it as their job to provide empathy and compassion,” she said.

Morrison, the clinic physician, said both workers have become an essential part of the health team.

“There is just a limited amount I can accomplish in 15 or 20 minutes,” Morrison said. “There are all these mysteries of my patients’ lives that I know are getting in the way of taking care of their chronic medical problems. I either don’t have time to get to the bottom of it or they are never going to really feel that comfortable talking to me about it.”

Natalia Pedroza, who wears a colorful scarf around her head and speaks only Spanish, is a perfect example.  Morrison said before Lopez came on board, “I wasn’t getting anywhere with her.”

Initially, Lopez had a hard time helping her understand her health conditions and overcoming her distrust of the system. When they first met, Pedroza believed the dialysis that kept her kidneys functioning was the cause of her health problems. And she didn’t get why Lopez was always around.

But he helped her — by getting her appointments, for instance, and helping arrange for Pedroza to get pre-packaged medications so she wouldn’t have to read the directions. Now Pedroza thinks Lopez is helping her to get better.

On a recent afternoon, Lopez sat down with Pedroza before her medical appointment.

“How are you feeling?” he asked in Spanish.

Pedroza responded that her hair was still falling out and that she still felt sick. She also said she hadn’t been checking her blood sugar because she didn’t know how to use the machine. Lopez calmly demonstrated how the machine worked, and then the two spent several minutes chatting about her job and her neighborhood.

Lopez said he believes he has a made a difference for other patients as well. On a recent Sunday, a 43-year-old patient with chronic pain who initially refused his help texted that he planned to go to the emergency room because of a headache. Lopez reached Morrison, who agreed to squeeze him into the schedule a few days later. And the patient didn’t go to the ER.

Patient Maria Rivera, 48, at her home in La Puente, California, on Friday, October 9, 2015. Rivera is diabetic, dealing with high blood pressure and recently had a tracheotomy (Photo by Heidi de Marco/KHN).

Patient Maria Rivera, 48, at her home in La Puente, California, on Friday, October 9, 2015. Rivera is diabetic, dealing with high blood pressure and recently had a tracheotomy (Photo by Heidi de Marco/KHN).

Lopez persuaded another patient, a 56-year-old woman, to take her blood pressure medication before her appointments so that when she arrived, the doctors wouldn’t get worried about her numbers and send her to the hospital.

In one case, his ability to bond with a patient almost undermined his goal of getting the man the help he needed. The patient, who was depressed, said he didn’t want to go see a mental health counselor because he was more comfortable talking to Lopez.

“It was touching,” Lopez said. “I was about to cry.”

Blue Shield of California Foundation helps fund KHN coverage in California.

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Dementia taks toll of unpaid caregivers, study

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And younger man's hand holds an elderly man's handBy Michelle Andrews
KHN

Unpaid caregivers and family members spend more than 100 hours a month, on average, assisting elderly people with dementia who live in the community and not in residential care or nursing homes, according to a new study.

As people live longer, the number with dementia will increase, further straining caregiving resources.

The time commitment was significantly higher than for similar caregivers who helped elderly people without dementia, who themselves put in an average 73 hours each month.

Overall, people with dementia make up 10 percent of noninstitutionalized adults age 65 or older, but they account for more than 40 percent of unpaid caregivers’ time. Continue reading

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Surrounded by poverty, urban hospitals reach out

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By Michael Ollove
Stateline

Johns_Hopkins_HospitalJohns Hopkins University and the Hopkins health system said the upheaval in Baltimore last April, which revealed the depths of economic misery in the city, lent urgency to the major jobs, contracting and purchasing initiative they announced last month. Other hospitals around the country have also launched anti-poverty efforts. 

BALTIMORE—As a child, Bishop Douglas Miles heard the warnings about vans trolling East Baltimore streets, snatching up young African-Americans for medical experiments at nearby Johns Hopkins Hospital.

Whether there was any truth behind those stories—Hopkins has always denied them—hardly mattered. The mythology lived on and, combined with the hospital’s very real development decisions, contributed to a persistent view of Hopkins as an imperious, menacing presence amid the largely poor and African-American neighborhoods surrounding it.

“Hopkins was viewed with a great deal of suspicion and anger,” said Miles, who graduated from the school in 1970 and is the bishop of Koinonia Baptist Church in northeast Baltimore.

But now, Miles says, that perception could be changing. Johns Hopkins University and the Hopkins hospital and health system have launched an ambitious initiative to fill many more jobs with residents from distressed Baltimore neighborhoods, boost the use of minority contractors and vendors from those areas, and require their partners to follow their lead. Continue reading

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How heroin is hitting the foster care system

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320px-HeroinBy Sophie Quinton
Stateline

Timothy Dick’s office receives all kinds of reports of child abuse and neglect. Perhaps a child has a broken bone, or is underfed, or has been left home alone for too long.

But when caseworkers drive to the child’s home to investigate, they often discover the same root cause. “What we’re finding more and more is that the parents are addicted to opiates. And more often than not, it’s heroin,” said Dick, assistant director of child protective services in Clermont County, Ohio.

In Ohio and other states ravaged by the latest drug epidemic, officials say substance abuse by parents is a major reason for the growing number of children in foster care. In Clermont County, east of Cincinnati, more than half the children placed in foster care this year have parents who are addicted to opiates, Dick said. Continue reading

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Number of older prisoners grows rapidly, threatening to drive up prison health costs

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StatelineAgingPrisonersLineGraph (1)

By Matt McKillop and Frances Mcguffey
Stateline

In a year when the nation’s overall prison population dropped, the number of older inmates grew rapidly in 2014, continuing a trend that translates into higher federal and state prison health care spending.

New federal data show that from 1999 to 2014, the number of state and federal prisoners age 55 or older increased 250 percent.

This compares to a growth rate of only 8 percent among inmates younger than 55, according to the Bureau of Justice Statistics, which also reported that the U.S. prison population fell in 2014 to its lowest level since 2005.

In 1999, inmates age 55 and above—a common definition of older prisoners—represented just 3 percent of the total population. By 2014, that share had grown to 10 percent. Continue reading

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US awards $21 million to support tribal domestic violence programs

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From the US Department of Health and Human Services and the Indian Health Service

indian-health-services-seal-200pxThe U.S. Department of Health and Human Services Administration for Children and Families (ACF) and Indian Health Service (IHS) announced Thursday the award of nearly $21 million to support tribal domestic violence victims and organizations in American Indian and Alaska Native communities across the nation.

ACF funding announced today is being awarded under the Family Violence Prevention and Services Act (FVPSA), which is the primary federal funding source dedicated to providing immediate shelter and supportive services for victims of family violence, domestic violence, or dating violence and their dependents.

Grants will be awarded to 136 tribes and tribal organizations serving 274 tribes.

These funds will help to strengthen tribal responses to domestic violence and emphasize public awareness, advocacy, and policy, training, and technical assistance. Continue reading

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How one home health agency earned five stars

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annie-wilson-brookdale-home-770

Annie Wilson swings a soccer ball back and forth as physical therapist Kurt Harcar supports her. (Photo by Michael Tomsic/WFAE)

By Michael Tomsic, WFAE
KHN

CHARLOTTE — Home health agencies are a segment of the medical industry that you may not know about if you or a loved one has never needed one. The companies send therapists and nurses into the homes of Medicare patients to help them recover from an illness or surgery.

This summer the federal government started rating home health agencies – doling out one to five stars – to give consumers a better picture of the job  they do. The top grades were elusive: only 239 agencies out of 9,000 nationwide earned five stars, according to a Kaiser Health News analysis.

In North Carolina, Brookdale Home Health Charlotte was one of just two agencies out of more than 170 in the state to earn five stars. How did they manage it? Continue reading

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Most middle and high schools start too early – CDC

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Students need adequate sleep for their health, safety, and academic success

From the US Centers for Disease Control and Prevention

school-busFewer than 1 in 5 middle and high schools in the U.S. began the school day at the recommended 8:30 AM start time or later during the 2011-2012 school year, according to data published today in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report.

Too-early start times can keep students from getting the sleep they need for health, safety, and academic success, according to the American Academy of Pediatrics.

CDC and U.S. Department of Education researchers reviewed data from the 2011-2012 Schools and Staffing Survey of nearly 40,000 public middle, high, and combined schools to determine school start times.

Schools that have a start time of 8:30 AM or later allow adolescent students the opportunity to get the recommended amount of sleep on school nights: about 8.5 to 9.5 hours. Continue reading

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Texting, talking and walking – distracted pedestrian injuries jump

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texting walking iPhone cell phone mobileBy Tim Henderson
Stateline

They walk in front of cars, and into tree limbs and street signs. They fall off curbs and bridges into wet cement and creek beds.

They are distracted walkers who, while calling or texting on mobile phones, have suffered cuts and bruises, sustained serious head injuries or even been killed.

As many cities and states promote walkable neighborhoods, in part to attract more young people, some also are levying fines on distracted walkers and lowering speed limits to make streets gentler for the inattentive.

Pedestrian injuries due to cell phone use are up 35 percent since 2010, according to federal emergency room data reviewed by Stateline, and some researchers blame at least 10 percent of the 78,000 pedestrian injuries in the U.S. in 2012 on mobile device distraction.

texting walking graphic

The federal Fatality Analysis Reporting system attributes about a half-dozen pedestrians deaths a year to “portable electronic devices,” including phones and music players.

Continue reading

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Minimum wage a health issue? States take a broader view of health disparities.

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Minnesota_population_map_croppedBy Michael Ollove
Stateline

MINNEAPOLIS, Minn.— For years, proposals to raise the minimum wage in Minnesota bogged down over economic concerns: Would a raise impel businesses to leave the state? Would it decrease employment? Would it touch off inflation?

The supporters’ main argument, that raising the minimum wage would put more money into the pockets of low-wage workers and their families, fell short.

This year, proponents seized on a new strategy: They convinced the legislature to ask the Minnesota Department of Health to analyze the health impact of the state’s minimum wage of $6.15 an hour, which is among the lowest in the country.

The department’s subsequent analysis revealed that health and income levels were inextricably linked. Whether it was rates of adequate prenatal care, infant mortality, diabetes, suicide risk, or lack of insurance, the results for poorer Minnesotans were vastly inferior to residents with higher incomes.

In fact, Minnesotans living in the highest income areas of the Twin Cities region lived eight years longer than those living in the poorest.

The report virtually ended the debate. The legislature voted to phase in an increase in the minimum wage to $9.50—one of the highest in the country—with automatic subsequent increases indexed to the rate of inflation. Continue reading

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