A five-year, $19.4 million grant from the National Institute on Minority Health and Health Disparities will help researchers and community activists from around Minnesota understand and develop ways to address the impact of racism on the cardiovascular health of members of the state’s people of color.
The grant will be administered by the Center for Chronic Disease Reduction and Equity Promotion Across Minnesota (C2DREAM), a new research center based at the University of Minnesota and the Mayo Clinic that will conduct its work in collaboration with a number of community-based health organizations across the state.
In Minnesota, Black, Indigenous and People of Color (BIPOC) communities experience the highest rate of health inequities in the U.S. The grant’s goal is to use the knowledge and experience of community based organizations to narrow that gap, gaining a deeper understanding of strategies that can effectively address health needs based on community ways of knowing.
Michele Allen, University of Minnesota Medical School associate professor of family medicine, director of the school’s Program in Health Disparities Research and one of C2DREAM’s principal investigators, said that the work of administering the C2DREAM grant will be complex, but she is optimistic about its potential.
“We had very short turnaround time to get this grant submitted and everybody dug in and wanted to get it done because we are all really committed to what can come out of this and the opportunity for action that can come out of the center.”
An arm of the National Institutes of Health, the National Institute of Minority Health and Health Disparities wanted to fund centers that they felt would do the hard work of identifying workable strategies for closing health gaps, Allen explained.
“They have funded nine of these centers across the country that are trying to understand how chronic conditions link together and why we end up with disparities among a number of chronic conditions for BIPOC communities in particular.”
In Minnesota, Allen continued, C2DREAM will focus on links between hypertension, heart disease and obesity in minority communities. “We are looking at factors on multiple levels that contribute to these diseases and factors that limit our ability to address these diseases.”
As part of the grant, NIH required recipients to build a regional center with multiple actors working together. To do that, C2DREAM will pull in people from a number of larger organizations, including the University of Minnesota Medical School’s Twin Cities and Duluth campuses and the U’s School of Public Health, as well as Hennepin Healthcare and the Mayo Clinic.
“It’s really health equity researchers, community partners, leaders in this area from across the state working together,” Allen said. “We are looking closely at the relationship between racism and these chronic diseases.”
The heart of the problem
In Minnesota, one way to demonstrate the impact of structural racism on health is to look closely at the state’s Native American community. Antony Stately, president and CEO of Native American Community Clinic (NACC), a multifaceted health care organization focused on members of Minneapolis’ Native community, said research show that the people he serves carry greater health burdens than members of the state’s other ethnic groups.
“Generally speaking, Native Americans in Minnesota have higher rates of cardiovascular-related health conditions like heart attacks, COPD, things that are related to other chronic diseases like diabetes,” Stately said. “What we know about other research that’s been done in the general community is that stressful life experiences contribute to greater risk of heart disease mortality from cardiovascular events. Native Americans have higher rates of cardiovascular mortality than the general population.”
When examined from a wider view, it appears that structural racism may play a role in these significant health disparities, Stately said.
“There is a body or research emerging that has shown that racialized stress, a byproduct of living in a society influenced by structural racism, sets the stage for conditions to be more pronounced in terms of lack of access to jobs to housing, things that are called social determinates of health,” he said. “We know that those things are much greater and more pronounced for communities that are impacted most by racism, like BIPOC communities.”
In BIPOC communities, Stately explained, there is an “overabundance of burden” that is demonstrated in the rate of chronic diseases and the lack of access to resources for the prevention of those diseases.
Living conditions in Minneapolis’ Native American community, one of the largest and most dense urban populations of Native Americans in the United States, are a good example of the impact of these disparities, he said. “We live in a food desert in South Minneapolis with very limited access to healthy foods and grocery stores. There is not a lot of green space and parks available in the community. Access to parks and community centers where children and families can be outdoors and engage in physical activity is very limited in our community.”
Allen said that NACC will be working with C2DREAM to analyze the larger societal factors that create such disparities, and then move to address those problems with solutions born from organizations that are embedded in affected communities. This makes NACC, with its long history of working with Native American people, a perfect match.
“We’re hoping to understand these big-picture patterns and uncover practical ways to pinpoint and address how racism intersects with poor outcomes,” Allen said. “We’re really doing it locally with a very intentional involvement of community leaders who are going to help us develop those solutions and to move them into action.
“NACC and Antony are doing so many exciting projects,” she said. “The study he’s part of with C2DREAM is really trying to elevate the very exciting work that is happening already in the native community.”
Stately explained that the C2DREAM study will reach participants where they feel most comfortable. “Our project will work specifically with our home visiting programs to work with families enrolled in those programs to build activity and healthy traditional foods in their homes,” he said. “We will also work with existing youth activity programs in our communities in Minneapolis that are offering traditional Native lacrosse or health and wellness programs for Native kids.”
By working with existing community programs, Stately said that he and his C2DREAM colleagues hope to get greater buy-in and participation from study participants.
“We are going to leverage all of our partnerships in our community that serve young people in some capacity, including health, social education,” Stately said “We’re going to engage these partners we work with who are already doing work around food sovereignty and providing nutritious meals. “
By taking this community-centered approach, Stately said, this research will be more likely to be fruitful and directly impact members of the community. He said he hopes that this collaboration will uncover strategies and solutions that mainstream health care providers have overlooked.
“Our thought process is that culture matters and that culturally centered and grounded activities and food and community engagement is the antidote to racialized stress,” he said. “We’re trying to leverage these resources from a research perspective to say, ‘These communities are already doing this work, doing these small community led projects. What happens when we bring these five or six or seven groups that are doing this work together?’”