With the election behind us, COVID vaccines rolling out and the state's legislative session about to begin, it's time to start planning for life after the pandemic.
Minnesotans need to be healthier — physically, mentally and civically. We must commit to the vision of a state whose people and communities thrive.
Health and well-being are declining in our state on many fronts, including poor birth outcomes (especially for rural, Black and Indigenous Minnesotans), rising suicide, obesity and addiction rates, and declining mental health. COVID and the death of George Floyd in police custody have helped bring inequities into stark relief.
Once Minnesota, overall, was the envy of the country, rating among the top three healthiest states for more than a decade. Now, we rank seventh on UnitedHealth's respected list and may lose further ground in the coming years. The United States, meanwhile, is near the bottom of the list among developed nations. Why?
The answers boil down to this: Relative to the rest of the developed world, America invests little in the "upstream" social, behavioral and economic factors that create the conditions for the health and well being of its people. Worse, for decades we have created conditions that assure non-whites and people marginalized for other reasons are deprived of equity in education, health, social support and employment. Discrimination costs all of us through lost productivity, wasted lives and violence.
Solutions lie upstream in factors such as public policies, the environments we live in, social and economic conditions, and behaviors influenced by our social and community context. We need livable, equitable and connected communities, in other words. Yet we spend most of our money on sick care and "containment" of social problems downstream.
Consider the disparate budgets of the state Department of Health — which emphasizes preventive health policy — and the Department of Human Services, which primarily spends on "downstream" health services and long-term care. The health department's budget totals less than 2% of that of the Human Services Department.
Other countries have learned that spending "upstream" lowers the cost of downstream fixes. But in the U.S. and Minnesota, we have narrowed our focus to a small area of the relevant landscape. We are expecting less and paying more for it. And our lack of preparedness for a predicted pandemic has made this worse.
Of course, access to high quality health care and attention to the social, behavioral and economic determinants of health both are important. Without collaborative action and investment, we cannot strike a better balance between upstream community-level prevention and downstream fixes for individuals.
Prevention and health promotion in communities is more effective and cheaper than acute fixes for one person at a time, by an estimated factor of five. Focusing upstream works.
It's time for MNThrive.
How can Minnesota shift its paradigm toward preparing, rather than repairing?
Imagine a future where public and private institutions invest in multi-sector partnerships in greater Minnesota and the underserved communities of metro areas. Imagine a focus on innovations through building local capacity to create livable communities that are economically and educationally sustainable. Imagine that what the public and private sectors learn together could break the "Minnesota paradox."
The truth is that all communities, urban and rural, have social assets to become healthy and livable, if they are supported. They can adapt and make decisions that advance our collective well-being. Taking the steps to understand what's necessary and for whom, and to invest in our most valuable asset — human thriving — is the right thing to do. We can advance what we've learned from good science and use what we know to tackle these complex areas.
Other states have done this well. In North Carolina, for example, the state invests millions annually in an institute that connects UNC-Chapel Hill to communities statewide in pursuit of improving public health and well-being, and building the capacity for good governance and decisionmaking. The initiative connects UNC faculty and students in partnership projects with local institutions and leadership-building capacity.
In Missouri, Communities of Excellence 2026 is a nonprofit organization that has worked to unite sectors and leaders across a community and produce sustainable results to key areas of community performance such as educational attainment, economic vitality, health and safety.
The University of Minnesota has enormous social and scientific assets that could be brought to bear with the help of the Minnesota Legislature, just as it did in its unique investment in MnDRIVE a few years ago, when legislators invested in important research to benefit Minnesota.
As the Legislature gets underway, we recognize that other issues affecting the University and higher education are priorities right now. Down the post-COVID road of the next few years, we hope these ideas will rise on the list as well. Let's call it MNThrive.
The authors are University of Minnesota faculty members. Laura Bloomberg is dean of the Humphrey School of Public Affairs. John Finnegan is dean of the School of Public Health. Vanessa Laird is director of the Center for Integrative Leadership. Beverly Durgan is dean of University Extension. Mary Jo Kreitzer is director of the Earl E. Bakken Center for Spirituality and Healing. Opinions expressed are their own.
