Monday, March 31, 2014

Take Me Out to the Chaos!

Research in nonlinear dynamics has demonstrated that cells in healthy hearts seem to behave in a random, complex and unpredictable fashion. Contrary to conventional wisdom, it is this variability, or chaos, that keeps healthy hearts beating normally. Loss of complexity and variability leads to simple and fragile rhythms that put a heart at high risk for sudden cardiac arrest.  

“It is this variability that gives a living, dynamic system, such as the heart, the robustness it requires to cope with change.”
-Ary L. Goldberger, MD – cardiologist, Harvard University

Winter, Baseball, Health, and Chaos
The lack of variability this winter (cold, cold, cold, and more cold) made me ponder the benefits of chaos. A little more variety and unpredictability in the weather would have been welcomed by most Minnesotans. The foot of snow on the ground outside my window the day before Opening Day of the Major League Baseball season helped me finally understand why people wanted an open-air baseball stadium in Minnesota – it assures variability, unpredictability, and chaos.  Same, same, same, is not as much fun. This made me wonder if our health care system is also influenced by the dynamics of chaos.  The more I thought about it, the more I became convinced that baseball and our health care system are prime examples of the power of chaos theory. Let me explain.

My childhood summers were filled with baseball – collecting baseball cards, keeping track of batting averages, listening to Milwaukee Braves games, and playing the game as often as I could. Even though I played baseball almost every day, no two days were alike. Baseball brought me new adventures, new insights, and new challenges almost every day. Baseball was the heart of my summer.

After finishing my morning chores, I would jump on my bike and head to one of the many local ball diamonds. With my baseball glove hooked to the handlebars, a ball in my pocket, a bat in my hand, and a blessing from my mom to “play hard and have a good time,” I would stop by the houses of my friends to recruit participants for the day’s game.

Sometimes only two or three people would be available. At other times 15 or 20 would play.  Regardless of the number, we’d always have a game and we’d always follow an unwritten rule that no one would sit on the bench.  his meant we made up new rules to accommodate the number and skill level of players available. Except for the fact that we used bats, balls, and gloves, our games often bore little resemblance to the official version of baseball advanced by Abner Doubleday. Each day we found new, creative, and unconventional ways to play the game that all of us loved. Each day was wonderfully satisfying and we always looked forward to the next game.

As I got older and became more involved in “organized” baseball, the pick-up games became less frequent – not because of lack of time but because “real” baseball began to put limits on what we could do. In hopes of becoming “better” players we began to pay more attention to the rules that the Little League coaches taught us and work on the “weaknesses in our game” that they had noticed.  The game became a more serious undertaking. Soon the afternoon pick-up games stopped completely and our only baseball time was team practices or games. Since the number of people on the team roster was limited, many of the neighborhood players who hadn't made the team hung up their gloves and moved on to other things. In the process, my circle of friends became smaller and baseball lost much of its variability and spontaneity.

It appears that my experience may not be unique because fewer children are playing baseball today than at any time during the last 50 years. Some of this decline may be the result of increased activity options available to children, but I believe a major reason is that baseball has lost the spontaneity and dynamism that could have kept it fun, robust, and inclusive. Youth baseball has become adult-directed and tied to a set of confining rules so that the variability and innovation needed to survive in our ever-changing world has been curtailed. Baseball has become less chaotic and interesting and increasingly irrelevant to most American children. While baseball still claims to be America’s pastime, that status is now in doubt.

In many ways our health care system parallels baseball. Over the last several decades there has been an increased emphasis on uniformity in health care. Consolidation of health care clinics, providers, and systems has occurred while standardization of disease management protocols has become the norm. Definitions and measures of success have also been standardized and policies have been put in place to facilitate progress toward the desired and defined outcomes. Evidence-based practices are touted as the ideal, leaving little tolerance for spontaneity, individuality, creativity, and variability.

Like baseball’s development system which continues to produce some superstar players, this standardization of health care has also provided some tremendous benefits.  The quality, safety, and value of services have increased and overall health outcomes have improved.  These efforts have helped create one of the best medical care systems in the world and they need to be maintained and expanded.

However, as our society becomes increasingly diverse and complex, we are seeing that the things that most affect health are beyond the scope of “traditional” medical care. The diseases and disabilities affecting society today are influenced mostly by socio-economic and environmental conditions and lifestyle choices rather than health care. Income, economic policies, education, housing, community livability, and social capital are the real determinants of health today. Yet, our health care system with its traditional focus on preventing and treating disease rather than creating health has limited capacity and ability to address or influence these factors. While health care continues to be important, we are learning that its impact on overall health has limitations.

To maximize health, we need a broader approach to health that identifies, embraces, and supports the opportunities to create health in our communities. It needs a bit of disruptive, chaotic innovation that will stimulate complex, diverse, flexible, and dynamic approaches to health. To me, public health’s role in the 21st Century is to bring a bit of chaos (in the non-linear dynamics sense) to our health system.

If we continue to invest most of our resources in disease treatment and management and not in creating health, our health care system will, like baseball, risk becoming somewhat irrelevant – a casualty of its own inflexibility.  Our health system, like a healthy heart, must maintain a high level of variability and chaos. It can only do that by embracing a broader public health context that allows the flexibility to deal with not only the medical determinants of health but the social and environmental determinants as well.

Although we probably can’t do much about the current state of baseball, public health is in a unique position to help stimulate changes in how we create health. By encouraging and supporting creativity, diversity, innovation, risk-taking, and inclusivity in discussions about the social determinants of health, we can maintain a healthy and necessary level of chaos. Changing the current culture and modifying the rules of the health care will be a challenging, chaotic, and rewarding process – one that will most likely go into extra innings. Do you want to play?


Monday, March 17, 2014

Wages are a public health issue

When people think about minimum wage, they most often think about the impact on their bank account and their job. But policies that impact employment and income are actually about health – the health of individuals, families, and communities.

When 19th Century industrialization drove workers from farms and home workshops into urban areas and factory work, our economic system changed dramatically. This change was particularly devastating for poor families and children. Working conditions were unregulated and often unsafe, leading to tens of thousands of work-related deaths. Millions of children were forced to work long hours in hazardous conditions at low wages because their poor families desperately needed the income to supplement the parents' low wages. Factory owners benefitted from child labor because children were more manageable, cheaper, and less likely to strike. The reality for children was poor health and loss of educational opportunities.

These horrid conditions persisted for decades until progressive 20th Century laws restricted child labor, improved working conditions, and established a minimum wage. These laws significantly reduced fatalities and improved overall health. Families at the lower end of the socio-economic scale benefited the most. Low-income communities saw improvements in life expectancy and lifetime earning capacity.

Even though Minnesotans no longer work in sweatshops or send children into dangerous mines, how we work and what we earn continues to impact our health and that of our communities. Studies show that income is the strongest and most consistent predictor of health and disease. People with higher incomes are healthier and live longer than people with lower incomes. Lower incomes are consistently associated with higher rates of disabilities and chronic physical and mental conditions. Poverty also leads to faster disease progression, more complications, and poorer survival rates. The vast majority of diseases are much more common among the poor and near-poor at all ages. Recent data show Minnesotans making less than $20,000 a year were more than twice as likely to have diabetes compared to those making $75,000 or more a year.

Children are particularly vulnerable to the health impacts of poverty, and the more years a child spends in poverty, the more negative outcomes accrue. Poor children are more likely to experience injuries, violence, inadequate health care, poor nutrition, and insecure housing. These conditions have a powerfully negative affect on health and development. Children from poor families are less likely to live in a neighborhood with healthy food options, safe places to play, good schools, libraries, or other quality public services that help set them on the path to a successful, healthy life.

The relationship between health and income is not just about individual access to medical care, but how income affects a range of opportunities for health. Communities with residents with higher incomes are likely to have better recreational amenities, housing stock, food access, and schools, and tend to be safer – all of which impact health. Income is also associated with other factors that create the opportunity to be healthy, such as employment opportunities, reduced environmental contamination, and greater transportation options.

Health improves with increasing income, and the impacts of a rise in income are greatest for those at the lowest end of the wage scale. Moving from the lowest income level to the next lowest provides the largest percentage increase in life expectancy and health status. In other words, a family living on minimum wage realizes greater health benefits from an increase, in that low salary, than a middle-class family receiving the same raise. Increasing the minimum wage is a sound public health investment for Minnesota. The health of Minnesota’s lowest wage earners will improve along with that of their families and communities.

We all benefit from and have a role in creating healthier communities. It’s time for us to come together to implement a minimum wage that further enhances the health benefits of employment and lifts more than 350,000 Minnesotans out of poverty. As Health Commissioner and a physician, I prescribe an increase in the minimum wage to improve the lives and health of vulnerable Minnesota children and families. It will be a great investment in the health of individuals, families, communities, and our state.


P.S.  Check out our White Paper on Income and Health -

Monday, March 10, 2014

Lifeboats, Torpedoes, and Social Policies

On the south coast of County Cork, Ireland is the sheltered seaport town of Cobh.  The town is best known as the final port of call of the RMS Titanic which sank on April 15, 1912 with a death toll of 1,517. Another maritime disaster that is part of Cobh’s history is the sinking of the RMS Lusitania on May 7, 1915. The Lusitania was torpedoed by a German U-boat ten miles off the shore of Cobh with a loss of 1,198 lives. 

Less well known is the fact that for over a hundred years Cobh was the single most important emigration center in Ireland. Between 1845 and 1851 over 1.5 million adults and children emigrated from Ireland.  Ultimately, over 6 million Irish people emigrated, with over 2.5 million departing from Cobh. 

I visited Cobh 6 years ago and this quaint town resurfaced in my mind this weekend when I purchased some corned beef in preparation for St. Patrick’s Day. I remembered that as I walked along the docks of Cobh, the specter of those three traumatic events was everywhere. Wherever I looked, whatever I read, and with whomever I talked, these historical events which occurred 100 + years ago were still vivid in people’s minds. 

The more engrossed I became in the stories of Cobh, the more I realized that the unifying lesson in all of these events was the role of policy decisions in causing these tragedies. Different individual or societal decisions could have prevented or significantly reduced the loss of lives and the human trauma caused by these events. 

On the Titanic the number of lifeboats was inadequate for the number of passengers. The ship had been designed for more lifeboats but a decision was made to fit it with a lower number that met the minimum requirements of an outdated law that based lifeboat numbers on tonnage not on number of passengers. Plans were to add more only if the law required them. 

In early 1915 a policy decision was made by the German military to do whatever was necessary to gain control of the waters of the Atlantic Ocean. This decision led to the torpedoing of the passenger ship Lusitania and the eventual US entry into World War I – a war that killed or injured over 37 million people.  

The policy decisions that led to the starvation and mass emigration of the Irish were more subtle and indirect but just as lethal as the iceberg and the torpedo that sunk the Titanic and the Lusitania. Decades of state-sponsored discrimination promoted laws that influenced all aspects of Irish life including the restriction of education, the practice of religion, and the use of Gaelic by the Irish people. It also fostered passage of the “penal laws” that affected land ownership and which led to total dependence on the potato for sustenance. These prejudicial policies inevitably caused the 1.5 million deaths and mass emigration precipitated by the potato famine that plagued Ireland for decades.

In each of these situations, conscious policy decisions led to catastrophic results that negatively affected the life and health of large numbers of people. Yet, none of these policy decisions was related to health care. They were policies emanating from consideration of business and political needs or the maintenance of a social and economic order that favored those in power.

I relate this story about Cobh not just for historical interest but because the impact of policies on health continues to play out every day. The discussion around minimum wage, one of the 2014 legislative session’s major policy issues, is a good example. The debate has centered mostly on the business, economic, and political ramifications of increasing the minimum wage. Yet, our recent report on “Income and Health” points out the fact that minimum wage is a public health issue – as income increases, health improves. Even though minimum wage is not being heard in health committees, policy makers need to be aware of the individual and community health implications of this policy decision. 

Similarly, last month MDH submitted a report to the legislature entitled “Advancing Health Equity in Minnesota.” The report notes that “(w)hen groups face serious social, economic and environmental disadvantages, such as structural racism and a widespread lack of economic and educational opportunities, health inequities are the result.” The report underscores the fact that health is determined by much more than just health care. In fact, the majority of the health of individuals and communities is influenced by the “non-health” sectors. When health is not considered, policy decisions in these sectors often establish barriers that inhibit equal opportunities for health for all. These policies particularly affect“(t)hose with less money, and populations of color and American Indians, (who) consistently have less opportunity for health and experience worse health outcomes.”

Certainly, “health care policies” need to be part of the policy milieu that influences health. However, the example of Cobh demonstrates that business, occupational, educational, transportation, economic, and social policies can have an even larger impact on the survival and health of individuals and communities. 

As the state’s lead public health agency, MDH has a responsibility to help create the conditions in which all Minnesotans can be healthy and that responsibility goes far beyond just dealing with issues in the clinical care and public health arenas. To be true to the vision of advancing health and health equity, MDH and all public health professionals need to be actively involved in assessing and monitoring policies at the local, state, and national levels that could have a health impact and advocating for decisions that will ultimately benefit the health of all Minnesotans and every community in our state. 

The history of Cobh reminds us that policy decisions are important to the health of the public. There is health in all policies. 


Thursday, March 6, 2014

Greetings from the ASTHO Day at the capitol

Wednesday, March 5, 2014 
Greetings from Washington, D.C.,
I’m in Washington for the Association of State and Territorial Health Officials’ (ASTHO) Day on the Hill.  Actually, I’m here for three days, two of which are “on the hill.”  Since I’m on the Board of ASTHO as the Region V representative, I spent the first day of this Washington visit at the ASTHO board meeting discussing the various issues facing states and territories, and preparing for visits with our congressional delegation and Obama administration leadership. 
The fiscal year 15 budget is the biggest issue of immediate concern for ASTHO and MDH.  Congress is in the process of preparing that budget and it has great implications for public health.  Conversations were quite animated because the President released his budget on the same day as our board meeting.  As with most budgets there is some good news and some bad news.  But since congress has to act on a budget of their own, the President’s budget is just the first step in a long and complicated process of coming up with a final budget – if they ever do.  However, the President’s budget served as the basis for the subsequent visits on “the hill.”
Today, I joined a group of 7 ASTHO board members in meetings with agency leaders within the Obama administration at the Hubert Humphrey Office Building. (Please excuse the acronyms that follow.) I got to meet with Tom Frieden, CDC Director; Pamela Hyde, SAMHSA Administrator; Mary Wakefield, HRSA Administrator; Sally Howard, FDA Deputy Commissioner; Nicole Lurie, Assistant Secretary for Preparedness and Response; and Anand Parekh, Deputy Assistant Secretary for Health.  We were scheduled to meet with Marilyn Travenner, CMS Administrator, and Kathleen Sebelious, HHS Secretary, but their visits got pre-empted by some public announcements they were making today. 
Each of the visits dealt with some important and pressing problems.  Each of the meetings could warrant a separate note.  Since I’d lose you before getting to the second visit, I’ll relate the events of just one of the meetings – the one with CDC Director Thomas Frieden, MD.
Dr. Frieden spent a few moments talking about the budget but spent most of the time talking about his priorities and some of his thinking about public health.  In the next fiscal year, CDC has three major priorities:  Global Health Security, Anti-microbial resistance, and prescription drug overdose. 
Global Health Security:  On February 13, 2014 the U.S. joined 26 countries and international partner organizations to accelerate progress toward a world safe and secure from the threat of infectious disease.  From the point of view of CDC, the importance of global health security has never been clearer;  influenza could affect millions, new microbes are emerging and spreading, drug resistance is rising, and laboratories around the world could intentionally or unintentionally release dangerous microbes. Globalization of travel and trade increase the change and speed of these risks, spreading disease. 
Anti-microbial resistance:  Drug resistance is a growing problem and creates risks for all medical procedures.  CDC is looking to work with hospitals and health departments on developing antibiotic stewardship programs in hospitals and with health departments.
Prescription Drug Overdose:  The rapid rise in drug overdoses and deaths in the last few years has highlighted the problem of prescription drug overdosing.  One of the ways to address this is with a Prescription Drug Monitoring Program (PDMP).  Dr. Frieden stated that, in his view, an ideal PDMP has 4 components:  it’s universal (covers all patients and all providers), it’s real time (should be able to get data immediately), it’s embedded into the EMR, and it’s actively managed.  Many states have PDMPs but few contain all of the necessary components which would include monitoring both patients and providers.  Minnesota doesn’t have an ideal PDMP.
After an hour of dialogue, Dr. Frieden ended his time with us by stating that he’s concerned about how public health is viewed.  He said that too often, public health gets criticized for working toward a “Nanny state.”  To combat that, he has started to say that public health is about increasing freedom.  There are three ways that public health increases freedom:
  1. Public health provides information to citizens, providers, policy makers so that they can make decisions based on the most recent information and knowledge available.  Public Health information gives people the freedom to choose, knowing the risks, from a list of options.
  2. Public health protects individuals from the actions of others.  Public health protects individuals from being injured by a drunk driver, from unsafe food, from  poor quality care, etc.  These protections give people freedom to act without worry.
  3. Public health does certain things that could be done by individuals but is more efficiently done for all by a public agency.  For example, everyone could boil his/her water but it’s much cheaper and more efficient to have water made pure and safe by a publically-accountable public agency.  This collective action leads to more freedom for individuals to pursue other activities.
I thought this was one good way to characterize public health. These ways to increase freedom are also relevant to our advancing health equity efforts.  These freedoms, if enhanced, would allow everyone the opportunity to be healthy. 
Tomorrow, I meet with our congressional delegation.  It will be a long day but I’m hoping it will be a productive one.

Monday, February 24, 2014

It’s the Little Things that Count


“I will tell you something about stories . . . They aren't just entertainment. Don't be fooled. They are all we have, you see, all we have to fight off illness and death.”
Leslie Marmon Silko, Ceremony

I was worrying about all of the big things that were facing me in the upcoming day when I left home on a recent sub-zero, cloudy, and dreary February morning. It was one of those days that prods one to question the reasons for living in Minnesota. To make matters worse, I was now stuck in a traffic jam on Interstate 94 where it crosses Hiawatha Avenue. Most of the gray exhaust rising from each of the cars idling on this highway turned parking lot was creating an environment that was not quite pea soup but more like dirty dishwater left in the sink overnight. The remainder of the exhaust was freezing on the pavement creating a black ice that made whatever movement there was hazardous and stressful.

The longer I was trapped in this traffic jam the more irritable I became. It was dawning on me that I was going to be spending a large chunk of time in my car in one of the gloomiest parts of town on one of the gloomiest days of the year. The irony of the presence of such ugliness as I sat stranded over a street named after a famous American Indian, whose name evokes images of nature's beauty, was not lost on me and made my frustration even more intense.

That thought, however, momentarily took my mind away from I94 and Hiawatha Avenue and transported it to a storytelling session that I had attended over twenty years ago. Despite the fact that it had occurred so long ago, I could vividly recall the setting – a small cottage nestled in a small clump of trees in the middle of a preserved patch of prairie just south of the Twin Cities. The cottage was decorated with hand-crafted furniture, fabrics, and art. It was a magical place that gently coaxed stories out of people.  It was the antithesis of I94 on this gloomy morning.

One of the storytellers made a particularly vivid impression on me. Her name was Anne Dunn, an Ojibwe woman from Cass Lake, MN. She had made the trip to the Twin Cities solely for the storytelling session.  She knew it didn't make any sense for her to come all that way just to tell a story or two but she had a feeling that she had to be there – so she was.

Her story was about a young man who had gone on a Vision Quest.  Just before he departed, an elder approached him and advised him that over the next three days he should pay attention to the little things around him because they might hold something special. The young man said that he would and then departed with hopes of having a great vision that would give him some purpose and direction in his life. 

When the young man reached the top of the hill that he had chosen for his quest, he set up his camp and began the fasting and prayer that he hoped would lead to his vision. 

For three days he waited. No dreams came while he slept. He looked for signs from eagles, wolves, bears, or deer but nothing appeared. He gazed at the sky looking for clouds or thunder and lightning but nothing was visible to him. He looked at the trees and the rocks and the hills but he saw nothing but the landscape. He prayed, and even begged, for a sign but nothing came that he could recognize. Finally, exhausted and in despair he gave up his quest and headed back to his people.

Upon entering the village the young man was met by the elder who had talked with him before he left. The elder asked about the Vision Quest. The young man dejectedly replied that it was a failure; nothing had happened. He felt depressed and cheated.

The elder asked him about the bird. The young man replied that there were no birds. 

The elder asked him again about the bird. The young man again replied but this time with some impatience in his voice that there were no birds. He had looked diligently for three days for signs of eagles, hawks, loons, or even owls but none had appeared.

For the third time the elder asked him about the bird. By this time the young man was beside himself.  He screamed that there were no birds, that the place was barren, and that his whole Vision Quest was a waste of time. 

The elder quietly asked "what about the bluebird?"

"O, that pesky little thing," the young man replied. "He kept bothering me. I tried to chase it away but it kept coming back. After a while I just had to ignore it because it was interfering with my Vision Quest."

As he was talking, the young man suddenly remembered the words of the elder before he had left on the Vision Quest -”pay attention to the little things.” With great despair he realized that he had disregarded this advice. The bluebird was trying to tell him something but he didn't pay attention because he was looking for something more dramatic and spectacular than the appearance of a lowly little bluebird. 

The young man went away and cried with the realization that he had wasted a golden opportunity.

Just then, I was jolted back to the present by a horn sounding behind me. The traffic had begun to move and, for the person behind me, I had been too slow to respond. I slowly pushed down on the accelerator and caught up with the flow of traffic. The cars were now moving but the murkiness and glumness of the surrounding cityscape remained. My mind went back to the advice of the elder in the story - "Pay attention to the little things around you. They may hold something special for you."

At that moment I looked up through the dirty gray air toward the sun that was slowly rising directly ahead of me. Around the sun a glorious rainbow had appeared and was forming an arch over the road. The rainbow was created by the exhaust and polluted air which moments before I had been cursing. 

I began to smile as I noticed that the most vibrant color of the rainbow was blue – a blue that matched the hue of a bluebird's wing. At that point I knew that I was one of the reasons Anne Dunn came to the Twin Cities. I needed her story even though it took 2 decades to understand that. To paraphrase Leslie Marmon Silko, I needed her story to fight off the frustration and stress that was not leading to health. Her story also assured me that the big things in my day would take care of themselves if I stopped worrying and simply paid attention to the little things all around me. 

It turned out to be a great day.

The 2014 legislative session starts this week. That’s a big thing. While we deal with that, let’s be sure to pay attention to the bluebird on our shoulder.


Tuesday, January 14, 2014

Excellence in State Public Health Law


For the last 3 days a team from Minnesota has been meeting with similar teams from 7 other states to learn about how to use public policy approaches to advance public health initiatives. The program is conducted by the Aspen Institute and funded by the Robert Wood Johnson Foundation. Entitled Excellence in State Public Health Law (ESPHL), the premise of the program is that teams consisting of state health commissioners, state legislators, and policy directors in governors' offices could learn from each other and collectively advance public health policies; legislators and policy directors could learn about public health while public health folks could learn about policy development.

Each team at the meeting was focused on a different public health issue that was relevant to its state. Hawaii focused on improving the oral health of children. Washington State is trying to increase the number of "Baby Friendly Hospitals" as a way to increase breast feeding rates and reduce obesity. Arkansas is attempting to increase the physical activity levels of girls. Louisiana is working to improve the vending options in their office building and strengthen their retail food regulation. Virginia is also looking at improving the quality of food served in public facilities and is working on establishing a model public health policy development process. Rhode Island is hoping to create a Neighborhood Health Station that would integrate primary care and public health and get financed through a Primary Care Trust Fund established by an insurance claims tax. Connecticut is trying to align and organize (regionalize) its 169 independent local public health agencies.

The focus chosen by Minnesota is to find the policy initiatives that could reduce the negative consequences of high risk (binge) drinking. The Minnesota Team consists of 2 senators (Chris Eaton and Jeremy Miller), 2 representatives (Susan Allen and Nick Zerwas), the governor's legislative director (Jamie Tincher), three commissioners (Lucinda Jesson DHS, Mona Dohman Public Safety, and me), and one MDH assistant commissioner (Manny Munson-Regala). (Tincher and Jesson were unable to join us this weekend.) The make-up of the Minnesota team recognizes the Health in All Policies approach that will be necessary to have an impact on high risk alcohol use. Policies like increasing the price of alcohol, lowering the Blood Alcohol Concentration (BAC) for DUI designation, eliminating drink specials, and increasing the use of ignition interlock systems (among many others) will probably come out of legislative committees other than health and human services, if they come at all.

After evaluating the research evidence of effectiveness of various interventions, polling Minnesota residents about their support of these initiatives, and considering the political feasibility of these initiatives in an election year, the MN team decided to focus on enhancing and expanding the use of ignition interlock systems - systems that prevent a car from being started if the driver has been drinking. This has been shown to be an effective intervention and our polling shows that 85 percent of Minnesotans are supportive of this approach.

However, as we began to look more closely at ignition interlock, we realized that there are some significant issues that need to be addressed before we can think about changing current policy. The biggest hurdle will be overcoming the cultural norm of excessive alcohol use in MN and the belief that severe penalties should not be levied on first offences. Given that culture, expanding the use of ignition interlock systems more broadly and thus affecting many more people may be a tough sell in our state.

In addition, there are multiple other perplexing issues. For example, ignition interlock systems can be affected by severe cold. These systems are also quite expensive to the individual and to the monitoring agency. And how this approach may disproportionately affect low income and other disadvantaged communities is a real and significant issue. Our discussion proved that seemingly simple solutions seldom are. It also proved the value of engaging a diverse team with varied perspectives when trying to come up with solutions to "wicked" problems.

Although we weren't able to finalize our policy approach at this meeting, our team is committed to continue to work together to come up with a recommendation about how to proceed with ignition interlock. More importantly, our team recognizes that high risk drinking and other alcohol-related issues will not be resolved by a 1 year project like this ESPHL project. They recognize that the misuse of alcohol is a significant public health problem in Minnesota and that it is past time for a serious and concerted effort to be made to address the issue with thoughtful and well-informed public policies.

The Minnesota ESPHL team is committed to the long-term task of developing those policies. So, stay tuned.


Monday, December 23, 2013

Three Little Pigs - A tale of unstable housing

Members of the Jackson Elementary School Student Council were strategically placed in the school’s media center during Thursday’s press conference on the release of “Heading Home: Minnesota’s Plan to Prevent and End Homelessness.” Their visible presence underscored the fact that half of the 10,000 Minnesotans who are homeless every day are families with children – just like these.  They were also a reminder that having stable housing is important for school success. Holding the press conference at a Promise Neighborhood School in Frogtown, also gave the message that resolving major social problems like homelessness is beyond the capacity of individuals – it requires a concerted community-wide effort.

During the course of presentations by commissioners Tingerthal and Jesson (co-chairs of the Minnesota Interagency Council on Homelessness [MICH]) and the mayors of Minneapolis and St. Paul, the students attentively listened and jotted down notes on their clipboards. Their attention never waned, even during the “in-the-weeds” question and answer period following the presentations. As I stood with the other commissioners who were part of MICH, I was impressed with these student leaders.

Following the event I took the opportunity to meet the Student Council Members. I shook their hands, introduced myself, and asked what they learned from the press conference. Most said that they learned a lot from the press conference and were glad that something was being done to help people find a place to live. Several knew students who were in unstable living situations. However, most admitted that they got lost in some of the details of the press conference. In response to that admission, one 4th grade girl stepped forward and said, “It’s pretty easy to understand. It’s just like the Three Little Pigs.”

The other Student Council members looked perplexed so she went on. “The pigs that lived in a straw house or a house made out of sticks were never really safe. They always had to worry about the Big Bad Wolf coming and blowing their house down. They could never sleep well or settle into their house because they always had to be ready to move. Only when they got into a house made of bricks were they really safe from the wolf and able to relax. The wolf is like all the bad things people have to face that makes it hard to live and the brick house is what these people here today are trying build for everyone."

The other students said, “That makes sense.” All I could say was, “I think you got the idea quite well.”

I left the press conference with a smile on my face, confident that our future will be in good hands.