Creating Healthier, More Equitable Communities

Recent media reports have highlighted startling trends in U.S. maternal health with stark differences across racial and ethnic groups. Maternal deaths associated with pregnancy and childbirth are high when compared to other developed countries and have increased substantially over the last two decades.

Like many communities in the U.S., the Twin Cities metropolitan area has become increasingly vocal around social justice—exposing and documenting local poverty, inequity, and discrimination. Amid this wave, Hennepin County is actively seeking out population health policy opportunities to engage high-risk families and children, with the goal of developing and implementing upstream, cross-sector interventions to preserve unified, healthy families and avoid out of home placements (i.e., foster care).

In 2015, the North Carolina legislature passed “The Healthy Food Small Retailer Program” (HFSRP), allocating $750,000 over three years to small food retailers located in USDA-defined food deserts. These funds could be used to purchase and install refrigeration equipment, display shelving, and other equipment necessary for stocking nutrient-dense foods, including fresh vegetables and fruits, whole grains, lean meats, and seafood.

The impact of the opioid epidemic on children, their families, and on child-serving systems (early childhood education, schools, child welfare, etc.) is not well understood. This exploratory project will examine some of the most critical dimensions, urgent challenges, and important nuances for policymakers and others, drawing on a review of the existing literature and a deeper dive into two states at the forefront of the opioid epidemic.

In the U.S., the key challenge for many households is housing affordability. Households paying more than one-half of a limited total income for rent have very little left over for food, transportation, education, and other critical expenses. And these rent burdens have only been growing. In 1960, fewer than one in four renters was rent-burdened (or paid more than 30 percent of their income on rent); today that fraction is nearly half.

A growing literature has documented the detrimental effects of housing instability (often generated by evictions and foreclosures) on health. Using the RealtyTrac foreclosure dataset, which includes information on every foreclosure action in the U.S. between 2006 and 2015, the research team will match foreclosures with Medicaid address data and follow units through the foreclosure process (from initial notification that a mortgage holder is behind on their payments through repossession by the lender).

Each day in the U.S. there are approximately half a million individuals detained while awaiting trial. This high rate of pretrial detention may be due both to the widespread use of monetary bail, and to the limited financial resources of most defendants. Less than 50 percent of defendants in the U.S. are able to post bail even when it is set at $5,000 or less. While some defendants are detained for only a few days, others are detained for the entire period prior to the final dispositions of their cases.

In many jurisdictions, offenders who commit relatively minor offenses are arrested and prosecuted to the full extent of the criminal law. Yet subjecting these offenders to pretrial detention, post-conviction incarceration, and searchable arrest and conviction records, may have hidden social costs.

Late elementary school and middle school has long been seen as a critical point in child development, and several studies have shown that students experience a decline in performance when they transition from elementary to middle or middle to high school, and that they do not recover from these dips. Local school boards may choose to operate schools as K-8 combined elementary and middle schools or as K-5 elementary schools with separate middle schools, but little is known about how this structuring of grades might influence health outcomes or behavior.

Leveraging more than a decade’s worth of data, the researchers will examine relationships between at-risk children’s health and education outcomes, as well as access to public services. This is vital information as states across the country, and Tennessee in particular, adopt new laws and resolutions that encompass a wide range of policy actions related to child health and education.

While multiple studies show a positive association between employment status and improved physical and mental health, it is unclear whether this relationship is causal. Building on work in Kentucky, Louisiana, Arkansas, and Texas, the research team will analyze the effects of Medicaid work requirements on coverage rates, access to care, and employment among low-income adults.

In January 2020, the Supreme Court allowed the Department of Homeland Security to implement a new rule regarding the definition of “public charge.”  Our team is collecting primary data from two distinct populations to explore awareness of the public charge rule, sources of information about the rule, and how the rule may affect decisions on obtaining medical care and participating in public programs.