Member approved December 14, 2023

WHEREAS, there is considerable evidence that many vaccines for people of all ages have had a significant public health impact¹; and

WHEREAS, school age screening mandates help ensure that students are healthy²; and

WHEREAS, we need 95 percent immunization to create herd immunity³; and

WHEREAS, non-medical exemptions have increased thereby reducing rates below herd immunity⁴; and

WHEREAS, Minnesota has had outbreaks of vaccine preventable diseases among school aged children⁵; and

WHEREAS, Minnesota’s outbreaks have impacted communities of color in greater numbers⁶

NOW, THEREFORE, BE IT RESOLVED that the Minnesota Public Health Association supports:

1. Policies that encourage vaccination;

2. Promoting public policies that oppose non-medical exemptions to school age vaccine mandates.

1. Echeverria-Londono, S., Li, X., Toor, J. et al. How can the public health impact of vaccination be estimated? BMC Public Health 21, 2049 (2021).
   https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-12040-9
   

2. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Applying Neurobiological and Socio-Behavioral Sciences from Prenatal Through Early Childhood Development: A Health Equity Approach; Negussie Y, Geller A, DeVoe JE, editors. Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity. Washington (DC): National Academies Press (US); 2019 Jul 25. 1, The Need to Intervene Early to Advance Health Equity for Children and Families. Available from:
   https://www.ncbi.nlm.nih.gov/books/NBK551489/
   

3. Plotkin, S.L. and Plotkin, S.A. (2004) A Short History of Vaccination. Vaccines, 5, 1-16.
   https://linkinghub.elsevier.com/retrieve/pii/B9781416036111500052
   

4. News, M. P. R. (2023, September 8). Back-to-school vaccinations urged as MN immunization rate declines. Twin Cities
   https://www.twincities.com/2023/09/06/back-to-school-vaccinations-encouraged-as-minnesotas-immunization-rate-declines/
   

5. Leslie TF, Delamater PL, Yang YT. It could have been much worse: The Minnesota measles outbreak of 2017. Vaccine. 2018 Mar 27;36(14):1808-1810. doi: 10.1016/j.vaccine.2018.02.086. Epub 2018 Feb 26. PMID: 29496348; PMCID: PMC6626669

6. Covid-19 Vaccine Equity in Minnesota. COVID-19 Vaccine Equity in Minnesota - MN Dept. of Health. (n.d.)
   https://www.health.state.mn.us/diseases/coronavirus/vaccine/mnsvi.html
   

Member approved December 14, 2023

WHEREAS, MPHA recognizes and supports the American Public Health Association (APHA)’s policy resolutions on Community Health Workers (CHWs)¹; and

WHEREAS, MPHA recognizes and supports the APHA definition of CHWs which includes the idea that they “facilitate access to services and improve the cultural competency of service delivery”²; and

WHEREAS, CHWs engage in culturally sensitive systems navigation in diverse settings, striving to improve access to integrated health services, assist in navigating systems, connect individuals with covered services, foster information sharing within the care team, ensure continuity of care, and ultimately enhance health outcomes, promote health equity, and reduce costs; and

WHEREAS, Centers for Medicaid and Medicare Services (CMS) is expanding reimbursement for CHWs for Medicare services in 2024, including Community Health Integration services addressing social determinants of health (SDOH) needs interfering with a medical diagnosis/problem, and Principal illness Navigation which includes patient care navigation as a part of the treatment of a high-risk disease/diagnosis^3,4,5,6; and

WHEREAS, many states proposed and CMS has approved Medicaid reimbursement beyond “patient education” including system navigation, linking people with medical care and addressing social determinants of health⁷; and

WHEREAS, the Legislative Action Committee (LAC) of the Minnesota Community Health Worker Alliance (MCHWA) has studied this issue and believes that it reflects the work done by CHWs in Minnesota.

NOW, THEREFORE, BE IT RESOLVED that the Minnesota Public Health Association supports:

1. The MCHWA position that State Medicaid reimbursement should be expanded beyond patient education to include system navigation;

2. Additional legislative and administrative public policies, which increase reimbursement and expand current Medicaid reimbursement for CHWs to services including the connection of individuals with covered services, efforts to improve access to integrated health services, support for navigation systems, sharing information within the care team and ultimately enhance health outcomes, promote health equity and reduce costs.

1. “Support for Community Health Workers to Increase Health Access and to Reduce Health Inequities” American Public Health Association website Policy Number: 20091 Date: Nov 10 2009
   https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/09/14/19/support-for-community-health-workers-to-increase-health-access-and-to-reduce-health-inequities

2. “Community Health Workers Member Sections” American Public Health Association Website
   https://www.apha.org/apha-communities/member-sections/community-health-workers/

3. “Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule”, CMS.gov website Nov 02, 2023
   https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule
   

4. ”Medicare and Medicaid Programs; CY 2024 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program” Federal Register website 11/16/2023
   https://public-inspection.federalregister.gov/2023-24184.pdf
   

5. Amy DeGroff, Susan White, Stephanie Melillo, William E. Rorie, Carmita-Anita C. Signes, and Paul A. Young “Use of Community Health Workers and Patient Navigators to Improve Cancer Outcomes Among Patients Served by Federally Qualified Health Centers: A Systematic Literature Review” Katherine B. Roland, Erin L. Milliken, Elizabeth A. Rohan, Health Equity. Dec 2017.61-76
   https://www.liebertpub.com/doi/full/10.1089/HEQ.2017.0001
   

6. Kristen J. Wells, Janna R. Gordon “The Wiley Encyclopedia of Health Psychology: Patient Navigation/Community Health Workers” 02 September 2020
   https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119057840.ch193
   

7. Sweta Haldar and Elizabeth Hinton, State Policies for Expanding Medicaid Coverage of Community Health Worker (CHW) Services, Kasier Family Foundation Website Jan 23, 2023
   https://www.kff.org/medicaid/issue-brief/state-policies-for-expanding-medicaid-coverage-of-community-health-worker-chw-services/

The Minnesota Public Health Association supports sacred/cultural use of traditional tobacco and related cultural practices by American Indians and Alaskan Natives (AI/AN).

MPHA Members approved by electronic vote on August 18, 2023.

Rationale 

● Whereas, tobacco is a sacred gift that is used for spiritual, cultural, and ceremonial practices by Tribal Nations in Minnesota, following strict codes and protocols^1; and 

● Whereas, traditional tobacco has been used by American Indian and Alaskan Natives (AI/AN) for centuries as a medicine with cultural and spiritual importance, with many Tribes maintaining teachings and stories on the origin of tobacco²; and 

● Whereas, there are many names for this sacred tobacco, in Minnesota it is generally referred to as cansasa, asemaa³, and kinnikinnick; and 

● Whereas, cultivation of tobacco for spiritual and ceremonial use is an infinite and inherent right for American Indian and Alaskan Native spiritual, religious and ceremonial traditions and practices; and 

● Whereas, tribal tobacco methods and ingredients differ, by tribal nations, it could be used as an offering to the Creator, or to another person, for prayer, healing, and ceremony^3,4,5,6; and 

● Whereas, traditional tobacco may be smoked or burned, but it is not inhaled and is not used recreationally^3,4,5,6; and 

● Whereas, the U.S. Religious Crimes Code of 1883 banned American Indian dances and ceremonies that included traditional tobacco and resulted in American Indians using

commercial tobacco for traditional purposes. It was a way to hide the use in plain sight and avoid punishment^7,8; and 

● Whereas, an investment is required to expand access to traditional tobacco by cultivating and harvesting it for ceremonial use.^4; and 

● Whereas, commercial tobacco such as cigarettes, e-cigarettes, cigars, and chew are prepared, and sold in mass quantities and include thousands of chemicals that are proven to be highly addictive and contain cancer-causing chemicals including menthol and ammonia that are not present in traditional tobacco^4,5; and 

● Whereas, The American Indian Religious Freedom Act of 1978 (AIRFA) (42 U.S.C. § 1996.) protects the rights of Native Americans to exercise their traditional religions by ensuring access to sites, use and possession of sacred objects, and the freedom to worship through ceremonials and traditional rites⁹; and 

● Whereas, almost 45 years have passed since the passage of AIRFA, public resistance to the law continues in the present, signaling a need for continuing public education on American Indian rights, culture and history.¹⁰ 

Resolution: 

Therefore, be it resolved that the Minnesota Public Health Association supports: 

1. Uplifting the cultural, spiritual and ceremonial use of tobacco as a positive contributor to the American Indian individual and community well-being. 

2. Allowing traditional tobacco and related cultural practices at public and private events. 

3. Exempting traditional tobacco and related cultural practices from any commercial tobacco related bans/ordinances/laws. 

4. Increasing access to traditional tobacco with the cultivation and harvesting of traditional tobacco for cultural, spiritual, and ceremonial use. 

5. Protecting the right of AI/AN state or federal prisoners to access and use traditional tobacco for spiritual and ceremonial uses.¹¹ 

References 

1. Scott S, D'Silva J, Hernandez C, Villaluz NT, Martinez J, Matter C. The Tribal Tobacco Education and Policy Initiative: Findings From a Collaborative, Participatory Evaluation.

Health Promotion Practice. 2017 Jul;18(4):545-553. doi: 10.1177/1524839916672632. Epub 2016 Oct 14. PMID: 27744374. 

2. National Native Network. 

https://www.npaihb.org/images/resources_docs/Resource%20Guidebook.pdf 

3. IN A GOOD WAY: Indigenous Commercial Tobacco Control Practices, 2017. https://truthinitiative.org/research-resources/targeted-communities/blueprint-tobacco-control-indigenous-communities 

4. Minnesota Department of Health. Traditional Tobacco and American Indian Communities in Minnesota. https://www.health.state.mn.us/communities/tobacco/traditional/index.html 

5. Counter Tobacco. 

https://countertobacco.org/resources-tools/evidence-summaries/native-americans-point of-sale/ 

6. South Dakota Department of Health: Tribal Tobacco Policy Toolkit. https://www.findyourpowersd.com/wp-content/uploads/2020/06/Tribal-Community-Toolkit.pdf 

7. Nies, J. (1996). Native American History: A Chronology of a Culture’s Vast Achievements and Their Links to World Events. New York City, NY: Penguin Random House, Inc. 

8. Commercial Tobacco Free Policy Guide. 

https://keepitsacred.itcmi.org/wp-content/uploads/sites/5/2017/09/CommercialTobaccoFreePolicyGuide_MSA_V1.pdf#:~:text=Traditional%20tobacco%20was%20seen%20as%20an%20American%20Indian,way%20to%20hide%20the%20use%20in%20plain%20sight. 

9. Protection and preservation of traditional religions of Native Americans. TITLE 42—THE PUBLIC HEALTH AND WELFARE, Page 4378. 

https://www.govinfo.gov/content/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap21-subchapI-sec1996.pdf 

10. National Oceanic and Atmospheric Administration United States Department of Commerce. 

https://coast.noaa.gov/data/Documents/OceanLawSearch/Summary%20of%20Law%20-%20American%20Indian%20Religious%20Freedom%20Act.pdf 

11. Native American Rights Fund, Protections for Native Spiritual Practices in Prisons, 2014. http://www.narf.org/wordpress/wp-content/uploads/2014/12/2014-03-xx-FINAL-Prison-Guide-00041641x9D7F5.pdf

Call for the Minnesota Public Health Association (MPHA) to support policy and advocacy efforts to increase voter registration and voting participation, which leads to healthier communities.

MPHA Members approved by electronic vote on September 22, 2022

 

Whereas, the Robert Wood Johnson Foundation’s Culture of Health action framework and the American Public Health Association Healing Through Policy Initiative have identified voting participation and voting rights protection as important measures of health and racial equity^1,2 and

Whereas, high levels of community engagement help people recognize their own agency and ensure they are connected with each other, which improves neighborhood cohesion, health outcomes, and community resilience³; and people who value community health are more likely to translate those values into civic engagement; which includes involvement in civic organizations, participation in advocacy and voting, and other actions to change laws or policies, bring about systemic change and produce healthy communities³; and

Whereas, a positive relationship exists between civic engagement and physical and mental health, health behaviors, and well-being^3,4; while social isolation, marginalization, lack of trust in institutions, poor health, and the burden of chronic disease result in lower voting participation rates and less civic engagement. This creates a reinforcing feedback loop where people who have good health participate more, reinforcing their good health, and people with poor health participate less, reinforcing their poor health^3,4,5;and conversely, participation in voting is more likely among those who enjoy good health⁶; and 

Whereas, a study of 44 countries, including the United States, found that voter participation is associated with better self-reported health, even after controlling for individual and country characteristics^,7; 

Whereas, regardless of political party, a plurality of likely voters consider health care issues extremely important, with voters’ values, beliefs, and concerns about issues such as health care costs, insurance coverage, and benefits influencing both candidates’ campaigns and legislators’ votes; and policy issues about health and health care influencing a majority of voters’ choices when voting for candidates⁸, and ballot initiatives³; and

Whereas, public health can be politicized, such as the compromising of public safety during the COVID-19 pandemic by state legislators enacting partisan measures that limit the power of governors, local elections officials, and the authority of public health officials in at least 26 states⁹; and

Whereas, public health considerations should be the guiding factor in health policy decisions, individual legislators within political systems craft legislation that affects population health, opening the possibility for political ideologies and partisan agendas to influence essentially apolitical public health interventions or guidelines^10,11,12; and

Whereas, public policies can affect voter participation, such as increased voter turnout associated with increased Medicaid enrollment as a result of the Affordable Care Act’s Medicaid expansion¹³; and 

Whereas, because of the COVID-19 pandemic, primaries were postponed, election laws were changed, and emergency powers were invoked in dozens of states to give election administrators more time and resources to conduct elections safely, yet high levels of civic engagement continue to be threatened by the ongoing COVID-19 pandemic and an increase in legislation and policies restricting access¹⁴; and

Whereas, people experience barriers to registering to vote and casting a ballot for many reasons, including many that intersect with barriers to receive healthcare. These reasons include the lack of identification documents¹⁵, frequent changes in home address¹⁶, limited English proficiency¹⁷, misconceptions about the rights of people with disabilities to vote and issues of accessibility ¹⁸,a combination of poor health and low income¹⁹, and voter registration office closures due to emergencies like COVID-19²⁰; and 

Whereas, voters of color and American Indians and Alaska Natives face heightened barriers when it comes to voting and participating in our democracy.²¹ Voters of color are more likely to experience longer polling lines, are disproportionately burdened by stringent voter identification laws, and have fewer polling locations per capita than their white counterparts. American Indian voters also face unique barriers to voting by mail on reservations²²; and

Whereas, the Cost of Voting Index ranks Minnesota #15 among the states on accessibility to voting, and in 2020 83% of those eligible to register to vote did register, and 80% of those registered cast a ballot²³; and  

Whereas, Minnesota Statute 201.162 requires that state agencies, as well as community-based public agencies and non-profit corporations that contract with a state agency to carry out obligations of the state agency, shall provide voter registration services for employees and the public²⁴; and  

Whereas, disparities exist with a negative correlation between those enrolled in Medicaid and voter registration. Currently, 13 states have laws that allow Medicaid-based registration which combats these disparities ²⁵;

Whereas, civic participation and voter registration were included as measurable objectives with the Social Determinants of Health - Healthy People 2020 and voting metrics were initially omitted from the Healthy People 2030^26,27; and

Whereas, an easier transition in the development of a voting habit, and an interest in politics more broadly, happens through the presence of resources⁵; and

Therefore, be it resolved, the Minnesota Public Health Association (MPHA) shall:

1. Support legislation, policies, and practices that encourage state and local agencies who administer health and social service programs to integrate voter registration opportunities for applicants who are U.S citizens, eligible to vote, and at least 18 years old on Election Day.
2. Support legislation, policies and practices that encourage all health-related organizations, including public health, health systems and health plans, to include voter registration and education in their programs and services. 
3. Support efforts that make compliance with Minnesota Statute 201.162 by state agencies, community-based public agencies, and nonprofit corporations a routine practice; and 
4. Support policies and practices that allow for those who are 16 and 17 years old to pre-register to vote, when they will reach voting age and then be eligible to vote.
5. Support policies and initiatives that increase voter registration and voting for American Indians/Alaskan Natives and people of color.
6. Support policies and practices that allow people with disabilities to fully participate in the political process, including ensuring the accessibility of polling locations and through promoting the availability of accessible voting technology.²⁸ 
7. Support policies and practices that increase the number of eligible Minnesotans who both  register to vote and cast a ballot in elections and increase awareness of these policies and practices, through the creation of an even lower cost to vote by making elections more accessible across the state, including considerations for people with varying literacy and/or abilities. These include: 
   1. automatic and same day registration;
   2. early voting; 
   3. vote-by-mail;
   4. no-excuse absentee voting; 
   5. convenient voting locations and hours 
   6. physical accessibility of polling sites, and assistance with equipment, languages, and awareness of assistance methods for casting a ballot.
8. Oppose policies and practices that create barriers - or discourage, suppress, or restrict the ability of eligible voters to either register to vote and/or cast a ballot in free and fair elections. These include but are not limited to: 
   1. partisan or otherwise biased redistricting
   2. requiring identity verification or other additional documentation requirements at the polls after the person has already established their eligibility to vote
   3. unnecessary registration deadlines
   4. prohibiting online registration
   5. requiring an approved excuse for early voting
   6. minimizing poll locations or hours of operation
   7. restricting voting by mail
   8. disallowing nourishment in voting lines
   9. policies and initiatives that reduce voter participation of American Indians/Alaska Natives and people of color
9. Support the inclusion of civic participation and voter registration as a measurable objective for public health agencies and initiatives, including the Healthy People-2030 initiative. 
10. Encourage its members and other stakeholders to promote the health of communities by reminding them of upcoming elections and to vote in every election in which they are eligible to vote, while making the connection of how voting impacts their health and improves health equity, and
11. Provide members and other stakeholders with opportunities to learn about issues that will shape policy and encourage members and other stakeholders to support elections and to be civically engaged, by serving as election workers or volunteers and by participating in town halls and other public meetings.
12. Provide its members and other stakeholders with information on how public health experts can play a larger role in helping election administrators manage safe options for voters to cast their ballots; including voters who may have active COVID-19 infections, those who are particularly vulnerable to a host of other health concerns, or those who are not familiar or comfortable with absentee or vote-by-mail options.

References 

References are available for download.

Climate change is one of the greatest threats to public health and requires renewed efforts to expand policies that increase actions to reduce harmful health and ecological impacts. Climate change threatens the very foundations of human health and wellbeing, with the Global Risks Report registering climate change as one of the five most damaging or probable risks every year for the past decade¹.

WHEREAS, beyond the obvious forms of climate change—from, extreme heat, hurricanes, drought, wildfires, and tsunamis to biological threats such as vector-borne diseases—the effects of climate change are pervasive and impact the very food, air, water, and shelter society depends on, extending across every region of the world¹; and

WHEREAS, climate change is worsening stark and persistent health inequities which interact with existing social, environmental, and economic inequalities¹; and

WHEREAS, those who disproportionately bear the health impacts of climate change in Minnesota include: children, seniors, pregnant women, low-income communities, communities of color, , people with disabilities and people with chronic disease^{2 3}; and

WHEREAS, atmospheric influences such as increases in greenhouse gas emissions, ambient temperatures, precipitation, and humidity cause disruptions in human environment that threaten the health and vitality of human communities⁴; and

WHEREAS, in Minnesota, the most concerning impacts of climate change include injury and death from extreme weather events including heat waves and floods, disease from changing tick and mosquito populations, illness from drinking or swimming in contaminated water from increased runoff and floods, respiratory and cardiovascular impacts from increases in wildfires, ozone, fine particulate matter, pollen, and mold, and mental health impacts from experiencing an extreme weather event or from a loss of sense of place⁵; and

WHEREAS, climate change stresses our health care infrastructure and delivery systems . There is a pressing need to prepare for potential health risks^{6 7}; and

WHEREAS, extreme weather patterns destabilize communities, increase economic stress and poverty, reduce access to essential healthcare, and increase risk for mental health concerns, such as Post Traumatic Stress Disorder (PTSD), depression, anxiety, aggressive behavior, and relationship and social unrest^{8 9 10}; and

WHEREAS, the Intergovernmental Panel on Climate Change (IPCC) recommends a global goal of net zero carbon emissions by 2050 to prevent the worst effects of climate change, which include increases in heat-related morbidity and mortality and ozone-related mortality, as well as, increases in vector-borne disease and heat waves amplified by urban heat island effects¹¹; and

WHEREAS, as public health professionals, we are best poised to prevent, detect and manage the health implications of climate change. We need to be the leading voice in advancing climate change strategies and interventions that have co-benefits for all¹².

THEREFORE, BE IT RESOLVED, that the Minnesota Public Health Association:

1. Calls on policy makers and state and local leaders to integrate climate change solutions and climate justice into all relevant federal, state, and local public health systems and programming and to adopt policies and programs to create an equitable and just transition to a 100% carbon-free economy by 2050; and
2. Urges for a just transition away from the use of coal, oil, and natural gas to clean, safe, and renewable emergency and energy efficiency; and
3. Supports leadership by the Minnesota Department of Health, the University of Minnesota system schools, and other entities to study, analyze, provide data and recommendations, training, technical assistance, and funding in support of efforts to address the negative impacts of climate change on state and local communities; and
4. Take bold and timely action to promote awareness of environmental injustices that harm historically oppressed communities, undermine tribal sovereignty, disadvantage poor neighborhoods, and worsen the effects of climate change; and
5. Supports the funding of climate-health risk assessments, expanded disease surveillance systems, early warning systems, and research on climate and health to strengthen Minnesota’s capacity for an effective health response to climate threats; and
6. Adopts an interdisciplinary and inter-professional approach to addressing climate change, including collaborations with other scientific, professional, and community organizations in Minnesota based on scientific evidence and public health expertise; and
7. Pledges to help its members and other stakeholders readily access resources regarding climate change from credible sources, including the American Public Health Association, the Centers for Disease Control and Prevention, as well as organizations named above.

1. Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Beagley, J., Belesova, K., Boykoff, M., Byass, P., Cai, W., Campbell-Lendrum, D., et al. (2021). The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. Lancet (London, England), 397(10269), 129–170. https://doi.org/10.1016/S0140-6736(20)32290-X
2. Voskoboynik, D. (2019). A Guide to Climate Violence. The World at 10C. Accessed 2/12/2021 at: https://worldat1c.org/a-guide-to-climate-violence-4cfbc5a7648f
3. Minnesota Declaration on Climate and Health. (2021). Accessed 2/15/2021 at: https://drive.google.com/file/d/1ggWbqIH937RF4zTxbfkBR7ydzged0Bmd/view
4. Minnesota Department of Health. February 2015. Minnesota Climate and Health Profile Report 2015: An 4 Assessment of Climate Change Impacts on the Health and Well-being of Minnesotans. Accessed 3/30/2021 at: hAps://www.health.state.mn.us/communiCes/environment/climate/docs/mnprofile2015.pdf
5. Minnesota Department of Health Climate & Health Strategic Plan: An update on program successes and next 5 steps. April 2019. Accessed on 3/30/2021 at: https://www.health.state.mn.us/communiCes/environment/climate/ docs/progressreport.pdf
6. National Institute of Environmental Health Sciences. (2021). Accessed 3/22/2021 at:  https://www.niehs.nih.gov/ 6 research/programs/geh/climatechange/index.cfm
7. Centers for Disease Control and Prevention. Accessed 3/22/2021 at: https://www.cdc.gov/climateandhealth/ 7 policy.htm
8. Minnesota Department of Health. Minnesota Climate Change Vulnerability Assessment. Accessed 2/15/2021 at: https://www.health.state.mn.us/communities/environment/climate/docs/mnclimvulnsummary.pdf
9. Clayton, S., Manning, C. M., & Hodge C. (2014). Beyond storms and droughts: The psychological impacts of climate change. Washington, DC: American Psychological Association and ecoAmerica.
10. Clayton, S., Manning, C. M., Krygsman, K., & Speiser, M. (2017). Mental health and our changing climate: Impacts, implications, and guidance. Washington, D.C.: American Psychological Association and ecoAmerica. https://www.apa.org/news/press/releases/2017/03/mental-health-climate.pdf
11. IPCC, Special Report Global Warming of 1.5°C, Summary for Policymakers. hAps://www.ipcc.ch/sr15/chapter/ spm/
12. American Public Health Association (APHA). Climate Changes Health: #ActOnClimate. Accessed 3-30-2021 at: hAps://www.apha.org/Topics-and-Issues/Climate-Change/Act-On-Climate

WHEREAS, race is a social construct with no biologic basis¹; and

WHEREAS, society is built on racial hierarchies, established through colonization, that pervade structures, histories, politics, and, ultimately, minds; and

WHEREAS, racism is a social system with multiple dimensions, including individual racism, which is internalized or interpersonal¹; and

WHEREAS, systemic racism, which is institutional or structural, is a system of structuring opportunity and assigning value through the social interpretation of one’s race²; and

WHEREAS, the cumulative result of these racist systems and structures has contributed to an environment that is persistently unhealthy and unsafe for Black communities, American Indian communities, Latinx, and Asian communities³; and

WHEREAS, studies show moderate to strong positive relations between racism and trauma. Black, American Indian, and People of Color are unfairly burdened with the responsibility of coping with the painful existence of those oppressive experiences⁴; and

Whereas, racism in all its forms causes persistent discrimination and disparate outcomes in many areas of life, including housing, education, health, employment, public safety and criminal justice5. And it is amplified during this pandemic as communities of color face inequities in everything from a greater burden of COVID-19 cases to less access to testing, treatment and care^{5 6 7}; and

WHEREAS, a multitude of studies connect racism to inequitable health outcomes for Black, American Indians, and People of Color, including cancer, coronary heart disease, asthma, diabetes, hypertension, mental health, high infant and maternal mortality rates demonstrating that racism is the root cause of social determinants of health^{8 9 10 11}; and

WHEREAS, racism is killing Black Americans—both by fueling police violence against them and by propelling adverse socioeconomic conditions that contribute to serious health issues. George Floyd’s death at the hands of Minneapolis police officers is a visceral reminder of the reality Black Americans know all too well: Racism is a public health crisis¹²; and

WHEREAS, the Minnesota Public Health Association (MPHA) recognizes that Africans were forcibly brought to this country, enslaved, and after the Emancipation Proclamation, citizens of this country perpetuated Anti-Black racism through violence, mass incarceration and Anti-Black policies, including redlining, and that the social construction of race was used to justify their enslavement as well as the removal of American Indian peoples off their land pushing them onto land deemed less desirable¹³; and

WHEREAS, Minnesota—which received its name from the Dakota [Sioux] word for Mississippi’s major tributary in the state, the Minnesota River, “Sky-Tinted Water”¹⁵—is largely built upon Ojibwe [Anishinaabe] and Dakota homelands. American Indians have lived upon this land and waters since time immemorial, and the land and water itself carries historical trauma, and that genocidal policies have aimed to strip tribal nations not only of land, but of culture, language, and family systems¹⁴; and

WHEREAS, MPHA also recognizes that the long-standing persuasive anti-immigrant sentiment and treatment works against the well-being of Latinx peoples—whether an immigrant or born in the U.S. Viewed as an alien and low status, many continue to be scapegoated and targeted for mistreatment¹⁶; and

WHEREAS, the COVID-19 pandemic is not the first public health crisis for racist policies and political rhetoric targeted Asian-Americans. During the bubonic plague in 1900, public health officials quarantined Chinese residents in Chinatown and during the SARS outbreak in the early 2000’s East Asians experienced stigmatization worldwide. Today, Asians and people of Asian descent around the world continue to be subjected to attacks and beatings, violent bullying, threats, and discrimination linked to the current pandemic¹⁷; and

WHEREAS, anti-racism means actively participating in dismantling racist systems and institutional practices, as well as addressing personal and interpersonal acts of racism; and

WHEREAS, embodied anti-racism acknowledges the historical roots and contemporary manifestations of racial prejudice and discrimination that lives in bodies today⁸; and

WHEREAS, unfair and race‐based inequities will continue unless we undertake the uncomfortable but necessary work to dismantle the institutions and systems that perpetuate racism, violence, poverty, and injustice¹⁸; and

WHEREAS, MPHA membership is committed to ending racism and building an active, anti-racist culture across the organization and community;

NOW, THEREFORE, BE IT RESOLVED that upon adoption of this resolution, by the MPHA:

That by declaring racism a public health crisis, MPHA will recognize the severe impact of racism on the well-being of Minnesotans and actively engage in racial equity in order to name, reverse, and re- pair that harm done to American Indian and People of Color in Minnesota, including the following actions:

1. Assert that racism is a public health crisis affecting our entire society
2. Honor the Dakota and Anishinaabe people, ancestors, and descendants, as well as the land and water itself
3. Center the voices, work, and leadership of the communities most affected by racism
4. Reshape our discourse and agenda and commit to recognizing personal biases, educating ourselves to understand the structures and behaviors that propagate racism, listening to and speaking up for those who are affected by racism so that all MPHA workgroups, membership and our overall work and strategic plans actively engage in anti-racism.
5. Continue to advocate locally for relevant policies that improve health in American Indian communities and communities of color, and support local, state, regional, and federal initiatives that advance efforts to dismantle systemic racism
6. Further work to solidify alliances and partnerships with other organizations that are confront- ing racism and encourage other local, state, regional and national entities to recognize racism as a public health crisis.

1. Krieger N. (2000). Refiguring "race": epidemiology, racialized biology, and biological expressions of race relations. Int J Health Serv. 30(1):211–216.
2. Jones, C. P. (2002). Confronting institutionalized racism. Phylon (1960-), 7-22.
3. Krieger N. The science and epidemiology of racism and health: racial/ethnic categories, biological expressions of racism, and the embodiment of inequality—an ecosocial perspective. In: Whitmarsh I, Jones DS, editors. What’s the use of race? Genetics and difference in forensics, medicine, and scientific research. Cambridge, MA: MIT Press; 2010. p. 225–55.
4. Krieger N. Discrimination and health. In: Berkman L, Kawachi I, editors. (2000). Social epidemiology. Oxford: Oxford University Press; pp. 36–75
5. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. (2020). COVID-19 and Racial/Ethnic Disparities. JAMA; 323(24):2466–2467. doi:10.1001/jama.2020.8598
6. Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429—445.7 Minnesota Compass. Disparities by Race. http://www.mncompass.org/disparities/race#1-9538-g. Accessed on August 9, 2020.
7. Krieger N. (2001). A glossary for social epidemiology. Journal of epidemiology and community health, 55(10), 693–700. https://doi.org/10.1136/jech.55.10.693
8. Institute of Medicine. (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. https://www.nap.edu/read/10260/chapter/2#7. Accessed August 9, 2020.
9. Minnesota Department of Health. Advancing Health Equity Executive Summary. https://www.health.state.mn.us/communities/equity/reports/aheexecutivesummary.pdf. Accessed August 9, 2020.
10. Link BG, Phelan JC. Understanding sociodemographic differences in health--the role of fundamental social causes. Am J Public Health. 1996 Apr;86(4):471–473.
11. Merelli, A. (May 2020). “Black people are at the center of two public health crises in the US: Covid-19 and police brutality.” Retrieved August 9, 2020 from https://qz.com/1862403/black-people-are-at-thecenter-of-two-public- health-crises-in-the-us-covid-19-and-police-brutality/
12. Gee, G. C. (2008). A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. American journal of public health, 98(Supplement_1), S48-S56.
13. Dunbar-Ortiz, R. (2015). An indigenous peoples' history of the United States.
14. Encyclopaedia Britannica. Minnesota. https://www.britannica.com/place/Minnesota. Accessed on August 9, 2020
15. Blakemore, Erin. (August 2018). The Brutal History of Anti-Latino Discrimination in America. https://www.history.com/news/the-brutal-history-of-anti-latino-discrimination-in-america Accessed on August 9, 2020. 
16. Gover, A. R., Harper, S. B., & Langton, L. (2020). Anti-Asian Hate Crime During the COVID-19 Pandemic: Exploring the Reproduction of Inequality. American Journal of Criminal Justice, 1–21. Advance online publication. https://doi.org/10.1007/s12103-020-09545-1
17. Krieger N, Birn AE. (1998). A vision of social justice as the foundation of public health: commemorating 150 years of the spirit of 1848. Am J Public Health. Nov;88(11):1603–1606. 

WHEREAS, millions of Americans live in households that struggle against hunger and in Minnesota 13.7 percent of children live in food-insecure households¹ and that number has likely increased significantly as families have lost jobs and wages due to the economic impact of the COVID-19 pandemic; and

WHEREAS, hunger has been shown to reduce academic achievement as children experiencing hunger are more likely to have repeated a grade, received special education services, or received mental health counseling, than low-income children who do not experience hunger;² and

WHEREAS, hunger creates barriers to learning as children experiencing hunger are more likely to be hyperactive, absent, and tardy, in addition to having behavioral and attention problems more often than other children,³ and

WHEREAS, the National School Lunch Program and the National School Breakfast Program play an important role in reducing childhood hunger by providing a nutritious breakfast and lunch every school day; and

WHEREAS, school meals support struggling families trying to stretch their limited resources and provide children with a significant portion of the daily nutrition they need to be healthy; and

WHEREAS, school breakfast and lunch provide students the nutrition they need in order to learn and have success throughout the school day; and

WHEREAS, the National School Lunch Programs work hand-in-hand with other federal nutrition programs such as the Child and Adult Care Feeding Program (afterschool snacks and meals) and the Summer Food Service Program to create a nutritional safety net for low-income children throughout the year.

Therefore, be it resolved that the Minnesota Public Health Association:

1. Supports state and federal policies that seek to protect, strengthen, and expand access to the National School Lunch Program, the National School Breakfast Program, the Child and Adult Care Feeding Program (afterschool snacks and meals) and the Summer Food Service Program.
2. Encourages work at the school-district, state and federal levels to reduce barriers to participation in the programs; to eliminate stigma associated with program participation; to implement innovative models that improve program participation such as breakfast in the classroom and “grab and go” breakfast stations and to enhance the nutritional quality of food served.
3. Stands in support of providing free and nutritious meals to every student that needs one, regardless of income eligibility, so that all students have the nutrition they need to learn and grow.

1. Food Research and Action Center analysis of 2014-2016 Current Population Survey-Food Security Supplement (CPS-FSS) data.
2. Kleinman, R. E., Murphy, J. M., Little, M., Pagano, M., Wehler, C. A., Regal, K., & Jellinek, M. S. (1998). Hunger in Children in the United States: Potential Behavioral and Emotional Correlates. Pediatrics, 101(1),E3.
3. Murphy, J. M., Wehler, C. A., Pagano, M. E., Little, M., Kleinman, R. F., & Jellinek, M. S. (1998). Relationship Between Hunger and Psychosocial Functioning in Low-Income American Children. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 163-170.

WHEREAS, the largest proportion of the population of the United States of America is composed of people whose ancestors immigrated to this country from other lands¹;

WHEREAS, immigrants to the United States, categorized as foreign-born in the U.S. Bureau of the Census reports, are a diverse group including both documented and undocumented individuals who make up 13.5% of the current population². Immigrants and their U.S born children constitute 86.4 million people, or 27% of the overall U.S population. The population of foreign-born children has decreased by 21% between 2000 and 2016, from 2.7 million to 2.1 million³.

WHEREAS, Minnesota's first large groups of immigrants arrived from Europe, primarily Norway, Sweden, Ireland, and Germany. Today, the majority of Minnesota's immigrants arrive from Mexico, India, Laos, and Somalia. Between 2010 and 2016, Minnesota has had a 20% increase in immigrant population growth3. About 8% of Minnesota's residents are immigrants, and 7% are native-born U.S citizens with at least one immigrant parent⁴.

WHEREAS, the experience of immigration has immediate implications for the psychological, health and social well-being of individuals and families⁵ which are especially intense for children, people of color, people of the impoverished socioeconomic classes¹, as well as women⁷, lesbian, gay, and bisexual persons⁸, and individuals with disabilities;

WHEREAS, as of May 2018, over 10,000 immigrant children have been separated from their parents and/or family members as part of the current immigration policy towards undocumented individuals entering the US at the border. Of those, almost 1,500 have gone missing from the homes of their caregivers. Instead of detaining families together, ICE has been mobilized to separate children from families;

WHEREAS, separating children from their parents exposes them to trauma and toxic stress that can have lifelong negative impacts on their mental and physical health. As noted by the American Academy of Pediatrics (AAP), exposing children to traumatic events and prolonged or toxic stress such as separation from a parent disrupts a child’s healthy development and can lead to physiologic changes that result in short- and long-term negative effects on physical, mental, and behavioral health^9-19;

WHEREAS, detention, for even brief periods, has short- and long-term negative effects on the health of parents and children. Studies show high levels of psychiatric distress, including depression and post-traumatic stress, among detained asylum seekers, even after short detention periods, and that symptoms worsen over time^{20, 21};

WHEREAS, the separation of a child from his/her/their parent or family member/caregiver, constitutes an Adverse Childhood Experience, or a significant trauma experienced by an individual before the age of 18. Adverse Childhood Experiences, or childhood trauma, has been shown in numerous studies to substantially increase the risk of mental, emotional, and physical health outcomes long term^10-19;

WHEREAS, Adverse Childhood Experiences have been strongly correlated to increased levels of mental health outcomes (depression, suicide, addiction and substance abuse), chronic health conditions (obesity, diabetes, stroke, heart disease), and significant effects on economic potential (educational attainment, lost productivity, future income growth)^22-23;

THEREFORE, BE IT RESOLVED that the Minnesota Public Health Association urges the government of the United States to revoke and reverse the current policy of separating migrant, undocumented, or immigrant children from their parents. Regardless of how they come into the United States of America, they are first and foremost children, and human beings, deserving of care, dignity, and respect.

1. Fix, M., & Passel, J. S. (1994). Immigration and immigrants: Setting the record straight. Washington, DC: The Urban Institute.
2. Census Bureau's 2010 and 2016 American Community Survey (ACS)
3. Jeanne Batalova and Elijah Alperin, "Immigrants in the U.S. States with the Fastest-Growing Foreign-Born Populations," Migration Policy Institute, (July 10, 2018).
4. Immigrants in Minnesota Fact Sheet, 2017, American Immigration Council. https://americanimmigrationcouncil.org/sites/default/files/research/immigrants_in_minnesota.pdf. Accessed on 10/14/2018.
5. Beiser, M. (1988). After the door has opened: Mental health issues affecting immigrants and refugees in Canada. Ottawa: Health and Welfare Canada.
6. Board on Children and Families, Commission on Behavioral and Social Sciences and Education, National Research Council, Institute of Medicine (1995). Immigrant children and their families: Issues for research and policy. The Future of Children, 5, 72-89.
7. Yee, B. W. K. (1997). The social and cultural content of adaptation of aging among Southeast Asian elders. In J. Sokolovsky (Ed.), The cultural context of aging, 2nd Edition, New York: Greenwood Publishers.
8. Espin, O. (1997). Crossing borders and boundaries: The life narratives of immigrant lesbians. In Greene, B. (Ed.), Psychological perspectives on lesbian and gay issues: Vol. 3. Ethnic and cultural diversity among lesbians and gay men (pp.191-215) Thousand Oaks, CA: Sage.
9. Colleen Kraft, MD, MBA, FAAP, “AAP Statement Opposing the Border Security and Immigration Reform Act,” American Academy of Pediatrics, (June 15, 2018), https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAPStatementOpposingBorderSecurityandImmigrationReformAct.aspx Accessed 7/19/2018. 
10. Center on the Developing Child, NGA Center for Best Practices, and National Conference on State Legislatures, In Brief: The Impact of Early Adversity on Children’s Development, (Cambridge, MA: Center on the Developing Child, Harvard University, 2015), https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp- content/uploads/2015/05/inbrief-adversity-1.pdf; Hillary A Franke, “Toxic Stress: Effects, Prevention and Treatment,” Children 1 (2014):390-402;
11. Sara B Johnson, Anne W Riley, Douglas A Granger, and Jenna Riis, “The Science of Early Life Toxic Stress for Pediatric Practice and Advocacy,” Pediatrics 131, 2 (February 2013):319-327
12. Jack P Shonkoff, Andrew S Garner, et. al., “The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” Pediatrics 129, 1 (2012):e232-e246;
13. Committee on Psychosocial Aspects of Child and Family Health, et. al., “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science into Lifelong Health,” Pediatrics 129, 1(2012):e224-e231
14. National Scientific Council on the Developing, Child Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9, (Cambridge, MA: National Scientific Council on the Developing Child, 2010), http://www.developingchild.net
15. Jack P Shonkoff, W Thomas Boyce and Bruce S McEwen, “Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention,” Journal of the American Medical Association 301, 201 (2009):2252- 2259
16. Jennifer S Middlebrooks and Natalie C Audage, The Effects of Childhood Stress on Health Across the Lifespan, (Atlanta, GA: Centers for Disease Control and Prevention (CDC), 2008), http://health- equity.lib.umd.edu/932/1/Childhood_Stress.pdf
17. Stanley D Rosenberg, Weili Lu, Kim T Mueser, et. al., “Correlates of Adverse Childhood Events Among Adults with Schizophrenia Spectrum Disorders,” Psychiatric Services 58, 2 (2007): 245- 253
18. Shanta R Dube, Robert F Anda, Vicent J Felitti, et. al., “Childhood Abuse, Household Dysfunction, and the Rise of Attempted Suicide Throughout the Life Span: Findings from the Adverse Childhood Experiences Study,” JAMA 286, 24 (December 2001): 3089-3096;
19. Vincent J Felitti, Robert F Anda, Dale Nordenberg, et. al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 14, 4 (1998):245-258.
20. Janet Cleveland, Cecile Rousseau, and Rachel Kronick, The harmful effects of detention and family separation on asylum seekers’ mental health in the context of Bill C-31,” April 2012, https://csssdelamontagne.qc.ca/fileadmin/csss_dlm/Publications/Publications_CRF/brief_c31_fin al.pdf; Julie M. Linton, Marsha Griffin, Alan J. Shapiro, and Council on Community Pediatrics, “Detention of Immigrant Children,” Pediatrics, March 13, 2017,; http://pediatrics.aappublications.org/content/early/2017/03/09/peds.2017-0483,
21. Wendy Cervantes, Family Detention: The Harmful Impact on Children, (Washington, DC: First Focus, December 8, 2015), https://firstfocus.org/resources/fact-sheet/family-detention-the- harmful-impact-on-children.
22. U.S Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2018). Retrieved from: https://www.samhsa.gov/capt/practicing-effective- prevention/prevention-behavioral-health/adverse-childhood-experiences.
23. Schilling, E., Aseltine, R., & Gore, S. (2007). Adverse childhood experiences and mental health in young adults: A longitudinal survey. BMC Public Health, 7, 30.

WHEREAS, On Tuesday, September 5, 2017, President Donald Trump ordered an end to the program known as Deferred Action for Childhood Arrivals, or DACA.¹ Congress is being given six months to determine the legal status and ultimate fate of 800,000² immigrants, known as “Dreamers”, who were brought into the United States as children, and who are eligible, under the existing DACA program, to apply for temporary residence in the United States; and

WHEREAS, A compromise devised by the Obama Administration after Congress failed to pass the bipartisan Development, Relief and Education for Alien Minors (DREAM) Act, which would have offered eligible immigrant children the chance of permanent legal residency in the United States, the DACA program, established by Executive Order on June 15, 2012, offers temporary residence status to these children, and protection from immediate deportation, if certain conditions are met: and

WHEREAS, An undocumented immigrant is eligible to claim DACA status if, as of June 15, 2012, the individual was under the age of 31, came the United States before turning age 16, lived continuously in the United States for five years since June 15, 2007; and either has a high school diploma or GED certification, or has been honorably discharged from the military or is currently enrolled in school.³ Applicants for DACA status are fingerprinted and rigorously vetted by the Department of Homeland Security for any criminal history or threat to national security. If the applicant passes the vetting, action to deport the person is deferred for a period of two years, with an opportunity to renew the deferral, and the individual becomes eligible for basics such as a driver’s license, college enrollment or work permit; and

WHEREAS, To date, 800,000 individuals have qualified for DACA status. As President Obama put it when he signed the Executive Order creating the DACA program: “These are young people who study in our schools, they play in our neighborhoods, they’re friends with our kids, they pledge allegiance to our flag. They are Americans in their heart, in their minds, in every single way but one on paper. They were brought to this country by their parents – sometimes even as infants – and often had no idea that they’re undocumented until they apply for a job or a driver’s license, or a college scholarship”; and

WHEREAS, In an act of faith and trust in America’s promise of hope and opportunity, “Dreamers” came out of the shadows and gave their names, addresses and telephone numbers to the United States Government in order to participate in the DACA program; and

WHEREAS, deportation and threat of deportation affect not only undocumented people, but also their children and family members who are often legal residents, anyone perceived to be an immigrant based on skin color or other factors, other people with whom they share communities or schools, and our broader society⁴; and

WHEREAS, fear of deportation makes communities less healthy. People are afraid to drive, afraid to use parks and exercise outdoors, afraid to use public health services like clinics, and afraid to participate in their communities⁵; and

WHEREAS, deportations and threat of deportations impact children and lead to poorer child health, poorer child behavioral outcomes, poorer child educational outcomes, and poorer adult health and shorter lifespan.⁵

WHEREAS, an increase in risk of deportation is associated with a decrease in Medicaid use and mental health services. The implications of this outcome have tremendous impacts for health service providers and policy makers interested in preventing and reducing health disparities in complex family structures^{6, 7}; and

WHEREAS, The mission of the Minnesota Public Health Association is to create a healthier Minnesota through effective public health practice and engaged citizens; DACA has provide many immigrants the opportunity to join the health field to work towards improving the health of Minnesotans. “Majority of DACA recipients are still students and 17 percent are pursuing an advanced degree. By contrast, most recipients of H-1B visas are between 25 and 34 and hold either a Bachelor's Degree or a Master's Degree. In short, they appear to be a close reflection of what DACA recipients will look like a few years from now as they complete their educations." DACA recipients are relatively well-educated, meaning they are highly skilled workers who benefit the rest of the nations' workers in the long term.⁸

WHEREAS, During the difficult days ahead, the Minnesota Public Health Association wants all of its Dreamers to know that: “You are welcome here in Minnesota and in our schools.”

THEREFORE, BE IT RESOLVED that the Minnesota Public Health Association Urge the Governor of Minnesota and the Minnesota Legislature:

1. To establish a Minnesota Dreamers Bill of Rights to ensure that the State of Minnesota is doing all it can to remain a welcoming place for the more than 6,000⁹ Dreamers that live, work and study in our great State.
2. To amend State law to allow Dreamers to obtain the licenses and certifications they need to enter additional professions, such as health care, education, social work and real estate, and to remain in those professions after their DACA work permit expires.
3. To establish a statewide legal protection fund to assist residents in navigating the immigration process.
4. To strongly prohibit cooperation or communication with Immigration and Customs Enforcement (“ICE”) with respect to Dreamers.
5. To disallow local governments from exempting themselves from these new Dreamer protections.

1. Memorandum on Rescission Of Deferred Action For Childhood Arrivals (DACA).https://www.dhs.gov/news/2017/09/05/memorandum-rescission-daca. Accessed 9/15/2017.
2. Pew Research Center, DACA has shielded nearly 790,000 young unauthorized immigrants from deportation, http://www.pewresearch.org/fact-tank/2017/09/01/unauthorized- immigrants-covered-by-daca-face-uncertain-future/. Accessed 9/15/2017
3. American Immigration Center. https://www.us-immigration.com/deferred-action-application-I-821D.jsp. Accessed 9/15/2017.
4. Public Health Actions for Immigrant Rights: A Short Guide to Protecting Undocumented Residents and Their Families for the Benefit of Public Health and All Society. https://unafraideducators.org/wp-content/uploads/2017/04/PHAIR_guide_2017.01.27.pdf. Accessed on 11/20/2017
5. Human Impact Partners. June 2013. Family Unity, Family Health: How Family-Focused Immigration Reform Will Mean Better Health for Children and Families. Oakland, CA. https://humanimpact.org/wp-content/uploads/2017/09/Family-Unity-Family-Health-2013.pdf. Accessed on 11/20/2017.
6. Vargas, Edward D., Immigration enforcement and mixed-status families: The effects of risk of deportation on Medicaid use, Children and Youth Services Review. Volume 57, October 2015, Pages 83–89.
7. The Lancet. Health consequences of the US Deferred Action for Childhood Arrivals (DACA) immigration programme: a quasi-experimental study. March 2017.
8. “Characteristics of H-1B Specialty Occupation Workers,” Fiscal Year 2014 Annual Report to Congress (Washington: U.S. Citizenship and Immigration Services, February 26, 2015),https://www.uscis.gov/sites/default/files/USCIS/Resources/Reports%20and%20Studies/H- 1B/h-1B-characteristics-report-14.pdf. Accessed on October 17, 2017.
9. U.S. Citizenship and Immigration Service.

WHEREAS, Tobacco industry documents show that the tobacco industry used targeting strategies intentionally tailored to market menthols to African Americans, Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) communities, and youth at disproportionate rates.^1,2 Documents also revealed Lorillard Tobacco Company characterized high-school students as “the base of our business” for menthol cigarettes,³ and

WHEREAS, a 2013 U.S. Food and Drug Administration (FDA) report showed that menthol cigarettes increase youth smoking initiation, lead to a greater addiction and decrease successes in quitting smoking.⁴ A study demonstrated that menthol levels in cigarettes were deliberately manipulated by the industry to broaden the appeal of cigarettes to youth.⁵

WHEREAS, eighty-three percent of African American youth smokers⁶ and 71 percent of LGBTQ youth smokers report smoking menthol cigarettes.⁷

WHEREAS, African Americans in Minnesota smoke at a rate of 22.3 percent.⁸ Tobacco use is the top cause of preventable death and disease among African Americans. Among adult African American smokers, 88 percent smoke menthols, compared to 26 percent of adult white smokers.⁹ Eight out of every 10 (83 percent) African American youth smokers smoke menthols.¹⁰ African Americans have the highest death rate and shortest survival rate from most cancers.¹¹

WHEREAS, members of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) communities smoke menthol cigarettes at higher rates than the general population. The smoking rate for lesbian, gay and bisexual persons in Minnesota is 25.7 percent.¹² More than 36 percent of LGBTQ smokers smoke menthol cigarettes, with LGBTQ female smokers smoking menthols at an extremely high rate (42.9 percent).¹³

WHEREAS, menthol tobacco use is a specific problem for Minnesota with 25.1 percent of smokers report smoking menthol cigarettes,¹⁴ half of Minnesota teen smokers (44.3 percent of high-school student smokers) smoke menthol cigarettes,¹⁵ and smoking-related disease rates among American Indians are at epidemic levels, and 30 percent of American Indian smokers smoke menthol cigarettes.¹⁶ 

WHEREAS, policies that regulate or restrict menthol tobacco products have potential to reduce tobacco addiction and improve health. Research suggests that if menthol were banned in the U.S., 39 percent of menthol smokers, including 47 percent of black menthol smokers, would quit smoking.¹⁷ Among Minnesota menthol smokers, approximately half reported they would quit smoking if menthol cigarettes were banned.¹⁸

WHEREAS, on 2016, the National Association for the Advancement of Colored People (NAACP) Board of Directors ratified a resolution to support efforts at local and state levels to restrict the sale of flavored and menthol tobacco products.¹⁹

WHEREAS, the a ban of menthol from cigarettes is supported by several public health entities, including the Truth Initiative (American Legacy Foundation), the American Cancer Society, ClearWay Minnesota, the American Heart Association, the American Lung Association, the Campaign for Tobacco-Free Kids, the National African American Tobacco Prevention Network, the American Academy of Pediatrics, the American Public Health Association, the Center for American Progress and the Delta Sigma Theta sorority.

THEREFORE, BE IT RESOLVED, that the Minnesota Public Health Association:

1. Supports the rights of state and local governments to regulate menthol to the extent it is legally permissible. Potential regulatory options include restricting the sale of menthol tobacco products and restricting point-of-sale advertising.
2. Supports a federal ban on menthol in cigarettes and in all other tobacco products to reduce the impact on the public’s health.
3. Support funding communities most impacted by menthol to organize from within the community and support practice-based evidence strategies that respect community tradition and knowledge.

1. Yerger VB. Menthol's potential effects on nicotine dependence: A tobacco industry perspective. Tobacco Control. 2011;20(Suppl. 2):ii29-ii36.
2. Reynolds R. Project SCUM. December 12, 1995.
3. Achy TL. Tobacco industry product information. 1978; http://legacy.library.ucsf.edu/tid/nlt13c00.
4. Food and Drug Administration. Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol versus NonMenthol Cigarettes. 2013; http://www.fda.gov/downloads/ScienceResearch/SpecialTopics/PeerReviewofScientificInformationa ndAssessments/UCM361598.pdf.
5. Kreslake J, Wayne G, Alpert H, Koh H, Connolly G. Tobacco Industry Control of Menthol in Cigarettes and Targeting of Adolescents and Young Adults. Am J Pub Health. 2008;98(9):1685- 1692.
6. Substance Abuse and Mental Health Services Administration (SAMHSA). The NSDUH Report: The Use of Menthol Cigarettes. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; November 19, 2009.
7. National Youth Advocacy Coalition. Coming Out about Smoking: A Report from the National LGBTQ Young Adult Tobacco Project. 2010.
8. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System. Minnesota data; http://www.cdc.gov/brfss/, 2015.
9. Giovino GA, Villanti AC, Mowery PD, et al. Differential trends in cigarette smoking in the USA: is menthol slowing progress? Tob Control. 2015;24(1):28-37.
10. National Youth Advocacy Coalition. Coming Out about Smoking: A Report from the National LGBTQ Young Adult Tobacco Project. 2010.
11. Society AC. Cancer Facts & Figures for African Americans 2016-2018. Atlanta: American Cancer Society;2016.
12. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System. Minnesota data; http://www.cdc.gov/brfss/, 2015.
13. Fallin A, Goodin AJ, King BA. Menthol Cigarette Smoking among Lesbian, Gay, Bisexual, and Transgender Adults. Am J Prev Med. 2014.
14. ClearWay Minnesota, Minnesota Department of Health. Minnesota Adult Tobacco Survey: Tobacco Use in Minnesota: 2014 Update. February 2015.
15. Minnesota Department of Health. Teens and Tobacco in Minnesota, 2014 Update - Results from the Minnesota Youth Tobacco Survey. November 2014.
16. American Indian Community Tobacco Projects. Tribal Tobacco Use Project Survey, Statewide American Indian Community Report. 2013.
17. Hartman AM. What Menthol Smokers Report They Would Do If Menthol Cigarettes Were No Longer Sold. Paper presented at: FDA Tobacco Products Scientific Advisory Committee MeetingJanuary 10-11, 2011.
18. D’Silva J AM, Boyle RG. Quitting and switching: Menthol smokers’ responses to a menthol ban. Tobacco Regulatory Science. April 2015;1(1):54-60.
19. NAACP Board ratifies resolution to support State and Local Restrictions on the Sale of Flavored Tobacco Products. Accessed July 20, 2017.