Read a PDF of the letter here.

March 20, 2024

Dear Chair Hassan, Vice Chair Hanson, and members of the Economic Development Finance and Policy Committee,

 

We are reaching out to convey the Minnesota Public Health Association's (MPHA’s) unwavering endorsement of HF2821, a crucial bill that seeks to create a framework for requesting a racial equity impact note for proposed legislation.

 

MPHA is a volunteer-driven professional organization with 350 public health professional members throughout the State of Minnesota. Our mission is to create a healthier Minnesota through effective public health practice and engaged citizens. We are an active, independent voice for public health in Minnesota. MHPA is an affiliate of the American Public Health Association whose mission is to improve the health of the public and achieve equity in health status for all Americans.

 

HF2821 aligns directly with MPHA's endeavors to foster a healthier Minnesota by incorporating a process for a Racial Equity Impact Note (REIN) into proposed legislation. A REIN is a systematic examination of how different racial and ethnic groups will likely be affected by a proposed action or decision. REINs are used to minimize unanticipated adverse consequences in a variety of contexts, including the analysis of proposed legislation, policies, institutional practices, programs, plans and budgetary decisions. The REIN provides an objective-based assessment to inform legislators and the public of potential racial economic disparities that may be exacerbated or created by proposed legislation. It can be a vital tool for preventing institutional racism and for identifying new options to remedy long-standing inequities.^[1]

 

As underscored by the House Select Committee on Racial Justice’s: Report to the Legislature^[2], these racial economic disparities are deeply rooted in structural inequities, including racism, housing insecurity, and economic instability. Furthermore, racism was declared a public health crisis^[3] in 2020 by the Minnesota House of Representatives and is aligned with MPHA’s Declaration of Racism is a Public Health Crisis Resolution.^[4]

 

Research conducted by Blue Cross and Blue Shield of Minnesota has revealed the staggering economic toll of health inequities in our state^[5], estimating that addressing these disparities could save billions of dollars annually. Similarly, the Center for Advancing Research in Health Equity^[6] (CARHE) at the University of Minnesota emphasizes the urgency of implementing policies aimed at advancing health equity and addressing the social determinants of health.

 

HF2821 has the capacity to enhance governance, foster economic stability, and make significant progress in promoting racial and health equity in Minnesota by incorporating REINs into the legislative process.

 

Furthermore, this bill aligns with Voices for Racial Justice's approach as outlined in their Racial Equity Impact Assessment Pocket Guide^[7], which emphasizes the importance of integrating racial equity impact into policy and decision-making processes.

 

“We know that although Minnesota is one of the healthiest states in the country, not all of our communities are afforded the same opportunities for health.^[8]” The enactment of HF2821 marks a significant milestone in the journey towards closing some of these gaps and for creating a fair and inclusive society for every resident of Minnesota. We strongly encourage your backing for this essential bill and guarantee its prompt approval by the Economic Development Finance and Policy Committee.

 

We appreciate your consideration of this issue. If you have any questions or need further information, please do not hesitate to contact us at info@mpha.net.

 

Sincerely,

 

Antonia Apolinario-Wilcoxon, Ed.D

President, Minnesota Public Health Association

On the second anniversary of the January 6th insurrection of the US Capitol, we remember a day where democracy was threatened, and one that should be remembered among the most infamous events in our country’s recent history for its demonstration of violence against democratic processes. The Minnesota Public Health Association and the Minnesota Society for Public Health Education is reminding Minnesotans that democracy is not self-standing, it requires the active participation of all citizens and a resistance toward acts of self-preservation over the defense of the common good.

As public health professionals we know that states with more inclusive voting policies and greater levels of civic participation are healthier, while the opposite is true for states with exclusionary voter laws. Communities with higher voter participation enjoy greater social cohesion, belonging, and better health. Populations that face significant barriers to voting suffer worse health outcomes. When individuals feel healthier and more connected to their neighbors, they feel valued, a stronger sense of community, and are more likely to vote.

Since the formation of the United States, there has been a desire to self-govern through representative government and voting. However, there have been all too frequent attempts to impose limitations or barriers to voting upon different groups of citizens, such as populations of color and American Indians with major barriers persisting in modern society. Broad civic engagement and voting both facilitate a strong and healthy democracy, and therefore healthy communities.

The 2020 election and subsequent events on January 6, 2021 were filled with actions to sow doubt and mistrust in our country’s electoral process. The rampant spread of dishonesty and misinformation caused our political divisions to grow even wider. For the health of all people, our two organizations stand in support of policies that make elections accessible for all eligible voters, and oppose policies that discourage, suppress, or restrict the ability of eligible voters to either register to vote and/or cast a ballot in free and fair elections. The promotion of health and the advancement of health equity is vital to ensuring an inclusive democratic process and broad participation in the electoral system.

The events of January 6th showed that democracy is fragile, and requires all to be civically involved; to vote, to run for office, and to support candidates that embrace policies that leave no communities behind. Our democracy and our health depend on it.

Signed,

Ellen Saliares, President - Minnesota Public Health Association

Mary Kramer, President - Minnesota Society for Public Health Education

Subject: Written Comments on Proposed Healthy People 2030

Objectives: Social Determinants of Health-NEW-07: Increase the proportion of the voting age citizens who vote.

Comment Reference: 87 FR 64240

Submitted by the Minnesota Public Health Association (MPHA) in response to the Department of Health and Human Services’ (HHS) Solicitation of Written Comments on Proposed Healthy People 2030 Objectives: Social Determinants of Health-NEW-07: Increase the proportion of the voting age citizens who vote.

MPHA was established in 1907 and is a volunteer-driven membership organization for over 350 public health professionals throughout the state of Minnesota. We represent a wide variety of public health disciplines from across the state. Our mission is to create a healthier Minnesota through effective public health practice and engaged citizens. Our vision is to be an active, independent voice for public health in Minnesota.

MPHA recognizes the positive relationship between civic engagement and mental health, healthy behaviors and well-being. We understand that when more people are engaged in the democratic process, people and communities are healthier and that civic and voter participation contributes directly and indirectly to community health. We believe that to promote health and advance health equity it is vital to assure inclusive democratic processes and participation in the electoral system.

The Healthy People framework is a roadmap for achieving national-level health goals over 10- year spans. Setting, measuring, and tracking progress on these goals informs health improvement planning across federal agencies. Healthy People goals also inform the process of setting health goals and priorities at state and local level health agencies and non-profit hospital systems. MPHA supports the inclusion of voter participation to a core objective in Healthy People 2030. We urge you to transition the measure from a research objective to a core objective as soon as possible.

The evidence summarized below demonstrates that voter participation (the proportion of the voting age citizens who vote) meets the criteria for inclusion as a core objective in the Healthy People framework:

1. Have a reliable, nationally representative data source with baseline data no older than 2015; 
2. Have at least 2 additional data points beyond the baseline during the decade; 
3. Have effective, evidence-based interventions available to achieve the objective; 
4. Be of national importance; and 
5. Have data to help address disparities and achieve health equity. 

Evidence Included in This Comment

HHS should consider all citations supporting evidence and authority included in this comment as part of the formal administrative record for purposes of the Administrative Procedure Act. Throughout the comments that follow, we have included citations to supporting evidence, including links. We direct HHS to each citation and corresponding links and we request that the full text of the evidence and authority cited, along with the full text of our comment, be incorporated into the formal administrative record for purposes of the Administrative Procedure Act.

Core Objective Criteria

Reliable, Nationally Representative Data Source

Public data on elections are readily available from four federally managed databases: Current Population Survey (CPS), U.S. Census Bureau, the U.S. Bureau of Labor Statistics, and the Election Administration and Voting Survey (EAVS). All of these data sources meet the two data criteria for inclusion as a core objective in Healthy People 2030. They all have reliable, nationally representative data with baseline data no older than 2015 and have at least 2 additional data points beyond the baseline during the decade.

The Current Population Survey (CPS), U.S. Census Bureau, and the U.S. Bureau of Labor Statistics are data sources HHS is using to measure the proportion of the voting age citizens who vote. The primary strength of these data points is the ability to make conclusions about disparities in voter participation based on race, gender, disability status, income, and other characteristics discussed in the survey instruments. One weakness of these data sets are that they rely on self-report and proxy-reported data¹ which is known to inflate the voter participation rates as compared to actual ballots counted.² Additionally, while these datasets include state level metrics they do not include representative samples for many counties. Instead of solely relying on these self-reported measures, we propose using additional sources to determine a more accurate representation of voter participation across the country.

The EAVS is a national survey of county election offices conducted after general elections. The survey includes election office reports of voter registration, election infrastructure, and voter participation.³ The inclusion of this dataset can help ensure accurate reports of voter turnout are included in Healthy People 2030 tracking. Similarly, accurate statewide turnout results for both voting age (VAP) and voting eligible (VEP) populations are provided each election cycle by the US Elections Project, directed by Michael McDonald at the University of Florida.⁴ One limitation of the EAVS is that it does not include any population estimates such as age, sex, race, or ethnicity for those who voted.⁵ To ensure the most accurate voting data is used, Healthy People 2030 can combine population estimates from The CPS, U.S. Census Bureau, and the U.S. Bureau of Labor Statistics to determine weights for relevant demographic data with the county elections reports from the EAVS and statewide turnout from US Elections Project.

All of these data sources meet the two data criteria for inclusion as a core objective in Healthy People 2030. The EAVS includes baseline data from 2016, 2018, 2020, and soon will have 2022 data available with most counties across the country consistently submitting the survey instrument. The CPS, U.S. Census Bureau, the U.S. Bureau of Labor Statistics, all include annual questions in their national population surveys about voter participation.

Effective, Evidence-based Interventions to Improve Voter Participation

There is a growing body of evidence about policies and practices that can both bolster or hinder voter participation. Despite record voter turnout in the 2020 election, approximately one-third of eligible Americans did not cast a ballot.⁶ Increasing voter turnout requires both inclusive policies and robust community efforts to educate and mobilize eligible voters ahead of each election.

Policies that enable voter participation are described in the Cost of Voting Index (COVI), developed by political science researchers at Northern Illinois University in 2016. The COVI analyzes the relative “cost” of voting in each state in terms of time and effort associated with casting a vote. States with a lower COVI Index have less restrictive voting policies and are associated with increased voter participation.⁷ An analysis driven by the Healthy Democracy Healthy People in 2021 uses the COVI rankings to illustrate that diverse policies granting greater access to the ballot are positively associated with individual and community level health indicators.⁸ 

1. Addressing Structural and Systemic Barriers to Voting

Policies such as increasing access to mail voting (which historically has not impacted partisan vote share);⁹ increasing the window for early voting; expanding available polling locations and hours of operation to accommodate nontraditional schedules;^10,11,12 and ending restrictive voter identification policies¹³ would go a long way toward ensuring community members have a direct say on policy decisions that affect their health. Additionally, being more inclusive with policies such as restoring the right to vote for those who are (or have previously been) incarcerated–¹⁴ an estimated 6.1 million Americans are denied their voting rights due to policies that disenfranchise people with felony charges. These policies disproportionately affect Black Americans.¹⁵ Currently, only two states and Washington, D.C. allow people with felony convictions to vote, even while incarcerated.¹⁶ Additionally, voter identification laws have shown to suppress voters from racial and ethnic minorities in both primary and general elections.¹⁷

2. Enabling Inclusive Voter Registration

The most common reasons people do not vote is not being registered and not understanding how to navigate the voting process.^18-19 Eligible people are successfully registered to vote when they are offered active voter registration services.²⁰ This includes being asked if they want to vote or to update their registration, receiving assistance as they complete the voter registration process, and ideally having their completed registration application collected and transmitted to the appropriate election officials or, if that is impractical, receiving a stamped envelope in which they can submit their voter registration application. Government agencies can aid in active voter registration efforts by accepting designation as voter-registration agencies under the National Voter Registration Act of 1993 (NVRA). Section 7 of the NVRA requires that:

“Any office in a covered State that provides either public assistance or state-funded programs primarily engaged in providing services to persons with disabilities must offer voter-registration services. Armed Forces recruitment offices must also provide voter registration services. In addition, a State must designate other offices in the State as voter-registration agencies.”²¹

One way the voter registration process can be streamlined is through Automatic Voter Registration (AVR) programs. AVR allows eligible voters to be automatically registered when they interact with the state Department of Motor Vehicles (DMV) through data sharing between the DMV and the state’s voter registration system. AVR removes barriers to registration for eligible voters, which is a first step in increasing voter participation. According to the Brennan Center for Justice, states that have enacted AVR saw up to a 94 percent increase in voter registrations.²²

AVR is not appropriate in all settings. When AVR is not plausible or appropriate, community health programs and state agencies can ensure that members of the public can update their voter registration by including voter registration in all external operations by providing the necessary paperwork, contact information for local elections offices and educating them on how to exercise their voting options. Additionally, states can make sure voters have more opportunities to register to vote by enacting policies like same-day and Election Day voter registration.

3. National Importance of Voter Participation

Improving voter participation is crucial for advancing health and racial equity. Research has shown that civic and voter participation is strongly associated with health outcomes: states and countries that have more accessible voting policies and higher levels of civic participation are healthier across multiple public health measures.²³ High levels of civic participation– including voter participation– help ensure that people in communities are connected to each other, improving neighborhood cohesion, health outcomes and community resilience.²⁴ Voters show better future mental and physical health compared with non-voters, even after adjusting for a range of other factors.²⁵

Ahead of the 2020 elections, states implemented policies and programs that led to more inclusive access to voting opportunities. These included expanding and promoting mail voting and early voting options.²⁶ This resulted in historical voter turnout rates with 159 million people voting.²⁷ Despite record voter turnout in the 2020 election, approximately one-third of eligible Americans still did not cast a ballot.²⁸ Additionally, disparities in voter turnout persist despite overall increases in voter participation.²⁹ Historically, voter turnout is lower for Black, Latino, Asian American, Pacific Islander, and American Indian people than for their white counterparts, as well as for younger voters and voters with lower education levels.^30,31,32,33

Measuring voter turnout as a core objective in the Healthy People framework is key to better tracking inequities in civic and voter participation and identifying actions and policies that will improve participation and health outcomes. While we know that voter participation is a key indicator of social cohesion and contributes to community social capital,³⁴ we do not effectively track and aspire to improve voter participation in public health research and practice. To effectively advance health equity, Healthy People must acknowledge the deep history of structural racism, ableism, and xenophobia that has been used to systematically restrict voter access. Healthy People must recognize the importance of voting as a matter of public health and equity.³⁵

Importance of data to help address disparities and achieve health equity. Public health research and efforts to address disparities and advance health equity have focused on the social determinants of health and on increasing access to quality health services among marginalized populations. The social determinants of health differ from the social needs of individuals and instead exist at the population or community level. They are impacted through policies.³⁶ Policy campaigns that aim to address health outcomes and social determinants of health require addressing the political environment. Within a fully functioning democracy, policy decisions are directly and indirectly determined through elections. Decisions made directly through elections include policies that communities vote on through ballot initiatives and referendums. People also decide on policy indirectly by delegating power to elected representatives who make policy through legislative and formal decision-making processes. However, despite community efforts to build power and influence decision making to advance health and racial equity, there continue to be intentional efforts to limit civic and voter participation that lead to ongoing health inequities.

As discussed earlier, research shows that states with better access to voting have better health. Additionally, those states that have less restrictive access to voting see disparities shrink for maternal mortality.³⁷ Black, Latino and American Indian voters face heightened barriers when it comes to voting and participating in our democracy. Black, Latino, and American Indian voters are more likely to experience longer polling lines,^38,39 are disproportionately burdened by stringent voter identification laws,⁴⁰ and have fewer polling locations per capita than their white counterparts. American Indian voters face unique barriers to mail voting on reservations due to non-traditional addresses, homelessness, overcrowding, language barriers, and lack of broadband access and use of PO boxes.⁴¹ Additionally, 15 percent of Black voters and 14 percent of Latino voters had trouble finding their polling locations compared to only five percent of white voters.⁴²

Voters with disabilities face numerous challenges to voting. Americans with disabilities were 7 percentage points less likely to vote than people without disabilities in the 2020 election even after adjusting for age.⁴³ In 2020 voters with disabilities were also nearly twice as likely as nondisabled voters to experience problems when voting, and 1 in 9 voters with disabilities faced barriers accessing the ballot box.⁴⁴ People with vision and cognitive impairments were especially likely to face obstacles during the 2020 election, which accounts for roughly 7 million eligible voters and 13.1 million eligible voters, respectively.⁴⁵

These structural barriers to political participation and power keep communities most impacted by inequities out of effectively influencing critical decision-making processes. In order to address these disparities, Healthy People must focus on improving voter participation and access over the next decade.

Recommendation

The Minnesota Public Health Association encourages Healthy People 2030 to transition voter participation rates to a core objective. The evidence discussed above clearly demonstrates voter participation meets the criteria for inclusion as a core objective in the Healthy People framework.

1. IPUMS. Voting and registration supplement sample notes. IPUMS CPS. Available at: https://cps.ipums.org/cps/voter_sample_notes.shtml. Accessed November 4, 2022.

2. Tittle CR, Hill RJ. The accuracy of self-reported data and prediction of political activity. Public Opinion Quarterly. 1967;31(1):103-106. http://www.jstor.org/stable/2746888

3. EAVS faq. U.S. Election Assistance Commission. Available at: https://www.eac.gov/research-and-data/eavsfaqs#What-is-the-Election-Administration-and-Voting-Survey. Accessed November 4, 2022.

4. US Elections Project. Available at: https://www.electproject.org/election-data/voter-turnout-data Accessed November 10, 2022.

5. EAVS faq. U.S. Election Assistance Commission. Available at: https://www.eac.gov/research-and-data/eavsfaqs#What-is-the-Election-Administration-and-Voting-Survey. Accessed November 4, 2022.

6. US Elections Project. 2020 November General Election Turnout Rates. 2020. Available at: http://www.electproject.org/2020g. Accessed November 4, 2022.

7. Schraufnagel S, Pomante II MJ, Li Q. Cost of voting in the American States: 2020. Election Law Journal: Rules, Politics, and Policy. 2020;19(4):503-509. doi:10.1089/elj.2020.0666

8. Health & Democracy Index. https://democracyindex.hdhp.us/.

9. Thompson DM, Wu JA, Yoder J, Hall AB. Universal vote by mail has no impact on partisan turnout or vote share. Proceedings of the National Academy of Sciences. 2020;117(25):14052-14056. DOI: 10.1073/pneas.2007249117.

10. Dionne Jr. EJ, Rapoport M. A dozen ways to increase voting in the United States: Voting. Carnegie Corporation of New York. https://www.carnegie.org/our-work/article/dozen-ways-increase-voting-united-states/. September 12, 2022. Accessed November 7, 2022.

11. Newkirk II VR. What early voting in North Carolina actually reveals. The Atlantic. November 8, 2016. Available at: https://www.theatlantic.com/politics/archive/2016/11/north-carolina-early-voting/506963/ Accessed November 7, 2022.

12. The Leadership Conference Education Fund. The Great Poll Closure; 2016. Available at: http://civilrightsdocs.info/pdf/reports/2016/poll-closure-report-web.pdf.  

13. Alvarez RM, Bailey D, Katz JN. The effect of voter identification laws on turnout. California Institute of Technology Social Science. 2008; Working Paper No.1267R; doi:10.2139/ssrn.1084598

14. Uggen C, Larson R, Shannon S, and Stewart R. Locked Out 2022: Estimates of People Denied Voting Rights. The Sentencing Project. Oct 25,2022. Available at: https://www.sentencingproject.org/publications/locked-out-2022- estimates-of-people-denied-voting-rights/.

15. Hunter D. Restoring the right to vote is a pathway to better health – a look at felon re-enfranchisement and the 2020 Election. The Network for Public Health Law. 2020. Available at: https://www.networkforphl.org/newsinsights/restoring-the-right-to-vote-is-a-pathway-to-better-health-a-look-at-felon-re-enfranchisement-and-the-2020- election/. Accessed November 4, 2022.

16. National Conference of State Legislatures. Felon voting rights. 2021. Available at: https://www.ncsl.org/research/elections-and-campaigns/felon-voting-rights.aspx. Accessed November 4, 2022.

17. Hajnal Z, Lajevardi N, Nielson L. Voter identification laws and the suppression of minority votes. Journal of Politics. 2017;79(2),363–379. https://doi.org/10.1086/688343

18. Flaxman S, Gaskins-Nathan K. The Untold Story of American Non-Voters. The Knight Foundation; 2016:68. Available at: https://knightfoundation.org/wp-content/uploads/2020/02/The-100-Million-Project_KF_Report_2020.pdf

19. Montanaro D. Poll: Despite Record Turnout, 80 Million Americans Didn't Vote. Here's Why. NPR. December 15, 2020. Available at: https://www.npr.org/2020/12/15/945031391/poll-despite-record-turnout-80-million-americansdidnt-vote-heres-why Accessed November 4, 2022.

20. The Leadership Conference on Civil and Human Rights. The Leadership Conference Urges Strong Implementation of Executive Order Promoting Voting Access. May 26, 2022. Available at: https://civilrightsdocs.info/pdf/policy/letters/2022/05262022LCCHR%20VR%20EO%20Letter.pdf. Accessed November 4, 2022

21. The United States Department of Justice. The National Voter Registration Act of 1993 (NVRA). Available at: https://www.justice.gov/crt/national-voter-registration-act-1993-nvra 

22. Morris K, Dunphy P. AVR Impact on State Voter Registration. Brennan Center. 2019. Available at: https://www.brennancenter.org/our-work/research-reports/avr-impact-state-voter-registration Accessed November 3, 2022.

23. Nelson C, Sloan J, Chandra A. Examining Civic Engagement Links to Health: Findings from the Literature and Implications for a Culture of Health. RAND Corporation; 2019. Available at: https://www.rand.org/pubs/research_reports/RR3163.html

24. Ibid.

25. Ballard PJ, Hoyt LT, Pachucki MC. Impacts of adolescent and young adult civic engagement on health and socioeconomic status in adulthood. Child Dev. 2018;00(0):1–17. Available at: http://doi.wiley.com/10.1111/cdev.12998.

26. DeSilver, Drew. Turnout Soared in 2020 as Nearly Two-Thirds of Eligible U.S. Voters Cast Ballots for President. Pew Research Center, 28 Jan. 2021. Available at: https://pewrsr.ch/3oAN3MB. Accessed November 4, 2022.

27. Frey WH. Turnout in 2020 election spiked among both Democratic and Republican voting groups, New Census Data shows. Brookings. March 9, 2022. Available at: https://www.brookings.edu/research/turnout-in-2020-spikedamong-both-democratic-and-republican-voting-groups-new-census-data-shows/. Accessed November 4, 2022.

28. US Elections Project. 2020 November General Election Turnout Rates. 2020. Available at: http://www.electproject.org/2020g. Accessed November 4, 2022.

29. Ibid

30. Ray R, Whitlock M. Setting the record straight on black voter turnout. Brookings. Available at: https://www.brookings.edu/blog/how-we-rise/2019/09/12/setting-the-record-straight-on-black-voter-turnout/. September 12, 2019. Accessed November 10, 2022.

31. Joint Center for Political and Economic Studies. 50 years of the Voting Rights Act: the state of race in politics. 2015. Available at: https://jointcenter.org/50-years-of-the-voting-rights-act-2/. Accessed November 4, 2022.

32. Alexander D. Why young people don’t vote, and why 2020 might be different. Johns Hopkins University. 2020. Available at: https://hub.jhu.edu/2020/10/20/mobilizing-youth-voters-scott-warren/. Accessed November 4, 2022.

33. Wang T. Ensuring Access to the Ballot for American Indians & Alaska Natives: New Solutions to Strengthen American Democracy. New York, NY: Demos; 2012. Figure 1. Available at: https://www.demos.org/sites/default/files/publications/IHS%20Report-Demos.pdf. Accessed November 4, 2022.

34. National Research Council. Civic Engagement and Social Cohesion: Measuring Dimensions of Social Capital to Inform Policy. Washington, DC: The National Academies Press; 2014. https://doi.org/10.17226/18831.

35. Anderson C, Durbin RJ. One Person, No Vote: How Voter Suppression Is Destroying Our Democracy. New York: Bloomsbury Publishing; 2019.

36. Hacker K, Houry D. Social needs and Social Determinants: The role of the Centers for Disease Control and Prevention and Public Health. Public Health Reports. 2022;137(6):1049-1052. doi:10.1177/00333549221120244

37. Health & Democracy Index. https://democracyindex.hdhp.us/.

38. Chen MK, Haggag K, Pope DG, Rohla R. Racial Disparities in Voting Wait Times: Evidence from Smartphone Data. Cornell Uni, Gen Econ. October 31, 2020. https://doi.org/10.48550/arXiv.1909.00024 Accessed November 2, 2022.

39. Klain H, Morris K, Ayala R, Feldman M. Waiting to vote: racial disparities in Election Day experiences. Brennan Center for Justice. 2020. Available at: https://www.brennancenter.org/our-work/research-reports/waiting-vote. Accessed November 4, 2022.

40. Jones RP, Cox D, Griffin R, Fisch-Friedman M, Vandermaas-Peeler A. American democracy in crisis: The challenges of voter knowledge, participation, and polarization. PRRI. August 8, 2019. Available at: https://www.prri.org/research/American-democracy-in-crisis-voters-midterms-trump-election-2018. Accessed November 4, 2022.

41. Native American Rights Fund. Vote by mail in Native American communities. Available at: https://www.narf.org/vote-by-mail/. Accessed November 4, 2022.

42. Ibid.

43. Root D, Ives-Rublee M. Enhancing accessibility in U.S. elections. Center for American Progress. 2021. Available at: https://www.americanprogress.org/article/enhancing-accessibility-u-s-elections/. Accessed November 4, 2022.

44. Ibid.

45. Ibid.

The Minnesota Public Health Association (MPHA) stands in support of the Indian Child Welfare Act (ICWA), and its purpose "...to protect the best interest of Indian Children and to promote the stability and security of Indian tribes and families by the establishment of minimum Federal standards for the removal of Indian children and placement of such children in homes which will reflect the unique values of Indian culture... "(25 U.S. C. 1902). ICWA provides guidance to States regarding the handling of child abuse and neglect and adoption cases involving Native children and sets minimum standards for the handling of these cases. It is also critical to rear children within their own communities as they are the future of protecting native government, language, and culture.

ICWA was enacted in 1978, less than a decade after studies from the Association on American Indian Affairs found that 25 to 35 percent of all Native children had been removed from their families and placed in foster homes, with non-Native parents nine out of 10 times. This contributed to the already devastating legacy of Indian boarding schools, where generations of Native children were removed from their homes and communities and sent to boarding schools across the country, with the intent of eliminating their languages, cultures, and family and community ties.

When Congress enacted ICWA, it allowed tribes to alter the order of placement preferences that would protect the heritage and culture of Native American children. The implementation of the ICWA has promoted the protection of Native American children by requiring higher levels of parental engagement and has encouraged efforts to keep families together. These measures help reduce the trauma a child may experience when they are placed in foster care, and by helping the child maintain their culture, they are more likely to be resilient and to be able to create a deep bond with their family.

The Biden administration, like past administrations of both political parties, is defending the law. Citing a string of precedents dating back to the early days of the republic, the government says that ICWA draws classifications based not on race but on connections to tribal groups. And under the Constitution, those tribal groups are separate sovereign nations, essentially a political group.

MPHA strongly supports the ICWA law based on historic precedence, and because tribal nations are sovereign and should be trusted to take care of their own children in order to support their indigenous culture. MPHA, further advocates for children and support that tribal communities receive the child welfare financial support that is available.

1. Affairs, B. of I. (n.d.). Indian Child Welfare Act (ICWA). Indian Affairs. https://www.bia.gov/bia/ois/dhs/icwa
2. Martin, N. (2022, October 1). Can Indian Country withstand the new Supreme Court? High Country News. https://www.hcn.org/issues/54.10/indigenous-affairs-law-can-indian-country-withstand-the-new-supreme-court
3. Kennard, A. (2022, November 9). The Indian Child Welfare Act: What it is and what's at stake. Native News Online. https://nativenewsonline.net/sovereignty/the-indian-child-welfare-act-purpose-and-what-s-at-stake
4. Totenberg, N. (2022, November 8). Supreme Court considers fate of landmark Indian adoption law. NPR. https://www.npr.org/2022/11/08/1134668931/supreme-court-icwa
5. Herrera, A. (2018, March 5). Who can adopt a Native child? High Country News. https://www.hcn.org/issues/50.7/tribal-affairs-who-can-adopt-a-native-child

The Minnesota Public Health Association recognizes abortion as an essential healthcare service and access to it as an important public health issue. Restrictions and bans on abortion undermine the Roe v. Wade decision and serve as a means to further exacerbate systemic inequities experienced by many communities, including American Indians, communities of color and LGBTQ+ communities.

The recent Supreme Court decision allows a Texas law to ban abortion at six weeks of pregnancy.¹ It also allows for legal action to be taken by ordinary citizens (including those from outside of Texas) against abortion clinics, doctors, any person seeking or planning to seek abortion services or anyone helping a person get an abortion in Texas after the six-week timeframe.² If successful, plaintiffs can earn up to $10,000. Moreover, this ban does not make exceptions for rape or incest.³ The Texas law is contrary to longstanding MPHA policies supporting people’s fundamental right to a full range of reproductive health services, including abortion.

Recent years have seen increasing attacks on reproductive rights, nationally and in Minnesota.⁴ The Texas statute bans abortion before many people know they are pregnant, encourages intimidation of people seeking healthcare, and effectively removes freedom of choice. Abortion restrictions and bans increase medical risks for pregnant people, disproportionately impacts low-income communities and communities of color, disrespects the relationship between a patient and medical provider, and undermines the autonomy of people over their own lives. This has widespread and serious consequences and is contrary to public health goals.

Federal courts in other states have struck down similar bans. The Texas ban must not be allowed to stand, similar efforts in Minnesota must be defeated and we must support efforts to protect the reproductive health of Minnesotans.⁵ The Minnesota Public Health Association stands firmly committed to reproductive justice, and that a person’s reproductive health should be decided between that person and their medical provider.

1. American Public Health Association. (9/1/21) APHA dismayed over Texas abortion ban, court refusal to act. https://www.apha.org/News-and-Media/News-Releases/APHA-News-Releases/2021/Texas-abortion-ban
2. The New York Times. (9/7/21) Citizens, Not the State, Will Enforce New Abortion Laws in Texas. https://www.nytimes.com/2021/07/09/us/abortion-law-regulations-texas.html
3. New Mexico Public Health Association. (9/3/21) NMPHA dismayed over Texas abortion ban, court refusal to act. http://www.nmpha.org/resources/Documents/NMPHA%20SB8%20Statement.docx
4. Unrestrict Minnesota. Minnesota Laws. Retrieved September 14, 2021, from https://unrestrictmn.org/minnesota-abortion-laws/
5. Unrestrict Minnesota. Welcome to the Community Hub. Retrieved September 14, 2021, from https://unrestrictmn.org/community/

The Minnesota Public Health Association (MPHA) supports Governor Walz’s decision to require all state employees working on-site to receive the COVID-19 vaccine by September 8, 2021, due to the recent COVID-19 surge and the availability of safe and effective vaccines. Employees not vaccinated, must receive a negative COVID-19 test at least weekly. COVID-19 cases, hospitalizations, and deaths are once again rising throughout the United States, because of highly contagious variants, including the Delta variant, and significant numbers of unvaccinated people.¹ All authorized vaccines in the United States are highly effective at preventing severe illness and death. Vaccination is the primary way to put the pandemic behind us and avoid the return of stringent public health measures.

A growing list of American governments are requiring workers to be vaccinated. New York, Virginia and Puerto Rico are among those that have instituted similar directives, and President Joe Biden recently instituted those orders for all federal employees and the U.S. military. Governor Walz’s announcement, which includes all “state agency employees,” also listed numerous hospital networks, institutions such as colleges and universities, and major employers such as Tyson Foods, Microsoft, United Airlines and Disney as among those that have also instituted COVID-19 vaccine mandates.² The American Public Health Association has also released a joint statement in support of COVID-19 vaccine mandates for all workers in health and long-term care³, additionally, the National Education Association, the largest U.S. teachers’ union announced support for vaccination for educators.⁴

This directive is vital to keep state employees safe as well as the people they serve, especially people of color and American Indians who suffer disproportionately from COVID-19. These inequities arise from structural racism, discrimination, and conscious and unconscious bias that is engrained in all our systems. The data is clear; The Delta variant is spreading rapidly across five states with the lowest vaccination rates in the country—those being Alabama, Louisiana, Wyoming, Idaho, and Mississippi.⁵ Minnesota is again leading by example and ensuring that public employees are vaccinated to protect themselves, their co-workers, and their communities. This important public health action is being adopted by businesses and colleges across the state and the nation and is a critical step to stem the tide of the coronavirus pandemic.

1. Centers for Disease Control and Prevention. Covid Data Tracker Weekly Review.
2. Governor Walz Announces Vaccination Requirements for State Agency Employees https://mn.gov/governor/news/?id=1055-493652. Accessed on 8/12/2021
3. https://apha.org/News-and-Media/News-Releases/APHA-News-Releases/2021/COVID-19-vaccine-mandates
4. The largest U.S. teachers’ union announces support for vaccination or testing for educators. https://www.nytimes.com/2021/08/12/world/teachers-union-vaccine-mandate.html Accessed on 8/12/2021
5. Delta variant hits hard in the five worst states for vaccination rates: It's spreading 'like a tsunami,' one health official says. https://news.yahoo.com/delta-variant-hits-hard-five-145039569.html Accessed on 8/12/2021

Dear MPHA Members and Community,

Yesterday's guilty verdict of Derek Chauvin is a historic step in our endeavor to undo centuries of systemic racism. This verdict does not bring George Floyd back to us, his life is lost forever, but it may be a turning point in our justice system. Now we have to pause and reflect on what we all have to do both professionally and personally to continue our anti-racism work to create more just and equitable systems.

Your MPHA Governing Council

Dear MPHA Members and Supporters,

Again we find ourselves saddened by another death of a Black American at the hands of a police officer. We are heartbroken and outraged that Daunte Wright’s life was taken. As our community continues to grieve the murder of George Floyd during the Derek Chauvin trial, we find ourselves traumatized by police violence again.

We again implore our MPHA membership and all Minnesotans to join with us to create more just and equitable systems and institutions. We must strive to unravel systemic inequities like racism and discrimination and work to promote equitable distribution of resources and services that can reach all communities, but especially those that are most vulnerable.

We have previously called on Governor Walz to declare racism a public health crisis in our state. Racism can manifest itself in many ways, including both structurally and in long-standing institutions. As stated by the American Public Health Association, we must “acknowledge that violence in policing and the racial profiling that can perpetuate it are a public health crisis that needs our attention now”. Change will require brutally honest conversations. These conversations will likely be hard and some may find them uncomfortable, but they are vital to ensuring health and well-being of all Minnesotans.

Below are some resources from the Minnesota Department of Education, the University of Minnesota, and the National Institute of Mental Health.

• Resources to Help Educators, Adults Respond to Racism, Violence and Trauma
• Responding to Trauma and Tragedy
• How to Talk About Traumatic Events and Tragedies
• Talking to Children About Racism
• Helping Children and Adolescents Cope with Disasters and other Traumatic Events
• Anti-Racism resource list curated by the University of Minnesota

Below are some ways that you can support those living in Brooklyn Center who may be impacted by school and business closures.

• Brooklyn Center Schools Food Drive (Monday-Friday at the “Blue Barn” gym at Brooklyn Center High School at 6500 N. Humboldt Ave, Brooklyn Center, MN 55430 from 8:00 am until 5:00 pm
• Brooklyn Center Schools GoFundMe: here and here
• Brooklyn Center Mutual Aid GoFundMe
• More listed in the Sahan Journal article here

The Minnesota Public Health Association (MPHA) supports the concern expressed in the Letter from the Director of the Council of Asian Pacific Minnesotans Regarding the Atlanta Shooting. Anti-Asian hate crimes in 16 of America’s largest cities increased 149% since the start of the COVID-19 pandemic. Bigotry and racism toward Asian Americans are unacceptable. MPHA stands in solidarity with these communities and embraces the richness of diversity from all populations.

#StopAAPIhate #StopAsianhate #PublicHealth #ThisIsPublicHealth #AntiRacism #Minnesota #TwinCities #GreaterMinnesota

Dear MPHA Members and Friends:

The jury selection began this week for the criminal trial of Derek Chauvin for the death of George Floyd. This is a time of intense apprehension for our communities and our state. The Minnesota Public Health Association (MPHA) acknowledges that for many of us—especially for Black, American Indian, Latinx and other community members who often feel targeted by police violence and harm—the coming days may feel deeply distressing. Many of you may carry the pain, grief, and rage that arises from a system that too often oppresses and targets Black lives.

Over the summer, Minnesota became the epicenter of a global movement for racial justice. Many Minnesotans are bracing for another public reckoning. We have long weeks ahead—weeks filled with media coverage, a trial with a yet to be known outcome, and a militarized city. We understand that there is a strong desire for Derek Chauvin to be held accountable for George Floyd’s death. However, our all-too-recent history has shown that cases like these have been difficult to prosecute. However, public outcry has begun to shift the tide.

Please know that your MPHA members stand with you along with the thousands of people that have gathered in Minneapolis every day this week to demand justice for George Floyd. As public health professionals, students, advocates, and health providers, we are acutely aware of the deep-seated and longstanding disparities in health outcomes among Black, American Indian, Latinx and other communities of color in Minnesota. These inequities arise from structural racism, discrimination, and conscious and unconscious bias ingrained in all of our systems. There are many ways to support and strengthen our community in the weeks to come—whether that be making space for healing for loved ones and friends, listening to community voices, or participating in peaceful protests while following COVID-19 precautions.

There is also a need to move the criminal justice system to a more preventative model that results in a more just and equitable Minnesota for ALL citizens––this is the responsibility of all of us.

Sincerely,

The Minnesota Public Health Association