The population of Minnesota is rapidly becoming more racially, ethnically, and culturally diverse. People of color (those self-identifying as one or more races other than white and/or Latino) who made up 14 percent of the population in 2005 will increase to 25 percent by 2035, adding more than 500,000 people of color between now and 2035.“Census data from 2000–2014 indicates that the rate of growth among populations of color (74 percent) in Minnesota far outpaced that of the state’s white population (2 percent).” Similar demographic changes are occurring throughout the nation. However, in Minnesota and other states, the structural components of how public and private entities operate day-to-day do not yet fully reflect and embrace the population’s diversity with regard to race, ethnicity, culture, gender, gender identity, sexual orientation, individuals with disabilities, veterans, and others. Customary ways of doing business—hiring, retention, advancement practices, contracting and procurement, and civic engagement—have failed to keep pace with, and be responsive to, the needs of the state’s diverse population.
Community representatives, philanthropic foundations, public policy and public health advocacy groups, policymakers, and government officials have called for structural, comprehensive changes in governmental and private processes to reduce and eventually eradicate structural racism. Structural racism and inequities stand in the way of a truly representative democracy where all individuals can thrive and achieve their full potential. A growing body of evidence demonstrates the harmful effects of racism on health outcomes. This research examines the costs to individuals and society of failing to implement changes that can reduce disparities and eliminate inequities in access to government services and in health and well-being outcomes. State government leaders and policymakers have responded with a rising sense of urgency by introducing a mix of legislated and non-legislated structural approaches to eliminate disparities.
This article describes policy and programmatic approaches in four states, with a focus on a landmark equity policy recently adopted by the Minnesota Department of Human Services (DHS). Section II provides an overview of recent pioneering state-level efforts to embed consideration of health equity and equity in government processes and decision-making. Section III offers a detailed case study of the development and early steps toward implementation of the DHS Policy on Equity in Minnesota. Section IV describes policy and programmatic approaches taken in the states of California, Washington, and Vermont. Lastly, in Section V, we offer recommendations, drawing from our research, to inform future work and to stimulate discussion throughout the country.