United States

United States

In the United States, the three participating counties in Minnesota were examined in detail in order to identify the areas and populations in greatest need of additional NCD-related health services. On average, Minnesota is one of the highest-performing US states in terms of health outcomes, with relatively low prevalence of key risk factors. An analysis of disease and risk factor prevalence, performed for 13 sub-county areas, identified large health disparities within the three counties. The worst-performing areas were Minneapolis North (composed of Camden and Near North), Rice County (and its Southern region in particular), and Ramsey County as a whole. Across the 13 sub-county areas, self-reported hypertension prevalence ranged from 11.2% to 26.2%; self-reported diabetes prevalence ranged from 3.2% to 9.2%; and the prevalence of daily smoking ranged from 4.0% to 18.4%. The percentage of people who had received any medical care in the past year ranged from 54.2% to 86.1%. Major differences between men and women were not identified for the outcomes examined.

Using survey data representative at the zip code level, more specific high-need areas were identified. In terms of meeting clinical targets, populations in North Minneapolis and Camden were the lowest-performing in Hennepin County. In Ramsey County, populations in Downtown St. Paul, Southwest Downtown St. Paul, and South East Downtown St. Paul had the worst health outcomes. In Rice County, rural areas had worse outcomes. Across the three counties, there was a consistent pattern of high comorbidity, with over 30% of individuals having more than one condition.

Qualitative data suggested that the worst-performing areas faced unique challenges, though common themes in these areas were larger minority and immigrant populations, lower income levels, and higher use of emergency room and urgent care for general health care. Minneapolis North was described as a largely impoverished, African-American population characterized by low educational attainment and high levels of violence. Downtown St. Paul areas of Ramsey County were noted as having large homeless populations, in addition to recent-immigrant populations, including a large number of undocumented immigrants who may have difficulty understanding or accessing the formal health system. Rice County was identified as more rural, with outreach and supportive services more difficult to access, and also had a large undocumented and recent-immigrant population.

Three primary recommendations were developed from these findings to inform HealthRise programming in the United States. First, interventions should be targeted in areas of highest need and with the poorest clinical outcomes: North Minneapolis in Hennepin County, Downtown St. Paul in Ramsey County, and rural and South Rice County. Second, the focus should be to diagnose and treat individuals who may not have been previously diagnosed. Third, a primary objective should be to reach clinical targets for people in care in these areas.