In This Issue: • Minnesota Governor’s Race • Colleague Interview with Comissioner Jan Malcolm • BCBS Support Leads to Successful Advocacy Partnership • Fellowship Alum Seeks City Council Seat 2022Fall Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDIC AL SOCIET Y Doc tors Your ImpactsVOTEourHealth
CR UT CHFIELD D ERMA TO LO GY 1185 Town Centre Drive, Suite 101, Eagan | 651.209.3600 | CrutchfieldDermatology.com Recognized by Physicians and Nurses as one of the best Dermatologists in Minnesota for the past twenty years.SEAL OF APPROVALAESTHETIC “YOUR PATIENTS WILL THANK YOU FOR REFERRING THEM TO DR. CRUTCHFIELD” Dr. Crutchfield Sees All Patients Personally. Specializing in all hues of skin, including skin of color. Experience counts. Quality matters.
3 IN THIS ISSUE It’s Your Voice, So Use It! By Thomas E. Kottke, MD, MSPH 4 PRESIDENT’S MESSAGE Evolve With Us Your Career, Our Health By Zeke J. McKinney, MD, MHI, MPH 5 TCMS IN ACTION By Becky Timm, MA, CEO VOTING AND HEALTH 6 • COLLEAGUE INTERVIEW: A Conversation with Commissioner Jan Malcolm 10 • INTERVIEWS WITH MINNESOTA GUBERNATORIAL CANDIDATES: Gubernatorial Candidate Hugh McTavish, PhD Gubernatorial Candidate Governor Tim Walz 14 • Voting is a Health Issue By Edward P. Ehlinger, MD, MSPH 16 • Voting for the Future our Patients Deserve By Sakina Naqvi, MD, MBA and Aliya Bhatia, MPP 18 • Democracy and Power: Why Voting Matters for our Health By Jeanne F. Ayers, RN, MPH 20 • Providing Essential Care While Rights Are On the Line By Sarah Traxler, MD, MSPH 22 • Blue Cross and Blue Shield of Minnesota and TCMS Celebrate 10 Years of Partnership By Jenny Song 23 • Free School Meals Nourish Kids and Communities By Leah Gardner, MPP 25 • PAID SupportedEDITORIAL:Decision-Making and Advanced Planning: When Your Patients Need Support By Roxanne Jenkins 27 • ENVIRONMENTAL HEALTH: Vote As Though Your Life Depends On It By Mike Menzel, MD Career Opportunities 28 FUTURE PHYSICIAN LEADERS From the Bedside to the Ballot Box By Justice Spriggs, MS4 VOLUME 24, NO. 3 FALL 2022 CONTENTS Page 6 With the election season upon us, the authors in this issue of MetroDoctors hope to emphasize the many ways your vote impacts the health of our communities and state. Articles begin on page 6.Page 11 Page 28 Page 10 In This Issue: Colleague Interview with Comissioner Jan Malcolm CBS Support Leads to Successful Advocacy Partnership ellowship Alum Seeks City Council Seat 2022Fall Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIET Y Doc tors Your ImpactsVOTEourHealth MetroDoctors The Journal of the Twin Cities Medical Society Fall 2022 1
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Nancy K. Bauer, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893; nbauer@metrodoctors.com
Lucy Faerber, MPH, Program Manager lfaerber@metrodoctors.com
MetroDoctors (ISSN 1526-4262) is published quarterly by the Twin Cities Medical Society, 2355 Fairview Ave, #139, Roseville, MN 55113. Periodical postage paid at St. Paul, Minnesota. Postmaster: Send address changes to MetroDoc tors, Twin Cities Medical Society, 2355 Fairview Ave, #139, Roseville, MN 55113.
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MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
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At-large: Ryan Greiner, MD TCMS Executive Staff Becky Timm, MA, CEO (612) 362-3715; btimm@metrodoctors.com
Secretary: Cora Walsh, MD Treasurer: Alex Feng, MD, MBA Past President: Sarah Traxler, MD, MSPH
Editor-in-Chief: Thomas E. Kottke, MD, MSPH Managing Editor: Nancy K. Bauer Editorial Board Members: Clare Buntrock, Medical Student Carol Coutinho, Medical Student Dennis Cross, MD Peter J. Dehnel, MD Edward P. Ehlinger, MD, MSPH Robert R. Neal, Jr., MD Lynne Ogawa, MD Richard R. Sturgeon, MD Production Manager: Sheila A. Hatcher Advertising Representative: Betsy Pierre Cover Design by Amber Kerrigan
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Doctors
Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 2355 Fairview Ave, #139, Roseville, MN 55113 E-mail: nbauer@metrodoctors.com.
In addition to using your voice with the legislature and other policymakers you, the reader, have many other pro-democracy opportunities this fall. Top of list? Vote. The voting rules in Minnesota make it easy. If you will be out of town or busy on election day, request an absentee ballot at the Secretary of State website
Local: The Power of Engaging in Grassroots Advocacy, writ ten by TCMS advocacy staff Lucy Faerber, MPH and Kate Feuling Porter, MPH.
By Thomas E. Kottke, MD, MSPH Editor-in-Chief, MetroDoctors
IN THIS ISSUE... It’s Your Voice, So Use It!
Eithermayvotingthatyousite.thatofferingthetowaysnot,elections-voting/other-ways-to-vote).(https://www.sos.state.mn.us/Anyone,athomeorispermittedtovotebymail.EdEhlingerwritesthat,inhispediatricspractice,healmadeinformationonhowtoregistertovoteavailableparentsaspartofthe“anticipatoryguidance”portionofwellchildvisit.Vot-ER(vot-er.org)makesthiseasybyhealthcareworkersafreebadgewithaQRcodetakestheusertoanon-partisanvoterregistrationwebMaybeyourpatientorco-workerwon’tvotethewaywouldvote,butthat’sOK.Itistheveryactofvotingstrengthensourdemocracy.I’mtakingadvantageofMinnesotaelectionlawandearlythisyear.YoumaychoosetodothesameoryouchoosetogotothepollsinpersononNovember8.wayknowthis,yourvoteisavoteforhealth.Lastly,visittheTCMSblogforanarticle:
All Politics are
When I read the trilogy, Berlin Noire, in 2019, my first thought was that it was written as an allegory for 21st Century America. In the three books, Bernie Gunter, a police detective, experiences political crime, thuggery, and violence as autocracy crushes democracy in 1930s Germany. We know how it ends very poorly for everyone. Written in the 1990s, it couldn’t be an allegory for the 2020s; maybe it was just prescient. It should come as no surprise to anyone who receives a newsfeed or reads a newspaper that democracy in America is under assault as it was in Germany in the 1930s. From the Supreme Court who made it harder to vote by disman tling the Voting Rights Act in 2013 to physical threats and intimidation of local election workers, the anti-democracy movement is strong, ubiquitous, and violent. What may surprise the reader is the strength of the association between democracy and health.
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The evidence can be found at Healthy Democracy, Healthy People, led by Jeanne Ayers. This nonpartisan initiative supports public health professionals and policy makers who are working to advance civic participation and public health. Visit their interactive website (healthyde mocracyhealthypeople.org) where you’ll find that Minne sota does well with both voting and public health; but it is not at the top. This is particularly true for populations of color. Ayers has also contributed an article in this issue of MetroDoctors. Unfortunately, the violent, anti-democracy movement has carried with it a likewise violent anti-public health movement. In a July JAMA commentary (doi:10.1001/ jamanetworkopen.2022.23501), the University of Minnesota’s Sara Gollust wrote that, in a 2021 survey, one-third of Republicans and one-fifth of Democrats expressed belief that harassment of public health officials is justified. As Commissioner Jan Malcolm describes in her Colleague Interview, this belief has taken a toll. Many public health workers have received threats for simply doing their jobs, and Commissioner Malcolm warns that, “I don’t think we fully appreciate yet the consequences of the shift away from understanding or believing in science, and the absolute disdain that many have for expertise of all kinds, much less in govern ment.” I urge you to carefully read her entire interview, reflect on it, and act on her advice to express an opinion: “Your voices can make a tremendous differ ence at the legislature and among private sector business and healthcare leaders.”
Evolve With Us Your Career, Our Health
ZEKE J. McKINNEY, MD, MHI, MPH
The past year and a half brought an immense amount of change for Twin Cities Medical Society with us stepping forward as an independent organization. While this portend ed an administrative shift in our business operations and reconsideration of how we can be successful amidst competing demands for physician time, social capital, and financial support, it provided the opportunity for us to focus more clearly on what makes us unique. In particular, this change reinforced our commitment to community-led initiatives to improve public health through use of our expertise and privilege as physicians. Broadly, we envision this goal manifesting through the overlapping and independent domains of education, advocacy, and programming. In terms of education, we not only hope to provide the settings and context in which physicians can gain additional expertise aligning with what they find relevant as their career progresses, but also to be the stewards of translating complex scientific, medical, and sociopolitical topics into concise and meaningful information digestible by the communities we serve. Our physicians continue to communicate gaps in mentorship and clinical experi ences for trainees even prior to medical school, as well as in public health, leadership, and communication-based education that are necessary or at least highly-desired by practicing physicians. For trainees, we continue to have remarkable success with our rapidly growing Public Health Advocacy Fellowship and anticipate additional new partnerships wherein trainees can be paired with physicians and other trainees at all levels seeking to guide those coming behind us. For those of us already in practice (mid-career and beyond) we are exploring partnerships for programs and educational events. The broadening expertise of our physicians can then proceed to ensuring that contemporary topics of concern can be shared with individuals without medical expertise, which is an expanding need as the world faces multifaceted issues intersecting public health and public policy, such as emerging infectious diseases, issues of health equity, and the spread of medical misinformation. Such audiences could also include the institutions and representatives holding the power to instate change via public policy.
President’s Message
However, advocacy stretches well beyond the domain of political change to include ensuring specific organiza tions including the healthcare systems in which we work become both aware of the needs of their communities and have the appropriate information and/or means by which to enact necessary change. Where TCMS differs from other organizations is that we seek to support data-driven decision-making regardless of the sociopolitical popularity of a topic of interest. This means that we reinforce individual and community-based advocacy for their own needs, rather than a privilege-based focus on what community needs are from an external perspective. For example, we want to ensure that engagement in health care is not precluded by social or medical stigmatization of certain conditions or behaviors, whether related to weight, diet, substance use, or occupation. This type of work requires a reorientation of our thinking from necessarily blaming individuals for their social or health outcomes, and rather facing and dismantling the systems resulting in these effects, which is where our programs aim to succeed. With these loci in consideration, TCMS seeks to expand our existing successes in public health education and advocacy via additional programs driven by our physicians and supported by our staff. We are encouraged by the leadership of our new CEO, Becky Timm, who quickly integrated herself throughout our organization to enact the changes we need as a unique physician-based organization no longer necessarily bound by geography, specialty, or politics. All of which needs physicians like you to speak up to let us know if there is a gap in what you want for the world around you. The consequent impact of our intent is that you as a physician will feel compelled, if not obligated, to be a part of this vision of physician leaders in the community. We know your resources are limited, so we truly ask you to consider where you want to put your time, money, and wisdom. Thank you for your ongoing support and engagement!
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Staff: Front: Nancy Bauer, Kate Feuling Porter, Amber Kerrigan, and Patrick Jones. Back: Becky Timm and Lucy Faerber.
Fall is my favorite season. This year, I am looking forward to welcoming our 35 medical students as they start their advocacy journey through the TCMS Dr. Pete Dehnel Public Health Advo cacy Fellowship. I am excited to spend Saturdays with our physicians tabling at local neighborhood health events in the Twin Cities. And I cannot wait to share the next chapter of our organization’s story with our members, partners, and the greater public health community.
Let’s Connect I am thrilled to be at the organization’s helm during this exciting time of change and reprioritization. These initiatives will not only create meaningful change and advance the health of our com munities, they will also support the health and well-being of our physicians while reconnecting them to their role as community healers. As COVID-19 has made abundantly clear, we are all deeply connected when it comes to health. Please reach out to me about the transition to ABH Advocates for Better Health, the survey, or other items of interest.
Members of the TCMS Board and staff gathered for an informal, outside get (re)acquainted dinner in July.
Seasons of Change
What’s Ahead When the East Metro and West Met ro Medical Societies merged in 2010 establishing Twin Cities Medical Society, our inaugural president Dr. Ed Ehlinger had a vision for a new kind of medi cal society, one that acted as a bridge between the medical profession and public health. At the beginning of this year TCMS announced our intention to become a medical association wholly focused on public health. Throughout the year, the TCMS Board has worked hard on the next steps as our organization continues our evolution to live into our mission as a new kind of medical society to meet the shifting realities in public health. Through these conversations we have adopted a new name: ABH Advocates for Better Health which reflects an evolution in our mission and the vision of the organization toward physician and medical student advocacy dedicated to healthier, more equitable communities.Ournew name and brand repre sent our desire for ABH to have a more direct, immediate impact on Minneso ta’s most pressing healthcare issues. Our members will be focused on making real change that improves the lives of our patients, and everyone in our communities.TheTCMS Foundation Board of Directors, our philanthropic arm, has also embraced this evolution and will become ABH The Foundation. ABH initiatives will advance the health of our Minnesota communities while at the same time promote physi cian well-being. ABH will accomplish this by fostering connections between our member advocates and provid ing ways for physicians and medical students to collaborate and grow in advocacy together. Your Voice Counts In this issue of MetroDoctors, you will read many outstanding articles about how your vote impacts our health. This theme complements our invitation for you to have a voice. We invite you to be a part in the shaping of ABH and our future priorities in public health as well as the professional and personal support for our physician community. We want to hear from you! We’ve created a survey that will guide our strategic direction. There are three op tions for your voice to be heard: scan the QR Code; access the survey via this toABH;https://bit.ly/TCMSlink:orvisitourwebsite: www. metrodoctors.com.Pleasecomplete the survey by Sep tember 12, 2022. All voices are strongly encouraged to participate and share thoughts on public health trends and how we can work together to make real change.
TCMS IN ACTION BECKY TIMM, MA, CEO
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Board: Standing (L): Jennifer Kuyava, Ryan Greiner, Cora Walsh, Tyler Winkelman, Sruthi Shankar, Riley Shearer, Alex Feng, and Caleb Schultz. Seated: Hannah Lichtsinn and Zeke McKinney.
The span of our work is enormous, from environmental health to infectious disease prevention and control, maternal and child health, chronic disease prevention and management, tracking healthcare spending and outcomes, formulating policy recommendations, and enforcing the laws and regulations which deal with these things. Public health focuses on prevention, which is very different from what gets the attention and the funding in our system.
Voting and Health
How did equity considerations influence your decisions during the COVID-19 pandemic?
Governmental public health has been underappreciated and underfunded for decades, and it shows. The US has less appre ciation for prevention and the role of public health than most, maybe any other developed country. That is a significant reason for the huge and growing gap between expenditures on health care and population health outcomes in the US compared to other countries. It’s certainly true that the US, and Minnesota, have some of the best capability in the world great providers and great innovation. Individual patients (some, not all) get fantastic outcomes. It just doesn’t hold for the population as a whole. And that costs us dearly.
Colleague Interview:
A Conversation with Jan Malcolm, Commissioner Minnesota Department of Health
We knew from the outset that populations who have historically faced health inequities populations of color and American
Jan Malcolm is a graduate of Dartmouth College and holds an Honorary Doctor of Laws from U of M School of Public Health. You’ve been Minnesota’s Health Commissioner under three governors Ventura, Dayton, and Walz. From those experiences, what have you learned about how governmental public health can best meet the needs of the state? It has been an enormous privilege to serve Minnesota with each of these governors. Governmental public health has a unique role to protect and improve the health of ALL Minnesotans without regard to whether or by whom they are insured, and who (if anyone) is their regular source of health care. I don’t think that uniqueness is well enough understood by most folks in either the public or private sectors.
Commissioner Malcolm was appointed in January 2018 as Commissioner for the Minnesota Department of Health and is responsible for directing the work of the Minnesota Department of Health. The department has approximately 1,400 employees in the Twin Cities area and seven offices in Greater Minnesota. Prior to being appointed commissioner, Jan Malcolm was an adjunct faculty member at the University of Minnesota School of Public Health, where she co-directed a national research and leadership development program funded by the Robert Wood Johnson Foundation. Earlier she also helped develop initiatives to strengthen the nation’s public health system as a senior program officer at the Robert Wood Johnson Foundation.Commissioner Malcolm previously served as CEO of the Courage Center and as President of the Courage Kenny Foundation following the merger of Courage Center and the Sister Kenny Rehabilitation Institute. She has also worked as Vice President of Public Affairs and Philanthropy at Allina Health. From 1999 to 2003, Ms. Malcolm served as Commissioner of the Minnesota Department of Health. Throughout her career, she has been active in state and national health care, public health associations, and government commissions on healthcare access and quality.
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What have you learned over the past two-plus years leading in the time of a worldwide pandemic?
This will be studied and debated and written about for years to come. Since the first weeks and months of the pandemic there has been huge tension between the need to act quickly and the knowledge that our information was very imperfect and fast changing. That leads to a lot of Monday morning quarterbacking. It’s certainly true that we would have made different decisions or had different public guidance and messaging at some points had we known then what we know now. In addition, how to effectively communicate given the dynamics mentioned above, along with the meteoric rise in both mis- and dis-information, remains a really big challenge.
The disparities in COVID outcomes still exist, and we will keep focused on that as the response continues. MDH has also committed to embed the learnings from COVID into our agency and all of our work going forward. To lead that effort Dr. Brooke Cunningham has joined us as the Assistant Commissioner for a new Health Equity Bureau at MDH, which will broaden and deepen our work in this area. Dr. Cunningham is challenging and inspiring us simultaneously and it is wonderful. Dr. Chomilo continues to serve as a senior advisor for equity beyond COVID.
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Despite that knowledge, our early efforts clearly fell short against so many barriers. We knew we had to get deeper into communities and let community leaders show the way. Dr. Nathan Chomilo, Medicaid Medical Director at DHS, joined MDH as a special equity advisor for the pandemic response, and made a huge difference. (I’m grateful to Commissioner Harpstead for sharing him with us!) Dr. Chomilo pushed us hard on the data we were collecting to see where our efforts were falling short. We made good improvements on that front as time went along.
(Continued on page 8)
Indians, people with disabilities, and those living in high social and economic vulnerability would be harder hit by this pan demic as well. A whole confluence of factors put them at greater risk for infection to begin with and for worse outcomes. Their occupations, their housing, transportation challenges, their lack of insurance and paid leave, systemic biases even for those with benefits all made exposures to SARS CoV2 more likely and their access to testing, care, and immunizations less likely.
We made good progress by funding a large group of COVID Community Coordinators community-based organizations deeply embedded in communities, along with funding an import ant group of diverse media organizations to help us communicate more effectively in each community of focus. Employees from all over MDH also came together in a Culture, Faith and Disabilities Branch of our Incident Command System for the response, and it was transformational for our agency.
It’s hard to find the words, really. It has been devastating. The unrelenting pressure of the last 2 and ½ years shared with healthcare providers as well, has been incredibly hard. And all of the polarization around COVID goes to the core of what we’re about, at both the state and local levels. We train to stop or contain these things, and this has been something on a level we’ve never seen before, both in the size of this globally, and in the dysfunction of it domestically. We literally could not succeed. Public health and healthcare workers have shared the personal and professional traumas that come with that stress, and that moral distress, exacerbated by the politicization of the pandemic that somehow turned us into being the bad guys instead of the good guys. I don’t think we fully appreciate yet the consequences of the shift away from understanding or believing in science, and the absolute disdain that many have for expertise of all kinds, much less inCombinedgovernment.with the threats many of us both state and local have faced just for trying to do our jobs, we’ve seen a lot of departures from public health positions all over the country and here in Minnesota, and tremendous burnout among those who remain. Recent surveys have shown that almost half of all public health workers nationwide report significant mental distress, and 40% of those still here are thinking of leaving their jobs. I know that the statistics among healthcare providers are similarly disturbing.
How has the stress of COVID-19 affected you and the staff of MDH and local public health?
I’m excited about their leadership, to put it mildly.
Dealing with the issues named in the last question! We have some systemic challenges that existed before the pandemic that have been accelerated and exacerbated by it. Workforce shortages all over the health continuum and all parts of the economy will not be quickly solved. We’ll need new care models, smarter use of technology, and ways of collaborating beyond anything we’ve done before. Incentives and reimbursement systems have got to align, not just in demonstration projects and through “charitable” work, but in the mainstream of health policy. Including but beyond the health sectors, we need to take seriously the challenge of rebuilding trust with the public, and genuinely tackling the systemic challenges behind health and otherAndinequities.wewill need leaders in health care, public health, busi ness, and policymaking that see the possibilities for a better system and are not stopped by the obstacles. I hope that those of us who have been around for awhile can help to support the rising generation of new leaders that we need in order to make it happen.
I would also say that it just isn’t possible to mount an effective response in Minnesota without a stronger national strategy and capacity, and without more global coordination. This must be an urgent priority going forward.
Colleague (ContinuedInterviewfrompage
The last 2 and ½ years have reinforced my belief that it’s the people in the health system writ large in Minnesota that make a critical difference, and how important it is to not give up on that. We are not done with this pandemic, and we have work to do to think deeply about what lessons we should learn from this experience in order to build a stronger system going forward.
Generally, I think we can all be proud that collaboration among the key players is better in Minnesota than in most places. At least that’s my conclusion from talking to colleagues around the country. But I also think the mechanisms to foster collaboration beyond individual relationships are really lacking, and we should work on that. Individual relationships, and trust, are necessary, but not sufficient. Those take time to develop, and even the strongest relationships and the trust gets very stressed in a crisis.
What do you see as the biggest and most pressing challenges facing our healthcare and public health systems in the next 10 years?
How can/should organized medicine assist you and your agency?
As mentioned in the earlier questions, medicine and public health have to come closer together. We need to see how essentially interdependent our missions and outcomes are, and we need to figure out how to best leverage both our different roles and our overlapping ones. That will take deeper engagement from both of our sectors. When it comes to helping the legislature understand the importance of public health, they need to hear from you. They hear the rationale differently from you. From us, it too often sounds to them like we are just trying to build the bureaucracy.
Any specific requests or tasks come to mind for TCMS as we dive into our mission to engage physicians in community-driven public health initiatives?
I really appreciate your embrace of public health and the broader social determinants context of what actually promotes health and what threatens it. The data have gotten more and more robust that we can’t improve population health without attention to social determinants, but our public policy-making generally has not reflected that. Your voices can make a tremendous difference at the legislature and among private sector business and healthcare leaders.
Not just for future emergencies and unfortunately, we should expect that there will be more of those given all of our global challenges but also for our day-to-day service to Minnesotans. We have to keep at it.
What are the most effective mechanisms and strate gies you’ve learned to foster collegiality and collab oration when working with different systems, like government agencies, health systems, and insurance?
7) From a “health system” perspective, the pandemic has really reinforced that our non-system is terribly fragmented and mis aligned in terms of roles and incentives. The acute care system has done an amazing job of serving under terrible conditions, and of learning and improving quickly when it comes to treat ment. But it hasn’t been and isn’t clear what the roles should be between acute care and public health, and between governmental and private payers, when it comes to things like how to assure the right levels of testing, vaccination, and now the test-to-treat model for quickly getting people diagnosed and treated with oral antivirals or monoclonals when indicated. Roles are not explicitly enough defined and incentives are not aligned well enough for us to successfully manage challenges such as what we have faced, and certainly will again. In terms of the continuum of healthcare services, when capacity is stressed, hospitals can’t discharge pa tients for ongoing rehab and recovery if long-term care facilities can’t admit them due to staffing shortages. Long-term care has been dealing with a growing staffing crisis for years, and it has been made significantly worse by the pandemic. Conflicting re imbursement incentives here too keep the different parts of the continuum in their silos.
Voting and Health 8 Fall 2022 MetroDoctors The Journal of the Twin Cities Medical Society
CALLCOPIC.COM | 800.421.1834
CONFIDENCE
Drop me an email. jan.malcolm@state.mn.us
During your Robert Wood Johnson Foundation tenure, did any Twin Cities teams get trained in the Interdisciplinary Research Leaders Program?
I get a LOT of emails and am sometimes slow to answer, but I will!
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Can I take the liberty of naming a few?
MetroDoctors The Journal of the Twin Cities Medical Society Fall 2022 9
In the very first cohort we had a great Twin Cities team: Rebecca Polston, founder and director of Roots Birthing Center, and Dr’s Katy Khozimannil and Rachel Hardeman at the U of M. They studied the impact of culturally-focused midwifery services on birth outcomes, where Minnesota has had some of the worst ineq uities in the nation. All three are rising stars, and I hope the IRL program gave them some extra encouragement and connections.
What is the best way for an interested party or system to collaborate or start a conversation with MDH?
What is your most proud accomplishment?
I am enormously proud of and grateful to my colleagues in public health and in health care for their incredible dedication and skill.
From my private sector career, I would say two things: helping to craft a very forward-looking and comprehensive health reform bill in 1992 that contained MinnesotaCare, progressive insurance market reforms, and some really good ideas for cost control that were passed and too soon repealed; and serving as CEO of the Courage Center and working with Dr. Penny Wheeler to create Courage Kenny Rehabilitation Institute from the merger of Sister Kenny and Courage Center. It’s now one of the most compre hensive and innovative centers in the nation serving people with disabilities.Frommy public sector career, it would be the comprehensive tobacco prevention and control program we put in place with tobacco settlement dollars under Governor Ventura (the ongoing State Health Improvement Program, SHIP, still carries some of the same ideas); improvements in the regulation of assisted living centers under Governor Dayton and passage of assisted living licensure under Governor Walz. And I think history will show that we in Minnesota with Governor Walz’s leadership did a pretty credible job of managing the COVID-19 pandemic when we look at the whole picture of health, economics, and social factors. And in health, I think we will be shown to have been leaders by looking at things like excess mortality over time. That will capture both the direct and less direct impacts of the virus.
Aside from mental health strategies or adding more policing interventions, what is at least one other proposal for reducing gun violence?
Interviews with Minnesota Gubernatorial Candidates
I have a simple proposal. Allow police chiefs to fire bad cops. Currently, state law requires that all discipline or firing of police officers must go through ar bitration, and both of my opponents support keeping it that way. Arbitra tors usually decrease any discipline and usually reverse dismissals. My position is to simply make police officers at-will employees and give police chiefs absolute authority to fire and discipline officers as they see fit. I would also give mayors and city councils authority to fire offi cers. This will get rid of the bad cops. The culture of silence about misconduct will change. Pretty soon you have very few bad cops. Police killings and abuse of civilians will decrease drastically, and the remaining good cops will be better at fighting crime, so crime will decrease.
Also, community relations will be im proved, so the public cooperates with the police and crime is reduced.
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First, I would never have instated COVID lockdowns, because we should have known, and I did know and wrote about it, that this would result in an explosion of clinical depression (went from 8% to 27% of the population in depression) and corresponding explosion in drug abuse, alcohol abuse, and drug
Gubernatorial Candidate Hugh McTavish, PhD
How will you address the racial inequi ties that exist in health care, education, and housing that are affecting the overall health of too many Minnesotans?
EDITOR’S NOTE: MetroDoctors extended an invitation to all three Gubernatorial candidates to par ticipate in a brief questionnaire relating to their positions on six health-related topics. Dr. Scott Jensen did not respond to the invitation. The responses from Hugh McTavish, PhD, and Governor Tim Walz are printed verbatim below.
Frankly, I do not have any brilliant ideas. But the core proposal of my campaign is Jury Democracy, where we would have large, statistically valid juries of 500+ randomly selected voters come to the capitol, hear arguments for and against a particular bill or proposal, deliberate on it, and then vote on that one bill or proposal. I would allow every legislator as well as interest groups and the public to introduce bills to the juries. So we would have some very innovative ideas to address these and other problems and actually give those ideas a hearing where the public would be the judge of them. What strategies will you use to promote opioid harm reduction?
I also will enforce pollution laws and expand parks and green spaces in inner cities as well as suburbs.
I am a PhD biochemist. I have exten sively researched COVID and all aspects of the lockdowns. The current strains of COVID are 36-fold less deadly than the original strains, which were themselves only 1.7 times deadlier than the flu (if you did not have a vaccine against either disease). So the response to COVID at this point should be the same as the re sponse to the common cold. Ignore it. Tell people this is over. Stop being wor ried or afraid of it. Go back to your lives. The lockdown response to COVID was one of the worst public policy di sasters in history. All data indicates it had no effect at all on COVID cases or deaths but threw one in five of us into major clinical depression and killed far more people than it saved due to increased suicides, murders, drug and alcohol deaths, cancer, and other medical deaths. What steps will you take to promote en vironmental health?
How will you address the racial inequi ties that exist in health care, education, and housing that are affecting the overall health of too many Minnesotans?
As a former teacher, I believe every stu dent deserves a quality education no matter their zip code. We’ve invested millions to hire more teachers of color; expanded college readiness programs for BIPOC students; and created Direct Admissions Minnesota to boost access to students of color. But we can do more.
I want to rewild Minnesota. I will pro pose to convert half our land back to nature over a 50-year period and have abundant prairies, abundant wildlife of all sorts, and have buffalo and wolves running wild across most of the state.
We must do more to keep guns out of the hands of people who should not have them by requiring background checks on every gun sale, passing Extreme Risk Protection Orders (“red flag” laws), bar domestic abusers from having guns while subject to short-term emergency orders, and prohibit guns in bars in Minnesota.
By Jury Democracy we can enact abor tion rights into statute and be done with abortion as an issue in Minnesota.
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Aside from mental health strategies or adding more policing interventions, what is at least one other proposal for reducing gun violence?
and alcohol deaths, which has also happened. Beyond that, I would welcome proposals to the Jury Democracy juries.
If Roe v Wade is overturned, Minnesota will become an island. How will you ad dress abortion access and decision-mak ing between a physician and patient?
I’m fighting to fully fund our schools and better equip our teachers so every student has the opportunity to succeed.
And what is your plan for interaction with bordering state agencies and the citizens of those states?
Lieutenant Governor Peggy Flanagan and Governor Tim Walz.
What will you do to mitigate the bur den of COVID-19 in a post-pandemic Minnesota?
Gubernatorial Candidate Governor Tim Walz
I’m also fighting to put homeownership within reach for more Minnesotans (Continued on page 12)
I would amend the state constitution to require that every bill to become law must pass a citizen jury, and I would introduce bills to citizen juries and af ter they pass the jury demand that the legislature hold a vote on that bill. A bill that codified abortion rights at least in the first trimester would easily pass a jury and once it was enacted into law, it would never be repealed because the repeal could never pass a jury. We would be done with abortion as a contentious issue and have abortion rights guaran teed by statute.
of color through enhanced funding for our down payment and closing cost assistance programs. And in an effort My latest budget also improved access to care, providing additional funding for mobile mental health crisis response teams throughout the state and established a Medical Assistance benefit more test-to-treat sites, where high-risk patients who test positive can receive a prescription for the antiviral medication Paxlovid at the same time for no cost. We’ve also exceeded our goal of recruit
Gubernatorial Candidate Gov. Tim Walz (Continued from page 11) Voting and Health 2022Fall Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIET Y Doc tors Your ImpactsVOTEourHealth 12 Fall 2022 MetroDoctors The Journal of the Twin Cities Medical Society
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Voting is a Health Issue
Recent analyses of state voting policies by Healthy Democracy/Healthy People demonstrate that states with more inclusive voting policies have a higher level of health.5 The easier it is to vote, the healthier the population.
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By Edward P. Ehlinger, MD, MSPH
In addition to the standard inquiries about illnesses, vaccinations, diet, and behavior, somewhere in the se ries of well-child visits I would always ask the parents of my patients four addition al questions. Does your child know how to swim? Does everyone in your family have a library card? Have you taken your child(ren) to visit the state capitol? Are you registered to vote? (Although I’m no longer in clinical practice, I still ask those questions of my neighbors and friends with young children.) Parents intuitively understood that swimming was a life-saving skill and quickly grasped the link between reading and educational success and health. But they were usually perplexed and intrigued by the last two questions. They were surprised to dis cover that the policy decisions made at the state capitol (and at all levels of gov ernment) had a bigger impact on their child’s health than the medical care they received. Once they understood that, it was easy to convince them that voting was one of the best ways to influence those decisions. I always made informa tion on how to register to vote available to parents as part of the “anticipatory guidance” portion of the well-child visit. In my various public health roles, I have continued similar discussions about what determines health. Most people are astonished to learn that medical care accounts for only 10%-20% of society’s overall health while at least 50% of health is determined by the social, eco nomic, and environmental conditions1 in their communities, i.e., the social determinants of health that are influ enced by policy decisions at all levels of government. Like my former patients, once people recognize that fact, they better understand why voting is a pub lic health issue. The American Medical Association has also recently recognized that by acknowledging voting as a social determinant of health.2
Multiple studies confirm the health consequences of voting. Where voting participation is high, the population’s health is better.3 The 10 least healthy states in America have voting participa tion rates nearly 10 percentage points lower than the 10 healthiest states. 4
History also demonstrates the im pact of voting on health particularly the health of mothers and babies. Af ter women gained the right to vote in 1920 maternal and infant mortality rates dropped precipitously.6 Among other things, this can be attributed to the passage of the Sheppard Towner Act of 1921, which set up maternal and child health (MCH) units in every state health department, expanded collection of birth and death data, and began federal funding of state MCH programs. Similarly, when many of the racially-based barriers to voting were eliminated by the passage of the Voting Rights Act of 1965, infant mortality rates again dropped and the Black/white disparity narrowed.7 In both situations, policy makers began to address the needs of previously disenfranchised people only when they were able to express their will by voting. In this election year, like that of 2020, our country is in the midst of interconnected crises: an infectious dis ease pandemic, nationwide struggles to confront racial injustice, and economic hardships affecting millions. Each of these crises reveals the deficiencies and inadequacies of our health, social, and economic systems, and the urgent need for significant policy changes to address the flaws. When you add to that the crisis caused by the overturning of Roe v Wade, the importance of voting gets further magnified. Officials elected in November will be the people with the
Edward P. Ehlinger, MD, MSPH, is a former State Health Official from Minnesota and past president of the Association of State and Territorial Health Officials (ASTHO), TCMS, and the Minnesota Public Health Association. He is the acting chair of the HHS Secretary’s Adviso ry Committee on Infant and Maternal Mortality, provides coaching for the Na tional Leadership Academy for the Public’s Health, and advocates for public health, social justice, and community-building initiatives locally and nationally. For over 50 years he has been working to socialize an alternative narrative to the dominant one about what creates health especially the health of mothers and infants. The story he tells most often is Abiyoyo, which is based on a South African lullabye and folk story.
7. thomasson-011011.pdf.files/Workshops-Seminars/Economic-History/https://economics.yale.edu/sites/default/files/
1.(Endnotes)Tarlov AR. Public policy frameworks for im proving population health. Ann NY Acad Sci 1999; 896; 281-93. 2. erage/ama/99223.https://www.medpagetoday.com/meetingcov
3. Kim S, Kim CY, You MS. Civic participation and self-rated health: a cross-national multi-level analysis using the world value survey. J Prev Med Public Health. 2015;48(1):18–27. 4. ed_States_elections.https://ballotpedia.org/Voter_turnout_in_Unithttps://www.americashealthrankings.org/ 5. org/.https://www.healthydemocracyhealthypeople.
6. Achievements in Public Health, 1900-1999: Healthier Mothers and Babies, MMWR, Octo ber 01, 1999 / 48(38);849-858.
The lessons of 1920 and 1965 teach us that universal suffrage is essential not just for the health of our democracy, but for the physical and mental health of individuals and communities.
opportunity to craft policy changes to address all these issues. Thus, it is im portant that all our citizens have their voices heard particularly those who have been disenfranchised in the past. The lessons of 1920 and 1965 teach us that universal suffrage is essential not just for the health of our democracy, but for the physical and mental health of individuals and communities. While everyone should be engaged in increasing voter participation, health care and public health professionals are in a unique position to promote in a non-partisan way the civic engagement necessary to enhance health and build democracy. Since many healthcare and public health professionals work directly with populations that have frequently experienced voter suppression, it is well within their purview to encourage peo ple in these communities to vote and to advocate for the removal of the systemic barriers that prevent or discourage them from voting. Increasing civic participa tion is an essential task for anyone in terested in advancing health and health equity. Part of our clinical and public health roles is to help make that happen. As a parent, grandparent, and pedia trician, I recognize that raising a healthy child is a difficult task. I’ve also learned that no parent can do it alone. It is a tired, overused, but accurate cliché that “it takes a village to raise a child.” What is not well recognized is that part of that village’s role is to encourage every adult to vote. A village of voters is necessary to create the conditions in which every child and every adult has the opportu nity to be healthy and thrive. As the November election nears, now is the time for everyone in every village to step forward and vote. We can help make that happen by facilitating voter registration and encouraging voting among our fam ily, friends, neighbors, and patients. It is the most powerful thing we can do for the health and well-being of ourselves, our children, and our community.
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Vot-ER is a 501(c)(3) nonprofit organization working to integrate civ ic engagement into health care. In the spring of 2020, an election year, VotER reached out to Minnesota Doctors for Health Equity. The two organiza tions have a natural alliance and have approached civic health with a similar mindset: to mobilize health profession als to be engaged in building a strong democracy.Vot-ER has developed nonpartisan civic engagement tools and programs for every corner of the healthcare sys tem from private practitioners to medical schools to hospitals. They also convene an annual month of action in August called Civic Health Month. Their work is driven by a community of healthcare professionals, organizers, students, and technologists united by a common vision: healthy communities powered by inclusive democracy. MDHEQ and Vot-ER helped ex pand the work of voter access during the pandemic into the greater Minneapolis area, including bringing M Health Fair view, Hennepin Health, and Children’s Minnesota into the fold. In addition to these institutional level partnerships, Minnesota health professionals began using Vot-ER badges1 with their pa tients and medical students got involved through the Healthy Democracy Campaign2Togethercompetition.with organizations like MDHEQ, Vot-ER has now expanded Vot-ER programs into over 500 hospitals and clinics and helped more than 47,000 Americans prepare to vote. Vot-ER highlights the efforts of Minnesota’s committed health professionals in a case study that they share with their Civic Health Fellowship, a leadership development program focused on com munityRecently,organizing.the American Medical Association passed a resolution that af firms voting as a social determinant of health. The resolution points out the bi-directional link between voting and health outcomes. The resolution also takes it a step further and shines a light on gerrymandering, a vicious process corrupting our democratic system that locks the visions of our patients into maps that fail to uplift their voices. In doing so, the American Medical Association the largest association of phy sicians in America is helping to bring the health field into the broader coalition to protect and renovate America’s dem ocraticImprovinginfrastructure.access to the vote is not merely a process of guaranteeing the rights enshrined in our constitu tion, but also an effective way to build a more equitable country and improve
Minnesota Doctors for Health Equity (MDHEQ), is a non-profit organization that serves to educate health professionals about inequities and engages in grass roots community efforts. Its members have previously testified in front of the state senate, written opinion pieces, connected with local and regional rep resentatives, have received grant funding for various efforts around health ineq uities and spoken at public forums to talk about health disparities. As a part of this same effort, they have also shed light on physician disengagement with the electoral process.
By Sakina Naqvi, MD, MBA and Aliya Bhatia, MPP
Voting for the Future our Patients Deserve
Voting and Health
Aliya Bhatia, MPPSakina Naqvi, MD, MBA
our health outcomes. As the future of the health field is crafted from the rubble of COVID and the many moments of grief in America’s present, doctors can play a unique role in shaping the foun dations of better health through voting, encouraging their patients to vote, and wherever possible, building more equita ble systems to ensure that our voices are heard in the creation of policy at every level of government.
2.1.References:https://vot-er.org/free-badge/https://vot-er.org/healthy-democracy-campaign/
Aliya started her career as a high school educator and then as a strategy consultant at the Boston Consulting Group (BCG). She prioritizes diversity and inclusion in all her endeavors. Aliya resides in Washington, DC where she works to realize Vot-ER’s vision of healthy communities powered by an inclusive democracy. She is a Georgia native and has worked in Louisiana, Ala bama, Mississippi, and Missouri. She can be reached at: aliya@vot-er.org.
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Sakina Naqvi, MD, MBA grew up in Karachi, Pakistan and attended Dow Medical College. She moved to the Unit ed States after her medical education and completed a residency in Internal Medi cine at Hennepin County Medical Center. She subsequently pursued a fellowship in Pulmonary and Critical Care at the Uni versity of Minnesota and has completed a Masters in Business Administration from Kellogg School of Management at North western University. She currently serves as the Pulmonary Service Line Director at M Health Fairview and is also an Adjunct Professor of Medicine at the University of Minnesota Medical School. Having grown up in a developing country she has also had a strong interest in health disparities and led her to serve on the board of Minnesota Doctors for Health Equity (MDHEQ). She remains strongly connected to her roots in Pakistan and is currently involved in operationalizing a hospital that will focus on providing high quality, free of cost or at cost health care in Karachi, Pakistan. She can be reached at: Naqvi.sakina@ gmail.com.
As the future of the health field is crafted from the rubble of COVID and the many moments of grief in America’s present, doctors can play a unique role in shaping the foundations of better health through voting, encouraging their patients to vote, and wherever possible, building more equitable systems to ensure that our voices are heard in the creation of policy at every level of government.
Aliya Bhatia, MPP is the Executive Di rector at Vot-ER and Civic Health Month where she works to bring voter registration into healthcare settings, including emer gency rooms, hospitals, and community health centers. She completed her Masters in Public Policy from Harvard Kennedy School as a Sheila C. Johnson Leadership Fellow and is a graduate of the School of Foreign Service at Georgetown Univer sity. Aliya was drawn to the connection between health and democracy through the combination of being raised by parents in the medical field and various defining experiences while studying, teaching, and working on housing and health initiatives.
Althoughprograms.policymaking often feels distant from our lives, our participation is urgently needed and critical to our health. A recent analysis of health and civic participation demonstrates that inclusive voting policies and expanded voter participation contribute to improved collective health.3 Building our power and influence is necessary to ad dress unacceptable health inequities. Since 2020 the nation has expe rienced adoption of some of the most restrictive voting laws we’ve seen in re cent history. New restrictions on ab sentee voting, early voting, and drop boxes along with gerrymandering are expected to lead to even more barriers for communities already underrepresented at the ballot Conversely,box. robust and inclusive democratic practices can serve as a ve hicle for building power and provide the foundation for healthy thriving com munities. Health professionals work ing collectively can advance health and voting equity by championing policies that strengthen civic and voter partici pation. Faced with an urgent imperative to protect and promote inclusive voting policies, major public health and civic engagement groups came together in 2020 to form VoteSAFE Public Health now called Healthy Democracy Healthy People (HDHP). HDHP is a non-par tisan coalition5 with the overall aim of advancing health and racial equity by strengthening civic and voter participa tion and ensuring access to the ballot for all eligible voters. The HDHP approach is centered on three practices shown to build power including: organize people and organizations, organize narrative and
By Jeanne F. Ayers, RN, MPH
Why Voting Matters for our Health
My personal awareness of the connections between civic engagement and everyday life began with my early experience growing up on a family farm in central Minne sota. For over 140 years decisions about access to electricity, roads, schools, grain marketing cooperatives even recovery from the cropland damage of the dust bowl years were addressed through a combination of political, individual, and community efforts. These efforts were supported and sustained through public policies at a local, state, and national level. Our elected bodies made many decisions and investments to create the conditions to assure everyone had an opportunity to thrive. For example, advocates registered Black voters after the Civil War and elected representatives who then created a division of medical services for new ly freed slaves;1 with women’s suffrage, child mortality rates declined by 8 to 15%;2 the 20th Century Civil Rights Movement spurred an expansion of voting rights and ushered in more in clusive policies in education, housing, economic opportunity, and health care including the establishment of Medicare and Medicaid;1 and in 2010 health care and health equity champions organized to pass significant national health reform measures while others organized state level ballot initiatives to assure Medicaid Expansion.1 In addition to improved health care, it has been clear for decades that access to healthy food and clean water, affordable housing, health care, quality education, and other conditions vital to community health are created through policies influenced by the public and political will created by voters. Minnesota has many protective policies when it comes to voting we enjoy inclusive voter registration, no excuse absentee voting, and our voters led the country with 80% turnout in 2020.3 However, our state is ranked 15th out of 50 on the Cost of Voting Index, a tool measuring ease of voting.4 This demonstrates there is more to be done in Minnesota. We can improve health and voting disparities by protecting and promoting inclusive policies such as re storing the right to vote for those who have been incarcerated and adopting automatic voter registration across all state
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Democracy and Power:
• Promote policies to restore voting rights to citizens with past criminal convictions.
1.(Endnotes)Dawes, Daniel E., and David R. Williams. “Chapter 2: Setting the Precedent America’s Attempt to Address the Political Determinants of Health Inequities.” The Political Determi nants of Health, Johns Hopkins University Press, Baltimore, MD, 2020, pp. 39–67. 2. Miller, Grant. “Women’s Suffrage, Political Responsiveness, and Child Survival in American History*.” Quarterly Journal of Economics, vol. 123, no. 3, 2008, pp. 1287–1327., https://doi. org/10.1162/qjec.2008.123.3.1287.
• Identified policies and practices we can influence in our very own orga nizations including adopting policy statements in our professional and work organizations.
• Civic Engagement Groups • Center for Civic Design • Center for Tech and Civic Life • Institute for Responsive Government 6. Recordings of these presentations can be found on the National Academies of Science Engineering and Medicine website: • and-new-tools-for-action.event/08-31-2021/voting-and-health-evidence-https://www.nationalacademies.org/ • panding-opportunities-for-inclusion./09-15-2021/webinar-voting-and-health-exhttps://www.nationalacademies.org/event
7. tives-and-data.https://health.gov/healthypeople/objec 8. Healthyvoting.org.
3. Health & Democracy Index, Healthy Democracy Healthy People Initiative, Aug. 2021, https:// democracyindex.hdhp.us/. 4. Scot Schraufnagel, Michael J. Pomante II, and Quan Li. Cost of Voting in the American States: 2020. Election Law Journal: Rules, Pol itics, and Policy. Dec 2020. 503-509. http://doi. org/10.1089/elj.2020.0666.
• National Network of Public Health Institutes (NNPHI) • Network for Public Health Law (NPHL)
• Adopt policies and position statements in your professional, academic, and community organi zations to promote civic and voter participation.
• Association of Schools & Programs of Public Health (ASPPH)
• Incorporate voter education into your everyday practice using tools such as the Healthy Voting Guide.8
• Developed the Health & Democ racy Index (HDI)3 to expand the current public health understanding of the relationship between health and voting. The HDI presents a wide range of health indicators and correlates these indicators to voting policies. It is designed to provide a shared health equity analysis of voting policy and serve as a tool for practitioners to use to strengthen civic and voter participation.
• Expand the opportunities to register to vote by promoting Automatic Voter Registration through motor vehicle registration, hunting and fishing licensing, and healthcare services such as Medicaid. Go to hypeople.orgwww.healthydemocracyhealtforinformation.
Building upon these community orga nizing strategies the 11 HDHP Coali tion partners have:
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• Public Health Accreditation Board (PHAB)
• Engaged federal Health and Hu man Services (HHS) Administra tion officials to employ the policy and administrative levers they can influence such as: • Including voting as a Research Objective in Healthy People 20307 and continuing to work to formalize inclusion of voting as a Core Objective and Lead ing Health Indicator.
• Sponsored educational events for health care, public health, civic engagement, and philanthropy groups to share the research on health and voting and build public support for inclusive democratic practices.6
• Big Cities Health Coalition (BCHC)
• Engage with elected officials about issues that matter to you between election cycles.
What You Can Do as a Healthcare Provider
5. Healthy Democracy Healthy People coalition partners include:
data, and organize policy and resources.
• American College of Preventative Medicine (ACPM)
Jeanne F. Ayers, RN, MPH, leads Healthy Democracy Healthy People, a coalition of 11 public health organizations committed to advancing health and racial equity by strengthening civic and voter participation and ensuring access to the ballot for all eligible voters. Prior to establishing this coalition in August 2020, Ayers held lead ership roles in state governmental public health for over nine years. She served as the Wisconsin State Health Officer and Assistant Commissioner and Chief Health Equity Strategist for the Minnesota Department of Health. She can be reached at: Jeanne.ayers@hdhp.us.
• Society for Public Health Education (SOPHE)
• Trust for America’s Health (TFAH)
• Build political will for promotion of inclusive civic and voting policies by conducting and sharing research on health and voting.
• Serve as election workers and support organizational policies to encourage co-workers to serve as election workers.
• Developing guidance for federal HHS funding recipients on promoting civic and voter par ticipation such as: registering staff and members of the public to vote, participating in state ef forts to expand automatic voter registration, educating the pub lic about their voting options during the months leading up to elections and expanding and improving voter registration opportunities such as Automat ic Voter Registration (AVR) through government services and State Medicaid programs. Promoting registration through government supported services clearly offers opportunities to address persistent health and voter disparities.
• American Public Health Association (APHA)
• Association of State and Territorial Health Officials (ASTHO)
• National Association of County and City Health Officials (NACCHO)
By Sarah Traxler, MD, MSPH
Providing Essential Care While Rights Are On the Line
Yet, as an abortion provider and Chief Medical Officer at Planned Par enthood North Central States, I have watched as elected officials have politi cized reproductive health care, erecting barriers to safe and legal abortion care. These politicians lack any medical exper tise or understanding of the situations facing each patient who enters our exam rooms.In June, the U.S. Supreme Court overturned almost 50 years of federal abortion protections, leaving it up to states to determine the future of abortion access. Following the ruling, abortion ac cess in some of Minnesota’s neighboring states immediately went dark. Politicians in other states, like Iowa and Nebraska, have made it clear they intend to outlaw safe and legal abortion. But in Minnesota the court doubled down on its protection of abortion rights. The court ruled in July most medically unnecessary abortion restrictions un constitutional. This ruling allows more medical professionals to provide abor tion care, while eliminating medically unnecessary mandated wait times and state-required medical scripts riddled with misinformation. These decisions ensure Minnesotans and others in states where abortion is no longer legal and who choose to come to Minnesota have access to safe and legal abortion care. With each court ruling and political ly charged change to abortion access, our health center staff react, adapt, and con tinue to dig into the work of providing the critical reproductive health care that our patients need. As a five-state affiliate covering Minnesota, Iowa, Nebraska, South Dakota and North Dakota, we have been forced to quickly find ways to implement medically unnecessary waiting periods and ensure patients in South Dakota, where abortion is now illegal, receive the reproductive health care they need. The work is hard. And we are tired. But we remain driven by the shared commitment of healthcare providers across the state to provide es sential care to those who need it. We are painfully aware of the impact to our patients with each legal change. We have been flooded with calls and questions from confused patients who are unsure if they can legally access abortion care. They are navigating an ever-changing landscape when all they want is accurate, comprehensive repro ductive health care. We are seeing an influx of patients coming to Minnesota for care, because they live in a state where abortion is banned. They travel from as far as Texas and Louisiana, so they can have the right to choose what’s best for their unique situation and have control over their future. We even now have staff dedicated to helping patients navigate through the many obstacles they face to getting care. It shouldn’t be this hard to get an abortion.Weknow every ban and restriction has the greatest impact on those who cannot afford to travel to access safe and legal abortion. Individuals with low in comes, people of color and young peo ple are faced with forced pregnancies or other difficult decisions, because they cannot access the care they need.
State leadership matters. The values and policy priorities of our state legis lators and governor directly impact the daily experience of our health center staff and the ability of our patients to get the care they need. We need elected leaders who trust Minnesotans to make the best decisions about their own bodies and will fight to protect these personal decisions.
A ll healthcare decisions are deeply personal and belong between a patient and their healthcare provider. Patients come to us, each with their own unique circumstances, looking for medical guidance rooted in compas sionate science. There is an intimacy and trust in the relationships and conversa tions we have with patients.
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MEDICAL SPACE FOR LEASE 1,000 TO 35,000 SQUARE FEETMIKE(952)FLEETHAM767-2842 MFleetham@MedCraft.commedcraft.com/leasing JOLENE LUDVIGSEN (952) 838-7126 JLudvigsen@MedCraft.commedcraft.com/leasing Leased By: Owned By: G M C St. Paul, MN S M C Edina, MN BE PART OF A MEDICAL COMMUNITYWPlymouth,CMN2800/2828 M B Minneapolis, MN • 8,000 square feet available • On Children’s Minnesota Hospital campus • Turnkey suites available • Custom design/build your new space • 1,000 - 35,000 square feet of space to accommodate all users • 6,000 square foot suite to custom design your new space • Limited on-campus space available • Rare vacancy on campus • 1,750 to 4,500 square feet available • Turnkey suites available • Opportunity to expand your presence on campus MetroDoctors The Journal of the Twin Cities Medical Society Fall 2022 21
Last December, as the U.S. Supreme Court heard oral arguments about the fundamental rights of Americans, Min nesota medical organizations represent ing thousands of medical providers and over 100 individual providers signed onto an open letter in support of abor tion access. It was an inspiring call to arms that reminded me of the power of our community.Therearemany more ways we can speak out and show up: write an op-ed for the local newspaper on how this elec tion will impact your work, volunteer to speak at upcoming press conferences and legislative hearings, and speak out against hospital policies that hinder doctors from doing what’s in the best interest of their patients. And above all else, we need more healthcare systems and staff offering abortion. As we brace for more and more patients to come to Minnesota from other states, we need all hands-on deck. We need you. As medical providers, we’re uniquely positioned to demonstrate the impact legislation and elections have on health care. We must do everything in our pow er to secure our ability to provide pa tient care without political interference. I hope you take action today, for our patients and for our future patients.
Sarah Traxler, MD, MSPH is Chief Medical Officer of Planned Parenthood North Cen tral States, overseeing the provision of sex ual and reproductive health care for Iowa, Minnesota, Nebraska, North Dakota, and South Dakota. She is a board certified OB/GYN and completed her fellowship in complex family planning. She provides the full range of sexual and reproductive health care, including abortion. Dr. Trax ler is the immediate past president of Twin Cities Medical Society. She can be reached at: straxler@ppncs.org, or 651-696-5534.
*Tobacco use here refers specifically to the use of manufactured, commercial tobacco products, and not to the sacred, medicinal and traditional use of tobacco by American Indians and other groups.
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“ThroughCoalition. our collaboration with Blue Cross, our physicians and staff have made important public health improvements at the state, county, and local levels for the past decade,” said Becky Timm, TCMS CEO. “Our work together with Minnesota partners, law makers, and regulators have improved health outcomes for our state residents and we are proud to be a part of this dynamic team.”
Voting and Health
Jenny Song (she/her/hers), Senior Commu nications and Advocacy Consultant, Racial and Health Equity & Community Health, Blue Cross and Blue Shield of Minnesota.
TCMS members have testified at dozens of hearings at the city, county, and state level in support of legislation to limit access to commercial tobacco products, raise the sale age from 18 to 21, and secure dedicated funding for prevention and cessation programs for all Minnesotans.“TCMShas been instrumental in fostering strong relationships between community partners, legislators and its physician members and have demon strated the role that policy advocacy can play in the health and well-being of their patients’ everyday lives,” explained Chris Matter, senior program manager of community health and health equity at BlueBlueCross.Cross recently expanded its partnership with TCMS by also focusing on sugary beverages among children, food access, and racism as a public health crisis.“Getting involved with PAN has provided me a community of physi cians seeking positive change for better health through policy action,” said Dr. Caleb Schultz, MD, MPH. He is an anesthesiologist, practicing at Hennepin Healthcare and a longstanding member of TCMS.“Look for opportunities in your own backyard to raise your voice whether that’s in the schools or through city health boards/commissions. As a phy sician you can provide a ‘health in all policies’ approach for grassroots-driven change,” said Dr. Schultz.
Celebrate 10 Years of Partnership Through Health Advocacy Blue Cross and Blue Shield of Min nesota has a decades-long legacy and commitment to reducing commercial tobacco use* and exposure to second hand smoke through policy and advoca cy, community funding initiatives, and programs for our members. In 1994, Blue Cross and Blue Shield of Minnesota and the State of Minnesota filed the first lawsuit of its kind against the tobacco industry. The suit was successful and resulted in $241 million to be reinvest ed by Blue Cross to improve the health of all Minnesotans. Today, Blue Cross continues its role as a funder in address ing the root of preventable disease and death commercial tobacco use and unhealthy eating and as a leader in local and statewide policy and advocacy. For the last 10 years, Blue Cross and Twin Cities Medical Society have worked together to provide education and training opportunities for physi cians and medical students on public health initiatives and the role of policy advocacy on the local and state level. The partnership began as new tobacco products rapidly emerged in popularity among both youth and adult consum ers, such as e-cigarettes, hookah pipes, little flavored cigars, as well as a concern for the persistently high use of menthol products. Physicians felt a need to both properly advise their patients about the use of these products, as well as to help ensure that good public policy existed to limit the potential negative health outcomes from these products.
By Jenny Song
Blue Cross and Blue Shield of Minnesota and TCMS
Advocacy photo frame: Drs. Alex Feng, Caleb Schultz and David Bernstein.
TCMS and Blue Cross’s closely aligned missions have allowed for an exceptionally strong relationship not only with one another, but as members of several key statewide coalitions, such as Minnesotans for a Smoke-Free Generation and Minnesotans for Healthy Kids
The relationship between food access and healthy growth and development makes sense from a medical perspective.* TCMS member Dr. Andrea Singh, a Park Nicollet pediatrician who leads children’s health work at HealthPartners, explains it clearly.
on page 24) MetroDoctors The Journal of the Twin Cities Medical Society Fall 2022 23
The Body-Brain Connection
Free School Meals
On top of the effects of nutrition deprivation on the developing brain, the stress of food insecurity has long-term ramifications, a point Dr. Singh makes: “There’s an added layer of stress there, that causes a physiologic reaction in your body where your stress response is auto matically on alert...That causes increased adrenaline which then can lead to high blood pressure later in life, it can lead to heart disease, it can lead to a lot of grownup medical conditions that we don’t necessarily see [in food-insecure children], but we see the effects as they enter our world and our economy and the healthcare system as adults...”
School Meals for More Nutrition and Better Health School cafeterias haven’t always received top marks for the nutritional content of their meals, but updated standards in 2012 began to change that. The Food Research & Action Center (FRAC) reports that students with access to school meals consume more fruits, veggies, and milk and are less likely to have nutrient deficiencies. In a study conducted after the new standards, FRAC found that lunches brought from home by pre-kindergarten and kindergar ten students have more fat, saturated fat, and sugar than school lunches, and less protein, fiber, vitamin A, and calcium.* Low-income students stand to gain the most from free school meals by getting the fuel and energy needed for a productive school day, and by consuming more nutritious food than they would oth erwise. FRAC has found that low-income students who eat both school breakfast and lunch have a significantly better diet than low-income students who don’t eat school meals. And this has a positive impact on obesity rates: Students who participate in federally funded school meals have signifi cantly lower BMIs. Economists have esti mated that receiving free or reduced-price school lunch reduces obesity rates by at least Clearly,17%.* the benefits of free school meals extend well beyond the school day. Just as children who live with food insecurity often experience cascading negative
Nourish Kids and Communities
By Leah Gardner, MPP (Continued
“First and foremost, when we’re talking about younger kids, there’s so much brain development that goes on. [It] requires extra fat, protein, and nutrition and un fortunately, when kids don’t have that, their bodies respond.” When kids consistently get the nour ishment they need, grades and math scores go up while absenteeism and tardiness go down, and fewer students have to repeat grades. Common behavioral issues are less prevalent; students have more positive social interactions and more mental and emotional resilience.*
The past two-plus years have stressed pub lic health resources, emptied grocery store shelves, and strained family budgets. But our team at Hunger Solutions saw that the challenges also presented some opportu nities. At the start of the pandemic, the federal government issued waivers that allowed every public school in the country to provide school meals to all students at no cost, something we had been working toward for Unsurprisingly,years. free school meals make a difference, and we have firsthand evidence of the benefits to students, fam ilies, schools, and communities. Unfortu nately, the federal aid ended in June, and despite support from the governor’s office and the Minnesota House of Representa tives, funding for school meals was not approved during the 2022 spring legisla tive session.Asinflation and the cost of living continue to rise, many families will send their students back to the classroom this fall knowing that their household budgets can’t afford school lunch. For some students, this means trying to focus and learn while experiencing the effects of skipping meals. As one parent described it, “You can’t think if your stomach’s growling. You can’t concentrate. Eight hours is a long time to be in school, and to be there hungry? What’s the point if all I’m doing is thinking about the pain in my stomach?”
health and life outcomes as adults, students who get a consistent source of nutritious food are building the foundation for a lifetime of better health.
Free School Meals (Continued from page 23) Voting and Health LSS Decision-MakingSupported Services Planning ahead can make life easier to navigate later. LSS can act as • Health Care Agent, and provide support for completing a Health Care Directive • Personal Representative of the Estate • Power of Attorney When patients need support with advanced care and estate planning, LSS can help. 888.806.6844 lssmn.org/careplanning 24 Fall 2022 MetroDoctors The Journal of the Twin Cities Medical Society
Minnesota Needs Free School Meals
hungry kids comes from a household that doesn’t qualify for free or reduced-price school meals. Participation in these pro grams can be difficult to navigate for busy parents, and the financial threshold of any means-tested program will always leave behind those families who live just on the other side of meeting the requirements. During the past two years of federal waivers, participation in school meals in creased statewide. Parents came to rely on the ease, convenience, and peace of mind in knowing their child would get healthy meals at school. School nutrition staff were able to spend their energy and time prepar ing and serving the best, most nutritious meals possible to their students rather than focusing on complicated paperwork or chasing down meal debt. Now, with the waivers ended, we’re bracing for a return of hungry kids in the classroom and schools focused on administrative burdens rather than improving the nutrition of its meals.
Leah Gardner, MPP, (she/her/hers) is Policy Director for Hunger Solutions Minnesota and Campaign Manager for the Hunger Free Schools campaign. Prior to that she was Campaign Manager for the Good Food Access Campaign at the American Heart Associa tion. Leah’s career has been grounded in a commitment to racial and economic justice. She previously led grassroots efforts in policy campaigns to advance economic equity for the Minnesota Budget Project at the Min nesota Council of Nonprofits. She began her career managing employment training and fundraising at Project for Pride in Living.
In Minnesota, one in six children is food-insecure and one in four of these
Join the Hunger-Free Schools Campaign Minnesota has a huge opportunity to give our students the daily support they need, plus lay the foundation for a stronger to morrow. We thank the Twin Cities Med ical Society for being part of the Hunger Free Schools coalition, and we encourage interested members to join in. Visit hun gerfreeschoolsmn.org to learn how you can help our students, and Minnesota’s future, thrive.
One parent sums it up: “[Taking away free school meals] would put parents in the position of deciding whether to spend their money on feeding their children or paying their bills. It’s gonna put a lot of struggle on parents, [especially] those on fixed income and working parents….”
Leah is a Voices for Racial Justice Apprentice and a graduate of the Humphrey Institute with a Master of Public Policy. She can be reached at: Phone: 651-789-9850; Email: lgardner@hungersolutions.org. gram/benefits-school-lunch.*https://frac.org/programs/national-school-lunch-proReference:AccessedJuly5,2022.
Having a health care agent in place to make decisions can ensure patients’ decisions will guide their care team.
1.ReferencesAmerican Medical Association. “AMA Principles of Medical Ethics, I, IV. Code of Medical Ethics Opinion 5.2.” Accessed July 18, 2022. vance-directives.https://www.ama-assn.org/delivering-care/ethics/ad
2. Auriemma, Catherine L., MD; Halpern, Scott D., MD, PhD; Asch, Jeremy M., BA. 2020. “Completion of Advanced Directives and Documented Care Preferences During the Coronavirus Disease 2019 (COVID-19) Pandemic.” JAMA Network Open. https://doi. org/10.1001/jamanetworkopen.2020.15762.
Contributed by Roxanne Jenkins Paid Editorial Advanced planning could have made communication regarding treatment choices less arduous for many people who found themselves critically ill and isolated from their loved ones during the pandemic. The physician’s ethical code adheres to person-centered care, respecting an individual’s autonomy and commitment to their wishes for treatment.1 Health crises can occur at any time. When patients have outlined their wishes and have legal representatives in place, medical staff know the care they administer aligns with their patient’s choices. Without a health care directive and proxy when a patient becomes unable to communicate, doctors may administer treatment which does not align with patient wishes or may cause unintended health or financial outcomes.TheJournal of American Medical Association reported in 2020 that only one-third of adults in the U.S. have an advanced care plan in place.2 And, a 2021 AARP survey revealed that only 1% of older adults surveyed said the pan demic motivated them to complete a health care directive.3
Lutheran Social Service of Minnesota’s Supported Decision-Making Services can be a resource for your pa tients, including Health Care Agent, Personal Represen tative of the Estate and Power of Attorney. LSS can act in capacity of health care proxy, personal representative and/or attorney-in-fact for individuals. LSS is the largest provider of both supported and substitute decision-mak ing services in Minnesota, with a long-standing reputa tion for trustworthy, ethical, person-centered financial, personal and medical decision-making. We have a statewide presence able to meet your patients’ needs in their own communities. If your patients need advanced planning services, consider Lutheran Social Service of Minnesota’s Sup ported Decision-Making Services. LSS can be a great re source to ease the path to more patients having advanced care plans in place before they need them. Learn more at lssmn.org/careplanning.
4. Jones, Jeffrey M. 2021. “How Many Americans Have a Will?” Gallop, June 23, 2021. many-americans-have-will.aspx.https://news.gallup.com/poll/351500/how-
5. Walls, Barbranda Lumpkins. 2017. “Haven’t Done a Will yet?” AARP, February 24, 2017. millennials.little%20over%20half%20of,with%2041%20percent%20of%20info-2017/half-of-adults-do-not-have-wills.html#:~:text=A%20https://www.aarp.org/money/investing/
Number of adults in the U.S. with:
Supported Decision-Making and Advanced Planning: When Your Patients Need Support
• Power of attorney: 50%5 Advanced planning is an important conversation to have with the people in your care. It will help protect their rights to treatment choices should they become incapacitat ed and will guide your treatment plan.
An opportune time to ask if a patient has an advanced care plan is when discussing medical care options for major health events or end-of-life decisions. Medical professionals have an intimate, yet professional, relationship with their patients, putting medical staff doing direct care in a unique position to discuss advanced planning.
Roxanne Jenkins, Associate Vice President of Services for Older Adults, oversees service development and delivery, including Supported Deci sion-Making focusing on empowering persons to be active participants in the design of their support network.
3. Horovitz, Bruce. 2021. “Pandemic Isn’t Spurring Older Adults to Discuss, Record Advance Health Care Wishes.” AARP, April 6, 2021. poll-many-have-no-advance-directives.html.https://www.aarp.org/caregiving/financial-legal/info-2021/
• Will or estate planning: 46%4
MetroDoctors The Journal of the Twin Cities Medical Society Fall 2022 25
• Health care directive/health care agent: 33%2
Having a power of attorney can help ensure financial matters are handled in a timely manner. For end-of-life planning, naming a personal representative of the estate can assure patients their wishes will be handled according to their will.
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PHONE: 952-442-4461 ext. 7215
MetroDoctors The Journal of the Twin Cities Medical Society Fall 2022 27
Interna tional Panel on Climate Change report, confirms that humans cause change. “This report must sound a death knell for coal and fossil fuels, before they destroy our planet,” António Guterres, the UN sec retary general, warned: “[This report] is a code red for humanity. The alarm bells are deafening, and the evidence is irrefutable.”3NaomiOreskes in her book, Mer chants of Doubt,4 outlines how the fossil fuel industry, in much the same manner as the tobacco industry, has persistently fueled doubt about the role fossil fuels played in climate change. Exxon’s own scientists confirmed the harm from fossil fuels in the 1970s. However, once climate scientists rang the alarm bell, the industry quickly pivoted to creating doubt. Efforts to address this rapidly growing disaster has been met with a firewall of resistance from the fossil fuel industry and complicit politicians who have their own playbook of well-worn phrases acquired from the fossil fuel industry. Until voters elect leaders at all levels who are committed to passing comprehensive climate legislation, we will watch horrible disasters unfold. Your vote is one of the best ways to mitigate climate change. Make sure you educate yourself about the candidates from school boards to federal offices. The easiest way to find out if you are registered to vote and how to vote can be found at state.mn.us/elections-voting/.https://www.sos.
The health of our patients and our planet has been affected by the influence of the fossil fuel industry. The elected officials who support and subsidize the fossil fuel industry allow uninhibited pollution of our atmosphere from emissions. The Bush, Clinton and Obama administrations came close to regulating the fossil fuel industry but each time our leaders caved at the unsubstantiated threat of economic and job losses.1 Climate scientists have sent out alarms about the consequences of un abated climate change for over 40 years. Health professionals have observed the health consequences of societies’ inaction on global warming. India and Pakistan recently had temperatures approaching the limits of human tolerance. Minnesotans don’t even need to travel to experience the health effects from climate change. Vector borne illnesses are more common, allergy sufferers experience more days of symptoms, and people with pre-existing cardiac disease are at higher risk of death due to air pollution from wildfire smoke and transportation “Unequivocal,”emissions.2The2021
CAREER OPPORTUNITIES
4. Merchants of Doubt, Bloomsbury Press, 2010.
WEB: www.lakeviewclinic.com
CONTACT: administration@lakeviewclinic.com
Mike Menzel, MD, member of TCMS and MMA is co-founder of Health Professionals for a Healthy Climate.
1.References:ThePower of Big Oil, April 9, 2022, PBS Front line. 2. Climate and Health, MDH.
Vote As Though Your Life Depends On It
3. The IPCC Climate Change 2022 Impacts Report: Why it matters, February 24, 2022.
Lakeview Clinic has what you are looking for! Join an independent, physicianowned group of 50 providers in the SW Metro. Be a part of a collaborative work environment in a primary care group of family physicians, internists, pediatricians, general surgeons and OB/GYNs. 4-day work week with 32 contact hours achieving excellent work/life balance Excellent compensation with a 2-year partnership track to earn in the top 10% in the state Outstanding benefits including 100% paid family health insurance and dental insurance, 401K and profit sharing We have 4 sites in the southwest metro: Chaska, Waconia, Norwood, and Watertown to retirements and growth, we are currently looking for:
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By Mike Menzel, MD
Environmental Health
◦ Internal Medicine ◦ Family Medicine ◦ Pediatrics
“Why?” you may ask. When I saw my City Council fail to provide protections for our community during the pandemic, not support a levy for our schools, have a harsh tone towards affordable housing projects, attempt to cap the number of rentals in our community, thwart opportunities to increase diversity and inclusion in our leadership, and not be transparent and responsive to constituents, I knew we needed a change. Looking at the field of candidates and seeing an opportunity to be part of change in Columbia Heights, I jumped in. To me, it is that important that we tackle these social issues that our patients face. It is great to be able to manage or solve a medical problem in the hospi tal or clinic, but if we are sending them home to situations where they do not have adequate support and opportunities to be successful, we are putting temporary pressure on a wound that will continue to bleed.
From the Bedside to the Ballot Box FUTURE
As physicians, we must embrace the unique training in medicine, science, and public health and how we can use that to make legislative change in our communities. We know the importance of advocating for policy change as we know how social determinants have long-lasting effects. We, as a profession, must also continue to show up in our communities, at the voting booth, and even on the ballot our patients depend on it.
28 Fall 2022 MetroDoctors The Journal of the Twin Cities Medical Society
During my medical school journey, I have had an increasing interest in public policy. Partially this comes from a place of curiosity and genuine interest in how our govern ment and laws work, but also part of necessity. Throughout my clinical experiences, I have helped care for many patients who come in with health concerns but also have a multitude of societal factors that are also negatively impacting their health. We may be able to start a treatment plan for them, but in the larger context of their situation, it is only scraping the surface of what they need. Many of our patients do not know that several hardships in their lives are due to inten tionally created exclusionary policies that make the lives of members of our communities harder. It is easy for providers and patients to see national policies and decisions such as the recent overturning of Roe v. Wade or the passage of the Affordable Care Act in 2010 as how our government has directly played a role in our health. But what many do not realize is that other issues such as school funding, transpor tation, affordable housing, and public safety are not just problems for Congress to solve, but for local officials at all levels.Physicians need to actively engage in the political process as we have the unique perspective and training to know how policies impact the health of our communities.
I often refer back to the quote of the late German physician and anthropologist Rudolph Virchow, “Medicine is a social science, and politics is nothing else but medicine on a larger scale…the physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.” We need to use tools such as Vot-ER to both educate our patients on how to vote and why their vote impacts the health of their community, but we should not stop Asthere.our society stands today, medicine and politics are deeply intertwined, and we must embrace this relationship. We need physicians to be loud, bold, and brave for the good of our patients. From officials,emailingtestifying at hearings, and hold ing rallies, this is our lane. But sometimes this is not enough. In the words of President Barack Obama, “If disappointedyou’rebyyour elected officials, grab a clipboard, get some signatures, and run for office yourself. Show up. Dive in. Persevere.” Yes, you should consider running I am. As a fourth-year medical student, I am taking a leap of faith to unconventionally run for my local city council.
By Justice Spriggs, MS4
Physician Leaders
Mental health. Physical health. Social determinants of health. All things we learn about in medical school and residency. But what about Civic Health?
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• Expanded training – More doctors are gaining expertise in SSRF, including several fellows trained at Regions Hospital. 21-1035709-1236111 (10/21) © 2021 HealthPartners For more information, visit healthpartners.com/orthotrauma or call 651-254-8300. 640 Jackson St. St. Paul, MN 55101
Bridging the gap in chest wall injury repair
Thanks to innovations in the treatment of flail chest and fractured sternums, we’re able to improve outcomes for patients, helping them recover faster and with less pain.
We take a departmental approach to treating chest wall trauma. By having an advanced team of six surgeons who treat chest wall injury, we’re available to provide optimal treatment every day of the year. This approach is working and we’re seeing promising trends:
• More success stories – 10 years ago, our team did 5-10 operations per year. Now we treat a new patient almost every week.
• New tools – Thanks to instrumentation and implants specifically designed for different anatomical locations, chest wall repair is now an option for more patients.
Innovation in chest wall injury repair
