INSIDE THIS ISSUE
THEME: PREVENTATIVE CARE
In this newsletter, you will find materials regarding training opportunities, department updates and additional tools related to community engagement. This newsletter aims to disperse valuable information on ways to ensure that every person has the opportunity to “attain his or her full health potential.”
- Term of the Quarter Prevention
- Quarterly Article "Preventive Health Care-IncreasingAccess to Screening"
- Community Engagement Champion Spotlight
- Community Engagement Unit Collaborations
- Special Populations Minority Health
- Training Opportunities and Resources
- Picture of the Quarter
- Quote of the Quarter
- Contributions to this Issue
TERM OF THE QUARTER
PREVENTION
the action of stopping something from happening or arising. It may refer to: preventive health care, which are measures to prevent diseases or injuries rather than curing them. In other words, it refers to taking steps to ensure that people are kept healthy and to prevent or avoid risk of poor health, illness, injury and early death. The result will be the increase in the chances of people staying healthy for as long as possible.
QUARTERLY ARTICLE
PREVENTATIVE HEALTH CARE– ELIMINATING DISPARITIES IN PREVENTATIVE HEALTH SCREENINGS
Written by: Agnes Mason and Adebanjo Adeyeye, Community Engagement Unit Graduate Assistant
Routine health screenings for high blood pressure, cholesterol, sexually transmitted diseases, some types of cancer, and diabetes may help detect health problems early enough to successfully treat some of these diseases. According to the Centers for Disease Control and Prevention (CDC), diabetes affects approximately 11.3% of the US population, or around 37.3 million individuals, with 1.4 million more Americans diagnosed with diabetes yearly. Approximately 54,372 people in North Dakota, or 9.1% of the adult population, have diagnosed diabetes. The American Diabetes Association cites early detection and treatment of diabetes through preventive screening can improve health outcomes. Cancer is the second leading cause of death in the US; every year, 1.7 million people are diagnosed, and 600,000 die. Routine screenings for cancers, including breast, cervical and colorectal cancers, may help with early-stage detection, making it easier to treat or cure.
Preventive screening is an essential component of health care to prevent and detect chronic diseases, however, it may only be readily available to some. Unequal access to health screenings is a significant cause of health disparities. These screening disparities directly contribute to poorer health outcomes and lower survival rates. In the US, racial/ethnic minorities have some of the highest rates of chronic diseases. Due to equitable health screenings being essential to reduce health disparities and advance health equity in our communities, North Dakota Health and Human Services (ND HHS) focuses on preventive screening for underserved communities and populations.
To improve early detection and interventions for diabetes and prediabetes for underserved populations, the North Dakota Diabetes Prevention and Control Program (NDDPCP) has collaborated with health systems, Federally Qualified Health Centers (FQHC), and community pharmacies to increase prediabetes and diabetes screening. The NDDPCP has assisted Family Healthcare, an FQHC, in developing and implementing policies to ensure equitable availability for screening, testing, and referrals for prediabetes, diabetes and other chronic diseases. In addition, they have increased point-of-care blood sugar testing in community pharmacies.
A first step in boosting prediabetes diagnosis and intervention rates involves expanding the use of the prediabetes risk test. The Health and Lifestyle Training (HALT) platform launched by the NDDPCP offers online delivery of the National Diabetes Prevention Program, removing travel, child care, and scheduling barriers that prevent access to the prediabetes risk test. The NDDPCP has partnered with the FQHCs and community pharmacies to increase access. This HALT platform has successfully reached American Indian participants, supported North Dakota’s first Spanish-speaking National Diabetes Prevention Program cohort in Western North Dakota, and recruited campus staff to co-facilitate lifestyle change classes for tribal colleges.
Another statewide initiative, Women’s Way, a North Dakota Breast and Cervical Early Detection Program, takes a proactive approach to breast and cervical cancer screening disparities by offering free screening to eligible women who may lack access to preventive care services. Women’s Way promotes breast and cervical cancer screening throughout North Dakota through its ten local coordinating units. The program organizes events to educate women about the importance of screening, to help enroll new patients, and complete the screenings. As many as 1 in 17 women may be eligible for free breast and cervical screenings through Women’s Way, about 21,000 North Dakota women. These women can receive screening through approximately 850 participating providers across 287 medical facilities, including those in urban, rural, and Tribal communities. Since 2001, uninsured Women’s Way clients who are diagnosed with breast or cervical cancer have access to treatment coverage through Medicaid, with eligibility determined on a case-by-case basis.
Women’s Way recognizes that reaching diverse North Dakota populations requires cultural awareness and sensitivity. This includes translating educational materials into other languages and partnering with community organizations to reach diverse, underserved women. For example, last year, Women’s Way and the Maternal and Child Health (MCH) Title V Block Grant Well Woman team joined a local-based community organization to host breast and cervical cancer screening promotion events for Hispanic women in the Dickinson area. Through partnering state-wide with community-based organizations and translators, Women’s Way screened over 100 Hispanic women during the first six months of the current program year, doubling the number of Hispanic women screened in the previous 12 months.
Women’s Way addresses cancer screening barriers such as time restraints, lack of transportation, and living in medically underserved areas. One way Women’s Way addresses these barriers is to provide funding to increase access to breast and cervical cancer screenings to a limited number of organizations that serve individuals who experience health inequities. Projects have included after-hour clinic access, transportation support, and access to mobile mammography services.
ND HHS was instrumental in creating two coalitions, the North Dakota Colorectal Cancer Roundtable (NDCCRT) and the North Dakota Cancer Coalition. These coalitions work to reduce the incidence and mortality of colorectal cancer in the state and to meet the nationwide challenge to increase colorectal screening to 80% among individuals ages 50–75 years old. Thanks to the NDCCRT, colorectal cancer screening for North Dakotans ages 50-75 years have increased from 57% in 2012 to 67% in 2021. In order to address longstanding disparities in colorectal cancer screening, the North Dakota Cancer Coalition works with over 30 medical providers to finance colorectal cancer screening for eligible low-income and underinsured individuals, especially from rural and Tribal communities.
Regular screenings and preventive care save lives. Click here to learn more about prevention programs and resources available to North Dakotans.
Interested in this topic? Check out these resources:
National Diabetes Prevention Program Diabetes Self-Management Education and Support Cervical Cancer Prevention Breast Cancer Prevention Colorectal Cancer Prevention
COMMUNITY ENGAGEMENT CHAMPION SPOTLIGHT
Each quarter, we recognize North Dakota individuals working as champions to ensure that every person has the opportunity to “attain his or her full health potential.” This is your chance to be featured for your work or to nominate someone you know!
SHANNON KLATT
Written by: Payton Drent, Community Engagement Unit Undergraduate Research Assistant
Shannon Klatt, MPH, is a champion for health equity for the underserved and vulnerable populations in North Dakota. Klatt received her undergraduate degree in public health education and a minor in graphic design at the University of North Dakota in 2016. She then pursued her Master of Public Health (MPH) with a specialization in Community Health Science at North Dakota State University.
Shannon used her education to her advantage in her projects and roles in public health. She has worked in youth alcohol prevention, physical activity promotion and health equity efforts for breastfeeding and postpartum mothers.
According to Shannon, "it is difficult to find funding streams for achieving health equity at the local level." The evidence she gathered through a community health assessment was instrumental in obtaining a grant to address underage drinking and creating marketing campaigns surrounding underage drinking laws in the state. The campaign was successful and gained attention statewide.
As an advocate for the breastfeeding community and their rights, Shannon worked with her colleagues to improve the accessibility of feeding rooms in businesses and workplace settings in Jamestown, North Dakota.
Additionally, her passion for maternal and community health drives her work to ensure equitable access to resources in the workplace and within state legislation for postpartum and breastfeeding mothers.
Shannon exemplifies a Community Engagement Champion; she displays her commitment to advancing health equity for all of North Dakota through her work in public health.
Thank you, Shannon, for your dedication to improving the health of communities in North Dakota!
JACQUELINE HASSETT
Written by: Asiedu Valentina Asiedu, Graduate Assistant/Intern
Jacqueline Hassett, born in Grand Forks, North Dakota, is a licensed social worker and the Health Equity Coordinator for the Grand Forks Public Health Department. Jacqueline views building a connection with communities as a necessary step to advance the principles of health equity. She seeks opportunities to improve livelihood in Grand Forks by being a connector for community members through providing support and education. Jacqueline spends about a quarter of her time on relationship-building and outreach efforts. She dedicates the remainder of her time managing grants, staff education, tracking data trends in health disparities, and on policy work.
Jacqueline credits her background in social work and the relationships she has made within the community for the strides she made in her current position with Grand Forks Public Health Department. She said:
"I was a good person to step into that role, not only because of my social work background but my general experience and my community connections. I think my job would be very challenging if I didn't have some connections already existing!"
Jacqueline understands the importance of continuing education as a public health professional. She spends time on personal development by expanding her knowledge base in public health, such as learning about public health standards, training on evidence-based practices, coalition building, and developing a health equity strategic plan.
When asked about one thing she could change in the state, Jacqueline said:
"I would like to see better representation at all levels of the work being done as I believe that is a missing piece of building trust."
Jacqueline explained that this is necessary because when community members have people who look like them doing the work and who share and understand all parts of their lives/culture, they are more likely to believe that their interests matter to those making the decisions.
Jacqueline directs her efforts at improving the health and well-being of all North Dakotans. She states:
"It's a matter of being fair and that all people are going to receive services have the information they need to make choices and having someone who can focus on health disparities and social determinants to allow for change to happen."
The driving force for most of Jacqueline's work is a compliment from the President of the School Board she served on. The President said to Jacqueline, "you know your kindness is the heart of the Board; always talking for people who aren't at the table and pushing those alternative views."
Through Jacqueline's work, she has built her network with like-minded professionals whose goal is improving Grand Forks and its people's health. Jacqueline has realized that it takes a lot of resources for change to occur. She said:
"There are hidden pieces of this work, resistance to change, that people don't always realize, so I spend a good amount of my time facilitating that trusting relationship and sometimes that means transforming the work culture."
As community engagement is at the heart of Jacqueline's work, she has built relationships with community-based organizations serving minority populations. Some include food shelters, Global Friends Coalition, New Hope for Immigrants, New American Integration Center, Greater Grand Forks American Indian Parent committee and local lesbian, gay, bisexual and transgender (LGBT) advocacy groups. Additionally, she does some work with religious organizations such as Islamic centers.
In her free time, Jacqueline loves to skate. She spent some time in Roller Derby League when it started in Grand Forks. Additionally, she is an excellent photographer and spends most of her free time taking wedding pictures for couples who cannot afford a professional photographer at their wedding. She believes each interaction could be a change for somebody and that could lead to the best thing for that person
Jacqueline's endless commitment to public health makes her an excellent example of a community engagement champion. In her own words:
"When I do this work, I keep asking myself, whom am I missing?"
COMMUNITY ENGAGEMENT UNIT COLLABORATIONS
American Indian (AI) Public Health Workers. The Community Engagement (CE) Unit is meeting with various American Indian (AI) Public Health workers to increase the number of AI Public Health workers joining the North Dakota Public Health Association (NDPHA) and attending the Dakota Conference of Rural and Public Health 2023 and beyond. The goal of the project is to expand the AI membership to a level that fully represents the population of North Dakota. For more information, please contact the Community Engagement Unit (hhs-engagement@nd.gov).
ND HHS Injury Prevention Director and Communications Coordinator. The CE Unit is partnering with the ND HHS Injury Prevention Director and Communications Coordinator to create injury prevention topic sheets for each Tribal Nation in North Dakota. These topic sheets will be available in paper format and a digital version. Tribal partners have been engaged in this process to determine injury prevention needs in their community. The goal is to understand better what topics are more pertinent to the Tribal communities. Topics may include safe sleep for babies, child passenger safety, harm reduction, and commercial versus traditional tobacco. For more information, please contact the Community Engagement Unit (hhs-engagement@nd.gov).
New American Consortium. The CE Unit is partnering with the New American Consortium on a Doula Pilot Project. This project aims to help improve maternal and infant health outcomes. The project’s mission is to ensure that the physical well-being of the pregnant person, including emotional, physical, psychological, spiritual and cultural beliefs, needs and values, are honored by providing adequate nonjudgmental, compassionate support during pregnancy, childbirth and early parenthood. For more information, please contact the Community Engagement Unit (hhs-engagement@nd.gov).
- Blue Cross Blue Shield North Dakota (BCBSND) Caring Foundation x North Dakota State University's Center for Social Research. To better understand how the social determinants of health (SDOH) impact North Dakotans' lives, the Blue Cross Blue Shield North Dakota (BCBSND) Caring Foundation partnered with the North Dakota State University's Center for Social Research to conduct a research project on SDoH. Team members of the CE Unit facilitated round table discussions in partnership with BCBSND to discuss the research study's findings and provide a premise for collaboration on how to develop community-driven solutions to improve the well-being of North Dakotans. For more information, please contact the Vice President of Public Affairs at Blue Cross Blue Shield of North Dakota, Pam Gulleson. Click here to access a full report about the study and the roundtable slides.
SPECIAL POPULATION HIGHLIGHT
PREVENTATIVE HEALTH SCREENINGS - MINORITY HEALTH
Written by: Jorden Laducer-Dix, CE Unit Special Populations Coordinator
Welcome to Special Population Highlight! Each issue, this new section will provide specialized health equity and cultural awareness information about one special population. In this issue, we will look at Preventative Health Services for Minority populations.
Did you know that the Patient Protection and Affordable Care Act (ACA) requires most health plans, including private health insurance, to cover a set of preventive health services, such as immunizations and screening tests, at no cost to the patient? Preventive health screening is critical to a person's overall health. Preventive care services, such as regular checkups and screenings for cancer and chronic health conditions, allow patients and providers to detect diseases earlier.
However, the gaps in awareness of preventive care and insurance coverage requirements, lack of provider access , and cost of insurance and services are barriers to accessing preventive health services.
According to a survey conducted by Ipsos in 2023 and commissioned by the Alliance for Women's Health and Prevention (AWHP), 45% of 3,204 American women reported skipping preventive care services such as checkups, tests, treatments and vaccines due to the inability to afford out-of-pocket costs and limited time to schedule appointments
Survey findings show that three out of four women (76%) indicated they had received a cervical cancer screening at some point in their lifetime. However, "white women are more likely to have received a cervical cancer screening (81%) than Black women (65%), Asian women (66%) and Hispanic women (68%)." Further, insured women (79%) are more likely to have received a screening than uninsured women (51%). Moreover, patients with Medicaid coverage were less likely to have received a screening than those with other insurance
A 2022 Kaiser Family Foundation Women's Health Survey showed that 44% of uninsured women ages 50-64 said they had not had a mammogram in the past two years due to cost.
While there is a need for preventive health screenings across the board, minority populations receive less preventive care than their white peers. Cancer screenings are lower among Black, Hispanic, Asian and American Indian/Alaska Native patients than White patients. Compared with other racial groups or ethnic groups in the United States, Asian American screening rates are lower for cervical and breast cancer. Research suggests that “people of color receive later-stage diagnoses for some types of cancer.”
Preventive care services are critical for identifying risk factors for disease and promoting early detection of illness and infection. Health experts have continually advocated for increased access and education about the types of preventive care people need. These efforts are critical for communities at high risk of chronic disease and premature death. The United States Department of Health and Human Services (HHS), the Office of Disease Prevention and Health Promotion (ODPHP), and other organizations, such as the Centers for Disease Control and Prevention (CDC), recognize the value of preventive care in lowering health care costs, increasing life expectancy, and improving quality of life for millions of Americans.
TRAINING OPPORTUNITIES AND RESOURCES
Healthcare.gov CDC Prevention Prevention Programs for Youth and Families
PICTURE OF THE QUARTER
QUOTE OF THE QUARTER
"PREVENTION IS BETTER THAN CURE"
- Desiderius Erasmus
CONTRIBUTIONS TO THIS ISSUE
- Ruth Nwatu
- Valentina Asiedu
- Juliana Antwi
- Jorden Laducer-Dix
- Payton Drent
- Agnieszka Mason
- Adebanjo Adeyeye
- Rob Sanderson
- Krissie Guerard
- Dr. Alicia Belay
- Sara Upgren
- Kim N. Mertz
YOUR HEALTH MATTERS IS A NEWSLETTER PRODUCED BY NORTH DAKOTA HEALTH AND HUMAN SERVICES COMMUNITY ENGAGEMENT UNIT.
We welcome your feedback. Email us here (hhs-engagement@nd.gov).
The NDHHS CE Unit works to understand and reduce health disparities among all North Dakotans. The primary goal is to work alongside North Dakota communities in addressing health-related needs to reduce disease rates by providing opportunities for interventions and improving access to health care. This will ensure that all North Dakotans have the ability to reach their optimal health.