Public Health = Public Safety

Published on August 12, 2020

“If there ain’t no justice, then there ain’t no peace”
– Prince

Prince was not alive to write a song about George Floyd’s murder in Minneapolis on May 25, 2020. But Baltimore, one of the last singles Prince produced, was about Freddy Gray, a 25-year old Black man who died in police custody in 2015. Referring to the outrage-fueled protests that followed, Prince sang, “If there ain’t no justice, then there ain’t no peace.”

Since the events in Minneapolis this summer, the community call for justice has been loud, clear, and persistent. At Carrot Health, we are passionate about using data to identify and address the root causes of adverse health outcomes, such as chronic illness and high healthcare spending. As we looked at our Social Determinants of Health (SDoH) data for Minneapolis – our hometown – we discovered something striking: the same behavioral, economic, social, and environmental risk factors that contribute to disparities in health outcomes also directly impact public safety, economic opportunity, and social justice.

Using our Carrot Social Risk Grouper (SRG) taxonomy, which gives individuals a numerical score of their SDoH risks, we analyzed Black and white populations in different neighborhoods in the Minneapolis-St. Paul metropolitan area. We focused on the following three SRG component risk factors, which have the greatest impact on health and safety:

  • Housing Instability: Lack of permanent housing or presence of housing quality risks (such as lead paint, mold, radon, inadequate cooling or heating)
  • Food Insecurity: Inability to pay for, or access, healthy food
  • Financial Insecurity: Volatility in family finances due to bankruptcy, short-term loans, high debt-to-asset ratio; or low income, assets, home value or purchasing power

Overall, for both housing instability and financial insecurity, we found that Minnesota residents have 20-30% less risk than the rest of the nation. In Hennepin County, where almost one-quarter of the population is wealthier than Minnesota as a whole, that risk is even lower.

Something interesting happens when we look more closely at Minneapolis, broken down by neighborhood and race. As the table below shows, in the “least risky” ZIP code of 55410, there are 35 white residents for each Black resident. In the “most risky” ZIP code of 55411, that ratio becomes 1 white resident to 5 Black resident — a 175-fold difference. The higher the concentration of Black residents in a community, the higher the likelihood that the population will be subject to financial instability and experience a lack of adequate housing and food.

Carrot SRG Scores by ZIP Code, White vs. Black

Source: Carrot Health

In every ZIP code, we found wide SRG risk disparities between Black and white residents. Predominantly white communities in Minneapolis have 30-60% lower SRG risk than the national average, while predominantly Black communities have 50-150% higher risk. This means that a Black person in North Minneapolis, for example, is 2.5 times more likely to have unstable housing, two times more likely to grow up in poverty, and 1.6 times more likely to have limited access to food.

Left unaddressed, these social risks drive up the need for expensive police enforcement. Homelessness, hunger, and financial despair are criminalized outright, or contribute to disturbances or crimes that police get called in to resolve. This means that law enforcement is being asked to ameliorate needs exacerbated by the lack of spending on public health.

In their recent budgets, both Minneapolis and Hennepin County have devoted more resources to public safety than to public health. The county and city spent $761 per capita on public safety (including expenditures on police, sheriff, courts, attorneys, and prisons) versus $117 per capita on public health (including spending on community services that address issues like mental health and homelessness).

Shifting some of those dollars upstream – toward investments in social services that address poverty, mental health, homelessness, substance abuse, domestic violence, education and hunger – could generate an enormous return on investment. For example, investments in early childhood education have some of highest rates of return among public programs, resulting in future prison avoidance, better health outcomes, and substantially higher employment and income rates. The cost of preschool ranges from $4,460 to $13,158 annually, compared to $36,000 per year for prison. Investing in preschool — adding the savings from reduced incarcerations over time — results in an annualized 13% rate of return.

In the neighborhood where George Floyd lived and died, the stark truth is that Black people are more likely to experience disproportionate barriers to health, and more likely to experience disproportionate police enforcement measures. The same underlying causes of our public health problem also contribute to our public safety, economic opportunity, and social justice problem. If we can solve one problem by addressing its upstream factors, we’ll be well on the way to solving the other – and well on our way to achieving justice and peace.

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