Minneapolis Health Department officials say homelessness and substance abuse remain focuses for the city this year as they face uncertainty from President Donald Trump’s revamping of federal agencies.
The department was re-accredited by the Public Health Accreditation Board this month, which means it meets national standards for public health work. Minneapolis Public Health Commissioner Damón Chaplin and senior public health specialist Margaret Schuster say the re-accreditation will help the department remain a trusted voice for Minneapolis residents amid the current political climate.
Chaplin, who recently celebrated his second anniversary in the position, took the job with the goal of focusing on homelessness, substance abuse and health equity. But as Chaplin begins his third year with the aim of maintaining that, a flurry of executive orders from Trump has eliminated funding for one position in the department, and raised questions about the future of other jobs and programs.
“We’ve lost a public health associate in our school-based clinics program,” Chaplin said. “But more importantly, the war that we’re fighting right now is a war of attrition. It’s not just the loss of jobs, which some folks are feeling at the federal level and at the state level and local level, but it’s the fear of job loss that’s causing folks to leave the profession as well.”
The department was first accredited in 2016 after a multi-year process that began when Schuster was brought into the department in 2012. The accreditation expired after five years, prompting the department to seek re-accreditation, which endorses its standards for emergency operations, workforce development and communications, among other areas.
“We want to be that trusted messenger, because as the federal landscape changes, waxes and wanes and creates potential chaos, we want to be that partner that people can turn to for trusted information, for continued investment in who they are and the conditions in which they’re living,” Schuster said.
Sahan Journal sat down with Chaplin and Schuster to talk about the re-accreditation and the department’s response to national politics, such as widespread cuts to federal agencies and members of Trump’s cabinet expressing skepticism about vaccines.
This interview has been edited for length and clarity.
What does it mean for the Minneapolis Health Department to achieve re-accreditation?
Chaplin: It basically tells the community and all of our partners that we have met a national standard of certificate of fitness for service, and that’s a big deal. There are a little more than 3,000 health departments across the country, and probably close to 10% of those are accredited. We’re one of those 10%.
Schuster: National public health accreditation is specific to standards that are set up for public health. How do you do your work? How do you engage the community? How do you improve health outcomes?
The public health accreditation standards are applied to how we do our work here in Minneapolis, so that we are not only responsible to ourselves of improving ourselves, training ourselves, diversifying our workforce, managing our budgets and contracts appropriately, but that we are also in the best position to provide the best care, the highest performing care for our community, which is Minneapolis.
Damón, what were your goals when starting the job two years ago?
Chaplin: When I came into the job, what was shared with me prior to me arriving was focus on homelessness, substance abuse and equity. Those were the top three things that the city was facing.
The city has seen … this proliferation around large (homeless) encampments. In these encampments, one of the root drivers of homelessness is substance misuse. So, you get a two-for-one: If you deal with the substance misuse, in some ways, you’re impacting people who are homeless. Obviously, equity is also part of our DNA as a city, particularly as a health department.
Several other things have come out of that as part of the working model for the health department were community engagement, which is a humongous piece of what we’ve been doing. Since being here, obviously we also had a change in (presidential) administration, which is a big deal and really has impacted the way we do business.
We were just coming out of COVID when I started, so that really was impacting folks, both the staff and the residents. Then the last piece is helping the city kind of right itself following the murder of George Floyd. That includes working with other city partners around the Safe and Thriving Communities report. That means working with Neighborhood Safety around violence prevention. That means working with the neighborhood community relations.
It means a bunch of different stuff. It means applying a public health lens to this violence prevention work. There’s a lot of things that are happening behind the scenes, and the health department is, in a lot of ways, the anchor institution within the city for a lot of this work.
What existing programming or outreach is there within the health department to reach immigrant and BIPOC communities, and are there plans for expansion on that front?
Chaplin: We have a lot: our Climate Legacy work, our lead abatement program, our REACH program, our opioid program – and they all have different strategies on meeting that equity benchmark.
Pretty much any program that we have has an equity lens to it, and oftentimes we’re talking about immigrant populations. All of our programs really look at those folks who are most burdened by the system and we try to help them first, and in a lot of different ways that does include our immigrant population.
You mentioned you started this position as the world was coming out of the COVID-19 pandemic. How do you think that experience helps you, as well as the department, prepare for another potential pandemic in the future?
Chaplin: I was in Massachusetts for much of the COVID-19 pandemic, where I led a smaller department through it. The one thing that was glaring to me coming out of COVID, and I think was probably the same situation here, is that those relationships have to be developed before you need them.
Strengthening relationships with community partners, for me, was the big thing, the red flag that came out of the pandemic. It’s very hard to engage with folks in “microwave” relationships when there’s no trust building, when they haven’t seen you, when they don’t know you. We experienced that in New Bedford. We had transactional relationships with the community but not trust building relationships, and what I mean by that is that the community partners that we were dealing with were only working with us because we have money, and we were supporting their organizations or initiatives, but we didn’t really have real relationships with them or the people that they touched.
The trust building relationship piece is what I try to focus on here – I want to shake hands, I want to get to know who you are and I want to get to know the people you are serving. We can have all the PPE (personal protective equipment) and all the vaccines in the world, but if people don’t trust us as a service provider, it doesn’t matter because they won’t utilize it.
We do these Wellness Walks that are simply an opportunity for the health department and City Council members to [represent] their wards. We ask them to invite us to their wards, they invite business partners and community members to a meeting, and then we walk through the ward.
During that walk, we meet businesses and community members, and we get to learn about some of the challenges that they have. We’ve done it in the Somali community when I first got here, and it’s an opportunity for them to see who I am, for me to know who they are and for us to get to know what’s happening in the neighborhoods.
Schuster: Even from the inspection side of things, we intentionally employ people who speak the languages of the places where they are inspecting, so our food inspectors, our Lead and Healthy Homes inspectors, other environmental inspectors that we have. That’s a real shift that we’ve made from that transactional relationship to what we can do together.
You touched on looking at violence prevention through a public health lens. Can you talk about what that work looks like?
Chaplin: The Office of Violence Prevention lived within the health department, and there was some exceptional work being done. When we talk about the prevention of violence prevention, you’re talking about public health because in public health, we’re trying to get to the root cause. We’re trying to understand what’s causing the problem in the community, and then we’re trying to eradicate that problem. That’s a big difference between healthcare and public health, in my opinion.
Healthcare is focused on treatment and therapy. In public health, we’re focused on cure and prevention. We’re trying to prevent violence from happening, so that means engaging with students, engaging with youth. We’re talking about gun violence and youth violence and gang violence, and how do we prevent those situations from happening?
We’re beginning to drive this conversation about concentrated violence, which we really don’t have a national definition for. But within the health department, we’re hoping to develop that definition. It basically means in some of our neighborhoods right here in Minneapolis, there are folks experiencing violence at a very high rate, much higher than other people in other neighborhoods within the city. We want to talk about what that experience is like, and what we can do to mediate that.
How have the City of Minneapolis, and the health department specifically, been affected by the Trump administration, and what are you expecting going forward?
Chaplin: There are some real things that have happened: We’ve lost a public health associate in our school-based clinics program. We lost that position as a result of the executive orders from the Trump administration.
But more importantly, the war that we’re fighting right now is a war of attrition. It’s not just the loss of jobs, which some folks are feeling at the federal level and at the state level and local level, but it’s the fear of job loss that’s causing folks to leave the profession as well. As long as that continues, we will continue to see folks retire earlier than they probably would have. We see folks leaving those temporary positions that they would have been in for a year, within two or three months. It’s that type of impact that that type of action will have on public health threats.
For us in public health, the CDC (Centers for Disease Control and Prevention) is our CIA. They really are a big piece of the work that we do. They provide guidance to us, they provide research for us, they provide funding. Without the CDC or with a weakened CDC, it weakens public health writ large across the country.
So although as a department we may have seen minimal impacts thus far, the residual impacts are happening all over the place. It’s really concerning, because people are afraid. They’re really concerned about what’s going to happen to public health.
Most of our grants we’ve been able to draw down on, but there is a real potential over the next six to nine months that we will not be able to, and what that leads to is job loss. That means that some folks won’t be able to continue the work that they’re doing, and at the end of the day, it means that community members won’t be able to receive the services that they are used to receiving from the health department.
Schuster: That’s part of the importance of being a re-accredited health department. We want to be that trusted messenger, because as the federal landscape changes, waxes and wanes and creates potential chaos, we want to be that partner that people can turn to for trusted information, for continued investment in who they are and the conditions in which they’re living.
Thinking about how information is getting scrubbed off of these national websites – how can we, through our communications, be that trusted messenger for that information so that if information begins to disappear, where are people going to go? Who are they going to turn to?
That’s what our relevance really becomes for individual community members, and certainly, neighborhoods.
What are some public health issues that are on the horizon for the department?
Chaplin: Substance abuse. Global warming. Poverty is another issue – when there’s talk about limiting or reducing Medicaid, and access to health care, that is a concern for us. Access to vaccines as well. We’re also talking about diseases that we pretty much have eradicated coming back. Those are concerning.
We’re in the winter now, but what happens when we get into the summer and we’re concerned about vector-borne illnesses? How do we communicate across state lines about issues that are happening? People don’t realize how much we rely on nationwide information to drive some of the things that we do locally.
What are we going to do about the fires that we’re seeing in California, and that we experience in Canada that are affecting our air quality here? There’s lots of things that will happen that we are not faced with right now, but we will need to think about in about three to six months.
People don’t realize how much what we do in public health is to try to prevent things from happening. We averted a measles outbreak because of what we did within public health to communicate and engage with hard-to-reach populations, but because we averted it, it’s not here, so you don’t hear about it, but those are the types of things that we do in public health that people never really understand or see. Those are the efforts that are being threatened – our ability to circumvent issues before they happen.
Minneapolis Health Department:
- Keep up with the department at its website: https://www.minneapolismn.gov/government/departments/health/
