March 24, 2023
Moving toward equitable outcomes for kids means taking actions in addition to creating the case for change. From his background in education to his current position in the Governor’s office, Gov. Tim Walz has a history of advocating for and creating change for the benefit of kids. Join hosts Angela Kade Goepferd, MD, and James Burroughs as they talk to Gov. Walz about what it takes to improve kids’ health in Minnesota.
Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the kid experts where the complex is our every day. Each week we bring you intriguing stories and relevant pediatric healthcare information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge, and perhaps change how you care for kids.
Welcome to talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. Joining me today, as well as the guest host of our equity actions episodes, James Burroughs, our SVP of advocacy and public policy and chief equity and inclusion officer at Children’s Minnesota. We are both here hosting today because we have a very special guest on the podcast today to talk to us about all things kids’ health, equity and inclusion, in the state of Minnesota.
Joining us today is the governor of Minnesota, Tim Walz. Governor Walz’s career has been defined by public service, from serving our country in the military to serving our students as a high school teacher and football coach, to serving our state and Congress. And we are certainly honored to have him on our podcast today. Welcome, Governor Walz.
Gov. Tim Walz: Thank you, Dr. Goepferd. James, good to be with you too.
James Burroughs: Good to see you, Governor.
Dr. Angela Kade Goepferd: Well, let’s start off with: When you think about kids’ health, Governor Walz, what are your top priorities for kids’ health this year?
Gov. Tim Walz: Yeah. Well, first of all, I appreciate the work you all do and that Children’s does. It’s obviously critical. But I think the work that we all do together starts way before that, whether it’s maternal health, or whether it’s the opportunities for children to get off to that great start. We keep saying that we want Minnesota to be the best state in the country for children to grow up in. That’s all children. And we’re thinking about things like housing stability, we’re thinking about food security. We’re thinking about access to preventative health care. We’re thinking about safety in their communities, gun safety, all of these opportunities to make sure that children get off on the right foot and have that opportunity to thrive in Minnesota. And I think that means creating that inclusive environment. We know that it’s all too often that when we start to disaggregate data, we see differences of outcomes based on race, based on gender identity, some of those things.
Minnesota can do better than that. We think first of all, it’s a moral responsibility to do right by people. But it’s also an economic responsibility to make Minnesota a destination workplace. By the time children experience health outcomes, there’s many things that could have been done before that. And so we see ourselves as partners in a broader ecosystem. And I think we’re trying to reimagine state government as being a partner in that.
Dr. Angela Kade Goepferd: Are there any particular policies or changes that you think would make a big impact for kids?
Gov. Tim Walz: Yeah. I think so. And I’m talking all children too in this, but I think these are conversations we’ve had, the work that James has done around equity and inclusion and helping both inside and outside state government. This idea, again, when we disaggregate data, certain communities being hit harder. I think some of the things that we think make a big difference, the child tax credit, we saw during COVID that if you get money back in the pockets of especially those families most struggling, it makes a huge impact.
We think the data supports that the proposal would put forward to continue that on a state level can reduce childhood poverty by 25%. And I mean, you all are the experts over there, you know there’s a direct correlation between children and poverty in those first 1000 days in some of these chronic health conditions based off of what I think for families, it’s this ability of creating generational wealth, down payment assistance on housing, targeting the middle class for child independent care credits, making sure that folks have a safe place where they can get their kids off to an early start while they’re out making a living wage. And then I think addressing the issues head on, on equity, inside the Minnesota Department of Health on health equity, especially around Black communities, [inaudible 00:03:48] Black women that we see at a higher rate.
I think just a lot of things to kind of wrap the arms around this idea of: How do we keep our children safe? And then of course, making sure that their outcomes in schools are able to make sure they mirror their peers. All of those things are part of it. But I think it starts with that economic security at home and access to preventative health care. If we can get them off to that good start, get them into good childcare, early learning situation, get the parents in a stable situation, things like universal meals at school. You tell me where you fill out the paperwork and how you get that all done, not that folks don’t want to, they’re busy. And we predicate if a form was turned in right or something. And the idea that we pay for their desks, we pay for the heat, we pay for the lights. But a child walks into school and we make them jump through hoops to get fed. I think just little things like that change the whole atmosphere of how we’re viewing kids.
James Burroughs: Along those same lines, I want to commend one of your former commissioners, now Dr. Jan Malcolm, who’s run the MDH for you and looking at health equity in a very serious way during her tenure. Now you have Dr. Brooke Cunningham leading the MDH to work. You alluded to it earlier about Black maternal health, things around food security. But are there specific policies around health equity that are a priority for you and your administration going forward?
Gov. Tim Walz: Yeah. And I think what we’ll see, James, I know you worked on this too, and I appreciate you saying that about Jan Malcolm. She led a great team, a legacy during COVID and so many other things, a very well-known public health official. But our new commissioner on the scene, Dr. Brooke Cunningham, has the potential I think to lead the nation in this issue, establish an office of African American health inside MDH, using data to drive our decisions. I think you saw it during the COVID pandemic. We were one of the early states using social vulnerability index to determine where the vaccines were going to go, with a clear indication that this is not about equal resources across equal communities. This is about putting resources where communities that have been harmed the most. And so I think that’s a specific one.
And I think some of the connections that might not be as easy to see, connecting A and B, as we move towards a clean energy economy, we know that our children in communities of color are hurt worse by environmental policies that whether it’s living next to a metal shredder, or lead in the pipes in their homes. I think a real concerted effort, putting in MDH, making sure that there’s going to be a focus over there on African American health in particular, and then have the data drive decision making, whether it’s again around vaccine distribution or trying to reduce some of these horrific disparities we see in health outcomes, whether it’s women dying in childbirth at a much greater rate in 2023, simply because they’re Black. We have to do better.
Dr. Angela Kade Goepferd: One of the things that we talk about a lot in pediatrics and the language that we use is around social determinants of health. And we understand that the care that we provide within the walls of Children’s and the care that we provide to kids is somewhere between 10% and 20% of what ultimately is going to impact their health outcome. And so for those of us who are taking care of kids, we’re always trying to think about: What are other areas and ways that we could lean in and help improve kids’ health. You mentioned a few already. You talked about food security and meals at school. You talked about economic security. I know that there are other things that make up social determinants of health, housing and other issues. Can you give me a sense of what your administration would like to see around social determinants of health, and how we can partner with you to move some of those things forward to keep kids healthy?
Gov. Tim Walz: When you tell people, I can stand up and I know this as a teacher, I can have two children walk through the classroom, and I can determine with pretty good accuracy life expectancy, some of those outcomes are already determined by that child’s skin color when they come in, or the social determinants of poverty early on. I think that’s why making sure, again, access to early healthcare for the mothers, prenatal, postnatal care, making sure that all children are covered and we don’t get that gap or that drop off, making sure we’re focusing historic amount around this issue of housing and housing insecurity. I mean, again, you would know this, but when you tell people it doesn’t necessarily make a direct connection to them that housing insecurity will impact the lifelong health outcomes of that child if they’re insecure. Same thing with food insecurity and that.
So I think us focusing, and again, I would make the case we’re going to kind of rearrange state government to have a children, youth, and family to bring all of these things together and quit looking at children kind of in pieces. This is a pretty big task to do, but we’re hearing it from you. And to be very candid, by the time they walk through the door at your place, we’ve set them on a path. And what I would say is we want to set them on that right path. So I hope we’re taking this holistic way. I think we’re seeing it across the spectrum of services that we can deliver, understanding that their parents are going to be a big part of this too. So when people hear me say, “I want this to be the best state in the country for children to life,” and I’ll hear sometimes people say, “Well, what about the parents? What about older people?” That’s all part of it. That’s about creating that ecosystem around children to lift them up, to make sure they’re there.
And so thanks to the quality health care we get, thanks to the work you’ve done, thanks to many factors, thanks to previous administrations who’ve laid the groundwork on many of these things that we’re kind of standing on the shoulder of giants on right now. Minnesota does rank relatively high in childhood poverty and things and health outcomes. But I just think we’re really trying to set the tone that this is a zero-sum proposition. Every single one of those children need to have that opportunity. The social determinants and how you’re embracing who these children are, I’m horrified to be candid with you, some of the decisions that are being made around our children in surrounding states, just quite candidly further a political agenda that all of the data shows is putting our children at risk, either of self-harm or of long-term health outcomes.
James Burroughs: So one of the things, Governor, you mention is how Minnesota differs most other states around racial equity, your intentionality around that, and not avoiding the terms diversity, equity and inclusion, but embracing them in the work. And I want to talk to you about a specific effort you’re working on called Mind, Body, and Soul. Can you tell us about what that is and why that work is so important?
Gov. Tim Walz: All this ties in, and I think, Dr. Goepferd, you probably know in full disclosure, James is a friend of mine and has worked on this issue with me, of trying to understand the Black community’s needs, trying to understand this diversity of making sure that the administration was intentional, and we had an individual named Dr. Stephanie Burrage, she works with us. She’s a long time educator, also very visionary around this. And she said we need to get deeper, we need to understand this is not a monolithic community, and we need to make sure that there’s access to the highest levels of state government decision making for communities, specifically the Black community before budget decisions are made. That budget is not just a fiscal document, it’s a moral document. And it needs to include and understand that we are making up for historical inequities, and just to name that, that there’s catching up to do here. And Dr. Burrage held well over a year worth of meetings. We would take a topic, we would break into interest groups. We would build on what was needed.
And it’s kind of this holistic approach to children that we’re talking about today was the outcome of that, things like the Office of African American Health Equity inside MDH came out of that work. And so it was good for me. It was a good opportunity to listen. It was an opportunity to learn, to have communities on there, and to watch for me to see the diversity amongst this community talk about what state government can do to improve the lives of their children. So a lot of what came out of that was a very intentional decision making. It was led by incredible leaders. And I think and I hope decisions like Brooke Cunningham being in charge of Minnesota Department of Health is a direct result of saying, “We need leaders in positions of authority that understand and reflect those values.”
Certainly, Jan Malcolm did. But I think it’s different with the intentionality that came out of Mind, Body, and Soul. And if there’s anything that came out of that, this is a community that’s many times been told things were going to happen and they didn’t. And it’s not as if you get to stand up and run for office and tell them you’re going to do this. This was much different than that. This was a roadmap of intentional interventions that were data supported to make the change in the lives of people. And so I’m really grateful for that work that was done, certainly not a finished product. It was meant to get us to the point of introducing a budget as a platform and a vehicle to talk about these issues.
James Burroughs: And one of the things I’ve heard in the community as what you just said, these communities aren’t a monolith. One person can’t speak for everyone, so taking the time to go for over a year and hearing those different voices, those dynamic voices is important. And also, too, I believe that could be done in other communities as well, Latino community, Asian community, LGBTQ community as well, intentionality. So thank you for that model.
Gov. Tim Walz: As government, it’s always have to be really careful with this because one thing I’ve learned is that we learn the language of how to talk to different folks. But I keep talking about, we hear about the communities of color, or we talk about the POCI Caucus. And people were very intentional to me is, look, we care deeply about all this, but the Black community’s issues are maybe not the exact same as the Hmong community, they’re not the same as the LGBT community. There’s intersectionality, certainly, amongst all those. But you need to be more specific to address those issues. And I think that was one of the best things that came out of that because it let us take each of these communities as their own selves, as their own being valued, rather than saying, “Look, we have policies in here for communities of color.” Specifically, which communities, specifically which interventions?
Dr. Angela Kade Goepferd: A lot of what you were just responding to was talking about partnerships with community. And I think again in health care, that’s something that we are trying to work on is: How do we partner with communities to, one, not get lost in the danger of a single story, to really understand what stories are within communities, and how we can meet their needs, whatever community they come from? Are there other examples, or best practices, or ideas that you can share about how your administration has really partnered with different communities to understand how to build solutions and how to work toward improving health, or improving equity?
Gov. Tim Walz: Yeah. And I think our method is, again, I go back to Mind, Body, and Soul helped us with this, focusing on understanding that and taking a little more than just a shallow dive, but the deep dive into community, realizing it’s not monolithic, realizing the issues. And then having the patience to allow all those voices to be heard, and then I think gathering those together and doing the same thing with other communities, and then coming back to the table because I think we do know some of these issues on generational wealth cut across communities of color. They’re in the Hispanic community, they’re in the Hmong community, they’re in the Somali community. But understanding that newer immigrants versus more established communities are going to see these things differently.
And I think our take is to not jump to the easy conclusions, not to do the grouping together, but recognize once we feel like we have a bit of a road map, or we have some of the suggestions that were coming out, bringing those to the broader communities of color to bring up our strength, to bring up our numbers, to bring up other things that we can do across those communities. So I think continuing to talk, and finding in many cases, maybe counterintuitive allies in these fights that we know are out there. Again, I would say this, and I don’t know if it’s necessarily counterintuitive, but there’s been a communication strategy that the business community is opposed to some of these things. The business community’s absolutely not opposed to these things. The business community knows their future lies in equity and inclusion. They’re not just doing this because they think it’s the politically right thing to do at the time. They’re doing it because they recognize if they can’t make an inclusive environment for all, very hard to hire, hard to hire doctors, hard to hire folks that are going to come.
And I think that’s the lesson we learned, is there are things that you can share amongst those communities. We’ve got to find some of those commonalities without taking away that individual differences amongst them. And I think that’s where it’s a little more sophisticated than how we’ve done. We’ve done things in the past, trying to do them for all communities and impact, but being more intentional about the differences.
James Burroughs: What are some of the things … This is a two part question. What are some of the things health care systems like Children’s can partner with you on in the government to say, “We’re going to do this in the benefit of children and families and we’re going to partner together on”? And then the second part of that question is: Even those that are not healthcare systems, like the other businesses, what can they do in order to partner with government to address these issues in a positive way?
Gov. Tim Walz: Yeah. I think sometimes, and I’m always really careful about putting your reputations on the line because a lot of times, if I say it’s Thursday, and I’ll get fight that it’s not, just because it’s politics. If I say up, they say down. It’s kind of one of those. We try and get the nonpartisan validators to stand up and say, “Look, here’s what the data says.” Now I’m not naïve. I depended greatly on the health systems for health advice, imagine that, during the pandemic. Those became politicized, not to a majority degree, but it became somewhat politicized. But I do think partnering together with the data and the caregivers, and you know this, the data still supports this.
People trust their children’s doctors. They trust the people who are around them. Parents know that’s true. So I think on things where we are trying to make change for the better, having your voices stand up, not to put you in the line of fire, but let’s be clear. I’ve had a standing executive order that should not be controversial at all because the science does not support this idea that you can change someone’s gender, who they are, this idea of conversion therapy, it discredit it, it puts children at risk, it risks their lives. It increases suicides, all those things. We’ve not been able to get a bill passed on that. I’m trying. And I think what I need and one of the ways you can partner, and businesses partner with us, is to just simply say, “Look, we need you to do this because of this reason, this reason, and this reason, based on the data.”
The same thing with businesses, say, “Look, how am I going to attract [inaudible 00:18:04] professionals to Minneapolis if their only vision was May of 2022 in George Floyd’s murder?” It has to be more to it. What’s the state doing? What are they doing to acknowledge this? And I think when businesses both push us to do more, but lift us up when we’re doing things together, because I’m learning much from the business community on your inclusion policies, things that we can do. So I just think it’s, again, not to drag you into a fight where you get hit with the politics of it, but young leadership for example, stood up and was there at a press conference on the CROWN Act. And I think all of us recognize why that was so important. At first blush, if you’re one of these people who believe that they don’t see color and there’s no problem with race or whatever, this thing didn’t seem that important.
But if you really understand what systemic racism looks like, you understood how big a deal this was, and why it made a difference. And to see leadership of children in Minnesota standing up there attesting to that, that’s really helpful because there’s a lot of folks out there. It is not, I truly believe this, it is not malice. It’s ignorance in a lot of cases of just not ever been in this situation. And they’re just wondering. What is the deal with hairstyles? How can this possibly be an issue? Well, it’s a huge issue. It’s a huge issue of discrimination and we knew that.
Dr. Angela Kade Goepferd: Governor Walz, you talked about us as a health care system, Children’s Minnesota standing up to advocate for kids and the things that we believe are right for kids, regardless of partisan politics. I am always trying in my role as a pediatrician to get my colleagues to understand how important their voices are. And I’ve been with you at the Capitol to talk about things like conversion therapy, have been up at the Capitol alongside some of our representatives to talk about creating Minnesota as a refuse state for trans affirming care. And I know and I can see how much it means to those legislators to have a pediatrician there with them to provide that expertise. I sometimes feel like my colleagues and partners in pediatrics underestimate the impact that they can have and how their voices could be heard. And I wonder if you might just throw in a little pep talk for them about how valuable. And teachers I think in many ways are the same, how valuable our voices are as people who are caring for kids.
Gov. Tim Walz: Yeah. I don’t know if I can stress enough how valuable it is. And it’s not to give cover for a political ideology because you would not come there if it were something maybe even tax policy or whatever, unless you felt it was impacting families. Something as profound as a practice that harms and puts children at risk, like conversion therapy, or making sure that we are going to make this a safe haven for trans families and trans individuals to be able to come here, and to have them hear that from someone who doesn’t feel like they have a political foot in the game, it is everything. And I talked to this, my good friend, Keith Ellison, always used this line, and I loved it when people say, “I’m just really not into politics.” And he says, “Too bad, politics is into you.” And it’s going to impact everything you do. Just step up and do this.
And I’ll give you an example of this. This is not a stretch because I asked this question. I served on a special commission in Congress, the China Commission, that looked at human rights violations in China, political prisoners and things like that. We would at times get folks who had escaped and had come, and had endured horrific conditions for political persecution, if you will, or human rights things in China. And I would ask them, “Does it help or hurt you when we speak up about that when you’re in captivity?” And they would say, “In the short run, it hurts us because they punish us. In the long run, it’s the only way we end this.” You have to speak up. You have to be there. And I think that thing just always rang to me is watching someone who endured years in political prison under horrific conditions said, “You have to know there’s an ally. They’re speaking up.” And I think if you’re thinking about that community, you’re not speaking up to support the politicians. You’re speaking up to support the people and the children. So if there’s anything I could say to them, it resonates so deeply.
I’ve had interactions with this. I was in Mankato at a coffee shop, and we were talking about marriage equality years ago or whatever. And there was a young man came up from the back of the room and he had tears in his eyes. And he said, “I’m from Alabama.” He goes, “I can’t believe I’m in a place where my congressman’s talking about marriage equality.” Just little things like that, and I think if they recognize what that means, the power of what it means, the sense of that one student, if they see a doctor up there talking about this, that may be all it takes for them to go home and say, “You know what, I’m in. I’m going to make this [inaudible 00:22:38].” So please encourage them to. I can’t say it enough because again, it’s easy to dismiss. I’ll just get dismissed and it’s political ideology, I’m trying to gain votes. I understand. That’s the space that I’m in.
I try and approach it from a teacher, a parent, other ways. You, on the other hand, and folks that are out there, and again, doctors, nurses, teachers, are held in high esteem, especially amongst parents, we should understand that we have the power to make a difference.
James Burroughs: Food security is a nonpartisan issue. Housing’s a nonpartisan issue. Children’s health, not a partisan, so it’s not about who’s in office or what political party, it’s about kids and families, and we want to make sure we address. So any way that we can do that and get others to do that, we are willing to do that, Governor, so thank you for being on the show today.
Gov. Tim Walz: Yeah. That’s the biggest thing if you’re able to do that. And we actually saw it this week. We saw a bipartisan vote, not a big one, but we saw a member cross over on this idea of restoring the right to vote for folks who’ve done their time through incarceration, again, a nonpartisan issue about reintegration of folks back into community. Anything you can do not forcing the political hand, but forcing I would argue the moral hand, if we can get kids a stable house, stable food, stable daycare situation, put the families in a position of a stable income, you’re going to see better outcomes once they come to Children’s Minnesota. That’s simply factual, so we want to help you with that.
Dr. Angela Kade Goepferd: Thank you so much. And thanks, Governor Walz, too. I’ll just put in one last thank you for your stance on science and data. It was such a relief to me as a physician during the pandemic to see someone leaning so heavily into science and data. And I think your administration’s been really strong on that, and that is something that really resonates with those of us in health care. We have data and we have science on these things, and let’s listen to it. So thanks for your leadership in that arena, and thanks for joining us on Talking Pediatrics. It’s really a pleasure to have you with us today.
Gov. Tim Walz: Good to be with both of you. Have a good week.
Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. Our executive producer and showrunner is Ilze Vogel. Episodes are engineered, produced, and edited by Jake Beaver. Amie Juba is our marketing representative. For more information and additional episodes, visit us at childrensmn.org/talkingpediatrics, and to rate and review our show, please go to childrensmn.org/survey.