North Minneapolis, one of the most racially diverse neighborhoods in Minnesota, was already dealing with high coronavirus infection and death rates when George Floyd was killed by police outside a corner store just 3 miles away.
His death on May 25 sparked deeper conversations all across the U.S. about the ways racial inequality plays out, including when it comes to health. Nationally, Black people are at least twice as likely to die from heart disease, from COVID-19 or in childbirth, compared with white people, and north Minneapolis mirrors those trends. Nearly two-thirds of Latinos in the area who get tested for the coronavirus test positive — that's a rate nearly 10 times higher than the state's rate overall.
"We were not surprised, because we serve a community that has health disparities," says Stella Whitney-West, CEO of NorthPoint Health & Wellness Center, a community health and dental clinic and social services agency located in the heart of north Minneapolis.
But NorthPoint also has a five-decade history of addressing public health through the lens of race. It was founded with a mission to increase access to health care and social services in a community that today is 90% Black, Latino or Asian.
Central to its approach is tackling the social problems that contribute to illness — in order to better prevent and treat disease. Over the years, the center has made strides in public health: increasing the rates for child vaccinations and screenings for things like cancer, depression and dental care needs.
Of course the coronavirus pandemic has also added weight to many existing social burdens that contribute to poor health: loss of employment and insurance, poverty and food scarcity, stress and anxiety. Whitney-West says the racial strife layered on top of that also feels like a step backward.
"It's been hard — not only for the community but patients, clients and our staff," says Whitney-West. "Our staff is reflective of our community that we serve. Civil unrest — the riots in the aftermath of George Floyd's death — brings us back to the history of how NorthPoint was started."
The NorthPoint center began during a time eerily reminiscent of today.
NorthPoint is located at a corner of Plymouth Avenue that burned down during protests and rioting in 1967, when long-standing grievances in the Black community over lack of access to adequate housing, education and health care turned violent.
"I was 10 years old at the time, but it was very traumatizing to see all these Black people getting beat up by police and the fires right on our block," says Gary Cunningham, who lived on Plymouth Avenue and watched it burn that night.
Inadequate access to medical care was a major issue that shaped life for Cunningham and his neighbors.
"There was an issue with ambulance service," Cunningham says. "The ambulance wouldn't serve the Black community there," so he and his mother would take the bus across town when they needed care. "Most Blacks went to Dr. Brown — his office would be like 200 people in the waiting room because he was one of the few Black physicians."
The federal government tried to increase access to health care for minorities. Among other efforts, President Lyndon B. Johnson's War on Poverty established pilot programs in 14 cities to offer health and social services.
North Minneapolis got one of those programs. Months after the 1967 riots, Pilot City — which later became NorthPoint — opened in an old synagogue on Plymouth Avenue.
"I just remember it being a place where community gathered. The health center and social service center at that time were one place," Cunningham recalls.
Nearly four decades later, Cunningham took over as the clinic's CEO.
By then, Pilot City had fallen into disarray — its public image was that of an impoverished clinic of last resort. By 2002, when Cunningham took over, he says, it was running a $2 million annual deficit, and few patients were getting regular vaccinations or mammogram screenings.
So Cunningham refocused on Pilot City's original mission: to increase access to health care by also identifying and enhancing social services to support that goal.
Cunningham's team developed some innovative solutions to bring more patients in, including providing bus tokens to patients who couldn't otherwise afford transportation. NorthPoint's new approach reached a growing Somali and Hmong population in the area through hosting lunch events with religious leaders and featuring food from those communities. Over the last 15 years, vaccination and health screening rates more than doubled, to close to 80%.
That has meant more prevention of disease and lower costs for treatment and care.
Diabetes, lead poisoning and depression are also big problems in the community. So NorthPoint lobbied local agencies to get lead paint safely removed from homes. The center stocks a free-food shelf with healthy, culturally relevant food. All patients — regardless of what health problem they come in for — are now automatically screened for depression and dental care needs and are told to bring their family members in as well.
These measures have increased NorthPoint's reach into a diverse community — something many other medical centers facing similar dynamics are struggling with today.
As a child, Rashida Jackson, 52, came to NorthPoint for health care, and now her mother, children and all her grandchildren see their doctors there.
Jackson is now on NorthPoint's board of directors, which draws a majority of its seats from patients like her, who are members of the community.
"This is one of those powerful institutions that developed out of a lot of civil unrest and pain," says Jackson, "and it's a thing of pride to see this small community health clinic explode and grow. Whatever social service support you need, they have."
That's why the center is so beloved by the community, she says: "We own it, it's family — it's almost a living, walking, breathing thing."
And today, NorthPoint is once again being held up as a model.
This past summer, in the wake of George Floyd's death, Minneapolis and the Hennepin County Board of Commissioners declared racism a public health crisis.
Irene Fernando, one of the co-authors of the county's declaration, says just as NorthPoint has done in the health realm, the county wants other government agencies to rethink policy — by looking at how race affects outcomes in education, employment and criminal justice.
"NorthPoint listens to the community," says Fernando, who also serves on NorthPoint's board. "Earlier than other entities, NorthPoint was reporting on race; earlier than other entities, NorthPoint was willing to do free testing for COVID." So thinking about improving access to health care "is in how NorthPoint operates," she says.
One reason its approach differs from those of other health centers is that it is a community health clinic, not a hospital, says Ed Ehlinger, former Minnesota health commissioner, who has written about racism in health.
That means, he says, its mandate is to improve public health in the community; it's not under the same commercial pressures many private hospitals are up against.
Ehlinger compares NorthPoint to medical centers in countries that have universal public health care. "They focus on community-oriented primary care and have much better outcomes and lower health care costs," he says. "So even though there aren't as many of those neighborhood health centers left, I see them as the model that we should look to replicate, in moving forward."
At a time when few patients trust their health care providers, NorthPoint has bucked that trend.
LaVonne Moore, a midwife and lactation consultant with the center, says that's in part because NorthPoint recruits its leaders and doctors from the community it serves.
Moore, who lives nearby, says that interconnection between residents and staff fosters enduring, trusted relationships with patients and a level of care that is highly unusual today.
"I'm a provider," she says. "I have dropped medicines for COVID-19 patients at their door: I just leave it at the door, go back in the car, make sure they know what's out there, and they come to the door and pick it up."
That trust is critical, especially given the gravity of problems that north Minneapolis faces these days: Nearly two-thirds of Latino patients who test for the coronavirus at NorthPoint are testing positive. While that's an alarmingly high rate, CEO Whitney-West says it's also a positive sign. A significant number of those patients are undocumented immigrants, she notes, and the findings suggest they trust NorthPoint enough to get tested at the center.
And from a public health standpoint, that's a win, she says, because you need to know where the virus is in order to stop its spread.
Credit: Nancy Rosenbaum assisted with research and field recording
DAVID GREENE, HOST:
When George Floyd was killed by police earlier this year, it sparked both massive protests and conversations about the many ways racial inequality plays out in this country. One of those ways is health. Black people are twice as likely to die of heart disease and COVID-19 as white people. Those differences are visible in one of Minneapolis' most diverse neighborhoods. It's just three miles from where George Floyd was killed. But there's a clinic there that has decades of experience grappling with race and health. And it's now being held up as a model. NPR's Yuki Noguchi has been reporting in north Minneapolis and joins me. Hi, Yuki.
YUKI NOGUCHI, BYLINE: Hi, David.
GREENE: So take us there. What got you interested in this neighborhood?
NOGUCHI: Yeah. What interested me in north Minneapolis is its incredible racial diversity within a state that's mostly white. Ninety percent of residents there are a racial minority. It's about half Black, about a third Latino and about a tenth Asian, mostly Southeast Asian. And the area reflects what we know nationally, that communities of color have more health problems, especially now with the pandemic. Cases of COVID in north Minneapolis run five to six times higher than the state.
GREENE: So it's safe to say this is a place that's been grappling with questions about race and health and that relationship for a very long time.
NOGUCHI: Absolutely. North Minneapolis is like a poster child for race and its effect on health. And that's been the case for decades.
GREENE: Well, I know we're going to talk about this one clinic I mentioned, but, you know, you mentioned the case, for decades. I mean, tell us more about that history.
NOGUCHI: You know, George Floyd's death struck a real chord here. And the protests afterward felt like a real echo from the past. And to explain why, let me take you back 53 years ago. There were similar protests there back then. There was unrest over discrimination, including in access to health care, among other things. And that led to similar sort of rioting and protests on the streets of north Minneapolis.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED REPORTER: Violence on the city's north side, gruesome isolated acts to mob action. Store windows were shattered by hundreds of stones and bricks.
NOGUCHI: A man named Gary Cunningham remembers that. He grew up on Plymouth Avenue in north Minneapolis. And in the summer of '67, he watched it burn.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED PROTESTERS: (Shouting).
GARY CUNNINGHAM: I was 10 years old at the time. But it was very traumatizing to see all these Black people getting beat up by police and the fires right on our block.
NOGUCHI: You know, back then, Plymouth Avenue had a lot of shops catering to mostly Jewish and Black residents. But getting medical care was a problem.
CUNNINGHAM: There was a issue with the ambulance service. The ambulance wouldn't serve Black community there.
NOGUCHI: So to see a doctor, Cunningham and his mother had to take the bus across town.
CUNNINGHAM: Most Blacks went to Dr. Brown. His office would be, like, 200 people in the waiting room because he was one of the few Black physicians. There was a couple of Black physicians there. Access to care was a major issue for Black people.
NOGUCHI: And the government tried to close that gap. President Lyndon Johnson's War on Poverty set up pilot programs in 14 cities to offer health and social services. And that's when North Minneapolis got something it hadn't had before, a community health center. It opened months after the 67 riots and was known as Pilot City. It was located in an old synagogue on Plymouth Avenue, just three blocks from where Cunningham lived. Today, it's called NorthPoint Health and Wellness.
GREENE: That's NPR's Yuki Noguchi there talking to us about north Minneapolis and the history. And, Yuki, I mean, how important is having access to a community health center like that? It sounds like a really big deal.
NOGUCHI: Yeah, it was because it was nearby, but also because of how the clinic operates. And here's Gary Cunningham again.
CUNNINGHAM: I just remember it being a place where community gathered. The health center at that time and the social service center were one place.
NOGUCHI: And, David, you notice how Cunningham talks about health and social service in the same breath there? That's key to understanding what makes NorthPoint different. It looks at the social reasons that people end up with the health conditions they have. That concept's become very popular recently, but it's been NorthPoint's focus for decades. So here's an example of what I mean. Four decades after Pilot City - now NorthPoint - started, Gary Cunningham ended up taking it over as CEO.
And at the time, the clinic was in disarray. I mean, patients weren't getting regular vaccinations or mammogram screenings. And under Cunningham, it developed some unusual solutions. It provided bus tokens to patients who couldn't otherwise afford transportation. And they made inroads with a growing Somali and Hmong population by hosting lunch events with religious leaders and food from those communities.
GREENE: And did that make a difference? I mean, did you see the vaccination or screening rates start to change?
NOGUCHI: Yeah, it did. I mean, in 15 years, childhood vaccinations and mammogram rates have more than doubled to close to 80%. But it's not just vaccinations, David. I mean, diabetes, lead poisoning and depression are also huge problems there. So NorthPoint lobbied to remove lead paint from homes. It stocks, even today, a free food shelf with healthy, culturally relevant food. People are screened for depression and dental care just automatically. So David, what you're seeing here is that instead of just writing a prescription, NorthPoint is looking at the whole picture. It treats disease not just as a medical problem, but one that has social roots.
GREENE: And is that still the case even in the middle of a pandemic and all the extra challenges we are seeing right now? Is that approach still working?
NOGUCHI: Yeah. And one of the great things about this model is that it's developed a lot of trust in the community. You know, a majority of NorthPoint's board of directors is run by patients from the community. They reflect the community. And NorthPoint's current CEO, Stella Whitney-West, told me that is critical.
STELLA WHITNEY-WEST: The people who operate or who have the responsibility for overseeing your clinic are the same people who are the patients and customers of your clinic.
NOGUCHI: You know, they know what the community needs even right now because they are the community. And so people trust them, which is critically important during the pandemic. Nearly two-thirds of Latino patients testing for COVID at NorthPoint test positive. That's extremely high and very worrisome. But Whitney-West says it's also a positive sign. It means undocumented immigrants trust NorthPoint.
WHITNEY-WEST: When I talked with the staff, they started telling me people feel safe here. So they're likely to come here as opposed to going downtown to the hospital.
NOGUCHI: And from a public health standpoint, that's essential. You know, you need to know where the virus is in order to stop its spread. And, you know, David, we are at a critical time right now, with COVID cases spiking around the country. And a lot of experts are saying we need more of a public health approach to delivering care, the very kind of thing NorthPoint has been championing for decades.
GREENE: Well - and, Yuki, I know this is just the beginning of your reporting. And we're going to be hearing your reporting on other aspects of race and public health. NPR's Yuki Noguchi, thank you so much.
NOGUCHI: Thank you, David.
(SOUNDBITE OF CITY OF THE SUN'S "YOUNG FOLKS") Transcript provided by NPR, Copyright NPR.