Engaging Our Diverse Communities: Demographics, Strategies, and Stories

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1 Engaging Our Diverse Communities: Demographics, Strategies, and Stories Minnesota Safety & Health Conference May 10, 2018 Danushka Wanduragala, MPH International Health Coordinator Refugee and International Health Minnesota Department of Health

2 Agenda Minnesota s Refugee & Immigrant Communities Applying the Health Equity Lens Multicultural Resources, Strategies, and Partners Reaching Specific Communities: Engagement and Collaboration

3 What does it mean to be a refugee or asylee? Non citizen U.S. resident who: cannot return to his or her country of origin because of a well founded fear of persecution due to race, religion, nationality, political opinion, or membership in a particular social group Different from other immigrants because change is unplanned & traumatic Refugee Health Program, Minnesota Department of Health

4 Worldwide Statistics, 2016 Total forcibly displaced Total internally displaced persons Total refugees and asylum seekers New refugee and asylum seekers 65.6 million 40.3 million 25.3 million 3.4 million Total resettled 189,300 UNHCR Global Trends 2016, United Nations Higher Commissioner for Refugees

5 Total Arrivals: 53,716 Primary Refugee Arrivals by State of Initial Resettlement, October 2016 September /11/ Source: Refugee Processing Center/WRAPS

6 Refugee Arrivals to MN by Region of the World, Southeast Asia Sub Saharan Africa Eastern Europe FSU Middle East/North Africa Other 5/11/ Number of arrivals

7 Top 10 Countries of Origin among Primary Refugee Arrivals, Minnesota, Somalia 23, Laos (Hmong) 22, Vietnam 15, Former Soviet Union* 9, Burma 8, Ethiopia 6, Cambodia 5, Laos (Other) 4, Liberia 4, Bosnia and Herzegovina 2, Other 7,667 Total 108,583 *Includes Armenia, Azerbaijan, Belarus, Estonia, Kazakhstan, Kyrgyzstan, Latvia, 5/11/2018 Moldova, Russia, Tajikistan, Ukraine, and Uzbekistan 7

8 Primary Refugee Population in Minnesota, 2016 Kitts on Rose au Mars hall Po lk Pennin gton Beltra mi Koochic hing St. Louis Lak e Co ok 2016 Total Population of MN: 5.5 million Norm an Cl ay Wilk in Trave rse Gra nt Steve ns Mahno men Beck er Otter Tail Sw ift Dougl as Po pe Hubb ard Wade na Kandiy ohi Mee ker Redw ood Bro wn Ca ss To dd Morri son Stear ns Crow Wing McLe od Aitk in Le Sue ur Kana bec Isa nti 7 1 Henne pin Carlt on Pin e Total Primary Refugee Arrivals N=107,684 Ro ck Fillm ore 5/11/2018 8

9 Primary Refugee Arrivals to Minnesota, [CATEGORY NAME], [VALUE] ([PERCENTAG [CATEGORY E]) NAME], [VALUE] ([PERCENTAG E]) [CATEGORY NAME], [VALUE] ([PERCENTAG E]) [CATEGORY NAME], [VALUE] ([PERCENTAG E]) N=41,002 [CATEGORY [CATEGORY NAME], NAME], [VALUE] [VALUE] ([PERCENTAG ([PERCENTAG E]) E]) 5/11/2018 9

10 Primary Refugee Arrivals, Minnesota, 2017 [CATEGORY [CATEGORY NAME], NAME], [VALUE] [VALUE] ([PERCENTAGE]) ([PERCENTAGE]) [CATEGORY NAME], [VALUE] ([PERCENTAGE]) [CATEGORY NAME], [VALUE] ([PERCENTAGE]) Other*, 110, 10% N=1,099 [CATEGORY NAME], [VALUE] ([PERCENTAGE]) [CATEGORY NAME], [VALUE] ([PERCENTAGE]) [CATEGORY NAME], [VALUE] ([PERCENTAGE]) * Other Belarus, Cameroon, China, Djibouti, Dominican Republic, El Salvador, Eritrea, Guatemala, Honduras, Indonesia, Kenya, Liberia, Mexico, Moldova, Nepal, Philippines, Russia, South Sudan, Sudan, Syria, Ukraine, and Vietnam 5/11/

11 Kittson Marshall Roseau Lake of the Woods Koochiching 2017 Primary Refugee Arrivals to Minnesota (N=1,099) Beltrami St. Louis Polk Pennington Cook Red Lake Clear Water Itasca Lake Norman Mahnomen Hubbard Cass Clay Becker Aitkin Wilkin Otter Tail Grant Douglas Wadena Todd Morrison Crow Wing Mille Lacs Kanabec Carlton Pine Number of Refugee Arrival By Initial County Of Resettlement 0 Traverse Big Stone Lac Qui Parle Yellow Medicine Lincoln Stevens Swift Lyon Pope Chippewa Renville Redwood Stearns Kandiyohi Brown Meeker Sibley McLeod Nicollet Benton Wright Sherburne Carver Le Sueur 71 Anoka Washing- Hennepin Ram-tosey Scott Isanti Rice Dakota Chisago Goodhue Wabasha >500 Pipestone Murray Cottonwood Watonwan Blue Earth Waseca Steele Dodge Olmsted Winona 5/11/2018 Rock Nobles Jackson Martin Faribault Freeborn Mower Fillmore Houston 11

12 Top Minnesota Counties of Primary Refugee Resettlement, Ramsey Hennepin Stearns Anoka Olmsted All Other 184 Total 1,099 5/11/

13 200 Country of Origin by County of Resettlement, Burma Somalia DR Congo Ethiopia Afghanistan Somalia Ethiopia Afghanistan Other Other Ramsey N= Hennepin N= Afghanistan Somalia Other 20 Iraq Other N=84 N=77 0 Stearns Anoka 5/11/

14 Secondary Refugee Arrival Notifications to Minnesota, 2017 [CATEGORY [CATEGORY [CATEGORY NAME], [VALUE] NAME], [VALUE] NAME], ([PERCENTAGE]) ([PERCENTAGE]) [VALUE] ([PERCENTAGE]) N=551 [CATEGORY NAME], [VALUE] ([PERCENTAGE]) 5/11/

15 Kittson Marshall Roseau Lake of the Woods Koochiching 2016 Secondary Refugee Arrival Notifications to Minnesota (N=977) Beltrami St. Louis Polk Pennington Cook Red Lake Clear Water Itasca Lake Norman Mahnomen Hubbard Cass Clay Becker Aitkin Wilkin Otter Tail Grant Douglas Wadena Todd Morrison Crow Wing Mille Lacs Kanabec Carlton Pine Number of Refugee Arrival By Initial County Of Resettlement 0 Traverse Big Stone Lac Qui Parle Yellow Medicine Lincoln Stevens Swift Lyon Pope Chippewa Renville Redwood Stearns Kandiyohi Brown Meeker Sibley McLeod Nicollet Benton Wright Sherburne Carver Le Sueur 71 Anoka Washing- Hennepin Ram-tosey Scott Isanti Rice Dakota Chisago Goodhue Wabasha >300 Pipestone Murray Cottonwood Watonwan Blue Earth Waseca Steele Dodge Olmsted Winona 5/11/2018 Rock Nobles Jackson Martin Faribault Freeborn Mower Fillmore Houston 15

16 Net Secondary Refugee Migration by State, FY2014 Minnesota has the highest number of incoming secondary refugees! Source: The Office of Refugee Resettlement, ORR Indicators for Refugee Stakeholders June 2015.

17 Languages Children from Nyarugusu Camp, Tanzania Photo by Patrick Willocq

18 Languages* Used by Primary Refugee Arrivals to Minnesota, [CATEGORY [CATEGORY [CATEGORY NAME], [VALUE] NAME], NAME], [VALUE] [VALUE] ([PERCENTAG [CATEGORY ([PERCENTAG ([PERCENTAG NAME], E]) [VALUE] [CATEGORY ([PERCENTAG NAME], E]) [VALUE] ([PERCENTAG E]) E]) E]) [CATEGORY NAME], [VALUE] [CATEGORY ([PERCENTAG NAME], E]) [VALUE] ([PERCENTAG E]) [CATEGORY NAME], [VALUE] ([PERCENTAG E]) N=33,526 [CATEGORY NAME], [VALUE] ([PERCENTAG E]) *Language used during the domestic refugee health assessment, which generally occurs within 90 days of US arrival. Language is only available for refugees who initiated a refugee health assessment and used an interpreter. **Other includes Acholi, Afar, Amharic, Anuak, Bali, Bari, Bassan, Bhutanese, Chin, Chinese, Dinka, Farsi, French, Fula, Ghanaian, Gio, Gola, Haitian Creole, Ifran, Indonesian, Italian, Kachin, Karenni, Kayah, Khmer, Kinyabwisha, Kinyarwanda, Kono, Krahn, Kuranko, Kurdish, Liberian, Madi, Mandingo, Mano, Mende, Moldovan, Mon, Nuer, Oromo, Pashto, Romanian, Russian, Sarpo, Sign Language, Spanish, Sudanese, Swahili, Thai, Tibetan, Tigre, Tigrignae 5/11/

19 Top 15 Languages in MN in 2016 from Census & DHS Rank Language Estimate 1 Spanish... 83,799 2 Hmong... 24,584 3 Cushite*... 18,500 4 Vietnamese... 13,241 5 Chinese... 9,922 6 Russian... 6,463 7 Laotian... 5,053 8 Amharic*... 4,395 9 Karen*... 4, German... 4, Mon Khmer, Cambodian... 3, Arabic... 3, French... 3, Korean... 2, Tagalog... 1,800 Resource for Entities Covered by Section 1557 of the Affordable Care Act Estimates of at Least the Top 15 Languages Spoken by Individuals with Limited English Proficiency for the 50 States, the District of Columbia, and the U.S. Territories. *An asterisk after the language denotes that the data came from the detailed language data in the 2013 ACS 5 year estimates (released in Oct. 2015) rather than from the 2014 ACS 5 year estimates (released in Dec. 2015). Cushitic languages include Somali and Oromo

20 Applying the Health Equity Lens

21 Health Equity Work Internally Examining and revising how we promote and give grants Post job postings in diverse job posting sites and listservs Advertising student worker positions at more schools In IDEPC Division: Unit liaisons Section Liaisons Division Workgroup Unit level Health Equity (HE) Workgroups: What are three efforts/changes each year to promote HE in daily work? Standing portion during division meetings Division Workgroup allows champions to rise up and work together Agency wide workgroups to tackle bigger initiatives Any examples from others?

22 Health Equity In Partnerships Bringing partners on early and often Not to just approve something when it is in final stages Funding when possible Building capacity with partner orgs Win/Win Shared learning = deeper understanding Recognizing wisdom and knowledge within communities Priorities of community vs. priorities of your funded work Any additions? From Community Campus Partnerships for Health

23 Multicultural Resources, Strategies & Partners

24 Reaching Cultural Communities Limited funds = being thoughtful on which languages for your region Use language data to help guide Use context relevant to each community Example: Context vs. Level of Information Use culturally appropriate and relevant images Take time to strategize how best to reach community. Take into account: Years in U.S. Fluency Literacy Target subgroup can change strategy Collaborate each partner brings their strengths!

25 Health Education MDH RIH Community Health Education (CHE) Project Partner with and FUND refugee and immigrant led community organizations Activities include radio and TV shows, presentations, groups, etc. Variety of topics covered, such as mental health, hepatitis B, healthy lifestyles, flu Other Health Education Activities Health curriculum for English language learners Community events: health and resource fairs Hmong Health Care Professionals Coalition Karen Organization of Minnesota Southside Center Adult Education

26 MDH Diverse Media Campaigns MDH RIH works with over 25 diverse media vendors print, radio, and online New vendors: KALY Radio, Voices Magazine, Somali American Newspaper Supports communication channels among our diverse communities Great for health campaigns as well as emerging issues or emergencies

27 Other MDH RIH Resources RIH Publications Directories, Provider and Partner Information, Material for Refugee Education Metro Immigrant and Refugee Health Network (MIHRN) Since the 1980s, convening to share information and resources, network, and continue members education on immigrant and refugee health topics Listserv has 1,700+ members, sharing biweekly updates listing diverse community events, job and grant opportunities, resources, and other information related to immigrant/refugee health

28 Multicultural Media Partners & Events Radio KFAI Fresh Air Radio Programs in a variety of languages Events Twin Cities World Refugee Day Sunday, July 15, 2018 Resource Fair / Online and Print Media African News Journal anjnews.com Asian American Press Mshale Mshale.com

29 ECHO (Emergency, Community, Health, and Outreach) tpt Multilingual health, safety, and emergency education Video: Full length and shorts in a variety of languages Available on YouTube Bilingual cultural teams Partners with sponsors and subject matter experts Cultural Trainings Cultural information sheets on local immigrant communities

30 Collection of 18 independent community radio stations across MN Including 4 tribal run radio stations, KFAI, and KALY Somali American Radio Can do campaigns as well as in depth, targeted message creation Tells a story or shares perspective

31 Stories and Strategies for Reaching Specific Immigrant Communities MDH and Ramsey County staff on Hmong Radio to discuss TB

32 Hmong Community Hmong Freedom Celebration, July 4 th, 2014 Source: Ackerman + Gruber/For MPR News

33 Hmong Community

34 Reaching the Hmong Community Community Partners Hmong American Partnership Hmong Health Care Professionals Coalition (HHCPC) Current Secretary: Kab Nras Lee, Community Events Hmong Freedom Celebration/Soccer Tournament 4 th of July weekend each year Hmongtown Festival Hmong New Year

35 Reaching the Hmong Community (cont.) Online and Print Media Hmong Times (Print & Online) Steve Wetzler, Hmong Today (Print) Wameng Moua, Radio KFXN Hmong Radio AM690 Asian American Broadcasting, LLC. P: KPNP Hmong Minority Radio AM

36 Engaging the Hmong Community: TB Key Takeaways Increase in TB and MDR TB cases among Hmong elders Trying to overcome: stigma of disease misinformation Created and receiving guidance from Hmong TB Advisory Group Utilize community s methods of communication Hmong radio, TV, newspapers, gathering spaces Creating a video that tells a story Engage and partner with Hmong pharmacists and physicians Partnering with the Hmong Council of 18 Clans and Hmong legislators

37 Burmese (Myanmar) Refugee Communities

38 Background Ongoing war and persecution by ruling Burmese military junta against ethnic minority groups within Burma Karen, Karenni, Rohingya, Shan, Mon, Chin, Kachin, and others About 150,000 refugees from Burma, mostly Karen, are living in protracted refugee situations in camps on the Thai side of the Thai Burma border Minnesota: Burmese started arriving in 2003; the Karen started arriving in 2006 As of 12/31/2017: 8,231 arrivals Fiscal Year US Arrivals , , , , , , , , , , ,347 Total 161,304 Source: Human rights watch and US State Department, and Office of Refugee Resettlement

39 Karen Community

40 Reaching the Karen Community Community Partners Karen Organization of Minnesota (KOM) bi monthly Karen Culture Presentations Register through website Community Events KOM Gala Karen New Year (Jan 1 st )

41 Engaging the Karen Community: Bed Bugs & Orthene Bed bugs remain an issue among many communities, including the Karen Alerted that Orthene was being used to clear home of bedbugs Issue in getting access into homes Partners Karen Organization of MN MDH Lead/Healthy Homes MDH Refugee and International Health MN Department of Agriculture Ramsey County Public Health University of MN Innovative Plan Zip Code Leaders Train the trainers Supply equipment to remove Orthene from homes

42 Latino Communities Cinco de Mayo celebration in St. Paul Source: el MN de Hoy

43 Spanish Speaking Communities

44 Latino Community Source: Star Tribune/U.S. Census Bureau

45 Reaching Latino Communities Community Partners CLUES (Comunidades Latinas Unidas en Servicio) Consulate of Mexico in St. Paul Minnesota Council on Latino Affairs Community Events Cinco de Mayo (St. Paul and Mpls)

46 Reaching Latino Communities (cont.) Online and Print Media El MN de Hoy (Online daily) Gustavo Mancilla, La Prensa de Minnesota Latino American Today Rick Aguilar, Vida y Sabor Steve Wetzler, tcbmarketing@gmail.com Radio La Raza, 95.7FM, 1400 & 1470AM info@laraza1400.com Radio Rey, 630AM Felicia Ortega, felicia@radiorey630am.com Television / Online Telemundo MN KNJK TV 25 Armando Quintero, General Manager, armando@telemundomn.com

47 Engaging the Latino Community: Flu Shots Minnesota Immunization Networking Initiative (MINI) Collaboration with MDH, Fairview, and many faith based and community orgs, including churches serving Spanish speakers Building on strength of church and church leaders within community Trusted messengers Already sharing health information Faith partners announce flu clinics in advance, host clinic before or after service Many churches have well attended health fairs

48 Somali Community

49 Background ocivil War in 1991 By 2009, 678,000 Somali refugees under responsibility of UNHCR omostly coming to US from refugee camps in Kenya and Ethiopia omn has largest Somali population in the US osomalis started arriving to MN in 1993 oas of 12/31/2017: 23,914 MN arrivals Fiscal Year US Arrivals , , , , , , , , , , , ,020 Source: United Nations High Commissioner for Refugees and Office of Refugee Resettlement

50 Somali Community

51 Reaching the Somali Community Community Partners Confederation of Somali Community in MN mn.org/ Ka Joog Somali American Parent Association Community Events Somali Independence Day Saturday, June 30 th, 2018 Part of Somali Week, events through Mpls and St. Paul Fanka Arts Programming Pics from Somali Week website

52 Reaching the Somali Community (cont.) Television, Online, and Print GeelTV (St. Cloud) Haji Yussuf, ; Rochester Somali TV Contact Abduallah Hared, ; The Somali American Newspaper Contact Warsame Guled ; admin@thesomaliamerican.com Somali TV Contact: Siyad Salah siyadsalah@hotmail.com Tusmo Times Abdirahman Mukhtar, abdirahmanmukhtar@gmail.com Radio KALY Somali American Community Radio, 101.7FM Mahamed Cali, mcali@kalyradio.org KFAI Somali Maanta program on Sundays

53 Engaging the Somali Community: Measles Key Takeaways Utilize community s methods of communication Radio, TV, phone lines, newspaper Elevate expert voices from within community Radio appearances on KALY Somali Community Radio Engage and partner with Imams Pairing imams and physicians or other experts Lots of effort to dialogue with parents to understand school exclusions Increase agency capacity as Somali staff were much more effective than using over the phone interpretation Support community partners, sometimes from behind the scenes only

54 Thank you! Danushka Wanduragala International Health Coordinator MDH Refugee and International Health Program Website: Phone: or

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