Engaging Our Diverse Communities: Demographics, Strategies, and Stories

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

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

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

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

Total Arrivals: 53,716 Primary Refugee Arrivals by State of Initial Resettlement, October 2016 September 2017 5/11/2018 5 Source: Refugee Processing Center/WRAPS

Refugee Arrivals to MN by Region of the World, 1979 2017 8000 7000 6000 5000 4000 3000 2000 1000 0 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 Southeast Asia Sub Saharan Africa Eastern Europe FSU Middle East/North Africa Other 5/11/2018 6 Number of arrivals

Top 10 Countries of Origin among Primary Refugee Arrivals, Minnesota, 1979 2017 1. Somalia 23,914 2. Laos (Hmong) 22,033 3. Vietnam 15,075 4. Former Soviet Union* 9,077 5. Burma 8,231 6. Ethiopia 6,254 7. Cambodia 5,003 8. Laos (Other) 4,927 9. Liberia 4,022 10. Bosnia and Herzegovina 2,380 11. Other 7,667 Total 108,583 *Includes Armenia, Azerbaijan, Belarus, Estonia, Kazakhstan, Kyrgyzstan, Latvia, 5/11/2018 Moldova, Russia, Tajikistan, Ukraine, and Uzbekistan 7

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 1979 2016 N=107,684 Ro ck Fillm ore 5/11/2018 8

Primary Refugee Arrivals to Minnesota, 2004 2017 [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

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 5/11/2018 10

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 1-10 11-30 31-100 101-250 251 500 >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

Top Minnesota Counties of Primary Refugee Resettlement, 2017 1. Ramsey 456 2. Hennepin 238 3. Stearns 84 4. Anoka 77 5. Olmsted 60 6. All Other 184 Total 1,099 5/11/2018 12

200 Country of Origin by County of Resettlement, 2017 150 150 100 50 Burma Somalia DR Congo Ethiopia Afghanistan 100 50 Somalia Ethiopia Afghanistan Other Other 0 100 Ramsey N=456 0 40 Hennepin N=238 80 30 Afghanistan 60 40 Somalia Other 20 Iraq Other 20 10 0 N=84 N=77 0 Stearns Anoka 5/11/2018 13

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]) 5/11/2018 14

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 1-10 11-20 21-40 41-100 101 300 >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

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.

Languages Children from Nyarugusu Camp, Tanzania Photo by Patrick Willocq

Languages* Used by Primary Refugee Arrivals to Minnesota, 2004 2016 [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 5/11/2018 18

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*... 4,045 10 German... 4,032 11 Mon Khmer, Cambodian... 3,691 12 Arabic... 3,251 13 French... 3,187 14 Korean... 2,146 15 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

Applying the Health Equity Lens

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?

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

Multicultural Resources, Strategies & Partners

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!

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

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

Other MDH RIH Resources RIH Publications www.health.state.mn.us/refugee 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

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

ECHO (Emergency, Community, Health, and Outreach) tpt http://www.echominnesota.org 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

Collection of 18 independent community radio stations across MN http://www.ampers.org/ 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

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

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

Hmong Community

Reaching the Hmong Community Community Partners Hmong American Partnership http://www.hmong.org/ Hmong Health Care Professionals Coalition (HHCPC) Current Secretary: Kab Nras Lee, hmonghcpc@gmail.com Community Events Hmong Freedom Celebration/Soccer Tournament 4 th of July weekend each year Hmongtown Festival Hmong New Year

Reaching the Hmong Community (cont.) Online and Print Media Hmong Times (Print & Online) http://www.hmongtimes.com/ Steve Wetzler, tcbmarketing@gmail.com Hmong Today (Print) Wameng Moua, hmongtoday1@gmail.com Radio KFXN Hmong Radio AM690 Asian American Broadcasting, LLC. http://hmongradioam690.com/ kongsuex@yahoo.com, P:612 810 6412 KPNP Hmong Minority Radio AM1600 http://kpnp1600.com/ Peter@kpnp1600.com

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

Burmese (Myanmar) Refugee Communities

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 2006 1,612 2007 13,896 2008 18,139 2009 18,202 2010 16,693 2011 16,972 2012 14,160 2013 16,299 2014 14,598 2015 18,386 2016 12,347 Total 161,304 Source: Human rights watch and US State Department, and Office of Refugee Resettlement

Karen Community

Reaching the Karen Community Community Partners Karen Organization of Minnesota (KOM) http://www.mnkaren.org/ bi monthly Karen Culture Presentations Register through website Community Events KOM Gala Karen New Year (Jan 1 st )

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

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

Spanish Speaking Communities

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

Reaching Latino Communities Community Partners CLUES (Comunidades Latinas Unidas en Servicio) http://www.clues.org Consulate of Mexico in St. Paul https://consulmex.sre.gob.mx/saintpaul/ Minnesota Council on Latino Affairs http://www.mcla.state.mn.us/ Community Events Cinco de Mayo (St. Paul and Mpls)

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

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

Somali Community

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 2005 10,405 2006 10,357 2007 6,969 2008 2,523 2009 4,189 2010 4,884 2011 3,161 2012 4,911 2013 7,608 2014 9,000 2015 8,858 2016 9,020 Source: United Nations High Commissioner for Refugees and Office of Refugee Resettlement

Somali Community

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

Reaching the Somali Community (cont.) Television, Online, and Print GeelTV (St. Cloud) Haji Yussuf, hajiasad123@gmail.com ; 320 259 7177 Rochester Somali TV Contact Abduallah Hared, anhared@somalcrs.org ; 507 271 7759 The Somali American Newspaper Contact Warsame Guled ; admin@thesomaliamerican.com Somali TV Contact: Siyad Salah siyadsalah@hotmail.com Tusmo Times http://tusmotimes.com/ Abdirahman Mukhtar, abdirahmanmukhtar@gmail.com Radio KALY Somali American Community Radio, 101.7FM http://www.kalyradio.org/ Mahamed Cali, mcali@kalyradio.org KFAI Somali Maanta program on Sundays

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

Thank you! Danushka Wanduragala International Health Coordinator 651 201 5587 Danushka.Wanduragala@state.mn.us MDH Refugee and International Health Program Website: www.health.state.mn.us/refugee Phone: 651 201 5414 or 1 877 676 5414