2035 Minnesota Cardiovascular and Diabetes Health State Plan

2035 State Cardiovascular plan 

Recorded on: Oct 6, 2023

Published on: Oct. 8, 2023

Stanton Shanedling: Hello, everybody. Welcome to health chatter today is a, in my estimation, a special edition, because we're gonna be dealing with 2 subjects, namely, cardiovascular health and diabetes, as it relates to a new brand new State plan that's being published, or was published just a couple of days ago Stanton Shanedling: in the State of Minnesota. We have 2 great guests with us. We'll get to those 2 great people in just a moment. In the meantime, as always, I like to recognize our illustrious staff that without them Clarence and I would be lost altogether. We have great researchers that do background research and give us some good talking points that include Maddie Levine Wolf, Erin Collins, Sheridan Nygard, and Deondra Howard. Matthew Campbell is our producer Guru. Without his logistics all these shows would not get out to you the listening audience. So thank you to Matthew, and then finally shared in my guard, helps us not only with research, but also marketing the show. So thank you to everybody. Then, of course, there's my partner in crime in getting health. Chatter out for all of you and that's Clarence Jones, Clarence and I go back a long ways. He's a great community health organizer and professional, and I really appreciate his insights. I've learned a lot from him. Whoa! All these shows that we've done so with that. Let's get on to. Oh, by the way, we have a good partnership right with human partnership, who actually does some sponsoring of this show. You could visit them at huemanpartnership.org

clarence jones:  Yeah, they. I always get that wrong doing it.org partnership dot org check them out.

Stanton Shanedling: Great community organization. So with that, let's get into our our great people that are with us today, and that includes 2 colleagues I've worked with for a long time. Doctor Courtney Jordan. bachelor, who'swho's got her? Md. Actually got all of her training at the University of Minnesota medical degree her degree and public health and epidemiology and public policy. She's born certified internist cardiologists, and is involved in a lot of different things  way beyond frankly just the field of cardiology, her insights and her passion

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Stanton Shanedling: to try to affect change, to make us all healthy is is really second to none. Her you'll see her her total bio in our on our website. So check it out. But just a dear, dear friend and colleague. So court B. Thank you for being with us. And then there's Jim Peacock. Jim and I have a great history we work together for for many, many years  at the Health Department and the cardiovascular unit. He! He started there back was in 2,007, wasn't it, Jim? And it's to be asked with you the listening audiences probably the best hire I ever did. He and I were like linked at the hip and we were.  It's just incredible interactions that that we have had over the years and from different perspectives. But his, you know, his training is a doctorate in in. in epidemiology and his master's in in public health. And I always have appreciated Jim's perspective as an epidemiologist, and he recalls. This is like, you know, it's one thing to know the data, and it's and it's and just to present that. But he always has always carried the torch of. So what? How is it that we can, based on the knowledge that we get from analyzing all this information? How is it that we can affect change, and he is really, really carry that towards professionally. And and I've I've greatly appreciated that perspective, not only working with you, but also the torch that you carry on at the Health Department in the cardiovascular Health unit. So thank you both for being with us today  Alright. So let's get this ball rolling here.So you know, I thought that and and actually both of you have involved. Historically, I thought maybe first to give the listening audience perspective historically. And we've had plans and what drove the creation of State plans, and mostly was first they were divided up. If I remember right, there was the cardiovascular health plans, and then there was a diabetes plan. But we'll get to the combination in a minute. But: what really drove the the necessity. historically, of creating the plan. Any perspectives on that either one of you can just chime in.

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Jim Peacock: But I mean I could jump in first, Stan, and thanks for that really warm and introduction there. yeah, from a State Health Department perspective. When I came to Mdh. In 2,007 we were admiss. We were in the middle of a implementing a state plan, and I think that they largely were born, at least here in Minnesota, out of a necessity as a deliverable for the funding we receive from the centers for disease control and prevention. Cdc tends to fund programs in in silos within a disease. So there's a Cvh program, a diabetes program, a cancer programs, and so on. And an important part of receiving that funding was to create a coordinated, comprehensive plan for how you'll address those conditions in your State, bringing in community clinical public health and support and information to to design that Cdc has moved away from that in recent years and requiring states to do that. But I think what was exciting here is that, you know. What is it? 4 years ago, Pre Covid? We asked that question of folks in cardiovascular health if they felt it was important, and we heard a resounding. Yes. even though it's not required by the Funder for Mdh's work that it was an important way to bring together many partners across Minnesota.

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Stanton Shanedling: Yeah. So, Courtney. You've been involved in the history you know, from  different angles, frankly. And your really good, direct questions that really drove the the, the development of plans. You often hit these questions, you know. You know they hit the nail on the head. So as you reflect on the previous plans, and then maybe morphing into the one that we're dealing with. Now. where's your head at? Where? How do you think? Historically, things have morphed or change going forward?

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Courtney Jordan Baechler, MD, MS: Yeah. Well, it's fun to hear, you know, just like Jim saying your intro into all this, because I realize that Jim and I actually started at the same time in terms of my involvement with the Stroke and Prevention committee was 2,007, so I remember you getting introduced. It was either my first or second meeting, and how excited I was that you were joining. Now, just to put this in context. I was in the middle of my epidemiology and cardiology fellowship, so I think my mind had not been co completely corrupted by medicine. Yet so I did choose during my intern year to go get my Public Health Training Cause. I realized how broken I felt the system was, but what I would say is, at that time I had just come back from Finland, where I got to see the North Korea project, and the way that they had it from a country level. Improved cardiovascular disease mortality by 85% over 25 years. So I knew it was possible. And I am a hundred percent being honest with you, that the one thing that gave me the most excitement and optimism was the Statewide Committee, where we came together around prevention of heart disease and stroke, because, as a clinician that rotated through 5 different of the leading hospitals in the twin cities, you realized how disjointed and fragmented. It was for the human being, the community, you know everyone and and largely who we were, and we're not seeing and what stage we were, and we're not seeing them so.

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Courtney Jordan Baechler, MD, MS: I just think the infrastructure that the Department of Health and both you, Stan and Clarence has been a part of all of this and Jim leading. Now that for me, it's been a really exciting to know that we've had this infrastructure in place, that, despite funding, changing we still have continued it. And now I'm the most excited I've ever been with what the 2,035 plan looks like, because it looks very different than the plans have looked in the past, because of whose voices and thoughts have been involved, which was nobody's fault. But it's just exciting to see where we've evolved and the direction we're heading.

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Stanton Shanedling: Yeah, Clarence.

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clarence jones: So both of you talked about joining the the program at 20 7. And now it's 2023. And though we talked about the fact that there have been a lot of changes I just wanna know to walk me through. And because I'm a community person, walk me through the the changes that have occurred in terms of community engagement and community input. As we've talked about this plan. And you know where we at today. And how is the community gonna be engaged in is that we haven't gone very deeply into the plans yet. But I but I think from a community perspective, all of this information is coming out, you know, is that where is that voice being heard or is it being heard?

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Jim Peacock: Yeah, II can take us an attempt at that answer first. Clarence, you know the the plan. When Courtney and I joined back in 2,007 and Courtney, I'd I'd forgotten about that. So thank you for bringing that back to mind for me that we have a history going back 16 years. The the the plan that was developed that was in place from 2010 through 2020 had a lot of engagement from many members of the professional clinical community, from academic settings, from public health, and not a lot of input from folks in the community that are working with populations that are experiencing disparities or populations that lack access to services. And this change that we made with this new plan being developed as we centered the community voice in not only how we collected information, the people we brought together to discuss what was really going on. What do people need to be healthy in the community many times people aren't thinking about? Oh, I've got heart disease, but they're thinking about. Oh, my! My blood pressure might be a little bit higher. I'm not able to eat the healthy foods, or I don't have access to those. We wanted to bring those voices in to identify community based solutions? To these problems that are happening way before someone would intersect with the healthcare system. How can we help someone feel good and have access to those things to be healthy. So those voices were brought in initially. And that's how we centered the plan outcomes which there are 10 of them. I think we'll maybe talk a little bit about those later. But they're really centered in a way that makes it so many different people could look at the plan and say, Hey, there's something I can do in this space. I'm not a clinician. I don't actually work in health. But I work in a small community, and I can make things better for the people that live here. By offering healthy fruits and vegetables in my store, or by providing a place for people to be physically active. Where they feel safe to do that and support it. To do that. Those are just some small examples.

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Stanton Shanedling: So what are the one of the keys? You know? Certainly, anybody with some health education background will say that in order. For frankly, either an individual  or in this sense a community to be involved. It. It's one thing to show interest, it's another to show ownership and move with it. Okay, so, Mike, my question is. you know, as I review the plan. There are great goals. There are great strategies as you developed them all and were engaged with community representatives. Did you get a sense that they're going to run with it? They're really gonna embrace it and run with it. Or  you know, what we all hope is that they aren't just phrases on a piece of paper. But they're really something that people can do. People and communities organizations can really get engaged with and excited about. Did you get that sense?

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Courtney Jordan Baechler, MD, MS: I would say, in the conversations that we've had so far absolutely to the point that we have to cut people from talking about where they see potential partnerships or ways that they'd like to use this framework and these goals to implement change. So I think that there is a lot of enthusiasm for how we can do things differently. And again. I think, in part because  I think we'll talk about the goals and the outcomes are different. It doesn't mean that they won't. Our goal right is that they lead to these other things that we've been measuring for a long time. But rather than talking about an optimal vascular score to a community member which isn't really right, how most people wake up and think there's things about investing in partnerships with the community, you know, in improving and changing and diversifying who is a part of healthcare making access easier. I mean all these things that people say, yeah. I waited an hour on a 15 min lunch break yesterday to try to get into my primary care, and ultimately just sat on hold the whole time, you know. Well.there you go like that's not gonna that's not gonna work, but when they hear things that resonate with them, there's interest.

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Stanton Shanedling: So I you know, we're talking, you know, to to our audience out here. We're talking with 2 epidemiologists here, you know, who have a strong shall we say data? Strong, in inquisitive Sherlock Holmes types of minds. Okay, so I'll be honest with you that the situation in the State of Minnesota isn't great. You know. It was reported in the plan. Correct me if I'm wrong, that you know there are over 8,500 residents that died from cardiovascular disease 2,400 around that that died from stroke. 1,500 died from complications of diabetes. you know, while the years that certainly I was involved in the arena. The question that remained is from an epidemiological stand. Are things getting better? Are things getting worse? Are we at the same place, or do we just assume that we're all gonna die from something and guess what those happen to be, you know, for human beings at this stage of the game, at least cancer number one in the State of Minnesota. Then cardiovascular stroke diabetes are we just gonna deal with it like that going forward from? And I'm talking with from an epidemiological standpoint. 

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Jim Peacock: so, yeah, Stan, it's a It's an interesting trajectory for these conditions. Sort of the deaths in Minnesota. For cardiovascular disease especially, and for stroke to some degree.  All across the country we saw rapid declines, really big improvements for decades in the death rates due to these conditions, and that's due to a number of things reduction in the amount of people smoking, the introduction of new therapies like high blood pressure medications or statins as a way to manage and control the risk factors that lead to those conditions. But that has really flattened out since about 2010 in every state in the country. Minnesota, historically, has had the lowest death rate in the country due to cardiovascular disease. I believe that's still the case. But the data that you quoted are from 2021. Although not released yet. Provisional data from 2022 show a pretty large increase in heart disease deaths in Minnesota. last year every state in the country has seen this happen in different ways and at different times. I will say Covid has had a very large impact on chronic disease. Deaths and cardiovascular disease, diabetes and stroke are part of that equation. Those have gone up fairly strongly. In all parts of the country. Since 22020 So it it's really it's not that we're at an inflection point but we really are at a point where those trends that had existed for decades where we could sort of rely on improvements in health.They just aren't happening anymore. And Covid has, I think, laid bare, not only it really is laid bare. A chronic disease epidemic in the United States, where many people have poor risk factor profiles in ability to access healthy foods or : find a place to exercise lack of awareness about whether or not they have high blood pressure and or not able to control that. If they are on medication it's it's it's a larger problem, the United States than many other Western industrialized countries. And that's evidence in the fact that our our death rate or our length of life has has been slowing in this country compared to other places. We're falling behind a lot of other places With similar economies and some similar levels of development.

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Stanton Shanedling: Yeah, what do you think, Courtney? You agree with all that

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Courtney Jordan Baechler, MD, MS: I do, but I don't well, II don't. Wanna Miss Clarence's question. I just I was. What I was gonna say is: yes, Jim summarize the data perfectly and a couple of things that I would just add on to is number one. When we look at that data, the disparities within it of who's doing decent living with chronic disease and who's doing poorly and dying more prematurely. Definitely, disproportionately impacts black and brown people. Number one. That's a huge issue. It's particularly a really big issue in Minnesota. We have some of the largest disparities based on our overall, fairly great outcomes for white people. We do not see the same for our black and brown populations. So that's a big issue. And then the other thing that I would just emphasize as somebody who is seeing people on the clinical side. People don't feel well. So, even though our for a couple of decades our life expectancy had been improving for folks with chronic disease, that we had been managing cardiovascular and diabetes better. People do not have a high quality of life with these coexisting diseases. And this is this, as you're talking about this inflection point of  we're off the rails. We have got to do more upstream primary and secondary prevention, and that is what the community has been asking for, loud and clear. Yes no one wants to die from heart attack, stroke, or diabetes, complications, but in between they don't wanna feel like they're walking through, you know, cloud their whole life because they're on 15 medications to manage this disease process, which is what it is for a lot of people who have these 3 conditions. So we have a lot of work to do to actually again respond to what people are asking for versus responding to the disease process. Those are 2 different things, and I think challenging, as someone who was trained in a Western medicine. That's not what we learned to do in medical school. So we we got a lot of change that has to happen.

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Stanton Shanedling: you know. Let's link to us. I'll get to a second. It's just the idea of It's a balance in my mind between urgency, which we're seeing in A, in A, in a lot of situations and motivation. Motivation is is a key not only from an individual standpoint, but also a community standpoint in order to engage in essence in this case, around a plan. Clarence.

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clarence jones: yeah, I wanna talk a little bit more about the community engagement aspect of it because you, I think you made it very clear that you know we're growing and not in the right kind of way around these issues. And so in order for us to be able to address them, we're gonna have to do something a little bit different. And I know that this plan get there, because you talk a little bit more specifically about the the need for community engagement, but also a strategy for engaging people and making them feel like they are part of the solution and not just a problem.

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Jim Peacock: Yeah, I can. I can start on that clearance. So  the point of this plan. And we, I think we list this, how we we described it as a call to action for communities. And we healthcare systems, community and organization leaders. But we specifically put communities first in that list as Courtney just described. Communities are much closer to understanding what's going right. But also what's not going right in in in their community. And we want to make sure that  this plan is designed in such a way that it's not just the State Health Department. Or it's this esteemed group of committee members that helped finalize this plan making decisions. It's creating the conditions for communities to come to us and say, we have a solution for this problem. We've identified a way to make our community members feel better, or we've identified a way to connect people with the right type of resource, so that they're not experiencing 15 medications and living in this cloud as Courtney just described.

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Jim Peacock: So the the goal of this plan is really to grow and change over time. And it's an invitation for more community input. It's not just something we want to sit on a website and not be changed for the next 15 years, or however many years But we wanted fit to grow and change. And it's community input to tell us what's working and what's not working that is going to be so important for making this an impactful plan, not only improving outcomes for people: but in solidifying and increasing the types of partnerships that government, community organizations, healthcare systems, public health agencies can have with one another to affect positive change.

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Courtney Jordan Baechler, MD, MS: And if I can just say one more thing to to that, Jim, and to answer your question, Clarence, one of my favorite systems that I have seen within the us is in Alaska, Nuka, or the South central Foundation, which has been a federally qualified clinic for decades, or, I should say federally qualified clinics received dollars from DC. You know, over to Alaska, dictating how health care should be done there as you would expect all the challenges that we face largely around cardiovascular stroke and diabetes and a few decades ago they decided to actually listen to what the community said. While the healthcare system was saying, we need better diabetes control. We need better blood pressure control. We need all, you know all these different metrics, the community said, what we want help with is domestic violence, and you can, you know, keep saying all this. But this is actually the number one thing impacting us. : And as soon as the health systems and, you know, largely, collectively, change to listen and respond. Then the community there was different trust. There was different partnerships and relationships that responded collectively to how best they could engage around diabetes, heart disease, and stroke, and now they have lower er rates. They have better control of these diseases. They have all sorts of metrics that we consistently look at financially and other ways of who's using what, but it was a different model. And took totally reversing how things were done, because I think, on the clinical side it was so hard for people to get to. Well, is that our lane? I mean the number of times I hear. That is that our place to be in? You know we're not gonna fix homelessness, Courtney, you know. That's not we. We treat cardiovascular disease. But it turns out right, as everyone on this call knows that to the individual experiencing this. That's what is, of course, most important to them, or whatever the case is, is that social need? And certainly, as it relates to these healthy behaviors that we're talking about all the time. You can't right. We can't expect people to do any of this if these basic needs are not met.

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Stanton Shanedling: you know. It's interesting. You know, it's a really good example of People are really engaged with things that are really urgent: in their mind, and if you show them, first and foremost that all right, let's tackle that. Then they could be open to a true partnership in dealing with all the other stuff  that we also have to address health wise. But I think urgency for a lot of people is is right up there, you know, gun violence. If you don't solve that in our community the heck with cardiovascular, the heck with diabetes, let's deal with that first, and then we'll get to it. So it might be this kind of one at a time in order to help build trust.: So you know what what's really cool to me is you know. First of all, you have 3 3 major goals, but then you get into your your outcomes and and investing in partnerships which I think we've alluded to a little bit here. It's like. you know, we've had in our show, Clarence and I. We talked about the issue of trust and how it is that you build a just a partnership with your primary care provider. Yeah. I mean, you could almost use that as an illustration of how you know, and maybe bring it up a notch in a community. How is it that we could build trust with one another so that we can work together in order to do these things that are outlined in the plan. A perspective that I have is this, that the previous plans, kind of created a common denominator of things that we needed to address. And now we're really coming up the funnel, so to speak, and really addressing and hopefully addressing the things that are.

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clarence jones: We have to address. You know, disparities, social determinants of health, etc. Clarence. Yeah, you know, I think one of the things that I like about this. This broader view of addressing these diseases is the fact that they're so interconnected with other things. You know you you talked about Cordy, about the the group in Alaska. You know we we talk about, you know, and talk about dementia in in my group. Okay, a lot. But but diabetes type 3 to diabetes is is is part of the Hearing is part of that. I mean we I mean, you know we're getting more out of those those lanes, and you know which lanes are important as well. But we're trying to get to the finish line. and I think it's only by running alongside each other versus bumping into each other. I would want to be able to make that. And so, you know, I'm hoping that with this particular plan we, we are talking more about the social determinants of hell. We talk about that broader perspective. And then we're really making people understand how important it is for us to work together versus trying to be. You know, you know, I this is just me, and that's you, you, and so like that. So I'm hoping that with this plan and looking forward to working with this plan to show the importance of working together, and then how we are, how we definitely are interrelated and these diseases impact one another. So that's just my quick community comment.

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Jim Peacock: hey, Claire, I wanna react to that comment for a second. And I wanna verify this with Courtney. But Courtney, if I recall correctly investing in partnerships this very first outcome here in the plan. That's what our committee members were most excited about and felt intense passion around. This is the place we need to start. And it makes sense. Because, as you've said, Clarence, we need to build trust. And that trust is multiple directions. And there's a real opportunity in a an interest in doing that from all perspectives of the folks that contributed to putting this plan together. So we're we're excited about that. We feel like we're starting from a really good place where everyone has sort of a common understanding and interest.

Stanton Shanedling: So far our listening audience. I'll tell you that there's, you know, there's 10 basic when we call it outcomes that you're looking for here. Obviously, we look at investing in partnerships, and I'll just, I'll just kind of react to these kind of in the Gestalt of it all. working towards health equity, sharing power to effect change, creating systems that improve access to care, improve health data collection, which, by the way. Yeah, epidemiologists, I'm going to get back to you on that one in a second, expand and diversify health care, expand health education, support the implementation of community led programs enhance delivery of quality, whole person care and ensure. All people have access to the necessary resources. Okay, so : Courtney and Jim just respond overall to those outcomes that we're trying to do.

Courtney Jordan Baechler, MD, MS: I guess I would just say that it just makes me so excited because this this is something that I can share with any audience. Right? Sometimes I feel like when I bring things from the health side of things. The health system side of things. I have to justify or decode when I'm with community facing, and then vice versa  If I come up with things on more, with nonprofits and different community facing folks. I have to explain them to the clinical side. So somebody who lives in both worlds I love that this is very unified, and it's, you know, just to some of the other points that you brought up. Clarence. It's this could be any disease process. Yes, we are talking about cardiovascular stroke and diabetes. But we're talking about whole person. We are recognizing that people don't like having to see all these different specialists and kind of well, how does that impact my mental health. How does that impact this? And so I just, I'm I'm super proud of the work that we've done. I feel like it really is a great framework to move forward in: in getting to these outcomes. And that, I hope resonates with a lot of people. But, like Jim said. We don't think we're perfect and we are interested in wanting to adapt and change as people see fit. If we miss the mark

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Jim Peacock: and people cause. This is a podcast you couldn't see me shaking my head vigorously. During what Courtney just said, there, yeah, okay, there we go. So what I would add to it as well. Is these these 10 outcomes, if you dive deeper into some strategies that underneath them there's so much overlap, and that was intentional. We wanted people to be able to see work that maybe they found in one part of this plan intersecting with other parts, so it could open up the way that it could deepen the impact that their work could have. It could expand their ideas around, how does they can improve health? And well, being in the community. It can potentially unlock and open doors for new partnerships that can strengthen that impact. That a community or health system or public health is having.

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clarence jones: That's the question. Okay? Alright. Here we go. Here we go. I want to ask this question in my mind. How did cardiovascular help. and diabetes  joined together to work on this plan. What? What was the impetus behind that?

Jim; II can jump in first, but II I'd like Courtney to follow up on. That is when people are talking about how they feel well or don't feel well, and they go to the doctor. They come like. Oh, my blood pressure is high! Oh, what they called! They said. I might have something called pre-diabetes, too. These conditions operate together.

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Jim Peacock: and many people who have cardiovascular disease. Also experience diabetes or prediabetes. Folks that aren't able to manage their blood pressure often have another one of these. These conditions are so intersecting.

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Jim Peacock: We wanted to make sure that. You know, we were able to talk again about this whole person. As much as we could with these conditions that are often happening. You know, at the same time, in a person or in a family or in a community.

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Courtney Jordan Baechler, MD, MS: Courtney, how would you add clinical perspective. I would just and emphasize that the number one thing people with diabetes die from or suffer with in between them is cardiovascular disease and stroke complications. It's so connected. And, in fact, from a research perspective. Right now, what we're seeing with all these new, super expensive drugs that are coming out, these inhibitors

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Courtney Jordan Baechler, MD, MS: that were initially created to manage diabetes. And we're talking about ozmic and semi-glutide. We'll go be all those guys initially created to manage blood sugar

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Courtney Jordan Baechler, MD, MS: turns out that they had weight loss, implications. And now, oh, what did they just get an FDA approval for cardiac

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Courtney Jordan Baechler, MD, MS: prevention? So it is so interconnected that basically all the trials that we do on the clinical side. Now we look at the Slp ones that we use in heart failure have diabetes, implications in terms of improving cause. It's just it's such an interconnected process. And, in fact, from an epi perspective, the next sort of biggest proposed

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Courtney Jordan Baechler, MD, MS: issue that we're gonna have as a country is diabetes actually overtaking cardiovascular disease, which, again, isn't surprising, like we just said, because

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Courtney Jordan Baechler, MD, MS: in this case it usually comes first, and then the cardiovascular disease comes second with what we're dealing with now. With our card, with our culture of obesity and poor nutrition and poor exercise and poor sleep and high stress.

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clarence jones: I am just. I'm ex. I'm glad to hear that. And I'm I'm really hoping, because, you know, when I think about community and you know it. I mean this. This is important news for people be talking about, you know, and I'm I'm hoping that there is a a plan to to talk very clearly about the the connection between the 2, because,

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clarence jones: you know, we think of them as 2 different things.

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Stanton Shanedling: You know, it's interesting historically. And Jim, you and I can reflect on this good data and different when you get funding mechanisms that require that you have state plans. Okay? So like from the centers for Disease control, they required that the State of Minnesota in this case, actually, every state in the in the country have a state plan for cardiovascular

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Stanton Shanedling: and a state plan for diabetes. Then, when they loosened it up altogether, and they say, Well, we're not requiring that you have plans. Then that kind of opened up the gates, for, like the State of Minnesota, say, Hey, why don't we all talk together? Okay, and put it all together in one. And so, yeah, I agree with that completely, Stan. I mean it. I think it allowed us a lot more freedom to be responsible.

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Jim Peacock: and flexibility, instead of being responsive to the desires of the Cdc. Who is funding things. Cardiovascular disease funding is completely separate and distinct from their diabetes funding governments. Yeah, if I have a chance, I just wanna jump in something that Clarence mentioned a few moments ago You talked about a lot of conversations about dementia in the community. Yeah, something that we aren't talking about here. But it's it is how? What's good for your heart, and what's good for your blood? Sugar is really good for your brain, health as well. And so communicating about how all of these conditions? High blood pressure, high blood sugar, high cholesterol impact so many parts of our bodies and our ability to live. Well. there's great benefit to be talking about these as a group instead of individual, distinct diseases. There's a lot of benefit in coming together. It's it's improving everyone's health.

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clarence jones: And now I can't help. But

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Courtney Jordan Baechler, MD, MS: yeah, I can't help but just add one more thing for our for your listeners, too. Is that the number? One thing I hear from people when we wanna start a statin drug, which you know, is the number one drug that we prescribe in this country, not as cardiologist, but as anybody is. Oh, I've heard that they cause diabetes, statin drugs in trials. They showed people who are on statins.: I got diabetes 6 months earlier, and for Jim and I and anybody who's an epidemiologist. That is what we call true, true and unrelated, because people are usually walking around with diabetes for quite some time before we actually diagnose it. And so it's totally, not casually related to these drugs, and speaks more to what we are saying in that these conditions diabetes and cardiovascular disease for the individual that is living with them coincide often together. And so it really takes a more holistic look at how we prevent it, treat it effectively and prevent deaths.

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Stanton Shanedling: You know it's II know II was kind of chuckling frankly as I was as I was reading this plan? I know that epidemiologists will say that we'll ask this very question, how in the hell are we gonna measure this? Okay? And I kept thinking in the back of my head and those of you who know I've I've often signed off on emails with a with an infamous quote from Albert Einstein. who basically said, not everything that counts counts. So when you really think about that, there's some real that really intersects beautifully with with this plant. epidemiologists will say, Hey, you know what? We'll still be able to report how many people died, and how many people had heart attacks, and how many people had strokes, and it, etc., etc. We'll still be able to do that while hopefully, the success of the plan will be inherently going forward with all these different objectives and strategies. And then when we when we look at the data, we'll be able to say, Jeez, you know, something must be going on right here because we're seeing decreases in desperate decreases. So anyway, when I alright, so epidemiologists respond.

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Jim Peacock: Well, Stan, you're right. We have a lot of data systems to sort of measure disease impact through things like number of deaths, number of hospitalizations, number of people that are meeting a vascular disease target for their blood pressure medication and their stat, and so on.

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Jim Peacock: What we don't have a great time or great ability to measure is how people feel. And that's another reason going up to community and having community really lead on this plan and we don't want to be in a position as as folks that have put this plan out of deciding how to measure some of these outcomes that you described a few minutes ago. We really want the community to help tell us what is the right way to measure this community. Tell us what is real impact for the populations that you work with or in the neighborhood where you operate. We. We believe this investing in partnerships outcome, which I mentioned a couple of minutes ago is really key to developing that trust and communication so that we can together measure measure that impact. And the impact may just be who's engaged in the plan.

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Stanton Shanedling: And what are they doing? And and we're working on those systems in order to put that together, to to to communicate out the successes. Yeah, yeah, Courtney, what do you think?

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Courtney Jordan Baechler, MD, MS: I? Yeah. The only thing I would add to that is, you know, can we excuse me? Be patient and wait. Because again, we, there are a lot of examples that have shown that if you respond to what community is actually asking for, we can get to this place, but so far, you know, we've been impatient and wanting our needs. Our clinical needs met first and just met resistance. So I think I think this is really. I think it's a critical piece that we we give this time and are open to some of quote the softer metrics that might actually be more important than some of quote the hard metrics that we've done.

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clarence jones: So let me let me say this real quick cause. I know we we can come into the end of our program this conversation did not emerge like I thought it was going to. It's it's very positive, though what I want to tell you is very positive, because II think, in what you have described has been the the community engagement aspect which I, which I thought was so needed or the work that we're trying to do. I mean you have you? Have. You have not talked so much about the clinical aspect of it, as much about the community engagement. So II think I feel much more engaged with this plan, because I see our voices in there. I see the the fact that the way that the leadership talks about it, you know I feel very comfortable that we could, we should be able to do more in terms of our community. So thank you very much. From my perspective of of being open about community engagement, because I think it's so important. And for you, hearing our voice.

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Health Chatter: I wanted to jump in and just kind of summarize what I've heard over the last forty-fiveish minutes. The conversation revolved prominently around an assumption that communities are eager to be engaged with this plan and a thought that comes to mind is communities who are not eager to jump on with this plan, or are reluctant to jump on to this plan. And I just wonder if either of you had anything to say to our listeners in general about engaging in this plan, or if you had any thoughts or ideas about how to get those reluctant communities engaged with this plan and and on board with it.

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Courtney Jordan Baechler, MD, MS: II think your your point is a good one, Erin, and we certainly did our very best in making this plan to be engaging with community, obviously the ones that we engage with, where people who want wanted to engage to what you're saying. But we the Department of Health and the Leadership team that help create this had lots of various connections that way that we tried to use as much as possible to engage with people and different sectors that historically have not been involved. And I think part of our thinking that way is that we sort of just continue to build that tree with broader roots as we change who is involved? And look at different ways, easier ways for people to engage in terms of how we access virtually in person. You know all the different things that that's not how it's always done in the past. So I think, like everything else, the proof will be in the pudding right? And the final product in the sense of. I'm sure there are some people who are kind of cautiously watching from afar to see. Well, let me see how that works with that group, and if that goes well, then

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Jim Peacock: we would be willing to, etc. So but open to people's feedback and Jim. Anything else that you would add there, yeah, one thing I would add to that cordy, I think. Spoken. Yeah, that's exactly how I would answer that question. You said it more eloquently. What I would add is that embedded in these 10 outcomes, we also made an effort over the last 18 months to reach out to diverse communities in multiple parts of Minnesota to show work that they were doing, demonstrate their successes that often were not funded by the Health Department. They may have not been funded by a health system, that they were community driven initiatives that really speak to the spirit of this plan. The idea there was to show Minnesotans other organizations, folks from all across the country, the type of impact that a community-based initiative can have in improving the health and well being of members of that community. So we're reviewing that as sort of its inspiration from many different types of players and organizations with whom we may have not worked directly in the past. They may have not even been at the table with the development of the plan that we had in 2,010, or the plan from 2,000. But they were at the table this time, and we're trying to elevate that voice.

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Stanton Shanedling: I like, I said. I read. I read through this plan, and it's, you know, in in my mind. II kind of closed it and I sat back, and I really felt good. and so I would encourage listeners to take 10 min and go through this plan, cause I guarantee you there will be something in this plan that will make you feel good that yeah, this is a good direction to take. It's not as technically or medically oriented. It's really getting down to us. And what we really need to do to effect, change and make us all: feel healthy. So you know, I encourage everybody. Look at it pick something in there that's of of interest to you, and and see how it is that you can. You can link with another partner to affect : change. I personally think this is a feel-good plan. It really it should stop there. There's stuff in it frankly for for everyone, Clarence.

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clarence jones: No, I was. Gonna say, I think if you can give us information on how we could locate the the state plan and talk. Talk about it. I think I listen. Would love to do that.

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Jim Peacock: Sure, the plan is available for anyone to view right now. I'll give you the website, but also give you a special trick as well you can go to health dot state  dot mn dot us slash 2035 plan. You can also just go to a Google browser and type in Mn 2035 plan. And I'm happy to say it's already the top link on that search history. So that's a way you can connect. And as I mentioned, there's success stories. There's voices from community members. Both Courtney and myself talk a little bit in a short video about why this plan is needed. In Minnesota at this time.

Stan: all this information will be available on the Health Chatter website as well. So all the background research, and the links to the full plan, the Pdf of it are also on our website. So again, I am. I encourage you. II want to reserve. And I say this to a lot of our guests. But baby, in this case, you know YouTube for sure, because going forward, there's gonna be a lot of action around this. And I want to encourage you to feel free to use health chat, or is another vehicle, to communicate, and we'll continue to be your partner. There you go. You've got a partner. a number one partner in from the planned in order to promote it and hopefully make it work. So thank you both very, very much, and thank you all to our listeners for listening in, and remember to keep health chatting away.