APPLE VALLEY (Twin Cities Region)

APPLE VALLEY (Twin Cities Region)

 (Twin Cities Region)
 CULTURE CARE CONNECTION is an online learning and resource center
 designed to increase the cultural competence of health care providers, administrators,
 and health care organization staff in serving diverse populations. Simply put,
 “culture” can refer to a variety of factors, including age, education level, income
 level, place of birth, length of residency in a country, individual experiences, and
 identification with community groups. “Competence” refers to knowledge that
 enables a person to effectively communicate, and “care” refers to the ability to
 provide effective clinical care.

 Through Stratis Health’s Culture Care Connection City Profiles, health care
 organizations can better understand their geographic service areas by observing the
 characteristics of the city, surrounding region, greater Minnesota, and the nation with
 respect to demographic, socioeconomic, and health status data. The quantitative and
 qualitative data in this profile can broaden understanding and help users consider
 actions for responding to the area’s most pressing needs.

 Use this information to advance your organization’s implementation of the Office of
 Minority Health’s Culturally and Linguistically Appropriate Services (CLAS)
 Standards. The 14 CLAS standards serve as guiding principles for ensuring
 accessibility and appropriateness of health care services delivered to diverse
 populations. This information also is valuable if your organization uses less formal
 approaches in providing culturally sensitive services, or if you just are interested in
 learning more about health disparities in your city.

 Region is defined as Economic Development Region (EDR), the multi-county groupings established by the
 Minnesota Department of Employment and Economic Development.
 The Twin Cities Metropolitan EDR is composed of Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and
 Washington counties.
 To prevent inaccurate extrapolation, careful attention should be paid to identifiers in graphs and narrative, which
 delineate between city, county, region, and state level data.

 Demographics                                   Age • Gender • Race • Foreign Born • Language

 Demographic data reveal the following state-level trends:
• Minnesota’s population is projected to grow substantially by 2035, with slight growth
  in younger age groups and substantial growth in older age groups. These changes will
  influence the overall age composition of the state.
• Gender is evenly distributed across age groups, with notable exceptions in the older
  age groups which have a larger proportion of females.
• Minnesota’s population continues to become more diverse. Between 2000 and 2010,
  the Asian, Black, and Hispanic/Latino populations increased at a rate of 50.9%,
  59.8%, and 74.5% respectively, as compared with the white population which
  increased by only 2.8%.
In 2010, the city of Apple Valley had a population of 49,084, up from 45,527 in 2000. In the Twin Cities, the
population increased by 7.9%, growing from 2,642,062 to 2,849,567 based on economic development region
(EDR) data during the same decade. In Dakota County, the population increased by 12%.

Apple Valley's population is projected to grow to 71,200 by 2030. Estimates from 2005 project that the
entire Twin Cities metro area's population will increase by 20.6% between 2005 and 2035, growing from
just over 3 million people in 2005 to 3,352,500 in 2035.

Sources: Metropolitan Council Community Profiles viewed on 6/7/2011
Minnesota Population Change by Region 2000-2010
Minnesota Population Change by County 2000-2010

                                                                                                   Projected Population - Minnesota: 2005 - 2035
Between 2005 and 2035, the population of Minnesotans
over age 65 is predicted to more than double due to

greater longevity. By contrast, the population under age
65 will grow by only 10%. As a result, the age                                                  900,000
composition of all parts of the state, including Apple                                          600,000
Valley, will be much older in 2035.                                                             300,000
Between 2005 and 2009, the median age in Apple Valley                                                      0-14   15-24 25-44     45-64   65-84    85+
was estimated at 35.8 years, compared to 36.5 years for                                                              Age Group
the United States as a whole, with 8.3% of Apple Valley                                                           2005   2015    2035
residents over age 65 and 6.6% under age 5. According
to 2010 Census data, the median age in Minnesota is 37.4

What providers need to know:
The proportion of Minnesota’s older population, as well as ethnic and immigrant communities, will
grow faster than the rest of the state’s population in the next 25 years. Consider whether your
organization is prepared to meet the special needs of these populations.


Become familiar with the needs of older populations, as well as individuals from diverse backgrounds,
and develop strategies to accommodate them, including: referrals to transportation services, allowing
more time for patient encounters, incorporating age related issues such as hearing screens into preventive
services and providing patient education materials in alternative formats.

Source: U.S. Census Bureau, 2005-2009 American Community Survey viewed on 5/25/2011
Minneosta Population Projections 2005-2035

STRATIS HEALTH - WWW.CULTURECARECONNECTION.ORG                                2                                          CITY REPORT: APPLE VALLEY
Gender                                                                                          Projected Gender Distribution: Minnesota: 2035

According to 2010 Census data, Apple Valley's gender                                      1,000,000
distribution was estimated to be 47.8% male and 52.2%

female. In 2035, projections indicate the overall gender                                   600,000
distribution for Minnesota to be 49.4% male and 50.5%

More variations appear when data are viewed by age range:                                        0
                                                                                                         0-14   15-24     25-44      45-64      65-84    85+
• 25 to 44: 48.5% male, 51.4% female                                                                                Age Group
• 65 to 84: 48% male, 52% female                                                                                Females         Males
• 85 and above: 40% male, 60% female

Sources: Metropolitan Council Community Profiles viewed on 6/7/2011
Minnesota Population Projections 2005-2035

                                                                                             Population by Race and Ethnicity - Apple Valley: 2010
Minnesota’s population is considerably less diverse
than the U.S. population. Minnesota’s populations of                                                                    White (81%)
color accounted for 17% of the population in 2009,                                                                      Black or African American (5%)
compared with 34% of the national population.
                                                                                                                        Asian (5%)
However, populations of color are growing faster in
Minnesota, 28% compared with 19% nationally.                                                                            Two or more races (2.48%)

                                                                                                                        American Indian & Alaska Native (0.3%)

In the Twin Cities metro area between 2005 and 2015,                                                                    Some other race (0.16%)
the population is expected to grow 9% . The white                                                                       Native Hawaiian & Pacific Islander (0.07%)
population is not expected to change while populations                                                                  Hispanic or Latino (of any race) (4.9%)
of color are expected to grow 44.5%.

In 2010, 81% of Apple Valley's population was white,
                                                                                          Projected Populations of Color - Twin Cities: 2005-2035
5% black/African American, 5% Asian, 2.48% two or
more races, 0.3% American Indian/Alaska native and                                          400,000
0.07% Native Hawaiian/Pacific Islander. Almost 1 in 20
                                                                      Number of People

Apple Valley residents, or 4.9%, were Hispanic/Latino.                                      300,000

What providers need to know:
The health issues, health-seeking behaviors, cultural
norms, and communication preferences of populations                                                      American       Asian           Black      Hispanic/
of color vary considerably. As Minnesota’s population                                                     Indian                                    Latino
becomes more diverse, patient populations and the                                                                   2005        2020      2035
work force within the state’s health care organizations
will become more diverse as well.

STRATIS HEALTH - WWW.CULTURECARECONNECTION.ORG                        3                                                     CITY REPORT: APPLE VALLEY
Get to know your patients and staff on an individual level. Not all your patients and staff from diverse populations
conform to commonly known culture-specific behaviors, beliefs, and actions. Understanding an individual’s practice
of cultural norms can allow providers to quickly build rapport and ensure effective health care communication.

Sources: Minnesota Population Projections 2005-2035
Metropolitan Council Community Profiles viewed on 6/7/2011

                                                                               Immigrant Population by Region of Birth - Minnesota: 2009
Foreign Born
Minnesota's population growth between 2000 and
2010 was driven by an increase in minority residents
that accounted for more than 80% of the state's
growth. Minority residents now make up about one of
every seven state residents. In 2009, one third
Minnesota's immigrant population came from four
countries: Somalia (23%), Ethopia (9%), Kenya (6%)
and Liberia (6%).

During the period 2005-2009, 8.6% of Apple Valley's population, or 4,260 people, were estimated to have
been born outside the U.S. - lower than the 12.4% estimate for the U.S. as a whole.

What providers need to know:
Important factors to consider in providing care to immigrant populations include: nutritional status, mental
health (especially in refugee populations), infectious diseases such as Hepatitis B status, dental screening,
and preventive health measures, including cancer screenings which are not often available in third world
countries. Specific health care screening recommendations depend on an individual’s country of origin and
immigration status.

Provide information to patients not familiar with the western medical system such as guidance on obtaining
health insurance, setting up initial and follow-up appointments, and practicing preventive health, including
cancer screenings. Become familiar with health screening recommendations for your patients based on their
country of origin and immigration status.

Conduct a CLAS (Culturally and Linguistically Appropriate Services) Standards Assessment to identify
strengths and opportunities for improvement in the services your organization offers to diverse populations.
An online assessment, which offers customized evaluation and recommendations, can be found at:
CLAS Standards Assessment .

Sources: U.S. Census Bureau, 2005-2009 American Community Survey viewed on 6/20/2011
Report immigrants to Minnesota by region and selected country of birth
Star Tribune, Minnesota's Changing face news viewed on 9/23/2011

STRATIS HEALTH - WWW.CULTURECARECONNECTION.ORG                                4                             CITY REPORT: APPLE VALLEY
According to the Minnesota Department of Education, during the period 2008-2009, the most common languages
spoken other than English in the Twin Cities metro area were Spanish (8.4%), Asian and Pacific Islander languages
(3.6%), other Indo-European languages (2.8%) and other languages (4.3%).

In Dakota County, during the period 2008-2009, Spanish was the primary language in 3,193 homes, while
Vietnamese was spoken in 528 homes, Russian in 358 homes, Hmong in 325 homes and Cambodian in 314 homes.

During the period 2005-2009, more than 1 in 10 Apple Valley residents, or 11.4%, was estimated to speak a language other
than English at home. According to the 2010-2011, Primary Home Language report from the Minnesota Department of
Education, Spanish was the number one language spoken, other than English, in Rosemont-Apple Valley-Eagan ISD 196.

What providers need to know:
Language barriers pose a challenge to even the most basic clinical encounters. According to the U.S
Department of Health and Human Services, Office of Minority Health:
• Health care organizations must offer and provide language assistance services, including bilingual staff or
  interpreter services, at no cost to each patient/consumer with limited English proficiency (LEP) at all
  points of contact, in a timely manner, during all hours of operation.
• Family and friends should not be used to provide interpretation services.

Provide an interpreter to patients who do not speak English or who have Limited English Proficiency as a
way to encourage them to freely communicate expectations and preferences.
For all patients, especially those who speak English as a second language, use simple language, avoid
technical terms, abbreviations, and professional jargon.

Sources: Minnesota Department of Education 2008-09 PDF maps viewed on 6/20/2011
U.S Department of Health and Human Services, Think Cultural Health viewed on 10/3/2011
Primary Home Language Totals - District 2010-2011 viewed 6/20/2011
U.S. Census Bureau, 2005-2009 American Community Survey viewed on 6/20/2011

Socioeconomic Status                                               Education • Income • Occupation

Socioeconomic status is a measure of an individual’s economic and social position relative to others, based
on education, income, and occupation. It provides valuable insights about diverse populations.

Education influences occupational opportunities and earning potential in addition to providing knowledge
and life skills that may promote health. Income provides a means for purchasing health care coverage and
also may determine eligibility for assistance programs for those who cannot afford coverage.

STRATIS HEALTH - WWW.CULTURECARECONNECTION.ORG                                  5                    CITY REPORT: APPLE VALLEY
Across Minnesota, high school graduation rates increased between 2005 and 2009. While projections indicate
a continuous decline for the general population, high school graduation rates in populations of color will
increase as much as 40% between 2005 and 2015.

In 2009, an estimated 95% of Apple Valley residents over age 25 had a high school diploma or higher. An
estimated 42.5% had at least a bachelor's degree.

Source: U.S. Census Bureau, 2005-2009 American Community Survey viewed on 5/25/2011

In Apple Valley, the median household income, based
on 2005-2009 estimates, was $78,470 - higher than the                                                      Poverty - All Ages - Minnesota: 2002-2006
national median income of $51,425 per household.                                                         10%

                                                                                 Percent of Population
Income level influences an individual’s access to                                                        8%
health insurance and health care, and is used to                                                         6%
determine poverty status, which may determine
eligibility for various assistance programs. Rates of
uninsured can be difficult to measure. Wide                                                              2%
variability exists across racial and ethnic groups.
Historically, white populations are the most likely to                                                            2002         2003      2004          2005       2006
be insured and Hispanic/Latino populations are the                                                                    Dakota            Twin Cities            Minnesota
least likely to be insured.

Source: U.S. Census Bureau, 2005-2009 American Community Survey viewed on 5/25/2011

According to 2005-2009 estimates, 78% of Apple Valley residents over 16 years of age were employed,
compared to 65% for the U.S. as a whole. For current, quarterly unemployment data, visit the
Minnesota Department of Employment and Economic Development.

Employment or lack of employment influences a                                                                  Uninsured by Race - Minnesota: 2001-2010
variety of social and health risks, such as access to                                                    35%
                                                                                 Percent of Population

health care insurance, or psychological needs. For                                                       30%
example, employed individuals in office-based                                                            25%
occupations are at risk for repetitive stress injuries                                                   20%
and musculoskeletal disorders due to the sedentary                                                       15%
nature of this work. Individuals who are unemployed                                                      10%
or experience job insecurity may face health risks                                                        5%
such as increased blood pressure and stress.                                                              0%
                                                                                                                 American      Asian     Black        Hispanic/   White
                                                                                                                  Indian                               Latino
                                                                                                                     2001        2004      2007         2010

STRATIS HEALTH - WWW.CULTURECARECONNECTION.ORG                               6                                                         CITY REPORT: APPLE VALLEY
What providers need to know:
Chronic stress associated with lower socioeconomic status can contribute to morbidity and mortality and is
linked to a wide range of health problems, including arthritis, cancer, cardiovascular disease, hypertension,
and low birthweight.

Consider how a patient's socioeconomic status (education, income, occupation) may affect health risks and
ability to follow treatment plans. Become familiar with eligibility requirements and service offerings from
local health, housing, and social service programs, including medical assistance, food support, and cash
assistance. Dial 211 United Way First Call for Help to get information and referrals about employment,
health services, etc. Establish a culturally sensitive plan for identifying and referring patients who may benefit.

Source: U.S. Census Bureau, 2005-2009 American Community Survey viewed on 5/25/2011

Health Status Data                                   Birth • Morbidity

The health status data concerning birth rates and factors contributing to the incidence of disease revealed the
• A need for increased efforts to provide prenatal care in the general population as well as an awareness of
  birth trends in populations of color.
• Greater potential for engagement in behaviors which increase the burden of poor health in populations of
                                                                                                                          Births in Minnesota: 2006-2009

Birth Rate                                                                                                38,000
                                                                                 Number of Births

Between 2007 and 2009, birth rates in Minnesota
fell. The pattern of decline suggests a relationship to                                                   36,000
the recession. The decrease in births was                                                                 35,000
concentrated among groups most vulnerable to
unemployment and financial uncertainty: the young                                                         34,000
                                                                                                                              Jan-June 2006

                                                                                                                                                                                                          Jan-June 2008

                                                                                                                                                                                                                                            Jan-June 2009
                                                                                                                                                  July-Dec 2006

                                                                                                                                                                                          July-Dec 2007

                                                                                                                                                                                                                            July-Dec 2008

                                                                                                                                                                                                                                                               July-Dec 2009
                                                                                                                                                                        Jan-June 2007

and less educated. However, the number of births
decreased in all racial/ethnic groups.

The largest decreases from 2007 to 2009 were
among Latina/Hispanic mothers (5.2%) and white
mothers (5.0%). Births to mothers under age 20
                                                                              Decrease in Birth Rate in Minnesota Racial and Ethinic Group
(which involve more complications during                                                             from 2007-2009
pregnancy and childbirth, more infant deaths, low
birth weights and congenital anomalies) decreased in                                                      6.0%
                                                                                 Percent Fall in Births

both 2008 and 2009, when they dropped by 10.6%.

Source: Minnesota Department of Health "2009 Minnesota Health
Statistics Report viewed on 5/25/2011                                                                            0.0%


                                                                                                                                                                  Not Hispanic



STRATIS HEALTH - WWW.CULTURECARECONNECTION.ORG                               7                                                                                                          CITY REPORT: APPLE VALLEY
Morbidity                                                                                            Behavioral Risk Factors: 2011
Behavioral risk factors such as use of alcohol and                                 25%
 tobacco, diet, exercise, and preventive health                                    20%
practices play an important role in determining a
person’s overall health status. Control over such
factors can decrease a person’s risk for adverse health
outcomes including illness and premature death.                                        5%
According to 2011 national county health rankings,                                          Adult smoking      Adult obesity      Excessive drinking
Dakota County ranked 14 among 85 Minnesota counties                                                         Dakota    Minnesota
in health behaviors. Areas for improvement still exist as
17% of the county's population smokes, 27% are obese
and 19% drink excessively.

What providers need to know:
Patients from diverse cultures may have varying perceptions of the concepts of disease and preventive care.
Patients may not understand the reason for their illness or the importance of keeping follow-up appointments
and adhering to treatment plans even though they may no longer be feeling symptoms. Follow-up visits are
important in identifying changes in health due to treatment and to avoid potential disease reccurrence.

Provide alternative treatment options and acknowledge that patients from diverse cultures may use
traditional cultural approaches to health care.

Source: County Health Rankings viewed on 5/25/2011 (85 of 87 MN counties ranked)

Next Steps CLAS Assessment • Visit
1) Conduct a CLAS (Culturally and Linguistically Appropriate Services) Standards Assessment to identify
   areas of strength and areas of opportunities for improvement in the services your organization offers to
   diverse populations. An online assessment which offers customized evaluation and recommendations,
   can be found at: CLAS Standards Assessment.

2) Visit the Culture Care Connection website, an online learning and resource center aimed at providing
   Minnesota health care organizations with actionable tools in support of providing culturally and
   linguistically appropriate services.

3) Contact Stratis Health to learn more about how we can assist in your organization's efforts to build
   culturally and linguistically appropriate service offerings.

STRATIS HEALTH - WWW.CULTURECARECONNECTION.ORG                                     8                                 CITY REPORT: APPLE VALLEY
Contact us for assistance with your quality improvement and patient
safety needs related to reducing health care disparities.

Stratis Health is a nonprofit organization that leads collaboration and
innovation in health care quality and safety, and serves as a trusted
expert in facilitating improvement for people and communities.
Stratis Health works with the health care community as a quality
improvement expert, educational consultant, convenor, facilitator, and
data resource.

2901 Metro Drive, Suite 400
Bloomington, MN 55425-1525

(952) 854-3306 telephone

(952) 853-8503 fax

1-877-STRATIS (1-877-787-2847) toll-free

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