Steering a Large Ship
Dr. Carlos D. Miranda on His Work at Sanford Health and on the Multi-Partner Health Collaborative
Once you give the tools to the kids and to the family, they can build their own diet around what the options are.
— Dr. Carlos D. Miranda
Launched in 2024 by the Foundation for a Healthy North Dakota, American Heart Association, and North Dakota Health & Human Services, the Multi-Partner Health Collaborative (MPHC) is building a healthier North Dakota by teaming up with communities, tribal nations, businesses and other sectors to equitably enhance wellness across our state. We recently chatted with Carlos D. Miranda, M.D. — a pediatric cardiologist at Sanford Health — about the state of children’s heart health in North Dakota and his involvement as chair of the MPHC.
Kids have long been at the center of Dr. Miranda’s work. In his job at Sanford Health, he specializes in heart care specifically for children and spends his days promoting healthier lifestyle habits in families across North Dakota. Rather than simply giving parents a list of “good vs. bad” snack or meal options, though, Dr. Miranda instead teaches patients and their families the impact that different foods have on the body.
“I emphasize understanding foods, and then they can make their choices,” Dr. Miranda told us.
When it comes to heart-healthy eating for kids, Dr. Miranda is a “big proponent” of focusing on high-fiber foods. This means he first teaches kids and parents to recognize which foods are high in fiber.
“For example: All fruits are good for you, and certain fruits are better,” he explained. “If you have a fruit that spoils quickly or needs refrigeration — like berries — that’s a hint that they have higher fiber.”
There are of course many things parents can do to promote heart health in their children, Dr. Miranda shared with us, such as reducing the amount of refined sugar in their diet, building exercise and activity into their daily routines, and using better-for-you oils like avocado and olive when cooking.
“Once you give the tools to the kids and to the family, they can build their own diet around what the options are,” he said.
Dr. Miranda also recognizes that for many families across the state, most of these tips feel out of reach, if not impossible. Many North Dakotans who live in more rural and remote areas face a shortage of medical providers in general, let alone cardiologists, and he sees every day the impact that food deserts and other food access issues have on people’s health.
“If you only have a convenience store near you and don’t have available fresh fruits and vegetables, you’re locked into things like cookies, crackers, chips, juices, and soda,” he told us. “In order for us to move the needle and prevent and reduce heart disease, kids really need to have a fair chance and access to fresh foods.”
These disparities and access gaps are why Dr. Miranda got involved with the Multi-Partner Health Collaborative this past summer, helping to unite government, nonprofit and health care organizations to address public health challenges across North Dakota.
“I have a very privileged role in that I see patients one on one, so I’m able to make a difference in each of these kids’ lives as I see them in my office, but being part of the MPHC allows me to see things more from a bird’s eye view,” he said. “I’m able to help manage social determinants of health from a population perspective and help move toward a healthier state.”
Social determinants of health refer to the non-medical factors that can profoundly shape a person's health and well-being, such as those food deserts and medical provider shortages that Dr. Miranda mentioned. Access to nutritious foods, safe outdoor spaces, and preemptive health care all play a huge role in children’s health. Social determinants of health and other data points were taken into consideration when the state developed North Dakota’s State Health Improvement Plan (SHIP). Outlined in the SHIP are four critical areas — strengthening the workforce, cultivating wellness, expanding access and connection, and building community resilience — and the MPHC has formed goal groups to focus on these areas.
“Being part of the MPHC allows me the opportunity to make a large population-based impact and take a holistic approach to health promotion. It’s steering a large ship, so change might be slow, but if we do it correctly I think we’ll be able to have farther reach and more sustainable reach than just by me doing it in my clinic patient by patient.”
When it comes to the future of children’s health in North Dakota, and children’s heart health specifically, Dr. Miranda has a lot of hope, even when the path forward seems challenging.
“The MPHC has an amazing public-private partnership,” he said. “We have built and continue to improve a network of health professionals, a community of leaders, and policymakers that work together to enhance preventive care, to expand specialty services, and address social determinants of health. I think collectively if we do this right, we will reduce these barriers that we have, and we will improve outcomes.”