MyMichigan Health calls on its “village” to impact social determinants of health

Most people have heard the phrase, “It takes a village to raise a child.” Every parent’s village looks a little different. Perhaps it consists of compassionate employers, who are understanding when parents need a day off because a child is sick. Maybe it includes dedicated teachers who pour their hearts into the child’s education. The DoorDash driver, who delivers food when parents don’t have the energy to cook, may even be part of a parent’s village. Not every member of the village participates in actually raising the child – some may never even meet them – yet every member makes a difference in the outcome of that child’s life. 

In the same way, it takes a village – not just healthcare workers – to keep people healthy. Perhaps the village consists of transportation drivers who ensure patients arrive at appointments. Maybe it includes college professors, who help arrange meaningful internships so students can find higher-paying jobs. The food pantry volunteers, who ensure a patient has access to food, may be part of that community as well. 

These non-medical factors – transportation, education, food security, internet access, and more – are known as Social Determinants of Health (SDOH), and they make a significant impact on the health of a community. In fact, Ashleigh Palmer, President of MyMichigan Health Network & MyMichigan Collaborative Care Organization and Executive Director of Population Health, says those factors can have an even bigger impact on someone’s health than their genetics. 

“If a person does not have reliable transportation, and that individual is diabetic, they may fail to complete routine annual visits simply because they can't get there. They may fail to complete preventative screenings. Over time, not having transportation to those key annual visits or those preventative screenings can contribute to poor health or poor health outcomes,” she explains.

Addressing Social Determinants of Healthcare and engaging communities in that effort is something that the Department of Health and Human Services focused on in the Healthy People 2030 objectives. While there are over 300 targeted objectives, the two of the five overarching goals of Healthy People 2030 are:
  • Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.
  • Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.
Now, in 2025, we are halfway through the timeframe to achieve these goals; and, leaders at MyMichigan Health are working hard with community partners to do just that. 

“Our organization can't do this on our own,” says Brent Mikkola, Manager of Community Health at MyMichigan Health. “We need community support to be able to make change in these areas. It's important that organizations and agencies across the state, across the country, are working together.” 

While Healthy People 2030 looks at goals for Americans on the whole, MyMichigan Health narrows some of those goals down to apply specifically to people within the regions they serve through a Community Health Needs Assessment (CHNA), which is completed every three years. 

MyMichigan Health“The  Community Health Needs Assessment helps us identify areas within the social determinants of health that are impacting the needs of our specific communities,” says Palmer. “We work with our community members, community partnerships, and community stakeholders to really get a true sense of the health status of the people that are living within our counties. Based off of those assessments, we work to complete a Community Health Improvement Plan (CHIP).” 

For example, the most recent CHNA completed by MyMichigan Health showed that in Isabella County, about 23% of adults do not have access to broadband internet services. This could impact whether someone can access telehealth and communicate with providers in a timely fashion. 

Perhaps unsurprisingly, given that MyMichigan Health serves many rural communities, access to housing, food, and transportation were top concerns in many of the regions they serve. As such, policies are being implemented to address those areas.

“We've created transportation assistance policy for patients that we will provide non-emergent medical transportation if they meet certain criteria to get to their medical appointments,” says Mikkola. “We're seeing reduced no-shows, improved well visits, and child well visits. Hopefully, in the long-term, we will see a reduction in certain chronic diseases or illnesses, or at least better management of them.”

Additionally, MyMichigan Health is employing Community Health Workers to help address SDOH. These are people that Primary Care Providers or other staff members can refer a patient to for support based on their specific needs. 

“They are trained to promote the health of the patients, but also to simultaneously reduce any of those health disparities that may occur as a result of an SDOH barrier. So, they not only help with the SDOH, but they also provide education and resources for patients. Additionally, they serve as advocates for those individuals,” explains Palmer. “These are people that we have embedded within the health system currently, and it's something that we're looking to expand because we see the huge need, and we see the benefit of having them on the team.”

However, MyMichigan Health can’t impact change on the scale it wants to without help from community partners. That’s why it has developed relationships with various organizations that are better equipped to handle housing, food, transportation, and other SDOH. Some of those partnerships include Isabella Community Soup Kitchen, Midland’s Open Door, and Clare County Transit Corporation

“We might be impacting health care, but we're not necessarily doing medical or health care work,” explains Mikkola. “We're creating collaboration with different organizations to be able to impact health. We’re utilizing the conduits that currently exist.”

At the end of the day, creating lasting change that betters the health of the entire community – whether that’s a small rural region in Northern Michigan, a large city, or the nation – will take a village.

“Where one person is doing well, there are 10 others that aren't,” says Mikkola. “For the entire community to do well, everybody has to be involved.”

Read more articles by Gabrielle Haiderer.

Gabrielle "Gabe" Haiderer is passionate about sharing stories that show the positive interactions between individuals and businesses that occur every day in our communities - interactions that inspire hope and motivate community growth. She has used this passion to share stories through a variety of media outlets - from television to radio to traditional newspaper to digital news. When she's not writing, Gabe stays busy running her own videography and social media management business in Northern Michigan, caring for her two furkids (Watson the siamese cat and Holmes the Corgi), spending time with her husband, and tending her garden.
Enjoy this story? Sign up for free solutions-based reporting in your inbox each week.