This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Michiganders suffer from some of the worst health outcomes in the country, outcomes exacerbated by disparities based on race, ethnicity, income, and geography. According to America's Health Rankings, Michigan ranked the 32nd healthiest of the 50 states in 2008 and 39th in 2022. Social and economic determinants of health, such as education, poverty, exposure to crime, food insecurity, and racism are contributing factors.

"We are, generally, a state that is not in very good health. And that covers a very wide range of conditions," says Eric Lupher, president of the Citizens Research Council of Michigan. "Many young mothers are having health problems with the birth of their babies, especially people of color. Our children are growing up, too many of them with asthma, too much obesity. And when you get to the older ages, there are a number of maladies related to heart and lung, again, [with] obesity carrying these forward."

Despite these challenges, Lupher and other state and local political, health care, community, and foundation leaders are working together on a project that aims to coordinate sustained investments in Michiganders' health. The Citizens Research Council, the nonprofit Altarum, and the nonpartisan Michigan Governor's Office of Foundation Liaison are currently in the midst of releasing a five-part analysis entitled "Michigan's Path to a Prosperous Future: Challenges and Opportunities."

Making change happen

The series presents a realistic, data-informed vision for Michigan's future based on current trends and trajectories across multiple topics. The third paper in the five-part series, "Health Challenges and Opportunities," concludes that poor health stands in the way of a thriving Michigan.
Corey Rhyan.
"The goal of this report was to try and identify where the health of Michiganders is impacting our overall state's economic competitiveness and our overall population growth trends," says Corey Rhyan, research director for health economics and policy at Altarum. "Michigan's life expectancy was lower than the national average and has been over the past couple of decades. And the gap between Michigan's life expectancy and the national average has been increasing over time, indicating Michigan's health is not improving. During the COVID-19 pandemic, life expectancy fell in the state much greater than it did in other states."

Michigan's health care systems compare favorably to other states, with low rates of uninsured, lower-than-average health care costs, and higher-than-average physicians per capita. However, these resources are not distributed equally across the state. In addition, Michigan's public health system is not as well funded as other states', consistently ranking in the bottom 10 states for per capita public-health spending.  And its public health sector has lost a good number of its experienced workers since COVID-19.

"Michigan has higher rates of chronic conditions such as cardiovascular disease, diabetes, and obesity that are major factors that contribute to our overall health and our overall life expectancy," Rhyan says. "We see also that when Michiganders qualitatively report what their health is, they are less likely to report being in good overall or excellent health than the national average. Only about half of our state's population reports being in good or excellent health."

While Michigan's older population is growing, its younger population is declining. These trends will impact the availability of resources, workforce, and family caregivers in meeting the health care and social support needs of older adults.

Good health equals a better economy

When companies searching for new locations to start or grow business look at Michigan's health trends, they may choose to locate in a state where the workforce is healthier and, hence, more reliable.

"Here's something where we can draw a direct line. If people do not feel good, they either don't join the workforce, or if they're in the workforce, they have problems showing up consistently for work. That's both physical wellness and mental wellness," Lupher says. "So it leads to lower productivity and the inability to find labor. The workforce shortages we see in restaurants and in factories all around us are directly related to the health conditions of our state."
Eric Lupher.
Michigan was an early adopter of Medicaid expansion, which led to more of the lower-income working population having health insurance. But rates for private insurance, which is often paid by employers, are higher here than in many other states. While manufacturing and agriculture are mainstays of the state's economy, these workplaces often come with additional health hazards.

"When you're working a factory job, a lot of times you're exposed to chemicals or other elements that get into your system and have negative health consequences," Lupher says. "We also have a high percentage of the population that is smoking tobacco and drinking too much. And we've been a fairly sedentary population."

While the automotive industry historically has been a boon to the Michigan economy, the predominant car culture has rendered Michigan's cities and towns less walkable. 

"Our cities all throughout the state have really been designed to facilitate automotive transportation. The idea of a walkable city is sort of an afterthought," Lupher says. "We have the ability for our children to get to school hampered in many places, where you are either concerned about the safety of crossing major streets or are worried about other aspects. We have really designed our built infrastructure – the roads, the sidewalks, and the places that describe how we live – in a way that really doesn't accommodate general exercise in terms of getting out, walking more. To get to a transit station, bus stop, train station, [or] whatever, there is a little bit of walking involved. But we don't even have that. You walk out of your house, into the garage, hop in your car, and away you go."

Addressing disparities essential to overall health

In order to improve Michigan's overall health, Altarum, Citizens Research Council, many of the state's chambers of commerce, and other stakeholders are pushing for the significant progress needed to reduce health disparities, especially since populations of color are driving Michigan's population growth.  
 
"When you look at the disparity between the highest-performing population compared to the lowest-performing groups, you see over a threefold difference between different racial and ethnic populations," Rhyan says. "Communities of color are very significantly impacted by a lot of these worse health outcomes. This really calls for greater investments in these communities and particular populations in order to improve their health."

Huge geographic disparities also exist

Like race, one's location within Michigan can also have a profound impact on health outcomes.

"The county that has the greatest overall life expectancy has a life expectancy that's eight years higher than the worst county," Rhyan says. "When you drill down to the neighborhood level, you see that in the best-performing neighborhood within the state, an individual is expected to live 29 years longer than the worst-performing neighborhood within the state."

Because state government plays a crucial role in funding public health, encouraging walkable communities, and crafting policies that address social determinants of health, individual Michiganders can advocate for their communities' health, as well.
Neel Hajra.
"By engaging with your county commissioners and engaging with your state legislative representatives, you can make a difference," Neel Hajra said during an August presentation of the third paper in the series. Hajra is CEO of the Michigan Health Endowment Fund, one of the organizations working on the project. "Those are the elected officials that do influence decisions on how not just to fund public health at the state level, but at the county level where those monies go. This is both a very local issue as well as a state issue. You as an individual can engage on this issue and influence both funding for and positive reforms to the public health ecosystem in Michigan."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Eric Lupher photos by Doug Coombe. Corey Rhyan photo courtesy of Corey Rhyan. Neel Hajra photo courtesy of Michigan Health Endowment Fund.