How addressing social and economic factors can help close the gap in Detroit’s health equity

The factors that regularly impact Detroiters’ health aren’t always clinical, don’t always relate to hospitals or doctors' offices, and don’t always have to do with a person’s genes.
Phyllis Meadows, a senior fellow at The Kresge Foundation's Detroit Program, explains that there's a clear understanding that the social determinants of health can significantly influence a person's well-being.
"If we look at health as an indicator, then probably 20% of what we see in health conditions, like high blood pressure, or you name it, is affected far more by our social and environmental conditions, than it is affected by our biology, or our genes," she says. "Looking at the social determinants of health means looking at some of the root causes that impact health. And those root causes have more to do with more tangible things in our environment."
Meadows points to factors like water quality, soil quality, whether a person is educated, exposed to toxins in their community, close to violence, or employed. All of those things, she explains, have a greater influence, collectively, on a person's health.
Addressing Challenges
Empowering residents better understand the social and environmental factors that impact their health, particularly maternal health, is a key focus of a community program called the Women-Inspired Neighborhood (WIN) Network: Detroit. The initiative, supported by the Henry Ford Health System, connects women with healthcare services and social services essential to preparing for a healthy pregnancy, birth, and baby.
"It's the well-being of the parents, the family, the surroundings, of each and every single child born in Detroit that will influence the way they grow and develop and learn for their lifetime," says Jaye Clement, director of community health programs and strategies at Henry Ford Health System. "So, being able to intervene on those things before a baby has been conceived, during the prenatal period, and, of course, from the point that it's born, is critical."
To start to get a glimpse of how social and economic factors converge to affect Detroiters' health, Clement tells people that when they look at a child, they must also look at their whole family, and who and what is around them.
"Everyone loves a cute baby, right? But, what if that cute baby doesn't have a safe place to live? What if there's not a good school system that they're able to be a part of, and that's stressing the parents?" she says. "Even things like the political atmosphere around a family's home can affect health and vibrancy and economic abilities."
Strength in Numbers
Taking a deep dive into conversations about this topic is something that Edward Lynch, senior program manager with the Center for Equity, Engagement, and Research department at Detroit Future City (DFC), would like to see more Detroiters do.
He points to the organization's The State of Economic Equity in Detroit report, which highlights some key insights. DFC found, for instance, that when it comes to where Detroit stacks up regarding infant mortality, the city's current rate is 1.5 times higher than the region and 1.7 times higher than the state. In Detroit, 11 infants out of 1,000 live births die before their first birthday, which is 1.7 times the rate for the state of Michigan.
Even more specifically, the infant mortality rate for African American infants, at 12.3 infant deaths per 1,000 live births, is about 1.25 times the rate for white infants, which is at 9.7 infant deaths per 1,000 live births. However, since 2010, the infant mortality rate in Detroit decreased by 17%, which was entirely driven by a decrease of 14% for African Americans.
"There's been substantial public programs, particularly in the City of Detroit, to improve the infant mortality rates, and they appear to be working right now," Lynch says. "The mortality rate is dropping, so we're at a point where we can see what can happen when substantial interventions are made." 
There has also been progress shown in the percentage of residents with health insurance coverage. Currently, 92% of Detroiters have health insurance coverage, which is lower than the 94% of residents across the region, but slightly higher than the national rate of 91%. Ninety-six percent of Detroiters 19 or younger, and over 99% of Detroiters older than 65, have coverage. Given the relatively low incomes of Detroit residents, advocates believe this is an indication of the effectiveness of public support programs such as Medicare, which covers 96% of people 65 and older, and Medicaid, which covers 47% of residents. 
However, while he is encouraged, Lynch says that there is still more to be addressed and more progress must be made.
"The access issue is important and can be multifaceted. It's not just about having good health insurance rates, or health insurance. It's not just about having a doctor in your neighborhood – it's about if you're even able to afford to get there," he says. "These are the types of challenges facing a lot of people in Detroit right now."
Both Lynch and Meadows are confident that real change can happen by opening up avenues to increased equity through economic opportunities. Poverty, Meadows explains, is one of the major issues adversely affecting the health outcomes in some Detroit communities.
"It's not enough to treat someone for a disease or help a mother grieve a lost infant, we need to look at all the economical, social, and relational stressors that contributed," she says. 
Lynch adds that he hopes more residents come to understand that the health of Detroiters plays an important part in the city's long-term prosperity, and feel motivated to create change.
"All Detroiters, no matter who they are, no matter where they live, no matter their demographic characteristics, race, income, or anything like that, should be able to prosper and live long and healthy lives that are fulfilling," he says. "Closing any sort of gaps on the economic and health side is particularly important to do that."
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