Partners for Health: Eliminating inequities

Healthy foods and healthful eating, physical activity, childhood asthma, access to health care, domestic violence prevention, policy-advocacy training: the Detroit Community–Academic Urban Research Center has made issues like these its focus for the past 17 years. An internationally recognized leader in community-based participatory research, the Detroit URC brings together community-based organizations, health care practitioners, and academic researchers from the University of Michigan, with the aim of examining the social determinants of health and eliminating health inequities in Detroit.

“The Detroit URC is about community leaders and academic researchers working together equitably,” says center director Barbara Israel, professor of health behavior and health education at SPH.

Detroit URC partner organizations include: Communities in Schools; Community Health and Social Service Center; Detroit Hispanic Development Corporation; Detroiters Working for Environmental Justice; Friends of Parkside; Latino Family Services; Neighborhood Service Organization; Warren-Conner Development Coalition; Detroit Department of Health and Wellness Promotion; Henry Ford Health System; and the University of Michigan Schools of Public Health, Nursing, and Social Work.

Detroit URC affiliated partnerships:

  • Neighborhoods Working in Partnership: a capacity-building program designed to address community concerns through policy-advocacy trainings and support to Detroit residents
  • REACH Detroit Partnership: a collaboration aimed at eliminating racial and ethnic health disparities in diabetes, high blood pressure, and related conditions
  • Community Action Against Asthma: a partnership focused on understanding environmental factors that contribute to health disparities in childhood asthma and developing strategies for reducing exposures
  • Healthy Environment Partnership: an initiative aimed at understanding and addressing social and environmental factors contributing to the excess risk of heart disease in Detroit
  • Neighborhoods Taking Action: an initiative to build both youth and adult capacity to implement systems change aimed at improving high school graduation rates, and in turn health outcomes, in selected public schools in Detroit

High School Diploma = Health

The newest of the Detroit URC’s affiliated partnerships is a two-year initiative called Neighborhoods Taking Action, funded by the Robert Wood Johnson Foundation, The Skillman Foundation, and the W.K. Kellogg Foundation. The initiative aims to improve health outcomes in the city by strengthening the capacity of both young people and adults to implement systems change designed to improve high school graduation rates. The project works with Detroit schools that are part of the Educational Achievement Authority, a new statewide effort introduced by Michigan Governor Rick Snyder to improve educational outcomes in the state’s lowest-performing schools. Danielle North, director of operations for the Detroit Public Schools Office of Charter Schools and a member of the steering committee of Neighborhoods Taking Action, spoke to Findings about the initiative:

What’s the link between high school graduation rates and health?
Although many people may not see it this way, education is definitely a factor in health. Studies show that if you have a high school diploma, then go on to college, it increases your chances in life as a whole. If you don’t have an education, you may not get a job that gives you health care, and you’re less likely to pay attention to health because you’ve got greater needs in your life, so the situation becomes compounded. It’s a vicious cycle.

What’s the situation in Detroit’s schools?
Dropout is a tremendous problem. Essentially, our kids are making that decision by ninth grade, and in some cases even earlier. Why? Unfortunately, illiteracy rates are very high, because a lot of our kids keep being passed through to the next grade. So by ninth grade a lot of our kids can’t read or write, and they think it’s a better use of their time just to go to work or stay at home. You really have to catch children at a very early age to bring a turnaround.

How will the Neighborhoods Taking Action initiative address the situation?
We’ll work with a select number of schools in seven different Detroit neighborhoods. Essentially, we want to build a network to help parents navigate the new Educational Achievement Authority that’s being developed by the state, so that they have an active part in what happens with their child’s education. A lot of work of the Detroit URC has been around policy-advocacy training and building relationships with the community, and we want to build on that to help parents and youth determine who they want to advocate to, who they need answers from, and who they want to work with to bring about change at these schools.

Heart Health

By taking to the streets, Detroiters are lowering their risk of cardiovascular disease.
Averaged over a three-year period, rates of cardiovascular death in Detroit are nearly twice as high as those for Michigan or the U.S. as a whole. Mortality rates are highest in areas with lower socioeconomic status, where a high percentage of African-American and Latino residents live. Established in 2000 as part of the Detroit URC, the Healthy Environments Partnership works to foster a heart-healthy Detroit. Affiliates of this community-based participatory research partnership include Detroit-based community organizations, residents, and health-service providers, as well as academic researchers from UM SPH. HEP partners examine and develop interventions to address facets of the city’s social and physical environment that contribute to racial and socioeconomic disparities in cardiovascular disease.

One such intervention is Community Approaches to Cardiovascular Health: Pathways to Heart Health, an initiative aimed at improving the walkability of the Detroit environment. Part of that initiative is the exercise program Walk Your Heart to Health, which is highlighted below in words and video:

Edna Nelson drives a good 20 minutes to get here. So does Viola Hunt, who lives on Detroit’s east side. “We make friends here,” Hunt says. “We enjoy being together.”“Here” is Galilee Missionary Baptist Church on Detroit’s East Outer Drive, where Nelson, Hunt, and a dozen or so other city residents gather three times a week to walk as part of Walk Your Heart to Health, a citywide exercise program offered by the Healthy Environments Partnership. There are eight such groups throughout the city. The one at Galilee started last summer, and by spring the group had graduated from one mile to six and logged a total of 37,624,695 steps—or about 21,000 miles. The walkers have lost pounds, lowered their blood pressure and cholesterol rates, boosted energy and flexibility, and gained friends.

Each walking session begins with stretching exercises and ends with games and discussion of a relevant health topic. Participants push each other to show up, walk further, celebrate milestones. And they energize the neighborhoods where they walk. Residents and shopkeepers come out onto the sidewalks to cheer them on, and some ask how they can join the group.

“My doctor had already told me that if I didn’t watch my diet I would become diabetic, so that is one reason that I joined. Before, I wasn’t doing anything. But now I walk every day—20,000 steps a day, about eight miles.” — Edna Nelson
“You motivate each other. The other day I was, like, ‘I’m not going today.’ And then you get that phone call: ‘Get up! I be there to get you in two minutes!’” — Viola Hunt
“I think more people would walk if we had a walkable community—if there was lighted pavement, lighted streets, and it was more open to walking.“ — Leslie Holsey
“When we first started walking last July, it was a little warm, but we fought it. When you’re walking and talking, you don’t pay it any attention. And another thing we do, we don’t use cell phones in this group. If people use phones, they pay a little fee.” — Frederick McCants


A Disease Takes Its Toll

In Detroit, where many live close to highways, pollutants contribute to high rates of asthma—especially among kids.
Asthma rates are on the rise worldwide, and Michigan is no exception. The problem is worse in major urban centers, among them Detroit, where children are especially hard hit. The burden is highest among low-income and ethnic-minority communities. In fact, says pediatrician and SPH faculty member Toby Lewis, “both asthma and hospitalization rates in this group are at least double what they are in the Caucasian, middle-class, suburban population.”

Lewis and her colleagues in Community Action Against Asthma (CAAA), a community-based participatory research partnership founded in 1998 under the auspices of the Detroit URC, are working to pinpoint environmental triggers, design interventions (both inside and outside the home), and help shape policy to reduce the burden of asthma in and around Detroit. Because kids inside the city often live as close as 150 yards to highways, and trucks are plentiful, particulate matter from diesel exhaust contributes heavily to Detroit’s high asthma rates. CAAA researchers are measuring the levels of particulate matter in different neighborhoods and comparing those measures against asthma prevalence. They’re also examining the degree to which viruses and indoor pollutants, such as cigarette smoke, exacerbate the disease, and they’re studying the efficacy of both air filters and air conditioning units in reducing asthma symptoms. The partnership’s work has promise for both behavioral interventions and policy decisions in Detroit.

Asthma Predictors: As part of her work as section manager for surveillance and evaluation in the Division of Genomics, Perinatal Health, and Chronic Disease Epidemiology at the Michigan Department of Community Health, Sarah Lyon-Callo, a doctoral candidate in epidemiology at SPH, studies asthma using surveillance data from the Michigan Medicaid program. She’s now using that data in her doctoral dissertation to try to identify the social and environmental predictors responsible for adverse asthma outcomes in both urban and rural Michigan. Medicaid claims data indicate that a high percentage of children in rural Michigan are not getting outpatient care for their asthma, and Lyon-Callo suspects these kids’ families may be having trouble getting access to routine asthma care.


AIR: In another year or so, Detroiters will be able to gauge their exposure to air pollutants through a project that uses geographical information systems to generate high-resolution maps showing air pollution levels throughout the city. SPH Professor Stuart Batterman and his research team are collaborating with the Graham Environmental Sustainability Institute at UM and Data-Driven Detroit, a local nonprofit, to produce a website that lets people check the impact of air pollutants on properties, including parks, throughout the city. For more visit

LEAD IN PIPES: Lead poisoning is a chronic public health problem in cities throughout the United States, Detroit among them. Under the direction of Jerome Nriagu, professor of environmental health sciences, and Brian Burt, professor emeritus of epidemiology, SPH researchers have identified elevated levels of lead in Detroit children. The source? Lead paint, lead dust, and lead pipes, says Nriagu, who notes that 90 percent of Detroit homes have lead pipes. Contamination from lead can stunt both the physical and mental development of kids. But like most other U.S. cities, Detroit lacks the financial means to address the problem. Says Nriagu, “We have not solved the issue of lead poisoning in U.S. children. We need to keep showing that it’s a serious issue in urban areas.”

A Frontier Metropolis

Founded in 1701 on the site of a French fort and missionary outpost, Detroit is one of the oldest cities in the American Midwest. During its long history, it’s been governed by no less than three world powers (France, Great Britain, United States). Located along the Detroit River—the strait, or détroit, connecting Lakes Erie and Huron—Detroit nearly succumbed to a massive fire in 1805 but was rebuilt along the lines of a plan similar to the design of Washington, D.C. Appropriately enough for a city inextricably linked with automobiles, Detroit is laid out like a giant wheel, with boulevards and avenues radiating out from its center at Grand Circus Park. The territorial capital in 1828, and a hub of commerce and industry in the 19th century, whose share of Gilded Age mansions helped earn its reputation as “the Paris of the West,” Detroit emerged as a global business center after World War II. Among its 20th-century inventions: automobiles, Motown, and Techno. Today, Detroit (aka Motown, The Motor City, Hockeytown, Rock City, or just “The D”) occupies 138.7 square miles and has a population of just under 800,000, according to the 2010 U.S. Census. At 2,026 square miles and a population of over four million, Metropolitan Detroit is the ninth most populous metropolitan area in the country.

Did You Know?

  • Detroit is home to the world’s first-ever mile of concrete highway (built in 1909 on Woodward Avenue, between Six and Seven Mile Roads).
  • The Detroit–Windsor Tunnel, built in 1930, was the first traffic tunnel connecting two nations.
  • The country’s oldest soda, Vernor’s Ginger Ale, originated at James Vernor’s drug store in downtown Detroit in the 1860s.
  • An estimated 75 percent of the illegal liquor brought to the U.S. during Prohibition entered the country by way of the Detroit River, Lake St. Clair, and the St. Clair River.
  • Detroit is the only city in the contiguous 48 states from which you can look south to Canada.
  • Detroit ranks third among U.S. cities, behind New York and Boston, in major sports championships.

 What Makes Young Detroiters Vulnerable?

In a study funded by the Ford Foundation, SPH researcher Rachel Snow and colleagues are working to identify the social, structural, and behavioral factors that contribute to sexual vulnerability—including HIV and STD risk—among young Detroiters. They’re focusing on three specific communities: transgender youth served by the city’s Ruth Ellis Center; primarily African-American adolescents and young women—most of whom have a history of transactional sex—served by Alternatives for Girls; and young Latinos in southwest Detroit who are affiliated with the Detroit Hispanic Development Corporation.
The first phase of data collection—life history, semi-structured interviews, and ethnographic observation—is nearly complete, and the research team is beginning to analyze and write up the data. Preliminary findings suggest that social factors, including social isolation and parental death, as well as structural factors, such as poor street lighting and the presence of abandoned houses, create an environment that contributes to sexual vulnerability in young people.

At Risk: Young Black and Latino Men

HIV/AIDS in the Detroit Metro area is a particular health concern among men who have sex with men. Within this population, young black and Latino men disproportionately account for most new HIV/AIDS infections. Jose Bauermeister, assistant professor of health behavior and health education, and colleagues at UM SPH are working with AIDS Partnership Michigan, Detroit Latin@z, the HIV/AIDS Resource Center, and the Ruth Ellis Center to find out why this racial/ethnic inequality exists and to propose long-term, sustainable solutions. Researchers are especially keen to understand the impact of community and city-level influences on this population and are collecting data through an online survey and in-depth personal interviews. They hope their findings will inform policy recommendations aimed at decreasing the risk of HIV infection among black and Latino young men.