21st Century Michigan

21st Century Michigan

Public Health’s “Big Three”

Once again Michigan is a proving ground—this time, for some of the country’s most formidable health care challenges.


Despite numerous efforts statewide, 67 percent of Michigan’s adults are obese or overweight, part of a nationwide trend that points to a looming—and costly—epidemic. With an eye toward halting that epidemic where it begins, faculty in the UM Center for Comprehensive Prevention of Obesity in Childhood, among them SPH researchers Julie Lumeng, Alison L. Miller, and Karen E. Peterson, are creating and testing interventions and policies to prevent obesity and reduce chronic disease risk during sensitive periods of development in childhood. Studies are currently underway in Head Start preschool programs throughout Michigan.

Chronic Disease

The leading cause of death and disability in the U.S., chronic disease accounts for 70 precent of all deaths. Under the direction of SPH Professor Noreen Clark, the UM Center for Managing Chronic Disease is working with the National Kidney Foundation of Michigan to help communities in Flint, Inkster, and Detroit reduce risk factors associated with diabetes. Faculty in the center are also working to reduce the burdens associated with asthma among African-American women in southeast Michigan, and they’re working with physicians around the state to encourage self-management in ashthma patients. The center has additional studies and evaluation programs throughout the U.S.

Health Reform

SPH faculty are conducting research on issues that inform and affect state and federal health policy, including initiatives to improve the quality of health care in Michigan and nationally, as well as components of the Affordable Care Act and regulations associated with its implementation. Under the direction of SPH Professor A. Mark Fendrick, faculty in the UM Center for Value-based Insurance Design (V-BID) are working with Michigan policymakers to incorporate innovative and effective benefit-design concepts into the state’s health insurance exchange, Medicaid reform proposals, and benefit plans for state employees. V-BID concepts—created at UM—focus on innovative benefit designs to ensure that people receive the health care they need, and are part of the Affordable Care Act.


“V-BID is one of the prime illustrations of achievement in innovation today, and so it’s with admiration and great respect that I salute those responsible. The leadership here [at the University of Michigan] is impeccable.” — Tom Daschle
Former U.S. Senate Majority Leader Tom Daschle spoke about health reform—and UM’s role in the reform process—in his keynote address at the 2011 V-BID Center Symposium in Ann Arbor last fall. Daschle also met at length with SPH students.

Ensuring Access for Michigan’s Uninsured

With an eye toward helping Michigan prepare for the implementation of the Affordable Care Act, SPH Professor Peter Jacobson is collaborating with the Washtenaw Health Initiative (WHI) to develop strategies to ensure that uninsured residents of Washtenaw County have access to health care when the ACA is implemented. WHI is identifying trends in the number of uninsured Washtenaw County residents, the major health problems confronting this population, and strategies the state can employ to ensure that the uninsured have access to care once it’s available in 2014.

Partners in the initiative include Washtenaw County’s two primary health systems as well as physicians’ groups, clinics, United Way, and the Washtenaw Health Plan. The UM Center for Healthcare Research & Transformation, directed by SPH alumna Marianne Udow-Phillips, M.H.S.A. ’78, is leading the effort. Of his volunteer role, Jacobson says, “Ensuring access to health care is an essential part of SPH’s mission, and I view the job I have at SPH as an opportunity to help achieve that goal.”

A Sustainable Public Health

As the deputy director of public health administration for the Michigan Department of Community Health, SPH alumna Jean Chabut, R.N., M.P.H. ’68, has been at the heart of the state’s public health efforts for more than 30 years. Before that, she spent 17 years with the Detroit Department of Public Health. In a recent conversation with Findings, Chabut shared her thoughts about Michigan’s future:

What are the major public health challenges facing Michigan in the next decade?
A big challenge clearly is that we have to be ready for 2014, which is when health care reform as we will come to know and love it will kick in full-speed. There are many, many things in the Affordable Care Act that would provide support for innovative public health programs and services. And with health care reform, the name of our game these days is that we have shifted focus from infectious- to chronic-disease issues, which account for about 70 percent of our costs today. And those issues are of course rooted in our adverse behaviors—most notably tobacco, obesity, and our lack of physical activity. So the challenge is to figure out how to get people to change their behavior, reduce their risk, and either delay or avoid some of the chronic illnesses that are both killing us and creating enormous health care costs that are no longer sustainable.

What’s happening with the public health workforce?
I n the next decade, over half the workforce at both the state and local level will probably retire. A huge proportion of our current workforce at the local level has had no public health training whatsoever. The new workforce, theoretically, will have access to online certificate programs and even undergraduate courses in public health. So this is a time of enormous opportunity if we get busy and do it right.

Budgets continue to shrink. How is public health coping?
In Michigan, our economy is beginning to turn around—it’s not booming as it has in the past, but we’re making slow and steady progress. That said, I worry about whether there is the political will to adequately fund the kinds of human services that are related to caring for your neighbor.

So health disparities are another big challenge?
We have an extremely diverse state, and wonderfully so, but we need people to be more cognizant that the health of our communities is very much determined by the access people have to healthful living conditions, healthy food, a roof over their heads, safe ways of moving about in the community. The stresses of belonging to an ethnic minority are also very real, and we need to believe in the impact of those stresses on health, and to work within the broader community to try to make a difference.

Are you optimistic?
If you look back over history, you will find a time when we had a huge public health workforce visiting every baby, taking care of infectious diseases, and then we experienced a sea change as we developed vaccines and shifted focus. We went from not having many clinical-care “bullets” to having lots of bullets, and now we’re emerging at the other end realizing we’re not going to get the results we need, and we can’t sustain the costs of that clinical care any longer. I think the world is beginning to see that prevention has to be the name of the game. I’m hopeful we’re going to do this right. I’m an eternal optimist about public health.

Forward Thinking

Michigan celebrated 150 years of statehood in 1987. By 2001, the celebratory mood had passed. The auto industry—long a mainstay of the state economy—was in trouble, and years of financial difficulties had taken their toll on many of the state’s residents. That year, the number of people emigrating from Michigan began to exceed the number of immigrants. Flash forward to 2012, where the picture is considerably brighter. The auto industry is back, statewide unemployment rates have dropped, businesses across Michigan are forging global ties, tourist spending is up, and the state’s leading research universities have partnered with the state to form a University Research Corridor dedicated to transforming, strengthening, and diversifying the state’s economy. These days, even the Lions are winning.

By the Numbers: Michigan Today
  • 498,000: Manufacturing jobs in Michigan
  • 26,400: Number of Michigan manufacturing jobs added in 2011
  • 104,000: Number of green jobs in Michigan (2010)
  • $17 billion: Annual tourist spending in Michigan
  • 193,000: Annual jobs in Michigan supported by tourism
  • $1.5 billion: Annual revenue in research and development grants brought in by Michigan’s public universities

Sources: U.S. Census; michigan.gov; Research in Quantitative Economics, UM