Environmental Justice & Vulnerable Populations

Not surprisingly for a city surrounded by factories and refineries, Dearborn has high rates of both asthma and lead poisoning.
It was the fall of 2001, and Jerome Nriagu was studying environmental contaminants in and around Dearborn, Michigan, and their effect on the area’s Arab-American community—the largest concentration of Arab-Americans in the United States. Not surprisingly for a city surrounded by factories and refineries, and consequently one of the most polluted areas of Michigan, Dearborn has high rates of asthma and lead poisoning, both of which can affect children’s mental and physical development. The city’s predominantly low-income Arab-American population, many of them recent immigrants, was especially vulnerable, and Nriagu, a professor of environmental health sciences with a longstanding commitment to environmental justice, was working to reduce the community’s risk.

Just how vulnerable this population was—and is—became acutely clear in the immediate wake of the terrorist attacks on September 11 of that year, when suddenly, Nriagu remembers, “almost all Arab-Americans were suspect,” and the participants in his study abruptly stopped volunteering information. “We had to change our methodology. They were terrified.”

He and his team were able to complete their research, but not without difficulty. For the Nigerian-born Nriagu, the experience served as a sharp reminder of the challenges confronting the 40,000 Arab-Americans who live in and around Dearborn—especially new immigrants, who in addition to economic, social, and political barriers, often face linguistic and cultural obstacles that can impede access to health care, employment, and other necessities.

Nriagu’s work with the community dates back at least to the mid-1990s, when he worked with Arab-American leaders in Dearborn to convince the Ford Motor Company to reduce environmental contamination from a new automobile factory in the region. More recently he has collaborated with ACCESS, a local nonprofit organization, to develop interventions to reduce the incidence of asthma and lead poisoning in Arab-American households, in part by reducing common home hazards. Older houses, often rundown, contribute significantly to lead exposure, Nriagu says.

Future projects include a community-based study aimed at disentangling the effects of acculturation and environmental exposure on the disease burden in Dearborn, with a particular focus on the high incidence of respiratory diseases, cancer, and low birth weight reported by Arab Americans. “These are all linked to exposure to high levels of environmental pollution in the Dearborn area,” Nriagu says. Stress—whether from immigration, unemployment, environmental degradation, or any number of other causes—only exacerbates this “potent mixture.” It’s a clear case of environmental injustice, Nriagu insists. “In many cases, these people have no choice but to live there.”

Refugee Health: What Don’t We Know?

Many of those who seek refuge in Michigan have witnessed or experienced violence, torture, oppression, or war—but officials have no mechanism for assessing their mental health status.
Annually, the state of Michigan receives as many as 3,500 refugees yearly from places as disparate as Iraq, Burma, and North Africa. Within 30 days of arriving, each one of these people is required by law to undergo a health screening. Officials are looking primarily for evidence of communicable diseases—especially tuberculosis—but as Azadeh Farokhi, a physician and third-year resident in the SPH Preventive Medicine Residency program, found during a rotation last summer in the CDC Quarantine Station at Detroit Metro Airport, there may be more pressing problems.

Far more common among today’s refugees, Farokhi says, are chronic diseases like diabetes and heart disease, “the kind of thing you find in the United States.”
Even more startling, the Refugee Health Assessment form issued by the Michigan Department of Human Services includes no provision for evaluating mental health—even though studies show that refugees have a heightened risk of developing conditions such as depression, anxiety, and post-traumatic stress disorder. Just recently, Farokhi learned of two refugees who hanged themselves, and a third who tried to kill himself by lying down in front of a train. “How much is going on that we don’t know about?” she asks.

Many refugees have witnessed or experienced violence, torture, oppression, and war, all of which can affect mental well-being, Farokhi says. “Plus they’re leaving their home country and in many cases coping with a new language and culture.”

Farokhi knows firsthand what it’s like. In 1987, toward the end of the Iran-Iraq War, she emigrated from Iran to California with her family, and she saw the difficulties her mother, in particular, endured. “I think my mom probably suffered from depression for some time, understandably. She’s fine now, but I think initially she questioned whether it was the right thing to do.”

As part of her rotation at the quarantine station, Farokhi interviewed providers who conduct refugee screenings in three Michigan counties to see how they handled the issue of mental health. Time and again, she was told, “If we ask them about it, and if they have a mental health condition, then what? We have no place to refer them—especially if the patient needs an interpreter. There’s no money.” Ingham County was one exception. There, Farokhi learned, refugees receive both screenings and follow-up primary care through the county health department.

Farokhi hopes her work may help lead to the “de-stigmatization” of mental health, especially among refugees. She’ll share her results with the CDC, the Michigan Department of Community Health, and the Michigan Department of Human Services’ Refugee Services program.

Obstacles and Opportunities: Latinos in Michigan

Latinos have been a vital presence in Michigan since the early 20th century, when workers from Mexico and south Texas first came north to work in the state’s sugar-beet fields and auto-assembly plants. Today, Latinos comprise nearly five percent of Michigan’s population. They live and work throughout the Upper and Lower Peninsulas, in both rural and urban settings.


The latest numbers show close to 100,000 seasonal farmworkers in Michigan, most of whom are Latino. Agriculture is one of the most dangerous industries in the United States. Fatalities in farm work reached 596 in 2010, which constitutes the highest fatality rate of any industry, with 26.8 percent per 100,000 workers.

Housing is another major health issue. There are frequent issues with overcrowding, which is especially important when it comes to communicable diseases. In 2009, Michigan saw a big H1N1 influenza outbreak in one migrant worker camp. Much of the housing for migrant workers has no running water or toilets. Sanitation facilities are frequently lacking in the fields as well.

Nationwide, more than 80 percent of migrant workers have no health insurance or access to care, according to the National Institutes of Health. Even where migrant health clinics do exist, there are often transportation problems and cultural and linguistic barriers.

Nutrition is another big issue. In many areas, the only food sources for migrant workers are little bodegas or stores that have high prices and few, if any, fresh fruits or vegetables. Diabetes is a growing problem. We also see a lot of musculoskeletal issues and pain among farmworkers. Chronic disease is endemic. Because of pesticide exposure, we see a lot of asthma among children and higher rates of some cancers among adults. And farmworkers have more tuberculosis than any other group in the U.S.”
—by Valentina Stackl, M.P.H. ’10, a program associate for communications and outreach for Health & Safety Programs at the Association of Farmworker Opportunity Programs, who helps train farmworkers in pesticide safety and heat-stress prevention.

Urban Dwellers

Southwest Detroit is predominantly Latino—mostly Mexicans, but also Puerto Ricans and Cubans. The community is split 50-50, legal and illegal. Most people came here for family and work, mostly landscaping and construction.

The biggest concern for our community is immigration and racial profiling. Latinos with illegal status can’t get jobs, and so we have food, job, and health issues which impact families all the way around—not just the providers of care, but the children. The need is worse than what people even think.

When it comes to health care access, there are a couple of issues. One, Latinos who aren’t here legally don’t qualify. Two, language is a barrier. Even for people who are here legally, language is a barrier, and many organizations don’t have the cultural competence they need in order to service these families. The Latino community in southwest Detroit has its share of health disparities. We are right by the bridge, so we have lots of pollution and consequently high asthma rates. A lot of kids in the community are obese because they don’t eat correctly, so diabetes rates are also high. In partnership with the Detroit Community–Academic Urban Research Center, we’re working to address these issues so we can go where we need to go.”
—Lidia Reyes-Flores, the executive director of Latino Family Services in southwest Detroit; she serves on the board of the Detroit Community–Academic Urban Research Center (URC), whose partners include researchers from UM SPH.

Destination Michigan

The first European explorers to reach what eventually became Michigan were French members of a 1622 expedition led by Étienne Brûle. Forty-four years later, Père Jacques Marquette founded Michigan’s first permanent European settlement when he established a Jesuit mission at Sault Ste. Marie. Michigan passed from French into British hands after the Seven Years’ War (1756-1763) and today Americans of European ancestry live throughout the state, with large numbers of Dutch descendants in western Michigan, Scandinavian and Finnish descendants in the Upper Peninsula, and German descendants in both peninsulas.

As a vital route on the Underground Railroad to Canada, Michigan drew significant numbers of African Americans to the region in the 19th century. But it was the birth of the auto industry in the 20th century (and Henry Ford’s famous promise of “$5 a day”) that brought workers from throughout the world and across the United States—many from southern states—to southeastern Michigan. Today, with nearly 10 million residents, Michigan is the eighth most populous state in the nation and one of the most diverse, with a significant population of Middle Eastern ancestry and a growing Hispanic and Latino presence.

Michigan Demographics

  • 76.6% Non-Hispanic Whites
  • 14.2% Black or African-American
  • 4.4% Hispanic or Latino
  • 2.4% Asian
  • 2.3% Multiracial
  • 1.5% Other race
  • 0.6% Native American

—Source: U.S. Census Bureau

 Behind the Numbers

A statewide project aims to reduce racial disparities in infant deaths.

Derek Griffith often reminds himself that behind Michigan’s infant mortality statistics lie heartrending stories—the premature baby who never got to experience the warmth of sunshine on her face, the parents and grandparents whose lives were upended by the loss of a longed-for child. Griffith, an assistant professor of health behavior and health education at SPH, knows that these stories happen with disproportionate frequency among racial and ethnic minorities, and he’s working to address the problem in Michigan, where infant mortality rates among both blacks and Native Americans are significantly higher than they are among whites.

Through a three-year project called Practices to Reduce Infant Mortality through Equity (PRIME), funded by the Kellogg Foundation, Griffith and a team of colleagues in the Michigan Department of Community Health are endeavoring to strengthen the capacity of the department’s Bureau of Family, Maternal, and Child Health to reduce racial disparities in infant mortality among blacks and Native Americans. In recent years, bureau staff members have worked to deepen their awareness of racism and discrimination and to learn about the root causes of social and health inequalities so that they can more effectively interact with people from different ethnic and racial backgrounds. Members of the PRIME team are seeking to expand and enhance this work by tailoring resources and information to individual staff members, units, and sections within the bureau, and by strengthening existing skills, policies, and practices. A key goal of the project is to help distinguish both common and unique determinants of infant mortality among blacks and Native Americans.

By the Numbers: Infant Mortality

  • 7.5 Infant mortality rate per 1,000 live births, Michigan
  • 6.3 Infant mortality rate per 1,000 live births, United States
  • 5.4 - White infant mortality rate per 1,000 live births, Michigan
  • 15.5 - Black infant mortality rate per 1,000 live births, Michigan
  • 6.6 - Mortality rate for infants of other races per 1,000 live births, Michigan
  • 14.8 - Infant mortality rate per 1,000 live births, Detroit
  • 21.3 - Infant mortality rate per 1,000 live births, Saginaw
  • 6.4 - Infant mortality rate per 1,000 live births, Ann Arbor
  • 7.8 - Infant mortality rate per 1,000 live births, Grand Rapids

—Source: 2009 Infant Death Statistics, Michigan Department of Community Health