Tag: Detroit

the limits of human research

Health, On the Ground

*Please note, the names and details of program participants have been changed to ensure anonymity.

After working with one of my first families, we’ll call the teen Larry, I began to feel limited by the research aspect of my current program. Since it is a research program testing various protocols for successful weight loss, my options and actions were often limited in what I could or could not do to help the family. At the time Larry was the heaviest teen in the program. I remember he was late for our first session at his house because he had missed the bus. I saw him walking down the street and knew immediately that he was who I was waiting for. Larry had knee and ankle problems as well as hypertension at age 15. At the time he was the heaviest teen in the whole program.

I built a strong rapport with the family and really enjoyed going to their house twice a week to work with them. Larry‘s weight fluctuated often, spiking and dropping dramatically from week-to-week. The family often attributed it to the medications that he was taking that cause him to retain water. However, over the first half of the 6 month program, Larry had lost about 20 lbs. from his starting weight. His Mom reported losing about 25 lbs. from participating and helping Larry during the program. She no longer needed to regularly wear oxygen and could walk more often than she was previously able.

In the last two months, Larry began to gain the weight back. Since his weight fluctuated so much it was hard to tell if he was really gaining a significant amount or if it was just related to the medications. By the final session of the 6 month program Larry had returned to his starting weight. His weight loss is considered significant and for him to gain it back is a red flag for larger problems. Research shows that when lost weight is gained back quickly it is much more difficult to lose again. His Mom was worried, he was confused, and I was unsure what to do. I gave the family additional information about other programs that Larry could participate in, but focused on affirming the skills that they had learned and the successes they had over the last 6 months.

It was during the following couple of weeks, which turned into months, that I really began dissecting Larry‘s dilemma. He was a very bright student, had some nice friends who helped him be active, and a very caring mother and grandmother. He took on more responsibility than most because his Mom wasn’t very mobile and yet he was unable to maintain his success in the program. I began to think back to other issues that the family dealt with during the program. The major one that jumped right out for me was their access to food. Larry and his Mom were getting food assistance and usually shopped once a month when the Grandmother could drive them to Meijer, which was located in another city. The family mostly ate frozen dinners that Larry could heat up in the microwave.

Beyond Larry and his family’s motivations, their social and economic situation became their largest barrier. Since they couldn’t afford to purchase healthier foods because they would go bad before the month ended, they were somewhat stuck to buy foods that were cheap and could be frozen. Their lack of money to be able to be more financially stable affected their food security in a similar way. Larry also reported eating a lot more at the beginning of the month. This is common among families using food assistance. One study found

“[…] a corresponding decrease of 10 to 15 percent in food consumption over the course of the month, suggesting some recipients may eat well for the first couple weeks after they’ve shopped and then run low on food near month’s end. This kind of ‘binge–starvation’ cycle has been linked to changes in metabolism, insulin resistance and, ultimately, increases in BMI.” (2004)

Larry‘s Mom would often report that he had eaten all of some food after they returned from the grocery store. Further research has identified connections between obesity and food stamps. The research found that the majority of food assistance receipts went shopping once a month, right after the food assistance amount is credited.

“Obesity cannot be totally pinned on food stamps,” says Jay Zagorsky, a research scientist at The Ohio State University’s Center for Human Resource Research and lead author of the study, “but it certainly is related to how the program is structured.”

In this situation, regardless of how committed the family was to weight loss and helping Larry manage his obesity, they were economically stuck in a cyclical nutrition pattern that would negatively affect his weight no matter his level of motivation. Socio-economic factors will win out over motivations every time, no matter the intentions. This is where human research is limited because the cause for failure is not pegged on the systematic inequality related to racial minorities and food assistance programs, but rather it is placed on Larry and his family for being unable to keep up with the program guidelines.

I keep reminding myself that this research will be applied to other programs in the future. Those programs will be able to replicate tactics that were most helpful and hopefully help even more adolescents in programs with more room to address multiple issues: medical, social, and economic.

real life public health isn’t sexy

Health, On the Ground

The field of public health does not lend itself to being glamorous or satisfying after a full day’s work.

I currently work as a Community Health Worker (CHW) in Detroit supporting a NIH funded grant using behavior change techniques to tackle childhood obesity among African-American adolescents.

Snapshot: Thursday, December 1st, 2011

After a meeting with my supervisor, I had three family appointments scheduled for the day. My first appointment was with a family that needed to be caught up after missing 2 weeks. We provide transportation for families that come into the office, so I had called them a cab. However, the cab company had not sent the cab after 45min. and the appointment had to be rescheduled for another day. My next appointment was with a Teen who obviously preferred not to be meeting with his Mom and me. We worked through topics on Hunger and Cravings, but had to finish early because I had another family appointment coming up. After waiting 10min., I called my last family to confirm and they had forgotten they were supposed to come in today.

I spent my 8 hours that day driving a lot and meeting with only my supervisor and one family. It was a long, trying day to only be able to check a few items on my weekly to-do list. The over-used quote that I have to keep reminding myself is:

“An ounce of public health is worth a pound of health care”

Hopefully somewhere down the line the families and Teens that I work with will someday use the skills and information that I share. All I can do is offer my knowledge and support for their efforts while reinforcing their positive changes.

Public health has become a buzzword along with the growth of the global health field. It’s great that health has become such a prominent topic of interest, but not everyone is going to save a life or change entire communities. Buzzwords don’t make the best career choices. It may be that you spend all day tracking people down and hoping some knowledge sticks, maybe you make posters for wellness events, or even get covered in dirt planting vegetables with kids who prefer to play video games. Public health isn’t sexy; work can be dirty, sometimes lonely, unappreciated and often unnoticed.

Public health is not a new field. It has been around for a long time, but in the media it has most often been portrayed by medical doctor drama series that always have to include twisted webs of personal relationships and hookups in broom closets from Boston to Kandahar.

Public health is intense and has its own great stories and dramas – can’t these stories tell themselves without the backdrop of casual sex and relationships gone wrong? When will the public be ready to watch a show that is about real public health?

The truth is that although public health may not be as glamorous as a television drama, but it is full of exciting adventures, dramatic endings, and stories of hope.

will big box grocers change access to food in Detroit?

Food, Health, Research

You can quote me on this:

“more big box stores will not equal better food choices”

On January 20, 2011, First Lady Michelle Obama launched an initiative with Walmart and the Let’s Move Campaign to increase access to fresh and healthy foods. The program is supposedly bneing evaluated by the Partnership for a Healthier America, whose Chair, James Gavin said he would like to see Walmart double its US store count.

I don’t often shop in Walmart (actually I try to avoid it), but last month I had a reason to be in a Walmart store. Working in childhood obesity research and surveying food outlets for nutritional quality, I took the time to notice the advertisements and products on display. To say the least, none of the food items advertised or on display were healthy or fresh.

There were none.

Behavior Change & Food

My point is that more Walmart stores in “food deserts” doesn’t necessarily mean that more people are going to be eating healthier. I don’t doubt that Walmart making an effort to improve the nutritional quality of its food products and offering more fresh and healthy foods will have a negative impact, however it is going to take more. When a low-income family has the choice between the on-sale advertised frozen dinners or the larger amount of fresh vegetables they are more than likely going to choose the product where they get more for their money (or at least what seems like it).

“there needs to be more education, access, and a american cultural shift towards healthier eating”

Everyday I work with adolescents and their families on managing childhood obesity. We talk about making healthy changes to their food intake and often times we talk about how to shop for healthy foods on a budget. It is possible and varies in difficulty, depending on your situation. Some families that I’ve worked with went the entire six months of the program without changing much in their eating habits. Changing your food choice is not that easy.

Eating healthier is easier if you are wealthier, have greater options, and have been introduced to ideas of healthy eating from a young age or cultural norm. Classism in the slow food movement is another topic, but extremely relevant as we talk about access to healthy food, urban settings, and growing income inequality often reflected in racial disparities.

Grocery Stores in Detroit

The idea of having more big box stores address “food deserts” and the lack of healthy foods isn’t new. The idea easily makes sense; large chain supermarkets are better able to supply larger amounts of fresh produce on a regular basis if they want to. Save-a-Lot released a report on food deserts in April 2010 and has also signed on to First Lady Obama’s campaign.

For Detroit, Save-a-Lot represents a greater potential than Walmart to be able to address the need to greater access to healthy and fresh foods since there are already ten locations in Detroit, Highland Park, and Hamtramack. I have yet to be able to assess the level and quality of fresh food available at a Save-a-Lot store (coming soon).

Anyone following food in Detroit knows that a Whole Foods store is being built in the Midtown district, near the Henry Ford Health System, Detroit Medical Center, Wayne State University and on the way home for downtown workers leaving the city. This was not the step forward that so many people were hoping for when there was talk of bringing in a national supermarket. Whole Foods is a specialty food store that caters to a wealthier clientele (Midtown avg household income: $113,788), I only go there for wine and dessert. It may bring more fresh food to the Midtown area, but won’t help many Detroiters without access to healthy foods.

A new development with more potential to impact the Detroit fresh food scene is the re-purposing of a former Detroit high school into a Meijer supermarket. Meijer often promotes healthy food options, has a partnership to offer healthy kids recipes, and has a fairly well-stocked produce section.

Big Box vs. Small Grocer

Like many locations that lack necessities, people create solutions to address those needs. Detroit has a number of small grocers and food supply stores, not to mention the largest Farmer’s Market in the US. As the #Occupy protests address money in politics and the ills of corporations, we need to be mindful of where and how food is accessed. Food is a critical piece of our national health and unfortunately our national politics.

People’s needs should be placed over profit and neither ketchup nor pizza are vegetables!

following the money & the loss of primary care

Featured, Health

Health statistics undoubtedly show the shortage of health workers and doctors around the world. Recently I wrote about the growth of hospitals in Detroit and the huge loss of primary care physicians. This is a health issue that is often associated with countries of the “developing” world, but the USA is facing a health shortage of a different kind: access to primary care.

Health financing has had the greatest effect on disparities in health care coverage as well as the structure of the health care system. Through our health care system, physicians have been incentivized to specialize as opposed to be a general medical practitioner. As technology has made medicine more efficient, it has not reduced costs, so “fees remained high, while the time and effort required to perform […] declined (Starr, 1982). The result was an increasing income disparity between physicians who specialized (Specialists) and primary care physicians (PCPs).

The advent of federal support for health care drove the income disparities between Specialists and PCPs. In 1946, the Hill-Burton Hospital Construction Act put $4 billion into the expansion of hospitals as opposed to ambulatory services (Starr, 1982). Ambulatory care services represent the single largest contributor to the increase of hospital expenditures and to decreased performance of the health care system in both the USA and many developing countries (Karpiel, 1994). In 1965, the start of Medicare and Medicaid allowed private insurance companies to continue their practice of providing higher reimbursements to procedural Specialists than to PCPs. Primary care was further marginalized when Medicare developed a policy that linked its teaching payments to a hospital’s level of inpatient, not outpatient, services. Medicare began giving extra payments to hospitals for residency training, pushing many hospitals to increase inpatient care in order to receive higher payments.

“Primary care brings promotion and prevention, cure and care together in a safe, effective and socially productive way at the interface between the population and the health system. The features of health care that are essential in ensuring improved health and social outcomes are person-centeredness, comprehensiveness and integration, and continuity care, with a regular entry into the health system, so that it becomes possible to build an enduring relationship of trust between people and their health care providers.”

“Primary Health Care – Now More Than Ever”
World Health Organization (WHO) Annual Report 2008

In a 2008 survey of Michigan physicians, 34% identified themselves as PCPs, which follows the national trend that two thirds of physicians are Specialists (Michigan Physician Profile, 2009). The report showed that numbers had not changed since 2005 and the number of PCPs entering the workforce equaled those leaving the workforce. The report also highlighted the rising costs of medical education and the debt that many young physicians will carry into the workforce. With this high level of indebtedness, why wouldn’t younger physicians look towards becoming a Specialist as opposed to a PCP with fewer financial incentives? A friend of mine studying to become a doctor noted that many of her colleagues were having conversations about whether to go into primary care or to specialize. Unfortunately the system seems to choose the path for young doctors as opposed to giving young doctors the choice to go into a medical field that they enjoy.

Health care reform has represents a huge win for those fighting for increased access to care along with the Affordable Care Act (ACA) providing a positive framework for many living in poverty. However, the largest reform may have been one that was minimally addressed by the ACA, including 10% bonuses for PCPs under Medicare and $300 million to recruit PCPs for underserved areas. I don’t think 300 million today goes as far as 4 billion did in 1946, nor does a 10% bonus equalize decades of subsidies for Specialists. The health care reform added $11 billion in support for community health centers, but some of that was cut in the 2011 budget deal. The inability of the current health care system to keep up with this new rising demand for PCPs on top of the increase of chronic diseases and an aging population that lives longer, represents the need for reform in our health care financing not just access to health care.

We have a health system that has subsidized specialized care for too long, taken health care to large technology driven hospitals, and limited the ability for new, young doctors to infuse our health system with much needed passion. The real health care reform should have included increasing support for primary care facilities (no cuts) and more for training.

If we want all people to be able to access health care affordably then we need to provide them with the necessary health workforce that can meet them where they are. For many urban poor the Emergency Department (ED) has become their primary care facility. Many individuals working in health care finance world note the cost of ED visits is covered by the premiums of the insured (roughly $1200-$2000/ year) .

Its exciting to see widespread support for increasing access for the uninsured, its amazing to see funding to bolster primary care facilities, but  if we are going to have young doctors who aren’t living paycheck to paycheck, then there needs to be a concerted effort to get doctors into those primary care facilities and greater incentives to join the growing trend in supporting community health through primary care.

why #OccupyDetroit won’t work

Activism

The #OccupyWallStreet protests have been incredible to watch. The protestors picked a great target for their message, organized without planning for a one day event, and have been building support ever since. I’ve spoken with friends involved in spinoff occupations and many ask me when “Occupy Detroit” is going to begin. Since then I’ve been throwing the idea around in my head and it never quite fits for Detroit. Just today I discovered that “Occupy Detroit” has already started to be organized for October 21, 2011.

1. What to Occupy

Interestingly the meeting point chosen is the iconic Detroit symbol of “ruin and decay,” Michigan Central Station. A large, empty building near Corktown, privately owned is not a great location to bring a large group of people to protest. I understand it is just the meeting point and protests will take place downtown, but that is where everyone should meet – downtown. It seems like the larger problem is that there is a group of people interested in occupying something, but they aren’t sure what to occupy yet.

The biggest corporate symbol in Detroit is GM Tower, right downtown by the river. The problem with protesting GM is that Detroiters and Michiganders are sick of being angry at the auto companies. It is a protest fatigue, everyone and their grandmother has something to say against the auto companies. It is an argument that doesn’t hold passion anymore. So what is next? Therein lies the problem. Detroit, corporately, is pretty small. The best large corporations that are in the city worth protesting are the banks. Many of the banks backed out of home loans for many Detroit residents during the recession. Just recently Citizen’s Bank was taken to court because of racial discrimination and unequal lending practices in Detroit and Flint.

Corporations take advantage of Detroit’s population in poverty all the time. A perfect example is Chase Bank, they have their community giving initiatives to look good, but where does the money they give away come from? It comes from all the people whose houses they foreclosed. Chase has set up a number of simple drive-through banking stations across the city. They’ve used technology to offer their service and avoided placing people in buildings to serve communities. Chase is notorious for its predatory lending services for home mortgages.

Chase Tower is located downtown, in the middle of an area where many wealthy people from the suburbs like to frequent. A potential place to make a statement in Detroit.

In the end, occupation in Detroit will be difficult. Many people “camp out” everyday for lack of a home or place to sleep. It is a divide between those who choose to take to the streets and those who have no choice. Another issue is that much of Detroit is unoccupied, so the message of an #OccupyDetroit effort may be easily lost.

2. Who will Occupy?

The other major problem that I see is that the young, white activist community in Detroit is doing the organizing. This is a far cry from the locally run organizations and neighborhood block clubs where the real effects of corporate greed are hardest felt. Many times African American residents of Detroit are very skeptical of young, white people making a lot of noise.

When the United Stated Social Forum (USSF) came to Detroit in the summer of 2010, there was a deep divide between the white activist community in Detroit (and the US) and the majority African American residents of the city. I was asked by many people, “what is going on?” and “why are all of these people here?” That isn’t to say that there was no racial diversity at the USSF, but unfortunately those who represented Detroit were a majority white activists disconnected from those living in Detroit.

I recently attended TEDxDetroit which was again a majority white. Detroit’s population is 76% African American, but TEDxDetroit was easily 80% or more white individuals with ideas to bring into Detroit without involving those who already live here. Why can’t organizations find and highlight the work done by people already here?

Detroit is full of vibrant ideas and interesting people. The problem is that the residents of Detroit who are facing the most difficult issues aren’t downtown. Most residents of Detroit live out in the neighborhoods and can’t often benefit from the downtown developments created to bring people in from the suburbs.

3. Already Occupied?

It is safe to say that many of those who live below the poverty line are less concerned with occupying something downtown and instead working on advancing their status in life. Detroit has a high percentage of its population living below the poverty line, hungry, without health insurance, and many without good paying jobs. The residents of Detroit are already occupied with making their lives and city a better place.

The recent Census showed that Detroit’s population is decreasing. Many people that I have talked to, including, Detroit high school student talk about getting out of Detroit and leaving for something better. How can a generation that wants to get out of Detroit be motivated to occupy what they don’t want?

If there is any sort of occupation in Detroit, it will represent the economic and racial disparities in the city and demonstrate the deep need to build real connections across communities. A real movement in Detroit would involve Block Clubs and Neighborhood Associations.

too much health care in Detroit?

Featured, Health

Detroit is a city where major landmarks are often its hospitals. The Henry Ford Health System (HFHS) operates three hospitals within the city limits and the Detroit Medical Center (DMC), recently bought by the private Vanguard Group, operates nine different health complexes. The St. John’s Providence group also runs two hospitals in the city. However, Detroit’s hospitals are just one side of health capacity in Detroit. The Detroit Wayne County Health Authority (DWCHA) lists thirty-six community health centers across the city, twenty of which are free or have a minimal fee to see a doctor. Not to be overlooked, Wayne State University’s (WSU) School of Medicine works with both HFHS and DMC as well as runs a number of health outreach programs for HIV, Diabetes, Asthma, Childhood Obesity, etc. to manage care for chronic conditions.

With such a wide array of health facilities and such a strong focus on health care it seems as though the population of Detroit should be one of the healthiest. Unfortunately, the socio-economic barriers faced by Detroit’s population leave it with the lowest numbers of individual with health insurance in the state, high rates of non-communicable/ chronic diseases, as well as a growing obesity crisis. From 2009 to 2010, in Detroit: median income dropped, numbers of insured decreased, and the numbers of those living below the poverty line increased. Likewise, the Michigan Department of Community Health (MDCH) doesn’t list all of Wayne County as a Medically Underserved Area/ Population (MUA/P), but much of the Detroit area has been given an MUA/P designation. So many health facilities, so little health care for the population.

American Public Media’s (APM) Marketplace and NPR’s Changing Gears ask if its health care overkill. With another new hospital proposed in Oakland County (next to Wayne County), politicians are hoping to bring in more jobs and revenue in the only sector that hasn’t been hit by the economic recession. “[…] there are already six existing hospitals within a 30-minute drive time that average occupancy is 55 percent. So it isn’t a hospital that’s needed by the community, it’s a hospital needed by one health system to capture market share from its competitors.” says Dennis McCafferty who represents a coalition of Michigan businesses and labor unions. Is it about the market or is it about access to care?

“Since about 1997, we’ve lost about 60 percent of our primary care physician capacity [in Detroit].” – Dr. Herbert Smitherman

As a result of the loss of primary care options, the cost of care is significantly increased for the uninsured. Over the past five years, Dr. Smitherman and the Health Centers Detroit Foundation, tracked 33,000 uninsured patients in Wayne County and moved 55% of them out of emergency rooms and into coordinated care through the Voices of Detroit program, which gave access to a primary care physician at reduced cost. The majority of patients are low income and uninsured, usually on medicaid. Dr. Smitherman says, “It is a very difficult population because often, when we want to adjust things and I want to prescribe a medication, they’re uninsured. People are literally having strokes and heart attacks because they can’t get access to a very simple medication. It is 50 times more costly to deal with that. It’s very frustrating as a practitioner that we don’t have the basic access to insurance products, etc. for people to cover their basic needs.”

With the Obama Administration’s health care overhaul Dr. Smitherman notes there will be added benefits for the uninsured.

About 56 percent of all those who are uninsured are people of color. Obviously, Detroit is 89 percent African American. – Dr. Smitherman

He notes that the many people who seek care in the most expensive environments: emergency rooms and hospitals, will have the opportunity to find a primary care physician instead of paying “10 to 20 times the cost” in the emergency room.

New options for the poor and uninsured are popping up across Detroit from the field of telemedicine. One such program is a partnership between CVS/Pharmacy and HFHS. CVS’s MinuteClinic’s, open 7 days a week and staffed by nurse practitioners and physician assistants, will have the added benefit of having the Henry Ford Physician Network doctors on-call. Henry Ford doctors won’t actually see patients in the clinics, but will consult with MinuteClinic staff as needed and will work with them each month to review patient charts. Patients who are visit a MinuteClinic and don’t have a primary care doctor will be given a list to help them find one. RiteAid is also launching NowClinic, which gives people a free call with a nurse or the option to pay $45 to talk with a doctor.

Governor Rick Snyder has called for better health and wellness across the state. Snyder’s proposal highlights the economic connections to a healthy population. He notes that everyone has a part to play whether business, nonprofit, or government.

Health is the foundation for Michigan’s economic transformation—it allows our children to thrive and learn, it readies our graduates for meaningful careers, and it permits our current workforce to grow and adapt to a dynamic economy. In this message, we lay the groundwork for a healthier Michigan, a Michigan in which residents of all ages prosper and contribute.

He has been innovative in hoping to create a database of children’s BMI’s to track the rise of childhood obesity and has called on the Michigan legislature to take action on a Michigan health insurance marketplace, where all can be insured to receive the proper health care. This seems to be the one area where Snyder isn’t cutting benefits for the poor or making it harder for them to access services.

To conclude, the health care landscape is rapidly changing across the State of Michigan and across the world. Many people are developing solutions to solve our lack of capacity in the health system through innovative programs and technologies. Politicians are on board, private companies are creating ideas, and nonprofit groups are making important connections for people without the right resources. What will be critical moving forward is to focus on patient needs as opposed to simple outcomes. People need solutions that they can control and maintain for themselves and their families. The future of health care must be collaborative.

poverty, in landscapes of scarcity and abundance

Development, Life, On the Ground

I haven’t been posting any new writing in a while because I’ve been off getting married to the love of my life! Everything went amazingly with the food, pictures, families, and the party after the ceremony. I couldn’t have been a happier person on that day, nor will I ever be happier than I was that day – at least until some other huge life events.

We spent 10 days on our honeymoon in Peru. Many people asked us how in the world we chose Peru. The truth is that we found a great deal on plane tickets and it was cheaper than Hawaii. What sealed the deal was that we both had never traveled anywhere in South America and wanted to see one of the wonders of the world: Machu Picchu. As long as our horrible Spanish was deciphered, we could buy the lower deck seats on the overnight buses (top deck feels like riding in a boat), and could find some fresh produce to eat – all of which are not necessarily easy, then we did alright. People were helpful, the Plazas de Armas were beautiful and manicured, the mountain scenery was incredible, and there were plenty of tourists – Peruvian and foreign alike.

What most shocked me about the experience was going back to work the Monday after we returned from our honeymoon. Driving down areas near Grand Boulevard and Trumbull:

Detroit’s poverty hit me hard.

I know that poverty and urban decline in Detroit have become romantically connected to the grit of America and its loss of industry, but this was different. I wasn’t excited to see the “ruin porn” or the decay of Detroit’s empty landmarks. I was having true culture shock. Growing up near Flint, urban decay and vacant industrial buildings were nothing new. On this drive, however, I could see the downtown Detroit skyline from the expressway while on my left and right were neighborhoods falling apart and huge structures with broken windows and without any activity.

The stark contrast was the difference between the poverty of abundance and the poverty of scarcity. Peru is not a wealthy country. The country gets a steady stream of tourists from around the world due to its pivotal location hosting the Incan empire and its prized city on the hill, Machu Picchu. Beyond the Plazas de Armas and the tourist meccas, there are obvious signs of poverty. My wife commented that just two or three blocks away from the manicured Plazas seemed to be the boundary for where any wealth reached. I recently wrote about how Mount Kilimanjaro is known for having the highest percentage of tourist dollars go back into the communities nearby, Peru made me wonder where all the tourist dollars were going besides improving tourism. In every city, we were met with street vendors, but also women and children dressed in traditional clothing asking if we wanted to take pictures with them for a fee. It hurt to see because it seemed to be a selling of their spirit, their culture, but it was one of the few ways they had to get by. Taking the taxi from Cuzco to Poroy train station gave a clear visual of the layers of wealth and poverty based on access to tourist dollars. The housing became more and more rundown as we went further from Cuzco and down into Poroy, where the best looking building was the train station. On many long bus rides we also witnessed the vast, empty, barren spaces were dotted with square homes. The poverty of scarcity was obvious in Peru, but it was also mostly hidden from tourists.

Maybe the reason that Detroit’s poverty hit me hardest was because Detroit doesn’t try to hid its poverty. There is no large tourism industry in Detroit and buildings lie abandoned, burned out, and collapsed. Our honeymoon to Peru really highlighted the differences between poverty based in areas of scarcity and poverty in places of apparent abundance. Even while Detroit has a history of abundance, many could argue that it is just as much a landscape of scarcity.

outsource to detroit: it’s like brazil

Development, Featured

I caught a recent news brief from the Detroit News reporting from the Mackinac Policy Conference put on by the Detroit Regional Chamber of Commerce and was surprised by the headline.

“Outsource to Detroit”

That’s a bit different than Chrysler’s “Imported from Detroit” tagline. I’ve been following this idea and imagery of Detroit. I’ve written previously about how misinformed the image of Detroit is, some critics call this “ruin porn,” while others (some academic professors) call Detroit Michigan’s “third world” city.

For these reasons I am not too surprised to read a headline that is generally associated with sending jobs to developing countries (“third world”). The article highlights the growth of businesses moving into downtown Detroit because of the low cost of office space and the surplus of technical talent. The technical talent may be reference to wider metro Detroit and the many existing technology companies, but I know that I often see billboards in Detroit promoting web and technology job opportunities.

In an interview with Tim Bryan, GalaxE Solutions, the CEO said,

“A hundred percent of the work we’re doing in Detroit is health-care related and is coming from outside Michigan. It validates our model to outsource to Detroit.” […] enable[ing] GalaxE to serve customers for roughly the same cost as operating from Brazil.

I would not call this outsourcing, since the primary idea with outsourcing is that the job leaves the USA for another country where business is cheaper. There are plenty of examples of companies shifting locations because of varying economic climates in different States. Case in point, GM moving production from Michigan to Tennessee because of different business regulations and tax breaks. Brazil is an up and coming developing economy with its hand in many international markets – is it bad to be like Brazil?

Detroit is quickly becoming an technology hub for Michigan, which is an amazing reversal from its manufacturing past, as well as innovating for better health care. Wayne State University School of Medicine is leading incredible research projects to improve health care along with the Detroit Medical Center’s (DMC) nine specialized hospitals, Henry Ford Health System, and Michigan State University’s College of Osteopathic Medicine.

If this is the future for Detroit, then things are looking good. This is an excellent example of economic growth in a downturn via two growing industries: health care and technology. If Detroit lawmakers play the cards right, everyone in Detroit could get the best of both worlds: job creation and city revitalization. These are important steps to pay attention to for a better Michigan future.

privilege is a key determinant of health

Featured, Health, Research

In our world of abundance there are growing areas of scarcity, our urban cities. These growing areas of scarcity once used to be bastions of wealth, but are now best known for their decaying infrastructures and lack of resources.

In some cases urban cities have faced industrial decline, in others its an issue of poor residents being marginalized. Either way, the health disparities that accompany low-income and minority communities is abhorrent.

One of the top health indicators related to privilege that can be seen in these communities is access to healthy food options. From Los Angeles to Detroit to Philadelphia, various communities lack basic nutritional resources like fresh produce and as a result have been disproportionately hit by health conditions related to lifestyle such as diabetes, high blood pressure, and obesity.

In the Ramona Gardens projects of Los Angeles, residents have to travel 3 miles by bus to reach the closest supermarket for fresh produce. The other small shops in the community just can’t stock as much as larger stores because they don’t sell the same quantities or they would have to charge higher prices. The health impacts such as hypertension and childhood obesity noted by a free clinic in the community show how critical access to healthy food options can be. The Ramona Gardens project is a great example of privilege playing a role in the health of low-income and minority communities by way of accessibility of resources.

photo credit: Dr. Hillier (NPR)

Similar issues have been found in black, low-income communities of Philadelphia. Like many urban areas, grocery stores fled to the suburbs where there was more space for larger stores and safer neighborhoods, not to mention higher paying customers. As a result of a community mapping survey, almost 20 supermarkets have opened in Philadelphia with the help of state funding. This brought access to healthy food for many low-income communities in the city.

As recently as 2007, large grocery stores have pulled out of Detroit. Not many have attempted to stay and Farmer Jack was the last standing. Detroit is often called a “food desert” because it lacks a major chain supermarket. The problem is not necessarily a lack of supermarkets, but rather the scarcity of healthy food options. Martin Manna, the Executive Director of the Chaldean American Chamber of Commerce of Southfield said,

“There usually is a market within walking distance of nearly every area of Detroit. It might not be a supermarket. That might be why there are so many people eating potato chips rather than wholesome foods in Detroit.”

Other Detroit residents have noted the lack of options at Detroit stores. Some stores claim to be serving a “black clientèle,” but  Gordon Alexander, who lives on the East side, says its just an excuse for stocking bad quality goods. This is a perfect example of racial privilege compounding income disparities when it comes to healthy food options in Detroit.

Our world of abundance needs to be able to serve everyone. There should be no reason that low-income communities struggle to purchase fresh produce or healthier foods. We can’t allow fast-food chains to make profits in the “marketplace of the poor” and add to the health disparities of minority communities. If anything, we should be able to find a way to offer healthy food to all citizens of our country regardless of race, income level, or location.

Featured on Americans for Informed Democracy Blog where I’m contributing as a Global Health Analyst.