Map: Arsenal of Health in Detroit 2020



During both World War efforts, Detroit’s factories and their manufacturing might was flipped from automobile production to support for the war effort. During World War II, at least 110 factories in Detroit retooled to produce parts for aircraft, tanks, and weapons.


Recently, the news media (Crains, Free Press, Detroit News) have reached back into history in an attempt to compare the Coronavirus global pandemic to a war effort. There are serious issues with comparing a public health response to a war, but today is all about the geography.

Detroit no longer has an arsenal from which to pull. There are no longer over 100 factories within the city limits. The auto industry’s operations are no longer are located in Detroit. The reverse prohibition trend in Detroit has led to the city’s strongest response as Detroit-based breweries and distilleries have started mass producing hand sanitizer rather than beer or spirits. Detroit’s…

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Map: Park Acres Per Resident in Detroit



A while back I saw this analysis completed by the WNYC Data News team on park access and wanted to recreate it for Detroit.

There has been a lot of change with parks over the years from the near closing of 50+ parks during Mayor Bing’s time, to an influx of funding to keep them open, then the widespread adoption of parks by community groups, now the new parks master plan, and $11.7 million being dedicated to 40 smaller neighborhood parks this summer.

The map was created by giving every census tract a half-mile buffer and then calculating how many acres of park space fell within those extended boundaries for each census tract. Those acres were then matched to the number of residents living within each census tract.

Some of Detroit’s more populated areas have much smaller parks. With more people and smaller park spaces that leaves fewer acres…

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Death, donations, and doing good

The ice bucket challenge was undoubtedly a media and fundraising success for the ALS Association. For many people this was an opportunity to “do good” and call out their friends on social media to do the same. Skepticism mounted as social media feeds were inundated with ice bucket participant videos.

Plenty Consulting looked at the data and found that daily donations to the ALS Association (ALSA) remained the same even as the number of ice bucket challenge participants grew exponentially. Donations to the ALS Association were 35% higher than last year, but were all the non-donating participants missed fundraising opportunities or simply “do good” imposters? Perhaps it is helping to foster a culture of giving?

Vox published a widely shared bubble chart (above) that demonstrated which diseases kill the most people compared to which diseases get the most donations. This chart is flawed in the sense that comparing one-time fundraisers, such as a Breast Cancer Walk, isn’t enough to capture which diseases get the most overall funding.

Others took a more statistical approach to their skepticism. One individual (redditor SirT6) chose to look at NIH funding and disability-adjusted life years (logarithmic) to compare some of the top diseases that get funding compared to their impact on lifespan.

I think both measures in the above chart are flawed in that NIH funding is a poor indicator of where the general public is donating and also it is nearly impossible to compare the suffering and impact of each individual disease through adjusted life years.

Instead I chose to identify the largest charity for each of the top 15 diseases that kill people in the US (excluding #5 unintentional accidents) based on the 2011 National Vital Statistics Report from the Centers for Disease Control (CDC). A few charities took on multiple diseases, such as the American Heart Association (AHA) working on heart disease (#1) and stroke (#4) or the American Lung Association (ALA) covering lower respiratory disease (#4), pneumonia (#8), and lung inflammation (#15). By searching the most recent IRS Form 990 from each charity I looked at their Total Revenue (fiscal year) as well as the percent of the Total Revenue that came from Contributions (fundraising, grants, etc.). I figured this gives the best indication of where both individuals and other foundations or nonprofits are giving their donations. I then compared each disease/ cause of death in its “per 100,000” prevalence rate.


The size of the bubble represents the percentage of total revenue that comes from donations. The big take away here is that some of the most deadly diseases are getting larger amounts of funding. However, there are a handful of diseases that definitely aren’t getting enough (i.e. Septicimia), but are three times as deadly as ALS. Lung diseases really aren’t getting a lot of donations, but seem to remain highly funded regardless. In my research for this I was surprised to find that HIV/AIDS per 100,000 rate is less than ALS at 2.5. In particular areas, such as Detroit, HIV/AIDS is a much larger problem, but it is good to see that advances in treatment and prevention have lowered the national rate.

The majority of charities depend on contributions and donations to fund their efforts, pay salaries, and cover expenses. It is difficult to say what percentage is used for prevention activities or for finding a cure, but very obviously not all diseases are funded equally. Likewise, not all diseases contribute to the deaths of people at the same rates. Does that mean some should get more funding over others?

Critical Questions on Mental Health in America

The topic of America’s mental health system and the need to improve it has become a hot topics following the most recent gun violence at an elementary school in Connecticut. Most of what I have heard from the media and politicians is a broad “need to improve mental health.” It is always a very generalized statement without many specifics on how or where or to what end. It is likely that these pundits and politicians have no idea, but I think this leaves a critical gap in the mental health discussion.

“As soon as I’m finished speaking here, I will sit at that desk and I will sign a directive giving law enforcement, schools, mental health professionals and the public health community some of the tools they need to help reduce gun violence.

We will make it easier to keep guns out of the hands of criminals by strengthening the background check system.  We will help schools hire more resource officers if they want them and develop emergency preparedness plans.  We will make sure mental health professionals know their options for reporting threats of violence — even as we acknowledge that someone with a mental illness is far more likely to be a victim of violent crime than the perpetrator.” – President Obama 01/16/13

An article that I read noted that it was easier to buy a gun than to access mental health services in America. Why is that true?

Mental Health Services Stigma

I seems as though the mental health climate in America is very similar to the stigma associated with PTSD within military circles. With the conflicts in Afghanistan and Iraq I remember reading that soldiers wouldn’t seek out counseling  for their PTSD because it was interpreted as if the soldier was unfit for service and had serious issues. This applies in both the military and civilian settings. When a soldier leaves duty they may still face stigma related to their PTSD.

Likewise, this often plays out in the civilian world. Seeking counseling is never seen as a positive endeavor. Meeting with a psychologist is a negative event in your life that you never hope to repeat and you most definitely don’t tell anyone publicly. But why?

Why Seek Mental Health Services?

What causes people to seek out mental health services? Are individuals only referred by their family doctor or sometimes do they attend because they are required?

Many people seek out mental health services as a result of substance abuse. Dealing with addictions is probably the most well recognized aspect of mental health in the US. However, there is often a high degree of stigma even for those with mental illness and addictions. Overcoming the stigma and discrimination against those in need of mental health is a huge hurdle if President Obama and others hope that mental health will be more easily accessible among the general public.

Other well known reasons for mental health services are: depression, bipolar, anxiety, and PTSD. Nearly 80% of individuals who suffer from depression say that they experienced some form of discrimination (Mental Health America). Other studies have found that racial discrimination and an individual’s level of poverty also contribute strongly to mental health. However, a recent poll has found that stigma against depression and seeking treatment for depression is decreasing.

Where are Mental Health Services Accessed?

I know for many students being on a campus makes it fairly easy to meet with a Counselor at various locations. How would individuals without easy access find and utilize mental health services. I know that individuals can go to a hospital or an emergency room if they are in immediate need of mental health services, but that can’t be the ideal method of accessing mental health.

Most people probably have no idea that they have access to preventative mental health care with their insurance, however this goes back to the stigma associated with seeking such treatment. The other major barrier to accessing mental health services is the high cost with a minimum around $100 and extensive treatment reaching over $10,000. As a result of the cost barrier, only around 7% of all adult Americans accessed mental health services (NSDUH report).

Since the majority of mental health tends to affect poor individuals this cost barrier makes it even harder to identify and treat mental health. Mental health services is included in the “essential health benefits” piece of the Affordable Care Act, but it is left up to States as to what is included. Without some serious thinking about why, how, and where individuals access mental health services – improving access will just be more political rhetoric. If we are serious about improving the mental health system then we need to be asking serious questions.

Polio Eradication Efforts: Militant or Ineffective?

Follow the Polio outbreak in real time with HealthMap

Smallpox has been globally eradicated since 1980, so why is the eradication of Polio so much more difficult? The World Health Organization (WHO) recently released that the Global Polio Eradication Initiative (GPEI) would be conducting a new targeted 15 country effort to vaccinate 72 million children in Africa. The new campaign follows numerous failed efforts of the past and reemerging outbreaks. Why does the African continent remain prone to Polio outbreaks that spread rapidly? Why did the organized campaign to eradicate Smallpox take only 21 years while Polio is going on almost 40 years?

Since 1796, when cowpox was used to protect humans from Smallpox, eradication efforts have taken place. It wasn’t until the WHO intensified the eradication of smallpox in 1967 that efforts were coordinated around the world. The Smallpox Eradication Program (SEP) was jointly run by the WHO, CDC, and National Ministries of Health in various countries. Doctors and epidemiologists from the US volunteered to help with the efforts. In many instances US volunteers were overbearing and controlling of their local counterparts. A report by Paul Greenough documented the use of intimidation and coercion in the final stages of the SEP. Foreign volunteers were sent to kick down doors (literally), force vaccination of those who refused, and fix the mistakes of local staff members (1995). These coercive tactics evoked resistance from local communities, but the SEP prevailed. The SEP was run in a structured, militant fashion, where individual human rights were overridden for the global public good. Similar issues with resistance have been seen in Polio eradication efforts, but responses to resistance have not been as militant. Could this be why Polio has continued to resurface?

The earliest documented case of Polio in Africa is traced back to 1580 B.C. in Egypt and still the virus continues to spread across the continent. The eradication of Polio relies heavily on National Immunization Days (NIDs), but these events are ineffective because they aren’t comprehensive vaccination efforts, positive cases are missed and some children aren’t vaccinated causing continued Polio outbreaks. Organized Polio eradication efforts began when the World Health Assembly launched the Expanded Programme on Immunization (EPI) in 1974, a program implemented through the NIDs . In 1988, the World Health Assembly said that by the year 2000 Polio would be eradicated and they launched the Global Polio Eradication Initiative (GPEI) to make it happen. Many prominent people and organizations put their support behind the program including Rotary International and Nelson Mandela, who in 1996 launched the “Kick Polio Out of Africa” campaign which vaccinated 420 million children. In the 90s, the UN Secretary General negotiated peace treaties to vaccinate in war-torn Liberia and Sierra Leone. Most recently in 2004, 23 African countries coordinated NIDs focused on Polio vaccination.

After all these efforts, Africa remains the only continent where Polio remains alive and well in multiple countries. A series of studies completed across West Africa showed that due to misconceptions about the vaccine, lack of adequate funding and corruption at the local level, and ineffective immunization campaigns, Polio has persisted on the African continent (Melissa Leach & James Fairhead, 2007). The year 2007 marked an outbreak of 25 cases in Angola which spread to 28 cases in the Democratic Republic of the Congo (DRC). In 2008, after an outbreak in northern Nigeria, where there have been vaccination conspiracy theories, spread to a dozen other countries, the WHO made Polio eradication their “top operational priority.”

Armed with a “more effective” version of the oral vaccine, the new GPEI organized effort across 15 countries hopes to eradicate Polio for good. However, just yesterday the New York Times wrote that the WHO reported 104 deaths and 201 cases of paralysis from Polio in the DRC. Is the renewed GPEI effort, launched Oct. 28, 2010, even working? Is eradication even a desirable goal at all, if past experience with Smallpox Eradication Program requires militancy?

Originally written for Americans for Informed Democracy (Dec. 4, 2010), where I wrote as a Global Health Analyst.

too much health care in Detroit?

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.

outsource to detroit: it’s like brazil

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.

dictators and democracies for health

Politics can have serious consequences for health. We need look no further than the US legislature for examples of the politics of health. The recent deeply partisan budget cuts threatened women’s health across the country and debates over the Health Care Bill easily demonstrates a democracy’s inability to provide basic health for everyone in its population. Other examples come from the USDA’s support for corporate farms over the population’s health needs amidst the growing obesity epidemic. Some of the best examples of health being politicized come from our own government, yet we rarely have to think about how the form of our government and political system has an impact on our health.

Whether it is a democracy or a dictatorship, politics influences health. Cuba has long held a spot as one of the top national health care systems as well as one of the top countries for medical education. Their system is completely government-run with no private companies controlling hospitals or clinics. Cuba has been innovative with their computerized system for blood banks, patient records, etc. However, their government is a dictatorship and this has created some negative effects on health (depending on who you talk to). During the 1990s, the loss of Soviet subsidies combined with other political and economic factors created a countrywide famine. Manuel Franco describes the Special Period as,

“the first, and probably the only, natural experiment, born of unfortunate circumstances, where large effects on diabetes, cardiovascular disease and all-cause mortality have been related to sustained population-wide weight loss as a result of increased physical activity and reduced caloric intake”.

Recently we have seen the horrifying impacts of dictators and authoritarian regimes crushing their own health care systems at the expense of their populations. In Libya, health workers have been shot at, ambulances have been bombed, and hospitals have been razed. Gadhafi has ruled Libya since leading a bloodless coup d’etat against the then King of Libya.

In nearby Syria, similar atrocities have been committed. A recent video from the protest against the Syrian government showed a pro-government Doctor beating an injured protester out of an ambulance. The main hospital in Deraa has reportedly received 37 bodies of protesters killed. Syria is officially a republic with a constitution and elected leaders. The real story is of a country run by one party handed from father to son that has been governed under “The Emergency Law” which suspends constitutional protections since 1963.

Chris Albon, author of Conflict Health, wrote an informative piece on how the protests in Bahrain are centered on the health care system. Protesters seeking refuge in the hospitals have been denied treatment by government troops and ambulances have been blocked. He notes a new report from Doctors without Borders that says, “the government has attacked and militarized the health system, making protesters and bystanders afraid to seek treatment.” Bahrain is a constitutional monarchy where people have long protested over their lack of personal rights and freedoms.

In another example of the difficulties of democratic politics to support health, Nigeria’s recent elections have fueled intense fighting across the country. Hospitals reported that over 300 people were seen for bullet wounds. The ethnic and religious divisions in Nigeria have long plagued efforts to build a unified democracy. Nigeria’s history of military rule and oil wealth has also exacerbated these divisions. When a democracy can’t hold elections without widespread violence, how can they provide health for their people?

Both dictators and democracies have the potential to instigate situations that have serious health impacts. Whether it is frivolous debate or armed conflict, the politicization of health has lead to serious health deficits around the world. No matter what country you live in there is always room for development when it comes to providing for the health of a population.

Featured on the American for Informed Democracy Blog, where I’m writing as a Global Health Analyst.

when conflict health becomes military tactic?

From refugee situations to border disputes, health crises that arise as a result of conflict are unfortunately quite common. Conflict health disrupts the ways that people access resources like food, water, and medicine. On the other hand, conflict health creates the circumstances where diseases spread, people are needlessly killed, and others are critically injured. These horrible results of conflict health are compounded by the destruction of infrastructure: roads, hospitals, etc.

What happens when conflict health becomes a military tactic? Since Medieval times (and before) armies attacking opposing castles would launch disease infested animal carcasses over the walls. In the 1800s, the US military gave smallpox blankets to indigenous North American groups in order to destroy their health and kill their populations. During apartheid in southern Africa, South African forces supporting RENAMO in Mozambique targeted health clinics and hospitals to cripple the health and infrastructure of the population.

During the World Wars, medics and vehicles with a red cross weren’t supposed to be targeted because they weren’t carrying out military actions. I had thought this idea was fairly widespread and that mercy was shown to health providers in times of conflict.

Recently, we have seen the complete opposite during the Libyan conflict. Libya’s pro-Gadhafi forces have targeted those attempting to provide health services to protestors and the population. In the early days of the protests it was reported that the military was entering the hospital to dump out blood supplies so that injured protestors could not be saved. In similar actions, Red Crescent medics and ambulances have been shot at, Colm O’Gorman, executive director of Amnesty International Ireland, said:

“This was a deliberate attack on medical professionals, who were wearing full medical uniform and arrived in two clearly marked Red Crescent ambulances.”

Ambulances have been bombed, The rebel spokesman confirmed that

“Gaddafi’s forces shoot three ambulances, killing two drivers.”

The Misrata hospital has been a flash point of intense shelling and fighting by Libyan forces. The hospital has been bombed from the air, shelled by tanks, and overrun by pro-Gadhafi troops.One person inside said,

“heavy tanks for Gadhafi troops start attacking the hospital – the bombs falling here 20 meters (66 feet) around us.”

The health of the Libyan people is under seige as much as the repressive dictatorship of Gadhafi. Many countries including Egypt, Morocco, and the UAE have established military field hospitals to be able to help the wounded who are leaving Libya. UNICEF is deeply concerned about the impact of the conflict on children and has distributed emergency health kits which contain enough drugs, medical supplies and basic medical equipment to cover the needs of 60,000 persons.

The conflict in Libya, through the blatant attacks on health providers and facilities, has demonstrated a new level of disregard for the basic health of a population. This is an obvious example that Gadhafi must be removed from power if the Libyan people are to regain their health and livelihoods.

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