This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.
After 20 years of research and data collection, the Detroit Area Agency on Aging's (DAAA) new report, "Dying Before Their Time III," could not have arrived at a more relevant time. Released just days after Gov. Gretchen Whitmer declared racism a public health crisis in Michigan, the report finds that in Detroit, where nearly 80% of the population is Black, the death rate for people ages 50 to 59 is 122% higher than those of the same age in the rest of Michigan. The death rate for people ages 60 to 74 is 48% higher.
The report found that every year 1,600 older adults die before their time in Detroit, Grosse Pointe, Grosse Pointe Farms, Grosse Pointe Park, Grosse Pointe Shores, Grosse Pointe Woods, Hamtramck, Harper Woods, and Highland Park. The 19-year comparative analysis of excess mortality in Detroit is based on publicly released state data, with analysis done by Wayne State University School of Medicine researchers Dr. Herbert C. Smitherman Jr., Dr. Lee Kallenbach, and Dr. Anil N.F. Aranha.
“We’re enthused about the report, not entirely about the results,” says Ronald Taylor, executive director of DAAA, which funded the report. “But if nothing else, I have seen in my short time here that we have a resilient community and resilient population. There’s also been a great deal of civic goodwill from corporations and other entities. … I do believe that there is a will to address these issues and that gives me excitement.”
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Ronald Taylor.“We kept seeing the population of older adults in the city of Detroit decline," Smitherman says. "The prevailing thought at the state of Michigan was an out-migration of elderly, i.e. people leaving Detroit and going to the suburbs. However, that didn’t make a lot of sense. And when I looked into it, there was no data. We found a big amount we were losing were not leaving the city. People age 60 and above were dying prematurely.”
The DAAA's original 1999 "Dying Before Their Time" study sought to understand the reasons for that decline. The two subsequent studies monitored trends in the data over time.
“I wanted to continue to see if there were any changes relating to mortality rates and disparities, which we know are prevalent in our community,” Taylor says. “It helps us to continue to advocate for policy changes, speak about the condition of our communities, and make scientific commentary and recommendations.”
Chronic illness and lack of care
Chronic illness plays a major role in why Detroit's older adults are dying prematurely. 89% of them have at least one chronic illness. More than one-third (39%) have three or more chronic illnesses. The most common include hypertension, arthritis, heart disease, stroke, dementia, and diabetes. The study also found that these older adults end up in the hospital 37% more often than their counterparts in the rest of the state.
In the Detroit area, 54.5% of older adults live in federally designated Medically Underserved Areas (MUAs), compared to 16.5% in the rest of the state. In fact, 25.4% of Michigan’s older adults residing in MUAs live in Detroit. About 60% of all Detroit hospital admissions are for conditions that could have been prevented by access to primary care. Older adults living in Detroit experience heart disease, kidney disease, diabetes, and stroke 2.7 times more often than older adults living in the rest of the state.
“The shortage of health care and health care professionals is also an issue that affects people’s ability to receive services, improve prevention, and address the chronic illnesses our population faces,” Taylor says.
The report’s evaluation of nursing homes found that while Detroit had more beds per capita than the rest of the state, they were generally of a lower quality and rating.
Roots in racism
Smitherman asserts that, while a superficial analysis might signal out individual behaviors as the root of these chronic conditions, the reality runs much deeper. The trail begins with enslavement, was paved by Jim Crow, maintained by racist economic and education policies, and leads to the social determinants of health that undermine people of color's physical and mental health across the nation: poverty, food insecurity, air pollution, barriers to education, unfair wages, and lack of access to health care.
“The majority of older adults in Detroit live in Medically Underserved Areas. What we are seeing is a significant chronic disease epidemic, largely because of social, economic, and health policies,” Smitherman says. “Public policy and social policy are the root causes. These historic policies have oppressed these communities and the result is social and health ills.”
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Dr. Herbert Smitherman.Like other large cities across the nation where residents experience high rates of chronic illness and shorter life expectancy, the root cause is racism.
“We have a crisis on top of a crisis that is on top of another crisis. COVID-19 is superimposed on a group that’s already dealing with high rates of chronic illness and then, on top of that, a crisis of poor economic health and social injustices,” Taylor says. “Racism is for real. It’s something that can’t be shoved under a rug. There’s been a strong realization that has renewed commitment to addressing and resolving some of these issues.”
According to Smitherman, since the results of inequitable health outcomes experienced by Black Americans were first documented in a 1967 federally commissioned report by Otto Kerner, those outcomes have not improved. To turn the tables, policies and dollars must defund racism by funding schools, improving nutrition, raising wages, providing homes, making medical care available, and demanding equity and equality.
“The question is 'What are you going to do about it?' Ultimately, you need a plan that requires investment,” Smitherman says. “To call racism a public health crisis with no investment will not change the trajectory we are talking about.”
Addressing social determinants of health
Since the first report came out in 1999, the DAAA has worked hard to address social determinants of health. The hope is that the newly released report will inspire policy changes and funding increases that make it possible to do so even better. According to Taylor, this work will require a collective community response with all segments of society coming together and intentionally working outside of their individual silos.
“I am hopeful that we can address the social determinants of health in regard to improving the quality of life of all of our residents. It will provide a stronger infrastructure as far as programs and services, relationships, and systems,” Taylor says. “... We need to look across the horizon and see how we can overlap and work together. How can we collectively move forward to address these issues as a community initiative?”
One of the report recommendations is that federal and state agencies incorporate social determinants of health when allocating resources. Current funding formulas are population-based rather than needs-based — even though needs like good food, medical care, education, transportation, jobs, clean water, and clean air are responsible for 60% to 70% of an individual's overall health status.
“We also have to do a better job to ensure that environmental factors are factored into the equations when talking about the social determinants of health,” Taylor says.
Taylor sees four action items arising from the report. First, he says it is vital to look downstream — to increase services for people ages 50 to 59 and extend educational and preventive resources to youth. Secondly, he wants to provide more support to caregivers of older adults and grandparents who are raising grandchildren.
“Caregivers are the backbone of the health care system,” he says. “The informal supports that these individuals provide is huge.”
Thirdly, Taylor hopes the report will convince funders to increase dollars and ensure robust community programs and services. Finally, he sees the report as vital to inspiring policy change that focuses on the needs of a community rather than the size of its population.
“We have to do a better job reaching people before age 60. Do the education and preventive services to address these chronic illnesses earlier in life,” Taylor says. “One of the biggest differences between this and the other reports is that it takes the emphasis off of addressing only the perspective of seniors and highlights that any solutions ... need to address the entire community [and] good quality of life across the lifespan.”
A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at [email protected] or www.constellations.biz.
Photos by Nick Hagen.