Executive Summary:
Health Equity & Prosperity: Building Healthy Communities & Opportunity for Michigan’s Future
The State of Michigan stands at a crossroads. Battered by the recession, the housing crisis and challenges in the
manufacturing industry, the state faces significant challenges and limited resources as it looks toward the future. This
challenging moment provides an opportunity for the State of Michigan to find a new path forward to provide
opportunity and prosperity for its diverse residents. Like an ailing patient’s vital signs, the State’s deep inequities across
the domains of race, place and class are indicators of peril for Michigan’s future.
Many Michigan residents face significant barriers to opportunity, prosperity and health. Growing inequities across
several domains exist for many of Michigan’s residents, most notably among the State’s racial and ethnic populations.
These growing and pronounced inequities are troubling indicators for the State’s future and its economic prosperity. In
particular, wide ranging health inequities across lines of race, class and geography, are holding back the State’s labor
force and act as an impediment to prosperity and opportunity for the State.
Public health data shows that the very existence of inequities between groups hurts the health of all groups.i Health
disparities produce widespread economic harm to the US economy and add additional cost burden to our nation’s
health care infrastructure. The Joint Center for Political and Economic Studies estimates that health disparities for racial
and ethnic populations produced $1.24 trillion in cost to the U.S. economy between 2003 and 2006. This included nearly
$230 billion in medical expenses and nearly $1 trillion in indirect costs to the economy.ii
If Michigan is going to have a prosperous future, the State needs healthy residents and a healthy workforce. Pursuing
health equity is a pathway to achieving these goals. Policy goals should support equitable access to health care, healthy
communities and affirmatively address the social determinants of health responsible for many poor health outcomes.
These social and environmental determinants of health can have a significant impact on health outcomes, accounting for
70 to 80% of disparate health outcomes. Investing in health equity and addressing social determinants of health is an
investment in human capital and furthermore and investment in Michigan’s economy.iii
The health equity frame does not downplay the role of personal responsibility, but enables individuals and communities
who are striving to pursue opportunity and live a healthy life, open pathways to the resources, knowledge and freedom
from community based barriers to health. Health equity assures that all communities have access to critical health
resources, have ample opportunity to make healthy choices and the opportunity to live in healthy communities, thus
providing the critical opportunities needed to thrive in our society.
Equitable health care in the state of Michigan benefits the not only the state but also the individual; focusing on
wellness prevention can lead to a better quality of life and a decrease emergency room and hospitalization costs.
Preventable disease adds to the cost of healthcare and decreases the overall quality of life. Roughly half of the causes of
death in Michigan are related to preventable risk factors. By addressing such preventable diseases, the State of Michigan
will be a healthier state, a more economically viable state, and a state which is more strategic, efficient and effective in
using its health care investments.
Addressing health equity and the social determinants of health is an approach that can more effectively lead to better
health outcomes for Michigan’s residents, producing a healthy population, healthy workers and contributing to an
economically healthy state. Health equity can be a transformative approach which can not only help the State of
Michigan’s resource challenges but also be a powerful tool to drive Michigan’s revitalization.
Page | 1
To begin to address this challenge to Michigan’s future, M.O.S.E.S., the Michigan Minority Health Commission and the
Michigan Universal Health Care Access Network request that the governor appoint a staff person to work with all
organizations to:

Establish a strategy/method to insure that health equity and strategies to address social determinants of health
are considered in Michigan's policy and legislation. In particular focusing on issues of infant mortality, which is
directly tied to social determinants of health.

Establish a time frame for implementing this strategy.

Connect with people in the governor’s administration and the Michigan Department of Community Health who
will further this work.

Establish a strategy to support the adoption of our agreed upon recommendations for promoting healthy
communities and the opportunity to lead a healthy life to all Michigan residents, with focused attention on
those groups facing the deepest health challenges.

In addition to the measures above, the State of Michigan should embrace:
o A “Health in in all Policies” framework, in which all state agencies and programs will work together,
across sectors and across departments to assure state policy is supporting positive health outcomes and
proactively targeting social determinants of health.
o The National Prevention Action Plan a Health and Human Services initiative calling for cross sectoral and
cross departmental strategies to support preventative investments and policies in addressing social
determinants of health which produce poor health outcomes.
Page | 2
Health Equity & Prosperity: Building Healthy Communities & Opportunity for Michigan’s Future
Jason Reece & Keischa Irons
The Kirwan Institute for the Study of Race & Ethnicity
Prepared in Collaboration with M.O.S.E.S, the Michigan Universal Health Care Access Network
& The Michigan Minority Health Coalition1
September 2011
Introduction:
The State of Michigan stands at a crossroads. The past decade has produced state-wide population loss, a loss of more
than 800,000 jobs and double digit unemployment rates. Detroit, once the third-largest city in the nation, lost more
residents than hurricane-stricken New Orleans. Battered by the recession, the housing crisis and challenges in the
manufacturing industry, the state faces significant challenges and limited resources as it looks toward the future. This
challenging moment provides an opportunity for the State of Michigan to find a new path forward to provide
opportunity and prosperity for its diverse residents.
Like the State, many Michigan residents face significant barriers to opportunity, prosperity and health. Growing
inequities across several domains exist for many of Michigan’s residents, most notably among the State’s marginalized
racial and ethnic populations. These growing and pronounced inequities are troubling indicators for the State’s future
and its economic prosperity. In particular, wide ranging health inequities across lines of race, class and geography, are
holding back the State’s labor force and act as an impediment to prosperity and opportunity for the State.
Comprehensive, successful health reform must include prevention, wellness, addressing social determinants of health
and empowering personal responsibility. Michigan must maintain the physical and mental health of its citizens, a
healthcare system designed to reduce costs, improve efficiency, increase access, and promote wellness is exactly what
the state needs to ensure the well-being of all communities.
The following white paper provides an overview of the health challenges facing Michigan’s most vulnerable
communities. We document the impact of social inequity and health inequities on the State of Michigan’s prosperity and
economic health. The paper closes by presenting a framework for addressing the State’s health inequity and a “new way
forward” in building healthy communities and a healthy, prosperous state. The economic future of Michigan and the
health condition of the future workforce is of paramount concern. All Michigan residents and communities share a
1
The research opinions expressed in this paper express the opinions of the Kirwan Institute. The policy pathway forward identified in
this report was identified and represents the position of the Michigan Universal Health Care Access Network, The Michigan Minority
Health Commission and M.O.S.E.S.
Page | 3
common future and impact one another. Michigan’s racial, geographic and social inequities harm more people than just
marginalized groups and communities; these inequities imperil the State’s economic future, thus impacting everyone.
The Cost of Inequity: Endangering the State’s Economic Health
Like an ailing patient’s vital signs, the State’s deep inequities across the domains of race, place and class are indicators of
peril for Michigan’s future. As we move further into our 21st century economy and learn how our economy is changing,
the push for collaboration, innovation, and harnessing our intellectual capital will be critical. The economic future for
regions will not look like the economy of the 20th century, a model of mass production or employment built around
unskilled labor. The future will be based on innovation and a work force that is skilled with technical prowess and more
advanced decision-making capability. Innovation is the road to regional and societal wealth in the 21st century. In fact, a
2006 Federal Reserve study found that a skilled workforce, high levels of racial inclusion, and improved income equality
correlate strongly and positively with economic growth at the regional level.iv But, an innovation-based economy will
struggle to succeed without an educated, healthy and skilled labor force.
To address this issue of health inequity we must first understand why improving health outcomes for all Michiganders
will lead to a better economy and prosperity. Geographic and social inequities harm people beyond the marginalized
groups and communities. They impact the health and vitality of the entire region, imperiling a community and region’s
economic future. Inequities and disparities are more than just a representation of one group or community doing worse
than others; they are a symptom of a greater challenge: the isolation or marginalization of a large number of a
community’s residents.
Disparities are an indicator that entire groups or communities are isolated from the critical opportunities and tools
needed to succeed, thrive, and survive in our society. These residents face many obstacles to success and many are
never able to meet their full potential, representing not only an individual tragedy but a societal tragedy. The high
school dropout who falls prey to the challenges in the community could have been the community’s next business
leader, educator, entrepreneur, community organizer, or political leader. This individual story is tragic, but an entire
community of youth lost this way is a societal challenge that can prove disastrous to having economically vibrant
communities and a sustainable future.
Inequities represent waste in our society -- wasted human capacity and human potential. As the economist Richard
Florida states in The Flight of the Creative Class:
“Rising inequality is a deadweight drag on our economic competitiveness…The basic formula is simple: Those
companies, regions and countries that reduce waste and effectively harness their productive assets have a huge
advantage in the Darwinian competition that powers creative capitalism.”
This presents a tremendous challenge to both our national economy and the economic future for the State of Michigan.
In the United States, the economic gap between the poor and wealthy continues to widen, more alarming, 46 percent of
children born into poverty remain poor throughout their lifetime.v Unemployment data from the Bureau of Labor
Statistics shows that African-Americans and Latinos have endured higher unemployment rates than Whites during the
Great Recession. As the American population undergoes a shift in demographics, access to jobs, education and health
will be imperative for the sustainability of America.
Page | 4
Shifting demographics will inherently be problematic for the State of Michigan as people of color, who suffer the
deepest inequality and barriers to opportunity, in the United States become the majority.vi By 2042, non-Whites will
make up the majority of the U.S. population. Data from the Census 2010 shows a fast growing non-White population.
Non-Whites made up 92 percent of the nation’s population growth between 2000-2010; those numbers represent 36
percent of the current population.vii Analysis of Census 2010 data for Michigan illustrates that the State of Michigan is
experiencing similar demographic shifts. The non-White and non-Latino population in Michigan remains the majority,
but shrank from 79% of the total population in 2000 to 76% in 2010.
Given the disparities and barriers to opportunity and health for many communities of color, the economic consequences
for a demographic shift will be a significant challenge. For example, closing the education gap among Latinos and
African-Americans in comparison to Whites will need to be a part of the discussion to ensure the approaching labor
force consists of skilled workers.
The rapid demographic transition will affect the American economy, politics, and cultureviii. However, research on the
topic has suggested greater strides towards equity promote a stronger economy and that inequality is harmful on
economic growth. Professor William Easterly of New York University found that societies that are economically
polarized, where a middle class exist, have more income and growth and Ohio State University’s Mark Partridge found
that “a greater share of income going to the middle-income quintiles within states leads to higher levels of growth”ix.
Lastly, the W.E. Upjohn Institute for Employment Research examined growth in 118 regions from 1994–2004 and found
that racial inclusion and income equality were positively correlated with economic growth measures including
employment, output, productivity, and per capita income. x
Investing in health equity is an investment in human capital and furthermore and investment in the American economy.xi
Public health data shows that the very existence of inequities between groups hurts the health of all groups.xii Even
more non-disadvantaged groups fail to reach the levels of health that are possible when there are inequities in
opportunity. Health disparities produce widespread economic harm to the US economy and add additional cost burden
to our nation’s health care infrastructure. The Joint Center for Political and Economic Studies estimates that health
disparities for racial and ethnic populations produced $1.24 trillion in cost to the U.S. economy between 2003 and 2006.
This included nearly $230 billion in medical expenses and nearly $1 trillion in indirect costs to the economy.xiii
Ultimately, a company’s productivity relies on the health conditions of the workforce.xiv According to research from the
University of Michigan Health Management Research Center, “individuals with multiple health risks (e.g., obesity,
cigarette smoking, and high blood pressure) tend to be less productive than their peers with better health profiles.”xv
Additionally, studies on health and productivity management have shown that an “at risk” workforce can be a liability
for businesses. Ultimately, investing in health equity issues can reduce absenteeism, reduce turnover rates, improve
employee stamina and focus at work, better relationships between employees and supervisors and finally increase job
satisfaction.xvi
In the Michigan Health Equity Roadmap, the Michigan Department of Community Health acknowledged the role of
addressing health inequity to support better conditions for all residents in the State.
“A focus on health equity, rather than health disparities, helps to broaden disease prevention efforts beyond
individual risk factors to the root causes that largely influence health behaviors and health outcomes. A health
equity focus also makes good public health sense. Addressing social, economic, and environmental conditions will
contribute more broadly to improving equitable health for all segments of the population, including socially and
Page | 5
economically disadvantaged populations, than to focus on individual risk factors alone. Health equity benefits
everyone.”xvii
Defining Equity & Health Equity:
What do we mean by “equity” in the domain of health? The term equity has been defined by scholars, researchers and
activists as fair access to critical opportunity structures, such as education, employment and healthcare, across class,
race and ethnic populations; connecting people to opportunity creates positive, transformative change in
communitiesxviii. Health equity does not take away from the role of personal responsibility, but enables individuals and
communities who are striving to pursue opportunity and live a healthy life, open pathways to the resources, knowledge
and freedom from community based barriers to health. Health equity assures that all communities have access to the
critical health resources, have ample opportunity to make healthy choices and the opportunity to live in healthy
communities, providing the critical opportunities needed to thrive in our society. Equitable health care in the state of
Michigan benefits the not only the state but also the individual; focusing on wellness prevention can lead to a better
quality of life and a decrease emergency room and hospitalization costs. Preventable disease adds to the cost of
healthcare and decreases the overall quality of life and that roughly half of the causes of death in Michigan are related
to preventable risk factors. By addressing such preventable diseases the State of Michigan’s will be a healthier state, a
more economically viable state, and a state which is more strategic, efficient and effective in using its health care
investments.
Choice and opportunity are fundamental principles of American society. Equity provides a framework for assuring all
Americans, regardless of their economic conditions, race, ethnicity, disability or location have the ability to make
informed and productive choices. Providing access to those critical pathways to success, education, sustainable
employment, the ability to build wealth and the freedom to live in a safe and healthy community, pursued by all
Americans.
Equity implies more than just equal treatment, but acknowledges the systematic challenges facing some communities,
and seeks to connect these marginalized communities to opportunities vital to living a healthy life and pursuing the
American dream. In short, equity provides the building blocks to success in our society, a foundation to support healthy
choices, healthy communities and ultimately a healthier society.
Moreover, a focus on health equity helps to broaden disease prevention efforts and close the health gap between
different racial, ethnic and social groups. As defined by the Paula Braveman and Sofia Gruskin:
“…equity in health is the absence of systematic disparities in health (or in the major social determinants of
health) between groups with different levels of underlying social advantage/disadvantage...”xix
Michigan’s Vital Signs: Indicators of Inequity and Health for Michigan
Given Michigan’s tremendous economic challenges from the past decade, many communities are struggling across the
State. Michigan’s child poverty rate of 22.5% in 2009 was one of the highest state rates in the nation. The Brookings
Institute predicts child poverty grew in 2010 to 23%.xx Deep disparities can be found among many of Michigan’s
communities, with the largest disparities impacting the State’s racial and ethnic populations. Poverty rates for African
Americans in Michigan were 35% in 2009, double the State average (16%) and nearly 30% of Latinos were living in
poverty.xxi The recession has exacerbated many of the State’s economic disparities, with unemployment rates for Black
Page | 6
men in Michigan at 28% in 2010, more than double the state average of 12%.xxii Economic challenges have been
particularly damaging to children of color, while one in five children in Michigan were living in poverty; poverty rates for
non-White children increased 50% between 2000 and 2009, with one in two African-American children and one in
three Latino children living in poverty in 2009.xxiii
Extreme community level-disparities and racial segregation are also prominent in many of the State’s urban areas.
Looking at conditions in the Detroit metropolitan area, we can begin to grasp the severity of segregation and community
isolation from opportunity facing many urban communities of color. The Detroit region has the highest rate of racial
segregation in schools and housing in the nation (ranking first in both measures out of 329 metropolitan areas).xxiv The
combination of geographic disparity and racial disparity combine to further isolate racial populations in these urban
communities. On average, African Americans in the Detroit region live in neighborhoods with poverty rates nearly
quadruple the rates experienced by Whites. Similarly, for the average African American in the Detroit region, both
neighborhood vacancy rates and unemployment rates were nearly double the rates experienced by Whites.xxv
Geography, race and poverty are intertwined in many of the state’s urban communities, an experience found in all of
the State’s urban areas, from Benton Harbor to Saginaw and Flint to Detroit. Given the importance of these urban
regions to the State’s economic health and economic competiveness, these disparities are going to severely limit the
State’s economic potential. Poverty and place work together in a systematic way, fueling racial disparities and isolating
communities of color from opportunity. The largest metropolitan region, the Detroit MSA, has the largest degree of “job
sprawl” and spatial mismatch for African Americans in the nation. The Brookings Institute found that more than 90% of
employment in the Detroit region had moved outside of the core business district in the region, while nearly 75% of
African Americans in the region were physically segregated from jobs.xxvi (Nationally, only about 1/3 of Whites and more
than ½ of African Americans were found to be spatially segregated from employment).xxvii Segregation also means more
students of color in the Detroit region are trapped in the region’s worst performing schools. More than 4 out of 5 African
American students in Macomb, Wayne and Oakland counties attend three districts.xxviii
In connection to job loss, Michigan’s Medicaid program has significantly increased in size during the economic recession.
Over the past decade the state has experienced a 53% increase in caseloads, which amounts to 564,000 additional
casesxxix. Additionally, 1.2 million Michigan citizens are uninsured. However, disparities and inequity for Michigan’s
communities of color are not limited to socioeconomic conditions and geography. Wide health disparities indicate a
significant public health challenges for the State. For example:

Mortality rates (represented as the number of deaths per 100,000 persons) for African-American Michigan
residents is 1041.7, 27% higher than the rate for Whites (768.5). African Americans in Michigan have highest
mortality rates in the state for cancer, heart disease, asthma and stroke.

The proportion of Native Americans (27%) and African Americans (23%) who reported having “fair” or “poor”
health was substantially higher than the number of White’s reporting the same response (13%).xxx

Infant mortality rates (represented as the number of deaths per 1,000 live births) for the African-American
community (16.5) are three times the rate in the Whites (5.8); rates for Native Americans (11.1) and Latinos
(10.3) were nearly double the White rate. xxxi More than 14% of African American births were low birth weight,
double the rate for White births. African American children also have the lowest rates for access to prenatal care
in the State.xxxii

Diabetes in the African American and Native American community is more than double the rate prevalence in
the White community. Native Americans have the highest diabetes mortality rate in the State, nearly double the
Page | 7
diabetes mortality rate for Whites. xxxiii Obesity rates for Native Americans (46%), African Americans (38%) and
Latinos (37%), compared to 27% for Whites. xxxiv

Racial and ethnic populations in Michigan also have divergent rates of health care access. One in five African
Americans and Latinos lacked access to health care insurance between 2005-2007, compared to the one in ten
Whites. xxxv
Geographic, social and racial disparities in socioeconomic conditions and health are more than just indicators of isolation
for marginalized populations. These disparities (and inequality) play a significant role in undermining the future for all
residents of the Detroit region and the State of Michigan. Inequality represents lost human capacity and social capital,
resources critical to Michigan’s economic prosperity. Addressing these inequities is a critical step to assure a functioning
democratic society and prepare the region for its future.
Toward a Healthy, Equitable and Prosperous Michigan: Providing Access to Health Care, Healthy Communities and
Addressing Social Determinants of Health
If Michigan is going to have a prosperous future, the State needs healthy residents and a healthy workforce. Pursuing
health equity is a pathway to achieving these goals. Policy goals should support equitable access to health care, healthy
communities and affirmatively address the social determinants of health responsible for many poor health outcomes.
The factors driving Michigan’s health inequities are complex and interact to depress health outcomes for the State’s
disadvantaged populations. As described by the Families USA in their report Reducing Racial and Ethnic Health
Disparities: Key Health Equity Provisions:
“Racial and ethnic health disparities continue to plague this nation and our health care system. People of color in
the United States are more likely to lack health insurance, to receive lower quality care, to suffer from worse
health outcomes, and to die prematurely. The causes of these disparities are broad and complex. They range
from societal issues like poverty, racism, and unhealthy environments, on one hand, to health system factors
such as lack of health insurance, linguistic or cultural barriers, and limited access to health care facilities, on the
other.”xxxvi
Addressing Social Determinants of Health and Providing Access to Healthy CommunitiesAlthough it is critical to address the need for equal and equitable health coverage, it is also essential to get at the root of
health issues calls for public policy to address the overall health of communities. Health problems can be the result of a
combination of issues such as hereditary or biological make up, health related behavior and social and environmental
determinants. A person’s health is strongly influenced by social determinants or the socioeconomic and environmental
conditions in which they live.xxxvii As described by the U.S. Department of Health and Human Services:
“The conditions in which people live determines, in part, why some Americans are healthier than others and why
Americans are generally not as healthy as they could be. Lack of options for healthy, affordable food or safe
places to play in some neighborhoods makes it nearly impossible for residents to make healthy choices. In
contrast, people living in neighborhoods with safe parks, good schools, and high employment rates are provided
with some of the key requirements to better health.”xxxviii
These social and environmental determinants of health can have a significant impact on health outcomes, accounting for
a majority of of disparate health outcomes.xxxix Social determinants of health can include: resource limitations, social
Page | 8
norms, exposure to crime, violence and social disorder, persistent or concentrated poverty, school quality,
transportation barriers and segregation. Environmental determinants of health can include: the built environment,
housing quality, neighborhood blight, exposure to toxins, air and water quality, and physical hazards.xl
Responding to the social determinants of health requires thinking outside of traditional models of health care
treatment, and focusing on socio-economic and community factors as a preventative measure. This multi-faceted and
nontraditional model of health equity is described by the U.S. Department of Health and Human Services as the best
approach to address powerful social determinants of health which drive health inequities.
“Improving the conditions in which people live, learn, work, and play and addressing the interrelationship
between these conditions will create a healthier population and a healthier workforce. Integrating health policy
efforts with those related to education, housing, business, transportation, agriculture, media, and other areas
outside of the health sector will ultimately improve the health, safety, and prosperity of the Nation.”xli
This multi-faceted approach is also supported by the Michigan Minority Health Commission’s “Michigan Health Equity
Roadmap: A Vision and framework for improving the social and health status of racial and ethnic populations in
Michigan”, as described by the Minority Health Commission:
“Improvement in social and environmental determinants of health through multiple approaches (e.g., reduction
of poverty and economic inequality, early childhood education programs, affordable housing, safe parks and
recreation, availability of nutritious foods, improved working conditions, social cohesion, and community
engagement) can contribute to more sustained health improvement than addressing healthcare or individual risk
behaviors alone. When we consider the harmful conditions that disproportionately impact racial and ethnic
communities, the importance of social determinants is particularly relevant. Public health systems are charged
to assure healthy conditions for all and to close the health gaps observed between the broader community and
vulnerable populations. Accordingly, many state and local public health departments in Michigan have echoed
their commitment to eliminating health disparities, especially among racial and ethnic minority populations.
Because the traditional focus on reducing disparities has centered on health outcomes and individual health
behaviors, less attention has been given to the social, economic, and environmental causes of ill health. To
reverse this trend, public health organizations have begun to shift their emphasis from health disparities to
health equity.”xlii
Shifting focus toward addressing the root causes of disparate health outcomes and health inequity in the State of
Michigan is a transformative approach which can be both more effective and cost-efficient than traditional approaches,
which target only health behaviors and health outcomes. This is an important first step in providing a more equitable
and prosperous future for all of Michigan’s residents.
Moving Forward: Recommendations
Michigan, like many states faces great challenges and stands at a cross roads while it seeks a new path forward and a
return to prosperity and opportunity. Michigan’s state budget deficit, totaling approximately $1.8 billion for the next
fiscal year, illustrates the need for new, transformative approaches to preparing the State for the future. xliii Budget
challenges are a tremendous obstacle to achieving these goals but also provide a moment of reflection and clarity to
think about new approaches to meet this challenge.
Page | 9
In states across the nation, governors and state legislators are struggling to craft sustainable solutions for the future.
Despite the need for new approaches, battles over programmatic spending cuts are dominating the debate. Budget cuts
alone will only exacerbate the conditions and inequities’ holding back the State’s disadvantaged populations and racial
and ethnic communities, which in turn my drive up future health care costs for the State. As described by the Michigan
League for Human Services:
“During challenging budget times, difficult decisions need to be made about the funding of state programs.
However, cuts to disparity reduction initiatives are very short-sighted. While they may save money in the short
run, they will cost money in the long run and they will cost lives, including the lives of our most vulnerable.”xliv
What is missing in this contested fight over resources and programmatic needs is identification of new policy paradigms
which can be both fiscally effective and produce positive policy outcomes. This experience is described in addressing
Minnesota’s recent budget debate by the faith-based association ISAIAH, which is leading health equity reforms in
Minnesota and working with Minnesota Governor Mark Dayton.
“….officials are looking at the structural budget deficit and fighting over where to cut spending, just to scrape by,
without recognizing that our marginalized communities of color, already disadvantaged, will bear the brunt of these
decisions. These piecemeal approaches do not acknowledge the true nature of the problem and will not create
healthy, thriving communities. Instead of looking at individual programs, we need to re-focus the conversation on
how we make decisions, how we allocate resources, and the outcomes of our policies.”xlv
Addressing health equity and the social determinants of health is an approach that can more effectively lead to better
health outcomes for Michigan’s residents, producing a healthy population, healthy workers and contributing to an
economically healthy state. Health equity can be a transformative approach which can not only help the State of
Michigan’s resource challenges but also be a powerful tool to drive Michigan’s revitalization. The following
recommendations are presented by M.O.S.E.S., the Michigan Minority Health Coalition and Michigan Universal Health
Care Access Network as the policy actions needed to blaze this new path forward and to assure a healthy, prosperous
and opportunity rich future for all Michigan residents.
To begin to address this challenge to Michigan’s future, M.O.S.E.S., the Michigan Minority Health Commission and the
Michigan Universal Health Care Access Network request that the governor appoint a staff person to work with all
organizations to:

Establish a strategy/method to insure that health equity and strategies to address social determinants of health
are considered in Michigan's policy and legislation. In particular focusing on issues of infant mortality, which is
directly tied to social determinants of health.

Establish a time frame for implementing this strategy.

Connect with people in the governor’s administration and the Michigan Department of Community Health who
will further this work.

Establish a strategy to support the adoption of our agreed upon recommendations for promoting healthy
communities and the opportunity to lead a healthy life to all Michigan residents, with focused attention on
those groups facing the deepest health challenges.

In addition to the measures above, the State of Michigan should embrace:
Page | 10
o
o
A “Health in in all Policies” framework, in which all state agencies and programs will work together,
across sectors and across departments to assure state policy is supporting positive health outcomes and
proactively targeting social determinants of health.
The National Prevention Action Plan a Health and Human Services initiative calling for cross sectoral and
cross departmental strategies to support preventative investments and policies in addressing social
determinants of health which produce poor health outcomes.
Page | 11
References Cited:
i
Wilkinson, Richard and Kate Pickett. The Spirit Level: Why Greater Equality Makes Societies Stronger. Penguin, March 2009.
LaVeist, T. Gaskin, D. & Richard, P. The Economic Burden of Health Inequalities in the United States. The Joint Center for Political
and Economic Studies. September 2009.
ii
iii
Partnership for Prevention. Healthy Workforce 2010. An Essential Health Promotion Sourcebook for Employers, Large and Small. Fall 2001.
iv
Paraphrased from the report: Jason Reece. Growing Together for a Sustainable Future: Strategies and Best Practices for Engaging
with Disadvantaged Communities on Issues of Sustainable Development and Regional Planning. The Kirwan Institute for the Study of
Race & Ethnicity. Commissioned by the Gulf Coast Regional Planning Commission – Sustainable Communities Initiative Consortium.
April 2011.
v
Treuhaft, Sarah and David Madland. Prosperity 2050 Is Equity the Superior Growth Model? PolicyLink. April 2011
Treuhaft, Sarah and David Madland. Prosperity 2050 Is Equity the Superior Growth Model? PolicyLink. April 2011
vii Treuhaft, Sarah and David Madland. Prosperity 2050 Is Equity the Superior Growth Model? PolicyLink. April 2011
viii Treuhaft, Sarah and David Madland. Prosperity 2050 Is Equity the Superior Growth Model? PolicyLink. April 2011
ix Treuhaft, Sarah and David Madland. Prosperity 2050 Is Equity the Superior Growth Model? PolicyLink. April 2011
x Treuhaft, Sarah and David Madland. Prosperity 2050 Is Equity the Superior Growth Model? PolicyLink. April 2011
xi Partnership for Prevention. Healthy Workforce 2010. An Essential Health Promotion Sourcebook for Employers, Large and Small. Fall 2001.
vi
xii
Wilkinson, Richard and Kate Pickett. The Spirit Level: Why Greater Equality Makes Societies Stronger. Penguin, March 2009.
LaVeist, T. Gaskin, D. & Richard, P. The Economic Burden of Health Inequalities in the United States. The Joint Center for Political
and Economic Studies. September 2009.
xiii
xiv
Partnership for Prevention. Healthy Workforce 2010. An Essential Health Promotion Sourcebook for Employers, Large and Small. Fall 2001.
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Families USA. Reducing Racial and Ethnic Health Disparities: Key Health Equity Provisions. Talking About Health Care Reform.
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Michigan Department of Community Health. Michigan Health Equity Road Map. June 2010
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HealthyPeople.gov; Resource website for the U.S. Department of Health and Human Services.
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xlv
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