This story was originally published by Bridge Michigan, a nonprofit and nonpartisan news organization. To get regular coverage from Bridge Michigan, sign up for a free Bridge Michigan newsletter here.
If Michigan policymakers want to improve the overall health of the state’s more than 10.1 million residents, they have to think outside traditional health policies and personal choice.
That’s the conclusion from a new report by Citizen’s Research Council, a Livonia-based research organization focused on Michigan policy.
Policy decisions on transportation, education, civic organizations and personal income — they all impact health, too, said Karley Abramson, the organization’s health policy research associate and lead author of the report, Social Determinants of Health: Pathways to a Healthier Michigan, released Tuesday.
Too often, people think a focus on insurance and health care providers is the only way to address health, Abramson told Bridge.
“We need to zoom out and look at the overlap with all of these other policy areas,” she said. “The key to improving health in the state of Michigan comes with improving Michigan's economy, its education systems, the average income level for Michigan residents.”
The 121-page report compiles dozens of data points to diagnose the root causes of Michigan’s poor health.
In some ways, it underscores what researchers have found for years: Michigan’s population is less healthy than most other states, including Midwestern counterparts.
Among the data shared in the report:
- Michigan has more cardiovascular disease, cancer and diabetes. It’s more obese, too, and Michiganders die earlier than the average American. The state ranked 30th in life expectancy — 75.7 years — compared to the national average of 76.4 years, according to 2021 data.
- As a general rule, its residents more often report feeling poorly. In Michigan in 2023, 45.7% of people reported they were in good or excellent health, compared to 47.8% across the country, the report notes.
- Michiganders report more days a month when they are physically or mentally ill, reporting 4.0 days of ill physical health compared to 3.9 days for the average American, and 5.6 days of poor mental health compared to 5.1 days for the average American.
- Michiganders report disabilities at a higher rate than most Americans — 9.5% of Michiganders aged 18-34 compared to the 8.6% among the same age group of Americans, and 14.4% of Michiganders 35 to 64 years compared to 12.6% of the same age group Americans.
Michigan also has wider health disparities than many other parts of the country.
Infant mortality rates are an example. Across the US, there are 10.7 deaths per 1,000 live births among Black Americans, and 4.4 deaths per 1,000 live births among white Americans. Yet in Michigan, the gap is 13.4 deaths per 1,000 Black Michiganders compared with 4.5 deaths per 1,000 among their white counterparts.
The paper contends a “state obligation and duty to promote health.”
After all, a healthy population is central to a state’s vitality, contributing to its economic engine and helping it to avoid excessive health care costs, its authors argue.
And while individual decisions play a role in health status, systemic and structural factors — cultural, environmental, political and income, for example — dramatically change individual health outcomes and, in turn, the statewide picture.
The report, built on 268 sources, categorizes social determinants of health by five areas: financial resources, health care, food and nutrition, safety and social support. And it stresses their “interconnectedness” to each other and to health.
Poverty can lead to poor education and a lack of transportation, which in turn lead to low-paying jobs and lack of insurance, which result in a lack of regular medical care, Abramson said.
An ‘interconnectedness’ to health
All of this means decisions that impact transportation safety, graduation rates and interpersonal or family violence, for example, ultimately impact health, too.
Even social support and civic engagement matters, according to the report’s authors.
Social connectedness can drive down levels of community-level crime and interpersonal violence, for example. Yet Michigan is average at best when it comes to such support. The state ranks 27 in both formal volunteering and charitable giving and 23rd in organizational membership, according to the report.
The most powerful predictor of health, however, is personal income, the report concludes. Lower pay means more risk of food insecurity or living in a neighborhood of higher violence, for example.
“This income problem, in general and as it interacts with race, cuts across all of the fundamental resources and explains other areas where Michigan appears to be lagging,” the report reads.
Personal income can allow more time to find ways to release stress and exercise. (Robin Erb/Bridge Michigan) The report doesn’t lay out how to change that income to improve health outcomes, but “when you map it all out, all roads lead back to the fact that people don't have enough money,” Abramson said.
On the upside, Michigan does well and could build on its foundation of better-than-average realities, including better insurance coverage and more reasonable cost of living, according to the report. For example, just 5.4% of Michiganders under 65 years old were uninsured in 2023, compared to 9.5% across the country.
This article first appeared on Bridge Michigan and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
