Wayne County ranks 82 out of 82 in health rankings among all counties within the state of Michigan. This includes being 82 out of 82 in social & economic factors (high school graduation rate, child poverty rate, no social support, violent crime, etc.) as well as physical environment (air pollution, severe housing issues, length of commutes, drinking water violations, etc.). Wayne also scores in the bottom three among other major indicators, like birth weight, lifespan, teen births, substance abuse, STDs, days able to function mentally or physically, physical inactivity, number of uninsured, number of providers available, preventable hospital stays and the list goes on.1 In addition, a significant amount of Detroit’s youth score high in both perpetrating and being victims of violence (in the context of threats, bullying, physical fights, carrying weapons and domestic abuse), obesity, poor diet, lack of exercise and risky sexual behavior.2 It’s pretty clear that what we are doing is not working. So what does work?

Historically, the medical society has focused its efforts and finances on treating diseases and conditions as they surface. When you break your arm, you go to the ER. When your depression is debilitating, you go to an ER as well, or maybe you go directly to a psychiatric who will prescribe you medication to mask the symptoms you’re having. We have state of the art medical technology that can clean your arteries when they are clogged. We even have a device that can be placed inside of your heart to keep it beating correctly for those of us who have had consistent heart failure. What we do less often is design play structures that project against injury, or teach adolescents how to be resilient and change their thinking patterns (75% of all mental disorder begin before age 24).3 We have only begun to help people exercise and eat healthy through the medical system. Don’t get me wrong, pacemakers and ER clinicians save lies. All the time. But treating ailments when they occur, instead of preventing them from even happening in the first place, is costing our country a shit load of money. So what do we do?

Let’s assess. We have an unhealthy urban community and region. We have a huge healthcare bill with little to no quality outcomes to show for (internationally, the U.S. is ranked #37 in healthcare system performance, which is one of the lowest of all developed countries, and #1 in cost spent for their healthcare).4 We have a healthcare system majorly focused on acute problems.

If we shift our focus and our finances to prevent illnesses and injuries before they happen, we will not only save lives and money but we will greatly improve the quality of life of a population. Quality of life comes with the community development that is tied to prevention, such as building infrastructure to include green space, providing access to free fitness space or standardizing preschool programs (the HighScope Perry Preschool program found positive and lifelong education, economic, social & behavior outcomes).5 It happens through teaching people how to take care of themselves and how to interact with those around them. It also happens through the larger landscape of reducing poverty rates, creating jobs or developing a functional pubic transit system. One thing in common with these strategies is they cross multiple industries and, in order to be successful, need to be operated by a diverse group of people, professions and organizations.

One, of the many, reasons I love being in Detroit is the opportunity to incorporate public health into the city in ways people probably won’t even notice. Ways in which they will utilize as just another part of their daily life. New development across the city gives us the chance to incorporate preventive health aspects into new spaces, businesses and communities. It’s then just a matter of finding that opportunity and acting on it.

 

References

  1.  County Health Rankings & Roadmaps. 2014. http://www.countyhealthrankings.org/app/michigan/2014/rankings/wayne/county/outcomes/overall/snapshot
  2. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Youth Risk Behavioral Surveillance System. June 2011. http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf
  3. Kessler, R.C, et al. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
  4. World Health Organization (WHO). Measuring Overall Health System Performance in 191 Countries. http://www.who.int/healthinfo/paper30.pdf
  5. HighScope Perry Preschool Project. http://www.highscope.org/Content.asp?ContentId=611