Michigan’s health is falling behind, new report warns — and financial insecurity is to blame – planetdetroit.org

Report on Social Determinants of Health in Michigan and Alignment with Sustainable Development Goals

A recent analysis by the Citizens Research Council of Michigan, titled “Social Determinants of Health: Pathways to a Healthier Michigan,” reveals that the state’s health outcomes are lagging behind national averages, with significant disparities that challenge the achievement of several Sustainable Development Goals (SDGs). This report synthesizes the findings, emphasizing the interconnectedness of health, economic stability, and social equity as outlined in the 2030 Agenda for Sustainable Development.

Key Findings: A Challenge to SDG 3 (Good Health and Well-being)

The analysis indicates that Michigan is underperforming on key health metrics, directly impacting its progress toward SDG 3. The state’s performance is below that of its Midwestern peers and the national average.

Primary Health Indicators

• Life Expectancy: Michigan residents experience a lower life expectancy compared to peer states.
• Premature Death: The state has higher rates of premature death.
• Chronic Disease: Rates of chronic illness are elevated across the population.
• Self-Reported Health: Residents report poorer overall health status.

These outcomes underscore a critical need for policies that address the root causes of poor health, moving beyond clinical care to focus on the broader determinants of well-being.

The Centrality of Socio-Economic Factors: Interlinking SDGs 1, 4, 8, and 10

The report identifies five fundamental resources shaping health outcomes: financial resources, health care, food and nutrition, safety, and social support. It concludes that financial stability is the most influential driver, linking directly to several SDGs.

Financial Resources as the Core Determinant

The findings highlight that economic and educational factors are at the root of Michigan’s health crisis, reflecting challenges in achieving the following goals:

1. SDG 1 (No Poverty) & SDG 8 (Decent Work and Economic Growth): Michigan ranks 35th in median household income and 50th in income growth. This economic stagnation limits the ability of families to afford necessities crucial for health, such as nutritious food and stable housing. Employment is identified as a key pathway to better health.
2. SDG 4 (Quality Education): A decline in educational performance, with the state falling to 44th in fourth-grade reading, is a core determinant of future income and long-term health. High rates of chronic absenteeism further predict lower earnings and poorer adult health outcomes.
3. SDG 10 (Reduced Inequalities): The report finds that racial and economic disparities in Michigan are wider than national averages. Black residents experience significantly worse health outcomes, with life expectancy in some areas over 10 years lower than their white counterparts. This points to systemic inequalities that must be addressed to ensure no one is left behind.

Environmental and Social Determinants: Implications for SDGs 11 and 16

Beyond financial resources, the report notes other critical factors that contribute to uneven health risks and align with goals for sustainable communities and peaceful societies.

Community and Environmental Factors

• SDG 11 (Sustainable Cities and Communities): The report identifies below-average air quality and variable access to safe housing and transportation as significant stressors on public health. These environmental factors disproportionately affect low-income communities.
• SDG 16 (Peace, Justice and Strong Institutions): Above-average levels of community violence are cited as a key contributor to poor health outcomes, undermining community safety and well-being.

Policy Recommendations for an Integrated SDG-Based Approach

The analysis concludes that “all policy is health policy,” advocating for cross-sector strategies that align with the integrated nature of the SDGs. To improve population health, long-term investments are required in areas that address the root causes of inequality and poor health.

Pathways for Civic and Policy Action

1. Prioritize Economic and Educational Policies: Voters and policymakers should focus on strategies that raise incomes, improve educational attainment, and expand employment opportunities, directly contributing to SDGs 1, 4, and 8.
2. Address Systemic Disparities: All policy and budget decisions must be evaluated for their impact on racial and economic disparities to advance SDG 10.
3. Integrate Health into All Policies: State and local governments should incorporate health impact assessments into decisions regarding housing, transportation, and environmental quality to build healthier communities (SDG 11).
4. Strengthen Community Health Systems: Investing in resources like community health workers can help mitigate risks driven by economic and social threats, bridging the gap between clinical care and social needs.

By framing Michigan’s health challenges within the context of the Sustainable Development Goals, policymakers and residents can better advocate for comprehensive, long-term solutions that foster a healthier, more equitable, and sustainable future for all.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article highlights several interconnected social and economic issues in Michigan that directly relate to multiple Sustainable Development Goals. The analysis identifies the following SDGs as relevant:

• SDG 1: No Poverty: The article emphasizes that “financial resources – education, employment, and income – is the story of Michigan’s lagging health outcomes.” It points to Michigan’s low ranking in median household income and income growth, directly linking poverty and financial instability to poor health.
• SDG 2: Zero Hunger: The report identifies “food and nutrition” as one of the five core social determinants of health. It mentions that “food access” varies widely and contributes to uneven health risks, particularly for low-income communities.
• SDG 3: Good Health and Well-being: This is the central theme of the article. It extensively discusses Michigan’s poor health metrics, such as “lower life expectancy, higher premature death rates, and poorer self-reported health,” and the severe health disparities faced by Black residents. It also mentions environmental health stressors like “below-average air quality.”
• SDG 4: Quality Education: The article establishes a strong link between education and health outcomes, stating, “Education is a core determinant of income and long-term health.” It cites Michigan’s “long decline in educational performance” in reading and math and one of the nation’s highest rates of chronic student absenteeism.
• SDG 8: Decent Work and Economic Growth: The connection between employment, income, and health is a primary argument in the article. It notes that Michigan’s struggles with “industrial disruption, talent outmigration, and policy inconsistency” have weakened economic mobility, which in turn affects health.
• SDG 10: Reduced Inequalities: The article is fundamentally about inequality. It repeatedly states that health disparities are widening by “race, income, and education.” It provides specific examples, such as the stark difference in life expectancy between white and Black populations in the Metro Detroit area, highlighting systemic inequalities.
• SDG 11: Sustainable Cities and Communities: The article touches upon urban and community-level factors affecting health. It mentions “neighborhood safety,” “below-average air quality,” and the need for cross-sector strategies in “housing and transportation” as critical to improving population health.
• SDG 16: Peace, Justice and Strong Institutions: The issue of safety is identified as a key determinant of health. The article specifically points out that Michigan faces “above-average levels of community violence” which acts as a stressor on public health.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

1. Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions.
   • Explanation: The article’s focus on low “real median household income” and the argument that improving “residents’ financial stability is the most powerful way to reverse declining health trends” directly aligns with this target of reducing poverty.
2. Target 2.1: By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round.
   • Explanation: The article identifies “food access” as a key determinant of health that varies widely, especially for “low-income and rural communities,” connecting directly to this target.
3. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Explanation: The article explicitly states that Michigan suffers from “higher premature death rates” and high “chronic disease rates,” which are the central focus of this target.
4. Target 3.9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.
   • Explanation: The mention of “below-average air quality as additional stressors on health” and the observation that financial resources determine who can “avoid exposure to pollution” relates to this target.
5. Target 4.1: By 2030, ensure that all girls and boys complete free, equitable and quality primary and secondary education leading to relevant and effective learning outcomes.
   • Explanation: The article’s concern over Michigan’s fall in “fourth-grade reading and math” rankings and high rates of “chronically absent” students, a “key predictor of lower graduation rates,” directly addresses the goal of quality education for all.
6. Target 8.5: By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value.
   • Explanation: The report identifies “employment” as a core component of the “financial resources” that are the most influential drivers of health, aligning with the goal of achieving full and productive employment.
7. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
   • Explanation: The article’s central finding is the “widening disparities by race, income, and education,” with Black residents experiencing “significantly worse outcomes.” This directly speaks to the need for social and economic inclusion as outlined in this target.
8. Target 11.6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management.
   • Explanation: The finding that Michigan has “below-average air quality” is a specific environmental issue mentioned in the article that this target aims to address.
9. Target 16.1: Significantly reduce all forms of violence and related death rates everywhere.
   • Explanation: The report’s identification of “above-average levels of community violence” as a health stressor directly corresponds to this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions several specific data points and metrics that can serve as indicators to measure progress:

• Life Expectancy: The article uses this as a primary indicator of health outcomes, noting Michigan is below the national average. It also provides a specific disparity metric: “the highest average life expectancy…is among the white population in Oakland County at 80.1 years. The lowest is among the Black population in Macomb County at 69.7 years.” This can measure progress for SDG 3 and SDG 10.
• Premature Death Rates: Mentioned as a key health metric where Michigan fares poorly, this is a direct indicator for Target 3.4.
• Chronic Disease Rates: The article states Michigan has high rates of chronic disease, serving as another indicator for Target 3.4.
• Median Household Income and Income Growth: The article cites Michigan’s rank of “35th in real median household income and 50th in income growth,” which are direct economic indicators for SDG 1 and SDG 8.
• Educational Performance Rankings: The decline in rankings for “fourth-grade reading and math” provides a clear, measurable indicator for the quality of education (Target 4.1).
• Chronic Absenteeism Rate: The fact that “one in four Michigan students is chronically absent” is a specific, quantifiable indicator related to educational engagement and outcomes (Target 4.1).
• Air Quality Levels: The mention of “below-average air quality” implies a measurable standard (like the Air Quality Index) that can be tracked as an indicator for Target 3.9 and Target 11.6.
• Community Violence Levels: The reference to “above-average levels of community violence” suggests that data on crime rates or violent incidents can be used as an indicator for Target 16.1.

4. Summary Table of SDGs, Targets, and Indicators

Source: planetdetroit.org