Social Determinants of Health in Detroit
Social Determinants of Health in Detroit
Nina Wimberley grew up in the in zip code 48238 in Detroit.
Population: 25,090
Unemployment rate: 25%
Michigan unemployment rate: 3.7%
Black: 93.6%
White: 1.8%
Latino: 0.8%
Other: 0.96%
Median household income: $28,701
State median household income: $63,202
Sources:
Nina Wimberley doesn’t remember a time when she didn’t struggle with asthma.
When she started elementary school, “there were always a lot of warnings around me,” she recalls. “She has really bad asthma,” her mom would tell school staff, especially gym teachers. “She has her inhaler with her, but she won’t be able to participate.”
Wimberley spent her early years in Detroit’s Northwest neighborhood, just feet from the I-96 freeway corridor. Her sister also has bad asthma, as does her mother.
Asthma is a complex condition with many potential contributing causes. According to the American Lung Association, those factors include family history, smoking in the home, viral exposure, obesity and air pollution.
However, research shows a link between asthma, especially in young children, and exposure to vehicle pollution.
One study found that children aged 5 to 7 who lived within 75 meters of a major road or freeway were 1.5 times more likely to have asthma symptoms than those living further away. Another study showed that every 10 percent increase in traffic density in a community resulted in a 15 percent increase in asthma-related hospital visits.
As she grew older, Wimberley learned to control her asthma by listening to her body and recognizing the signs of an impending attack. She’ll feel a tight chest, wheezing, a rattle.
“If I don’t have my inhaler available, all my focus is trying to breathe through the attack,” she said. The coughing often leaves her with a sore throat and back. She’s been hospitalized for her condition several times.
Every day, she must take care to monitor her body and surroundings, ensure she has ready access to her medications and try to control her environment as much as possible. That includes keeping her surrounding temperature constant and reducing her exposure to heat, which she knows can trigger an attack.
“I’m able to get it under control, but it’s definitely still something that I actively have to manage,” she said. “If I’m doing activities, I know I have to bring my inhaler – I have a car inhaler, a personal inhaler, and one at my parent’s house
Wimberley’s not alone among people living with asthma who struggle to keep the disease under control in their daily lives. Nearly a third of patients’ asthma in the United States was uncontrolled in 2019, according to the Centers for Disease Control & Prevention. And 44% of children between 2018 and 2020 did not have their asthma under control.
Asthma makes more Detroiters sick than anywhere else in the state, while Detroiters lack access to specialized asthma care that is crucial for managing the chronic disease.
According to the Michigan Department of Health and Human Services, 16.2% of Detroit adults and 11.1% of Michigan adults had asthma between 2017 and 2019. Asthma rates among Detroit residents during that period were 46% higher than those for Michigan residents – up from 29% higher between 2012 and 2014.
Not only do racial minorities across the United States experience a disproportionately high asthma burden, but they face inequities in asthma care. A 2022 study found that Black children utilize community health clinics for asthma less frequently than white children and end up in the emergency department more often.
Kathleen Slonager, executive director of the Asthma & Allergy Foundation of America – Michigan Chapter, cites various reasons for this. She points out that in Detroit, asthma specialists are available only through the city’s hospitals, where waitlists can stretch for months. Meanwhile, more than a dozen standalone asthma specialist centers are scattered throughout Detroit’s suburbs while none exist in the city.
The data in the above map is based on Detroit Medical Center and Henry Ford Health emergency department encounters between December 2018 through June 2023. The rate is calculated based on numerators of adult asthma encounters (ICD-10 code: J45) divided by adult population denominators (American Community Survey 2015-2019) per 100,000 residents. Credit: Phoenix, Wayne State University.
In response to this challenge, Slonager’s organization launched an intervention program called Health Equity Advancement and Leadership (HEAL), part of an 11-city program to address asthma management in cities known to have high asthma disparities impacting racial and ethnic minorities.
Slonager was thrilled to have metro Detroit included in the program, She focused on areas in the region with the highest asthma prevalence: Detroit, Hamtramck, Highland Park, Inkster, Redford and River Rouge. The project aims to equip people with asthma with better tools to manage their condition.
“We were excited to develop a program to meet the needs of southeast Michigan residents who have asthma,” she told Planet Detroit. “Asthma is epidemic here, and we see the need for people to become better educated and able to talk with experts on asthma management as well as lifestyle choices that improve overall health.”
The program aims to connect each participant with a primary care provider and an asthma specialist, and keeps the PCP updated with notes on the participant’s progress in the HEAL program.
“We are providing opportunities for participants to learn better asthma management from asthma doctors and community asthma educators,” she said. “But we also recognize that social determinants of health must be addressed for good asthma control to happen.”
A baseline survey found that a majority of HEAL program participants identified as Black or African American and about half were covered through Medicaid. Just over half reported an annual household income under $25,000. The vast majority (87%) say they lived within 5 miles of an area with heavy traffic, and a substantial proportion indicated they lived near a gas or oil refinery or manufacturing plant.
To address social determinants of health, the HEAL program offers participants one-on-one sessions with nutritionists to help them incorporate more fresh food and vegetables into their diets. HEAL developed a partnership with Eastern Market, where participants pick up a free “farm box” filled with fresh and healthy foods twice a month. Another collaboration with the Detroit area YMCA provides free family memberships to encourage exercise.
The aim is to offer a holistic intervention that equips participants with a range of tools to address their individual needs. As they hit benchmarks in the program, participants earn prizes like air purifiers and water filters.
To date, 33 patients have participated in the program. Six months in, participants report better asthma control, fewer missed days of school or work, better food security and more confidence in understanding and managing their disease.
According to Slonager, many participants have reported a reduction in their nighttime asthma symptoms and rescue inhaler use.
“Folks share that they have more confidence in managing their asthma condition. Ultimately, we hope to see reductions in hospitalizations, emergency department use, and better use of controller medications,” she said. “We’ve learned that people can better manage a chronic disease state when given evidence-based information and rewarding opportunities to make change.”
One stubborn challenge has been getting participants to see an asthma and allergy specialist. At the project’s outset, just 31% had been to see a specialist, and that number did not budge over the first six months.
“I was disappointed because I know that once you can get into the specialist and get a good plan of care, people’s condition improves so much,” she said. Slonager believes time and transportation are the main barriers.
Wimberley is one of those who has never been to see an asthma specialist. The HEAL Program gave her a referral, but she said she’s been too busy to take advantage of it, though she plans to.
She notes that her PCP often refills her prescriptions without listening to her concerns. “I think it’s important to see someone well-versed in these things,” she said. So far, though, she hasn’t made it happen.
“I recently switched positions, so I also had a change of healthcare,” she said. “Once everything settles down, I’ll probably start the search.”
Nina Misuraca Ignaczak is an award-winning Metro Detroit-based editor, journalist and documentary filmmaker.
She is the founder, publisher, and editor of Planet Detroit, a digital media startup with a mission to produce quality climate, equity, health and environment journalism in the public interest that centers grassroots voices, holds power accountable, spotlights solutions + serves the community.
