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Bringing Public Health into Urban Revitalization: Workshop Summary (2015)

Chapter:3 Rebuilding Efforts in Detroit, Michigan

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Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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Rebuilding Efforts in Detroit, Michigan

The workshop’s second session focused on case studies from Detroit, Michigan. The troubles facing the city of Detroit are well-known. For example, Detroit has lost more than half of its population since its peak in the 1950s, leaving a huge percentage of the city’s residential and commercial buildings abandoned. Session moderator Richard Jackson, professor and chair of the Department of Environmental Health Sciences at the Fielding School of Public Health at the University of California, Los Angeles, spoke of a visit to Detroit in which he was stunned to see block after block with few or no buildings and a vast collection of abandoned industrial infrastructure. Detroit’s once-gorgeous train station, 20 stories high, was deserted and beginning to fall apart, he said. In July 2013 the city filed for bankruptcy, which was the largest municipal bankruptcy ever filed in the United States.

Still, as the session’s speakers attested, the city is once again moving forward. On November 7, 2014, just 3 days before the workshop, the city’s bankruptcy plan was approved, and this approval is the first step in its process of exiting bankruptcy. The next few years will be crucial in the revitalization of this once-vibrant city. As the three presenters discussed, many of the organizations involved in the revitalization process recognize the importance of using this opportunity to address issues of public health, and various strategies have been devised for that purpose. In some ways, as individual speakers noted, because so many things in Detroit need to be fixed, the city will have more flexibility to attack such issues as infant mortality, obesity, and health equity. Although Detroit is not exactly a blank canvas, it is certainly a much emptier canvas than Washington, DC, or the New York City area, and the revitalization plans for the city reflect this.

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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DETROIT FUTURE CITY

The session’s first speaker was Dan Kinkead, the director of projects at the Detroit Future City Implementation Office.1 He spoke about what Detroit Future City has been doing to transform Detroit into a healthier, more vibrant city, including both the organization’s planning efforts and what it has done to this point to implement those plans.

The Detroit Future City initiative has been funded completely by philanthropic organizations, including the Erb Family Foundation, the Ford Foundation, the Knight Foundation, The Kresge Foundation, and the W.K. Kellogg Foundation, Kinkead said. It was begun in 2010, and its first 3.5 years were devoted to an extensive planning process, which led to the release in 2013 of a strategic framework, which Kinkead described as “a 350-page guide for Detroit’s transformation.” Shortly after the release of the framework, Kinkead was asked to help start up the Implementation Office.

This was very different from the normal sort of municipal planning exercises, which are generally done within a city government and moved forward by the city administration, Kinkead noted. “I think many would argue that we had a public sector that wasn’t entirely prepared to move this forward,” he said. “We wanted to make it happen, and I know many of the foundations that supported the work wanted to make it happen. So, since then, we have … moved a number of initiatives forward, built a staff, built a budget,” and put together an agenda of what we were going to accomplish.

With Detroit emerging from bankruptcy shortly before the workshop, it is a critical moment in the city’s history, Kinkead said. Although the city is typically defined by its overwhelming liabilities and overwhelming challenges, the people involved in the initiative believe that those liabilities can be converted into huge assets and allow Detroit to become a global leader for other cities to follow.

Showing an image of Detroit’s skyline, Kinkead said that although this is not the part of Detroit typically shown in the media, some remarkable growth is actually going on in the city center, with hundreds of millions of dollars being reinvested in the city, large-scale buildings being brought back on line, and many new jobs emerging every month. Also, plans are in place for 3,500 new multifamily dwellings to open over the next 18 months. “But at the same time,” he said, “it is one part of Detroit. In some ways it may be a privileged part that speaks to only a certain type of audience.”

Kinkead then showed a photograph of a neighborhood with empty lots and deserted houses. “This, of course, is the other Detroit,” he said. “This is

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1 More information about Detroit Future City is available at http://detroitfuturecity.com (accessed April 16, 2015).

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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the Detroit that we know well…. Basically, Detroit is defined in many ways by its overarching vacant areas that have negatively impacted quality of life. They begin to reduce opportunities for residents, and they begin to define an existence that is incredibly challenging for many, generation upon generation, with sites of massive disinvestment and depopulation over time.” Still, Kinkead said, it is possible to see this as another opportunity to move the city forward “in a highly equitable way that provides opportunity for all Detroiters.” That, he said, is what he would address in his presentation.

About 20 square miles2 of Detroit are mostly deserted—empty lots and empty houses—Kinkead said. “If you begin to consider the blight that exists on the streets today—blighted structures and the rights-of-way and streets that are adjacent to those—you’re closing in on probably 40 square miles, [and] some would argue 50 square miles.” For the sake of comparison, he noted that the total area of the District of Columbia is about 65 square miles, so Detroit’s situation is equivalent to having three-quarters of the District being vacant. The District of Columbia has a population of approximately 650,000 people, which is just a little less than that of Detroit, whereas the total area of the District is roughly half that of Detroit. “So, in half the size of Detroit, you have all of Detroit’s population,” he said.

“Here are some other key points to keep in mind,” he continued. “In Detroit, you have a city that in many cases, for most of the population, does not satisfy the health needs of its population. You have $1.5 billion worth of spending leakage going out of the city every single year; $200 million of that is for groceries alone. You have a city with three times the rate of childhood asthma compared to the national average. You have 50 percent greater the number of deaths to heart disease every year than the national average.” A variety of other challenges exist as well, he said, including high obesity rates. And even with all its vacant land, Detroit has less park space per resident than most of the largest U.S. cities. Those are some of the key problems facing Detroit.

Kinkead then spoke about the 50-year vision that Detroit Future City has developed to address those problems and create a better long-term future for the city. The long-term vision is composed of several major pieces that are fairly straightforward on their own but that combine in a way that should make a major difference, he said. The plan envisions a city with multiple employment districts and a transportation system that connects people with opportunities, it envisions a green city where the landscape contributes to health, and it envisions a city of distinct, attractive neighborhoods.

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2 Detroit comprises approximately 139 square miles.

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

“As we developed the work, there was a massive effort around civic engagement and building civic capacity,” Kinkead said. “This is not a top-down process. This was an effort that was fostered through 163,000 interactions with residents. This is a plan that has been authored by the residents of Detroit, including myself as one of them. Because of that, I think it not only has given all of us as residents a greater sense of authorship in the work, but it has allowed us to be much more informed and present in the implementation of it, and that is critical when you’re trying to move something like this forward in a city with the challenges that Detroit faces.”

A key principle underlying the development of the plan was that it should be evidence based, Kinkead said. “We have had many impassioned vision plans over the last two decades, … but none of them really landed on the ground firmly in a basis of understanding what markets were saying, what demographics were telling us, what educational trends were telling us, what mobility patterns were telling us. That is what this work began to do: a lot of deep-dive diagnostics tied to a wealth of information and community input.”

Looking at the situation that Detroit faced, one fact stood out: the current land use of the city is dominated by the single-family home. “This one-dimensional land use is crippling the city,” Kinkead said. “In many ways, the city, at nearly 2 million people at its peak population in 1995, was already not sustainable. Today we’re just a much more exacerbated version of that.”

Thus, the long-term vision calls for a more balanced city, one that actually recognizes all of the vacancies that exist in the single-family neighborhoods and reenvisions what the city should look like. “We are reconsidering the position of the single-family home in Detroit,” Kinkead said. “We’re understanding that there are opportunities for green residential living here in areas where we have moderate degrees of vacancy…. On top of that, we can begin to create more concentrated nodes of development that can support walkable urbanism, begin to support healthy lifestyles, and focus on connecting people from dense, sustainable neighborhoods [to] opportunities for employment in a range of employment districts across the city that go well beyond the greater downtown and midtown.”

A city typically thinks mainly in terms of residential areas and business areas and has zoning that reflects that. Detroit Future City, however, envisions a wide variety of land uses and has developed a set of land use typologies to capture that vision. In the past, for example, employment districts were usually thought of in terms of the places where doctors, lawyers, or businesspeople had their workspaces. “That’s fantastic if you happen to be a physician or a leader of a creative enterprise or a lawyer or financier,” Kinkead said, “but if you are anyone else, there are a lot of other places that provide employment across the city [that] we have just not recognized: important global logistics hubs in our southwest that were made

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

by the auto industry over nearly a century, large-scale manufacturing in the northeast, and an educational and medical anchor institution hub in our northwest that rivals that in our midtown area that we just kind of forgot about.”

This raises the question, Kinkead said, of how to attract investments in these areas to drive greater opportunity for the city overall. It is not feasible to design a 10-year capital expenditure program, he said, because in 10 years everything will be different.

“You have to understand how you can begin to make subtle moves along the way,” he said, “and that is what this plan begins to speak to: understanding areas where we need to double and triple down investment in fixed infrastructure to support the economic growth [that] we need to provide more Detroiters employment opportunities…. No matter what else we are doing, if we can’t get more folks employed and we can’t support them with the infrastructure systems, we are not going to be able to turn it around.”

At the same time, Kinkead said, it will also be necessary to rethink how the various city services are provided. “This is not about removing systems,” he said. “This is about delivering them in very different ways. This is about taking what was a fixed, large-scale unibody bus that drove down a street five times a day for a woman who might need a doctor twice a month, to an on-call paratransit system that provides for a much higher degree of service at an incredibly lower cost to the public transit provider. Those are the kinds of things of things we’re talking about.” As another example, Kinkead spoke of ideas to address the city’s rainwater capture system. That system is combined with the sewer overflow system, which means that each time that it rains, the water that flows into the catch basins combines with sanitary waste. Whenever the city gets more than half an inch of rain, it overwhelms the overflow system, and the extra water is discharged directly into the Detroit River, which in turn flows into Lake Erie. “This summer Lake Erie had a huge phosphorous bloom, not unrelated to these kinds of issues,” Kinkead said, “so this is a critical issue.”

In 2011, Detroit had 36 such direct discharges into the river, which is 31 more than the limit of 5 set by EPA. “We think we can get that down to around five discharges if we use our available land area,” he said. “The land that sits there fallow, contributing to blight, can actually help us create a new dynamic system, one that we have just not considered in the past.”

More generally, the long-term plan envisions a number of uses for the extra land that sits unused in Detroit today. “Detroit might be the first food-secure city globally by 2050 with the ability to produce energy, biomass, switchgrass, anaerobic digestion, and photovoltaic power production,” Kinkead said. “There was a comment earlier about DC and all the photovoltaic arrays that could go across your roofs. Imagine the costs that

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

go with planting those on roofs. What if you could do that in a holding strategy across open, available land and run green infrastructure systems through them to capture storm water? Then you’ve got something, and you could actually begin to provide major power back to the grid. We’re beginning to look at these things now.”

Of course, these plans must be implemented, and Kinkead next discussed the implementation process that is being put in place. First, he noted, there will be careful communication and coordination throughout the implementation. Everything that has been done so far has been done through partnerships, and that will continue. “We make sure that we’re strategically coordinating and informing decisions along the way in a way that we have just not done in the past.”

There are five implementation priorities, Kinkead said. The first is to create an open-space network to reutilize vacant land. This is being done in several ways. One is a carbon-buffering pilot program. The idea is, in essence, to plant trees and other plants along major highways to block much of the particular matter emitted by vehicles traveling along those roads and thus to improve air quality. Detroit also has a Dendro-Remediation pilot program that is intended to remediate toxins in the soil around Detroit. “Detroit has a lot of available land that is toxic,” Kinkead explained. “But we don’t have the need for reinvestment and reutilization of the land in conventional ways for a long time; therefore, we can use slower, more cost-effective, and more natural methods for that remediation.”

To help guide decisions about what to do with vacant land, Detroit Future City is developing a vacant land transformation guide with the goal of stabilizing neighborhoods.3 It provides a menu of options for residents to choose from to determine how to reutilize and improve the available land.

The second implementation priority is to renew systems strategically and innovatively. One such program is the one described earlier to minimize direct discharges into the Detroit River. Another is aimed at restoring much of Detroit’s tree canopy. “By some estimates, Detroit has half the tree canopy it should have,” Kinkead said. “If we can bring back the other half through concepts like this [i.e., restoration of the tree canopy] and the open-space network, we can begin to save lives. Most of our seniors live in areas that have low canopy coverage.” The effect, he said, is the loss of many lives each summer when temperatures rise.

Detroit Future City is also working with the U.S. Department of Energy to deploy solar power systems on some of the unused land. “We think that on 30 to 35 acres of land we can produce 5 megawatts each year and

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3 Since the workshop, the Vacant Land Transformation Guide has been released and can be found at http://detroitfuturecity.com/initiatives/vacant-land-transformation-guide (accessed August 4, 2015).

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

incorporate green infrastructure systems that can also go to pool water for irrigation for adjacent biomass and food crops,” Kinkead said.

The organization is also working with the White House Office of Science and Technology Policy to develop various technologies to help Detroiters in various ways, from figuring out the best way to catch a bus to learning what employment options are open to them. Because it has not had the money to invest in technology, Detroit fell behind other cities, but this could be turned to its advantage, Kinkead suggested. “Where many cities dutifully paid billions and billions of dollars for their Cray mainframes in the 1980s, we did none of it, and we have the ability to actually leverage cloud-based services and things like this to jump ahead…. We’re trying to get there quickly.”

The third implementation priority is to improve quality of life. As an example, Kinkead spoke of a community in the north-central part of the city along Seven Mile Road between John R and Woodward. Populated mainly by immigrants, such as Chaldeans (Christian Arabs) and Syrian refugees, the area has suffered mightily over the past few years and has seen many businesses and residents flee. However, historically, the area had a very strong commercial corridor, and efforts are now being made to bring that back and create a strong residential-commercial quarter outside of the downtown area.

Another example of improving quality of life is the way in which the city is approaching deconstruction. “We are bringing down blight in the city,” Kinkead said, “but doing it in a way that is much more thoughtful than straight demolition, which contributes to landfills and really underutilizes the opportunity for employment.” In particular, Detroit Future City carried out a study of 10 homes in the southwest part of Detroit using five different deconstruction techniques to determine what types of materials could be pulled out of the homes and sold. Straight demolition may seem less expensive, Kinkead said, “but if you add the revenue stream on the resale in there, then the equation changes and opportunities for employment change.”

Studies are also being carried out to determine the best ways to demolish structures without spreading toxic materials, such as lead. Nearly 40,000 structures that need to come down in the next year have been identified, and that number may reach 60,000. It is important that the demolition not contaminate the surrounding areas. “We already have an epidemic of lead poisoning in the city,” Kinkead said. “We don’t want to mushroom this into something colossal that is going to take the city back another 50 years, so we are working on dust management pilots and new techniques to manage this, which in many cases comes down to using a water hose. This is not high tech, but it’s important that these things get worked into contracts with contractors that do this work.”

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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The fourth implementation priority is to employ more Detroiters. One small way that they are doing this, Kinkead said, is by using some of the materials that come out of the deconstruction work and developing retail centers to sell the materials and staffing them with Detroit residents.

Detroit ranks second among major U.S. cities for entrepreneurial activity, Kinkead said. Often, however, the sole proprietors working there find it difficult to scale up their businesses. “They work out of their basements and do things at a small level,” he said. “How do we get them to rent space, buy equipment, et cetera?” One approach has been a recruiting effort to draw in the Goldman Sachs 10,000 Small Businesses Program, he said.

The fifth and final implementation priority is to strengthen civic capacity, which Kinkead described as “making sure our community in general is better equipped to move ourselves forward in the future.” One approach has been to develop curricula in local high schools that will better prepare students for the future.

Ultimately, Kinkead said, after the development of broad strategies and the implementation of policies, success or failure will come down to the efforts of thousands of individuals. Showing a picture of a large group of people helping plant trees along a freeway, he said, “It takes all of these pieces together to have an impact in a place like Detroit, and that is what we do.”

HEALTH IN ALL POLICIES

The next speaker was Loretta Davis, president and chief executive officer of the Institute for Population Health, who discussed the “health in all policies” approach and how it applies to Detroit and, more broadly, all of Michigan.

Davis began her presentation by citing a statement made by the National Association of County and City Health Officials. The association recommended that federal, state, and local governments all adopt a “health in all policies” approach in the policy-making process to ensure that policies made outside of the health care sector have either a positive or a neutral impact on the determinants of health.4

“When we first started talking about health in all policies,” Davis said, “many people saw that as a way to keep progress from happening. You don’t want to build this, or you don’t want to build that, and people became afraid of this concept of health in all policies.”

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4 Information on the Health in All Policies project can be found at http://www.naccho.org/topics/environmental/HiAP (accessed August 4, 2015).

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

In reality, though, the health in all policies approach is mainly a recognition of the fact that many policy decisions affect the social determinants of health: noise levels; the walkability of an area; how easy it is to travel to one’s job, family, or place of worship; and so on. Thus, it is important, Davis said, to involve individuals and groups in the policy-making process who are knowledgeable about health in a broad sense, that is, not just in the traditional medical sense of determination of blood pressure and cholesterol levels but also from a more socially and environmentally oriented point of view.

Davis commented that putting “health in all policies” into effect on a local level may require more than just buy-in from the local health department. “Many times, there are forces that can impede even local public health departments from saying and doing what is right around interventions that are being proposed,” she said. Thus, it is often useful to involve other partners, in addition to the local health department.

One such potential outside partner is Michigan Power to Thrive, a network formed by county health departments across Michigan as well as a number of other groups. The network represents the coming together of two powerful disciplines, Davis said: public health and community organizing. “Many times, we [the two disciplines] have not been at the same table,” she said, “and when we are, we have been misunderstood. Michigan Power to Thrive is trying to bring those disciplines together.”

Davis showed a slide indicating collaborations between community organizers and public health officials and professionals across Michigan. In Wayne County, which includes Detroit, there is a collaboration between the Detroit-Wayne County Health Authority and a community organizing group called MOSES (Metropolitan Organizing Strategy Enabling Strength, which is affiliated with a national network of faith-based community organizing groups). “Along with MOSES, there are public health professionals—not just public health departments, but a cadre of public health professionals—there are also religious institutions, businesses, there are people who are dedicated to schools, early education, all of us coming together to say if we really want to see a change, if we really want to see Detroit’s future become positive and bright, then we need to have health in all policies,” she said.

Not all of the communities across Michigan are dealing with the same thing, Davis said, so health in all policies provides a rallying call that appeals to people from around the state. “For some areas in Detroit, it may be about housing stock that is very old with lead contaminants,” she said. “In another area it may be infant mortality…. In some other area, it may be more about minimum wage.”

What, she asked, does that have to do with Detroit Future City, described previously? “One of the recent health impact assessments that we conducted took a look at infant mortality in relationship to pay inequity by

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

gender,” she said and noted that pay inequity for women has an impact on health and infant mortality. “As we start to look at economic growth in the city of Detroit, [we must ask], Are these jobs that are friendly to families? Are these jobs that are promoting and having pay equity? Truly, health in all policies from beginning to end.”

Davis then went into greater detail on the health in all policies approach, listing five elements key to the approach. The first element is that any policy being considered should promote health, equity, and sustainability. Second, all policies should support intersectoral collaboration. Third, policies should benefit multiple partners. Fourth, policies should engage stakeholders. Fifth, policies should create structural or procedural change. “We want long-term change,” Davis said. “We don’t want things that just started and then stopped along the way. And that is done by policy and procedure.”

Returning to Michigan Power to Thrive, Davis spoke of the network’s values. These are shared values of the public health and community organizing communities: commitment to a just and equitable society, a decent quality of life for all, and respect for human dignity. On the network’s calling, Davis said, “Our democratic tradition and our commitment to the principles of equity and justice demand that all have a right and duty to participate actively in the social, political, and economic decisions that affect our quality of life. We are called to work together for fundamental, transformational remedies to social and political forces that undermine democracy and limit the power of people to achieve well-being.”

There are various tensions between the public health and community organizing communities, Davis said. She mentioned in particular “agitation as a practice.” “That is not something that public health always is most comfortable with,” she said. “Being a long-time public health person, when they first said agitation as a practice, I got a little nervous myself. Then I came to understand that if we want things that are transformational, long term, and sustainable, it does take a certain level of boldness.”

Davis ended with a quote from Tony Iton, senior vice president for Healthy Communities at The California Endowment: “As public health professionals, we need a new kind of practice where public health practitioners understand that creating health equity requires us to be in deep relationship with people who understand and are willing to create and build power. Powerlessness is making us sick.”

THE HENRY FORD HEALTH SYSTEM

The panel’s final speaker was Kimberlydawn Wisdom, senior vice president of community health and equity and the chief wellness officer for

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

the Henry Ford Health System. She described the health system and its approach to improving health in Detroit.

The Henry Ford Health System is a $4.2 billion company with nine business units spread across three counties, Wisdom said. It has a 1,200-physician medical group and about 2,200 private practitioners as well as about 1,500 residents training in 40 specialties. The health system receives about $60 million in funding from foundations and the National Institutes of Health, and it has a health plan with about 600 members. “So we are a very complex, comprehensive, quaternary care organization in one of the most challenging cities in our nation,” she said.

Through the leadership of chief executive officer Nancy Schlichting and her predecessor, Gail Warden, Wisdom said, the Henry Ford Health System has been committed to the idea that health is more than just health care delivery services and that ensuring individual health requires taking community health into account. Twelve years ago, as Schlichting was directing the development of the health system’s strategic framework, she made sure that in addition to traditional pillars, such as people, service, quality, and research and education, a community pillar was included in what was described as “the Henry Ford experience.”

The health system’s vision statement calls for “transforming lives and communities through health and wellness one person at a time,” and that transformational element is key, Wisdom said. “It is not just improving, but we have to be out-of-the-box thinkers. We have to … find ways [in which] we can deliberately and intentionally transform our communities.”

Furthermore, Wisdom said, the Henry Ford Health System leadership has remained committed to staying in Detroit even during the city’s very challenging times. “We are not going to leave the city. We are committed to the city,” she said. “That has never wavered in the 30-plus years that I have been in the institution or part of the organization.”

Referring to Davis’s description of “health in all policies,” Wisdom said that the health system is committed to that approach in its own operations. For instance, the health system is redeveloping a 300-acre site just south of its main hospital in Detroit. The demolition of existing housing there offered an opportunity to mitigate various environmental hazards associated with the housing. Furthermore, attention has been paid to the health of the Detroiters hired for the deconstruction.

Showing an artist’s rendition of what the 300-acre site will look like once construction is complete, Wisdom described the process as “place making” and said that such place making is an important part of the health system’s vision for the area.” The goal is to blend the development seamlessly into the community to create a vibrant, walkable place where people want to be,” she said. The initiative will build on Henry Ford Hospital’s anchor status and will serve as a catalyst for additional growth

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

and development. “Henry Ford very much sees itself as a catalyst,” Wisdom explained. “We cannot do it alone. We need partners, but we can certainly catalyze the economic development in those areas.”

The 300-acre site will contain a cancer rehabilitation hospital, but the key to the development of the site, Wisdom said, will be the creation of mixed-income housing. The health system is making a deliberate effort to ensure that many of the employees, particularly those who are at entry levels, can live close to where they work. “So there is very much a focus on mixed-use housing to improve the physical infrastructure,” she said.

Another main focus is the creation of bike lanes both at this site and at other places in the health system. The rates of chronic disease in Detroit are much higher than the national average, Wisdom said, and studies have shown that communities with more walkable and bikeable places have lower rates of many chronic diseases. Furthermore, the National Academies of Sciences, Engineering, and Medicine has recommended the construction of sidewalks, bikeways, and other places for physical activity to occur as a way of fighting childhood obesity (IOM and NRC, 2009). “So,” Wisdom said, “the Henry Ford Health System is not just talking the talk, but we are trying to walk the walk—or at least bike the walk—where possible. In partnership with the Michigan Department of Transportation, Henry Ford has helped to install dedicated bike lanes on the streets around our main hospital campus. It has also helped to fund a feasibility study for a Detroit bike-share program.”

In a similar vein, she said, a major effort is under way to create an overpass over a major freeway that divides the main hospital from another part of the Henry Ford campus that contains the corporate offices, because people would like to walk between the sites.

The health system is also involved in dendro-remediation by installing sustainable landscaping that will include native plants that do not require extensive watering and that will help remove environmental contaminants.

Switching gears, Wisdom then described some of the community engagement and outreach efforts that the Henry Ford Health System engages in. Many of these efforts are aimed at improving equity in health and health care. For example, between 2009 and 2011, the health system carried out a major health care equity campaign whose goal was to ensure that health and health care equity were understood and practiced by the system’s providers and researchers as well as by the community at large. “We very much reach out to populations of different races and ethnicities,” she said. “We have community advisory boards that we work very closely with in order to help inform us. So it is more than a clinical or quality proposition; it is very much working with our key stakeholders within our community.”

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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The health system has also engaged in a major effort to collect and analyze data on the race, ethnicity, and primary language of its employees and users. The providers at Henry Ford speak more than 60 languages, Wisdom said, and the community that they serve in Detroit is also very diverse. “We have the second largest Arab-American population outside of the Middle East,” Wisdom said. “We have large Bangladeshi and Yemeni populations, a large Latino population, and a large African-American population, so understanding through self-report the community we are serving has been very important.”

Wisdom added that the health system has strong community ties through several Henry Ford Hospital initiatives. One such initiative, for instance, is Live Midtown, in which the health system collaborates with midtown Detroit, Wayne State University, and the Detroit Medical Center to offer financial incentives for people who are willing to relocate within the city of Detroit. Employees of Henry Ford, Wayne State University, and the Detroit Medical Center can receive loans of up to $20,000 toward the purchase of a primary residence or up to $2,500 to rent a home or apartment. Furthermore, one quarter of the loan is forgiven after each year that a person remains in Detroit, so in the case of the purchase of a primary residence, the entire $20,000 loan can be forgiven after 4 years.

Another community-related effort is Early College, which enrolls students—many of whom are at-risk students from underserved families—in Grade 9 and keeps them an extra year, through Grade 13, at which point they receive a high school diploma, an associate’s degree, and a clinical certification that helps them find employment. Yet another program hires community health workers who serve as liaisons between the health system and the community. Finally, the Henry Ford Health System participates in a variety of efforts to improve the quality of life in the community, from hosting public movie nights to supporting the creation of a large mosaic by 1,300 individuals from across Detroit. “We are trying to bring connectivity to Detroit and empower the individuals within the city,” Wisdom said, “but also to bring beauty and art to our communities as well.”

DISCUSSION

John Balbus of the National Institute of Environmental Health Sciences opened the discussion session by asking the speakers to comment about how the work that they are doing in empowering the community is being reflected in the institutions of the city of Detroit and how it is leading to a sustainable transformation of the status quo and the way in which things are done.

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

Wisdom answered that one of the ways is through the efforts to employ community health workers. “This is not something that many of us in health care have heard about, particularly those on the clinical side,” she said. Bringing these workers in to help those in the health care industry engage community members is one example of a transformational change.

Davis approached the question from a different angle: “Our effort actually is being led by a grass roots community group, which is transformational in itself,” she said. Depending on the particular issue, different groups are taking the lead in looking for solutions, but none of those groups are composed of people whose salaries are being paid by organizations that have some interest in the status quo, so it makes it easier for them to “speak truth to power,” Davis said.

Wisdom added that another example is that the Henry Ford Health System is working closely with three other health systems—the Detroit Medical Center, Oakwood Health Care, and St. John Providence—even though they compete for market share. Cooperating with them on community improvement efforts is transformational, Wisdom said. Yet another example is the way that the health system is taking a “collective impact approach,” bringing together all of the stakeholders affected by a particular issue and using a multisectoral approach to address the problems. “We can’t address them the same way by being in our silos,” she said. “We have to come together at a common table with that shared power in order to truly drive change.”

In response to a question from Jack Spengler of Harvard University, Wisdom said that the Henry Ford Health System has a very robust program to drive down the company’s health care costs by encouraging its employees to change their behavior in ways that improve their health. Employees are given health risk appraisals and then offered suggestions for changes in behavior and lifestyle. “We see a direct correlation,” she said. “When our scores go up related to our lifestyle risk score, we also see that it increases productivity and it decreases costs.” The health system is also interested in taking what it learns from working with its employees in this way and applying those lessons in the broader community, Wisdom said.

Brett Van Akkeren from EPA commented that one of the reasons that groups of artists moved to and thrived in Soho in Manhattan was that the government there was ineffective and did not enforce its zoning laws. This allowed artists to populate Soho, even though it was supposed to be an industrial area. “So you’ve got to make sure that government stays out of the way sometimes and lets people be creative,” he said.

On a different subject, Van Akkeren said that he had found, when working on community development with EPA, that in many communities the health care systems—and particularly hospitals—are wonderful civic institutions but lousy neighbors. “The reason,” he said, “is that often we

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

have medical campuses that are isolated from the rest of the community, and they create barriers in the community in much the same way that freeways create barriers in communities.” One area in Chattanooga. Tennessee, that he was familiar with had 9,000 medical jobs, but the area was a food desert. There was one restaurant, he said: Kentucky Fried Chicken.

Furthermore, Van Akkeren said, although hospitals themselves offer food, they are generally not designed so that the hospital’s neighbors can use the food services. Thus, he said, he was very impressed with what the Henry Ford Health System was doing with its new 300-acre development, at least judging by the renderings that Wisdom showed. “I liked that you guys had a grid that was open to the public,” he said. “I liked the fact that I saw things that looked like potential cafes on the first floor of the buildings. I would like to hear a little bit more about that.”

To illustrate what the Henry Ford Health System’s newer developments are like, Wisdom described a new health system hospital built in one of Detroit’s suburban areas, West Bloomfield. “It looks like a northern Michigan lodge. Every room is private. You walk in and you wouldn’t even know it was a hospital…. In this hospital is a community center where people come to play cards, they come to eat the food. All the food is prepared fresh; it’s organic. Some of it is grown in our greenhouse. Henry Ford Health System actually employed a full-time farmer. People see that as a place to come, to congregate, to enjoy themselves and enjoy the food. We actually even have weddings at the hospital…. Talk about being transformational! … People love to come there not only when they are sick, but they come when they are healthy.”

Chris Leinberger, a real estate developer who runs the graduate real estate program at George Washington University in Washington, DC, offered some background on walkable urban places and how Detroit compares with other cities. He and colleagues did a survey of the 30 largest metropolitan areas in the country, ranking them in terms of walkable urbanism, and Detroit ranked 22nd out of 30. However, the group also looked at future indices and how the cities are expected to change in coming years, and Detroit jumped up to number 8 on the list. “It has the second highest market capture of walkable urban development in the country,” Leinberger said. “In this real estate cycle, it has basically stopped sprawling. It is too early to say if that is going to be a long-term policy or long-term market trend, but we are seeing that now.”

More generally, he said, most of the metropolitan areas either have stopped sprawling or are expected to stop sprawling in the next decade. With this new trend, 80 to 90 percent of all development is likely to take place in less than 10 percent of the existing land mass of the various metropolitan areas. That does raise a couple of questions, he said. First,

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

what should be done with the remaining 90 percent of urban land, which is no longer seeing much new development? Second, will gentrification drive low- and moderate-income people out of these new walkable urban places? “We need a conscious social equity policy,” Leinberger suggested.

Harold Zenick with EPA said that he had observed over the past two decades that two groups, disadvantaged communities and those interested in sustainability, were often at odds and even confrontational. “The disadvantaged communities look at the sustainability people and think they have their heads in the clouds,” worrying about what is going to happen over the next 10 or 20 years, whereas the people in disadvantaged communities feel they need their problems solved now. “The sustainability community says, ‘Well, you are too narrowly focused; you’re looking oftentimes at symptoms and not causes, and the solutions you come up with are not sustainable.’” Thus, Zenick asked the panelists if they had seen any lessening of those tensions or if they still exist.

Kinkead answered that Detroit is dealing with circumstances that make collaboration both absolutely necessary and also fraught. “Detroit is a city that is 83 percent African-American,” he said. “It’s a city that has struggled mightily with civil rights issues in the past.” Thus, there is a great deal of sensitivity about equity, and collaboration in Detroit can be a struggle at times. However, robust and dynamic civic engagement processes exist in Detroit, with the various stakeholders clearly stating their positions and no one holding any punches. Thus, although it has not been easy, Detroit has been able to work through things and come up with a focused growth strategy for the city.

“As we go forward, particularly as the city comes out of bankruptcy and you see reinvestment really surging in the city, it’s going to be really important to watch Detroit over the next 6 months to see how we navigate this terrain,” he said. “In the past, for every $10 we had in the city, $4 was going to debt service. When you eliminate that burden, you can begin to actually do things; you can push things forward in a way you haven’t in the past. I think we have the opportunity now to do things which produce a much more dynamic and thriving city, but one that actually reaches out to everyone, and that is where we are pushing.”

Jackson then requested that each of the three speakers provide a memorable story about how some kind of transformation occurred—a concrete example of how something actually happened.

Wisdom spoke about the appallingly high death rate among infants less than 1 year old in Detroit, which she said is comparable to the rates in some developing countries. A task force was assembled in 2008 and 2009 to develop a plan to reduce these rates. The Kresge Foundation, PNC Bank, the Robert Wood Johnson Foundation, and the W.K. Kellogg Foundation

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

provided $2.2 million in funding over 3 years to engage community health workers and address the mortality rate.

“In the same neighborhoods where we saw these appallingly high rates,” Wisdom said, “we have had 200 babies born over the last year and a half, and we had zero deaths. It has transformed our communities not just because we see infants not dying, but we see women who are gaining employment, who have gained better housing, transportation, access to food, and are in a much more self-sustaining position so that they can then be part of the problem solving and part of the solution in the communities. That is what I consider a transformational story.”

Davis described how in February 2012 the mayor of Detroit, looking at an emergency financial manager coming in and facing the possibility of bankruptcy, took the bold step of announcing what services he felt were true municipal services, things like public safety, lighting, and garbage pickup. Public health was not on the list, and the budget for public health was zeroed out. Davis was the health officer for the city at the time, and she took this as a challenge to create a new way by which public health would be delivered in Detroit through a public–private partnership. “We weathered the storm of privatization,” she said, “and in that first year, in many cases, we were able to improve the quality and the quantity of services being provided to the residents of the city while relieving the city of the ever-growing financial burden” of maintaining a health department. “Now, as the city comes out of bankruptcy and is wanting to regain some of those services, it allows us to enter into a new and stronger relationship with some of our other community providers. So we were pleased to be able … to stand there in the gap and not only maintain the public health system but enhance it, and then be able to turn over what is a better system, now that the city feels it is ready to take those services back.”

Kinkead spoke of the fact that many of the foundations that have played a major role in Detroit’s recovery had their roots in a system that led to Detroit’s problems in the first place. The Ford Foundation’s original endowments came from Henry Ford, whose fortune was dependent on mass consumption and massive divisions of labor. “These institutions enabled one another, particularly in the first half of the 20th century,” Kinkead said, “and they allowed Detroit to grow rapidly—perhaps too rapidly—and, arguably, unsustainably.” The foundations that derived from those companies now have absolutely nothing to do with those original corporations, Kinkead pointed out, but they have been present to help in the city’s recovery, a true long-term transformation. “Somehow, there is some sort of sublime redemption in that, I think.”

In particular, he pointed to the “grand bargain” that prevented the Detroit Institute of Arts, which had been owned by the city, from being forced to sell off a large percentage of its collection to pay off the city’s debts.

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
×

Philanthropic leaders from the Community Foundation for Southeast Michigan, the Ford Foundation, the Knight Foundation, The Kresge Foundation, and a whole host of others came together around a strategy that saved public workers’ pensions while protecting the arts institute by putting it in the hands of an independent charitable trust. The foundations’ generosity helped put the city on a more sound financial basis without sacrificing the art that had been accumulated through the wealth of the industrial revolution in Detroit. “That is transformative,” Kinkead said, “and I’m very excited about where it leads us now.”

REFERENCE

IOM (Institute of Medicine) and NRC (National Research Council). 2009. Local government actions to prevent childhood obesity. Washington, DC: The National Academies Press.

Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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Suggested Citation:"3 Rebuilding Efforts in Detroit, Michigan." National Academies of Sciences, Engineering, and Medicine. 2015. Bringing Public Health into Urban Revitalization: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21831.
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A particularly valuable opportunity to improve public health arises when an urban area is being redesigned and rebuilt following some type of serious disruption, whether it is caused by a sudden physical event, such as a hurricane or earthquake, or steady economic and social decline that may have occurred over decades. On November 10, 2014, the Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine held a workshop concerning the ways in which the urban environment, conceived broadly from factors such as air quality and walkability to factors such as access to fresh foods and social support systems, can affect health. Participants explored the various opportunities to reimagine the built environment in a city and to increase the role of health promotion and protection during the process of urban revitalization. Bringing Public Health into Urban Revitalization summarizes the presentations and discussions from this workshop.

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