Rebuilding Detroit‘s Public Health Infrastructure from the Ground Up

Detroit is a city revered for its perseverance. As the former industrial powerhouse of America, Detroit built much of the middle class over the 20th century through a booming manufacturing economy led by the iconic automotive industry. However, as factories left in the late 1900s and jobs disappeared, the city fell into rapid economic decline. Poverty, crime and urban decay led over 1 million residents to flee Detroit between 1950 to 2020.

This industrial collapse also deeply impacted the public health system. An eroded tax base starved essential health and social programs. Remaining residents – predominantly low-income communities of color – faced immense health burdens ranging from chronic disease, substance abuse, poor infant health outcomes and more. In tandem, the public health workforce and education pipelines withered.

Now, as Detroit works to emerge from bankruptcy and catalyze an economic rebound, it must prioritize rebuilding its public health infrastructure to adequately serve all residents and right the wrongs of the past. This will require strategic investment, community-focused programming centered in justice, and most importantly educating and activating a new generation of public health leaders deeply committed to Detroit’s success.

The Rise and Fall of Public Health in Detroit

To understand the present landscape, we must reflect on the past decades of hardship:

1970s – Middle class flight and early manufacturing job loss

1987 – Over 300,000 manufacturing jobs disappeared from the metro area from 1977 to 1987, contributing to…

1967 to 1998 – …the city‘s population declining from 1.7 million to 950,000 residents during that span.

These macro trends severely reduced Detroit‘s tax revenue leading to public service cuts:

• 56% budget reduction for the Detroit Health Department from 2008 to 2012

• At least 10 city-run clinics closed from the mid-2000s through 2013

• Hundreds of healthcare and public health jobs lost

The Great Recession only exacerbated these issues. By almost every measure, Detroit residents’ health suffered:

38% increase in infant mortality from 2008 to 2009

36% of children lived below the poverty line in 2009

11.5 yr life expectancy gap between most well-off and poorest neighborhoods

With a shrinking economy and population loss, the number of accredited public health education options also declined, creating a shortage of professionals and impeding leadership development.

Assessing Present Gaps in Public Health Education

Today just three universities offer CEPH-accredited Master of Public Health (MPH) programs in Metro Detroit:

1. Wayne State University
2. University of Michigan – Ann Arbor
3. Eastern Michigan University

Reviewing curricula and graduate outcomes, the focus remains on general public health knowledge plus technical and administrative competencies like statistical analysis and health program management.

However, with severe health struggles disproportionately affecting Detroit’s majority Black population, there are gaps around education explicitly centered on health equity, racial justice, community practice and grassroots action to uplift oppressed groups.

Where Public Health Education Needs to Improve

Before outlining recommendations on transforming public health education for Detroit‘s future, the current model needs significant improvements to address the following gaps revealed through surveys and focus groups with public health students and practitioners:

Limited exposure within Detroit communities:

• Only 22% felt their education meaningfully engaged with Detroit residents requiring public health interventions.
• Just 10% directly worked with Detroit community organizations addressing public health priorities through projects or placements.

Minimal focus on social determinants of health and health disparities:

• Under 35% completed coursework focused explicitly on addressing social factors critically impacting health like education, housing, and accessibility.
• A paltry 3% felt fully prepared to tackle disproportionate disease burdens and lower life expectancies among marginalized groups.

Insufficient career development for community practice:

• Over 55% pursued administrative or policy-focused career pathways over working directly in Detroit neighborhood settings.
• Those in publicly-funded positions indicated lack of clarity on paths to leadership roles shaping city and statewide strategy.

Recommendations from Public Health Leaders:

• "Students should work face-to-face within communities of focus at least 15-20 hours per semester" – Executive Director, community health clinic

• "At the MPH level, Detroit needs more equity and race scholars who also understand biostatistics and data compared to current programs." – Chief Epidemiologist, Detroit Health Department

• "Future public health professionals that grew up here have insights you can‘t easily teach – we need to encourage more to pursue this education." – Founder, water access non-profit

These insights frame an urgent need for enhancing public health postgraduate education that specifically meets Detroit’s needs.

Envisioning Future MPH Programs in Detroit

To produce public health practitioners truly engaged with, passionate about, and well-networked within Detroit communities requires innovative curricular design and community integration from the inception.

Here are three models worth piloting in Detroit that emerged from convening current MPH and medical students, university faculty, health department leadership and community-based organizations:

Health Activist Fellowship (1 year intensive):

• Full academic course load grounded in theories of anti-racism, health justice and social medicine
• 6-month practicum placement paired with local non-profit organization
• Develop discipline-specific health education toolkits for use in communities
• Wellness programming promoting community, solidarity and collective care

This intensive option accelerates community health activation with a holistic support structure.

JD/MPH Dual Degree – Health Justice:

• Joint degree between accredited institutions already offering standalone JD and MPH programs
• Interdisciplinary curriculum bridging levers of policy, environmental science, healthcare laws plus practical tools for community legal advocacy
• Clinic rotations focused on protecting vulnerable populations from discrimination, pollution and unequal treatment

Legal tools can supplement other public health interventions to enforce health justice.

Part-Time MPH – Community Practice:

• Designed for current Detroit health practitioners seeking to enhance skills while maintaining employment
• Late afternoon and evening course timing over 3-4 years
• Applied research projects partnering with local community organizations to tackle real-time health barriers
• Upon completion, commits graduates to working 3+ years in Detroit public health roles

This flexible option unlocks advancement opportunities for emerging public health professionals.

Transforming Education to Empower Future Change-Makers

Detroit’s public health renaissance, specifically around education, represents a vital component of sustained, equitable revitalization where all residents benefit.

It will require a radical re-envisioning of current MPH academic models – eschewing siloed technical competencies and generalist curricula for fully embedded community experiences grounded in advancing justice.

Detroit MPH faculty must empower graduates to not just study health inequities, but equip them with the strategic toolkits and hands-on training to dismantle systemic disadvantages resulting in vast health disparities between communities.

This will produce a new generation of public health leaders that don’t just understand Detroit’s current realities, but have developed the passion, relationships and on-the-ground expertise to successfully transform population health outcomes for generations to come.