Race, Housing, and History Must Be Part of the Population Health Conversation

"Where do you think most of the health issues are? We have to first acknowledge that it, in fact, occurred.”

Authority Health CEO Chris Allen speaks at the Population Health Colloquium in Philadelphia.

There are 83 counties in Michigan. Wayne County, the state’s most populous and the home of Detroit, has the largest health systems, the most facilities, and the highest healthcare expenditures. It also has the worst morbidity and mortality rates out of all 83.

To Chris Allen, there are some obvious factors that go into the problem, and they’re ones that people typically don’t like to talk about.

He flashed a 1939 redlining map of Detroit on the 2 large screens that flanked the stage at the Population Health Colloquium in Philadelphia. Redlining, a practice that was at the time sanctioned by the Federal Housing Authority, allowed lenders to refuse mortgages to whomever they pleased. Typically, that was black people. The practice is widely blamed for America’s spatial segregation, in which heavy concentrations of black people ended up in crowded urban areas with low property values while whites were able to build wealthy enclaves and eventually spread into seperate suburbs.

“Fast-forward to 2018. Where do you think most of the health issues are? We have to first acknowledge that it, in fact, occurred,” Allen said. “Housing as a public health issue is real, and we need to be on top of that if we want to make a change.”

And that’s what his organization is after. Allen is the president and CEO of Authority Health, a public corporation created by the state, county, and city to promote population health. But the organization’s missions aren’t as vague and opaque as many of the private companies the hit the stage at conferences claiming to do that.

Authority has a number of initiatives built around understanding the factors that contribute to sickness, particularly in disadvantaged communities. Aspects like public transportation and access to work, which often affect citizens’ ability to support themselves and thus lead healthy lifestyles, receive heavy consideration. The group focuses on the role that social dynamics, like gentrification, play on the elderly citizens who are often displaced to make room for new expensive apartments.

And it has a series of residency programs to train physicians to work in diverse, vulnerable populations on a granular level. The programs typically have a few dozen openings. According to Allen, they usually receive a few thousand applicants.

“We’re using data analytics to teach our residents that when a patient from this or that zip code comes in, bells and whistles go off,” he said. They want their residents to understand the conditions from which their patients come and the unique challenges those conditions can present.

“48217 has the highest asthma rate in the state of Michigan,” he said, referencing the zip code. “Poor and black children,” and if you look around the country, he added, that’s common: Proximity to manufacturing hubs or even heavy traffic are often thought to contribute.

A lot of money gets spent on community health initiatives. But without an intense, studied understanding of how to improve specific aspects of people’s lives, Allen said that it often ends up spread too wide and too thin, unable to make a real impact.

“Very little time is spent on health behaviors, social and economic factors, and the environment,” he said. “I am so tired of excuses on why we can’t do something.”