This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Last year the state of Michigan formed 11 regional councils to spend about a year addressing health disparities in underserved communities – and all of them are already set to continue their work beyond the prescribed period.

In August 2022, the Michigan Department of Health and Human Services (MDHHS) formed Regional Health Equity Advisory Councils to decrease health disparities among Michigan's high-risk, rural, and underserved communities. The councils were formed in Genesee, Ingham, Kent, Oakland, Ottawa, Macomb, Muskegon, Saginaw, Washtenaw, and Wayne counties. Afton Shavers, MDHHS grant manager for health equity, says the council locations were chosen based on COVID infection and death rates, social vulnerability indicators, and racial and ethnic minority population concentrations.
Afton Shavers.
"Ultimately, the majority of the racial and ethnic populations in the state of Michigan reside in those regions that we chose," Shavers says.

The councils have worked hard to build networks of trusted community partners over the past year. The councils were funded through Centers for Disease Control and Prevention and Center for State, Tribal, Local, and Territorial Support grants, which were initially to be used by May 2023. However, funding has been extended through May 2024 — and several of the councils hope to continue beyond that end date.

"Those things that drove those COVID disparities are definitely connected to social determinants of health — those drivers that already existed but were amplified in response to COVID," Shavers says. "The work is still centered on the general principles that we initially started out with — connecting organizations to the communities that they serve, thinking about how to equitably distribute funds to community, and having the things that we prioritize be community-driven, not agency-driven. It's still the same work because we are still addressing those underlying factors that existed well before COVID."

The councils were tasked with five main goals: reducing racial health disparities in impacted communities, reducing community-identified priority risk factors, establishing practices and policies to promote equity and reduce health disparities, equitably and efficiently distributing resources to support affected communities, and affecting community-driven decision making and priority setting.

"One of the main things that I would uplift is everyone's efforts around vaccination, education, and outreach," says Danuelle Calloway, MDHHS health equity project coordinator. "The other part is the connectedness piece. We spent a lot of time thinking about a framework that made sense, really focusing on the human resources — the human capital — that exists in communities. So connecting traditional partners, such as health systems, with grassroots organizations has been a major aspect."

Genesee County

According to Nichole Smith-Anderson, senior director of programs for the Greater Flint Health Coalition (GFHC), Genesee County saw significant health disparities between its white and Black residents at the beginning of the COVID-19 pandemic.

"We had equal levels of folks getting sick, but we saw more Black individuals dying from COVID," she says. "A lot of various community organizations really worked to address that COVID disparity. One of the things that they did was making sure that testing and vaccinations were easily accessible."

GFHC is the organization leading the Genesee County health equity council. With additional funding from the Michigan Health Endowment Fund, GFHC made mini-grants available to community-based organizations so they could create community-driven projects to further decrease disparities.
A meeting of Genesee County's health equity council.
"We were able to fund upwards of 20 different community organizations," Smith-Anderson says. "They were able to do programming focused on things like mental health services, educational opportunities, and vaccine support."

As the Genesee County health equity council continues its grant-funded work for another year, its members are already thinking about ways to bring in additional dollars to continue their work after May 2024.

"Our council is a group of very passionate community residents," Smith-Anderson says. "Any way that we can identify resources, distribute resources, help build capacity, and continue to work to improve health outcomes in our community — that's our end goal, for sure."

Macomb County

The nonprofit Judson Center leads Macomb County's health equity council work. The county is home to large Latinx, Asian, Arabic, and Black communities, as well as other communities of color. Susan Salhaney, Judson Center chief operating officer, connects Macomb County's health disparities to systemic racism and social determinants of health like lacking access to good education, transportation, and food security, as well as occupational risks.

"All of this was really exacerbated with the COVID 19 pandemic," Salhaney says. "Not only are people foregoing their preventive and wellness care, [but] on top of that, [there was] a pandemic. The consequences were really felt so deeply."
Susan Salhaney.
Access to health care is compromised when people can't see a doctor because they don't have insurance or transportation — or when they feel mistrust of health care providers based on historical biases. The council's goal was to understand the community, address its barriers, and start moving health opportunities into the community. These opportunities were based on results of a community survey that enjoyed a robust response.

"We've done some really great things and really look forward to our year two," Salhaney says. "We hope to expand the council and really create an opportunity this year to build a model that can be sustained through partnerships and continuation of council work among the members."

The council sponsored numerous health fairs in collaboration with member organizations and trained 12 community health workers to staff events and provide community outreach and education. Training involved 102 hours of lecture, 40 hours of hands-on experience, and 24 hours of homework.

"They're able to provide health education, training on chronic disease conditions, and connection to health care providers," Salhaney says. "It's really taking health education to the next level by taking it out to the community."

Washtenaw County

According to Charles Wilson, the Washtenaw County Health Department's community health promotion supervisor, Washtenaw County reflected national trends of Black and brown people being disproportionately impacted by COVID infections and deaths.

"Even outside of the virus itself, the pandemic spawned other issues in terms of access — and not only to care," he says.
Charles Wilson.
By participating in a health equity council, Washtenaw County was able to convene a group of community stakeholders with lived experience, strengthen partnerships and relationships that were forged during the pandemic, and be ready for health emergencies that might arise in the future.

"We know that on the eastern side of our county, life expectancy is lower due to chronic disease," Wilson says. "By being more community-driven — having community people and stakeholders at the table — we're making decisions around how to use our resources to address this disparity."

Washtenaw County's council included grassroots, minority-led organizations as well as the local faith community. Many of these have hosted the county's mobile clinic, which offers vaccinations and other health services to community members.

"Those types of organizations are very important to our service delivery model, as well as to nurturing and strengthening relationships with the community," Wilson says.

Lessons learned
 
Shavers says another of MDHHS' goals for the health equity councils was to establish an advisory infrastructure between MDHHS and Michigan communities. That approach empowers community members to be a part of MDHHS' decision-making process, shifting the power imbalance at the local and state levels.

"We want to listen to these populations that traditionally have not really had a lot of say in what was happening in their community," she says.

Another lesson learned was that the MDHHS and Michigan's health systems lacked sufficient cultural competency. Health equity councils are moving these lessons learned forward to advance health equity in their regions.

"We're definitely excited about what's happening with these councils, excited that this has been a community-driven approach," Shavers says. "A lot of times community already knows. They don't need us to come in and reinvent the wheel. That's definitely helping us, from an equity standpoint, in really addressing needs individually."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Community health worker photo courtesy of Judson Center. Susan Salhaney photo by Nick Hagen. Charles Wilson photo by Doug Coombe. Flint council photo courtesy of Nichole Smith-Anderson.