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.
Black Michiganders were among the hardest hit in the early months of the COVID-19 pandemic, representing 29% of COVID-19 cases and 41% of COVID-19 deaths despite being only 15% of the state's population. In April 2020, Michigan Gov. Gretchen Whitmer established the Michigan Coronavirus Task Force on Racial Disparities
. By the end of September 2020, Michigan’s Black residents made up only 8% of cases and 10% of deaths.
"When that change happened, we were able to flatten the curve," says task force member Renee Canady, CEO of the Michigan Public Health Institute
(MPHI). "But more importantly, we were able to build and strengthen community voice and how government responds to the needs of individuals, needs they face all the time."
This dramatic reduction in disparities involved creating more opportunities for testing within communities, connecting people of color with primary care providers, improving contact tracing and isolation strategies, promoting safe reengagement, and utilizing trusted community leaders in the broadcast of reliable COVID-19 information. Now, as the task force prepares to disband, its members are looking back on the work they've accomplished and the groundwork they've laid for continued progress toward dismantling health disparities in Michigan.
"Collectively as a task force, I was amazed at the level of commitment and dedication. … We had to problem solve and think deeply," Canady says. "As a public health professional my entire career, seeing community engage and build partnerships at this deeply authentic level was absolutely inspiring and motivating for me. It really was about execution and action and change."
Comprised of 23 Michiganders
from diverse locations, backgrounds, sectors, and ethnicities, the task force was directed to increase transparency in reporting COVID’s racial and ethnic impacts, remove barriers to accessing health care, reduce medical bias in testing and treatment, mitigate environmental and infrastructure factors that exacerbated mortality, and improve systems for physical and mental health care as well as long-term economic recovery. To accomplish these directives, members of the task force joined other community leaders in workgroups focused on strategic testing infrastructure, primary provider connections, centering equity, telehealth access, and environmental justice. Task force member Jametta Lilly, CEO of the Detroit Parent Network
, says the task force's reports in November 2020
and February 2022
show that the workgroups became "fast-moving entities" that identified goals at the community and statewide levels.
"We brought together people who don't necessarily plan together — community-based organizations, faith-based organizations, hospital administrators, academic administrators," she says.
Overcoming roadblocks to telehealth
Lilly sat on both the Primary Provider Connections and Telehealth Access work groups. While increasing telehealth opportunities enabled people across the state to receive medical and mental health care during COVID shutdowns, the modality also underscored the reality of the digital divide.
"An accomplishment is the work that's been done to recognize how the digital divide exacerbated the death and mayhem that we saw, whether that was in health, in education, in all of our social services, in access to food, and in the employment market," Lilly says. "There was a recognition that the digital divide had to be addressed if we were going to create structural change not only to address COVID but also to move the state of Michigan forward."
The Telehealth workgroup's efforts were in part responsible for a subsequent gubernatorial executive order
that called for expanded high-speed internet access for all Michiganders, and an ensuing state investment
of $3.3 million to realize that goal.
Rooting out implicit bias
Following another recommendation from the task force, a July 2020 gubernatorial executive order
directed the Michigan Department of Licensing and Regulatory Affairs (LARA) to require implicit bias training for health care professionals
licensed and registered in the state.
"It takes a level of courage and investment to start the journey, to say, ‘This is not acceptable,’" Canady says. "We do have evidence of bias, experiences of community members, partners, and patients. We're not willing, as Michiganders, to look the other way on this. A one-hour training is not going to disrupt decades of socialization. But our hope, and certainly my hope as a member of the task force, is that it will whet the appetites of clinicians, employers, and civil servants in Michigan to say, ‘Wow, I didn't realize this. I need to learn more. I need to think about what we should be doing differently.’"
Dr. Denise Brooks-Williams.
Task force member Dr. Denise Brooks-Williams, senior vice president and CEO of market operations at Henry Ford Health
(HFH), acknowledges that HFH was invited to the table because of its long history of trying to eliminate health disparities, in part by requiring its staff to complete implicit bias training.
"Amongst the task force’s many accomplishments was putting a culturally diverse lens around marketing and how we try to attract people to health services," Brooks-Williams says. "As we moved into having vaccines available but seeing a low response among those wanting to have them, [it] really did take time to invest in some multicultural marketing resources. They did a really good job. That will pay dividends for a long time."
Canady hopes that, in addition to requiring implicit bias training, the state will be able to measure significant changes and greater awareness, knowledge, and understanding of the unresolved consequences of bias and discrimination.
"We need to think differently about systemic inequities and how to maintain relationships across disciplines," Canady says. "It's not just the Department of Health and Human Services’ responsibility. It's not just LARA pushing on people's licenses to practice. It really is all of us in partnership together."
Health care in community
The Primary Provider Connections workgroup sought to remove barriers to care by making health care more accessible. Strategies for doing so included creating test and vaccination sites within trusted neighborhood locations like churches and schools, developing mobile clinics, and involving trusted community leaders as ambassadors of reliable pandemic health information. Brooks-Williams reports that HFH’s mobile clinics will continue post-pandemic as a much-needed resource for communities that lack primary care locations. Another plus is that various community stakeholders are now connected in conversation.
"We've now got community agencies talking with health systems, talking with the health departments, talking with the state, in a way that we probably didn't before," Brooks-Williams says. "If we keep those conversations going in our communities, that will help."
Lilly says one key area for improvement is in quality care coordination – creating a primary care system where primary care providers, Federally Qualified Health Centers, community health workers, and hospitals are integrated into an accessible continuum of health and well-being for all.
"That's our nirvana," she says. "But that's not the system we have in the United States."
Funding will be a priority
Much of the task force's work was funded with COVID relief dollars. Task force members hope that when those funds dry up, those making budgetary decisions at the federal and state levels will continue to fund successful developments like telehealth, mobile clinics, implicit bias training, and culturally competent messaging.
"We are all saying that we need to have a more robust public health system that gets funded adequately, not just because we suddenly find ourselves in a pandemic," Lilly says. "Now that our public health systems have readiness, I think we are in a much better place. The Federally Qualified Health Centers are in a much better place. There are mobile clinics and electronic health systems that have the capability of talking to each other."
While the task force will disband in the near future, members hope that their legacy and work will continue to reduce racial disparities in health care and on other fronts such as education, employment, and economic opportunity.
"Relationships don't end when a committee ends or when a conference is over. They're fortunately transportable," Canady says. "I believe that those relationships will continue as we all, in our individual areas of responsibility, continue to try to execute on the things we learned on the task force."
Lilly adds that now it's time to assess the lessons learned from the task force's work.
"What are the gaps? What are we doing about them?" she asks. "What is so encouraging is that [the Whitmer] administration understands that we have to look very closely at what are the policies that either enable or perpetuate [disparities], or can possibly be a vehicle to create the systemic change we need."
Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at [email protected] or www.constellations.biz.
Renee Canady photo by Roxanne Frith. Jametta Lilly photo by Nick Hagen. Denise Brooks-Williams photo courtesy of Denise Brooks-Williams.