by Amy J. Schulz, PhD, MPH, Barbara A. Israel, DrPH, MPH, Linda Chatters, PhD, MSW, Roshanak Mehdipanah, PhD, Enrique Neblett, PhD

Emerging evidence indicates communities in southeast Michigan are hard hit by the COVID-19 infection, with the city of Detroit, Wayne County and Oakland County showing the greatest number of cases and some of the highest rates of mortality. This should come as no surprise. Higher risk of disease and death follow well-established patterns, structured by economic disinvestment and institutional racism that drive lack of access to critical resources necessary to maintain health.

The state’s latest COVID numbers show that non-Hispanic Black (NHB) residents, who make up just 11 percent of Michigan’s population, account for 35 percent of the cases and 40 percent of the deaths attributable to COVID-19 to date.  In Michigan, as in the United States, long histories of racism, segregation and economic disinvestment have contributed to disproportionate levels of poverty among NHBs, Latinx and Native Americans.

The excess poverty experienced by these groups is associated with increased prevalence of multiple chronic conditions, several of which (e.g., hypertension, diabetes) are linked to more adverse health impacts of COVID-19.   The increased vulnerability to more serious health effects is exacerbated by the inability to act on two primary recommendations for reducing risk of COVID-19: social distancing and hand-washing.

For many, social distancing is not an option.  NHB and Latinx residents are more likely to work in essential services (e.g., production and transportation jobs) and occupations in which working at home and taking time off are not an option.  Those living near the poverty line have limited financial resources, making it difficult to stockpile food and requiring multiple trips to grocery stores and food banks to replenish supplies.  While evictions have been temporarily halted in response to COVID-19, those who are already homeless are unable to practice social distancing as they rely on shelters or other temporary living arrangements, often in close quarters with others. 

Compounding this issue is the inability of many residents to act on the simple and effective advice of public health officials to wash their hands to help prevent the spread of COVID-19.  Evidence across multiple studies shows that hand-washing with soap and water, for at least 20 seconds, reduces the spread of multiple respiratory diseases. However, many residents of Detroit and other Michigan communities remain without access to running water. Unable to act on this simple advice, these households experience heightened risk of COVID-19 infection. 

This double jeopardy – greater likelihood of infection, combined with increased lethality of the infection – contributes to the emerging health inequities reflected in Michigan’s latest COVID numbers.

As members of the public health community, we urge the State of Michigan to recognize the role that economic disinvestment and institutional racism have played in heightening the risk of COVID-19 infection and mortality among NHB Michigan residents.  We applaud ongoing efforts outlined in the governor’s Executive Order to restore water service to all households and assure that the water is compliant with federal and state drinking water standards, and to place a moratorium on housing evictions. Such measures can, in the short term,slow the spread of COVID-19 and flatten the curve in Michigan communities. These short-term measures must become part of a longer-term strategy to promote national health by addressing deep-seated and pervasive inequities that increase vulnerability to poor health and premature and unnecessary mortality.