Michigan is obese, unhealthy and dying young. And that's costing billions.

Grand Rapids-based Cherry Health serves 70,000 low-income and under-insured patients a year in West Michigan. Michigan ranks low in many health measures, and some experts say the state needs more funding for public health. (Courtesy photo)

Michigan Health Watch is made possible by generous financial support from the Michigan Health Endowment Fund, the Michigan Association of Health Plans, and the Michigan Health and Hospital Association. The monthly mental health special report is made possible by generous financial support of the Ethel & James Flinn Foundation. Please visit the Michigan Health Watch 'About' page for more information.

Blessed with abundant water, beaches, hiking trails, bike paths and locally grown fruits and vegetables, Michigan has all the makings of a healthy and fit state.

But look closer and the reality is grim: All too often, in much of the state, residents can’t do a simple push-up or walk 2 miles. We smoke more, have more cases of diabetes and die earlier than the national average.

“We’re cheating ourselves on how long we’re going to live,” said Eric Lupher, president of the nonpartisan Citizens Research Council of Michigan, which studied the state’s overall health in 2018. “It’s kind of the antithesis of ‘Pure Michigan.’”

It’s a puzzling situation that has persisted for decades, even though Michigan has better access to primary care doctors, hospitals and insurance than the rest of the country: The state ranked 34th in overall health in 2018 compared to 35th in 1990, according to annual rankings from the United Health Foundation, a Minnesota-based nonprofit that works to improve public health.

Today, Bridge Magazine debuts Michigan Health Watch, a thrice-monthly report on issues relating to public health and policy, including mental health and the $3.5 trillion healthcare industry.

It’s an important topic that touches all walks of life, from insurance and Medicaid to hospital safety, infant mortality and the opioid crisis.

Coverage begins with a relatively straightforward question: How is Michigan doing on key metrics of health? The answer: Not well at all.

Michigan's health

The United Health Foundation ranks Michigan 34th nationally among states in overall health that measure factors like smoking, access to care and life expectancy. But differences within the state are profound. Many urban areas and those in northern Michigan, for instance, have far lower life expectancy rates than suburban areas. Click on a county to see how it compares to the state average in health factors, behaviors and outcomes.

Michigan has higher rates of obesity, more inactive adults than the nation as a whole, as well as higher poverty, which has long been tied to poor health.

According to the United Health Foundation’s 2018 rankings, Michigan:

  • Has the 13th highest rate of smoking and cancer deaths and 8th highest rate of cardiovascular deaths. Smoking alone costs the U.S. an estimated $170 billion annually in direct health care costs.
  • Is 16th in deaths before age 75, considered premature death. Its rate of premature deaths is 9 percent higher than the national average and 43 percent higher than Minnesota, which has the lowest rate nationwide.
  • Has the 18th highest rate of obesity and a correspondingly high rate of diabetes, a disease that costs an estimated $7,900 a year in medical care per patient, double the cost for someone of healthy weight.

Michigan and its Midwest neighbors, Ohio and Indiana, were in the bottom third in the nation in overall health along with states in the deep South, which have even higher poverty rates.

But even within Michigan, there are stark differences in health. On average, residents of urban areas and rural ones are in worse health than those in suburbs. Experts say that’s because stressors such as poverty and violent crime drag down life expectancy averages in Detroit, Flint and other poor cities, while access to care is a huge barrier in rural areas

Plenty of doctors – and ills to treat

All of this contrasts with Michigan’s health advantages: It has one of the lowest rates of uninsured residents and an above-average number of doctors and mental health providers.

In Michigan, there are 201 primary care doctors for every 100,000 residents –  sixth-highest in the country and 28 percent higher than the national average of 157 doctors, according to the United Health Foundation.

But Michigan spends comparatively little on health education, vaccinations and screenings: $58 per person for public health, below the $86 per person national average, and 41st overall, according to UHF.

In 2017, the most recent year for which figures are available, Michigan spent $300 million on public health, 16 percent less than 2004.

“We’ve just underinvested in our infrastructure for a long time and I don’t just mean roads,” said Marianne Udow-Phillips, director of the Center for Health and Research Transformation at the University of Michigan, a nonprofit that helps inform health research and policy in the state.

“Public health is part of our infrastructure and these are the results you get when you underinvest in these kinds of things.”

Michigan ranks poorly

Compared to other states, Michigan ranks 34th in terms of health indicators and has higher rates of poor health behaviors and higher rates of poor health outcomes. All of this despite having a low rate of uninsured residents and above-average number of doctors.

Measure Michigan U.S. Michigan's rank
Uninsured 5.3 % 8.7 % 8
Mental health providers
per 100,000 people
253 234.7 19
Primary care providers
per 100,000 people
200.6 156.7 9
Public health funding
(per capita)
$58 $86 41
Binge drinking 19.6 % 19 % 32
Obesity 32.3 % 31.3 % 32
Physically inactive* 27.2 % 25.6 % 29
Smoking 19.3 % 17.1 % 37
Diabetes 11 % 10.5 % 32
Low birthweight babies 8.5 % 8.2 % 30

Sexually transmitted disease

per 100,000 people

462.9 497.3 21
Premature death* 8,102 7,432 34

Note: Premature death is a measure of how many people die before age 75. Physically inactive is percent who reported in survey to have no physical activity outside of their job in past 30 days.

Source: United Health Foundation

States such as Minnesota show that innovative - and relatively inexpensive - preventive measures may make a difference.

Minnesota has invested in health promotion measures for more than a decade, with some evidence it’s helped mitigate the obesity epidemic. At about $17 million a year, Minnesota’s Statewide Health Improvement Program funds local initiatives to improve access to healthy foods at farmers markets and stores, ease access to hiking and biking and help employers improve worker health.

Though Minnesota’s obesity rate rose slightly to 28.4 percent in 2017, it remained under the national rate of 30.1 percent and has the lowest rate in the Midwest. (Nearly 1 in 3 adult Michiganders, in contrast, are obese, 32.3 percent.)

“We have more work to do in our state,” said Jan Malcolm, Minnesota’s commissioner of health. “At the same time, … Minnesota is outperforming our neighbors.”

In Michigan, more money and focus on public health – which new Gov. Gretchen Whitmer has promised – could help change the arc of the state’s overall health, Udow-Phillips and others said.

As a candidate, Whitmer said she’d defend the state’s Medicaid expansion, work to protect Michigan’s water supply and spend more money on public health.

The role of money in health

If Steve Hall had more money in central Michigan, he’d like to attack problems like nearly 40 percent of women who smoke while pregnant there, nearly double the 19 percent of all residents who smoke.

“It’s startling that it’s that high,” said Hall, health officer for the Central Michigan District Health Department that covers six counties, including two, Clare and Roscommon, that have life expectancy rates well below the state average.

Hall’s annual budget is about $10 million, of which just 4 percent comes from the six counties the department serves. A third comes from fees and the rest from state and federal sources.

But Hall said his department, like most around the state, is making due with funding that is nearly the same as it was five years ago.

Hall said more money could improve vision and hearing screenings, vaccinations, food and public water inspections and education programs to address other problems, like prenatal smoking.

“I know funding is not a panacea,” Hall said. “But it would help a lot of us to have programs.”

An Oakland County nurse give a vaccine to a patient recently. The county in southeast Michigan has some of the best outcomes in the state. (Photo courtesy Oakland County Health Division)

Indeed, when Michigan was No. 2 in the nation in public health spending in 1990, it was still 35th in overall health, according to the United Health Foundation.

And in 2018, five states that spent less were more healthy, including Wisconsin, and some states that spent more were less healthy. West Virginia spends, on average, four times what Michigan does on public health but is ranked 10 slots lower than Michigan in overall health.

Experts say poor health is tied to a complex web of factors that include poverty, lack of education and exposure to environmental risks like violence or other pollutants.

“There’s not one thing that government can do that will fix all,” said Phillip Berquist, COO of Honor Community Health in Oakland County, a federally qualified community health center. He is a former policy manager for the Michigan Department of Health and Human Services.

“It’s on us to do the things that will make a meaningful difference, even if they are not entire solutions. Part of the solution is private. Part of the solution is local business working to solve the issue.

“It’s one of the most important things that we do in community health; (learning) how to form those productive partnerships,” Berquist said.

Michael Van Beek, director of research for the Mackinac Center for Public Policy, a Midland-based free-market think tank, agreed that more money isn’t necessarily the answer, noting that government-driven solutions to improve health have obvious limits.

“One plan to become healthy for one person might not work for another person,” he said. “Because of the way government is organized, it’s always going to be a one-size-fits-all approach.”

Plus, he noted that research is often changing. In the 1960s, for instance, margarine was promoted as a healthy alternative. Now, evidence has emerged that some margarines had risky levels of trans fats.

Though woes are similar, reasons differ

In parts of Detroit’s west and east sides, life expectancy rates are below 70 years, nearly a decade shy of the state average and well below the 80-plus years seen in the city’s nearby suburbs and across the Upper Peninsula.

Averages are driven down by high murder rates but also higher rates of disease such as cancer and heart disease. Detroit residents suffer from heart disease at rates 61 percent higher than the rest of the state, according to the Citizens Research Council.

Demography shapes health

Across the United States, education and income are strongly linked to overall health, according to national survey data. Here’s a look at the role education and income plays across demographic groups.

  Ranges Smoking Obesity Physical
inactivity
Income Less Than $25,000 26.6 % 38 % 38.9 %
$25,000 to $49,999 19.7 34.2 31.1
$50,000 to $74,999 15.3 33 24.5
$75,000 or more 9.4 27.2 16.8
Age 18 to 44 18.5 26.7 22.6
45 to 64 18.2 35.6 28.6
65 or older 8.9 28.5 32.1
Race or
ethnicity
White 17.1 29.3 25
Black 18.5 39 32.2
Hispanic 13.5 32.4 31.4
Asian 8.1 11.2 20
American Indian,
Alaskan Native
28.7 38.7 28.4
Gender Female 14.3 30 28.1
Male 18.6 30.2 25
Education Less than high school 27.3 37.4 44.2
High school grad 22.3 36.1 35
Some college 17.9 34.8 26.4
College grad 6.5 23.3 15.5
Geography Rural 18.2 34.8 33.8
Suburban 12.5 30.6 27.9
Urban 12.4 30.3 28.9

Note: Physically inactive is percent who have no physical activity in past 30 days. 

Source: United Health Foundation

Yet some stretches of rural Michigan have seen some of the same health results as the state’s poor cities – but for different reasons.

When a Metro Detroit resident suffers a heart attack, they typically have multiple choices of hospitals and cardiologists.

But in the less populated stretches north of the Thumb, those choices may be separated by multiple counties.

The state may have lots of doctors, but many are concentrated in Metro Detroit and Grand Rapids.

While there’s a primary care doctor for every 1,261 people in the state, that ranges from one for every 575 residents in Washtenaw County and one for every 707 residents in Oakland County, to one for every 6,400 in Presque Isle County in northeastern Michigan.

Indeed, 17 counties have more than 3,000 residents for every primary care doctor.

Dr. Andrea Wendling has a private family practice in Boyne City and is director of the Rural Health Curriculum for Michigan State University’s College of Human Medicine.

Her job is to recruit and place rural doctors across the state in underserved areas that need the care and attention many do not get.

She talked about the potential problems facing someone who has a heart attack while snowmobiling in Cheboygan: Is there a witness? Can they get a cell signal? Can an ambulance get to them? And how long would it take to get to an interventional cardiologist?

“We might have the right number of physicians (statewide) but we’re not distributing them properly,” she said.

Her program at MSU has seen success over the years. The program has paired potential doctors with the communities that need them. More than 100  have graduated and returned to rural communities, with more than 75 percent in the Upper Peninsula.

“It’s working. We’re getting them back to these communities,” she said.

But access is not the only issue. A lot of it is behaviors that directly impact health, such as smoking, diet and exercise.

Dr. Andrea Wendling is a family practice doctor in northern Michigan. She also works to recruit and place doctors from the Michigan State University College of Medicine in rural parts of the state.

Education plays health role

One of the best predictors for better rates is education. For instance, roughly 7 percent of college graduates smoke compared to 26 percent of high school grads and 39 percent among people who did not graduate high school.

Many areas of rural Michigan that struggle with poor health behaviors have some of the lowest levels of educational attainment. Those with the fewest adults who attended college typically smoke more, are more obese and have higher rates of physical inactivity.

Rural Arenac and Montmorency counties, for instance, have lower rates of college grads but more smokers, overweight residents and shorter life expectancies.

In contrast, Livingston and Oakland counties, which have the highest percent of residents with a college education, have the lowest rates of those same behaviors –  and some of the longest life expectancies.

So efforts to increase college attendance rates in Michigan could have a trickle-down effect that improves both their prosperity and physical health, Udow-Phillips said.  

As it is, the state has the odds stacked against it when it comes to health, she said.

“Health is much more determined by other things – your genes, the environment, by socio-economic issues,” Udow-Phillips said. “Unfortunately in Michigan those kinds of issues are real challenges for us.”

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Comments

Matt
Wed, 04/24/2019 - 7:51am

"“We’ve just underinvested in our infrastructure for a long time and I don’t just mean roads,” said Marianne Udow-Phillips", Yep, just another one of the infinite number of things we don't tax ourselves enough for, pass laws and develop programs to prevent. Maybe we could just herd everyone into collectives and put Marianne in charge to make sure they live the way she wants and get the care she thinks they need? She means so well how could that not work out? Lets call Bill Gates to fund a test project.

Bernadette
Wed, 04/24/2019 - 8:54am

Once again Matt, your simplistic view of such a complicated problem amazes me. This is a multifaceted problem that will take years to unwind. Public/Private partnerships will be required. The relationship between poverty, poor health, education, healthcare access and state governmental policies are deep.

Why not open your eyes and broaden your view a little and stop "reacting" to the idea that you may be taxed more, and see the complex problem for what it is. The Republican approach of "what's mine is mine" and to hell with everyone else is very outdated.

Don
Wed, 04/24/2019 - 8:35am

Seems that this problem startd after they started putting GOM and HFCS in our foods!!!!

Arjay
Wed, 04/24/2019 - 8:42am

Another let’s throw more money at it problem. How about people taking personal responsibility to not smoke, not eat most of their meals at Mickey D’s, walk a little every day instead of sitting at a bar, and generally improving their lives. Or on the other hand, they could choose to do all that and die early. America is, after all, the land of freedom of choice. And yes, they can even choose to not see a doctor.

Bernadette
Wed, 04/24/2019 - 11:23am

This is a both/and problem, Arjay. Once again your approach is "personal responsibility", which is fine, but you never want to deal with the underlying systemic issues of poverty and racism which has been systematically used in Michigan to keep poor people suppressed. You act like everyone has had your opportunities.

You criticize people for eating at Mickey D's when that may be the only option people have. It may be what they pick up between the two jobs they are working to make ends meet. Your hard-heartedness, and lack of understanding of the deeper issues in Michigan disappoints me greatly as a fellow Michigander.

LLA
Wed, 04/24/2019 - 9:03am

"It’s a puzzling situation that has persisted for decades..." Is it really that puzzling? Michigan has lower educational attainment averages compared to many of the healthiest states in the nation. Michigan spends less on education than the majority of states in the nation. Michigan spends less on public health than the national average. Investment in education and in public health are directly related to health outcomes. Want healthier residents? Invest in education. Invest in local public health.

Marlene Lott
Wed, 04/24/2019 - 9:07am

It's people's lifestyle choices that has us unhealthy, you can throw all the taxpayer money you want at the situation but it won't change. Stop making taxpayers PAY for other people's lifestyle choices and then maybe they will change, but as long as there is no financial burden to them to stop smoking, why stop?

Marlene Lott
Wed, 04/24/2019 - 9:09am

It's amazing how "poverty" is blamed when the CAUSES are NOT WALKING and SMOKING. Walking COSTS NOTHING and those who are poor have no business paying $7 a day for a pack of cigarettes. It's NOT POVERTY, it's LIFESTYLE CHOICES.

Bernadette
Wed, 04/24/2019 - 11:25am

Thank you Bridge for taking on this complex issue. I have worked in healthcare for many years. I left the "healthcare system" many years ago to work in the area of "health promotion", and am happy that I did.

My experience has taught me that Michigan government is not capable of solving complex problems with a "bottom line", NO NEW TAXES mentality. The polarization and we/they mentality is crushing our ability to unravel this problem.

Simplistic thinking will no longer work. There are many people in this state who are okay with Michigan being in the bottom quarter of the country in all quality of life issues, but I am not. I will continue my work to promote health and I am hoping the new state administration will create a new vision for the future of MI.

Jeff
Wed, 04/24/2019 - 11:26am

Individual choice and responsibility account for a lot of this. However, many people are on a fixed income for life. With healthy food being far more expensive, people have to buy and eat what they can afford, not necessarily what is best for them.

Jerry
Wed, 04/24/2019 - 11:57am

I can't speak for everybody, but the reason I'm not more physically active is the weather. It just flat-out sucks in Michigan. Winter apparently runs from September to April. Then 3-4 months of rain. Then mosquito season (95 degrees with 99 percent humidity). And then right back to winter. Fall doesn't exist anymore.

Clark
Wed, 04/24/2019 - 12:08pm

Interestingly enough, a Minn group conducted the study that found Minn is the best in the nation. Hhmmm .

Jill
Wed, 04/24/2019 - 3:43pm

A different thought, we have more physicians but number of them associated with Catholic Hospitals is incredibly high. Since Catholic Hospitals answer to the Conference of Catholic Bishops and are not required to provide all services available to US citizens I, like many non-catholic residents of Michigan have to travel and search too hard for complete medical care. The number of physicians should be amended to reflect doctors who perform complete care since it effects availability .

Marie
Wed, 04/24/2019 - 6:34pm

Very true. I would not willingly choose a catholic hospital system either.

JOHN HULETT
Wed, 04/24/2019 - 6:34pm

Thank you for bringing attention to this serious problem in our state and nation. I live in Ionia County and according the average lifespan I will be dead in 3.5 years. Last year I decided to take responsibility for my own health. I had high blood pressure, developed Diabetes 2 and weighed 272. I met a Health Coach who came free with my food program and since Nov 26, 2018, I have lost 66 lbs. I am 6 lbs from my goal of 200 lbs. My wife has lost 35 lbs. We just returned from 100+ days in Florida and will soon see our primary Dr. for blood work. I am curious to see how he will react to my weight loss and the impact on my blood world. My Urologist was blow away and he said he needs to lose 30 pounds. When I left he was researching the program. So I am planning to beat the odds in my Michigan county. I studying at 75 to be a Health Coach so I can help others avoid the danger beginning obese.

Jim
Sun, 04/28/2019 - 6:44pm

Congrats to John!

John Q. Public
Thu, 04/25/2019 - 1:00am

Lots of us would rather live an Epicurean existence (our own version, not Epicurus') for sixty years than be Jack LaLanne for ninety.

Geoffrey Owen
Thu, 04/25/2019 - 1:32pm

Good start. Look forward to reading more. You tout some statistics like Doctors per capita, but not a complete list.