Smokestacks and forgotten residents: Dearborn opens new health department
DEARBORN—It’s one of those gloriously sunny, late winter days and the squeals of schoolchildren at recess at Salina Elementary School cut through the rumble and grind of truck traffic, trains and hulking steel plants.
Mayor Abdullah Hammoud climbs from a city SUV, standing before three smokestacks that jut into clear blue sky.
Health Care for Some
This is one in a series of reports focusing on health disparities in Michigan. The project was made possible by a grant from the nonpartisan, Washington-based National Institute for Health Care Management (NIHCM) Foundation. If you have suggestions for future coverage please contact Robin Erb at firstname.lastname@example.org
It’s here in 2018 that Hammoud — trained in epidemiology and genetics and later finance and business — first began fighting environmental toxins as a state representative. It’s here, too, that he launched his successful mayoral bid for Dearborn last year.
And it’s here — just east of what perhaps unfairly has been dubbed Michigan’s most polluted zip code — that the newly-minted mayor chooses to illustrate why the city is creating a new, built-from-scratch health department.
Hammoud sweeps his hand from the playground to the towering stacks — a “juxtaposition of a children's playground on the back of heavy industry,” Hammoud says. “This playground is where they're growing up.”
He notes that while the children are running around free at the school, in Dearborn’s industrial south end, “so is their asthma.”
A health department of one
In an audacious move this month, Dearborn established its own health department for its roughly 110,000 residents. In doing so, the city sidestepped the Michigan Public Health Code, which recognizes traditional health departments established only by counties or by cities with more than 750,000 people.
To be clear, what Hammoud is now calling a “department” is perhaps an overreach. Dearborn closed its former health department in 2011 amid budget problems and, at the moment, the department is a single person: Ali Abazeed, a son of Syrian refugees and a Dearborn native, like Hammoud.
Dearborn residents will continue to seek traditional health services — vaccines, health checks, well-baby visits — at Wayne County’s health department, Abazeed said. The new city department instead will set its gaze long-term, focused on addressing what city leaders say are environmental and other injustices foisted upon the city and its largely Arab American population.
Among the chief concerns: Arab Americans are often ignored in health research. More than 29 percent of Dearborn residents identify as “foreign born,” according to the U.S. Census, in a city recently dubbed “the heart of Arab America.”
“Being invisible is a health inequity, itself,” Florence Dallo, an associate professor specializing in culture and health at Oakland University, said at a recent panel discussion on Arab American health, sponsored by the University of Michigan School of Public Health.
Writing last year in the peer-reviewed Journal of Immigrant and Minority Health, Dallo and her team reviewed 215,494 Michigan death records, including death records of 2,801 Michiganders with apparent Arab ancestry based on their names but who likely would have been categorized only as "white" under the census.
The team confirmed long-understood disparities in, for example, Black men.
But more revelatory was this: Arab American men died at a higher rate than their white counterparts in six of eight common diseases or conditions — heart disease, stroke, diabetes, pneumonia and flu, and kidney disease.
Those are among factors that contribute to a shorter life expectancy for Arab Americans compared to their white counterparts — 1.4 years among women, and a full two years among men. What scant national and state data is available elsewhere also revealed worrying trends.
In Michigan, Arab Americans are less likely to have graduated from high school, more likely to be unemployed and live below 125 percent of the federal poverty level. They’re less likely to have private insurance and more likely to be uninsured, said Kristine Ajrouch, a sociology professor at Eastern Michigan University, who gathered data with the Dearborn-based Arab Community Center for Economic and Social Services (ACCESS), the largest Arab American service organization in the country.
And immigrants and refugees and their children have additional barriers that aren’t often reflected in traditional disparities data — challenges of language, acculturation and often the “trauma of coming from or living through violent events, such as war or being a refugee,” said Dr. Mouhanad Hammami, former health officer for Wayne County and a lecturer at the University of Michigan in Dearborn.
Research has long established that stress boosts heart rate and blood pressure, weakens the immune system and reproductive and growth processes and, over time, can make a person vulnerable to heart disease, heart attack, high blood pressure and stroke.
Building out that data is a crucial first step to addressing disparities, Hammami and others said, which in turn helps justify health findings “to yourself and to your funders,” he said.
“I can tell you that a certain group of people have higher obesity rates. I can tell you that they suffer from more cardiovascular rates or have lower access to health care. But it’s only theory unless I have the numbers to back it up,” Hammami said.
Everything is a health issue
Younger than the mayor by only a couple of months, 31-year-old Abazeed was an undergraduate student at U-M in 2011, as Hammoud was performing his master’s degree work in epidemiology and genetics.
They were drawn together by the comfort of familiarity, the first-generation college students from working families — “we were winging it,” recalled another Dearborn resident and student at the time, Bilal Baydoun, now the city’s 31-year-old spokesperson.
Meeting in coffee shops and classrooms left open late for students to study, the three men were struck by global events, including the Arab Spring unfolding in real time.
The Affordable Care Act had begun to click into place at that time, ultimately delivering health care to millions of Americans for whom it had been previously out of reach.
“We’d meet … ostensibly to study, but we had these winding conversations that would last until 1 or 2 in the morning,” Baydoun said. Over time, he recalled, “health care emerged into our collective conscience.”
A decade later, Hammoud, who had already taken a turn as a state representative, was elected the first Arab-American of a city once led by a mayor notorious for his racist views. He quickly turned to Abazeed who by now had moved to Washington where he was a public health advisor at the National Cancer Institute, leading discussions on health disparities.
Rather than running a brick-and-mortar provider of vaccines and other traditional public health services, the new health director begins his work with a mission to consider the health consequences of every decision the city makes. He will be an advisor of sorts in negotiations with businesses, in zoning decisions, and internal management, “imbuing health considerations into every single policy,” Abazeed said.
Call it Public Health 2.0. Or maybe 3.0, he said.
“Public health is fundamentally about justice. It's fundamentally about advocacy. And I think it's really important that, as we emerge from a once-in-a-century pandemic, that we start rethinking what public health is,” Abazeed said.
Dearborn’s economy is heavily reliant on industry, but its residents worry about the the manganese, mercury, nickel, lead, zinc, formaldehyde, chromium, polycyclic aromatic compounds, copper, phenol metals, xylene, ethylene glycol, ethylbenzene, toluene, methanol, butyl alcohol and other byproducts of these businesses, according to the U.S. Environmental Protection Agency and Michigan Department of Environmental Quality Air Quality Division.
On windy days, black dust settles on cars, homes and children’s playgrounds, and on hot, still days, the air feels caustic, residents told Bridge. Asthma rates, at least by some measures, rank as some of the highest in the state.
Hammoud recently led a small tour at a 30-acre, nearly-empty plot of land along the eastern edge of Dearborn at I-94 dominated by trucks, trains and heavy industry. Once a busy residential area and Eugene Porath Park, the city has purchased and knocked down homes over time, planning to sell the larger parcel for more industry, Hammoud said. His new administration has put the plan on pause. There are no other plans, but he said he wants time to consider other options.
“Historically, when you look at economic development projects, it's about capital,” Hammoud said.
“It's about ‘What are the profits here’… It's just now that we're adding another wrinkle, which is, okay, we got this site, we're thinking about a development project, what are the health considerations?” he said.
This Health-in-All-Policies (HiAP) approach to government has drawn increasing interest and mixed results in recent years, according to Dr. Peter Jacobson, professor emeritus of health law and policy at U-M who has studied the approach in 14 cities outside of Michigan.
“It changes the way we think about health and the health of the community,” he said. “It sets out a goal of improving the community's health and a process for doing so.”
How might the layout of new businesses or new roads, for example, affect walkable green space? Is there a better way to allocate city services — police, fire, housing — to help protect residents long-term rather than simply responding to crises?
Dearborn must figure out a way to pay for its new health department, which council approved in January, despite concerns about cost. The city must close a $16-million deficit in its general budget created last year when voters failed to renew a supplemental tax, so Hammoud and others now are eying part of nearly $1 million that Dearborn will receive from the state’s portion of an opioid settlement with several pharmaceutical companies.
Hammoud said he has communicated his plans to the Wayne County Department of Health, Veterans & Community Wellness.
Wayne County health leaders declined to be interviewed about the effort, according to spokesperson Tiffani Jackson. Instead, they offered a brief emailed statement through Jackson saying only that they “look forward to coordinating with the City of Dearborn on public health efforts” and noting that Wayne’s health department “continues to serve as the local public health authority.”
“A moonscape of industry”
Walk around Salina Elementary School and an adjacent intermediate school, and one gets a sense of what worries people like Eman Ahmed, a former student and teacher and now the principal of Salina Intermediate and its nearly 500 students.
There’s the low rumble of trucking hauling industrial product and waste and possibly kicking up toxic fugitive dust. To the south, the Marathon Oil Refinery has the ability to refine 140,000 barrels of crude oil per day. And there’s Dearborn Works, part of Cleveland-Cliffs, which melts, casts and cold-rolls steel. There’s the Ford Motor Company’s Rouge Complex and, most notably from its three tall smoke stacks, Dearborn Industrial Generation (or DIG) a 770-megawatt power plant that provides power for Ford as well as AK Steel, U.S. Steel and other nearby industrial customers. (DIG was named in 2010 for being a Michigan Clean Corporate Citizen.)
“We are literally surrounded” by industry, Ahmed said.
Paul Mohai, an environmental professor at University of Michigan whose work has linked air pollution to poorer attendance and academic outcomes and who has pushed to build schools farther away from industrial sites, said he was startled when he first looked up the area on Google Earth years ago.
“It’s this vast industrial zone, a moonscape of industry,” he said.
It is here that a black Yukon threaded its way along the potholed roads recently. Samraa Luqman was at its wheel, two empty car seats strapped to the back seat.
Luqman, 39, deflected the reference that others have pinned on her: Dearborn’s Erin Brockovich, referring to the California environmental activist made famous in the 2000 film starring Julia Roberts.
She is a single mom, the daughter of a Yemeni immigrant, a legal specialist with Social Security who also has learned her way around Google.
“I’ve learned more things about particulate matter that no mother should ever learn — about formaldehyde, manganese, lead, the content in the air and the different carcinogens,” she said, referring to byproducts that, at high enough doses, can lead to serious health problems.
To be clear, it’s impossible to precisely calculate a neighborhood’s risk from industrial pollutants, or even discern what particulates come from industry and what are byproducts of everyday American life — car exhaust, for example, as residents come and go to work and school or the grocery store — and what is locally produced and what drifts from neighboring Detroit.
But public health hazards from industrial toxins are long-established in research around the globe, and studies have repeatedly established a link between respiratory diseases, such as COPD and asthma, and air particulates.
Reports and stories over the years have repeatedly highlighted concerns on Dearborn’s air quality. Regulators since the 1970s have monitored the air around Salina school for fine particulate matter, metals, volatile organic compounds, black carbon and carbonyls, such as formaldehyde, the latter can irritate the eyes, nose and throat or lead to rashes, wheezing and lung problems.
A 2012 state report named Dearborn’s as one of four metro Detroit area monitoring sites in which was detected worrisome levels of manganese, a naturally-occurring element that in high levels can impair lung function or cause permanent neurological problems.
The seven counties of southeast Michigan last year were listed as a “nonattainment ozone area,” meaning they don’t meet federal ambient air quality guidelines, and an area stretching down the Lake Erie shoreline to the east of Dearborn has shown above acceptable levels for sulfur dioxide.
In 2019, a state review found that more adults were hospitalized in Wayne County — 23 people for every 10,000 — than anywhere else. In fact, they were hospitalized at twice the rate of the state’s average of 11.1 people per 10,000. Children were hospitalized for asthma at greater rates — 17.7 children for every 10,000 people, compared to the state average of 10.9 for every 10,000.
Still, tracking air pollution on the winds is tricky; linking it to local health problems even more so.
Luqman pulls out her phone, and thumbs open the daily state air quality monitoring report. There is an orange warning bar for the Detroit area from just a few days ago — “those with small children, people with heart or lung problems … and the elderly should limit prolonged outdoor activities,” the warning reads.
Grit, grime and the economy
Gravel crunches as the Yukon pulls onto a bank of the Rouge River, and Luqman steps into the gritty mud to cross South Dix Street. Low slung clouds bend emissions horizontally, so they hover parallel to the ground over a brown-red skyline of manufacturing plants and the industry detritus.
“I think it’s beautiful,” Luqman said. “It’s a glimpse of how far mankind has come and what we’re capable of.”
But that success comes at a cost — the worry that industry’s byproducts — tracked by the EPA’s Toxic Release Inventory Tracker — drift into neighborhoods made of immigrants and refugees, she said.
Ashwak Alshabibi is a resident here.
The 43-year-old director of technology at Troy Schools says her daughter struggled to breathe against attacks of severe asthma when she was growing up — “every week, she was in the hospital and she was getting a nebulizer (treatment) all the time.”
Alshabibi’s mother, too, has asthma, along with a nephew, a niece and a friend’s children.
Her father had chronic obstructive pulmonary disease (COPD) when he got COVID last year and died, even though he wasn’t a smoker. No, that’s hardly proof of air toxins, she acknowledged. And her father was 82, making him more vulnerable to the virus.
“But when I moved from Dearborn, my daughter got better. When we came back, she was grabbing her inhaler again,” she said. “It seems that every other person in this family has asthma. My friend moved, and her kid got better. My sister moved, and her son got better.”
And no, Alshabibi says, moving isn’t an option for her mother.
“This is a village for her,” she said. “Her neighbors — they know she is a widow. She wakes up and there’s a meal for her at the door. They take care of her.”
For her and others, Dearborn is home — with its mix of nationalities, welcoming mosques, restaurants that battle for the reputation of best shawarma and grocery stores that sell Indian rose syrup, biryani spices, tawook seasonings.
They grew up here in these schools, played in these parks, said activist Luqman, back in her vehicle. As she spoke, a passing motorist stopped to ask her if she needed help as she idled at an intersection. She smiled and waved him on.
“People don’t want to leave here. I don’t want to leave here. And I shouldn’t be made to feel like I should,” she said.
Luqman swatted in the air, as if pushing off the anticipated question.
“Why not move? That is such a loaded question,” she said. “It comes from privilege.”
Back at the school, Ahmed, the principal, strolled hallways adorned with posters and artwork from students, passed a noisy classroom where students had dressed up in construction paper beards and hats to act out a history lesson. In another classroom, students created binders for a course to help them with college preparation.
“You can’t stop industry; it’s the heart of our economy,” Ahmed said, smiling to a passing boy. “But we have to be strategic, building our economy and protecting our children’s health, too. And I am optimistic.”
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