About the Initiative

Healthy Community Zones (HCZ) is a public health initiative that uses a community-centered approach that elevates community voice in the decision-making process and provides resources to communities of color that have been historically underserved and excluded due to systemic racism.

Healthy Community Zones aims to increase community building and transformation to support Michiganders to live longer and experience a better quality of life. HCZ addresses inequities in the places where people are born, grow, live, work, learn, and age by increasing access to key Social Determinants of Health (SDOH) and include, but are not limited to, food security, safe places for physical activity, and social networks and community support.

Implemented strategies will be guided by community members and leaders to address their identified needs, interests and voices in transforming their community to influence community health and receptivity to public partnerships. After five years of funding, each Healthy Community Zone will have the resources, knowledge and support to move more, eat healthfully, and experience belonging to maximize physical and mental health, with an emphasis on rebuilding community trust in state and local institutions and enhancing opportunities within communities.

Healthy Community Zones is led by the Physical Activity and Nutrition Unit within the Cardiovascular Health, Nutrition and Physical Activity Section.
 

In 2020, Governor Gretchen Whitmer recognized racism as a public health crisis: “[The] COVID-19 pandemic has revealed, confirmed, and highlighted the deadly nature of pre-existing inequities caused by systemic racism.”

In Michigan, there is evidence that systemic racism is contributing to persistent racial disparities in overweight or obesity. For instance, 26.9% of White children aged 10-17 are overweight or obese, while 40.7% of Black children are overweight or obese.[1] This inequity persists for adults. Black adults had significantly higher rates of obesity (43.8%) than White adults (35.0%).[2]

Research has shown that overweight and obesity increase an individual's risk of developing certain chronic diseases, including hypertension, type 2 diabetes, stroke, and mental illness.[3]

These conditions are related to life expectancy, and the disparities across neighborhoods in Michigan are striking. Neighborhoods with large Black populations and Native communities tend to have lower life expectancies than communities that are majority White, Hispanic, or Asian.[4]

In Michigan, life expectancy at birth is seven years shorter among Black men than White men and nearly five years shorter among Black women than White women.[5]

It is estimated that Native Americans have a life expectancy that is 5.5 years shorter than the National average[6]. An examination of life expectancy in counties like Chippewa County, home to one of Michigan’s largest communities of Native Americans, shows a gap as high as 10 years.[7]

These inequities arise from policies and social structures and not from individual characteristics or lack of knowledge. In fact, ZIP codes have become better predictors of life expectancy and well-being than education or income.

In response to these inequities, Governor Whitmer established the Racial Disparities Task Force whose objective was to decrease racial inequities in health care accessibility and improve the long-term outcomes for marginalized communities. Funding, which includes Healthy Community Zones, is intended to be used to establish new infrastructure to support preventative health supports and services to regions with high health care access and outcome disparities.
 

References

1. Child and Adolescent Health Measurement Initiative. 2018-2019 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). www.childhealthdata.org. Retrieved [07/08/21].
    
2. Tian Y and McKane P. 2021. Health Risk Behaviors within the State of Michigan: 2019 Behavioral Risk Factor Survey. 33rd Annual Report. Lansing, MI: Michigan Department of Health and Human Services, Lifecourse Epidemiology and Genomics Division. www.michigan.gov/mdhhs/keep-mi-healthy/communicablediseases/epidemiology/chronicepi/bfrs. Retrieved [07/08/21].
    
3. CDC – Division of Nutrition, Physical Activity, and Obesity – The Health Effects of Overweight and Obesity. www.cdc.gov/healthyweight/effects/index.html. Retrieved [07/08/21].
    
4. Owens-Young, J. ZIP code effect: Neighborhood can affect life expectancy by 30 years. www.bluezones.com/2020/02/zip-code-effect-your-neighborhood-determines-your-lifespan/. Retrieved [07/08/21].
    
5. 1950-2019 Michigan Resident Death Files, Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services; Population Estimate (latest update 7/2020), National Center for Health Statistics, U.S. Census Populations With Bridged Race Categories.
    
6. Indian Health Service – Indian Health Disparities. www.ihs.gov/newsroom/factsheets/disparities. Retrieved [07/08/21].
    
7. Associated Press Interactive. Local life expectancy [map]. 2018. https://interactives.ap.org/local-life-expectancy. Retrieved [07/08/21].

Three areas across the state have been identified for Healthy Community Zones funding. Communities receiving funding are localities with disproportionate racial disparities in chronic disease burden and mortality/morbidity. These localities are also in need of interventions that connect and coordinate existing community resources and partnerships to improve health. The funded communities are as follows:

• City of Detroit;
• Chippewa County; and
• Saginaw County.
   

Food Security

Food security status is more strongly predictive of chronic illness in some cases even than income.[8] Thus, improving food security among racial/ethnic minorities is essential to decreasing obesity and chronic disease disparities.

Food is local; food security requires local community-driven solutions to resolve problems that cause food insecurity. The Physical Activity and Nutrition Unit (PAN) will support communities in adopting evidence-based and practice-tested strategies known to increase food security by building sustainable food systems that can last beyond this grant.

Approaches include (but are not limited to): increasing healthy food retail accessibility; supporting community kitchens that use multigenerational approaches to teach families how to prepare, preserve and store healthy food; establishing food policy councils that assist communities in creating policies needed to improve the food environment; and teaching methods for growing sustainable food sources.

Healthy Built Environment and Active Communities

The built environment includes all the man-made structures and features where we live, work, learn, and play.

Communities of color have less access to healthy neighborhoods, adequate education, employment, and health services than White communities do. Governor Whitmer has noted that “Communities that are walkable and have spaces for recreation have better property values, environmental health and quality of life.”[9]

Creating well-designed spaces can help individuals engage with their community, access everyday destinations, and prevent and manage chronic conditions, ultimately improving health outcomes and reducing health disparities.

Approaches to creating healthy built environments and active communities include: increasing connectivity and accessibility to everyday destinations to increase active transportation and walkability; creating or enhancing existing infrastructure to increase the number of communities that have access to safe and accessible parks and greenspaces; increasing access to fresh and affordable food; creating work environments that promote employee wellbeing and ADA compliant infrastructure. This work includes, but is not limited to, funding for trails, sidewalks, wayfinding signage, cross walks, accessibility improvements, and lighting.

Healthy, Thriving Babies

Increasing breastfeeding support and access to human milk is both an obesity prevention and a health equity strategy. Infants being fed human milk gain less weight while developing normally, and gaining less weight in infancy is believed to lead to healthy weight development as children grow.

Breastfeeding is especially important in racial/ethnic communities with disproportionate rates of maternal and infant mortality.

Breastfeeding support means helping parents to meet or exceed expert recommended goals by responding to common barriers to breastfeeding. Approaches to improving breastfeeding support include: improving maternity care practices in birthing facilities; establishing continuity of breastfeeding care; and strengthening infant feeding practices in childcare.[10]

Healthy, Thriving Children and Youth

In Michigan, 69% of children 0-12 have working parents and need some form of childcare or before/after school programs.[11,12] Nationally, access to these types of programs is limited, and demand is higher among Black children and youth.[13]

Schools, childcare settings, and out-of-school-time programs are in a unique position to support optimal childhood nutrition and physical activity, as well as belonging and social connectedness among youth.

Approaches include: embedding standards, and support for childcare providers to achieve them, into local early childhood systems; providing quality improvement support, including incentives; and increasing the availability of out-of-school-time programs implementing healthy eating and physical activity standards.

Social Cohesion

Social cohesion refers to the strength of relationships and the sense of solidarity among members of a community.[14,15] The relationships we have and the support we get from our communities are important for our overall physical health and psychosocial wellbeing.

Social cohesion is often fostered by the capacity of communities to create change driven by their own priorities and by leveraging community assets.

Policy, system and environmental change (PSE) approaches that foster social cohesion include: access to safe and accessible parks and greenspaces for social and health-promotion activities; and youth growing local food for elders, reinforcing The Seventh Generation Principle, which guides many Indigenous communities.
 

References

8. Christian A. Gregory, Alisha Coleman-Jensen. Food Insecurity, Chronic Disease, and Health Among Working-Age Adults, ERR-235, U.S. Department of Agriculture, Economic Research Service, July 2017.
    
9. Gretchen Whitmer for Governor. Get it Done: Healthy Michigan, Healthy Economy. Lansing, Michigan. 2018. https://s3-us-west-2.amazonaws.com/gps-public-static/Gretchen-Whitmer/Whitmer_HealthcarePolicyDocument_09252018.pdf. Retrieved [07/08/21].
    
10. Centers for Disease Control and Prevention. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta: U.S. Department of Health and Human Services; 2013. www.cdc.gov/breastfeeding/pdf/BF-Guide-508.pdf. Retrieved [07/08/21].
     
11. Population Reference Bureau. Children under age 6 with all available parents in the labor force in Michigan: analysis of data from the U.S. Census Bureau, 2008 - 2019 American Community Survey. https://datacenter.kidscount.org/data/tables/5057-children-under-age-6-with-all-available-parents-in-the-labor-force?loc=24&loct=2#detailed/2/24/false/1729,37,871,870,573,869,36,868,867,133/any/11472,11473. Retrieved [07/08/21].
     
12. Population Reference Bureau. Children ages 6-12 with all available parents in the labor force in Michigan: analysis of data from the U.S. Census Bureau, 2008 - 2019 American Community Survey. https://datacenter.kidscount.org/data/tables/5053-children-ages-6-to-12-with-all-available-parents-in-the-labor-force?loc=24&loct=2#detailed/2/24/false/1729,37,871,870,573,869,36,868,867,133/any/11463,11464. Retrieved [07/08/21].
     
13. Afterschool Alliance – America After 3PM for Black Families and Communities. https://afterschoolalliance.org/documents/AA3PM-2020/Black-Communities-AA3PM-2020-Fact-Sheet.pdf. Retrieved [07/13/21].
     
14. Kawachi I, Berkman L. Social cohesion, social capital, and health. In: Berkman LF, Kawachi I, editors. Social Epidemiology. New York: Oxford University Press; 2000. pp. 174–90.
     
15. HHS – Office of Disease Prevention and Health Promotion – Social Determinants of Health Literature Summaries: Social Cohesion. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/social-cohesion. Retrieved [07/08/21].
     

What Support Will the State Provide?

Communities of Practice: Healthy Community Zones are designed to create replicable models that MDHHS can utilize throughout the state. Healthy Community Zones grantees will participate in Communities of Practice (CoPs), which will allow grantees the opportunity to share information and improve their strategies by thinking together to solve problems that may arise during program implementation. The CoPs will also be a space to collect lessons learned to improve the Healthy Community Zones model.
 

Technical Assistance: Grantees will receive subject matter technical assistance as needed.