Feature Public Health

Taking the temperature of Detroit

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g485 (Published 24 January 2014) Cite this as: BMJ 2014;348:g485
  1. Suzy Frisch, freelance journalist
  1. 1Minneapolis, Minnesota
  1. suzyfrisch{at}yahoo.com

Suzy Frisch looks at health in the bankrupt city

The saying about Detroit goes, “When the nation catches a cold, Detroit gets pneumonia.” Battered by the turbulent US automotive industry, high unemployment, and global recession, Detroit has been critically ill for years, and its residents aren’t faring much better.

When the city declared bankruptcy last summer, it revealed festering problems that have been eroding this once vital American city. Detroit’s ugly financial crisis—including $18bn (11bn; €13bn) in liabilities and debt—unfolded dramatically as city services crumbled, crime rose to nation-leading levels, and residents’ access to jobs, insurance, and healthcare withered. Detroit was left with 23% unemployment—more than triple the national average—and 34.5% of residents living in poverty.

“The biggest health issue in the city is poverty,” notes Marianne Udow-Phillips, former director of the Michigan Department of Human Services, who now heads the University of Michigan’s Center for Healthcare Research and Transformation (CHRT). “There is a very high child poverty rate in Detroit, a very high adult poverty rate and illiteracy rate, and we know these things are more associated with poor health. It’s not that the bankruptcy is the cause, but they are so intertwined. It’s the story of changes in the auto industry leaving this city behind.”

As the auto industry began to flounder in the late 1960s, thousands of middle class jobs were lost causing a domino effect of brutal consequences. Though all of the blame can’t be dumped on the auto industry—Detroit’s leaders get a heaping dose of culpability for financial mismanagement—it certainly started the ball rolling.

Lack of well paid jobs prompted more crime, which led more employers and residents to leave. To make up for its shrinking tax base, the city raised taxes and cut services. Then race riots in the 1960s exacerbated white flight, leaving …

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