Detroit Health Research Articles

Invasive Nontypeable Haemophilus influenzae Disease Outbreak at an Elementary School - Michigan, May 2023.

In May 2023, the Detroit Health Department was notified of four cases of invasive nontypeable Haemophilus influenzae (Hi) disease among students attending the same elementary school and grade, all with illness onsets within 7 days. Three patients were hospitalized, and one died. Most U.S. cases of invasive Hi disease are caused by nontypeable strains. No vaccines against nontypeable or non-type b Hi strains are currently available. Chemoprophylaxis is not typically recommended in response to nontypeable Hi cases; however, because of the high attack rate (four cases among 46 students; 8.7%), rifampin prophylaxis was recommended for household contacts of patients with confirmed cases and for all students and staff members in the school wing where confirmed cases occurred. Only 10.8% of students for whom chemoprophylaxis was recommended took it, highlighting gaps in understanding among caregivers and health care providers about persons for whom chemoprophylaxis was recommended. Public health authorities subsequently enhanced communication and education to the school community, improved coordination with health care partners, and established mass prophylaxis clinics at the school. This outbreak highlights the potential for nontypeable Hi to cause serious illness and outbreaks and the need for chemoprophylaxis guidance for nontypeable Hi disease. Achieving high chemoprophylaxis coverage requires education, communication, and coordination with community and health care partners.

The Effect of COVID-19 on Mood Disorders in Urban and Suburban Detroit

Introduction: The COVID-19 pandemic has increased the global experience of anxiety and depression due to social isolation and government-mandated quarantine for transmission reduction. To date, literature surrounding the mental health effects of COVID-19 for the US population is limited. Methods: This is a retrospective study from a large metropolitan Detroit health system. Patient encounters between December 23, 2018, and June 22, 2021, with March 23, 2020, the start of Michigan state-wide lockdown, were used to define pre- and post-COVID-19. The data was divided into Detroit and non-Detroit based on patient zip code. All patients aged 13+ years old with a visit with a family medicine provider were included. Outcome variables included Patient Health Questionnaires-2 and -9 and General Anxiety Disorder-7 scores, diagnoses of depression, anxiety, adjustment and grief disorders, antidepressant prescriptions, and behavioral health referrals. Logistic regression was used to determine the incidence of composite mood disorder, depression, and anxiety. Results: A total of 20,970 individuals were included in this study: 10,613 in the Detroit subgroup and 10,357 in the non-Detroit subgroup. 88.2% of the Detroit population were Black and 70% were female. Logistic regression shows that the incidence of composite mood disorder decreased with increasing age (odds ratio [OR] 0.787, 0.608, 0.422, and 0.392; p<0.001). Male gender is a protective factor (OR 0.646, p<0.001). Federal insurance is the only factor presenting a statistically significant increased risk (OR 1.395, p<0.001). There was no statistical difference between residing in urban and suburban on incidence of composite mood disorder [OR 0.996 p=0.953] Conclusions: Our research demonstrates that residing in an urban setting did not increase the risk of developing a mental health disorder during the COVID-19 period.

1891. Descriptive Epidemiology of African-American Patients with Tuberculosis in in Detroit

Abstract Background Knowing local risk factors for tuberculosis (TB) facilitates identification of individuals with latent or active TB. The purpose of this study is to describe the epidemiology of TB among patients seen in the Detroit Health Department. We will refer to our study population as Detroit TB cases. Methods A retrospective descriptive study was conducted in collaboration with the Michigan Department of Health and Human Services. TB data submitted to MDHHS from Detroit between January 2017 and December 2022 was evaluated. Information on demographics, genotype clusters, and clinical / lifestyle risk factors was collected Results One-hundred forty-one TB cases were verified in Detroit during the study period and will be referred to as the study population. See Table 1 for baseline demographics. Sixty percent (85) of cases were males. Fifty-eight % (81) were Black / African American (B/AA). Sixty-two % (87) of cases were born in the U.S. Of persons with positive cultures for TB, 45% (37) were in a genotype cluster. Please see figure 1 for example of genotype cluster. The major clinical risk factors were diabetes mellitus in 31% (43) of cases, followed by incomplete treatment of latent TB infection (LTBI) in 11% (16). Major life-style risk factors included any substance use in 24% (34), non-injecting drug use in 18% (26), and excess alcohol use in 13% (18) of cases. Conclusion This study highlights epidemiologic differences between individuals with TB in Detroit and the US. Almost 60% of the 141 Detroit TB cases were B/AA. Nationally, 10% of non-US-born individuals and 30% of US-born ones were B/AA in 2022. More than 60% of the Detroit cases were US-born. This is in stark contrast to the U.S., where 37% of cases in 2022 were US-born. A significant number of Detroiters belonged to a genotype cluster, indicating continued transmission of TB. Alcohol and drug use were major lifestyle risk factors, suggesting increased contact in shared venues contributing to transmission of TB. Knowing these local risk factors for TB should lead to earlier detection and treatment of TB and LTBI and eliminate opportunities for transmission. Disclosures All Authors: No reported disclosures

Wastewater Monitoring for Infectious Disease: Intentional Relationships between Academia, the Private Sector, and Local Health Departments for Public Health Preparedness.

The public health emergency caused by the COVID-19 pandemic stimulated stakeholders from diverse disciplines and institutions to establish new collaborations to produce informed public health responses to the disease. Wastewater-based epidemiology for COVID-19 grew quickly during the pandemic and required the rapid implementation of such collaborations. The objective of this article is to describe the challenges and results of new relationships developed in Detroit, MI, USA among a medical school and an engineering college at an academic institution (Wayne State University), the local health department (Detroit Health Department), and an environmental services company (LimnoTech) to utilize markers of the COVID-19 virus, SARS-CoV-2, in wastewater for the goal of managing COVID-19 outbreaks. Our collaborative team resolved questions related to sewershed selection, communication of results, and public health responses and addressed technical challenges that included ground-truthing the sewer maps, overcoming supply chain issues, improving the speed and sensitivity of measurements, and training new personnel to deal with a new disease under pandemic conditions. Recognition of our complementary roles and clear communication among the partners enabled city-wide wastewater data to inform public health responses within a few months of the availability of funding in 2020, and to make improvements in sensitivity and understanding to be made as the pandemic progressed and evolved. As a result, the outbreaks of COVID-19 in Detroit in fall and winter 2021-2022 (corresponding to Delta and Omicron variant outbreaks) were tracked in 20 sewersheds. Data comparing community- and hospital-associated sewersheds indicate a one- to two-week advance warning in the community of subsequent peaks in viral markers in hospital sewersheds. The new institutional relationships impelled by the pandemic provide a good basis for continuing collaborations to utilize wastewater-based human and pathogen data for improving the public health in the future.

Pandemic response gaps: Infection prevention and control lessons learned during coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities in Detroit, Michigan.

Hospitalizations among skilled nursing facility (SNF) residents in Detroit increased in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Outbreak response teams were deployed from local healthcare systems, the Centers for Disease Control and Prevention (CDC), and the Detroit Health Department (DHD) to understand the infection prevention and control (IPC) gaps in SNFs that may have accelerated the outbreak. We conducted 2 point-prevalence surveys (PPS-1 and PPS-2) at 13 Detroit SNFs from April 8 to May 8, 2020. The DHD and partners conducted facility-wide severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of all residents and staff and collected information regarding resident cohorting, staff cohorting, and personnel protective equipment (PPE) utilized during that time. Resident cohorting had been implemented in 7 of 13 (58.3%) SNFs prior to point-prevalence survey 1 (PPS-1), and other facilities initiated cohorting after obtaining PPS-1 results. Cohorting protocols of healthcare practitioners and environmental service staff were not established in 4 (31%) of 13 facilities, and in 3 facilities (23.1%) the ancillary staff were not assigned to cohorts. Also, 2 SNFs (15%) had an observation unit prior to PPS-1, 2 (15%) had an observation unit after PPS-1, 4 (31%) could not establish an observation unit due to inadequate space, and 5 (38.4%) created an observation unit after PPS-2. On-site consultations identified gaps in IPC knowledge and cohorting that may have contributed to ongoing transmission of SARS-CoV-2 among SNF residents despite aggressive testing measures. Infection preventionists (IPs) are critical in guiding ongoing IPC practices in SNFs to reduce spread of COVID-19 through response and prevention.

Quality and Implementation of Diabetic Care at a Free Clinic.

INTRODUCTIONAlthough typically receiving little government funding, free clinics help ensure access to affordable quality health care to the medically underserved. Established in 2004, the authors’ metropolitan Detroit Health Unit on Davison Avenue (HUDA) Clinic delivers primary care and specialized services to uninsured populations. The authors compared proportionate changes in A1c levels compared to prior national averages to evaluate the significance of care a free diabetes clinic can provide to uninsured populations.METHODSRetrospective data from 2017-2019 were reviewed of adult patients who have been diagnosed with Type 2 Diabetes. From HUDA Clinic medical records, data were collected concerning patient demographics, insurance status, pregnancy, major comorbidities and several factors related to diabetes standards of care.RESULTSThere were a total of 2,231 patient visits to HUDA Clinic in 2019, of which 125 patients (5.6%) received care for their Type 2 diabetes. Forty (32%) clinic patients who had a visit in 2019 had an HbA1c <7.0 and 29 (23%) had an HbA1c > 9.5. This is comparable to the 2020 National Diabetes Statistics Report in which approximately 50% (n = 15.6 million) of Americans had an HbA1c < 7.0 and 14% (n = 5.1 million) had an HbA1c > 9.5.CONCLUSIONSHuda Clinic’s diabetes care percentages were quite comparable to state and national data and CDC parameters, although these comparative results need to be considered in terms of the authors’ smaller sample size. These overall results indicate that health care providers can meet major recommended diabetic care at inner-city free clinics in metropolitan communities. Future provider and patient study studies regarding free clinic care patterns are clearly required to identify gaps in healthcare access and formulate and test specific strategies to improve diabetes-related outcomes.

A Critical Examination of Senior Housing: Promoting Equity Through Ensuring Safe Spaces

As affordable senior housing communities aimed to address the health and well-being concerns of residents in the COVID-19 pandemic, special attention to safety during renovation had to be addressed. This paper offers case studies from members of a city-wide advocacy group, Senior Housing Preservation-Detroit. Eighty one percent of covid deaths in the City of Detroit are those 60 and above; 81.2% of deaths have been among African Americans (Detroit Health Department, 2021). With the grief and challenge in a city hit early on in the 2020 pandemic, these case studies will highlight how Covid-19 affected planned projects in senior buildings, how stakeholders such as developers, staff and residents responded and key considerations for future emergencies affecting senior housing communities. This paper offers critical perspectives applicable to many urban landscapes in order to raise awareness to policy makers, and practitioners.

425. Sustained Control and Prevention of COVID-19 Outbreaks in Detroit Skilled Nursing Facilities

BackgroundNursing home residents, a vulnerable population, experienced an extraordinary surge of COVID-19 cases and deaths at the beginning of the pandemic. Multidisciplinary collaboration from the Detroit Health Department (DHD), academic centers, along with interim guidance from the CDC provided a structured approach to control SARS-CoV-2 in Detroit skilled nursing facilities (SNF). We aim to describe this model. MethodsThere were 26 SNF prioritized by the DHD over a 13-month period from 3/2020 - 4/2021. Testing for SARS-CoV-2 occurred biweekly, on average, at each facility for staff and residents. Any staff or resident cases were investigated by a specialized investigations team to determine outbreak status. Any resident that was identified as positive for SARS-CoV-2 was moved to a designated in-house quarantine unit or specific COVID-19 designated nursing homes within the City of Detroit, and cohorting guidance was provided. Facilities were evaluated for environmental controls, PPE provided as needed and infection prevention guidance was provided. COVID-19 vaccination was conducted by pharmaceutical chains or the DHD and vaccine education sessions were conducted for nursing home staff and residents.ResultsOn average, SNF facilities served a total of 2,262 residents (2031-2367 range) and employed a total of 2,965 staff (1034-3124 range) during the period from 7/2020 - 4/2021. SARS-CoV-2 cases overall for Michigan and Detroit are shown in Figure 1. In SNF facilities, cases ranged from zero to 279 cases in residents and zero to 115 cases per week in staff (Figure 1). Beginning 3/2020, the majority of cases were residents, whereas after 10/2020, staff cases exceeded resident cases. Immunization rates were 63% (partial) and 58% (complete) for residents, and 26% and 23% for staff, respectively. Measures to reduce vaccine hesitancy included organized education sessions, messaging from trusted leaders and organized mass vaccination schedules. ConclusionWe describe the effectiveness of multidisciplinary interventions to control dissemination, morbidity and mortality of SARS-CoV-2 amongst SNF residents in Detroit. We emphasize the continued need to address vaccine hesitancy and importance of this model as successful interventions to decrease infection rates.Disclosures Paul E. Kilgore, M.D., M.P.H., Johnson and Johnson (Janssen) (Grant/Research Support, Scientific Research Study Investigator)Moderna (Grant/Research Support, Scientific Research Study Investigator) Marcus Zervos, MD, contrafect (Advisor or Review Panel member)janssen (Grant/Research Support)merck (Grant/Research Support)moderna (Grant/Research Support)pfizer (Grant/Research Support)serono (Grant/Research Support)

500. A Real-World Cohort Study of Bamlanivimab Versus Bamlanivimab-Etesevimab for Non-severe COVID-19

BackgroundAnti-spike monoclonal antibodies (mAb) including Bamlanivimab (BAM) and Bamlanivimab-Etesevimab (BAM/E) have shown reduced hospitalization rates for non-severe coronavirus disease 2019 (COVID-19) in clinical trials. Recent studies provided real-world hospitalization rates for BAM. But, similar data on those who received BAM/E are lacking. In spring 2021, Michigan experienced a surge of COVID-19 with more cases per capita than any other state. We sought to quantify the impact of BAM monotherapy versus BAM/E combination on hospitalization and mortality among a real-world high-risk cohort of outpatients with COVID-19.MethodsThis retrospective cohort study evaluated outpatients ≥18 years with laboratory-confirmed mild/moderate COVID-19 who received mAb in a Detroit health system based on emergency use authorization criteria. Inclusion began on December 3rd 2020 with BAM monotherapy, changed to BAM/E combination on March 27, 2021, and included patients until April 19th 2021 (Figure 1). Demographics, comorbidities, and clinical characteristics were compared between patients who received BAM verses BAM/E using Chi-square and Mann-Whitney U test. Primary outcome was 30-day COVID-19 related hospitalization. Secondary outcomes were 30-day mortality and length of stay (LOS). Inclusion began on December 3rd 2020 with BAM monotherapy, changed to BAM/E combination on March 27, 2021, and included patients until April 19th 2021. In spring 2021, Michigan experienced a surge of COVID-19 with more cases per capita than any other state resulting in a large sample of real-world patients for analysis.Results643 patients received mAb (294 in BAM group and 349 in BAM/E group). Patients in the BAM/E cohort were younger and more obese with lower rates of diabetes, myocardial infarction, and cancer. Other characteristics were similar (Table 1). BAM/E patients had longer time from symptom onset to infusion (6 vs 4 days, p< 0.001). COVID-19 related 30-day hospitalization rates did not differ between groups (7.8 vs 7.2%, p=0.751). LOS and 30-day mortality (1% vs 0.3%, p=0.238) were also similar (Table 2). Patients in the BAM/E cohort were younger and more obese with lower rates of diabetes, myocardial infarction, and cancer. Other characteristics were similar BAM/E patients had longer time from symptom onset to infusion (6 vs 4 days, p<0.001). COVID-19 related 30-day hospitalization rates did not differ between groups. Length of stay and 30-day mortality were also similar.ConclusionRates of hospitalization in our study were higher than in clinical trials of mAB and may reflect differences in study populations (Table 3). Compared to other real-world studies, our cohort of young, obese, and Black patients, had similar hospitalization rates of 7.5%. The lack of difference in outcomes noted among the mAB formulations in our study may be related to longer time from symptom onset to infusion in the BAM/E combination group. Our patients were older with higher rates of obesity and other comorbidities than those in clinical trials (shown in orange). Compared to other real-world studies (in blue), our cohort of younger, more obese Black patients had similar hospitalization rates of 7.5%.Disclosures All Authors: No reported disclosures

366 Detroit City Mass Vaccination Site Template

In 2020, the city of Detroit was impacted by the COVID-19 pandemic, with over 162,000 reported diagnosed cases and 4,800 deaths. In response to anticipated availability of a vaccine, the Detroit Health Department developed plans for a drive-through mass vaccination site to help distribute the vaccine to the city’s population. We describe the Detroit City Mass Vaccination Site and its methods of recruitment, enrollment, site selection, and logistics.

Detroit health system seeks upgrade of inpatient care via partnership

Leading academic medical center Henry Ford Health System has chosen the large Acadia Healthcare behavioral health network as its partner in an effort to modernize its Detroit‐area inpatient behavioral health care operations.

Urban HEART Detroit: the Application of a Health Equity Assessment Tool.

The Urban Health Assessment Response Tool (Urban HEART) was developed by the World Health Organization. In 2016, the Urban HEART was adapted and used by the Healthy Environments Partnership, a long-standing community-based participatory research partnership focused on addressing social determinants of health in Detroit, Michigan, to identify health equity gaps in the city. This paper uses the tool to: (1) examine the geographic distributions of key determinants of health in Detroit, across the five Urban HEART specified domains: physical environment and infrastructure, social and human development, economics, governance, and population health, and (2) determine whether these indicators are associated with the population health indicators at the neighborhood level. In addition to the Urban HEART matrix, we developed various tools including graphs and maps to further examine Detroit’s health equity gaps. Although not required by Urban HEART, we statistically analyzed the associations between each indicator with the health outcomes. Our results showed that all the domains contained one or more indicators associated with one or more health outcomes, making this an effective tool to study health equity in Detroit. The Urban HEART Detroit project comes at a critical time where the nation is focusing on health equity and understanding underlying determinants of health inequities in urban areas. A tool like Urban HEART can help identify these areas for rapid intervention to prevent unnecessary burden from disease. We recommend the application of the Urban HEART, in active dialog with community groups, organizations, and leaders, to promote health equity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-020-00503-0.

79. Detroit’s Response to COVID-19 in Homeless Shelters

BackgroundDetroit, Michigan has a poverty rate nearly three times the national average. Homeless shelters are at risk for infectious outbreaks due to reduced healthcare access for residents, compounded by overcrowding, hygienic challenges, lack of resources, and transient nature of residents. Prior to the first reported COVID-19 case in Michigan, the Detroit Health Department prioritized screening of both asymptomatic and symptomatic homeless residents residing in the city’s shelters. Early identification of COVID-19 positive cases allowed for implementation of strategies to halt further spread.MethodsA surveillance strategy was implemented prior to the first confirmed COVID-19 case in Michigan. Surveillance involved temperature and symptom checks at each homeless shelter, three times weekly. 24 shelters were screened for symptoms, 13 shelters had universal testing performed. Two city-operated quarantine sites for COVID-positive and –suspected homeless individuals were organized. If a shelter resident tested positive, that shelter was placed in quarantine, and new referrals stopped for 14 days. Temperature and symptom check frequency increased to daily for 14 days. If a patient was positive for fever or symptoms, they were transferred to the quarantine center for testing and isolation.ResultsOver 23,000 temperature and symptom checks occurred in 24 shelters across Detroit since February 22. This identified 15 patients who were referred to the quarantine site. From April 11 to May 31, 721 residents from 13 homeless shelters were screened with universal testing for COVID-19, and 93 (12.9%) tested positive (Figure 1). Of 95 homeless residents who were referred through shelter surveillance, from the local hospital system and via unsheltered street outreach, and tested on-site at the quarantine and isolation shelter, 29 (31%) tested positive for COVID-19, and 66 (69%) tested negative.Figure 1. System-wide homeless shelter testing of COVID-19 ConclusionHomeless populations across the US are especially vulnerable to COVID-19, with high risk for rapid spread due to crowding and difficulty with physical distancing. The need for increased testing- and prevention-based strategies in this population is crucial. The process performed in Detroit’s homeless shelters can be a model for other communities at risk for COVID-19 outbreaks.DisclosuresMarcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

Initial and Repeated Point Prevalence Surveys to Inform SARS-CoV-2 Infection Prevention in 26 Skilled Nursing Facilities - Detroit, Michigan, March-May 2020.

Skilled nursing facilities (SNFs) are focal points of the coronavirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19, among SNF residents and health care personnel have been described (1-3). Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 testing and implement infection prevention and control (IPC) activities in all Detroit-area SNFs. During March 7-May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7-April 7) and after two point prevalence surveys (April 8-25 and April 30-May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 transmission. With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs.

Making the invisible visible: the current face of tuberculosis in Detroit, Michigan, USA

ABSTRACT To describe the socioeconomic inequities among individuals with tuberculosis (TB) in metropolitan Detroit. We used data from the TB Social Survey to examine socioeconomic and demographic characteristics among individuals diagnosed with TB in one of three metropolitan Detroit health departments. We then examined mean levels of both economic disadvantage and socioeconomic instability across levels of race/ethnicity, nativity, and health department. Sixty-seven percent of individuals with TB in Detroit City were non-Hispanic Black, compared to 27% and 25% in Oakland County and Wayne County (excluding Detroit), respectively. Non-Hispanic Blacks, U.S.-born individuals, and those living in Detroit City had higher mean levels of both economic disadvantage and socioeconomic instability compared to non-Hispanic Whites, foreign-born individuals and those living in Wayne (excluding Detroit City) or Oakland County. The findings from this study highlight the ways in which TB is distributed along lines of socioeconomic disadvantage. This suggests that enduring inequities in socioeconomic resources may be contributing to inequities in TB disease, a trend that likely to continue with worsening socioeconomic disparities in the U.S.

Asthma as an outcome: Exploring multiple definitions of asthma across birth cohorts in the Environmental influences on Child Health Outcomes Children's Respiratory and Environmental Workgroup

Asthma definitions vary widely across research studies and feature a trade-off between inclusivity and precision. Harmonizing definitions across multiple asthma birth cohort studies highlights these challenges.

Achieving Sustainable, Community-Based Health in Detroit Through Adaptation of the UNSDGs

BackgroundIn 2012, the Rio+20 meeting initiated the concept of the Sustainable Development Goals (SDGs) as a continuation of the Millennium Development Goals. The resulting document “The Future We Want” is best conceived as a roadmap toward poverty eradication and sustainable development. Although the SDGs were developed for low- and middle-income countries, many of these same issues face low-resource cities and communities in higher-income countries. ObjectivesThe aim of this study was to use the SDGs as a platform to develop health-related goals for the city of Detroit. MethodsA 1-day workshop was convened in October 2015 including 55 representatives from government, academia, and community- and faith-based organizations. Four health-related SDGs were discussed: food security (SDG2); ensuring healthy lives at all ages (SDG3); access to potable water (SDG6); and making cities inclusive, safe, resilient, and sustainable living environments (SDG11). Workshop attendees broke into 4 groups to determine how the SDG targets for these 4 goals could be adapted for Detroit. At the end of the day, each group presented its decisions to the larger group. FindingsWorkshop participants expressed that the SDGs empower local communities to respond to their unique health challenges and to see themselves as part of a larger more global conversation about development and sustainability. Participants suggested that inclusive and participatory means of decision making were a significant component of the SDGs and that such a process is the direction needed to make community-focused changes in Detroit. Additionally, shortly after the workshop, a roundtable of participants representing 5 community partners began to meet monthly and has become an advocacy group for public health and addressing the city-order water shutoffs in neighborhoods throughout Detroit. ConclusionsFor participants and organizers, the workshop reinforced the hypothesis that the SDGs are relevant to Detroit and other low-resource cities in the United States.

Summit Conference Addresses MH Issues in Troubled City

Beset by economic distress, crime, and unemployment, Detroit residents will benefit from the commitment of several groups to enhance treatment access and mental health education and battle stigma.

Participatory Action Research and the Child Health Incubator Research Project: Expanding and Deepening the Learning Community for Children’s Health in Detroit

Participatory Action Research and the Child Health Incubator Research Project: Expanding and Deepening the Learning Community for Children’s Health in Detroit

Spatial Methods to Study Local Racial Residential Segregation and Infant Health in Detroit, Michigan

Over the last several decades, blacks in the United States have experienced substantial health disadvantages compared to other racial and ethnic groups. These disadvantages have been observed for important types of morbidity and early mortality, which public health interventions have achieved limited progress in improving. A promising new direction in health geographic research investigates the relationships among racial residential segregation, neighborhood socioeconomic inequality, and racial health disparities in urban areas of the United States. Historical evidence shows that as class isolation increases in racially segregated neighborhoods, poverty is concentrated, resulting in reduced opportunities and available and accessible amenities and resources, important factors in the promotion and maintenance of population health and well-being. Contemporary evidence shows that the ability to modify the structural constraints that create and exacerbate these unhealthy “place” environments are limited by social and public health policies. This study therefore explores modifiable pathways by which to inform social and public health policy to improve the health of black residents living in concentrated poverty. The historical context of racial residential segregation and neighborhood socioeconomic inequality in the United States is reviewed. A contemporary case study of racial disparities in low birth weight in the Detroit, Michigan, metropolitan area is also presented to demonstrate the persistence of racial health disparities. To address racial health disparities it is recommended that future health policy be linked to housing policy as a way to provide social mobility options for residents living in racially segregated, concentrated poverty neighborhoods.