In a Place “Where Everyone Thrives,” an Unrecognized Health Disparity

Midland County is ranked eighth for health outcomes among the 83 counties in Michigan. (Photo credit: Ron Beacom)

Everything looks perfect in Midland, Michigan. The farmers’ market is packed with fresh produce, locally crafted goods, and smiling, bustling customers. Local artists are asked to paint buildings in vibrant murals. In the summer, miles of marigolds line Eastman Avenue. Down by the Tridge (a nickname for a three-legged wooden footbridge), local musicians jam out for their audience, who relax in the grass at the confluence of the Chippewa and Tittabawassee Rivers.

Infographic by Kylia Ahuna.

Midland County feels like any normal place in the Midwest. The median income is even on par with the national average of $62,000. The Midland Area Community Foundation’s vision statement is, “Together. Forward. Bold. An exceptional place where everyone thrives.” For the most part, it’s true. Midland County is ranked eighth for health outcomes among the 83 counties in Michigan. But not everyone is thriving.

Behind this healthy façade is a disparity. Hispanic or Latino residents account for a disproportionate share of preventable hospitalizations, according to the County Health Rankings and Roadmaps program, a data project conducted by the University of Wisconsin Population Health Institute. These are hospitalizations resulting from chronic health conditions such as diabetes, chronic obstructive pulmonary disease (COPD), hypertension, heart failure, and so on. In 2020, Hispanic Medicare enrollees in Midland County were 1.6 times more likely than white non-Hispanic enrollees to be hospitalized for a preventable condition.

Why this disparity exists is unclear, but one explanation is limited access to health care. It’s challenging to pinpoint causality because this population remains hidden in Midland County.

Midland County is 91 percent white. According to the County Health Rankings’ 2020 demographics, 7,070 of 83,200 people in the county identify as anything other than just white. About one-third of those people identify as Hispanic or Latino. Even so, researchers and health care providers say they rarely see these groups in their studies and outreach efforts.

Meghan Baruth, a researcher from Saginaw Valley State University, led community health needs assessments for Midland County in 2015 and 2019. Baruth’s team sought to investigate racial health disparities. Because the number of non-white respondents was so low, however, she could not draw sound conclusions about any specific race or ethnicity. And so the results of the needs assessment were simply divided into “white” and “non-white.”

The West Midland Family Center is located on M-20, a local highway. Many low-income homes are nearby. (Photo courtesy: WMFC)

Dr. Paula Klose, community assistant dean at the Michigan State University College of Human Medicine, Midland Campus maintains that access is a larger issue. Where health disparities are concerned, she says, “I think in terms of Midland County, our biggest problem is really the uninsured and underinsured, and access—transportation.”

Besides the city of Midland, the rest of the county is rural. A 26-mile stretch of highway, M-20, connects the city of Midland with Mt. Pleasant, a city in Isabella County. Transportation to a city for preventive care can be costly and therefore deprioritized, and some families may only have one vehicle per household or none at all.

The West Midland Family Center (WMFC) is situated on M-20, alongside a small community of mobile homes and houses. WMFC is a nonprofit providing services such as childcare, food, and even rent and utility assistance for rural communities in the county.

“West Midland Family Center has developed this relationship with that community and is getting people to come there,” Klose says, “but most of them do not have a primary care physician, do not get immunized.”

“If you were not raised in a family where you go to a doctor without cause, it’s a language you don’t have,” says Sheleigh Nicolai, transportation supervisor and family liaison at WMFC. Going to the doctor “without cause” means going for preventive care visits. Nicolai supports families at the doctor’s office, reading forms—some parents are illiterate—and explaining why health care providers need the information.

Another barrier to care is distrust.

“It’s amazing how much lack of trust they have as an adult,” says Nicolai. Initially, families see WMFC as an agency like Child Protective Services and worry their children will be taken away, according to Nicolai. They come in and say, “’I don’t want to be judged.’”

WMFC holds food distribution events monthly. An average event sees about 225 vehicles, each receiving about 100 pounds of food. (Photo credit: Ron Beacom)

This lack of trust spurs another challenge: how can you get representative data if those who need the most help won’t fill out surveys?  Without representative data, it’s nearly impossible to identify health disparities, let alone solve them. In Midland County, do the disparities break down by income, race or ethnicity, or a combination of factors?

“We still don’t know if we really reached most in need,” says Baruth, the researcher who conducted the community health needs assessment. “We didn’t want to go knocking on doors. We tried to work with the community centers, churches, different organizations who might be able to get in contact with them. But it was hard.”

There is one new health initiative working to reach more people and provide care. In February 2021, mobile medical units began traveling to churches, community mental health offices, and nonprofits similar to WMFC: the North Midland Family Center and the Greater Coleman Family Center. The undertaking is hosted by Mid-State Network and Recovery Pathways. These units provide primary and dental care, substance abuse support, and mental health services on site. 

It’s still too early to tell if the program will create sustainable change, but there’s hope that bringing care to those who need it most will help. Without representative data, however, public health disparities in Midland County’s rural areas will continue to remain hidden and unsolved.