A group of about 50 Ann Arbor residents gathered at the Ann Arbor District Library to participate in the first forum of the Sustainable Ann Arbor 2019 series. The evening was engineered to address issues of health inequity among the U.S. population, particularly how minorities and undocumented immigrants suffer from lack of health care attention. The moderator of the event, Ann Arbor Sustainability and Innovations Manager Missy Stults, began the night with an interactive quiz regarding inequality statistics in America.

Ellen Rabinowitz, a health officer of Washtenaw County Health Department, began the first of three panelist presentations by focusing on the social determinants of health. She covered three main concepts: assurance, assessment and policy development. Part of her initiative was to change the way these topics are talked about. Rabinowitz repeatedly emphasized how public health must focus on the social climate of an individual as well. She mentioned that by researching a variety of topics, more evidence could be found that one’s health is influenced by more than just a handful of factors.

“We worked on a report called Reducing Youth Arrests Keeps Kids healthy and Successful,” Rabinowitz said. “Not necessarily something you think a health department would be involved in, but we’re really concerned about it and now we’re looking at what other communities have done.”

Felicia Brabec, licensed psychologist and social worker, continued Rabinowitz’s theme of social determinants affecting one’s health and included how race is often tied in with determining one’s health situation. She explained how her offices have taken a new approach to combating health inequality.

“We are operating under something called ‘targeted universalism which means that we are choosing to really focus on race and how it’s shared some of those determinants that we’ve heard about based on race,” Brabec said. “And what targeted universalism says is ‘Hey, we’re going to start with this sliver, we’re going to start with race, understanding that intersectionality is really important and part of all this and we’re not doing that to the detriment of these other intersectionalities, but this is where we’re starting.’”

She continued her presentation by informing the audience on how racism is institutional, individual and structural. She then brought the complexity of racism back to a local scale by citing an example of redlining in Kerrytown a few years ago. Redlining is the denial of a home in certain neighborhoods based on someone being deemed a “financial risk” because of their race. Brabec also supplied the statistic of Washtenaw County falling to the bottom 8 percent in the U.S. for upward income mobility.

The final panelist, Paul Fleming, assistant professor of health behavior and health education at the University, wrapped up the presentations by discussing what he deemed “the chilling effect” the 2016 election had on undocumented immigrants attending health care professional’s visits. After intensive research at several different health care institutions, Fleming and his team found a reason why immigrants skipped out on appointments was an increase and pervasive fear of deportations. The fear has resulted in fractures and strategic behavioral changes. One example Fleming mentioned of behavioral changes was when an elderly woman refused to leave her house because her grandson mentioned a U.S. Immigration and Customs Enforcement raid had happened not too far from her house. He also revealed this incident was not isolated, and that at every site they researched this theme was present.

“When folks hear about an immigration arrest happening, then they go into lockdown mode and try not to be visible,” Fleming said.

He said this can cause people to skip out on getting their medications for extended periods of time.

During the discussion, new Ann Arbor resident Anand Bhat, a physician, raised the question of how city residents must struggle with promoting equity in Ann Arbor when the primary focus of the city seems to be on university students rather than local residents.

“How would you empower people when the primary institution of this area is a university?” Bhat said. “And it’s not just the University of Michigan, it’s happening all over the country, which is a corporatizing university, which is there to serve the rich internationally or nationally, rather than local people?”

The question was met with applause as panelists agreed this question may not have been the focus of their research, but was an important topic that needed to be addressed.

The forum helped residents learn not only more about health inequity but also how creating a welcoming space and adapt to the needs of others, especially immigrants, can be done by any citizen. Ann Arbor resident Heather Gill added the presentations made helping more accessible.

“It’s one thing to see it on social media, but another thing when it’s like this is what you actually can do about it in your life,” Gill said.

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