This case study draws its key findings from the Michigan Coronavirus Racial Disparities Interim Report and other sources to explore Michigan’s approach, key features, results to date, and lessons learned.
The National Governors Association Center for Best Practices and Duke-Margolis Center for Health Policy, convene governor-appointed health equity COVID-19 task force leaders throughout the nation. This case study is part of a series that will feature innovative state practices to address health equity in COVID-19 response across the country
Introduction
The Michigan Coronavirus Racial Disparities Task Force has paved the way to address COVID-19 related health inequities in the state, resulting in the reduction of COVID-19 related cases and mortality among Black residents. As a result of the work, the average number of new cases for Black residents dropped from 176 per million population per day in March 2020 to 59 per million population per day in October 2020, and disparities in case rates among Hispanic or Latino Michiganders also narrowed.
Governor Gretchen Whitmer created the Michigan Task Force through Executive Order 2020-55 in April 2020 to reduce health disparities within communities disproportionately affected by COVID-19. The Michigan Task Force, which serves as an advisory body within Michigan’s Department of Health and Human Services (MDHHS), investigates the causes of COVID-19 related racial disparities and recommends actions to report and combat them. Chaired by Lieutenant Governor Garlin Gilchrist, the Michigan Task Force includes the Senior Advisor to the Governor, who serves as Director of the Task Force; the Director of MDHHS; the Chief Medical Executive; and 24 governor appointees. The Michigan Task Force has achieved positive results by investing in key strategies, which include establishing clear objectives with specific metrics, ensuring cross-sector collaboration and diversity within the task force, and allocating dedicated staffing and resources to implement recommendations focused on identifying
and addressing systemic inequities.
This case study draws its key findings from the Michigan Coronavirus Racial Disparities Interim Report and other sources to explore Michigan’s approach, key features, results to date, and lessons learned.
Key Takeaways
Michigan identified the following actions as critical to addressing inequities in communities of color:
- Establishing clear objectives with specific metrics to assess progress helps with designing and implementing targeted and effective interventions.
- Ensuring cross-sectoral collaboration and diversity within the task force helps with designing effective interventions and facilitates community engagement.
- Enabling leadership and state leaders who are committed to work and provide the right mix of expertise to minimize staff fatigue and stress.
- Developing a sustainable infrastructure is essential to maintain momentum beyond the pandemic to address inequities in health care, service delivery and outcomes.
Approach
The Michigan Task Force has focused on two main goals – saving lives through real-time action and proposing solutions to address systemic contributors to racial disparities in health. To achieve its goals, the Michigan Task Force has established workgroups to address five primary focus areas, including: 1) supporting testing infrastructure, 2) facilitating primary care provider connections, 3) centering equity, 4) increasing telehealth access and 5) addressing environmental issues. Despite persisting disparities, the Michigan Task Force aims to sustain progress by continuing to address the immediate needs of racial and ethnic minority groups disproportionately affected by the pandemic and proposing long-term solutions for lasting structural change.
Key Features
LEADERSHIP: In addition to a clear commitment from Governor Whitmer to decrease racial disparities through the establishment of the Michigan Task Force, the Task Force’s success also results from its membership structure. The Michigan Task Force, which includes leaders representing the diverse geographic, racial, cultural, economic, gender and cross-sector composition of the state, draws from a variety of perspectives when recommending and implementing solutions to address disparities throughout the state of Michigan.
SUSTAINABILITY: The Michigan Task Force will end 90 days after the termination of the declared states of emergency and disaster, or at such other time as identified by the Governor. However, Governor Whitmer has institutionalized two units under this administration – the Black Leadership Advisory Council and the Michigan Poverty Task Force – that will continue to address underlying inequities throughout the state after the Michigan Task Force is terminated.
SHORT-TERM AND LONG-TERM PARTNERSHIPS: The Michigan Task Force has designed action steps to achieve clear and measurable objectives and established partnerships with industry organizations (e.g., Ford Motor Company), civil rights organizations (e.g., National Association for the Advancement of Colored People) and community-based and faith-based organizations. The Michigan Task Force has also systematically engaged in community-focused outreach to ensure they both understand and respond to community concerns.
RESOURCES AND TOOLS: The Michigan Task Force has advanced efforts to address COVID-related disparities through financial and non-financial resources. It sustains operations through funding provided by the Federal Emergency Management Agency and the Coronavirus Aid, Relief, and Economic Security Act, including $20 million in federal funds that were invested in the Rapid Response Initiative. The Michigan Task Force is also responsible for identifying additional funding for combatting racial disparities across the state.
Key non-financial resources include staffing, strong leadership and innovative tools. By being housed in MDHHS, the Task Force has additional capacity to facilitate planning and implementation. Having adequate capacity is also key to minimizing staff fatigue nd stress. With strong gubernatorial support, some of the Michigan Task Force’s recommendations have been institutionalized through Executive Directives. This includes recommendations to declare racism a public health crisis and require implicit bias training for all state employees, both of which were outlined within Executive Directive 2020-09. Furthermore, the Michigan Task Force uses innovative tools such as an equity impact assessment tool and a data dashboard to collect and report data on COVID-related racial disparities and progress toward reducing them.
Results To Date
The Michigan Task Force has made substantial progress in addressing COVID-19 disparities and making lasting structural change. As shown in the figure below, the rolling 7-day average of daily new confirmed and probable COVID-19 cases and deaths per million population decreased significantly across racial groups from March 2020 to October 2020. The Michigan Task Force and Governor contributed to such reductions in health inequities by:
• Distributing six million free masks through the MI Mask Aid Initiative
• Administering more than 24,000 free COVID-19 tests in previously underserved communities across 21 neighborhood testing sites by establishing mobile testing infrastructure, drive-thru and walk-up testing
• Declaring racism a public health crisis through Executive Directive 2020-09
• Requiring implicit bias training for all state employees
• Increasing compliance with public health recommendations within Black communities, which may be attributed to targeted media campaigns for those communities
• Improving the quality of data reporting on racial disparities
• Funding 30 community organizations through the Rapid Response Initiative to address community needs associated with the disparate impacts the virus has had on communities of color
• Responding to social determinants of health by providing resources to quarantined individuals (e.g., food boxes, hygiene products, etc.), reducing housing insecurity through the Eviction Diversion Program, and expanding eligibility for Supplemental Nutrition Assistance Program benefits for residents formerly convicted of drug felonies
Conclusion
Strong leadership, sustainable infrastructure, accurate data and targeted strategies are key to addressing racial disparities and inequities during COVID-19 and beyond. This case study includes lessons that can be applied in states and territories across the nation to address this longstanding and difficult challenge. Implementing sustainable initiatives to address racial disparities and inequities will be critical to continued progress in the months and years ahead.
Authors
Duke-Margolis Center For Health Policy
- Yolande Pokam Tchuisseu
- Andrea Thoumi
- Hemi Tewarson
National Governors Association Center For Best Practices
- Lauren Block
- Sweta Haldar
Acknowledgements
The National Governors Association Center for Best Practices and Duke-Margolis Center for Health Policy would like to thank the state officials in Michigan who contributed their expertise towards development of this case study and the Robert Wood Johnson Foundation (RWJF) for their generous support of this project. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of RWJF.
