Community Needs Assessment Project

Chronic Diseases Risk Factors in Ypsilanti, MI

Wen Zhou

Supervised by

Dr. Suzanne Cole

November 13th , 2017

Background

Chronic diseases and conditions—such as cardiovascular disease, arthritis, diabetes, asthma,

cancer and chronic obstructive pulmonary disease (COPD)—are an increasing concern in the
United states. As of 2012, about half of all adults (117 million people) had one or more
chronic health conditions. One in four adults had two or more chronic health conditions.1 In
the low- and low-to-mid-income groups, the prevalence of chronic disease was even higher.2

At individual level, these diseases lead to impaired physical functions, mental depression and
shorter survival.3,4 According to CDC, 7 of the top 10 causes of death in 2014 were chronic
diseases. Two of these chronic diseases—heart disease and cancer—together accounted for
nearly 46% of all deaths. 5 Apart from personal suffering, chronic diseases are also a
significant burden to the economy. More than 68% of the $2.7 trillion spent annually in US
medical care are due to chronic conditions6; In addition to direct costs in health care, chronic
diseases also results in indirect costs due to limitations in daily activities, loss in productivity
and loss of days of work .

Like the rest of the country, the rate of chronic diseases in Washtenaw county is also high.
Among all cities and townships, residents of Ypsilanti, a small urban community of about
four square miles and 21,018 residents located in southeast Michigan, have a higher rate of
heart diseases, diabetes and cancer than county residents overall.7 Ypsilanti is the most
densely populated area of African Americans in Washtenaw county with 30%
Afro-descendant residents, and they accounts for approximately 40% of the total African
Americans in the county. 8 Washtenaw County Community Health data(HIP) shows that
blacks or African Americans have a higher cancer and heart disease mortality rate compared
to residents of other races.7 This partially explains the high rate of chronic disease in Ypsilanti
and shows the importance of further intervention in this area.

Understanding the major causes of chronic diseases is the first steps towards reducing chronic
diseases rate, and consequently reducing its social-economical effects. CDC reported that
much of the chronic disease burden is attributable to the four key risk factors5:

1. Physical inactivity. Physical inactivity results in overweight and obesity, which is a

contributing cause of heart disease, stroke, diabetes, and some types of cancer. Research
findings show that increased exercise can lower the risk of chronic diseases 9. However, more
than 80% of adults in the United States fail to meet the guidelines for physical activities.10
2. Poor nutrition. Sodium and saturated fat intake, vegetable and fruit consumption are the
major nutrition factors associated with chronic diseases. According to ODPHP, average fruit
and vegetables intakes is below recommendations while most Americans exceed the
recommendations for added sugars, saturated fats, and sodium.11
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3. Tobacco use. In the United States, smoking causes 33 percent of cancer deaths, 32 percent
of coronary heart disease deaths, and 79 percent of all cases of chronic obstructive pulmonary
disease (COPD).12
4. Alcohol abuse. Excessive drinking is associated with chronic diseases such as high blood
pressure, stroke, heart disease, and liver disease. It accounted for 1 in 10 deaths among
working-age adults in the United States from 2006 through 2010.13

Also note that among low income groups, poor access to medical care and lack of health
insurance are also contributing greatly to the growing chronic disease rate. Therefore, this
needs assessment would focus on these major risk factors of chronic diseases, to evaluate if
they are major contributors to chronic disease rate in Ypsilanti, to assess relevant programs
and services and to determine which factor(s) need to be further addressed. To conduct this
needs assessment, Ypsilanti residents, nutritionist, policy markers, local organizations should
be involved. A detailed list of stakeholders is shown below:

·Washtenaw County Board of Health

·Community leader of Ypsilanti and resident representatives
·Washtenaw County Parks and Recreation Commission
·Food Gathers and local farmer’s markets
·Healthy eating programs, e.g. Prescription for Health
·Tobacco prevention programs and alcohol rehabs

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Community Profile

Demographic & Economic Statistics

Population

Ypsilanti is a small urban community in southeast Washtenaw with a population of 19874 and
85.9% of the residents are adults (aged 18 or over). As shown in Figure1, Ypsilanti has a
much higher percentage of Black (i.e. African American ) residents compared to the
Washtenaw county (29.2% vs. 12.7%).

POPULATION DISTRIBUTION BY RACE

80 74.5
70 61.5
60
50
%

40
29.2
30
20 12.7
7.9 5.9 4.9
10 3.4
0
White Black Asian Others

Ypsilanti Washtenaw

Figure 1 (Adapted from U.S. Census Bureau, 2010 Demographic Profile; Include persons
report only one race. Data available at http://factfinder2.census.gov/)

Income

MEDIAN HOUSEHOLD INCOME

Ypsilanti, MI 31061

Washtenaw County, MI 61003

Michigan 49576

United States 53889

0 10000 20000 30000 40000 50000 60000 70000

Figure 2 (Adapted from U.S. Census Bureau, 2011-2015American Community Survey

5-Year Estimates; Data available at http://factfinder2.census.gov/)

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The median annual household income in Ypsilanti in comparison with that in it's parent
locations is shown in Figure 2. The community’s annual household income is lower than the
national average and is almost half of that in Washtenaw County. Having a low income level
puts residents at risk of poor physical and mental health , as a result it is closely associated
with chronic disease incidences.

Employment

As shown is Figure 3, Ypsilanti has a high unemployment rate compared with the Washtenaw
and Michigan. Among all races, black population has the highest unemployment rate.

UNEMP LOYMENT R ATE BY R AC E

Ypsilanti Washtenaw Michigan
25.7
UNEMPLOYMENT RATE (%)

20.7
15.1
12.4

9.8

8.1
7.7
7.4

6.2
5.5
6

2.5

OVERALL BLACK WHITE ASIAN

Figure 3 (Adapted from U.S. Census Bureau, 2015American Community Survey ; Data
available at http://factfinder2.census.gov/)

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Poverty

P OVERTY S TATUS IN THE PAS T 12

MONTHS BY R AC E
Ypsilanti Washtenaw Michigan

44.6
PERCENT BELOW POVERTY LEVEL

38.1
34.6
31.3

28.5

27.5

22.3
16.7
15.4

14.5
13.1
12
OVERALL BLACK WHITE ASIAN

Figure 4 (Adapted from U.S. Census Bureau, 2011-2015American Community Survey

5-Year Estimates; Data available at http://factfinder2.census.gov/)

Low annual income and high unemployment rate result in a high percentage of poverty in
Ypsilanti, with 44.6% of black residents and 27.5% white residents living under poverty level.
These higher rates compared to Washtenaw county and Michigan State, contribute to poor
nutrition and health care, leading to increasing chronic diseases among low-income groups in
Ypsilanti.

Vehicle Occupancy

Low income households are more disadvantaged than higher-income households in their
ability to travel because of fewer resources available for the purchase of a private vehicle and
for covering other costs such as insurance, parking, and fuel. And people without private
vehicle are seriously disadvantaged in their ability to reach grocery stores and health care,
contributing to the burden chronic disease, which will be discussed in the following sections.
Figure 5 shows the distribution of households without vehicles in Ypsilanti. This coincides
with the poverty distribution in this area14.

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Figure 5 (Adapted from “An Integrated Assessment of Transportaton to Healthy Food in
Eastern Washtenaw County”; Retrieved from http://graham.umich.edu/media/pubs/Food
TransportationReport.pdf)

Health Statistics

Prevalence of Chronic Diseases

With robust health promotion and intervention programs, death rates of all chronic diseases
except Chronic Obstructed Pulmonary Disease(COPD), diabetes and kidney diseases have
been decreasing significantly from 1989 to 201515. Yet they still place a heavy burden for
both individuals and government departments in Ypsilanti. We will evaluate several prevalent
chronic diseases in this section.

Heart disease is the leading cause of death in Ypsilanti16. High blood pressure contributes to
heart disease. According to 2015 HIP Survey17, 27.7% of Ypsilanti residents has ever been
told to have high blood pressure, this is higher than county average 22.4%. High risk groups
include African-Americans and low-income individuals. Distribution of reported high blood
pressure by race and income level are shown in Figure 6 and Figure 7.

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 EVER TOLD HAD HIGH BLOOD PRESSURE
Ypsilanti Adults
45
40
35
30
25
%

20 42
15 27.7
24.6
10
5
0
Overall Black White
Race

Figure 6 (Adapted from 2015 HIP Survey; Data available at https://healthsurveys.ewashte-

naw.org/#/)

EVER TOLD HAD HIGH BLOOD PRESSURE

Ypsilanti Adults

45
40
35 38.2
30
25
20 25.2
23.5
15 20.2
10
5
0
<$20000 $20000-$34999 $34999-$74999 >$74999

Figure 7 (Adapted from 2015 HIP Survey; Data available at https://healthsurveys.ewashte-

naw.org/#/)

Cancer is the second leading cause of death in Ypsilanti16. Although there is no available
community level data, the county data does suggest that African Americans are at higher risks
of cancer with a higher mortality rate (203 per 100,000) compared to residents of other races
in Washtenaw County (162 per 100,000 for whites; 113 per 100,000 for Hispanic or Latinos;
and 56 per 100,000 for Asians). These cancer mortality differences by race within the county
are mirrored in state and national averages as well18.

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Diabetes rate in Ypsilanti (11.0%) is higher than that in Washtenaw (8.1%) according to HIP.
Race has little influence on the morbidity rate while household income significantly affect the
incidence. As seen in Figure 8, the morbidity of the lowest-income groups is triple of that of
the highest-income group.

EVER TOLD DIABETUC BY HOUSEHOLD

INCOME
Ypsilanti Adults

25

20 21.4

15

10
10.1
5 7.5 6.8

0
<$20000 $20000-$34999 $34999-$74999 >$74999

Figure 8 (Adapted from 2015 HIP Survey; Data available at https://healthsurveys.ewashte-

naw.org/#/)

Obesity itself is a chronic condition and is also contributor to risks of other chronic disease
including diabetes and heart diseases. As of 2015, nearly 62% of adults in Ypsilanti reported
being overweight or obese. African Americans of Ypsilanti are heavier than County residents
overall with 69.6% overweight or obese. Also, they are the only subgroup in the county that
has higher obese rate (41.1%) than overweight rate (28.2%). 17

Death rate by race and poverty status

Table 1 Age-adjusted death rate by race1

Ypsilanti City, Washtenaw County

Location Death Rate

All races White Black

Ypsilanti 861.2 872.0 870.8

Washtenaw 605.8 596.2 857.1

(Adapted from community health information, Michigan Health Statistics; Data available at
https://www.mdch.state.mi.us/osr/index.asp?Id=4)
1
Age-adjusted death rates are based on age-specific death rates per 100,000 population in specified group.

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 Table 2 Age-adjusted death rate by poverty level2
Washtenaw County, Michigan 2014

Person Died in Census Tract with poverty level

Total 0.0-4.9 5.0-9.9 10.0-19.9 20.0-100.0

633.3 581.1 628.3 661.3 752.3

(Adapted from community health information, Michigan Health Statistics; Data available at
https://www.mdch.state.mi.us/osr/index.asp?Id=4)

Chronic diseases is disproportionately distributed by race and poverty status, resulting

differences of death rates. As shown in Table 1, Table 2, poverty status tends to have a greater
influence than race.

Medical care and health insurance coverage

Medical care and health insurance coverage plays and important role in prevention, early
detection and treatment of chronic disease. However, 13.3% people in Ypsilanti do no have
health insurance coverage, compared with 6.2% in Washtenaw and 9.6% across Michigan.
White people in the community have lowest coverage rate19.
12.8% residents reported that there were some time during past 12 months when they could
not afford needed prescription medicine. 19.8% of residents reported having not sought
needed medical care with African American having the highest rate of 22.5%. The major
barrier reported by African American residents is associated with transportation while white
people are more concerned with insurance and cost.20

Nutrition and Physical Activity Assessment

As discussed in the background section, poor diet, lack of exercise, tobacco and alcohol use
contribute to chronic disease risks.

Physical Activity

More than 50% adults in Washtenaw County fail to meet the physical activity
recommendation of at least 150 minutes moderate-intensity aerobic physical activity a week.
Among them, the physical exercise participation rate is even lower in Ypsilanti (71.7%) than

2
Census tract population poverty was estimated using methods recommended from the Public Health
Disparities Geocoding Project.

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in the County overall(76.8%) 21 . This is partially due to the limited access to indoor
recreational facilities in this area. There is currently no public or non-profit recreational
facility operating in the city. In a phone survey of 600 residents of Ypsilanti, 7% indicated
interest in the building of a full recreational facility. 22

Alcohol and tobacco

Smoking is linked to cancer and cardiovascular diseases. According to HIP survey data,
Ypsilanti has the largest proportion of smokers across the county. Among all the race groups,
African Americans have the highest percent of active smokers (28%). On contrary, Ypsilanti
residents have a lower drinking rate compared with other parts of the county. 23

Dietary intakes

According to HIP, Ypsilanti residents eat fewer fruit and vegetable servings and more fast
food than their county counterparts: 40.2% residents in Ypsilanti consumed fruit less than one
time a day; the data for vegetable is 26.9%. African Americans in Ypsilanti experience most
difficulty of fruit and vegetables consumption among all race groups due to limitation by
distance to full service grocery store.
In contrast, 56% of residents report eating fast food once or more per week. This is higher
than other areas (42% in Ann Arbor, 29% in Western Washtenaw County). Blacks or African
Americans were also more likely to report eating fast food once or more per week as were
those with low incomes. Fast food cost less and are more readily accessible: an estimated rate
of 73 fast food restaurants per 100,000 residents are located in Washtenaw County, which is a
slightly higher rate than the state (65 per 100,000) or the nation (70 per 100,000).24

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Healthy Food Availability25

Figure 9 Price and Location of Major Grocery Stores. (Adapted from “An Integrated
Assessment of Transportaton to Healthy Food in Eastern Washtenaw County”; Retrieved
from http://graham.umich.edu/media/pubs/Food TransportationReport.pdf)

A wide range of food is available in close proximity to eastern Washtenaw County, where
Ypsilanti is located. 190 stores is identified with varying food offerings within five-mile
range of Ypsilanti area, including 11 major grocery stores as shown in Figure 9. Although
most of them are on the bus lines, they are not within 20-minute bus ride of the residence
areas and they lack connections between each other, making it difficult if people want to
travel multiple destinations to get a wide range of food and save money. Considering the fact
that many people in this area lack private vehicle, chances are they shop for supplies every
two weeks or every month. This infrequent shopping requires buying large quantities of food
suggesting a relatively low amount of perishable fruit and vegetables.

Also, we have to note that despite a wide array of food offerings in close proximity, there are
still several pockets of territory where some people experience difficulty in traveling to food
stores by both automobile and public transit.

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Community Assets and Resources

Community Services and Programs

From the previous discussion, we can concluded that access to healthy food and medical care
is crucial yet lacking for low-income and African American residents in Ypsilanti. Therefore
in this section we will focus particularly on community resources addressing these issues.

The Supplemental Nutrition Assistance Program (SNAP).

SNAP benefits can be used to purchase any approved food item for human consumption and
seeds and plants that produce food. Clients receive their benefits via an Electronic Benefits
Transfer (EBT) system. Kroger, Walmart, Target, Meijer, and 18 out 25 smaller grocery stores
and ethnic food stores in eastern Washtenaw accept EBT.14

Double Up Food Bucks

Double Up Food Bucks program doubles the value of federal nutrition (SNAP) benefits spent
at participating markets and grocery stores, helping people obtain more healthy fruits and
vegetables.26 There are four participating sites in Ypsilanti.

Healthy Food Distribution at Washtenaw County Public Health

Washtenaw County Public Health and Food Gatherers offer food distribution to individuals
and families with lower incomes. Nutrition education is also available to help individuals and
families choose, prepare and eat healthy foods.

Prescription for Health (PFH)27

Prescription for Health Program connects patients with lower incomes to their local farmers
market through their medical clinic. Health care providers write “prescriptions” for their

patients to eat more fruits and vegetables. Participants receive up to $100 in tokens to

spend on fresh fruits and vegetables at participating farmers markets, as well as nutrition
education and support. The biggest beneficiary of PFS is Ypsilanti residents with a total of
$14,172 gained and spent at Growing Hope’s Ypsilanti Farmers Markets. 35% of program
participants are African American; 57% had a yearly income of less than $15,000. Participant
consumption of fruits and vegetables increased by over a half cup per day from pre- to
post-program. Participants also reported a decrease in consumption of unhealthy foods.

Project FRESH

The Senior Farmers Market Nutrition Program, known as Senior Project FRESH/Market
FRESH in Michigan, provides older adults who qualify with unprocessed, Michigan-grown
products from authorized farmers markets and roadside stands throughout Michigan.
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Other Community assets and resources

Downtown Ypsilanti Farmers’ Market

Downtown Ypsilanti Farmers’ Market is a important community assets as a health food

source and place to implement SNAP, Prescription for Health and Project FRESH. It aims to
serve low-income neighborhoods as well as the broader community. Cooking demonstrations
and food sampling, recipe cards, and nutrition information are also offered on site.

AATA Senior Ride: Ann Arbor, MI (cover Ypsilanti)

The Ann Arbor Transportation Authority (AATA) offers a service called Senior Ride, which
takes seniors living in six senior citizen housing complexes to two local grocery stores for a
fare of $0.75 each way.

Recommendation for Priorities

This needs assessment investigate prevalence of chronic diseases in Ypsilanti, at risk

population groups, key risk factors and existing community promotion and intervention
programs. Key observations include:

1. Prevalence of chronic diseases and death rates is relatively higher among African
American and low-income residents in Ypsilanti.

2. Low fruit /vegetable consumption and high fast food intake is the major cause of chronic
diseases in Ypsilanti. Also, smoking in African American groups is also an important risk
factor.

3. Restricted access to health food is due to low occupancy of private vehicle and
inconvenience of public transportation.

4. There are several existing programs addressing healthy food consumption.

Based on the results, priorities should be given to as-risk groups: African American and
low-income residents. Evaluation of whether they are covered under existing programs and
the effect should be conducted. Also, community with little access to public transportation
should be paid more attention to.

Reference

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quickfacts/fact/table/ypsilanticitymichigan#viewtop . Accessed October 2, 2017.
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14 Larissa Larsen and Joe Grengs. An Integrated Assessment of Transportation to Healthy
Food in Eastern Washtenaw County. Accessed from
http://graham.umich.edu/media/pubs/Food-
TransportationReport.pdf.
15 Michigan Department of Health and Human Services. Mortality Trends 1980-2015.
Accessed from https://www.mdch.state.mi.us/osr/CHI/CRI/frame.asp

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16 Michigan Department of Health and Human Services. Number of Deaths and
Age-adjusted Mortality Rates for the Ten Leading Causes of Death, Ypsilanti City .
https://www.mdch.state.mi.us/osr/chi/Deaths/leadUS/LeadingUSObject2.asp?AreaCode=172
4&AreaType=M&JS=No
17 HIP Survey, 2015.
18 Centers for Disease Control and Prevention, National Center for Health Statistics,
Underlying Cause of Death, 2006-2010. Accessed from www.chna.org
19 U.S. Census Bureau, 2015American Community Survey ; Data available at
http://factfinder2.census.gov/
20 HIP Survey, 2015.
21 HIP Survey, 2015.
22 Opportunities for a New Eastern Washtenaw YMCA Recreation Center, 2013.
23 HIP Survey, 2015.
24 Michigan Department of Community Health, Behavioral Health and Developmental
Disabilities Administration, Bureau of Substance Abuse & Addiction Services, Report for
Fiscal Year 2012, Prevention - Youth Tobacco Sales Rates, Synar, Washtenaw. Accessed from:
http://www.michigan.gov/mdch/0,4612,7-132-2941_4871_45835_48569-15628--,00.html.
25 Larissa Larsen and Joe Grengs. An Integrated Assessment of Transportation to Healthy
Food in Eastern Washtenaw County. Accessed from
http://graham.umich.edu/media/pubs/Food-
TransportationReport.pdf.
26 Double up food bucks offical websites. http://www.doubleupfoodbucks.org/
27 Prescription for Health. 2016 PHS outcome report. Accessed from
http://www.ewashtenaw.org/government/departments/public_health/health-promotion/prescri
ption-for-health/2016-prescription-for-health-outcome-report-1

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