COVID-19 has laid bare all of the systemic health inequities across the country, but also very specifically in Detroit.

Local public health systems including governmental health departments and health care providers are key to building public trust on an every day basis. In places where the local public health system has broken down, it is no surprise to see low levels of trust and low rates of vaccine uptake.

Detroit is likely an extreme example where the city’s largest health system almost shuttered its doors in the early 2000s before getting a monetary grant from the State government. Detroit has operated its own city health department on par with a county government since the 1970s, but decided to push provision of health services to an unproven non-profit in 2012 after a series of federal investigations that began in 2010.

The current health department was only just relaunched in 2015 and at best could be described as a “startup.” Detroit’s other hurdle is that roughly 70% of the population lives in a medically underserved area and almost 20% haven’t seen a doctor in over a year (MiBRFSS 2017-2019). COVID-19 vaccination rates remain low in Detroit at around 30%, however mass vaccination sites, mobile health vans, and tent style health clinics are not an ideal entry point to build trust in a local public health system that hasn’t been there for residents in over a decade. The issue in Detroit is not vaccine hesitancy, but the absence of a local public health system that will serve people well on a regular basis.