Priority areas

1. Behavioral health and substance use

Behavioral health includes mental health and substance use disorders. These issues were a clear priority in the community: 60% of 2022 Community Survey respondents identified mental health disorders as their top priority. Three of the top six issues identified—opioid and narcotic misuse, alcohol misuse, and suicides—are directly related to substance use.

Around 17% of people in Macomb County reported poor mental health for at least 14 days in the past month, which is slightly more than the state average. Additionally, 19% of people in Macomb County have been told that they have a depressive disorder. Unfortunately, many individuals with mental health issues resort to suicide or substance use as ways to cope. Suicide and alcohol-related mortality rates in the County are consistent with state and national averages. However, Macomb County has higher rates of overdose deaths and non-fatal drug and opioid overdoses. 

Goal: Enhance the overall well-being and mental health of Macomb County community members by increasing awareness and accessibility of public health behavioral services.

Objective 1: Increase awareness of available behavioral health services in Macomb residents.

• Strategy 1: By December 31, 2024, review, revise and publish behavioral health services map (BHSM).
• Strategy 2: Promote and advertise BHSM through social media and marketing campaigns by December 31, 2025.
• Strategy 3: Evaluate and report on BHSM and marketing campaigns by December 31, 2026.

Objective 2: By December 31, 2028, create and implement five awareness campaigns and conduct three awareness seminars in underserved communities.

• Strategy 1: Work with community partners to identify, promote or create peer-to-peer support groups by December 31, 2026.
• Strategy 2: Conduct mental health and substance use campaigns on social media by December 31, 2024, and annually thereafter.
• Strategy 3: Partner with community agencies providing meals to seniors to provide mental health and substance use education by December 31, 2026.

Objective 3: By December 31, 2026, expand suicide prevention and mental health intervention programs offered in Spanish and Arabic.

• Strategy 1: Translate available mental health materials to Spanish and Arabic by December 31, 2024.
• Strategy 2: Evaluate and determine additional languages for translation of materials by December 31, 2026.
• Strategy 3: Support and implement suicide and mental health intervention programs with community partners into multiple languages.

2. Social determinants and built environment

According to the CDC, Social Determinants of Health (SDOH) are the "nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life." 

The 2022 Community Survey identified affordable housing and access to healthy food as priority SDOH for Macomb County, especially among vulnerable communities. One third of respondents said access to affordable housing would improve quality of life. This was 10-20% greater for persons of color, identifying as LGBTQ+, living in poverty or with a high school education or less. Nearly 50% of residents who live in rental housing reported that their housing costs exceed 30% of their monthly income.

Macomb County also has fewer grocery stores and supermarkets compared to state and national averages. 25% of Macomb County residents reported struggles accessing healthy food, with higher rates reported by persons of color, identifying as LGBTQ+, living in poverty or with a high school education or less.

Goal 1: Increase equitable access to healthy food options in the underserved populations of Macomb County.

Objective 1: By December 31, 2028, increase the food environment index from 7.5 to 8.0.

• Strategy 1: Advocate for the continuation of the Universal School Meals program by December 31, 2024.
• Strategy 2: Implement evidence-based nutrition programs in Macomb County with emphasis on underserved or marginalized populations.
• Strategy 3: Increase the number of farmers markets that accept SNAP/EBT, WIC Project Fresh, Double up Food Bucks and/or Senior Project Fresh.

Goal 2: Increase access to safe, affordable and equitable housing in Macomb County.

Objective 1: Decrease the percentage of renters spending 30% or more of their income on housing from 48.2% to 45.0% by December 31, 2028.

• Strategy 1: Support grant writing efforts to seek funding for Macomb County agencies to increase financial literacy education.
• Strategy 2: Facilitate a community-led sharing of housing resources and opportunities among underserved populations.
• Strategy 3: Work with coalition partners to support aging in place policies and programming for Macomb County seniors.

3. Chronic disease and healthy lifestyle

The CDC defines chronic diseases as conditions that last one year or more and require ongoing medical attention, limit activities of daily living, or both. Over 80% of healthcare costs are attributed to chronic disease management. Chronic diseases such as cancer, heart disease and diabetes are the leading causes of death and disability in the County. Cancer and obesity were the leading health concerns for Macomb County residents, regardless of income, race, gender or community of residence.

To reduce the burden of chronic diseases in Macomb County, significant investments to promote healthy lifestyle behaviors are needed. Healthy lifestyle behaviors, including a balanced diet, regular exercise, consistent sleep, preventative screenings, avoiding tobacco and alcohol use and managing stress can both prevent and help manage chronic diseases. 25% of Macomb County residents report difficulty accessing healthy food, and 90% reported no leisure time activity in the last 13 days. 2022 Community Survey respondents identified access to healthy food and parks and recreation as top factors to improve their quality of life.

Goal 1: Reduce the prevalence of chronic diseases by promoting healthier lives through targeted interventions, prevention culture and resource support.

Objective 1: Increase awareness of and access to preventative screenings (diabetes, hypertension and cholesterol) by December 31, 2026.

• Strategy 1: Leverage local trusted people and places to expand screenings for chronic disease to diverse populations through methods, languages and champions.
• Strategy 2: Promote health screenings by creating culturally competent social and multimedia campaigns.
• Strategy 3: Collaborate with community partners to offer health screenings to diverse and vulnerable populations.

Objective 2: By December 31, 2028, ensure that at least 50% of Macomb County adults reached through community-based chronic disease screening efforts in diverse and vulnerable populations are recommended to a health care provider.

• Strategy 1: Conduct a comprehensive health care access assessment including primary care and behavioral health services.
• Strategy 2: Partner with Federally Qualified Health Centers and community partners to create workshops centered on prevention of chronic disease.

Objective 3: Reduce the proportion of Macomb County adults who engage in no leisure time physical activity from 23% to 20% by December 31, 2028.

• Strategy 1: Provide evidence-based programs to underserved and marginalized populations (Strong People Strong Hearts, Matter of Balance, Diabetes Prevention).
• Strategy 2: Work with parks and recreation programs to update and disseminate a resource identifying low-cost physical activity opportunities for all fitness levels, ages and abilities.
• Strategy 3: Advocate for passive recreation, Park Rx and trail expansion policies.

1. Chronic disease and healthy lifestyle

A decrease in chronic disease and an increase in healthy lifestyle behaviors is essential to a healthy community. Chronic disease and a healthy lifestyle can often be viewed as having an inverse relationship and the rise of healthy lifestyle education and application within a community could result in a decrease of chronic disease (obesity, diabetes, heart disease and cancer).  Results from the Community Health Survey demonstrated that chronic disease continues to be a top priority amongst survey respondents.  Results from the CHA also indicated a need for improvement when compared to the state and national benchmarks in chronic diseases and healthy behaviors.  Both Macomb County residents and supporting data confirm that chronic disease and a healthy lifestyle continue to be a major health concern for Macomb County.

GOAL: Promote health and reduce chronic disease risk in Macomb County

• Objective 1: By 2021 reduce the proportion of Macomb County adults who engage in no leisure-time physical activity from 30 percent to 25 percent.
• Objective 2: By 2021 reduce the proportion of adults who are considered obese/overweight based on BMI from 33.1 percent to 30 percent.

2. Behavioral health

Behavioral health is often used as an umbrella term, and refers to mental, behavioral or addictive disorders.  It includes not only promotion of well-being, but also includes prevention and intervention in substance abuse or other addictions. When asked to identify health concerns other than chronic disease, survey respondents identified mental health as a priority (53.2 percent).  When combined with drug/substance abuse, the behavioral health priority area was deemed absolutely essential to creating a healthier community. By educating community partners on early identification of behavioral health conditions, increasing awareness of public health behavioral services and decreasing the number of tobacco-using Macomb County residents, behavioral health improvement will be brought to the forefront of health priority in Macomb County.

GOAL: Improve behavioral health for all residents by expanding access to prevention, intervention and treatment services.

• Objective 1: Increase early identification of behavioral health risk factors by 2021.
• Objective 2: Increase awareness of public health behavioral services by 2021.
• Objective 3: By 2021 decrease the percentage of Macomb County residents who use tobacco from 21.4 percent to 18 percent.

3. Access to services

Access to many different health-related services was a prominent and recurring theme during completion of the Community Health Assessment, specifically throughout the Community Themes and Strengths Assessment (CTSA) and the Forces of Change Assessment (FoCA).  Increased access to affordable healthy food, access to housing, access to health care, and access to more jobs were selected as priority areas that would increase the quality of life for residents, as well as improve overall health for Macomb County.  Utilizing results obtained from the CTSA team and completed surveys and data from the CHA, Access to Services was summarized as a central theme with a focus on increasing knowledge and utilization of services that are already available in Macomb County.  Unique strategies must be developed and executed in order to capitalize on the community’s strengths and to develop the areas where Access to Services can be improved. With the future of the Affordable Care Act uncertain, now more than ever, residents need education on health insurance and services accessible to them. 

While Macomb County exceeds the benchmark in insured population as well as in the category of usual care provider selected, the County will continue to monitor these particular benchmarks and the focus will remain on increasing knowledge of accessible resources and services.

GOAL: Increase knowledge of Macomb County resources and services.

• Objective 1: Increase consumption of the daily recommended services of fruit and vegetables daily by 5 percent from baseline (43 percent fruits, 25.9 percent vegetables) for children, adolescents and adults by 2021 through educational programs and resources.
• Objective 2: Improve the community’s capacity to obtain, process and understand basic health information and services needed to make appropriate health care decisions and engage in health promoting behaviors by 2021.
• Objective 3: Improve coordination of referrals and services in Macomb County Health and Community Service agencies by 2021.
• Objective 4: Improve capacity and utilization of affordable, preventive and integrated oral health services for underserved populations in Macomb County by 2021

4. Social determinants of equity

The conditions in which residents live explain why some Macomb County residents are healthier than others. Heath is affected by social and economic opportunities in our communities, workplaces and environment. These can be called Social Determinants of Equity.  Addressing Social Determinants of Equity was selected as a priority area. By collaboration with community stakeholders, these disparities can be identified and addressed. The most basic of goals can be established to ensure that all services are accessible to the entire population of Macomb County and that these services are culturally and linguistically appropriate.

GOAL: Ensure health care services are culturally and linguistically appropriate.

• Objective 1: By 2021, train 100 percent of Health Department staff in cultural competency and cultural humility.
• Objective 2: Devise a collective strategy to assess and increase levels of health literacy among Macomb County Health Department staff, as well as increase staffs’ ability to address low health literacy and bridge knowledge gaps by 2021.

GOAL: Establish resources that create social and physical environments that promote good health.

• Objective 1: By 2021, improve utilization of The Right Connection by 20 percent.