Michigan Coronavirus Racial Disparities Task Force

State of Michigan’s progress on understanding

and addressing racial disparities since the

beginning of the COVID-19 pandemic.

Interim Report

INTERIM REPORT | NOVEMBER 2020INTERIM REPORT | NOVEMBER 2020

Table of contents

This document is an interim report. It communicates the initial

progress that the State of Michigan has made to understand and

address racial disparities since the beginning of the COVID-19

pandemic. It also recognizes the many continued challenges that

vulnerable communities in the state face and provides a direction

for the additional actions that will be necessary to achieve equity

for all Michiganders, during the rest of the pandemic and beyond.

As the COVID-19 pandemic is ongoing and conditions

can change rapidly, all gures and data shown in this

report are preliminary and subject to change.

Section I: Summary

Section II: Overview of Racial

Disparities During COVID-19

Section III: Michigan

Coronavirus Task Force

on Racial Disparities:

Overview and Impact

Section IV: Recent impact

of eorts to address

racial disparities

Section V: Next steps

for the Task Force

Section VI: Appendix

An October article in Politico lauded the

performance of Michigan’s broader pandemic

response, highlighting the tremendous

progress that the task force has made to reduce

disparities

. However, racial gaps in the

impacts of COVID beyond health still remain,

including in COVID-19 metrics, employment

gures, and other measures of well-being and

security. Closing these gaps will require

continued focus and vigilance.

Going forward, the task force will continue to

identify and recommend immediate and

long-term solutions to disparities caused by

the pandemic. Along with several specic

initiatives, it will prioritize the following goals:

 Maintain and expand the progress

made to atten racial/ethnic

disparities in cases and deaths

 Continue targeted encouragement

to remain vigilant in following

recommended personal behavior

guidelines to limit spread/exposure

 Develop and implement programs for

equitable management and distribution

of approved vaccine(s) and anti-viral

treatment(s) for COVID-19 and the u

 Propose policy changes that strengthen

communities of color’s resilience and

wherewithal to make it through this

pandemic and future public health

challenges

With the continued support and commitment of

state leadership, the task force will strive for racial

equity across Michigan, both during the ongoing

pandemic and after.

From the beginning of the COVID-19

pandemic, persons of color have faced

devastating and disproportionate harm,

both nationally and here in Michigan. From

health to nancial security, racial- and ethnic-

minority populations have experienced more

challenges than other populations, and have

done so across broad aspects of daily life.

Seeing the early disparities aecting persons

of color, and recognizing that these are

rooted in deep-seated inequities and systemic

racism, Governor Gretchen Whitmer signed

an Executive Order creating the Michigan

Coronavirus Task Force on Racial Disparities in

April. Since then, the task force has partnered

with a broad array of organizations to

understand and mitigate these disparities.

As a result of these eorts, the task force has

made numerous recommendations to address

immediate gaps in the state’s COVID-19 response;

provided vulnerable communities access to

other critical health and non-health resources;

and started the work to change the structures

that have perpetuated racial disparities.

The initial impact of these eorts has been clear.

Through October, racial disparities in COVID-19

cases and deaths have diminished greatly,

compared to earlier in the pandemic, especially

March and April. The eorts by the task force,

state agencies, and many other public and private

organizations have shown great initial success.

These interventions have helped reduce

the number of COVID-19 infections in

communities at high risk of spread and

with elevated risk of severe outcomes.

I. Summary

Politico: Which states had the best pandemic response?

Recognizing the need to understand how

COVID-19 aects each population dierently,

state leaders acted at the beginning of the

pandemic—more than one month before

the rst conrmed cases in Michigan—to

prioritize the tracking of race and ethnicity in

COVID-19 demographic data and statistics.

The state has ensured that labs comply

with federal requirements when reporting

COVID-19 test results, providing critical data

such as the race of individuals who are tested.

This has allowed the state to monitor how

the virus has spread in dierent populations

over time. In addition, by regularly matching

COVID-19 data with vital records data to

validate deaths, the state has been able to

track COVID-related mortality by race.

The data have shown that, while all communities

have been harmed, the COVID-19 pandemic

had an immediate, outsized impact on people

of color, especially Black and African American

persons. It has disrupted not only health but also

economic, educational, and social institutions.

It has aected both lives and livelihoods.

Even before the pandemic, Black Americans faced

disparate challenges, such as overrepresentation

in essential and frontline occupations

; greater

likelihood of living in multigenerational homes

than White Americans

; and greater likelihood

of reporting fair or poor health

. These factors

increase Black and African American persons’

risk of COVID-19 infection, severe outcomes,

and economic hardship during the pandemic.

Disparities have been evident in health

metrics such as COVID-19 cases and deaths,

in employment statistics, and in many

other measures of wellbeing and security

since the beginning of the pandemic.

COVID-19 CASES AND DEATHS BY RACE

From the identication of the rst COVID-19

cases in Michigan on March 10 through

October, cumulative case and death rates

per million population have been much

higher among Black and African American

persons than in other race categories.

Across the pandemic, the cumulative COVID-19

case rate in Black and African American

populations has been over 40% higher

than the rate in White populations (FIGURE

1A.). In addition, the cumulative COVID-19

death rate in Black and African American

populations has been over three times the

rate in White populations (FIGURE 1B.).

This observed higher ratio of cases to deaths in

Black and African American persons is due to

a variety of factors. Among them, dierences

in exposure led to higher case rates among

Black and African American persons early

in the pandemic, when testing capacity was

lower and more cases were likely not captured.

In addition, dierences in the prevalence of

II. Overview of Racial

Disparities During COVID-19

Project S.E.N.S.O.R (Michigan State University): Work, Health Disparities and COVID-19

Pew Research Center: A record 64 million Americans live in multigenerational homes

Center for American Progress: Health Disparities by Race and Ethnicity

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

underlying comorbidities have likely put

Black and African American individuals

at higher risk of severe outcomes.

COVID-19 CASES AND DEATHS BY

HISPANIC OR LATINO ETHNICITY

COVID-19 disparities have also appeared

by ethnicity. The cumulative COVID-19

case rate per million population

among Hispanic and Latino persons

in Michigan has been over 70% higher

than the rate in White populations.

The cumulative death rate is lower in

Hispanic and Latino populations than in

non-Hispanic and non-Latino populations.

This is likely due to a higher proportion

of younger individuals of Hispanic and

Latino ethnicity who are infected than in

non-Hispanic and non-Latino persons.

Over 70% of Hispanics and Latinos who

are infected are between the ages of 20

and 59 whereas less than 10% of those

infected are over 60. Furthermore, the

highest case rates exist for Hispanics and

Latinos between the ages of 20 and 59.

However, as cases continue to rise statewide,

it is important to consider trends in the

referent group (non-Hispanic and non-

Latino persons) when evaluating data

for the unequal impact of COVID-19.

In September and October, there were

marked increases in cases and deaths for

non-Hispanic and non-Latino persons,

which will conceal disparities, particularly

when looking at data in aggregate.

MICHIGAN UNEMPLOYMENT BY RACE

In addition to COVID-19 health disparities,

Black and African American persons have

FIGURE 1: Cumulative conrmed and probable

COVID-19 cases and deaths in Michigan per million

population by race, 3/1-10/31

FIGURE 2: Cumulative conrmed and probable

COVID-19 cases and deaths in Michigan per million

population by Hispanic or Latino ethnicity, 3/1-10/31

Figure 1: Cumulative COVID-19 cases and deaths in Michigan per million

population by race, 3/1-10/31

Notes: Cases reflect date of onset of symptoms and deaths reflect date of report;

most recent days of reports subject to change as additional data is received

Source: MDHHS – Michigan Disease Surveillance System, 11/17 report

304

266

1,833

548

WhiteAmerican

Indian/Alaska

Native

Asian/Pacific

Islander

Black/African

American

B. Deaths per million population, #

A. Cases per million population, K

21.9K

American

Indian/Alaska

Native

10.7K

12.1K

Asian/Pacific

Islander

Black/African

American

White

15.2K

Dr af t

Figure 2: Cumulative COVID-19 cases and deaths in Michigan per million

population by ethnicity, 3/1-10/31

Notes: Cases reflect date of onset of symptoms and deaths reflect date of report; most

recent days of reports subject to change as additional data is received

Source: MDHHS – Michigan Disease Surveillance System, 11/17 report

B. Deaths per million

population, #

28.5K

Hispanic

or Latino

Not Hispanic

or Latino

16.4K

A. Cases per million

population, K

368

704

Hispanic

or Latino

Not Hispanic

or Latino

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faced greater unemployment than White

persons. Michigan unemployment was

already about twice as high in Black persons

before the pandemic. However, Black

Michiganders were also much more likely

to lose their jobs during the pandemic’s

peak in the spring, and Michigan’s Q2

(April-June) Black unemployment rate of

35.5% was the highest in the country.

MICHIGAN HOUSEHOLDS FACING

FORECLOSURE OR EVICTION

Many other economic and social hardships

are disproportionately aecting communities

of color. Early in the pandemic, the U.S.

Census Bureau began conducting a recurring

Household Pulse Survey to understand

impacts of the pandemic on diverse

communities over time. One focus area of

this survey has been housing security.

Results from mid- to late-September showed

that Black households in Michigan were nearly

twice as likely as White households to report

being at a substantial risk of foreclosure

in the next two months. Among renters,

Black households were over 50% more likely

than White households to report being at

risk of eviction in the next two months.

This higher rate of housing instability is the

result of underlying inequities that could

further risk vulnerable residents’ health during

the pandemic. In order to ensure housing

security for vulnerable persons, the state of

Michigan temporarily suspended evictions to

provide relief for struggling families in March.

While this program and other eorts across

state government and communities have

made a dierence to support nancial

and economic well-being in at-risk

communities, there is more work to do in

these areas, and the task force continues

to evaluate approaches to address these

challenges along with health disparities.

FIGURE 3: Michigan unemployment by race

FIGURE 4: Michigan percent of households reporting

that in next two months they are “likely” or “somewhat

likely” to…

Note: Quarterly values are 3-month averages

Source: Economic Policy Institute analysis of Bureau of Labor

Statistics Local Area Unemployment Statistics and Current Population

Survey data, updated August 2020

Dr af t

35.5%

3.9%

3.7%

30%

10%

35%

25%

15%

20%

40%

‘

19 Q3 ‘19 Q4

7.0%

‘20 Q1 ‘20 Q2

3.2%

8.1%

6.8%

17.5%

Figure 3: Unemployment by race

Black White

Figure 4: Housing insecurity by race, Sep 16-28

Dr af t

37%

19%

Black (not

Hispanic)

White (not

Hispanic)

Source: U.S. Census Bureau Household

Pulse Survey, Week 15 (Sep. 16-28)

59%

38%

Black (not

Hispanic)

White (not

Hispanic)

b. face eviction

a. face foreclosure

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

OVERVIEW OF THE TASK FORCE

In order to rapidly address existing disparities and

work toward greater equity for all Michiganders,

Governor Gretchen Whitmer signed Executive

Order No. 2020-55 on April 20, 2020, creating

the Michigan Coronavirus Task Force on Racial

Disparities. Since then, the task force has acted

in an advisory capacity to the Governor.

The task force has studied the causes of racial

disparities as they relate to the impact of

COVID-19, and the group has recommended

actions to immediately address disparities in

the state’s COVID-19 response and impact on

 Chair: Lieutenant Governor Garlin Gilchrist (pictured)

 Executive Oce of the Governor Sta: Honorable Thomas F. Stallworth

III, Senior Advisor to the Governor and Director of task force

 Michigan Department of Health and Human Services (MDHHS) Sta:

Director Robert Gordon or his designee, and Chief Medical Executive

Dr. Joneigh S. Khaldun

III. Michigan Coronavirus

Task Force on Racial

Disparities

racial- and ethnic-minority populations. The

task force has also prioritized understanding

and addressing the historical and systemic

inequities that underlie these disparities.

The task force’s structure enables it to draw

on a variety of perspectives from government,

academia, and the private sector, and

the group includes leaders in healthcare,

economic development, education, and other

disciplines. It is also able to quickly submit

recommendations to inform the Governor’s

Oce on decisions related to the pandemic

and racial disparities more broadly.

 Governor Appointees: listed on the task force’s web page and in the appendix

 Community Stakeholder Attendees: Various community leaders have attended

Community Action Stakeholder meetings (FULL LIST IN THE APPENDIX)

MEMBERSHIP

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addition, the group will provide direction

for how to respond to and combat racial

disparities in possible new pandemics.

 Telehealth Access: African Americans and

communities of color disproportionately

suer from a shortage of doctors and

primary care services. These shortages

contribute to poor short- and long-term

health outcomes and reduce the ability

of community members to manage

chronic conditions. Increased access to

high-speed internet and telemedicine

and other forms of remote medical care

may contribute to overcoming obstacles,

including transportation and physician

shortages, that otherwise prevent or

diminish care for vulnerable communities.

 Environmental Justice: Environmental

issues play a signicant role in the health

and welfare of communities of color as

they are disproportionately exposed to

air and water pollution and suer from

associated chronic health conditions.

Access to clean water is a necessity, and

as such eorts should include improving

water aordability and accountability

for polluters. RDTF members will be

asked to act as representatives in the

already assembled Michigan Advisory

Council on Environmental Justice to drive

integration of coronavirus disparate impact

considerations in the environmental

justice problem solving process.

COMMUNITY ENGAGEMENT

The task force has strived to establish strong

relationships across Michigan’s diverse

communities. It has partnered with dozens of

organizations, businesses, and public gures.

This diversity allows the group to incorporate

varied perspectives into its recommendations

and provide tailored support that each vulnerable

PRIMARY FOCUS AREAS

The task force has established various work

groups to address core areas of focus:

 Strategic Testing Infrastructure: The

objective of this work group is to support

development of the infection testing

infrastructure needed to eectively meet

the needs of African American and other

vulnerable communities. In addition to

COVID-19 testing, this infrastructure is

working to support future delivery of a

COVID-19 vaccine while improving u

shot delivery, which in turn decreases

vulnerability to COVID-19. In the long

term, this infrastructure will also

support treatment for underlying health

conditions within these communities.

 Primary Provider Connections: The

historical disproportionate number of

uninsured and underinsured people

has exacerbated underlying chronic

health conditions in the African American

community. These conditions increase

the risk of severe COVID-19 cases and

death. This work group’s priorities include

short- and long-term eorts to connect

those in vulnerable communities to

primary care providers and help them

navigate the healthcare system.

 Centering Equity: COVID-19 continues

to impact communities that have been

marginalized, and it is essential that we

understand how racialized messages create

and sustain social injustice. The challenge

in race equity and social justice work is to

rst establish a deep understanding of the

concepts and then provide people with

the tools to act on that understanding.

This work group is focused on studying the

causes of COVID-19 racial disparities and

recommending immediate policies and

practices to respond to current needs. In

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

community requires. These stakeholders

participate in weekly two-way conversations to

hear about the task force’s activity and to provide

input to inform next steps. The task force has

also worked to provide transparency to the

public. A weekly call, open to the public, discusses

updates on the task force’s progress and next

steps. Meeting dial-in information, agendas and

minutes are available online on the task force’s

web page. Details on the weekly meetings:

 Task Force on Racial Disparities

Community Action Stakeholder Team

meeting: attended by community

leaders who communicate what they are

hearing from their community groups

to the task force and take feedback

from the task force to their groups.

Some leaders have organized town

halls and webinars to share and receive

information from the community.

 Michigan Coronavirus Task Force on

Racial Disparities meeting: attended

by task force members, work group

leaders and subject matter experts who

receive the same presentation as the

community leaders and update the task

force on how they are incorporating

the task force’s goals into their

respective processes and operations.

TASK FORCE’S IMPACT AS OF OCTOBER

The task force has taken action to address

disparities across two timeframes.

 Immediate disparities in COVID-19 response

 Lasting structural change

To date, there has been substantial progress

across both of these categories. Figure 5 provides

a summary of impact, and details on several of

the highest-impact initiatives are on the next page.

FIGURE 5: Summary of task force’s achievements to-date

Figure 5: Achievements

Immediate disparities in COVID-19 response

Lasting structural change

Adjusted testing protocol to include asymptomatic household members,

when any member tests positive

Established 21 neighborhood testing sites in at -risk communities, with

24,606 tests conducted between August 28 and November 16

DHHS order directing provision of employer testing for migrant agricultural

workers, with state support of both testing and isolation housing

Testing Policy and regulatory changes for greater equity

Strategic communications to communities of color (from April 1 to Sept 27)

across channels including over 400M TV/cable impressions in

programming that skews towards the African American audience

6 million free masks to vulnerable population

Pushed improvements in data quality to address racial disparities

Other Containment

Executive Directive requiring implicit bias training for over 400K health

professionals

Guidance letter to law enforcement to avoid discriminatory practice of targeting

black citizens wearing mask

Executive Directive declaring racism a public health crisis

Proposed and successfully moved legislation to allow eligibility for SNAP

benefits of residents formerly convicted of drug felonies

Piloting Equity Impact Assessment tool in DHHS, with plans to expand use

and potentially roll out to other state departments

Recommend changes in Michigan law to combat racial disparities in impact &

response to pandemics

Avoiding implicit bias and discrimination

Highlighted in this report

Resources for quarantined individuals – PPE, food boxes, hygiene

products, and home goods (Qcares and Qboxes programs)

MRRI funded 30 community organizations and an evaluation project led

by a state university for $20M

Deployed navigator services to neighborhood testing sites in Detroit to

connect community members with public health programs and human

services

Utility assistance and water shutoff moratorium – the latter stopped being

in effect after MI Supreme Court overturned executive orders

Reduced housing insecurity by initially issuing a moratorium on

foreclosures and evictions and later by providing $50M of funding through

the Eviction Diversion Program

Critical Resources

Details on select achievements:

Achievement #2

More than 24,000 tests have been administered

in previously underserved communities across

21 Neighborhood Testing sites, through

November 16. These state-operated sites

provide COVID-19 testing on a consistent

schedule, several days per week. One additional

site is scheduled to launch prior to the end

of the year. Additional details on the sites:

 Site selection: Neighborhood Testing sites

were selected using a data-driven approach

to identify and support communities at

heightened risk of outbreaks. The selection

process included use of the CDC’s Social

Vulnerability Index (SVI). The SVI uses social

factors related to “socioeconomic status,

household composition, minority status,

or housing type and transportation”

identify communities at greater risk in case

of events such as natural disasters and

infectious disease outbreaks.

By strategically placing sites in communities

of higher vulnerability, the state has been

able to greatly improve access to testing

for high-risk populations. Most locations

are in majority-minority areas (where

most residents are non-White); seven sites

are in Detroit and three are in Genesee

County. Sites operate on a xed weekly

schedule to provide consistent testing

support. In addition, state health leaders

review a health equity metric on testing

on a weekly basis to ensure adequate

testing in these communities, relative to

testing rates in the rest of the state.

 Impact to-date: Between August 28 (launch

of rst site) and November 16, 24,606

tests were administered at these sites.

 Accessibility: All sites provide translation

services, including American Sign Language,

and meet ADA accessibility requirements

so that persons who are dierently

abled can receive testing as well.

 Cost and eligibility: All sites oer free

testing, although insurance is accepted, if

available. A healthcare provider order or

prescription is not required for someone

to be tested, nor is any form of ID required

(insurance card required for those using

insurance). Individuals of all ages can

be tested. Scheduling in advance is not

required but is strongly preferred.

 Types of tests: Sites primarily use saliva

tests, which are less invasive.

Nasopharyngeal swab tests are also

available.

Achievement #4

In order to provide critical COVID-19 prevention

information, the Michigan Department of

Health and Human Services (MDHHS) has

launched educational and promotional media

campaigns, using multiple channels to reach

diverse audiences. These campaigns have

been concentrated in urban communities,

where racial- and ethnic-minority persons live

in greater numbers, as these areas have been

at heightened risk throughout the pandemic.

Various messages have been used, allowing for

testing to determine which are most eective.

Campaigns have provided information critical

for persons to protect themselves and their

communities. In a July survey of Michigan

residents, African American respondents

were signicantly more likely than all other

respondents to report always wearing a

mask in indoor public spaces and in crowded

outdoor spaces (FIGURE 6). Some of this can

likely be attributed to the targeted media

campaigns that the state conducted to promote

COVID-19 prevention in high-risk communities.

At a Glance: Social Vulnerability Index: https://www.atsdr.cdc.gov/placeandhealth/svi/at-a-glance_svi.html

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

Common topics of the campaigns:

 Masking

 Testing

 Contact tracing

 “Staying home. Staying safe.”

Achievement #6

The task force played a crucial role in requesting

improvements in data quality to highlight racial

disparities. By prioritizing completeness of

COVID-19 case data to include race and ethnicity,

the state has improved data completeness over

time, aiding its eorts to identify and address

health disparities. In June, as many as 30%

of cases had unknown race,

compared to under 20% from

July through October (FIGURE

7, red line). Despite increasing

case volumes in September and

October, data completeness

is higher than it was in June.

Achievement #8

The task force identied 30

community organizations and

an evaluation project led by a

state university to receive a total

of $20 million in funding under

the Michigan Rapid Response

Initiative. These organizations are

using funds to respond to needs

associated with the disparate

impacts that the virus has had

on communities of color.

Below is a summary of the

types of eorts that are being

funded as part of the initiative

(the full list is available from

the task force web page):

 Health services: Many organizations

are directly providing or enabling

access to health services. Some of these

eorts are specic to COVID-19, such

as providing testing in marginalized

communities. Others are focused on

broader healthcare needs, including

physical, mental and dental health.

Several eorts are focused on expanding

access to telehealth services by increasing

internet access or by distributing devices

in communities with access challenges.

 Non-medical resources: Organizations are

also focused on providing resources that

have become more dicult to access since

the pandemic began. These eorts include

Dr af t

Figure 6: Mask us by race survey response, July 2020

Source: MDHHS COVID-19 Campaign Research, responses from July 8-13, 2020

Everyone Else

African American

81%

13%

SometimesUsuallyAlways Never

69%

20%

UsuallyAlways Sometimes Never

FIGURE 6: Responses when asked “How often do you wear

a mask/cloth facial covering in indoor public spaces and in

crowded outdoor places?” 7/8-7/13

INTERIM REPORT | NOVEMBER 2020INTERIM REPORT | NOVEMBER 2020

food distribution, rehousing programs, and

expansion of shelters to provide socially

distanced housing to more people.

 Education and livelihoods: Both schooling

and employment have been disrupted

during the pandemic, especially in at-risk

communities, where parents are less likely

to work remotely, be able to aord tutors

or childcare, and have access to high

speed broadband internet. To address

these challenges, some organizations are

providing educational support, including

the development of virtual curriculums and

the provision of devices and internet access.

Other programs focus on supporting the

livelihoods of people in these communities.

Such eorts include providing technological

resources, giving guidance to those leaving

incarceration during the pandemic, and

oering support for small businesses.

 Data improvement: Some eorts are

focused on developing data systems

and processes to better identify

communities at heightened risk. These

eorts will inform allocation of resources

to those who need them most.

Achievement #9

The task force identied the need for navigators

to assist residents in signing up for insurance

and other support programs, and MDHHS

established multiple navigator programs to

support the COVID response. First, a phone-

based hotline was established for individuals

who could not nd COVID-19 test sites online.

Next, MDHHS established a phone-based

specialized group of navigators who can assist

residents with insurance enrollment, enrollment

in other state-run benets programs, and

referrals to community-based support services.

Finally, the Detroit Health Department deployed

Percent of COVID-19 cases with reported race over time

Dr aft

Figure 7: Cases by race, % of total, 3/1-10/31

Source: MDHHS – Michigan Disease Surveillance System, 11/17 report

60%

20%

40%

80%

4/1 5/13/1 6/1 7/1 8/1 9/1 10/1

Black/African American

UnknownAmerican Indian/Alaska Native White

Asian/Pacific Islander Multiple Races

Other

FIGURE 7: Rolling 7-day avg. percent of cases by reported race, 3/1-10/31

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

navigator services to Neighborhood Testing

sites in Detroit to connect community members

with a variety of public health programs and

human services. These include state benets;

immunizations and lead testing; the Women,

Infants, and Children (WIC) food and nutrition

program; Detroit municipal IDs; and referrals to

primary care providers. Navigation services will

also be provided at neighborhood testing sites

in Genesee, Calhoun and Macomb counties.

Achievement #11

The task force played a crucial role in developing

the Eviction Diversion Program to help Michigan

families weather the economic hardships brought

on pandemic-related economic dislocation.

The program was designed to keep Michigan

residents who fell behind on their rent during

COVID-19 in their homes. The program utilizes

a special court process to get fast rental

assistance for renters who have been impacted.

To date, the program has provided payments of

$17 million to landlords for back rent, keeping

5,200 families in their homes. About 47% of

tenants receiving assistance under the program

identify as African American. By the end of the

year, the Michigan State Housing Development

Authority projects that the program will have

allowed 16,000 households to remain in their

homes during the COVID-19 pandemic —

providing a crucial bulwark against housing

insecurity. (link: Eviction Diversion Program)

Achievement #14

The Equity Impact Assessment, a decision-making

model that MDHHS has begun to introduce,

provides a concrete, organized, and more

objective way of assessing processes, budget

allocations, policies and programs through

an equity lens. Inequities in programs and

outcomes are sometimes unintentional and

embedded into government systems and may

be amplied by implicit bias or the blind spots

of leaders. The Equity Impact Assessment will

guide MDHHS leaders to think through the full

implications these programs have on minority

populations. This informed perspective helps

reduce disparities, inequities, and unintended

discrimination in policy development and

program deployment. MDHHS has already been

piloting this tool and is committed to rolling it

out more broadly over the coming months. The

agency is also exploring how this approach can be

introduced to other departments and agencies.

Achievement #16

At the recommendation of the task force,

Governor Whitmer signed Executive Directive

#2020-7 on July 9, directing the Department

of Licensing and Regulatory Aairs (LARA)

to begin developing rules that will require

implicit bias training as part of the knowledge

and skills necessary for licensure, registration

and renewal of licenses and registrations

of health professionals in Michigan. These

trainings will ensure greater access to

equitable care by preparing healthcare

workers to recognize and mitigate implicit

bias. Over 400,000 current providers and

clinicians, and 30,000 new licensees, will

begin to receive implicit bias training.

INTERIM REPORT | NOVEMBER 2020INTERIM REPORT | NOVEMBER 2020

Comparing the earlier months of the COVID-19

pandemic in Michigan (March through April)

to more recent months (September through

October), some disparities between racial and

ethnic groups have appeared to diminish,

reecting great eorts by state and local agencies,

various organizations, and communities

themselves. However, some disparities persist,

even if to a lesser degree than earlier in the

pandemic.

Early in the pandemic, daily new case rates

among Black and African American persons

(FIGURE 8A.) were much higher than in any

other race category. In March and April, the

average for Black and African American persons

was 176 new conrmed and probable cases

per million population per day, compared to

39 among White persons. However, since April,

they have steadily converged towards the other

categories. In September and October, the

average in Black and African

American persons was 59 cases

per million per day, compared

to 130 among White persons.

Trends in COVID-19 mortality

(FIGURE 8B.) have correlated

with those in conrmed and

probable infection rates. Deaths

per million population were much

higher in the Black and African

American population early in the

pandemic. In March and April,

the average for Black and African

American persons was 21.7 new

conrmed and probable deaths

per million population per day,

compared to 4.5 among White

persons. Since then, deaths have

also converged, although the

gap has not closed completely.

In September and October, the

average in Black and African

American persons was 1.0 new

conrmed and probable deaths

IV. Recent impact of eorts to

address racial disparities

FIGURE 8: Rolling 7-day avg. daily new conrmed and

probable COVID-19 (a) cases per million population and

(b) deaths per million population, by race, 3/1-10/31

Dr af t

Figure 8: Daily cases/deaths per million population by race, 7-day

rolling average, 3/1-10/31

Notes: Cases reflect date of onset of symptoms and deaths reflect date of report;

most recent days of reports subject to change as additional data is received

Source: MDHHS – Michigan Disease Surveillance System, 11/17 report

400

300

200

100

6/15/14/13/1 7/1 8/1 9/1 10/1

(a)

(b)

4/13/1 5/1 6/1 7/1 8/1 9/1 10/1

American Indian/Alaska Native

WhiteAsian/Pacific Islander

Black/African American

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

FIGURE 9: Rolling 7-day avg. daily new conrmed and

probable COVID-19 (a) cases and (b) deaths per

million population by ethnicity, 3/1-10/31

Dr af t

Figure 9: Daily cases and deaths per million population, 7-day

rolling average, 3/1-10/31

Notes: Cases reflect date of onset of symptoms and deaths reflect date of report; most

recent days of reports subject to change as additional data is received

Source: MDHHS – Michigan Disease Surveillance System, 11/17 report

6/14/13/1 5/1 7/1 8/1 9/1 10/1

300

100

200

400

5/1 8/13/1 10/14/1 6/1 7/1 9/1

Not Hispanic or LatinoHispanic or Latino

(a)

(b)

per million population per day,

compared to 1.5 in White persons.

There were several spikes in

mortality in American Indian/Alaska

Native population, which averaged

1.4 new conrmed and probable

deaths per million population per

day in September and October.

As testing increased early in the

pandemic, a clear disparity in case

rates emerged in Hispanic and

Latino populations (FIGURE 9A.).

In March and April, the average

daily new case rate for Hispanic

or Latino populations was 76

conrmed and probable cases

per million population per day,

compared to 56 in non-Hispanic and

non-Latino persons. In September

and October, the average among

Hispanic and Latino persons was

170 cases per million per day,

compared to 127 among non-

Hispanic and non-Latino persons.

During September and October,

the disparity between Hispanic/Latino and

non-Hispanics/non-Latino populations began

to diminish, but that is primarily attributed to

a more rapid increase of cases among those

who were not Hispanic or Latino. It is important

to note that case rates are increasing for both

groups, particularly since early September.

Although case rates have been higher among

Hispanic and Latino Michiganders, death rates

have trended near or lower than in populations

not Hispanic or Latino for most of the pandemic

(FIGURE 9B.). In March and April, the average

for Hispanic and Latino persons was 2.3 new

conrmed and probable deaths per million

population per day, compared to 6.6 among non-

Hispanic and non-Latino persons. In September

and October, the average in Hispanic and

Latino populations was 0.9 new conrmed and

probable deaths per million population per day,

compared to 1.4 among those not Hispanic or

Latino. This is likely due to a higher proportion

of younger individuals of Hispanic and Latino

ethnicity who are infected than in non-Hispanic

and non-Latino persons. Over 70% of Hispanics

and Latinos who are infected are between

the ages of 20 and 59 whereas less than 10%

of those infected are over 60. Furthermore,

the highest case rates exist for Hispanics and

Latinos between the ages of 20 and 59.

However, as cases continue to rise statewide,

it is important to consider trends in the

referent group (non-Hispanic and non-Latino

persons) when evaluating data showing the

unequal impact of COVID-19. In September

INTERIM REPORT | NOVEMBER 2020INTERIM REPORT | NOVEMBER 2020

From mid-September through mid-October,

cases per million population in Black and African

American persons remained slightly lower than

in other race categories. However, American

Indian and Alaska Native communities faced a

noticeable spike relative to other race categories

beginning in mid-September, with daily case

rates approaching those in White persons.

Disparities in case rates by Hispanic and Latino

ethnicity narrowed in September and October

compared to earlier in the pandemic (especially

April through August), although a gap remains

(FIGURE 10B.). The eorts of the task force,

various state departments,

and numerous other

partners have provided

crucial support to protect

those at higher risk.

The reasons for these

changes in disparity are

complex as the ages and

sex of people infected with

COVID-19 were not the same

for all these populations.

Additionally, the testing

availability and treatment

for COVID-19 has improved.

However, those in vulnerable

communities, including racial-

and ethnic-minority groups,

continue to face factors that

make them more susceptible

to infection and to severe

outcomes. The continued

progress of the task force

and its partners will be critical

to slow the overall spread

of COVID-19 and to prevent

disparities from increasing.

FIGURE10: Rolling 7-day avg. daily new conrmed and probable

COVID-19 cases per million population by (a) race and

(b) ethnicity, 9/1-10/31

Dr aft

Figure 10: Daily cases per million population by, 7-day rolling

average, 9/1-10/31

Notes: Cases reflect date of onset of symptoms; most recent days of reports subject

to change as additional data is received

Source: MDHHS – Michigan Disease Surveillance System, 11/17 report

(a)

(b)

200

300

250

100

150

9/1 10/1

200

100

300

400

10/19/1

Hispanic or Latino Not Hispanic or Latino

American Indian/Alaska Native

WhiteAsian/Pacific Islander

Black/African American

and October, there were marked increases in

cases and deaths for non-Hispanic and non-

Latino persons, which will conceal disparities,

particularly when looking at data in aggregate.

In September and October, COVID-19 began

to spread more rapidly than at any time since

early in the pandemic (FIGURE 10A.). Most

populations experienced spikes in cases, and

numbers of deaths and hospitalizations also

increased compared to during the summer.

Racial disparities in case rates appeared to dier

across groups compared to early in the pandemic.

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

In order to sustain the progress made and to

better address ongoing disparities, the task force

continues to expand its impact. It is actively

working to implement multiple high-priority

initiatives, and has also identied broad themes

to improve equity during the pandemic and after.

Based on its research into the causes of

disparities and assessment of successful

interventions, the task force will continue to

advise the state on approaches and actions to

address the disparities that the COVID-19

pandemic has highlighted. Because the task

force was created by Executive Order 2020-

55, pursuant to the executive and supervisory

powers of the Michigan Constitution, the

task force’s work has not been disrupted by

the recent Michigan Supreme Court decision

regarding the governor’s emergency powers.

Nevertheless, that decision does constrain the

governor’s ability to address racial disparities

head-on through emergency executive orders.

Going forward, Michigan’s eorts to ght

COVID-19 and eliminate the disparate impact

of the pandemic on communities of color will

be channeled primarily through the powers

of the Department of Health and Human

Services under the Public Health Code, and

other state agencies as permitted by law.

In addition to many of the ongoing interventions

described above in Section III, several new

initiatives will provide additional support to

vulnerable Michiganders in the months ahead.

Along with these, the state will continue to

identify new ways to expand its impact, focusing

on several goals that the task force has identied

as critical to address racial and ethnic disparities.

INITIATIVES THAT ARE IN PROGRESS

Details on select initiatives:

Initiative #1: Close the digital divide

With the guidance of the task force, the

Governor’s oce is leading the charge in

bringing together a dozen dierent parts of

V. Next steps for the

Task Force

FIGURE 11: Summary of task force’s in-progress initiatives

Figure 11: Future initiatives

Immediate disparities in COVID response Lasting structural change

Closing the digital divide in telehealth and remote learning

“Get Covered” campaign to make coordinated push for every Michigander to

Mobile testing infrastructure that can also be extended for other health

services such as vaccine administration

Guidance letter to health providers on avoiding implicit bias.

Proposed change to lifetime cash assistance benefits from 48mths to

60mths

Launch implicit bias training for all state employees

Highlighted in this report

INTERIM REPORT | NOVEMBER 2020INTERIM REPORT | NOVEMBER 2020

state government to chart a joint path forward.

Together they will work to expand internet

access and close the digital divide and racial

disparities in internet access. These eorts

will be facilitated by Connected Michigan.

This multi-year internet access plan will address

barriers to full digital participation, including

lack of devices, lack of access to aordable,

speedy internet service, and a lack of digital

literacy. These eorts will address short- and

long-term disparities in telehealth, remote

learning, job training, access to information

about public assistance programs, and more.

Initiative #2: Increase enrollment in

health insurance plans

Multiple state departments have come together

at the direction of the Executive Oce of the

Governor (EOG) to make a coordinated push for

every Michigander to get signed up for insurance.

MDHHS and the Department of Insurance and

Financial Services (DIFS) are working together

to make it easy for Michiganders to nd out

about their options for aordable care, such as

Medicaid and federal marketplace plans. These

eorts are putting this information together and

adopting a “no wrong door” approach. They are

also coordinating on a joint $1M media campaign

to ensure all Michiganders get signed up this fall.

Additionally, MDHHS is working with the

Department of Treasury and the Department of

Labor and Economic Opportunity (LEO) to identify

and facilitate enrollment of eligible Michiganders

into Medicaid by identifying residents who

may have lost insurance coverage due to a

job loss or have otherwise raised their hands

to request more information about benets

programs. This eort will provide them with

easy information about how to get covered.

Finally the state is looking to expand residents’

access to navigators who can help answer their

insurance questions and get them signed up.

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

Initiative #3 — Mobile testing centers

MDHHS has partnered with Wayne State

University (WSU) and Wayne Health (WH) to

provide a mobile COVID-19 testing infrastructure.

This new, data-driven capability will allow

testing centers to move between target sites

and serve communities at the highest risk.

The initial mobile pilot program conducted

with WSU, WH, the Ford Motor Company and

ACCESS provided COVID testing to nearly

9,500 people between April 13 and May 31.

The partnership between MDHHS and WSU/WH

expands upon this model, including COVID-19

testing, u vaccinations, cardiometabolic risk

factor screenings, and social determinant

assessments with linkage to social services

and medical care. Additional services could

include future COVID-19 vaccine distribution.

For maximum accessibility, services will be

available to persons driving or walking to the

site, and will not require appointments or

prescriptions. MDHHS will expand mobile testing

in Flint, Lansing, Grand Rapids and Muskegon.

Initiative #4: Raise awareness of

racial- and ethnic disparities in

medical care

MDHHS will send a letter to providers across

the state, encouraging them to recognize

the disparities that aect their racial- and

ethnic-minority patients. The letter will

emphasize the need to consider social

context when making clinical decisions, such

as considering that patients may not be able

to safely isolate when making the decision

to admit the patient to the hospital.

GOALS FOR IMPACT

Going forward, the task force will build on

success to-date by maintaining existing eorts

and launching new initiatives. In order to achieve

greater equity in the months ahead, the task force

will advocate for and act on several core goals:

 Maintain and expand the progress

made to atten racial/ethnic

disparities in cases and deaths

 Continue targeted encouragement

to remain vigilant in following

recommended personal behavior

guidelines to limit spread/exposure

 Develop and implement programs for

equitable management and distribution

of approved vaccine(s) and anti-viral

treatment(s) for COVID and the u

 Propose policy changes that

strengthen communities of color’s

resilience and wherewithal to

make it through this pandemic and

future public health challenges

Alongside its partners across state departments

and in local communities, the task force will

continue to address the immediate needs of

vulnerable populations such as racial- and

ethnic-minority groups aected disparately by

the pandemic. It will also continue to work for

sustained equity across government and across

the state.

INTERIM REPORT | NOVEMBER 2020INTERIM REPORT | NOVEMBER 2020

FULL TASK FORCE MEMBERSHIP

Chair

Lieutenant Governor Garlin Gilchrist

Executive Oce of the Governor Sta

Honorable Thomas F. Stallworth III, Senior Advisor

to the Governor and Director of task force

Michigan Department of Health and

Human Services (MDHHS) Sta

Director Robert Gordon or his designee, and

Chief Medical Executive Dr. Joneigh S. Khaldun

Governor Appointees (listed on the

task force’s web page and below)

 Brandi Nicole Basket, D.O., Clinton

Township; chief medical ocer for

Meridian Health Plan Michigan Market

 Matthew L. Boulton, M.D., Ann Arbor; senior

associate dean for Global Public Health and

director of the Minority Health and Health

Disparities International Research Training

Program at the University of Michigan

 Renée Branch Canady, Ph.D.,

Lansing; chief executive ocer of the

Michigan Public Health Institute

 Denise Brooks-Williams, Detroit; senior vice

president and chief executive ocer of the

Henry Ford Health System North Market

 Sen. Marshall Bullock

 Dessa Nicole Cosma, Detroit; executive

director of Detroit Disability Power

 Connie Dang, Jenison; director of the

Oce of Multicultural Aairs and special

assistant for Inclusive Community

Outreach at Grand Valley State University

 Marijata Daniel-Echols, Ph.D.,

Farmington Hills; program ocer

at W.K. Kellogg Foundation

 Debra Furr-Holden, Ph.D., Flint;

epidemiologist and associate dean for

Public Health Integration at Michigan

State University, and director of the Flint

Center for Health Equity Solutions

 Audrey E. Gregory, Ph.D., Franklin;

chief executive ocer of the

Detroit Medical Center

 Whitney Grin, Detroit, director of

marketing and communications for

the Downtown Detroit Partnership

 Bridget G. Hurd, Southeld; senior

director of diversity and inclusion at

Blue Cross Blue Shield of Michigan

 Curtis L. Ivery, Ph.D., Detroit; chancellor of

Wayne County Community College District

 Solomon Kinloch, Jr., Oakland Township;

senior pastor at Triumph Church in Detroit

 Jametta Y. Lilly, Detroit; chief executive

ocer of the Detroit Parent Network

 Curtis Lipscomb, Detroit; executive

director of LGBT Detroit

 Mona Makki, Dearborn; director

of the ACCESS Community Health

and Research Center

VI. Appendix

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

 Alycia R. Meriweather, Detroit; deputy

superintendent of the Detroit Public

Schools Community District

 Randolph Rasch, Ph.D., East Lansing;

professor and dean of the Michigan

State University College of Nursing

 Celeste Sanchez Lloyd, Grand Rapids;

community program manager for Strong

Beginnings at Spectrum Health and a

fellow in the W.K. Kellogg Foundation

 Jamie Paul Stuck, Scotts; Tribal

Council chairman and member of

the Nottawaseppi Huron Band of

the Potawatomi Tribal Council

 Maureen Taylor, Detroit; state chair of the

Michigan Welfare Rights Organization

 LaChandra White, Allen Park; director of the

UAW Civil and Human Rights Department.

 M. Roy Wilson, M.D., Detroit; president

of Wayne State University

 Representative Sherry Gay-Dagnogo

 Attorney General Dana Nessel

 Congresswoman Brenda Lawrence

State departments represented

on the task force

 Michigan Executive Oce of the Governor

 Michigan Department of Health

and Human Services

 Michigan Department of Civil Rights

 Oce of the Attorney General

 Michigan Department of Labor

and Economic Opportunity

 Michigan Department of Licensing

and Regulatory Aairs

 Michigan Environment, Great

Lakes and Energy

 Michigan State Housing

Development authority

 Michigan Department of Military

and Veterans Aairs

LEADERS WHO HAVE JOINED COMMUNITY

ACTION STAKEHOLDER MEETINGS

 Alfonso Salais, Jr; Lansing

School District teacher

 Alisha Bell; Wayne County commissioner

 Alize Payne; Washtenaw

County equity ocer

 Andrea Acevedo; SEIU Healthcare president

 Benny Napoleon; Wayne County sheri

 Crystal Campbell; Washtenaw County

 Dave Coulter; Oakland County executive

 Denise Fair; City of Detroit health director

 Delores Harrison Brown;

AARP Chapter 4803

 Dr. Cheryl Moore

 Dr. David Brown; Michigan Medicine

– head of Dept of Health Equity

 Dr. Kent Key; College of Human

Medicine, Michigan State University

 Dr. Tonya Bailey; Chief Diversity Ocer, LCC

 Dr. Toshia Patman; Our Wellness Hub

 Dr. Deidre Holloway Waterman;

Mayor of Pontiac

 Gilda Jacobs; MLPP

 Genelle Allen; Wayne County

 Heaster Wheeler; SOS

INTERIM REPORT | NOVEMBER 2020INTERIM REPORT | NOVEMBER 2020

 Ken Siver; Mayor

of Southeld

 Lauren Bealore;

America Votes

 Lisa Canada; Carpenters

 Loretta V. Bush, MSHA;

Detroit-Wayne County

Health Authority

 Lynn Todman, Lakeland

Health in Benton

Harbor – St Joseph

 Marcus Muhammad;

Mayor of Benton Harbor

 Marilyn Lane;

Macomb County

 Mark Hackel; Macomb

County executive

 Michael Raerty;

New Detroit Inc

 Paula Cunningham;

State Director, AARP

 Palencia Mobley

 Phylis Meadows;

Kresge Foundation

 Rev. Wendall

Anthony; NAACP

 Rodd Mott; ACLU

 Rudy Hobbs;

Oakland County

 Sheldon Neeley;

Mayor of Flint

 Teresa Branson;

Kent County

 Tawana Nettles-

Robinson; Trinity Health

 David McGhee; Skillman

 Walter Watt; Mayor of

Muskegon Heights

 Warren Evans; Wayne

County executive

 Rep. Abdullah

Hammoud; Dearborn

WORK GROUP MEMBERS

Strategic Testing

Infrastructure Work Group

 Brenda Jegede

 Charles Stanley

 Curtis Ivery

 Philip Levy

 Mona Makki

 Whitney Grin

 Denise Fair

 Alfredo Hernandez

 LaChandra White

 Teresa Branson

 Larry Lewis

 Kimberly Trent

 Tiany King

 Rev. Solomon Kinloch

 Congresswoman

Brenda Lawrence

 Chris Kolb

 Linda Little

 Tonya Thompson

 Rep. Sherry Gay-Dagnogo

 Marijata Daniel-Echols

 Maureen Taylor

 Karen Phillippi

 David Sanchez

 Roy Wilson

 Andrea Taverna

 Yesenia Murillo

Primary Provider

Connections Work Group

 Randy Rasch

 Danielle El-Amin

 Brandi Basket

 Denise Brooks-Williams

 Bridget Hurd

 Jametta Lilly

 Audrey Gregory

 Tawana Nettles

 Zaneta Adams

 Celeste Sanchez Floyd

 Connie Dang

 Jacquetta Hinton

 Alize Asberry Payne

 Wenona Singel

 Crystal Brown

 Kathleen Oberst

MICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIESMICHIGAN CORONAVIRUS TASK FORCE ON RACIAL DISPARITIES

 Sarah Esty

 Chris Jackson

 John Breems

Centering Equity

Work Group

 Alize A. Payne

 Ken Borkowski

 David Brown

 Joyce Bryant

 Renée Canady

 Marijata Daniel-Echols

 Lonias Gilmore

 Alfredo Hernandez

 Brenda Jegede

 Dionne M. Smith

 Janee Moore

 Yesenia Murillo

 Karen Phillippi

 Cherie R. Jordan

 Chris Robinson

 Tari Muniz

 Steve Schreier

 Marquilla Chedester

 Tedra Jackson

 Josh Rivera

 Bridget Hurd

 Tonya Bailey

 Lauren Bealore

 Megen Miller

 Teresa Branson

 Lilianna A. Reyes

 Cynthia Taueg

 Aletha Carr

 Marlon Brown

 Karla Stratton

 Ashley Edwards

 Dessa Cosma

 LaChandra White

 CJ Eason

 Phyllis Meadows

 Jamie Stuck

 Mariah Martin

Telehealth Access

Work Group

 Sen. Marshall Bullock

 Rep. Sherry Gay-Dagnogo

 Denise B. Williams

 Judd Herzer

 Meghan Groen

 Darin McMillan

 Anthony Spagnuolo

 Paula Cunningham

 La’Toshia Patman

 Jametta Lilly

 Iris Taylor

 Marlon Brown

 Courtney Adams

 Sophia Hines

 Michelle Tylus

 Willie Brooks

 Casey McBryde

 Cheryl Moore

 Delores Brown

Environmental

justice Work Group

 Kara Cook

 Regina Strong

 Dessa Cosma

 Jamie Stuck

 Maureen Taylor

 Megan Miller

 Tremaine Phillips

RDTF Representatives

 Dessa Cosma

 Jamie Stuck

 Maureen Taylor

 Megan Miller

 Commissioner

Tremaine Phillips

EOG Support

 Kara Cook

 Regina Strong

INTERIM REPORT | NOVEMBER 2020INTERIM REPORT | NOVEMBER 2020