34

Analyzing
Communities:
The product of a long semester
Juan Miranda



2

Table of Contents
Me, Myself, and I ............................................................ 3

27407- A socio-demographic profile ............................... 4

Neighborhood Windshield Tour ..................................... 9

Convenient Enough?-an assessment of three
neighborhood stores .................................................... 13

The Tale of Two Counties (and two states)- a comparative
analysis ........................................................................ 17


The Best of the Best- my favorite reflections ................ 39





3
Me, Myself, and I

As the Title Page insinuates my name is Juan Miranda. As you may
have inferred, I am a first year Masters in Public Health Education here
at UNCG. I received my undergraduate degrees at the same institution
with concentrations in Sociology and International Global Studies. I am
passionate about community and social justice and firmly believe that
community based research can play a very important role in helping
understand and ameliorate many of the issues in our society.
I am an activist and a community organizer. In fact, I was attracted
to public health because I saw in it a platform in which community
organizing and applied research intersected. The best of both worlds, I
thought. Nevertheless, the program has not been exactly what I
expected, but I try to remain patient and optimistic that I can shape my
time here to have more fulfilling experiences. I believe that many of the
skills that I am learning, especially those I learned in this community
health analysis course will be useful in my future endeavors.
What drives me is my passion for people, for justice, and equality. I
am interested in finding ways to change the world by facilitating
communication, by making information and education accessible, by
amplifying the voices of those people who are not heard. I wish to be
part of a process in which people become empowered to take reigns of
their environment and shape it as they see fit--- a future in which all
people are treated with respect and dignity and are able to live a healthy
and fulfilling life. I am not sure what this profession is, but as soon as I
find out, I will get back to you.


4




27407-
A socio-demographic
profile




5

6

7

8


9


Neighborhood
Windshield Tour






10
Windshield Tours: Intersection of West Florida St and Freeman Mill

Our research team focused on the roughly 0.33 mile radius surrounding two of our
three target convenience stores. The two stores, Florida Grocery Inc. and Saigon Mart,
are located side by side at the Freeman Mill Square Shopping Center located where
Freeman Mill rd with Florida St. meet; a busy intersection in a historically working class
area in Greensboro. Freeman Mill rd is especially busy as it has many entries I-85 and I-
40 as well as other smaller highways, and also leads to downtown. There are sidewalks
for the most part, and a couple of bus stops. However, public transportation is not always
reliable.
As we arrived in the stores we could see a few people walking around, several
were gathered at the parking lot. We drove around the parking lot looking at the shops
and when we stopped, a young man approached us and offered us marijuana. This was
not surprising to me; in fact I recognized the young man from previous solicits.
The shopping center looks somewhat barren, run down, with little commercial
activity exemplified by the several empty shops. Some businesses have managed to stay
alive, however. Along with the two convenience stores, there is a Laundromat, a
barbershop, a tattoo parlor, and a beauty supply shop. There are a couple of restaurants as
well, including a pizza place and a Laotian and Vietnamese caf. One can even find some
other services being provided at the tax, staffing, and travel agencies.
While there are several businesses within this range, the area is predominately
residential. Across the street from the shopping center stands Smith Homes Apartments,
one of the larger public housing projects in Greensboro. Jameson Mills Apartments are
just down the road. Looking the other way, across the Freeman Mill side, sits Glenwood

11
Neighborhood, the first planned neighborhood in the city. The houses in the general area
tend to look older and in many cases uncared for; several of them are in fact abandoned.
On Terrell St., sits Wiley Elementary School, just a couple of blocks from Smith Homes.
For working parents who have pre-school aged children, they can benefit from Kinder
Village Child Care Center off Freeman Mill. The Salvation Army Boys and Girls Club sit
right on the Smith Homes area. They work with the at risk youth in the area to help
maximize their opportunities for success as they offer a wide variety of services; from
health and life skills to educational and career development. The Caldcleugh
Multicultural Center, off Orchard St., offers after school programs for children K-6 at
relatively low cost. They also run a variety of cultural arts programs for teenagers and
adults.
Another important resource in this community is the Servant Center located off
Glenwood and Lexington Avenue. It provides hope and services to enable vulnerable,
homeless and/or disabled people to be independent members of the community. These
services range from a food pantry to low-income housing. Another important resource in
the community is Glenwood Coffee and Books, a bookstore and a community space in
the heart of Glenwood Neighborhood.
The area also counts with various institutions of faith. At the shopping center
itself, a store space has been converted into a Latino Pentecostal church. Edging
Glenwood neighborhood congregations meet at Glenwood Emmanuel Church and
Glenwood Presbyterian Church. Within the radius you can also find St. James Baptist
Church and the Old Landmark Independent Church even a Mosque on the Corner of

12
Glenwood and Grove St. These churches and places of faith might provide a wide variety
of services to assist people in need.
Aside from a few parks within the Glenwood Neighborhood, there is a
scarcity of green spaces in the area. This should be a big concern because children
on the other side of Freeman Mill would have to cross a very busy street in order to
access the parks. Even if that werent the case, it would require quite a bit of
walking.
This is an area I am very familiar with due to the work I do in the community. It is
a lower income area, ethnically diverse although with a very large African American
population. It is a community with visible needs and deficiencies, but also a community
with many assets, even though these tend to be less obvious. These assets are not listed
on the yellow pages nor can be seen by driving through, as they are not always formal
institutions. It can be caring neighbors, a strong communal identity. In general is a
community where great change can and will happen.



















13


Convenient Enough?-an
assessment of three
neighborhood stores








14
Background
Our team was able to visit three convenience stores within the area ZCTA 27403. The first was
named College Mart and was located on the edge of UNCG Campus at 403 Tate St. Naturally, the
population in the immediate area was predominately comprised of college students. Students who live both
on campus and on the surrounding neighborhood frequent the store.
The two other stores, Florida Grocery Inc. and Saigon Mart, are located side by side at the
Freeman Mill Square Shopping Center located where Freeman Mill Rd with Florida St. meet; a busy
intersection in a historically working class area in Greensboro. Immediately across from the stores sits
Smith Homes apartments, one of the largest public housing projects in the city of Greensboro.
Research Question
While the two areas are significantly different, the questions remained the same. What are the
perceived strengths and shortcomings of these stores? What would people like to see more of or completely
change in the stores? And would the store owners/workers be interested in working to meet these wants and
needs? The bottom line, of course, being what could we do to improve the availability and access to healthy
foods in local convenience stores? However, the latter one would not be possible if neither, the community
nor the stores are interested.
Methods
In order to grasp a better idea of the needs and wants of the community we conducted interviews
with the owners/workers as well as some customers. Identifying the worker/owners was very easy since
they stood behind the counter. We explained to them the purpose of our visit, and asked permission to look
around. We then asked them if they were able to answer a few questions. We were able to interview the
owner at Saigon Mart and a worker at Florida Mart. The worker at College Mart did not feel comfortable
speaking to us because his English was limited.
We also asked the owners/workers if it was possible for us to interview a few customers, the all
agreed. We conducted interviews (n=4) with customers at two of the three stores. We were not able to
interview any customers at Saigon Mart as none entered the store during the hour we were there. We tried,
to the best of our abilities to target our participants in order to get a broader representation of the
population. For example, we interviewed a student and a storeowner at College Mart. The participants were

15
interviewed inside the stores and lasted between 3 and 5 minutes. We were very careful to fit in the
interviews without interrupting the flow of business; this was particularly difficult at Florida Grocery, since
it was very busy.
We utilized semi-structured instruments to allow for more participant input and give the
interviewer flexibility to ask follow-up questions. The questions were straightforward so that the answers
could easily be coded. The responses were discussed between the researchers and analyzed along with the
data from the respective store inventory.
Results
The customers
I was personally able to interview two customers at Florida Foods and College Mart. Both
Participants reported that they visit the store frequently, but also explained that it was not their main store
grocery store. They both agreed that they mostly came to the convenience stores for drinks and snacks. The
student at College Mart said that as far as snacks, he likes Twizzlers, peanuts, and BBQ chips. He also
buys juice for liquor and American Spirit Cigarettes. The woman at Florida Foods said that sometimes
she buys simple stuff, such as milk, bread, and eggs; however, the big groceries are done at Food Lion,
which is relatively close.
Both customers said that they would buy fresh fruits and vegetables if they were available at the
store. When asked what else they would like to see in the store, the woman replied a restaurant. The
college student joked that he would like to see a bar, than said that music on the speakers would be good
too, in general, he said to enjoy the company of the free-spirited in the community.
The store owners/workers
I was only able to conduct an interview with one worker at Florida Foods. He was very friendly
and cooperative. He has been working for about a year and said to work many hours a week. He explained
that the store receives about 120 shoppers every day, although many entered more than once. He said most
of what they bought was chips, bread, milk, and beer.
When asked if customers asked for healthier options, he responded not really. However, as he
explained, if people ask for something, they try their best to get it for them, after all, as he explained, they
are our customers, and we want to give them what they want. He said that if there was a large enough

16
clientele, they would love to have fresh fruits and vegetables, but he is not sure people would buy them.
When asked about the role of the store in the community, he answered, we are very important because we
are in a bad neighborhood and people buy a lot of junk foodwhatever they have access too.
Discussion
By analyzing the data gathered, we can see several patterns emerge, the most important being that
there is a desire in the community for the stores to carry more fruits and vegetables. Moreover, there is
willingness in the stores to carry fresh produce as long as there is a clientele for it. This opens up many
possibilities as long as we are able to work with the stores and the communities to make healthier options
available and accessible.
With that said, the data gathered is significantly limited and cannot be generalized. At the same
time there are other factors that have not yet been taken into account. For example, would people be able to
afford healthier options if they were available? Would people who are not used to consuming these
healthier options, feel comfortable, compelled to purchasing them? Furthermore, is there even a real
interest in the broader community for healthier options? These questions can only be answer through a
more thorough exploration of the needs and wants of the communities in the area. For now, however, it
seems like there is potential for great things to happen in the future.






17







The Tale of Two Counties
(and two states)
- a comparative analysis





Introduction

18

We can only manage what we measure. This is true about most aspects of life and no different
in the field of Public Health. Being able to access and comprehend health status and risk information is
essential for public health educators in helping us assess the strengths and needs in a specific community.
Understanding health information can provide us with a map of what the issues are, how they came to be,
what the tools we possess are, and how we should go about fixing them. Without data we would have no
idea where we stood, nor the direction in which we should go. Thankfully, such data exists.
For this assignment, I utilized the data found on americashealthrankings.org to conduct a
comparison between the overall health status of Michigan with that of Vermonts, the number one ranked
state in the nation in terms of health status. Furthermore, with information found in
countyhealthrankings.org, I conducted a similar comparison between the highest and the lowest ranked
counties in Michigan.
Being able to make these comparisons (between states and counties) is very useful because it
highlights the discrepancies between different geographical localities. Thus, we can prioritize where the
most help is needed and where resources should be allocated. At the same time, we are able to further
understand the factors that play a role in determining the health status of a particular area and we grasp a
better idea of the types of changes and modifications that could have a positive impact and lead to better
health outcomes.

Michigan

Located in the Great Lakes region, Michigan is the 8
th
(9,876,187) most

populous state in the country and 11
th
most extensive in total area.
i




https://en.wikipedia.org/wiki/File:Michigan_in_United_States.svg https://en.wikipedia.org/wiki/File:Flag_of_Michigan.svg



19
According to the 2010 Census, 50.9 percent of Michigans population is female, 80.2 percent is
white (4.5 percent of Hispanic or Latino Origin) while 14.3 percent is black. Alaskan Native and American
Indians make up .7 percent, Asians-2.5 percent, and those who reported two or more races were just above
2 percent of the population. The population has a healthy distribution among age groups with nearly a
quarter of the population being under the age of 18 and about 14 percent of people being 65 years of age or
over. In terms of income, per capita the average is $25,135 while the Median household income is
$48,432.
ii


Age Percentage
Under Age of
5 5.90%
Under Age of
18 23.20%
Over Age of
65 14.10%





Sex Percentage
Male 49.1
Female 50.9








Race Michigan U.S.
White 80.20% 78.10%
Black 14.30% 13.10%
American
Indian
and
Alaska
Native 0.70% 1.20%
Asian 2.50% 5.00%
Native
Hawaiian
and
Other
Pacific
Islander Z 0.20%
Two or
More
Races 2.10% 2.30%



Michigan U.S.
Per capita money income
$25,135 $27,334
Median household
income $48,432 $51,914






Overall Health

20

According to Americas Health Rankings:
iii


In the past five years, obesity increased from 26.2 percent to 31.7 percent of the adult population.
Now nearly 2.4 million Michigan adults are obese. Moreover, obesity is more prevalent among
non-Hispanic blacks at 41.1 percent than non-Hispanic whites at 29.1 percent.

In the past year, diabetes increased from 9.3 percent to 10.1 percent of the population; 761,000
adults now have diabetes. Diabetes also varies by race and ethnicity in the state; 13.8 percent of
non-Hispanic blacks have diabetes compared to 8.6 percent of non-Hispanic whites and 10.7
percent Hispanics.

While smoking has decreased from 24.1 percent to 18.9 percent of the adult population in the past
ten years, more than 1.4 million adults still smoke in Michigan.

In the past five years, the violent crime rate decreased from 554 to 490 offenses per 100,000
people.

In the past ten years, the percentage of children in poverty increased from 13.8 percent to 20.4
percent of persons under age 18.


Michigan Vs. Vermont

Overall, Michigan is ranked #30 among the 50 states in terms of health status. This is alarming
particularly because of the size of the population of the Great Lake State. Moreover, Michigan has been
one of the states most affected by the economic crisis, which is very much connected to many of the
determining factors of the health condition in which it finds itself today. On the other hand Vermont, which
is ranked #1 in the nation, has been able to maintain a generally better health status, even throughout the
economic uncertainty. Thus, it could only be beneficial to understand these difference and the factors that
have contributed to the discrepancies in the overall health status of both states. For this comparison we
focus on five general areas: Health Outcomes, Behavioral Factors, Social and Economic Conditions,
Physical Environment and Access to Health Care and Public Health Services.

Health Outcomes

Infant Mortality

This measure indicates the number of infant deaths that occur before age 1 per 1,000 live births.
This is an important indicator because high rates of infant mortality are preventable. Also, it represents
many factors related to birth including access and quality to prenatal care. Moreover, the United States has
a consistently higher infant mortality rate than other developing countries and reducing is one of the goals
of Healthy People 2020.
iv


21
By this measure, Michigan is ranked 39
th
with a value of 7.7 infant deaths per 1,000 live births as
opposed to Vermont which is ranked 2
nd
with a value of 4.8 infant deaths.



As demonstrated by the graphs above, while the general trend has been

decreasing, for the past four years Michigans chart has plateau while Vermont has

continued to decrease consistently and remains significantly lower.

Cardiovascular Deaths

This measure indicates the number of deaths due to all cardiovascular disease, including heart disease and
strokes. Like other lifestyle diseases, cardiovascular conditions can be prevented by simple changes such as
being physically active, eating well, and not using tobacco.
v
However, in the United States heart disease
and stroke are the number 1 and fifth most common cause of death, respectively. Based on this indicator,

22
Michigan is ranked 42
nd
with a rate of 306.5 deaths per 100,000 population while Vermont is ranked 10
th

with 235.1 deaths.




Once again, both states have had a similar reduction rate, however, Vermonts number of
cardiovascular death is significantly lower. It is also important to note, that while overall number of
cardiovascular deaths have gone down, this is greatly as a result of medical advances that are keeping many
sick people alive. Thus, it would be hard to tell from this indicator alone if Vermont is doing better because
they have better medicine or better preventive health care.



Behavioral Factors

Adult Smoking


23
Adult Smoking is defined as percent of the population 18 years and up who smoke tobacco products
regularly (those who have smoked at least 100 cigarettes and are currently doing so). Even though smoking
has consistently declined since 1990, it remains a serious health issue in the United States. The adverse
impact of smoking ranges from increased cases of respiratory diseases, to higher rates of heart disease,
stroke, cancer, preterm birth, and premature death. It is estimated that there are close to 443,000 tobacco
related deaths every year.
vi
Moreover, it is a lifestyle behavior that can easily be changed if proper support
and resources are accessible.
Michigan is ranked number 33 in this category where self-reported smokers make up 18.9 percent
of the adult population. Vermont, is ranked 12
th
where cigarette smokers make up 15.4 percent of the adult
population.



Both states seem to have a consistent decline in the percentage of their population that smokes. It
might be that with time Michigan will catch up with Vermont. Either way, as of now, there is a significant

24
difference of 3.5 percentile points. The higher rates of smoking in Michigan might be directly related to
other struggling indicators.
Diet, Fruit and Vegetables
This variable calculates the percentage of the population that reports to consume the recommended
servings of fruits and vegetables in their daily diet. These are based on the recommendations by Dietary
Approaches to Stop Hypertension (DASH), which suggests that half your plate should consists of fruits and
vegetables.
vii
This is an important category because a healthy diet is essential to overall health as fruits and
vegetables are the source for key vitamins, minerals, and fibers that protect us from chronic diseases.
Moreover, healthy eating is connected to a variety of other factors ranging from level of education to
socioeconomic status and availability/accessibility of foods.
For this indicator, Michigan falls to the 31
st
place with 22.5 of the population adhering to the
dietary recommendations set by DASH. The first place is reserved for Vermont where almost 30 percent of
the population meets the recommended minimum consumption of fruits and vegetables.


By looking at the graphs above it is evident that Vermont has been able to maintain a consistent
rate, while Michigan has struggled to increase the percentage of people who are adhering to the DASH
recommendations. There is a large difference (almost 7 percentile points) between both states and it would

25
be interesting to compare the number of food desserts in each of these to see if there is a relationship
between accessibility to fruits and vegetables and the discrepancies in overall consumption.

Physical Activity

This measure indicates the percentage of adults who have participated in any physical activities in
the last 30 days. Physical activity is broadly defined to encompass activities available to most individuals.
Physical activity is an important behavior because it has so many benefits to overall health, from mental
health, to stronger bones and muscles, to diminishing risk of cancer.
viii
In this category, Michigan is ranked
23
rd
where 76.4 percent of the population is reportedly physically active while Vermont is ranked number 2
(82.1 percent of population is physically active).



It doesnt seem like there have been significant changes in either state; both rates have remained
very consistent. It would be pertinent then to look at other structural and ecological factors that might
explain the disparities between both states. It could be as simple as the number of sidewalks and green
areas, to high crime rates that keep people inside their homes.

26

Social and Economic Conditions

High School Graduation Rate

This indicator estimates the percentage of incoming ninth graders who graduate within four years.
This is a very important measurement because education is essential to development of individuals a key
contributor to a persons overall health. People who are educated are more likely to live a healthier life
style and be more capable to navigate the health care system.
ix
It is also an important indicator because of
the large difference between Vermont and Michigan. Vermont is ranked number 2 with 89.3 percent of
incoming ninth graders finishing high school within four years while Michigan places 27
th
with only 76.3
percent.



As shown above, there is a difference of 7 percentile points between the proportions of students
that graduate high school in four years in Michigan and Vermont. This difference can be attributed to a
wide array of factors such as the amount of dollars being invested in education or other social and
economic problems such as high crime rates, unemployment.

27

Children in Poverty

This indicator measures the percentage of persons 18 and under living in a household with a
median income below the poverty threshold ($22,113 for a family of four).
x
This is an important measure
because it demonstrates the impact of tough economic times on a very vulnerable population. Children
living in poverty are more susceptible to disease due to improper nutrition and limited educational
opportunities as well as limited access to preventive and clinical health care. Vermont is ranked 10
th
, with
13.5 percent of children living below the poverty line, while Michigan sit on the 26
th
place with more than
20 percent of the children population are part of households living in poverty.



Even though Vermont is ranked 10
th
in this measurement it still has a clear

advantage over Michigan (roughly 7 percent).

Unemployment

This is a very important measurement because percentage of unemployed people is a strong
indicator of he economic state of a country. Moreover, many individuals depend on their employees health

28
insurance for coverage. Without a consistent income, it is difficult for an individual to live a sustaining and
healthy life. This is also a very significant indicator because Michigan sits second to last in this
measurement with a 12.5 percent unemployment rate, well above the national rate. Vermont is ranked as
number six with only 6.2 percent unemployment.
xi





Physical Environment

Air Pollution
xii


Air pollution is the population-weighted average exposure to fine particulates in the air (2.5
micron and smaller). Air pollution is an important indicator because its potential adverse effects: asthma,
chronic bronchitis, irregular heartbeats, decreased lung function, etc. Moreover, it is an important aspect of
our physical environment, because people, especially those with fewer resources, have very little control

29
over it. In this category Vermont is ranked 6
th
, with a value of 7.1 while Michigan sit on the 28
th
spot with a
value of 10.1.




Access to Health Care and Public Health Services

Public Health Funding
xiii


This indicator measures the amount of dollars per person that are spent on public or population
health through funding from the Health Resources Services Administration, The Centers for Disease
Control and Prevention, and the state government. This is also an indicator of the states priority to invest
in preventive and education programs designed to improve health of vulnerable populations within the
state. Michigan is ranked 40
th
by this measure with only $54.87 spent per person while Vermont which
spends nearly 3 times as much ($153.54) is ranked 3
rd.



30



Lack of Insurance

This indicator measures the percentage of the population not covered by private or public health
insurance. It is an important indicator because lack or insufficient insurance is the number one cause of
poverty in the United States. People without health insurance are unable to receive preventive care and are
forced to visit clinics or even the emergency rooms once they have become sick.
xiv
Vermont is ranked 5
th

with only 9.5 of the population being uninsured while Michigan is 16
th
as 13 percent of the population is
not covered by a health insurance policy.

31




Ontonagon County
xv


Ontonagon County is situated in the northwest corner of Michigans Upper Peninsula. The
natives named the area after the bowl-like shape of the mouth of the Ontonagon River at Lake
Superior. With its many waterfalls and rivers it has become a tourist hub. It has a local population of
about 6,600. The population is overwhelmingly white (97 percent), 1 percent of which is Hispanic.
The rest is mainly composed of American Indian/Alaskan Native people (1.7 percent). There are
more males than females (41.4 vs. 48.6 percent). The median household income is $35,269, which is
significantly lower than the state average (over $48K).
xvi
In terms of health, Ontonagon County is
ranked 82 out of 83 counties; the lowest since the 83
rd
county is not ranked.



34
Sex Ontonagon Michigan
Male
51.40% 49.10%
Female
48.60% 50.90%

Ontonagon Michigan
White 97.00% 80.20%
Black 0.20% 14.30%
American
Indian and
Alaska
Native
1.20% 0.70%
Asian 0.20% 2.50%
Native
Hawaiian
and Other
Pacific
Islander Z Z
Two or More
Races 1.30% 2.10%

Ethnicity Ontonagon Michigan
Hispanic or
Latino Origin 1.00% 4.50%
White
persons not
Hispanic 96.20% 76.40%



34
Measurement Ontonagon Michigan
Per capita
money income
$21,448 $25,135
Median
household
income $35,269 $48,432


Ontonagon vs. Leelanau
As mentioned previously, Ontonagon County is the lowest ranked county in Michigan in terms of
overall health. In order to better understand the health issues in Ontonagon as well as the factors associated
with its health outcomes we will compare five different aspects of health status and risk with the highest
ranked county Michigan, Leelanau County. The vice areas we will compare are: Health Outcomes,
Behavioral Factors, Social and Economic Conditions, Physical Environment and Access to Health Care and
Public Health Services.

Health Outcomes

Premature Death-Years of Potential Life Lost (YPLL-75)
xvii


This indicator represents the years of potential life lost before age 75 (i.e. a person who dies at age
25 equates 50 years of life lost). This indicator is very useful in that it represents the frequency and
distribution of premature deaths. In this case, comparing YPLL among counties can help us target resources
to counties with highest risk. Ontonagon is ranked 65
th
among all 82 ranked counties in Michigan with an
YPLL of 11,422 while Leelanau is number 1 with a mere 3,611. This shows that for whatever reason, more
people are dying at a younger age in Ontonagon than in Leelanau.
Poor Physical Health Days
xviii


This indicator represents the average number of days people reported that their physical health was
not good in the past 30 days. Physical health can include illness and injury. This is important because it
gives us an idea of the recent physical health of people. Ontonagon is ranked last with an average of 6.6
days of poor physical health while Leelanau is tied for 32
nd
place with an average of 3.5 days of physically
unhealthy days. In other words, people in Ontonagon are almost twice as much likely to feel physically ill
on any given day than people in Leelanau.

34

Poor Mental health Days
xix


This indicator represents the average number of days people reported that their mental health was
not good in the past 30 days. Mental health can include stress, depression, and problems with emotions.
This is important because it gives us an idea of the general mental health of people. Mental health is an
important component of overall health and gives us an idea of the overall quality of life people are leading.
Ontonagon is ranked second to last with an average of 7.3 days of poor mental health while Leelanau is tied
for 63rd place with an average of 4 days of mentally unhealthy days. In other words, people in Ontonagon
are significantly more likely to feel stressed, depressed, or have problems with emotions on any given day
than people in Leelanau.

Behavioral Factors

Adult Obesity
xx


The adult obesity measure represents the percent of the adult population (age 20 and older) that
has a body mass index (BMI) greater than or equal to 30 kg/m2. Obesity is the result of poor diet and
limited physical activity. Moreover, obesity is associated with health conditions such as heart disease, type
2 diabetes, hypertension, stroke, and many more. Thus, measuring it can help us identify other issues that
need addressing. There is not much of a difference between the Ontonagon and Leelanau counties as
obesity is present in 32 percent and 31 percent of their populations, respectively.

Physical Inactivity

This indicator estimates the percentage of adults aged 20 and over that report having no leisure
time physical activity. Insufficient physical activity is associated to several health conditions such as type
2-diabetes, stroke, cardiovascular disease, and premature mortality, independent of obesity. In this case,
Ontonagon County is better ranked with only 23 percent of the population reporting being physically
inactive as opposed of Leelanau with 29 percent.
Social and Economic Conditions

High School Graduation
This indicator estimates the percentage of incoming ninth graders who graduate within four years.
This is a very important measurement because education is essential to development of individuals a key

35
contributor to a persons overall health. People who are educated are more likely to live a healthier life
style and be more capable to navigate the health care system. Leelanau County has a significant advantage
of 3 percent over Ontonagon County, which has a graduation rate of 86 percent.

Unemployment

This is a very important measurement because percentage of unemployed people is a strong
indicator of he economic state of a country. Moreover, many individuals depend on their employees health
insurance for coverage. Without a consistent income, it is difficult for an individual to live a sustaining and
healthy life. There is a vast difference between the unemployment rates of both counties. While Leelanau
currently experiences a 10.1 percent unemployment rate (well below the state average, 17.1 percent of
Ontonagons workforce is jobless. This statistic by itself can help us identify potential factors connected to
the discrepancies we see in between the health outcomes of each county.

Children in Poverty

This indicator measures the percentage of persons 18 and under living in a household with a
median income below the poverty threshold ($22,113 for a family of four). This is an important measure
because it demonstrates the impact of tough economic times on a very vulnerable population. Children
living in poverty are more susceptible to disease due to improper nutrition and limited educational
opportunities as well as limited access to preventive and clinical health care. Once again we see a drastic
difference between both counties. Leelanau county is ranked 7
th
in the state with 15 percent of its children
population living under poverty while in Ontonagon County, over 27 percent of children live in households
with median incomes below the poverty threshold.

Physical Environment

Air Pollution-particulate matter days

Air pollution is the population-weighted average exposure to fine particulates in the air (2.5
micron and smaller). Air pollution is an important indicator because its potential adverse effects: asthma,
chronic bronchitis, irregular heartbeats, decreased lung function, etc. Moreover, it is an important aspect of
our physical environment, because people, especially those with fewer resources, have very little control
over it. In this case both counties fall below the state average of 5 days-Ontonagon County 1 day and

36
Leelanau 2 days, respectively. Perhaps we can look at some of the factors that contribute to these low rates
and find ways of incorporating them in solutions for the rest of the state.

Limited Access to Healthy Foods

This measure indicates the proportion of the population who are both living in poverty and do not
live close to a grocery store (1 mile in metro counties and 10 miles in non-metro counties).
xxi
This is an
important indicator because it reflects on the realities of certain food environments and the consumption or
lack there off healthy foods. This issue is predominately critical in Ontonagon County where 11 percent of
the population has limited access to healthy foods. In Leelanau County, 3 percent of population has limited
access to healthy foods.

Access Health Care and Public Health Services

Uninsured

This indicator measures the percentage of the population not covered by private or public health
insurance. It is an important indicator because lack or insufficient insurance is the number one cause of
poverty in the United States. People without health insurance are unable to receive preventive care and are
forced to visit clinics or even the emergency rooms once they have become sick.
xxii
Ontonagon County falls
slightly behind in this category, as 15 percent of its population is currently uninsured as opposed to only 14
percent in Leelanau. Nevertheless, both these rates are extremely high.

Primary Care Physicians
xxiii


This indicator measures the ratio of the population per one health care provider. Primary care
physicians include practicing physicians specializing in general practice medicine, family medicine,
internal medicine, pediatrics, and obstetrics/gynecology. This is important because availability of health
care providers is the other component along with insurance coverage to health care access. In this category,
Ontonagon County is doing significantly better than Leelanau County with a 2,242 to 1 patient to physician
ratio in comparison to Leelanaus 4,369 to 1 ratio. However, some factors need to be taken into account
such as the percentage of the population that can actually afford those physicians, and what the specialties
of those physicians are.

37
Health Outcomes
Health Behaviors
Social and Economic Conditions
Physical Environment
Access to Health Care and Public Health Services

Indicator
Ontonagon
County
Leelanau
County
Michigan
Premature Death (years
lost per 100,000
population)
11,422 3,611 7,273
Poor Physical Health Days
(Average (days) in the past
30 days)
6.6 3.5 3.5
Poor Mental Health Days
(Average (days) in the past
30 days)
7.3 4 3.7
Adult Obesity (percentage
of population)
32% 31% 32%
Physical inactivity
(percentage of population)
23% 29% 25%
High School Graduation
(percentage of students
from the same 9th grade
cohort)
86% 89% 76%
Unemployment (percentage
of working force)
17.1% 10.1% 12.5%
Children in Poverty
(percentage of population)
27% 15% 23%
Air Pollution-particulate
matter days (Average
(days) in the past 30 days)
1 2 5
Limited Access to Healthy
Foods
11% 3% 6%
Uninsured (percentage
population)
15% 14% 14%
Primary Care Physicians
(ratio patients: physician)
2,242:1 4,369:1 1,119:1



Conclusion

38
As mentioned previously, being able to compare the health status and risk data between states and
counties can very beneficial to public health professionals. It allows us to see where the greatest need
resides but also help us better understand those needs and the factors related to them.
By comparing Michigan and Vermont, we are able to see significant disparities between the two
states. Vermont has very successful in most of the categories presented above and consequently ranks first
in overall health outcomes. On the other hand Michigan has struggled to keep up with some of the most
basic indicators usually falling among the 30 something places. We can see similar patterns when
comparing Ontonagon County and Leelanau County. Leelanau tends to do better in almost every
behavioral, socioeconomic, ecological, and accessibility indicator. This is projected by the more positive
overall health outcomes.
While the answer to why they are so different is quite complex, it is important that we look at the
structural and ecological factors that play a role in determining peoples health. For example, the fact that
Vermont spends nearly three times as much than Michigan in health care and public health education is
more than just a coincidence. Or the fact that a significant larger portion of the population in Ontonagon
has limited access to healthy foods is likely to be related to the less successful morbidity indicators. For
these disparities to be abolished, it is essential that we address the broader issues that incapacitate people to
make better decisions.
Notes:

i
https://en.wikipedia.org/wiki/Michigan
ii
http://quickfacts.census.gov/qfd/states/26000.html
iii
http://www.americashealthrankings.org/MI
iv
http://www.americashealthrankings.org/MI/IMR/2011
v
http://www.cdc.gov/heartdisease/index.htm
vi
http://www.cdc.gov/tobacco/
vii
http://www.americashealthrankings.org/MI/Diet/2011
viii
http://www.americashealthrankings.org/MI/PhysicalActivity/2011
ix
http://www.americashealthrankings.org/MI/Graduation/2011
x
http://www.americashealthrankings.org/MI/ChildPov/2011
xi
http://www.bls.gov/eag/eag.mi.htm
xii
http://www.americashealthrankings.org/MI/PM25/2011
xiii
http://www.americashealthrankings.org/MI/PH_Spending/2011
xiv
http://www.americashealthrankings.org/MI/HealthInsurance/2011
xv
https://en.wikipedia.org/wiki/Ontonagon_County,_Michigan#Demographics
xvi
http://quickfacts.census.gov/qfd/states/26/26131.html
xvii
http://www.countyhealthrankings.org/app/michigan/2012/measures/outcomes/1/map
xviii
http://www.countyhealthrankings.org/app/michigan/2012/measures/outcomes/36/map
xix
http://www.countyhealthrankings.org/app/michigan/2012/measures/outcomes/42/map
xx
http://www.countyhealthrankings.org/app/michigan/2012/measures/factors/11/map
xxi
http://www.countyhealthrankings.org/app/michigan/2012/measures/factors/83/map
xxii
http://www.countyhealthrankings.org/app/michigan/2012/measures/factors/85/data
xxiii
http://www.countyhealthrankings.org/app/michigan/2012/measures/factors/4/map



39




The Best of
the Best:
My
Reflections








40


PHE 603- Week Two Reading Response
Posted by Juan Miranda Buzetta at Monday, September 3, 2012 8:05:22 PM EDT

This week, I paid particular attention to Taboada's paper on power and
privilege in health programs. I found her article incredibly insightful and pertinent
to our development as health educators, especially those who are interested in
working directly with the community. In general, power and privilege, especially
when dealing with disparities among marginalized groups, tends to be one of the
most overlooked and misunderstood aspects of any type of community organizing. I
know that in my personal experience as a social justice activist, there is a constant
struggle to keep this complex conversation at the forefront of any organizing and
interaction, especially when dealing with communities other than your own. On the
other hand, my experience working with agencies seeking to "help" communities
develop has often lacked the same discussion, even when the conditions are
identical. This contrast struck several chords in me.
The reality, is that a power/privilege analysis is essential to fully grasp an
understanding of the conditions of a specific community and have more clarity in
how we should approach working with it. Without it, how can one understand the
frustrations, the cynicism, the fear, the distrust, and the hopelessness in the
community. No matter how motivated a presumptuous hero is when he does not
realize that the people he is trying to save actually look at him as part of their
problems.
Today, in a society where we are told to be (or pretend to be) colorblind, after

41

all, we are all "equal", and where we are taught that poor people exist because they
either didn't work hard enough, or they were less fortunate than us, to have a deep
conversation about structural, cultural, and internalized racism, sexism, ageism,
classism, etc. is not the most popular thing. In fact, many people feel very
uncomfortable when presented with those types of questions. Even those with the
best intentions are likely to avoid, or get defensive when confronted with situations
when "checking" their privileges is necessary. Thus, we have eager to help people
diving into those "less fortunate" communities to save them who end up getting
burned out when the people she or he is trying to save fail to participate, or "help
her or him help them". The well-intentioned individual might become frustrated,
angered, and lose hope that anything can be done. In many case their conclusion is
that the people is the problem. It is not a very difficult trap to fall in, as I have
learned.
One day, a family came to our office asking for help. HUD was threatening them
with eviction. After examining all their paperwork and the claims by the HUD
officials, we determined that they were being unjustly accused of several violations
that they were not actually responsible for. There was substantial evidence of racial
discrimination and abuse of authority by the administration of the apartment
complex and the HUD officials. After trying to contact the HUD (they refused to
answer/return our calls, emails, and faxes). We warned with taking legal action.
They seemed to be intimidated because they returned the call right away agreeing
to meet with the family and us. I was extremely invested, both time-wise and
emotionally, in this particular case. I spent an entire week researching tenant rights

42

and public housing laws to help support the family. The day finally came when we
met with HUD. In short, they were as aggressive as we anticipated, accusing the
family of all these baseless claims all for which we had evidence to debunk. The
mother broke into tears and apologized to the same people that were discriminating
against her and begged for their forgiveness. The administration, while still
threatening, decided to give her one more chance, and she was happy to stay.
Needless to say I was enraged. Discrimination is very common in this county
and the opportunities to stand up against it are few and far in between. I wasn't
upset because all of the work I had put into it this case that basically went to waste,
but I felt betrayed. I had met in many occasions with the family to discuss what we
were doing. We had enough evidence to put some heat on the Housing Authority
and the administration of the apartment complex and set a precedent that they will
no longer be treating immigrant tenants badly. Begging for forgiveness even though
she knew she was on the right was not the plan. My boss agreed with me, he thought
that I had the right to be angry and encouraged me to let the family know how
disappointed I was. To this day, I am glad that I didn't.
After calming down, and spending lots of time thinking I began to see things
more clearly. Who was I to judge the mother's actions. Who was I, someone who had
the luxury to basically volunteering for less than minimum wage to "help" people in
need. Someone who was able to go to school, to have no problem paying for a
comfortable apartment, someone who did not have to worry taking care of my four
children on my own. Why would she be concerned about setting a precedent to help
all the immigrants of XXX County when she is not sure how she is going to feed her

43

children, she could most definitely not afford to be thrown out of her apartment. At
this point I felt disgusted with myself, felt really disappointed, but eventually was
able to learn from this experience and redirect is as energy to keep fighting a system
that incites fear in the minds of people, that dehumanizes and takes away their
dignity, to the extent that they will beg for forgiveness from the people who are
doing wrong to her.
The Rebirth of Oakland and Detroit
Posted by Juan Miranda Buzetta at Monday, November 19, 2012 11:27:42 AM EST

The documentary we watched in class depicted the stories of Oakland and
Detroit: two cities that experienced outstanding growth for most of the 20
th
century
only to find themselves in shambles today. These are just two examples of the
common trend experienced by many metropolitan areas across the country in the
past 30 years or so. In a combination of changes in the market along with
suburbanization of the land, dense urban were left behind.
While those with higher income, predominately white, middle and upper
middle class families, were able to escape to the outskirts of the cities, those who
remained, predominately families of color and of lower income remained in the
inner cities to face the realities of de-investment and mass-scale unemployment.
They gradually saw their neighborhoods fall apart as people started to move out,
leaving abandoned houses behind. Since little income taxes were being generated,
the city began to divest in the neighborhood schools, employment-training
programs, community projects, and services. Within a few years these communities
entered the vicious circle of inner city poverty.

44

The videos highlighted several of the public health concerns related to the
effects of the level of poverty and lack of resources in these communities. These
concerns range from food deserts to air pollution, to high crime rates, to access to
health care. The documentary did a magnificent job at putting in perspective the
implications these conditions have on people, such as the early development of
asthma in children, or the obesity problem as they grow up and become adults. At
the same time, however, the video demonstrated a different side of these
communities. A side in which stands out the resiliency of people, the love for their
community, their talent and creativity of individuals, as well as the willingness to
change their environment.
In both, Oakland, and Detroit we are able to see two communities that have
been devastated, yet consequently, brought closer together and re-energized to do
the work needed to bring their city back. They have been able to inspire others, with
their love and pride in their community. We can diverse peoples that have found
common grounds on which to build from and seem to have the same goals of
creating a sustainable and health promoting community.
Thus, they have been able to organize and mobilize to change policies that
help improve the air quality in their neighborhoods, they have found new ways to
build infrastructures, which are more sustainable and community friendly, they
have been able to start community gardens that can help make fresh fruits and
vegetables more accessible while also building a sense of community and a feeling
independency. These are peoples that have become empowered and are willing to
take control over their environment to shape it as they see fit.

45

This approach to development, however, is completely different, and to some
extent opposite to the process of gentrification. To gentrify, as defined by most
dictionaries, is to renovate or to improve so that it conforms to middle class taste.
In other words, gentrification is not necessarily about improving existing structures
but rather replacing them with others that adhere to the conventions of the middle
class. Moreover, while the former type of development focuses on the strengths in
the community and attempts to maximize the existing resources, gentrification
highlights the deficiencies in order to legitimize the overhauling of those
communities.
Many see gentrification as a very patriarchal approach because it basically it
basically deals with a more powerful, more resourceful group deciding what an area
should look like, even if there were already people there who had very different
ideas. It ignores the needs and wants of the existing population and forces them to
adhere to a new set of values endemic to the middle class. Another concern with
gentrification is that erodes diversity by transforming traditionally mixed-income
(often multi-cultural) areas into more exclusive zones, which ultimately lead to a
more homogenous population.
The process runs working class people out, because as they cannot afford to
live in the new shiny condominiums. Moreover, those who maintain their homes
struggle to keep up with the taxes as property values rise. As a result the community
around suffers as well, gentrification is an evolving, never ending, monster that eats
away diversity and replaces it with middle class ideals.

46

In view of this, gentrification does very little fix any of the existing ills in a
community, but rather displaces people and transfers the plight elsewhere. Thus
governments and private parties should invest more in the types of development
seen in Oakland and Detroit. These modes of development are more community
based, grass root and sustainable since it empowers people to take control of their
own lives. At the same time it is more effective because it focuses on the roots of the
problems rather than displacing the problems. Most importantly, it respects the
lives, the history, and the values of people who make the community work.


The End. For Now.