Sanilac County, Michigan

Located in Michigan’s “thumb” region, Sanilac County, with its fertile soil and proximity to Detroit’s auto industry, once offered residents a ticket to the middle class.

By the mid-1970s, however, profound environmental and economic events began to take hold in the region, influencing the future of Sanilac County and its residents. A 1973 incident in which mislabeled chemicals were accidentally sold as livestock feed and entered the food chain was described as one of the worst chemical disasters in U.S. history; it resulted in the quarantine of 500 Michigan farms and slaughter of thousands of livestock. In the late 1970s, the changing automotive industry began setting up assembly plants outside of Michigan, taking suppliers—and parts manufacturing jobs—with them. Even before the Great Recession, Michigan had already lost 211,000 jobs in the first years of the new millennium. The county continues to struggle from the permanent loss of auto parts manufacturing jobs that once supported Detroit’s automotive industry.

Today, farming remains vital to Sanilac County’s economy, with agriculture driving an increase in employment over the last 15 years. While the county’s population has declined, and health outcomes for adults are troubling, residents have higher rates of basic educational attainment compared with the state, and efforts to rebuild the county’s economy are ongoing.

Overview

Population and Demographics

Population: 42,000

SOURCES:
U.S. Census Bureau; photography courtesy of Flickr user Ken Lund, CC BY-SA 2.0.

Context and Actions

Community Context and Challenges

Higher educational attainment in Sanilac County lags behind the state; 11% of the population holds a bachelor’s degree or higher, compared with 29% for Michigan.
Between 2012 and 2014, Sanilac County’s mortality rates exceeded those in the state for several chronic diseases, including heart disease, liver disease, and diabetes.
Cases of child abuse and neglect in the county exceed statewide averages, with 124.7 children per 1,000 living in homes investigated for abuse or neglect, compared with the statewide average of 90 children per 1,000.
Sanilac county faces significant shortages in health care providers, with a ratio of 2,818 residents per primary care doctor, compared with 1,246 per primary care doctor for the state.
Access to and affordability of health care coverage are ongoing barriers to good health; one-fourth of residents polled in a hospital needs assessment said they or a family member did not obtain needed services in the past three years, with 12% reporting no insurance as the primary reason.

SOURCES:
Division for Vital Records & Health Statistics, Michigan Department of Health and Human Services (2014). Selected Chronic Disease Indicators, Sanilac County Residents and Michigan Residents, 2012-2014. County Health Rankings & Roadmaps (2015), Sanilac.

Taking Action

Sanilac County initiatives are focused on rebuilding the economic base and ensuring a healthier future for residents.

Despite the challenges of an uncertain economic future, unemployment in Sanilac County has dropped by more than half in the past five years, from more than 15% in 2010 to slightly above 6% in 2015, while efforts to retrain workers are showing encouraging signs as well. Meanwhile, residents and local organizations are taking part in initiatives to provide the next generation with a strong foundation for economic success and well-being.

Future Reports

Ways in which Sanilac County is making health a shared value will be explored in future reports.

Sanilac County Child Advocacy Center

The county health department, sheriff's office, public safety department, state department of human services and Michigan State University's extension service formed the S anilac County Child Advocacy Center in November 2013. The center offers integrated counseling services in a child-friendly setting to raise community awareness and protect children from further victimization.

Rising Tide

Sandusky, the County seat, was selected in 2015 as one of 10 pilot communities to develop new strategies for economic development. Sponsored by the Michigan Department of Talent and Economic Development, the Rising Tide initiative will help pilot communities develop zoning and development strategies to attract new businesses and help existing employers grow their businesses. Sandusky's plan emphasizes boosting homeownership and establishing a downtown development authority with the taxing authority to improve the downtown business district.

Responding to Practical Concerns

County health department officials are working to respond to practical concerns, such as transportation an internet connectivity, that contribute to residents’ difficulty in accessing health care services. The health department partners with the Thumb Rural Health Network, which attempts to better coordinate delivery of care for residents of Sanilac, Huron and Tuscola counties. Coordination of services is compounded by a significant shortage of primary care doctors, dentists and mental health providers compared with the state.

Going Forward

Sanilac County is slowly recovering from the economic turmoil of the past decade-plus, although the long-term stability of the region’s economy remains a work in progress. Efforts to improve the health and well-being of the population will require similar and sustained focus, given the prevalence of chronic disease and a significant shortage of health professionals. Additional surveillance, data and information gathering, analysis, and reporting will examine the extent to which current initiatives to retrain workers and improve child welfare are yielding positive outcomes, and whether the county is beginning to address the burden of chronic disease and shortage of health providers.

The following questions could help assess the extent to which health and well-being in Sanilac County will attain a similar degree of commitment as the region’s investments in economic redevelopment:

To what extent has the improved economy provided residents with jobs that offer health insurance benefits?
Which approaches are being examined or adopted by the health department and area health professionals to address the high rates of chronic disease and prevalence of smoking and obesity in Sanilac County?
To what extent can Sanilac County’s Great Start Program measure progress toward the goals it identified in its needs assessment for child health and well-being?
What evidence is there that Michigan’s changes to its Medicaid plan under the “Healthy Michigan Plan” demonstration program have improved health behaviors among Sanilac County residents?
How are community leaders and local hospitals working to attract and retain health care professionals to the region?
Which approaches have the county considered to address barriers to health care access associated with its rural nature?