Detroit built its public health departments back in the 1800s, when cholera was rampant.
But in 2012 the city gutted that department and privatized it. Now, after its historic bankruptcy, public health is back under city management. But it’s a shell of a what it once was.
The man in charge of building it back up is Abdul El-Sayed, a 31-year old Arab American born and raised in metro Detroit. I spent a day with El-Sayed to see what goes into rebuilding an entire division whose main purpose is to protect and improve people’s health.
El-Sayed is a Rhodes Scholar with a PhD from Oxford, a medical degree from Columbia University. With those credentials, he could’ve gone anywhere, done anything. But he wanted to give back to the city he calls home, so when he saw the health director position, he jumped at it.
Even if he only had $1 million to work with.
If that sounds like a lot, it's not.
El-Sayed points to Baltimore, a city "not known as a paragon of financial security" as a comparison. He says Baltimore invested "about $41 per person per year" as a city last year, whereas Detroit invested "$1.50 per person per year."
That was last year’s budget. Luckily, he says, they had some state and federal money to pick up the slack, and his budget is expected to grow to $10 million in three years.
His day is jam packed with meetings and one-on-ones, most of which I wasn't allowed to record: a cabinet meeting with the mayor, a phone call from a city council person; a chat with an epidemiologist about a potential company the department might team up with, etc.
While I wait for these conversations to end so I can turn back on my recorder, I can’t help but notice a book on the conference table in his office. It’s the only one on display; the rest are tucked away on a bookshelf. It’s about the making of the musical Hamilton.
There’s a line in the show where Hamilton says he's like America: young, scrappy and hungry. It occurs to me -- that’s an apt description for El-Sayed; he’s young, and hungry to get to work, to improve the lives of the 680,000 residents in the city.
El-Sayed has spent pretty much his entire academic career thinking about health disparities and why some groups have higher rates of certain diseases than others. He'd see those disparities play out in the New York City hospital where he worked for a time, but by then it's too late to change the outcomes. Health disparities aren't solved at the hospital level, he says, but rather are determined much earlier in life, during childhood or even before that, in gestation. "It became clear to me," he says, "that I wanted to work at the level where these disparities were created."
That's why he took the job in Detroit, and that helps explain why his vision for the department is so far-reaching. Ever the scholar, he calls it his "thesis."
"My thesis for our department is to leverage health to interrupt inter-generational poverty."
He wants to interrupt inter-generational poverty. As the head of the Public Health department. Sit with that for a minute.
It’s an enormous challenge, but El-Sayed is an optimist, with a plan.
The plan starts by improving early childhood outcomes. He and his team are working on a number of projects -- everything from helping kids with asthma get real-time information about air quality, to ensuring that every kid who needs glasses, gets glasses.
"There was a really fantastic study out of China where they ran a randomized trial of glasses for children," explains El-Sayed, "and they followed these children up over decades and found that the children that were given glasses to address their eyesight challenges, those kids had something like several thousand dollars' increase in earnings compared to the ones who weren’t, and so we really want to tackle that challenge."
His plan would streamline the process so that kids who get screened for vision can pick up their glasses at their school two weeks later.
He also wants to tackle the high rate of teen pregnancies. ("How do you save two kids' lives at one time?" he asks. "Prevent her from getting pregnant.") And he wants to reduce the number of homes with lead in them.
But perhaps the biggest motivating statistic for Abdul El-Sayed is the most depressing one: the city’s high infant mortality rate. Babies in Detroit are twice as likely to die in their first year than babies elsewhere in Michigan.
El-Sayed says every Monday he reviews "the names and stories of every baby that dies in the city, and that’s deeply grounding and motivating."
On average, El-Sayed is reading about the brief lives of at least two babies, every single Monday.
So, will he be able to bring down that high infant mortality rate during his tenure, and interrupt generational poverty while he’s at it? It’s a tall order. But like I said: He’s an optimist, with a plan.