“It is time to step up our efforts to protect the health and safety of all Michiganders.” – Gov. Gretchen Whitmer
By Dennis Archambault
Gov. Gretchen Whitmer launched her administration’s goal of restoring the physical infrastructure of the state during her 2019 State of the State address. She pledged to clean up drinking water, build bridges, and fix those potholes. She also pledged to “protect the health and safety of all Michiganders.” The two may not seem to be connected, but the term “infrastructure,” is the key.
The Oxford English Dictionary defines “infrastructure” as ‘the basic physical and organizational structures and facilities (e.g. buildings, roads, power supplies) needed for the operation of a society or enterprise.”
Dan Fredendall, PE, a member of the Michigan Infrastructure Council considers “infrastructure” as an “impersonal word” that “harbors many practical implications for our economy and way of life.” In a Detroit News opinion published in January 2019, Fredendall writes, “In the past year we were reminded regularly of the impact that infrastructure has on our lives.” His reference was the Flint water crisis and other threats to the natural infrastructure by unnatural causes created by human beings.
It’s only when an adjective like “public health” is added to “infrastructure,” that we begin to think that health factors into the discussion of “crumbing infrastructure.” And with it, the implication of how that “impersonal word” has a personal component.
AbdouMaliq Simone, an urbanist and academic who is concerned about the interaction of human beings in urban spaces, wrote “People as Infrastructure: Intersection Fragments in Johannesburg,” published in the journal Public Culture in 2004 (https://read.dukeupress.edu/public-culture/article-abstract/16/3/407/31780/People-as-Infrastructure-Intersecting-Fragments-in?redirectedFrom=fulltext). Examining the post-Apartheid Johannesburg – segregated by economic, geographic, and social ways – creates a dysfunction human infrastructure. The opportunity, he argues, is to “reconceptualize the notion of belonging in terms other than those of a logic of group or territorial representation. People as infrastructure indicates residents needs to generate concrete acts and contexts of social collaboration inscribed with multiple identifies rather than overseeing and enforcing modulated transactions among discrete population groups.” By integrating the diverse talents of the broader citizenry and the social infrastructure, ultimately the economic infrastructure is stronger.
This leads one to drill a little deeper to what “health people” means in the context of “people as infrastructure.” Or, what does “unhealthy people” mean? What affect does it have when a vast segment of the working population is uneducated in a technically complicated age? What does it mean if a vast segment of the working population is addicted and/or incarcerated? What does it mean if a vast segment of the working population is chronically ill and/or depressed and taking sick time off or just not working? What does it mean if a vast segment of the working population is disabled, or functionally challenged in way that hinders their productivity?
These are questions that relate to the economic well-being of society, not its holistic well-being. But even with this limitation, “health” becomes an important consideration for “people as infrastructure.” And “public health” is the traditional means that society has improved health for over 100 years.
So, as the “crumbling” pot holes and bridges have defined what it means to have an infrastructure that inhibits economic growth, we also need to look at the crumbling well-being of those who contribute to the economy, as well as those whose conditions are causing a drain on that economy.
The Citizens Research Council of Michigan, last summer, published “An Ounce of Prevention: What Public Health Means for Michigan.” “It is difficult to put a dollar amount on diseases that people didn’t catch, on injuries they didn’t sustain, or on poisonings that didn’t happen. It’s also difficult to monetize incremental changes in health quality throughout the course of a person’s life. These benefits are invaluable, however, leading to decades of added life and the potential for productivity and prosperity.”
The study notes that public health expenditures in Michigan have dropped 16 percent from a recent high point of social investment in 2004. Last year, the state spent just $12.92 per person on public health. Anyone who has interacted with public health departments knows how lean they have become, and how challenged they are in maintaining their core responsibilities, much less become engaged in community health improvement.
The “Health in All Policies” philosophy, along with increased public health spending, are key to creating a healthy infrastructure, the study recommends. “The public must develop a deeper understanding of public health, assume greater individual responsibility for personal and community health, and hold public leaders accountable for failures to protect the public’s health.”
People are infrastructure. To ignore this is no different than ignoring crumbling bridges or failing power sources preventing the manufacture and movement of goods. In fact, one could argue, that commerce begins with healthy, smart people able and willing to work.
Dennis Archambault is vice president, Public Affairs, for Authority Health