Urban health

Long-term approaches in Detroit, US

21 April 2021
4 min read

In Detroit, we learnt about the role philanthropic foundations can play in driving health improvements across the city.

This city profile is part of a series of ten, exploring how cities around the world are addressing health inequalities. Read the full report and sign up to receive more insights from us.

About Detroit

Detroit has come to exemplify post-industrial urban decline. From its peak population of 1.8 million in 1950, Detroit experienced dramatic population decline, shrinking to 670,000 in 2019: a 63% decrease.

Detroit today is a majority Black city (78%) burdened with significant levels of deprivation – 38% of Detroit residents live in poverty, compared to 7.8% in the adjacent Oakland county, one of the whitest and wealthiest counties in the United States. Detroit’s population decline was driven by twin forces of deindustrialisation and racial unrest; forces which continue to shape the outcomes for Detroit residents today.

12% of residents have no health insurance coverage, rendering most health services inaccessible. Perhaps as a result, a significant portion of the population suffers from preventable diseases like diabetes (13%), asthma (21%) and cardiovascular disease (11.4%). Detroit has a maternal mortality rate three times the national average, coming in last in State county health rankings.

Detroit’s legacy has also shaped the current culture of non-governmental civic development in the City’s absence. In the past ten years, private developers have put significant effort into revitalising the city, including large-scale redevelopment of the downtown area and the relocation of large corporate headquarters from surrounding suburbs to the city.

These changes have led to some early but encouraging environmental and social improvements, but are also driving demographic shifts as younger, wealthier and white residents move into the city, potentially setting up an emerging crisis of inequality between ‘New’ and ‘Old’ Detroit.

In numbers


people live in Detroit


decrease in the population size since 1950


of of the population considered to be in 'fair to poor' health

The role of philanthropic foundations in long-term support

Foundations hold a unique space in the urban health system. They are independent and able to take a long-term view, as well as to respond to change and emergent needs. This ability to take a long-term view means foundations can focus resource on issues where the desired change or impact is often only seen over a generation, providing opportunities to measure impact beyond two to three-year projects. The work of three foundations exploring opportunities to drive health improvements in Detroit demonstrates the impact these philanthropic organisations can have.

Initiative explored: The Kresge Foundation

The Kresge Foundation is a private, national foundation located in Detroit that works to expand opportunities in America’s cities through grant making and social investing in arts and culture, education, environment, health, human services and community development.

Foundations don’t have the answer - communities do. We have moved into more of a listening mode with communities recognising their assets, riches and intelligence and listening to their needs.

Stacey Barbas Senior Programme Officer, Health, Kresge Foundation

Initiative explored: The Michigan Health Endowment Fund

The Michigan Health Endowment Fund is a philanthropic foundation that works to improve the health and wellness of Michigan residents, while reducing healthcare costs. It considers the context in which health outcomes arise, including social and cultural drivers, and goes beyond qualitative data and short-term funding cycles. The Fund supports organisations across Michigan, from grassroots groups addressing local health challenges to large agencies working in every county.

Initiative explored: The Skillman Foundation

The Skillman Foundation is a private philanthropic foundation that serves as a champion of Detroit children. The Foundation works to ensure Detroit youth achieve their highest aspirations by strengthening primary and secondary public education, after-school learning opportunities and college and career pathways.

The strength of foundations and trusts to bear risk, bypass political cycles and set their own boundaries gives them a pivotal role in galvanising and initiating the conversation on addressing inequalities. Communities hold an understanding of what that community needs. Foundations are well placed to convene, galvanise and act as a central cohesive source of support and stability on addressing systemic drivers of health outcomes.

Communities of colour have been left out of traditional capital growth for forever. For example, Black farmers, indigenous farmers, they could never get loans or capital. We’re trying to work with equitable finance folks, so our community financial development institutions were actually created to give capital to communities.

Stacey Barbas Senior Programme Officer, Health, Kresge Foundation
Mother and child at a street market

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