We Need Jobs

Detroit – “We need jobs”

We had the opportunity to spend a few days in Detroit.  We live in Marquette, MI – 450 miles from Detroit (and not the farthest place in Michigan from Detroit), and while in the same state, Marquette is very different from Detroit.  It was a “big city” cultural experience for our family.

While driving to the Detroit Institute of Arts (DIA), our kids spotted some graffiti on a gas station.  The “S” on the “SHELL” sign was crossed out and it also said “We Need Jobs.”  The kids asked “what happened to this place???”  I am sure there is a complex answer to that question involving the sociology of race relations, suburban sprawl, highway systems, municipalities, the water system, city taxes, business locations, public transportation, and more – likely the topic of many dissertations.  I do want to focus on the “we need jobs” component as there is an analogy to healthcare.  I would argue that “we need jobs” doesn’t get to the root of the problem…

If the resurrection of Detroit was simply dependent on a few thousand “jobs” being available, then the city could have certainly avoided bankruptcy (and the potential of selling off the art in the DIA to pay bills).  The city spent $170 Million in financial consulting/legal fees just to navigate bankruptcy (http://en.wikipedia.org/wiki/Detroit_bankruptcy and http://www.mlive.com/news/detroit/index.ssf/2014/12/detroit_charged_more_than_170.html).  The bottom line is that things aren’t always as they first appear.

Let’s pretend that we could fabricate 10,000 jobs out of thin air.  Then what might the barriers be?  Workers may not have the skills for the positions that are needed.  This may be due to lack of schooling and poor graduation rates.  The poor graduation rates are due to lack of social support structures, financial barriers, and lack of role models. This is also affected by crime and punishment of crime.  Furthermore too many non-violent offenders are imprisoned and not “corrected” when they a released.  The list goes on: reliable transportation doesn’t exist, stable housing isn’t available, childcare isn’t easy/safe/affordable.  On the surface “jobs” are the only think needed, but looking deeper, the solution is a lot more complex.


Let’s switch gears to healthcare.  Do people simply need a doctor to improve their health?  For some people access to a doctor is all they need, but for many patients that is just the tip of the iceberg.  An adage of mine is “if you don’t take the medication, it won’t work.”  My diagnosis may be correct, and my counseling to the patient clearly understood, but if I don’t prescribe a medication that the patient can afford, it won’t work.  Moreover if I don’t elicit and address their concerns with the medication (i.e. statin medications), then they also may not take it.

There are also many determinants of health beyond medications.  The medication for depression may not work very well (even if they are taking it), if they are homeless, abused, addicted, or hungry.  Furthermore financial security, access to healthy food options, regular exercise, a supportive social structure, a stable home, etc. are also important determinants of health.  When these factors are the main drivers in the person’s problem, adjusting a medication can sometimes seem like rearranging the deck chairs on the Titanic.

When attempting to solve a complex problem, look beyond the “easy” or “obvious” answer to uncover the barriers to success.  If these barriers aren’t identified and addressed, the solution won’t work optimally. Furthermore you and your team will be frustrated with projects that don’t seem to work.  Avoid this frustration and improve your outcomes by looking deeper into these inconspicuous drivers.