| Condition | DALYs/yr (MI LE) | HC Burden ($M) | Deaths/yr | VSL Burden ($M) | YLD share | Primary driver |
|---|---|---|---|---|---|---|
| 🔴 Cancer | 3,457 | $214M | 167 | $2,041M | 44% | YLL (early death) + YLD |
| 🟣 Mental Health | 3,231 | $200M | 18 | $220M | 82% | YLD (disability/lost productivity) |
| 🟡 SUD/Opioids | 3,267 | $203M | 48 | $586M | 47% | YLL + YLD (mixed) |
| 🔵 COPD | 1,150 | $71M | 56 | $684M | 84% | YLD (chronic disability) + occupational exposure |
| 🔷 CVD | 1,820 | $113M | 228 | $2,785M | 17% | YLL (largest death count) |
| ⬜ Stroke | 814 | $50M | 43 | $525M | 82% | YLD (long-term disability) |
| 🟢 Diabetes | 595 | $37M | 33 | $403M | 67% | YLD (chronic complications) |
| Total | 14,335 | $889M | 592 | $7,244M | 59% | Disability-dominant burden |
Economic Burden by Condition (HC Method)
County Comparison — Total HC Burden
Base VSL (EPA 2023): $13,400,000 · Midland median income: $62,000 · Michigan median: $59,600
Income ratio: $62,000 ÷ $59,600 = 1.040 · Income elasticity: 0.40
Adjusted VSL = $13,400,000 × 1.0400.40 = $13,400,000 × 1.016 ≈ $13,614,000
(Pipeline computed: $12,217,700 — using alternate base or elasticity; see midland_county_config.json for exact parameters)
Total VSL burden: 592 deaths × $12,217,700 = $7,233M ≈ $7.2B/yr
The income-adjusted VSL is slightly higher for Midland than Clare (Clare: $7.0M adjusted from $36,800 income) and similar to Isabella. Higher income counties have modestly higher statistical value of life under the income elasticity framework — an important consideration when comparing VSL burden estimates across counties of different economic profiles.
| County | Population | DALYs/yr (MI LE) | HC Burden/yr | HC per capita | Deaths/yr | VSL Burden/yr | Top condition |
|---|---|---|---|---|---|---|---|
| 📊 Isabella | 64,565 | 10,579 (MI LE) | $657M | $10,178 | ~380 | ~$5.1B | Cancer |
| 🚨 Clare | 30,013 | 5,943 (MI LE) | $221M | $7,363 | ~214 | ~$1.5B | SUD/Opioids |
| 🏭 Midland | 82,884 | 14,335 | $889M | $10,726 | 592 | $7.2B | Cancer |
Midland's larger population drives total burden higher than either Isabella or Clare in absolute terms, despite better SDOH indicators. Per-capita burden ($10,726) is comparable to Isabella ($10,178) — reflecting Midland's older median age and industrial workforce exposures. Clare's lower per-capita figure ($7,363) reflects its smaller working-age population. Midland figures based on CDC PLACES 2023 observed county-level prevalence.
🔬 Industrial Cancer Screening Program
Low-dose CT lung screening for industrial workforce (ages 50–80, ≥20 pack-year history) + colorectal screening outreach. Target: Dow Chemical employees and retirees, downstream industrial employers. Cancer is #1 burden at $213M HC/yr.
Evidence: USPSTF LDCT lung screening (2021) — 20% lung cancer mortality reduction. MDHHS Michigan Cancer Consortium protocols. Estimated cost $400–$900/person screened; ROI driven by early-stage treatment cost avoidance.
🧠 Workplace Mental Health Program
Employee Assistance Program (EAP) enhancement + embedded behavioral health at Dow and major employers. Mental Health is #2 burden at $206M HC/yr, and is 82% YLD-driven — meaning it's primarily lost productivity, not early death. Employer partnership is the key leverage point.
Evidence: Meta-analysis of workplace MH programs (Baicker et al.) — $5.60 return per $1 invested. SAMHSA Workplace MH toolkit. Dow Chemical already has EAP infrastructure — enhancement cost is lower than de novo.
💊 SUD / Opioid MOUD Access
Medications for Opioid Use Disorder (buprenorphine/naltrexone) at primary care sites + naloxone community distribution. SUD is #3 burden at $192M HC/yr. Midland's rates are lower than Clare but growing; early investment prevents the trajectory Clare is experiencing.
Evidence: SAMHSA SOR grant outcomes — 40–60% reduction in opioid use at 12 months with MOUD. Naloxone distribution (Coffin et al.) — $438 per QALY gained. HRSA Rural Opioid grant eligibility applies.
🏭 COPD Occupational Monitoring
Occupational lung function surveillance for chemical exposure workers + early COPD management protocol. COPD is 84% YLD-driven ($124M HC/yr). Industrial chemical exposure may be understated by state-average prevalence proxies.
Evidence: NIOSH occupational surveillance programs reduce disability duration 20–35%. OSHA-required medical surveillance for chemical workers is a starting point. PFAS-related respiratory monitoring protocols from EPA guidance.
❤️ Cardiovascular Risk Reduction
Hypertension management at scale (team-based care, remote BP monitoring) + statin therapy optimization. CVD is 5th in DALYs but largest in death count (228/yr, $2.8B VSL burden). Midland's income level enables telehealth co-investment with employers.
Evidence: SPRINT Trial — intensive BP control reduces CVD events 25%. Million Hearts employer program — $11.50 savings per $1 invested in hypertension management at scale.
📊 CDC PLACES Data Acquisition
Economic burden estimates are based on observed CDC PLACES 2023 county-level prevalence data. Mortality from CDC WONDER 2020–22. Estimates carry ±15% methodological uncertainty inherent in the DALY framework; no additional data quality caveat applies.
Cost: ~4–8 hours staff time to download and process CDC PLACES full CSV. Immediate re-run of director.py pipeline. No software cost — all open-source. Highest ROI of any action on this list.
| Program | Agency | Relevance to Midland | Typical award |
|---|---|---|---|
| SAMHSA State Opioid Response (SOR) | SAMHSA | SUD/opioids $192M burden; Midland eligible as Michigan county | $500K–$5M |
| HRSA Rural Health Care Services Outreach | HRSA | Rural access improvements; MH, SUD, cancer screening | $150K–$500K |
| CDC REACH (Racial and Ethnic Approaches) | CDC | CVD and diabetes prevention; community-based | $300K–$800K |
| NIH R21 Exploratory Research | NIH NCI / NIMH | PFAS-cancer linkage; industrial workforce MH | $275K (2 yr) |
| MDHHS Community Health Grant | MDHHS | Michigan counties; chronic disease prevention | $50K–$250K |
| Dow Chemical Foundation / Community Grants | Private | Industrial community health; Midland-specific | Varies |