Community Context

Sanilac County has nearly 1,000 square miles of farmland, beaches, and waterways, and it attracts seasonal tourism. Primary industries include manufacturing, healthcare, and retail. The county is a Republican stronghold, and new county commissioners came into office in November of 2020 in three of the five districts. The county also has a new sheriff as of late 2020, signaling a change in law enforcement leadership for the first time in 12 years.

Sanilac County is largely rural, and as a result, a lack of transportation and broadband access are common barriers to accessing healthcare and community assets. The county is also a federally designated Health Professional Shortage Area. Although 16 percent of households fall below the poverty line, an additional 38 percent have incomes above the federal poverty level but below the basic cost of living. Sanilac County is fairly homogeneous in terms of race and ethnicity, with the majority being White and non-Hispanic, and the population is forecasted to decrease slightly over the coming years.

Sanilac County’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, Sanilac County’s community capacity to promote health and well-being has remained fairly constant, grounded by anchor institutions and local collaborations centered around healthcare and economic development.

Regional organizations that include Sanilac and neighboring counties also provide important capacity to promote health and well-being. In addition to ongoing work to address substance use in the region, other initiatives have sought to revitalize Sanilac County through scholarships for residents to obtain higher education or complete trade school, campaigns encouraging residents to donate to local nonprofits, and initiatives to encourage former Sanilac residents, particularly those with a healthcare background, to move back to the region. There has been little movement in terms of health priorities and narrative over the past five years, although there is slightly more emphasis on the importance of prevention. Given the racially homogeneous population in Sanilac County, racial equity has traditionally not been a part of the conversation, although this has changed somewhat with state-level initiatives. Within Sanilac County, health equity is largely centered around broadband access as a boon to telehealth.

Lessons Learned: Where is Sanilac County Five Years Later?

Sanilac County has remained largely the same in terms of health priorities and efforts to promote health and well-being, although there has been an increasing recognition around the importance of health prevention and promotion, particularly with respect to mental health. Collaborations have been important in meeting a diversity of needs, particularly for children and young families, although there remain important gaps in healthcare and other services. Other communities can learn from Sanilac County’s investments in its younger children and families and creative strategies to meet mental health needs, particularly for men who may be more reluctant to seek services. 

Because Sanilac County is a smaller region where local stakeholders know and have a long history working together, decision-making related to health and well-being is often expedited. Yet, barriers remain, particularly due to a shortage of health providers, a lack of broadband access, and a lack of public transportation. 


  • State policies and cross-county collaboratives to promote efficiency and minimize duplication 

  • Local businesses share health information

  • Small-town connections and support


  • Lack of broadband access

  • Health-provider shortage area and a medically underserved population

  • Lack of a reliable public transportation system

  • Stakeholders are spread thin