Most major American cities have been hit hard over the past three years by the recession and the attendant collapse of the housing market. Detroit is in a whole different category.

If Las Vegas has been the nation's boom town among major U.S. cities since the 1970s, Motown qualifies as one of the nation's most battered over that same period.

According to 2010 Census Bureau figures released this year, since the 2001 census Detroit lost 238,270 residents, a 25% drop. Its population of 713,777, its lowest in 100 years, has been falling since 1950, when it peaked at more than 1.8 million.

From January 2000 through April 2011, Detroit home values fell 37%, by far the largest decline over that period among the major housing markets tracked by the Standard & Poor's/ Case-Shiller Home Price Indices.

Vernice Davis Anthony, president and CEO of the Greater Detroit Area Health Council since 2002, is no stranger to bad news in the region. She previously served as senior vice president of corporate affairs and community health at the St. John Providence Health System, Warren, Mich., and is a former director of the Michigan Public Health Department. Anthony received a master's degree in public health from the University of Michigan and has a bachelor's in nursing from Wayne State University.

And yet, the shrinking census counts and plummeting home values don't fully mirror the story about the Detroit healthcare market—the bad or the good—Anthony says.

“The population that we have lost tends to be those with insurance as opposed to those without,” she says. “A lot of that loss has been to the neighboring suburbs, so it's still within the region of Southeast Michigan. And when you couple that with the economic downturn, you have more people with low-income households, so that brings with it all the other socio-economic indicators that impact health. Detroit is also aging. So you have a rapid increase in rates of chronic diseases—diabetes, stroke and heart failure.

“What's unique about Detroit is the extent that we have these issues,” she says. “Whether it's unemployment or the demographic shift outside of the community, what's unique in Detroit is the strength that we have as a coalition working together. I've traveled and you don't see that everywhere around the country, how the primary-care leadership has come together here, just the fact that we're making progress because we have a much higher hill to climb. People have not given up at all.”

Hospitals in the city have closed in response to the falling population, “but Southeast Michigan is still overbedded,” Anthony says.

A shortage of primary-care physicians, a common problem nationwide, is also an acute concern in Detroit, Anthony says.

“We're really trying to focus on solving the problem of primary care,” Anthony says. Most Greater Detroit Area Health Council member hospitals, if they don't own primary-care practices outright, support primary care in some other way, such as school-based clinics, she says.

Detroit hospitals have long supported primary care out of compassion and pragmatism, despite the cost, according to Anthony. “There's not a lot of reimbursement for that,” she says. “So, it ends up as uncompensated care. If they end up in the emergency rooms, they end up with even more uncompensated care. So, if you do the math, it just adds up.”

In May, the health council was awarded a $1.3 million grant by the Robert Wood Johnson Foundation to continue its Save Lives/Save Dollars project, which includes provider quality reporting, reducing unnecessary readmissions and improving care transitions between primary-care physicians and specialists on selected high-acuity conditions.

“Sometimes I think we're our own worst enemy, because we get into our problems and don't do enough of a job sharing our success,” Anthony says. “The universities, University of Michigan, Wayne State and Michigan State, with their research going on, it's as exciting an area in research as anywhere in the country. We need to do a better job of blowing our own horn.”

In Detroit, she says, “There are many people who want to make a difference, people go into healthcare to save people's lives, and Detroit is an excellent place to be.”