Abdul El-Sayed took over Detroit's health department in 2015 when the city was emerging from bankruptcy and the 185-year-old public health institution had been placed under state emergency management. He found approximately 85 employees working from the back of a municipal parking building.

El-Sayed, who holds both a medical degree and PhD in public health, led efforts to rebuild the department from what he described as practically nothing. Within 18 months, he expanded the staff to 220 employees and opened a new headquarters facility.

During his tenure, El-Sayed launched several major public health initiatives that became defining elements of his leadership. The department provided free eyeglasses to low-income schoolchildren and conducted comprehensive lead testing in every school, daycare, and Head Start facility throughout the city.

The department also engaged in environmental health advocacy, pursuing legal action that resulted in an energy company investing $10 million to improve local air quality. Additionally, El-Sayed implemented a peer mentor program for newly pregnant mothers, aimed at addressing elevated rates of infant and maternal mortality in the city.

The rebuilding of Detroit's health department occurred during a period when the city was working to restore essential services and infrastructure following its 2013 bankruptcy filing, which was the largest municipal bankruptcy in U.S. history at the time.