Moving Beyond #72

Moving Beyond #72:  Improving Health in Menominee County
Lauren Lamers, MPH
Wisconsin Population Health Service Fellow
Menominee Tribal Clinic
Shawano-Menominee Counties Health Department
Keshena, WI 

On March 26, the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute released the 2014 County Health Rankings.  Within each state in the U.S., the Rankings rank counties from most to least healthy based on heath outcomes as well as the environmental, clinical, social, and behavioral factors that influence health.  For many counties, the release of the Rankings is an opportunity to see how their community’s health measures up to other counties in their state, identify successes in improving community health, and hone in on areas that still need improvement.  For Menominee County, however, the Rankings tend to be all too predictable. 

County Health Rankings Model
University of Wisconsin Population Health Institute. 
County Health Rankings and Roadmaps 2014.

Every year since the Rankings have been released nationally, Menominee County has ranked 72nd of Wisconsin’s 72 counties for both health outcomes and the factors that influence health.  Perusing the data behind Menominee County’s ranking, several factors driving the low ranking quickly become apparent: unemployment and child poverty rates more than double the state average, high rates of teen pregnancy, and a high prevalence of health risks such as smoking and obesity just to name a few.  Furthermore, considering the wide disparities in health outcomes and health determinants between Menominee County and other counties in Wisconsin, the #72 ranking is unlikely to change any time soon.

Although consistently being ranked last in the Health Rankings can paint a rather grim and defeating picture, when I began my fellowship with the Menominee Tribal Clinic I quickly realized how much the Health Rankings, while not necessarily inaccurate, do not capture.  In many ways, it is the factors that the Rankings cannot directly measure that tell a much richer and more inspiring story about the health of this community.

First, there are a host of historical factors not directly captured in the County Health Rankings that nonetheless underlie the Rankings’ measures of heath outcomes and health determinants.  As a predominantly Native American community, the historical trauma experienced by the Menominee Tribe, including forced relocation to the present reservation, boarding school educational policies intended to destroy Menominee culture, and termination of the Menominees’ status as a federally recognized tribe in the mid-twentieth century, continues to dramatically affect the health of the community.  Many of the indicators captured in the Rankings, such as high rates of poverty, substance abuse, and premature death, are direct reflections of this legacy of historical trauma.

Many efforts are currently underway, however, to address and move beyond this trauma and improve the physical, social, emotional, and spiritual wellbeing of the Menominee people.  Through Fostering Futures, an initiative to promote trauma-informed care across tribal and county agencies, community leaders have joined together to discuss the impact of historical and intergenerational trauma and discuss how to build resilience among families and children.  Additionally, in response to the county’s health ranking, a Community Engagement Workgroup of stakeholders across a variety of sectors has been meeting for several years to implement initiatives aimed at reducing youth obesity and teen pregnancy and improving school readiness.  Other local coalitions and programs are actively addressing issues such as substance abuse and are promoting healthy youth development through the teaching of the Menominee language and traditional cultural practices.  Through this work, community members have identified how a variety of social, environmental, and behavioral factors interact to influence health, and their collaboration has enabled them to take a multifaceted approach to improving community wellbeing.

While the engagement, collaboration, and resilience of the Menominee community are not necessarily quantifiable factors that can be incorporated to a Health Rankings model, they are crucial for eventually making changes to improve community health.  It will take years for small improvements in health to be manifest in the overall health ranking, but there are already some indicators of the fantastic work that this community is doing.  For instance, in the 2010 Rankings, the percentage of Menominee County ninth grade students who graduated in four years was 68% – the lowest in Wisconsin.  In the 2014 Rankings, that number has increased to 93% - above state average.  Violent crime has decreased, and Menominee County is currently ranked 45th for clinical care and 15th for environmental factors. 

According to the Robert Wood Johnson Foundation and UW Population Health Institute, the County Health Rankings are intended to “serve as a call to action for communities to understand the health problems in their community, get more people involved in improving the health of communities, and recognize that factors outside medical care influence health.”1  The community members in Menominee County have certainly embraced this call to action wholeheartedly.  While it may not be reflected in the #72 health ranking, their fantastic work to improve health and wellbeing is an exemplary model for other communities to follow.

1.  County Health Rankings and Roadmaps.  Frequently Asked Questions.