How does the most racially diverse city in Wisconsin address racism and economic inequality to promote health equity? Recent events across the country have put the topic of race and equity at the forefront of national conversations. Implicit bias is now a catch phrase of presidential debates and public radio. For those of us working in Milwaukee, we are in the position of witnessing inequities first hand while struggling to get institutional buy in and a coordinated approach to address health and racial equity. As public health professionals we recognize how important and necessary it is to integrate and operationalize health equity principles in our work. While there is some really amazing work happening nationally, regionally, and locally, we feel that there are opportunities for us to recalibrate and be intentional about aligning our work using an equity lens.
Earlier this year, we started having conversations around how we can bring more of a health equity lens to the City of Milwaukee Health Department (MHD). We see the need in our work – violence prevention, maternal and child health, and men’s health – to address root causes of health outcomes. African American women in Milwaukee experience pregnancy and infant loss at a rate three times higher than white women. Changing individual behaviors will not reduce this disparity unless we also reduce poverty, discrimination, and the chronic stress that increases the risk for prematurity, the leading cause of infant mortality in Milwaukee. The case is similar for violence across the City. Data from 2015 indicate that homicides and non-fatal shootings occurred about 4.5 times more frequently in lower socioeconomic status (SES) ZIP codes compared to middle and higher SES ZIP codes. Even further, black males ages 15-24 are victimized at a shooting rate of 1109 per 100,000 city inhabitants compared to white males at 9 per 100,000. For homicides, the victimization rate for black males is 187 per 100,000 per city inhabitants compared to 4 per 100,000.
We’ve been able to learn from many in the fellowship community, including both current and former fellows and preceptors, who have been able to share their resources and ideas. In particular, Carly Hood and Evelyn Cruz shared their trainings and presentations they developed at the Wisconsin Department of Health Services-Division of Public Health to educate staff on health equity using NACCHO’s Roots of Health Inequity curriculum. Geof Swain has shared his expertise and work around the social determinants of health and health equity, specifically the 7 Foundational Practices for Health Equity, which are built on the WHO’s Conceptual Framework for Social Determinants of Health. Geof has used the image below to show how the foundational practices could be mapped on the Triple Aim of Health Equity, three objectives developed by the Minnesota Department of Health to advance health equity.
We’ve traveled to conferences, including the Government Alliance for Racial Equity’s Midwest Convening on Racial Equity and NACCHO, to learn from other health departments across the country as well. We took the opportunity to have a conference call with Jordan Bingham, the Health Equity coordinator at Public Health Madison Dane County to discuss what she has been able to accomplish in Madison as well as challenges she has endured. We’ve even tapped into local resources at the YWCA and met with the Racial Justice Director who facilitates the Unlearning Racism course in the Milwaukee area.
In all this gathering of information and learning, we’ve now asked the question “what do we do with it all?” We want to be purposeful in planning how our efforts fit into a mechanism that is sustainable but also want to hit the ground running with some of our ideas. In discussing our efforts to bring dialogue and strategies around health equity at MHD, we’ve been able to find other champions in the department who are supporting the effort, including Fiona Weeks, Erica LeCounte, Geof Swain, Angie Hagy, and Michael Stevenson. We are meeting in the next couple weeks to draft language around how we define health equity, health disparities and social determinants of health; identify current examples of work at MHD that already operates from an equity perspective; and brainstorm what MHD’s health equity framework or roadmap could look like. As something to start in the short-term, we are collecting names of all MHD employees who have taken the YWCA’s Unlearning Racism course to start an alumni group that would meet regularly to discuss topics related to health, social and economic justice.
We know this work takes a lot of creative and dedicated minds, and want to extend the offer to anyone in the fellowship community (or reading this blog) who may be interested in getting involve to get involved! Please share your ideas, concerns, resources, and/or lessons learned with us!
Salma Abadin, MPH
Wisconsin Population Health Service Fellow – 2nd year
Violence Prevention Research Coordinator - Milwaukee Homicide Review Commission, Office of Violence Prevention
City of Milwaukee Health Department
Milwaukee, WI
Anneke Mohr, MPH, MSW
Wisconsin Population Health Service Fellow 2011-2013
Health Project Assistant – Fetal Infant Mortality Review
City of Milwaukee Health Department
Milwaukee, WI
Marques Hogans, MPH
Friend of the Fellowship
Public Health Educator – Men’s Health Program
City of Milwaukee Health Department
Milwaukee, WI