Moving Beyond #72: Improving Health inLauren Lamers, MPH
Wisconsin Population Health Service Fellow
Menominee Tribal Clinic
Shawano-Menominee Counties Health Department
On March 26, the Robert Wood Johnson Foundation and
released the 2014 County Health Rankings. Within each state in the University of Wisconsin Population Health , 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 U.S. ,
however, the Rankings tend to be all
too predictable. Menominee County
|County Health Rankings Model|
University of Wisconsin Population Health Institute.
County Health Rankings and Roadmaps 2014. www.countyhealthrankings.org
Every year since the Rankings have been released nationally,
County has ranked 72nd of ’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 Wisconsin Menominee County and other counties in , the #72 ranking is unlikely to
change any time soon. Wisconsin
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
. In the 2014 Rankings, that number has increased to 93% - above state
average. Violent crime has decreased,
and Wisconsin is currently ranked 45th
for clinical care and 15th for environmental factors. Menominee County
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
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. Menominee