Health and Racial Equity at the City of Milwaukee Health Department from a Current Fellow, Former Fellow, and a Friend of the Fellowship

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

What did we learn from those conferences?

Hi fellowship community! As you can see, we had to get a little creative with our interview since we work in different cities. We both attended conferences in April and wanted to highlight our experiences. We came up with seven questions to share some of our learnings and how attending the conference has impacted our work. Please feel free to contact us if you have any questions or want more information on either conference!

Best,

Salma Abadin and Leslie Tou

Salma’s report:

What conference did you attend?

I attended the Midwest Convening on Racial Equity in Chicago, IL on April 25, 2016. It was hosted by the Government Alliance on Race & Equity (GARE), which is a national network of government working to achieve racial equity and advance opportunity for all.

How will the information presented at the conference help your work?

For me, sometimes health equity seems unattainable, but attending this conference really helped me see the possibilities of success around health equity. People across the country are invested in working with each other to advance equity and enhance success for all. GARE provided their published Racial Equity toolkit as a way to operationalize equity. It includes a worksheet that can be used at multiple levels. The overall questions are:

1. What is your proposal and the desired results and outcomes?

2. What’s the data? What does the data tell us?

3. How have communities been engaged? Are there opportunities to expand engagement?

4. What are your strategies for advancing racial equity?

5. What is your plan for implementation?

6. How will you ensure accountability, communicate, and evaluate results?

They also provided examples from Seattle, WA and our very own Madison, WI, two cities that have used the tool. The City of Seattle passed an ordinance in 2009 that required all City departments to use the toolkit, in particular for all budget proposals. In 2015, the mayor of Seattle required departments to use the toolkit at least 4 times every year, and hopes to include aspects of the tool in performance measures. Applications of the Racial Equity Tool in Madison included adopting a new mission, vision, work plan, and evaluation plan with a racial equity lens in the Clerk’s office and incorporating staff and stakeholder input, racial equity priorities and to guide goals and objectives for strategic planning at Public Health Madison & Dane County. The toolkit has been a great way to start having conversations with my colleagues in Milwaukee about what we can do to use a health equity lens in our work.

What were other attendees’ backgrounds? Any tips on networking?

One of the goals of the conference was to "further cross-jurisdictional, cross-community, and cross-sector strategies for racial equity with partners in housing, criminal justice, employment, education, transportation, public health, immigrant groups, and environmental justice." Attendees worked in many of these arenas through communities, businesses, nonprofits, and government. The workshops were small (no more than 25 people) and interactive, so there was plenty of time to network and introduce yourself. I also knew a couple of people at the conference and that helped in being introduced to their colleagues and people in their networks.

What were some of your favorite sessions/posters/presentations?

My favorite panel discussion was entitled "Eliminating Institutional Racism in Criminal Justice." The conversation focused on how policing and the role of police leadership are changing. Paul Schnell, Maplewood, MN police chief, emphasized that police officers’ role is to create and build a stronger community, which he sees as a fundamental difference in the culture of policing. The measure of success is not the number of incarcerated individuals, but rather if he and his colleagues serve and support communities to be stronger and safer. One other interesting comment was that the idea of power around safety and policing is being redefined. Power needs to be given up and redistributed, and police authority is ultimately given by the communities they serve.

Was it everything you were expecting or did you hope to get something else out of the experience?

To be honest, I did not know what to expect. What I appreciated was the focus on shared learning and finding new partners and frameworks to help support or improve your work. Presenters and organizers of the conference offered tools and strategies to take back home and use in our own work. I’m excited to see what the follow-up from the April conference will be like because I left wishing the conference was longer than a day.

Any other takeaways?

There are an incredible number of people dedicated to achieving health equity work and they are willing to help each other. Several people attended from Milwaukee and we are planning to reconnect in the coming weeks to debrief on the conference and brainstorm ways to collaborate with an equity focus. It’s energizing to know that many people in Milwaukee are ready to work together and make health equity a reality.

What’s the next conference you want to attend?

I’ll be attending the NACCHO conference in July in Phoenix, and the theme is "Cultivating a Culture of Health Equity." I’m interested to see what the similarities and differences are from the Chicago meeting to the larger, national conference. Stay tuned J .

Leslie’s report:

What conference did you attend?

I attended the Association of Maternal & Child Health Programs (AMCHP) 2016 Annual Conference in Washington DC in April this year.

How will the information presented at the conference help your work?

I’m new to MCH work at the state level and I thought this conference was a unique opportunity to hear about up-and-coming- innovative strategies from different programs across the country, as well as hear from the federal level on updates and current policies around Title V funding. Title V is critical as it is the only federal program that focuses on mothers and children. You can find more information here.

In my fellowship, I am dual placement: I split my time between the Lifecourse Initiative for Healthy Families (LIHF) and the MCH Program at the Department for Health Services. I love how overlapping the positions are- there is a shared vision of health equity among all mothers and children in Wisconsin at the heart of both placements but there are obvious differences in state public health work versus university initiative work. I loved that the conference covered both these perspectives- state, governmental work as well as the community grassroots approach and the challenges, limitations and advantages that come with each. I really appreciated going to different presentations and workshops and having great takeaways for both placements. 

What were other attendees' backgrounds and professions?

AMCHP is a large, national conference that is predominantly attended by state health departments, research institutions and other organizations working to "to improve the health of women, children, youth and families, including those with special health care needs".

State Maternal and Child Health Programs (MCH) are well-represented at this conference as there is a huge focus on Title V programs. This conference serves are an effective way for the Maternal and Child Health Bureau (MCHB) to directly interact with state and local health departments and address programmatic changes, issues, and share success and lessons learned. This was my first national conference for US-based public health issues and it was wonderful to meet MCH professionals from all over the country. 

What were some of your favorite sessions/posters/presenters?

One of my favorite sessions was a skills builder session on "Implementing Universal Adverse Childhood Experiences (ACEs) Screening at a Community Health Center", led by a team from Santa Rosa Community Health Centers in California. I was struck by how they really seemed to "walk the walk" on the importance of mental/behavioral health as well as physical health. The panel represented three different clinics- a pediatrics clinic, a large hospital clinic and one located within a public high school, all part of the Community Health Centers in CA- all who have implemented universal ACEs screening.

The fundamentals seemed to be truly patient-centered and trauma-informed. They had signs up in all their waiting rooms that let clients know right away all would be asked these 10 questions and no one was being singled out for them. They had warm hand-offs with behavioral specialists for patients who screened high and would need further services. I thought it was especially interesting that the pediatrics clinic talked about how they ended up screening the parents of the kids as well sometimes and connected them with behavioral clinicians at sister sites.

Overall, I walked away feeling really inspired that this recognition of the importance of trauma and mental health has become a reality in this community.  

Was it everything you were expecting or did you hope to get something else out of the experience?
Similar to Salma, I really had no idea what to expect. For a first time attendee, I thought I got a lot of out of the conference (especially considering it was so quickly rescheduled after DC’s Snowpocalypse 2016!) I’ve only attended a handful of conferences and these bigger ones always feel a bit overwhelming. On the other hand, because they are so large, there are so many great presentations to choose from. I can say I was actually excited to go to all the workshops and seminars I signed up for!

Any takeaways?
There really aren’t any magic bullets for most of our public health challenges. I can only speak for myself, but I walked away feeling both tired and uplifted (which I know sounds very contradictory).

On the one hand- this work is so hard! Trying to address issues at a population level is rightfully complicated as communities are dynamic, living entities with so many intricate layers and pathways. There are no quick fixes for issues like poverty, racial inequities, or childhood trauma. It was uplifting to see shared recognition and universal concern over these issues in public health communities and honestly, relieving to see how everyone is struggling with how to successfully affect change.

What is the next conference you want to attend?

The next conference I am hoping to attend is another MCH focused one- CityMatch and MCH Epi in Philadelphia this September: http://www.citymatch.org/conference/citymatch-conference/2015/Home

Lindsey Borleske (Intern)

How are you involved in the Fellowship?
I hold a student help position within the Fellowship. I work with Stephanie, Lesley, Marion, and Shor and assist with whatever tasks they need completed in the office ranging from preparing materials for Site Visits to organizing notes, etc.

What's your educational background?
I am currently a sophomore here at University of Wisconsin-Madison. My major is International Studies and I am also pursuing a certificate in Middle East Studies.

What are your long-term plans, in terms of your career?
I think human connection is key to making a difference. I would love to live abroad for some time after graduation to live and learn about different cultures. The area I am most interested in policy between the United States and the Middle East. Career wise I want to discover methods through which the United States and Middle Eastern governments can implement better policies to alleviate tension and human rights violations in that region of the world and teach how gaining appreciation for other cultures can lead to more effective policy making.

What are your favorite things about living in Madison?
Being raised in Madison, I've gotten to experience much that this city has to offer. My favorite thing about Madison is going to the Memorial Union on a summer evening with friends and dancing to the many different bands they have performing during the summer season. I also love the fact that Madison has many parks and paths throughout the city so that you can stay active outside all seasons of the year.

What do you like to do for fun?
In my free time I am a choreographer for the Madison Metropolitan School District for Madison East High School's Show Choir. I love being able to dance and share that passion with younger students at my Alma Mater. I love traveling, working out and spending time with my family here in town.