Navigating Health Disparities in Wisconsin
- WULR Team
- Jan 27, 2025
- 4 min read
The Role of Social Determinants and Policy Choices
Published January 27 2025
Analysis by Hailey Kjersten
Health equity is about more than clinical care. Our individual decisions alone do not determine our health; rather, health is the product of history, policies, and institutions that have created conditions in which health disparities can persist. These non-medical factors that influence health outcomes are called social determinants of health (SDH), which include the conditions where people live and work, as well as the wider set of forces and systems influencing daily life. Addressing SDH is imperative to reducing health disparities and ensuring people have the opportunity to live their healthiest lives.
What is SDH?
The five major domains of SDH include financial stability, education, social and community context, health care access, and neighborhood/built environment. However, countless categories could be considered, including food insecurity, environment/climate change, and structural conflict (1). The environments and experiences in which people are born, live, and work (the safety of one’s neighborhood, quality of one’s schools, access to healthy food, etc...) can all explain why some people are healthier than others, and show us why some populations experience poorer health outcomes and are at higher risk for other health challenges. SDH is a complex and multifaceted field, involving a wide range of stakeholders within the health sector and at all levels of government. Promoting healthy choices will not eliminate health disparities. Public health organizations and their partners in the education, transportation, and housing sectors must address SDH appropriately by taking direct action to improve health outcomes and reduce inequities in health.
Recent Initiatives
Wisconsin faces significant health disparities, with communities of color experiencing disproportionately higher rates of chronic illness and disease, overall life expectancies, and less access to quality health care. According to the University of Wisconsin’s Population Health Institute 2021 Health and Equity Report Card, Wisconsin received a ‘D’ for its overall racial health disparity grade (2). Wisconsin’s Department of Health has made addressing SDH a priority, with several programs created to combat disparities through SDH. The Wisconsin Minority Health Program, formed by Wis. Stat. § 250.20 in 1999, provides statewide leadership for policy measures aiming to improve the health of vulnerable populations in Wisconsin. The program identifies barriers to health care impacting economically disadvantaged Wisconsinites, monitors current emerging state policies and statutes, and disseminates information on the health status of economically disadvantaged minority group members living in Wisconsin (3). Additionally, the Governor’s Health Equity Council, created in 2019 via executive order, serves to address health disparities by creating a comprehensive plan to achieve long-lasting and equitable health outcomes for all Wisconsinites. This plan was completed in 2023 and includes 20 recommendations adopted by the council, robust data revealing the state of equity in Wisconsin, and an examination of the SDH contributing to differences in health outcomes (4).
On a local level, UW–Madison plays a significant role in shaping public health initiatives in Wisconsin, particularly through research, community outreach, and policy development. UW–Madison’s Population Health Institute is a major contributor to public health research, producing the County Health Rankings and Roadmaps program, which ranks the health of nearly every county in the United States based on factors like education, income, and access to medical care. County Health Rankings directly shines a light on social determinants of health that impact communities. Additionally, the Wisconsin Partnership Program within the UW–Madison School of Medicine and Public Health supports local projects across Wisconsin to address issues such as food insecurity, mental health, and healthcare access through grants and community partnerships. UW–Madison’s contributions to public health go beyond traditional research. The university’s role in state health policy and community health partnerships illustrates UW–Madison’s alignment with Wisconsin’s health policy goals and the movement to address SDH.
Impacts and challenges
As demonstrated by Wisconsin’s initiatives, SDH can be an effective tool when creating health policy. Understanding SDH makes both legislators and healthcare providers perform their roles more effectively, making them more knowledgeable about the populations they serve and the impact their decisions have on an individual level. Creating policies to improve community health will be more effective and long-lasting because of the upstream nature of SDH. Also, tackling SDH can lead to healthcare cost savings by reducing expensive emergency and chronic care services. Wisconsin can foster more economically stable and resilient communities by addressing SDH, contributing to a healthier and more productive workforce. This all culminates to have substantial impacts on health outcomes across Wisconsin, particularly in rural and low-income urban areas.
There are some challenges to achieving policy that addresses SDH, however. Wisconsin’s choice to not expand Medicaid fully under the Affordable Care Act limits healthcare for many low-income individuals and forces the state to rely on alternative funding sources to support SDH-related initiatives, which can constrain resources for these programs. Systemic inequities and racial disparities, as well as disparities across urban and rural areas also make it difficult to create uniform solutions across Wisconsin. Programs tailored to specific communities and counties, as well as equity-focused programs, are necessary to fully reap the benefits of SDH initiatives.
Conclusion
Understanding SDH is a necessary step to take for legislators, physicians, and those working in the healthcare field. Creating communities with equal access to healthcare and the equal opportunity to live a healthy life hinges on effective policy using SDH data to create long-term change. Wisconsin is taking several steps in the right direction by addressing SDH at the state and local level, but the importance of integrating healthcare with social services to tackle the root causes of health disparities cannot be understated. Continuous measures to study and address how SDH affects health outcomes will make these initiatives long-lasting and effective.
World Health Organization. “Social Determinants of Health.” Accessed November 9, 2024. https://www.who.int/health-topics/social-determinants-of-health.
Olson-Williams, Hannah, Keith P. Gennuso, Marjory L. Givens, and David A. Kindig. “Discounting Health Grades for Disparity: The 2021 Wisconsin Population Health and Equity Report Card.” Preventing Chronic Disease 20 (April 6, 2023): E23. https://doi.org/10.5888/pcd20.220301.
Wisconsin Department of Health Services. “Minority Health Program | Wisconsin Department of Health Services,” May 30, 2024. https://www.dhs.wisconsin.gov/minority-health/index.htm.
“2023 Governor’s Health Equity Council Report.” Wisconsin Department of Health Services, January 2023. https://www.dhs.wisconsin.gov/publications/p03236a.pdf.
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