New state health agenda could help Milwaukee
By Matt Hrodey
Wisconsin spends less on public heath than any state in America, and a new report by the Wisconsin Department of Health Services presents a 10-year plan to change this. The report has a long list of recommendations for how to upgrade state programs combating public health problems like obesity, alcoholism, infant mortality and smoking. Any improvements would be a boon to Milwaukee, which tends to have the biggest public health problems.
Although the report by the Wisconsin Department of Health Services has the upbeat title of “Healthiest Wisconsin 2020,” reflecting its vision of a state at peak health a decade from now, it paints a grim picture of state government’s current role in making that dream a reality. “Despite its progressive public health policy, Wisconsin is heavily dependent on federal funds and local property tax levy revenues to finance state and local governmental public health activities,” it says.
How little does the state contribute? Just $35 per person, compared to the national average of $94, according to a 2009 study by the United Health Foundation, a private foundation that does yearly rankings of states by public health. Wisconsin ranked dead last in spending and Midwestern states in general did poorly: Minnesota spends $41 per person (46th), Michigan spends $50 (39th), Iowa spend $51 (37th) and Illinois spends $55 (36th).
The lack of state funding, says Mary Jo Baisch, an assistant professor of nursing at UW-Milwaukee who was involved in the development of the state’s new 10-year plan, “puts us at a distinct disadvantage for providing public health. We put so much money into health care institutions, but we don’t put it into prevention.”
Despite the dearth of state funding, the Foundation ranked Wisconsin 12th in the country earlier this year for overall public health, a rating based on smoking, obesity, immunization and binge drinking rates, health insurance coverage, prenatal care, adult and infant mortality and other factors. The state’s robust Medicaid system, BadgerCare, might explain why the state is relatively healthy despite little funding for public health, according to Ron Cisler, director of the Center for Urban Population Health in Milwaukee.
In a similar study of Wisconsin counties by the UW-Madison Population Health Institute, Milwaukee County placed second to last (behind small, impoverished Menomonee County). Cisler says poor health, as measured by infant mortality, obesity and other indicators, is most intense in the city’s poorest areas. “Across the board, they do more poorly. Focusing on the poorest of the poor makes a lot of sense in our city,” he says.
Cisler expects the new emphasis on public health and eliminating disparities will help the city. “We could accomplish most of Wisconsin’s goals by focusing on the City of Milwaukee,” he says.
Inflexible funding
Local, federal and private funding make up for the lack of state funding. The state health department’s public health efforts get 75 percent of their funding from federal sources. Such money, the plan warns, comes with strings attached. It’s guided by federal priorities, which are set by the U.S. Department of Health and Human Services’ own 10-year plan (“Health People 2020”). “The priorities that are deemed important at the federal level may not be what are most important for improving the health of the people of Wisconsin,” the plan says.
John Dellinger, chairman of the new department of Pharmaceutical and Administrative Sciences at Concordia University, says the state health department has been successful at bringing federal money to the state for public health. “Wisconsin has done fairly well,” he says, but the funding has limits. “Most of federal funding, whether officially or not, is based on the population of the state.”
Baisch says the federal health care reform package, the Patient Protection and Affordable Care Act, is expected to increase funding for public health programs in the state, but, as usual, she says, funding for prevention is taking a backseat to funding for medical care.
Both she and Dellinger say the department will be comparing the state and federal plans for areas of overlap to capitalize on. Not by accident, Dellinger says, the state’s plan is coming out after the federal one.
State Rep. John Nygren (R-Marinette) calls the state health department’s call for more funding from non-federal and local sources “(an) expansive new plan to increase the cost, scope and size of government,” according to the conservative MacIver News Service.
Drinking to death
Some of the issues the state report raises might not fit into a federal agenda. Drinking-related deaths, for example, are the fourth leading cause of death in Wisconsin behind heart disease, cancer and stroke, the health plan says. “Wisconsin tops the nation in wasted lives, harm and death associated with its drinking culture,” it adds. “The roots of Wisconsin’s unhealthy and risky drinking are sunk deep in the state’s history, its ethnic heritage and the natural inclination of its residents to want to fit in.”
The plan calls for a host of legal changes aimed at bars, including greater liability for taverns that sell to drunk drivers, mandating training for bartenders on promoting responsible drinking and requiring keg registration – so when police bust an underage keg party, they can find the adult who purchased the keg using store records. The plan also proposes limiting “all you can drink” specials and alcohol sales at public events.
And it sounds the drum on two of the most criticized aspects of Wisconsin’s alcohol regulations – its DUI penalties and relatively small beer tax (6.5 cents per gallon), which hasn’t changed since Jimi Hendrix was still alive. Efforts by legislators this year to increase DUI penalties succeeded partially. Under most circumstances, the first offense is still treated as a traffic offense, not a criminal one. Changes that took effect at the beginning of this month make it a misdemeanor if someone under the age of 16 is riding in the car.
State law requires the health department to draw up a 10-year plan once a decade. This is the third one the state has produced. “It was a matter of getting a lot of people together, over 1,500, in different areas of the state,” says Beth Kaplan, department spokeswoman. “It’s a big effort and there are a lot of resources in terms of time taken, but it’s something that lays the groundwork for the next decade.”
Are local public health officials and providers paying attention? Apparently. “People across the state in public health setting are very aware of the state health plan,” Baisch says.