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University of Wisconsin–Madison

Assessing and Improving Community Health in Wisconsin

Alcohol use

The burden of excessive alcohol use is a major public health issue in Wisconsin. Heavy consumption of alcohol can lead to violence, injury, liver disease, cancer, and premature death. Wisconsin’s policy environment supports a pervasive drinking culture. Our state ranks higher than the national median for measures of excessive drinking and alcohol-impaired driving deaths. While reported alcohol use by Wisconsin high school students in 2013 was below the national prevalence, underage drinking, which is defined as drinking by youth ages 12-20, is currently higher than national rates. The estimated cost of excessive alcohol consumption in Wisconsin was $6.8 billion in 2012. These costs are borne by everyone in the state. Policy and environmental changes can help support opportunities for healthier choices and reduce excessive use of alcohol.

Sources:
Black PD, Paltzer JT. The Burden of Excessive Alcohol Use in Wisconsin. University of Wisconsin Population Health Institute, February 2013.

University of Wisconsin Population Health Institute. County Health Rankings 2016
Wisconsin Department of Health Services, Division of Care and Treatment Services and Division of Public Health. Wisconsin Epidemiological Profile on Alcohol and Other Drugs, 2016.

Diet & exercise

Poor nutrition includes under- or over-eating, not eating enough fruits and vegetables, and consuming excessive amounts of foods that are high in unhealthy fat, salt and sugar. Poor nutrition can lead to health problems including being overweight or obese, high blood pressure and high cholesterol, osteoporosis, depression and eating disorders. In Wisconsin, fewer than one in four adults reports eating the recommended five servings of fruit or vegetables per day. An individual’s food environment plays a big role in eating behavior.

Regular exercise is one of the most important things you can do to improve health. Exercise helps control your weight and reduces the risk of cardiovascular diseases, type 2 diabetes, and some cancers. In 2013, two out of three Wisconsin adults were overweight or obese, continuing a steady increase in obesity over the past decade. Obesity and physical inactivity is known to contribute to Type 2 diabetes, high blood pressure, heart disease, stroke, and cancer. Programs and policies can play a role in supporting opportunities for and promoting exercise, healthy eating and lifestyle changes. 

Sources:
Centers for Disease Control and Prevention. Nutrition, Physical Activity, and Obesity.
    http://www.cdc.gov/nutrition/
    http://www.cdc.gov/physicalactivity/everyone/health/ 

Hatchell K, Roubal AM, Catlin BB, Timberlake K. Opportunities to Make Wisconsin the Healthiest State, University of Wisconsin Population Health Institute, 2015.

Drug use

Drug use refers to the use of both legal and illegal drugs, including abuse of prescription drugs. Abuse of and addiction to legal and illegal drugs have negative consequences for individuals, their families and society, including harmful effects on health, workplace productivity, and crime.

Wisconsin has seen an increase in overall drug-related deaths and drug-related motor vehicle fatalities over the past ten years. Our state is also in the midst of an opioid epidemic, as prescription opioids have been a major driver in overdose deaths and poisonings. From 2006 to 2015, the rate of opioid overdose deaths in Wisconsin has nearly doubled and 70% of drug related deaths in 2015 involved opioids.  Policies and programs can increase opportunities to make healthy choices and support treatment to reduce the misuse or abuse of drugs.

Sources:
National Institute on Drug Abuse. DrugFacts: Understanding Drug Abuse and Addiction. Revised August 2016.
Wisconsin Epidemiological Profile on Alcohol and Other Drug Use
Wisconsin Department of Health Services: Select Opioid-Related Morbidity and Mortality Data for Wisconsin, November 2016

Sexual activity

High risk sexual practices, including unsafe sex and higher numbers of lifetime sexual partners, may lead to sexually transmitted infections (STIs) and unplanned pregnancies. The outcomes of these high risk practices often affect not only immediate and long-term health, but also the economic and social well-being of individuals, families, and communities.

In recent years, the total rate of reported chlamydia, gonorrhea and syphilis in Wisconsin has been rising.The teen birth rate in Wisconsin in 2015 was 16.4 births per 1,000 females aged 15-19, and while this has declined by more than half since year 2000, significant disparities in teen birth rates between differing racial and ethnic groups still exist. The policy environment can play a role in supporting community conditions and programs that reduce STIs and unplanned pregnancies.

Sources:
County Health Rankings and Roadmaps-Sexual Activity
Annual Wisconsin Birth and Infant Mortality Report, 2015
Sexually Transmitted Disease in Wisconsin, 2016

Tobacco use

Tobacco use is the leading cause of preventable death in Wisconsin and the United States. Even though cigarette smoking has slowly declined among adults in Wisconsin, nearly one in five Wisconsin adults still smokes and approximately 15% of annual deaths in our state are directly attributable to smoking. In Wisconsin, costs of smoking are $2.66 billion a year for medical costs alone.

Policy and environmental changes support opportunities for healthier choices and help motivate users to quit smoking, prevent youth smoking initiation, and improve the quality of the air we breathe.  

Sources:
Centers for Disease Control. Prevention Status Report: Tobacco use.
2015 Burden of Tobacco Report in Wisconsin
County Health Rankings and Roadmaps: Tobacco Use

Access to care

Access to care includes access to primary and preventive health care, dental care, and mental health services for residents in Wisconsin. In 2017, approximately 9% percent of the population under age 65 in Wisconsin were uninsured.

Having access to comprehensive, high quality, affordable health care affects an individual’s overall physical and mental health and well-being, as well as overall life expectancy. Significant differences exist in use of and barriers to healthcare in Wisconsin by population. Males are less likely than females to visit a doctor in the past year and older adults are less likely than younger adults to visit a doctor in the past year. Blacks, Hispanics, and Asians are more likely than whites to be unable to obtain care due to costs. Income, geography, and disability status are also barriers to obtaining care. Policy environments that reduce barriers to care and better match providers to community needs can help improve community health and well-being.

Sources:
CHRR Wisconsin Measures: Uninsured
HealthyPeople.gov. Access to Health Services.
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Quality of care

High quality health care requires health providers, health systems, and others to work together to improve the health outcomes and satisfaction of patients. This type of care includes evidence-based decisions, performance assessment, and explicit efforts to improve quality, reduce errors, contain costs, and involve patients in their care.

Quality of care varies by state, race, ethnicity, and income. The US has the highest per capita health care spending in the world, yet has shorter lifespans and higher infant mortality rates than other wealthy nations. Wisconsin quality measures are high compared to other states, yet there are prevailing disparities in health care delivery among racial and ethnic minority groups and low-income populations. Initiatives to improve the quality of healthcare in all settings can help us all get the care we need when we need it, leading to longer, healthier lives, and healthier, more productive communities.

Sources:
County Health Rankings and Roadmaps-Quality of Care
National Healthcare Quality & Disparities Report: Wisconsin Measures

Chronic disease

Chronic diseases and conditions—such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems. Chronic diseases and conditions, along with their health risk behaviors that cause them, account for most U.S. health care costs. The majority of deaths in Wisconsin are caused by chronic diseases, and chronic diseases are also a cause of significant morbidity in our population.

The places where we live, learn, work and play shape our opportunities to engage in healthy behaviors. Four major health behaviors—lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the problems related to chronic diseases and conditions. Policy and environmental changes can support increased opportunities to make healthier choices, including opportunities for physical activity and access to healthy foods.

Sources:
Centers for Disease Control and Prevention. Chronic Disease Overview.
Wisconsin Chronic Disease Quality Improvement Project HEDIS 2015 Summary Data

Mental health

Mental health refers to one’s state of emotional, psychological, and social well-being. Mental health is important to everyday life and affects how we live, feel, work, and interact with others. Poor mental health is associated with various factors such as rapid social change, stressful work conditions, gender discrimination, social isolation, unhealthy lifestyles, poor physical health, risks of violence, and human rights violations. Emerging evidence shows an association between positive mental health and improved health outcomes. Policy and environmental changes that improve living conditions and allow people the opportunity to maintain healthy lifestyles can promote mental health.

In Wisconsin, approximately 184,000 adults (4.2% of all adults) aged 18 or older in 2014–2015 had serious thoughts of suicide in the past year.  About 175,000 adults aged 18 or older (4.0% of all adults) in 2014–2015 had Serious Mental Illness (SMI) in the past year. Among youth in our state, about 61,000 adolescents aged 12–17 (13.6% of all adolescents) in 2014–2015 had experienced a Major Depressive Episode (MDE) in the past year.

Sources:
Centers for Disease Control and Prevention: Mental Health Basics
Behavioral Health Barometer: Wisconsin, Volume 4
World Health Organization, Mental health: strengthening our response

Community safety

Community safety reflects violent acts in neighborhoods and homes, as well as unintentional injuries caused by accidents. Living in unsafe neighborhoods is associated with chronic stress, which can accelerate aging and harm health. Injuries are often predictable and preventable. However, about 30 million Americans are treated for injuries each year, and more than 192,000 people died from these injuries in 2013. Injury is a threat to public health in Wisconsin, causing about 3,078 deaths annually and accounting for approximately 50,268 hospitalizations and 448,213 emergency room visits. 

Policies and programs to prevent accidents and violence can help support safe environments and protect residents.

Sources:
County Health Rankings and Roadmaps-Community Safety
Wisconsin Injury and Violence Prevention

Education

Research shows that higher levels of education correlate to individuals living longer, healthier lives and their children are more likely to thrive compared to those with less education. On average, college graduates live nine more years than those who do complete high school. Wisconsin has a 88% high school graduation rate, though these rates vary by county and some areas have much lower rates. Higher incomes, better employment options, and increased social supports are all linked to more schooling, and these factors offer opportunities and access to resources that support healthier choices.

Wisconsin is struggling to promote the health of infants whose mother has a high school level education or less and working age adults who have a high school level education or less, as higher death rates are seen among these groups. Communities and educators can work together to increase educational attainment for both children and adults in our state.

Sources:
Health of Wisconsin Report Card, 2016
County Health Rankings and Roadmaps-Education
CHRR Wisconsin Measures: High school graduation

Employment & income

Employment provides income and other benefits that can support healthy lifestyle choices. However, unemployment and underemployment limit healthy lifestyle choices, and negatively affect quality of life and overall health. Trends in Wisconsin show a decline in poverty and increase in employment since the great recession, though some parts of the state are doing better than others. Wisconsin actually saw an increase in income inequality between 2015 and 2016. Overall, 12% of our state’s population is living below the federal poverty line and 17% of children under age 18 are living in poverty. However, some regions of the state have much higher poverty rates than others. The policy environment plays a role in reducing and preventing poverty.

A community's economic conditions and an individual's level of educational attainment play important roles in shaping employment opportunities. Income offers economic resources that shape opportunities related housing, education, child care, food, medical care, and more. Accumulation of savings and assets help provide protection in times of economic distress. As income and wealth increase or decrease, so does health. Programs and policies can create opportunities to increase job skills, enhance local employment opportunities, and create supportive and safe work environments for communities.

Sources:
United States Census Bureau’s American Community Survey
County Health Rankings & Roadmaps-Income
County Health Rankings & Roadmaps-Employment
County Health Rankings and Roadmaps Wisconsin Measures: Poverty and Children in Poverty
Wisconsin Poverty Report: The Recovery from the Great Recession Lowers Poverty Rates in 2015

Family & social support

Those with greater social support, less isolation, and greater interpersonal trust live longer and healthier lives than those who experience social isolation. Neighborhoods with greater social capital provide residents with greater access to support and resources. In Wisconsin, 17% of adults are without adequate social/emotional support.

Policies and programs that support relationships between individuals and families across entire communities can benefit health, especially those made by emphasizing efforts to support disadvantaged families and neighborhoods.

Sources:
County Health Rankings and Roadmaps-Family and Social Support
County Health Rankings and Roadmaps Wisconsin Measures: Inadequate social support

Housing & transit

Access to safe, affordable, and accessible housing options and transit systems shape our communities' built environment and affect where we live and how we get around in our communities. Presence of asbestos, mold, pests, lead paint, and radon are some factors that can make homes unhealthy. Housing instability and unaffordable housing also greatly impact health. 62 percent of Wisconsin households with income less than $20,000 a year spend more than half of their income on housing. 15% of Wisconsin households experience severe housing problems such as overcrowding, high housing costs, or lack of kitchen or plumbing facilities.

Transit includes not only includes public transportation systems, but also cars, bikes, streets, sidewalks, bike paths, and highways. Often, neighborhoods lack sidewalks, safe crossings, or shared transit services that support healthy choices. In Wisconsin, 26% of workers who drive alone have a 30 minute or longer commute. Our state has 81 public transit systems in both urban and rural areas, though some rural counties are still unserved. Policies and infrastructure that support access to safe, affordable housing and transit can positively impact health.

Sources:
County Health Rankings and Roadmaps-Housing and Transit
United States Census Bureau’s American Community Survey
State of Wisconsin Department of Transportation

Other

This category is intended to include health improvement strategies that do not neatly fit into one of the defined health priorities.

Examples of implementation approaches that do not neatly fit into one of the health priorities include, but are not limited to, approaches related to maternal and child health, Adverse Childhood Experiences (ACEs), oral health (not related to access to care), and Health in All Policies.