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New State Plan Emphasizes Root Causes Behind Public Health Conditions and Outcomes

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by Erik Gunn, Wisconsin Examiner
February 6, 2023

A new state plan to improve public health calls for addressing broad social and economic problems and emphasizes making institutions and social systems in Wisconsin fairer to everyone. 

The State Health Improvement Plan from the Wisconsin Department of Health Services (DHS) says it will take “foundational shifts” to bring public health agencies into discussion and action on issues including child care, housing, broader community resources and even how communities and the state make policy decisions.

Paula Tran, Wisconsin state health officer (DHS photo)

“In the past, we have always thought as a nation that health is only about our individual decisions and our individual ability to make the right choices,” said Paula Tran, the state’s health officer and the administrator of the DHS public health division, at a Feb. 2 media briefing on the new plan. Individual choices are important, but they are “only one piece of the things that we can influence.” 

The new plan is based on an understanding  that “there are fundamental ways that we can be thinking about these issues, to really understand root causes [and] to create conditions” that will lead to better health outcomes, Tran said. 

The plan’s focus follows closely the perspective reflected in the final report from the Governor’s Council on Health Equity, issued Jan. 30. 

A statewide health improvement plan is required every 10 years under state law, 

The new plan sets as top health priorities social and community conditions; physical, mental and systemic safety; centering health care in the community and on the person; bolstering social connectedness and belonging; and attending to mental and emotional health and well-being.

Including social conditions among those priorities “is really responsive to the growing and consistent evidence that our health outcomes are shaped by the conditions around us, such as our economic well-being, our sources of health food, healthy housing,” Tran said. 

She called those among the “key drivers that shape the conditions where health begins,” making it important to address such matters in the context of public health.

“And if we’re not as communities making decisions and investments in those areas, to assure every individual in every community in our state has the opportunity to make the best decisions, then we’re not doing all we can to assure that all Wisconsinites can be well and healthy,” Tran said.

The plan will play out in the months and years ahead as DHS works with local and tribal health departments and community organizations, Tran said. 

The plan emphasizes “institutional and systemic fairness,” ensuring the public has “representation and access to decision-making,” and focusing resources and services on communities. That means, in the course of working with local agencies and groups, “ensuring community residents have an equal opportunity to be involved in local decision-making, and that resources are allocated in a way that’s really community centered,” she said.

The health improvement plan draws on a 2020 State Health Assessment, based both on health data collected by local departments and providers as well as on interviews with hundreds of state residents. 

Taken together, that report showed that “the mental health of Wisconsinites [has] long been suffering, and that has only worsened under COVID-19,” Tran said — leading to the decision to include that subject in the new plan. 

The plan’s emphasis on centering health care on individuals and communities is something that local health agencies and community groups are looking at as well, Tran said. 

One development, she said, is to focus more on deploying community health workers who reflect the people and lives who may be most affected by inequities in health outcomes.

“They are often either informally delivering care or formally being hired into health care systems or at the community level,” Tran said, to help ensure that the health care being provided is “responsive to a local community’s needs.”

Tran described a public whose input helped shape the new plan and whose members are already on board with that broader context for public health.

“That’s what residents told us,” she said. “It’s not just about what happens in the hospital. It’s not just about the decisions one person makes. Our residents told us that if they don’t have the opportunities to have well-paying jobs, if they don’t have systems that support dependent care [for] their kids or their aging parents, if they don’t have healthy housing, it makes it very difficult to make those good decisions to be well.”

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