Wisconsin Department of Health Services: Centering Health Equity in State Health Improvement Planning

This blog post is part of a new series highlighting the work of Healthy People State and Territorial Coordinators (Coordinators). Coordinators make Healthy People happen every day across the United States. ODPHP works with Coordinators to identify areas of alignment with their work and Healthy People 2030 goals and objectives. 

Healthy People 2030 goals and objectives guide the Wisconsin Department of Health Services (DHS) throughout the development and implementation of its State Health Improvement Plan (SHIP). Serving a population of approximately 5.9 million people, DHS acts as the lead state agency for public health in Wisconsin. DHS embraces its mission to “protect and promote the health and safety of the people of Wisconsin” and works toward a vision of “everyone living their best life.” Unlike other states with a standalone public health agency, DHS includes public health under its umbrella of programs and services. This brings with it both benefits and challenges.

“Public health is incorporated within a large health agency that also includes Medicaid services, quality assurance, and mental health treatment and care, which is a huge plus to us because we have in the same place all of these different programs that we can collaborate on,” notes Margarita Northrop, DHS’s SHIP Coordinator. “But it also presents unique navigation of system challenges to our team.” 

Wisconsin is a local control state which honors the “home rule”: a local jurisdiction can determine its local affairs, such as local services and public health planning specific to their communities. Home rule empowers local and tribal health departments to take action on the most pressing matters — while still accessing support, guidance, and funding provided by the state. This flexibility allows communities to conduct the necessary work, while contributing to the collective health of all Wisconsinites.

Aligning Wisconsin’s SHIP with Healthy People 2030 principles and practices creates collaborative efficiencies

DHS is a Public Health Accreditation Board (PHAB)-accredited public health organization and updates their State Health Plan on a 5-year cycle. The Wisconsin State Health Plan design includes a State Health Assessment (SHA), a SHIP, and a SHIP implementation guide. “It's considered to be our roadmap in Wisconsin for community health improvement,” says Northrop. “It reflects, very closely, what is happening locally, and it's aligned with local community health improvement plans as well as Healthy People.”

Throughout the process of developing and implementing their SHIP, DHS makes extensive use of Healthy People 2030 — identifying it as a connector across sectors, jurisdictions, and geographies, and using it as a model for their own framework. Several of DHS’s priority areas closely reflect Healthy People 2030 priority areas. For example, the consideration and goals of the Foundational Shifts section in the Wisconsin SHIP framework — which includes institutional and systemic fairness, as well as representation and access to decision-making topics — in many ways resembles and reflects Healthy People 2030’s prioritization of Health Equity. DHS’s Health Equity Assessment and Resource Team (HEART) uses Healthy People 2030’s disparities data and tools to promote greater health equity in over 70 local health departments in Wisconsin. 

Knowing that so much of their work is aligned with Healthy People 2030, DHS and HEART also encourage local health departments to use the Healthy People 2030 Social Determinants of Health (SDOH) framework and other Healthy People 2030 resources in their daily work. Notably, the Wisconsin SHIP framework addresses each of the Healthy People 2030 SDOH domains, but within the context of topic areas that include economic well-being; supportive systems of care; person and community-centered health care; healthy housing; physical, mental, and systemic safety; and social connectedness and belonging. 

“Healthy People 2030 is comprehensive, and a valuable shared language that is particularly helpful when connecting across states and between state and local levels,” says Abravi Sadji, DHS’s SHIP Liaison. “Aligning with Healthy People allows us to prioritize the most pertinent issues in our SHIP, but still not trivialize the importance of other public health issues that are not on our priorities list.”

Successful SHIP planning and implementation begin with inclusive outreach and engagement

Broad and bold public health initiatives require extensive stakeholder engagement, collective action among diverse constituencies, alignment across multiple systems in both the for- and non-profit sectors, and inclusion of government at national, state, tribal, and community levels. This idea is at the heart of the Healthy People 2030 overarching goal to engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve health and well-being for all.

DHS’s Office of Health Equity (OHE) is instrumental in enhancing the collaborative engagement vital to establishing health equity. OHE actively works to create partnerships throughout the state to address disparities, remove barriers to equitable access, and enhance well-being and resilience for all who call Wisconsin home. This work spans rural and urban environments but maintains a focus on groups marginalized by economic factors, identity, or place. Communities who, as MayChee Yang — a Health Equity Strategist within OHE — has observed, “experience the greatest burden of health disparities.” 

Much of this engagement depends on collecting community input from those with lived experience and those doing the work “on the ground.” By elevating community voices and listening in new ways, DHS can better ensure that health improvement planning is comprehensive, and that policies and programs equitably meet the needs of all community members. Direct collaboration with local partners — such as community-based organizations, academic institutions, corporations, and philanthropic organizations —provides additional avenues to connect and further align with the SHIP’s broader goals.  

State health improvement planning and implementation are living, ever-evolving processes

New data and outcomes assessments provide evidence of what’s working and what’s not. Timely information helps DHS further refine its approach to the design and content of their SHIP. For example, updates to public health models may require DHS to broaden or narrow the scope of their interventions, as well as reassess specifics of that decision-making process. For these reasons, DHS regularly revisits key questions throughout the process, such as: “Who are the key partners and collaborators needed to address social determinants of health?” 

DHS has also observed that as the concepts and language of health equity evolve, so do best practices for their communication and delivery. Historic tensions can present challenges to embedding health equity principles within established, localized systems. DHS recognizes that understanding these tensions is an integral first step in their alleviation. Local partners are encouraged to explore new ways to bridge real and perceived barriers to systems improvements, openly discuss partner’s concerns, and establish the foundational trust necessary to achieving health equity within communities throughout the state.

Lessons learned

DHS recommends keeping the following tips in mind when developing and implementing SHIPs:

• Qualitative data enriches quantitative findings, providing context and highlighting real life implications. The voices and stories of people can get lost in the numbers, population-level data, and empirical evidence. However, such information is critically important to better understand individual experiences and the implications of an agency’s work. Such data can also point toward challenges or outcomes not directly conveyed by those that the agency serves. 
• Strong relationships with community partners improve communication and transparency. Timely information-sharing makes both DHS and their partners more agile in responding to changes in community needs and priority shifts. Intentionally engaging with communities ensures that strategies remain relevant and impactful.
• Dedicating specific funding to SHIPs improves planning and increases the likelihood of positive long-term public health outcomes. Dedicating funding to the work of partners at the community and institutional level supports sustainability for effective interventions where help is needed most: in communities most impacted by health inequities.
• Understanding social, economic, and historical context is crucial for effective public health programming. The health inequities seen today are often historical in nature, deepening and broadening over decades due to an array of structural deficits, poor policy decisions, or policy inaction. Learn from the past, understand that these factors continue to influence health outcomes, and use these lessons to guide current and future program design and development.
• Understanding perspectives, fears, and aspirations among diverse communities is essential to developing adaptable and sustainable health strategies. Ensure that everyone has a seat at the table, their voice is heard, and that what they communicate is understood. Interventions are most successful when we understand the context of people’s lives, their communities, and the interplay of both — be it a service for a single person or a national policy shift.

By using a collaborative approach and involving community members throughout the process, DHS has developed a SHIP tailored to Wisconsin, but aligned with and supportive of Healthy People 2030’s national health objectives. DHS has embraced that public health change requires time and patience — and asks everyone in service to public health to take up their charge to “keep going!”

To learn more about the Healthy People 2030 objectives related to Wisconsin DHS's SHIP work, please click on the objective links listed below.