‘Not everyone in every county has the same opportunity to be healthy’: Outcomes among Wisconsin counties are unequal

Health outcomes are not even across Wisconsin’s 72 counties, and even the healthiest counties have sharp disparities, with Black residents far more likely to die prematurely, according to new data from the University of Wisconsin–Madison’s Population Health Institute.

The institute released its 2023 County Health Rankings last week, which looked at health outcomes in every county in the state and nearly every county in the United States. They also compared Wisconsin’s health outcomes to the nation’s, and looked at the civic health of each county.

Of the state’s 72 counties, Ozaukee County had the best overall health outcomes, while Menominee County ranked last. Those rankings evaluate length of life and quality of life, and several other measures.

The so-called “WOW” counties of Waukesha, Ozaukee and Washington all ranked in the top five, while neighboring Milwaukee County ranked 70th out of 72 counties, the data showed.

Nicholas Schmuhl, a research and analytics scientist with County Health Rankings & Roadmaps, said there’s a long-running pattern of Milwaukee being near the bottom of the state while its suburban neighbors rank near the top.

“Milwaukee County is suffering from more premature deaths than its neighbors and, in fact, more than the state of Wisconsin on average, and more than the United States on average,” he said. “Whereas those neighboring counties — Ozaukee, Waukesha and Washington counties — are doing a bit better than the state and better than the nation in general.”

At the same time, Milwaukee and the WOW counties all see disparities between Black residents and white residents, Schmuhl said.

In Milwaukee, Black residents are more than twice as likely to die prematurely than their white neighbors, he said. Neighboring counties had similar disparities.

“It’s not only important to look at that overall number. That certainly is indicative of how a community is doing overall, but we’re also concerned that everyone has the opportunity to be as healthy as possible within a county,” Schmuhl said. “And these data show that not everyone in every county has the same opportunity to be healthy.”

Milwaukee also struggled with low birth weights more than the WOW counties, and researchers saw similar disparities between Black and white residents in that category as well, Schmuhl said.

“In Milwaukee County, there’s quite a disparity between Black and white residents with Black residents suffering from nearly three times as much low birth weight as white residents,” he said. “Similarly, in Waukesha in Washington County, (there was) twice as much low birth weight among black residents as white residents.”

Milwaukee also lagged behind the WOW counties in terms of civic health, which Schmuhl said includes access to public spaces like parks, libraries, well-funded schools, community centers and voter turnout.

“Health also has to do with making one’s voice heard in their community, and having their values reflected in the decisions that are made in their community,” he said. “Because when people are able to have their voices heard, they tend to be able to have better access to the resources that they need to thrive.”

Milwaukee had lower voter turnout and census participation than the state average, while Waukesha, Ozaukee and Washington fared better than the state, Schmuhl said.

While the county containing the state’s largest city struggled, the county with the second-largest city fared much better. Dane County had the 8th best health outcomes in the state, but also saw disparities between its Black and white residents.

Black Dane County residents were three times as likely to die prematurely than white residents, and twice as likely to have low-birth weigh babies.

“It would be easy for Dane County to sit back and rest on its laurels and say, ‘We’re doing great, we’re in the top 10 in Wisconsin.’ But I think people in Dane County and leaders in Dane County should really dig deep into the data and find out what’s going on with those disparities because it’s really problematic that not everyone in Dane County has the same opportunity to be healthy,” Schmuhl said.

Wisconsin’s health compared to the United States as a whole varied. The data shows the state fares better in premature death, sexually transmitted infections, rate of people with health insurance and high school completion rates. But it’s worse than the country as a whole in excessive drinking, alcohol-impaired driving deaths, injury deaths and air pollution.

The new data comes as the United States has seen declining life expectancy since 2019, and lags behind other wealthy countries. The average life expectancy in America is 76.1 years, while the average among other comparable countries is 82.4 years, according to the nonprofit Kaiser Family Foundation.

Schmuhl said Wisconsin’s life expectancy was about 79 years, higher than country as a whole but still behind other wealthy nations. He said the declining life expectancy in the United States could be tied to racial and socio-economic disparities, like the ones seen in Wisconsin’s counties.

“Those disparities are becoming wider, and that might be a reason that we are seeing life expectancy decline,” he said. “People at the top have more opportunities to be as healthy as possible. That group of people may be getting smaller, and the group of people who have fewer opportunities may be getting larger.”