The COVID-19 pandemic has tested preparedness for a public health crisis in Milwaukee County in ways that even the savviest of emergency planners could not have possibly foreseen. One of the first actions taken by local leaders was creation of a Unified Emergency Operations Center (UEOC) to monitor and support the countywide response. Consisting of emergency management and public health officials from Milwaukee County government and the county’s 19 municipalities – as well as representatives from private health systems, academia, and the business community – the UEOC was charged with tracking cases of COVID-19 across the county, coordinating resources, providing necessary information to county residents, and implementing community mitigation measures.
The need for a UEOC was predicated, in part, on the need to coordinate the pandemic response among 11 municipal public health departments within the county. It also ensured coordination and cooperation between those departments and the distinct Milwaukee County government agencies that handle behavioral health, disability and aging services, and emergency management; and with an Emergency Medical Services (EMS) system that combines county-level oversight/coordination with municipal service provision.
The creation of a temporary oversight body to coordinate the pandemic response among this large group of key players showed creative foresight. It also raised questions, however, about the need either for a permanent coordinating body or structural change going forward.
At the same time, Milwaukee County government has declared as its foremost priority the goal of making Milwaukee County the healthiest county in Wisconsin. That lofty goal – which will only be fulfilled if longstanding racial disparities in public health outcomes are addressed – provides another motivating factor for a review of the public health infrastructure in the county and how it can be fortified in the years ahead.
Toward that end, Milwaukee County administrators commissioned the Wisconsin Policy Forum to lead a research project designed to examine the current structure for public health service provision in the county and possible opportunities for improvement. The key questions we consider in this report include:
- Is there a need for a permanent unified approach to public health in Milwaukee County that could promote coordinated public health programming, planning, and data collection among the existing municipal health departments, county agencies, and other stakeholders?
- Would such a unified approach benefit from structural changes, including an enhanced role for county government in coordination and oversight activities or a reduction in the number of municipal public health agencies in the county?
- Is there a need for better coordination and collaboration between public sector public health agencies in Milwaukee County and private health care providers?
We provide insights on the answers to those questions in the pages that follow. We begin by explaining the expectations laid out for local public health departments in Wisconsin by the federal government and the state. We then provide snapshots of the 11 municipal departments in Milwaukee County, focusing on their budgets, staffing, and programs and services offered. We add perspective on issues related to coordination and collaboration provided by our interviews with municipal health department leaders and then provide additional context by analyzing the unique governance structures used in Dane and Racine counties. The report concludes with a set of insights and policy options gleaned from this initial research and suggestions for next steps.
It is important to note that we were unable to gather the financial, staffing, and activity data we sought from each department. One department (South Milwaukee) elected not to participate in this research project and others did not respond to our requests for financial data. Such instances are noted in the report. Also, only eight of the 11 public health officers agreed to be interviewed.
The findings of this report will be considered by a stakeholders group formed by Milwaukee County government leaders to consider not only potential structural changes to public health services in the county, but also additional steps required to address racial health disparities and improve health outcomes. Additional knowledge will be provided by a complimentary report prepared by the University of Wisconsin Population Health Institute.
We hope these collective efforts will lead to a subsequent phase of research into specific new models and strategies that can be considered by stakeholders and policymakers to enhance public health services and coordination in Milwaukee County.
This report – as well as a companion report by the UW Population Health Institute that can be accessed here – was commissioned by Milwaukee County.