The COVID-19 public health emergency exposed weaknesses in the Wisconsin’s public health infrastructure and led to over-reliance on hospitals and health systems to take on public health roles, at a time when the hospital workforce and resources were already stretched to the limit providing medical care to the communities they serve. In 2022, the WHA Public Policy Council Subcommittee on Public Health will convene to develop recommendations for slowing this migration of public health functions to hospitals, resourcing these functions for hospitals, or both. A new report by the Wisconsin Policy Forum (WPF) provides insight into current public health department functioning and opportunities to improve.
The WPF report describes the roles played by different levels of government in the delivery of public health services and proposes potential policy options to enhance the breadth, scope and quality of those services within the federal framework of the Centers for Disease Control’s (CDC’s) 10 Essential Public Health Services and the U.S. Department of Health and Human Services Public Health 3.0 model.
WPF analyzed municipal health departments in Milwaukee, Racine and Dane counties and found providing basic health services like flu shots, maternal and infant health programs, restaurant inspections and investigations of communicable disease "continue to be the strong suit" of the suburban health departments. The report includes a tally of eleven public health departments in Milwaukee alone. There are 85 public health departments across Wisconsin.
A key theme of the report is the lack of capacity and, in some instances, motivation among public health agencies to go beyond basic service levels. WPF’s analysis found challenges in public health departments’ ability to quickly respond to new public health challenges as they emerge, as well as their capacity to conduct the types of activities needed to better inform their services.
In many of the assessed cities and villages, the report shows the existing service model "essentially is delivering the same types of services" that were delivered two decades ago. "That this is the case despite substantial progression in the thinking and recommendations of federal public health agencies, the [Wisconsin Department of Health Services], and experts with regard to what local health agency services should look like is worthy of community-wide review and deliberation," report authors wrote.
The report also identified gaps between services provided and the community public health issues identified in the Community Health Improvement Process (CHIP), gaps which must be addressed by strengthening the infrastructure, resourcing these functions for hospitals, or perhaps, a combination of both.
The WPF report provides insights into why and how the public health infrastructure could and should be strengthened, which will prove valuable to the WHA Public Policy Council’s Subcommittee on Public Health. Commenting on the WPF study and the important work to be undertaken by the subcommittee, WHA Senior Vice President of Public Policy Joanne Alig said, “Wisconsin’s medical infrastructure is a finite resource that cannot assume both the health care and public health mantle for the state.”