Addressing Racism as a Public Health Crisis
Milwaukee County, WI
Population: 750,000 - 1,000,000 | Government type: County | Topic: Systemic Racism
The designation allowed Milwaukee to identify and track COVID-19 cases by race ahead of other jurisdictions in the U.S. – even the federal government. (Photo: Yes! Magazine)
The policy
Milwaukee County has been plagued for generations with the reputation of being one of the most segregated communities in the country. This chronic condition has dragged on Milwaukee County’s measures of economic and physical health, disrupted educational attainment, and led to systemic poverty that has increased the cost of providing local government services. The resulting inequities are longstanding, complex, and interrelated. On April 4, 2019, Milwaukee County became the first jurisdiction in the nation to declare racism a public health crisis.
As a result of this declaration, the county government pledged to take the following steps:
Assess internal policies and procedures to ensure that racial equity is a core element of the county’s decision-making processes
Work to create an inclusive organization and identify specific activities to increase diversity
Incorporate inclusion and equity, and offer educational training to expand county employees' understanding of how racism affects individuals and the health of marginalized communities
Advocate for policies that improve health in communities of color
Encourage other local, state, and national entities to recognize racism as a public health crisis
Collaborative Governance
Milwaukee County engaged every facet of its community to craft its vision, from faith-based organizations and service partners in behavioral and public health to neighborhood and economic development entities and those in the criminal justice system. Internally, the county has trained all 4,000 of its employees on racial equity and the important role employees play in breaking down inequities in their departments (and, as a result, in the community). These training sessions cover a variety of topics and begin with a briefing on the strategic plan “One County, One Plan”’ the first strategic plan in 20 years and the first focused on fulfilling the county’s vision. The initial set of three-year objectives utilizes the “No Wrong Door” initiative, which allows residents who access any Department of Health & Human services program information about all DHHS’ programs and services in the county. The objectives are to create intentional inclusion by increasing diversity across every level of county government; to bridge the gap in services and health disparities; to invest in equity through an “upstream” model, which addresses the root causes of health disparities by enhancing fiscal health and sustainability; and to dismantle barriers to diverse and inclusive communities. The county provides a tiered training model to address various levels of leadership.
All employees will complete a 90-minute training provided by the YMCA. Managers participate in a “Nurturing Diversity Partners” 3 part series addressing the history on how we got here, bias, and hiring and retention practices. Senior leadership and elected officials complete a 16-hour “Unlearning Racism Leadership” training and a “Community & Dignity” training. In 2019, all leadership forum training participants completed a mini-training on othering and inclusivity.
In 2019, Milwaukee County launched Racial Equity (RE) Ambassador program with 60 employees - from leadership to front-line staff - to participate in racial equity action planning for the county. The program committed employees to a two-year timeframe in order to normalize, operationalize and institutionalize racial equity initiatives across the county. RE Ambassadors will complete an additional 104 hours of training over the tenure of the program. The program provides more than 4,160 hours of training in personal and racial identity, racial equity concepts & terminology, Racial Equity Toolkit implementation, communication for racial equity/change management, microaggressions, dignity and wellness, and race equity battle fatigue.
RE Ambassador members also contributed to several enterprise-wide projects and initiatives such as the Budget Toolkit (REBT), legislative research for Chapter 108, Milwaukee County toolkit creation, strategic planning initiatives, and various hiring initiatives.
Milwaukee County will be held accountable by external partners and community members who will be monitoring progress and results on its first strategic plan. The county will create a Strategic Plan Advisory Council to provide both input on and support for the implementation of solutions. The Advisory Council will consist of 11 representatives and have authority to enforce changes and recommendations. Recommendations for significant changes to the plan (for example, changes to wording of the objectives, or reallocating employee time or County resources to achieve the objectives) require a written recommendation to both the County Executive and the County Board Chair for consideration and approval.
Emphasis on equity
Milwaukee County has implemented its first strategic plan focused on fulfilling the county’s vision: “By achieving racial equity, Milwaukee County is the healthiest county in Wisconsin.” Together, county departments will work to dismantle institutional racism in local government and build up policies, practices, and cultures that ensure that race no longer predicts health outcomes. As a result, outcomes for the community will improve.
In April of 2020, Milwaukee County adopted an ordinance that will institutionalize and embed these new practices into law. Highlights include:
Diverse and Inclusive Workforce
Milwaukee County leadership, management, and staff will reflect the diversity of its residents to better represent the experiences and ideas of the people it serves. The county resolves to build a collaborative, supportive, and respectful workplace environment that increases the participation and contribution of all employees. Employees will understand what skills and experience are expected to advance to the next level and will have opportunities to gain those skills and experiences.
Employee Perspective
To enhance the health of Milwaukee County residents, the county government should strive to ensure that services meet everyone’s needs. Thousands of Milwaukee County employees directly serve residents each day. Their perspectives should be more intentionally considered to continually improve the equity of policies, procedures, practices, and power structures. County leaders and management will regularly consult and problem solve with a racially diverse representation of frontline staff to inform equitable policy, process, and customer service delivery decisions.
Improved Performance & Equitable Practice
The Milwaukee County government must improve the quality of the data it collects and the analysis of that data to better understand the impact of services on residents. The county does not want to simply assume that a service is producing its intended outcome. Instead, they intend to use qualitative and quantitative data to assess impact and continuously improve where services are falling short in order to improve the quality of life for all residents. The county declares that it will, at a minimum, use racial equity tools to evaluate the impact of decisions on black and brown communities for the budget and County-wide processes, policies, and procedures.
Fiscal Health
Over the past decade, Milwaukee County has cut between $20 and $30 million annually from their operating budget due to the structural deficit, and has accumulated hundreds of millions of dollars in deferred maintenance. Because of decisions made decades ago, and the restrictive authority given to local governments to generate new sources of revenue in the state of Wisconsin, county and municipal governments are forced to make decisions about cuts to services and repairs each year that can impact the health of county residents. The county government must find sustainable revenue sources and continue to pursue organizational efficiencies so they can make meaningful investments to advance racial equity. Declared county commitments include:
Securing additional revenue and achieving enough cost savings each year to be able to cover existing operating costs
Identifying and implementing mechanisms to make investments into strategic priorities to achieve the objectives outlined above
Using racial equity tools to evaluate the impact of decisions on Black and Brown communities for the budget, as well as operating processes, policies, and procedures
Offering training to support racial equity work at all employee levels
Requiring that every report submitted to the County Board includes an impact assessment that analyzes Milwaukee County’s vision statement as well as the report’s contributions (positive or negative) toward the goal of achieving racial equity
Creating and maintaining an external website dedicated to racial equity and health work in the county
Creating and maintaining an intranet site dedicated to racial equity and health work in the county
The county requires that departmental budget and program decisions undergo a racial equity analysis to demonstrate how decisions will impact racial equity. In practice, this means that decisions about taxation, park, or pool closures, or about employee increases, are analyzed to ensure that the action taken considers the impact on communities of color. Departments use the county’s Racial Equity Budget Tool, and each department presents their requested budget to the public and at the Finance Committee hearings prior to budget adoption this past November.
This year, the county faced a challenging budget in the wake of an ongoing structural deficit, a worsening Covid-19 pandemic, and public demand to dismantle generations of systemic racism that keeps Milwaukee County residents from getting ahead.
With the 2021 budget, Milwaukee County took an aggressive approach to bridge the gap in health disparities by advancing the No Wrong Door model of customer service to create easier access to quality care. Each step toward breaking down the silos that currently exist within county government increases access to services for all county residents and makes the best use of our limited resources.
On November 9, 2020, the Board of Supervisors approved an amendment to the 2021 budget from Chairwoman Marcelia Nicholson that makes additional investments in racial equity efforts and in improving the health of Milwaukee County residents from all walks of life. This budget was the first in Milwaukee County history to be guided by a plan for achieving racial equity and improving the health of all Milwaukee County residents. The amendment builds on this foundational and historic budget from County Executive Crowley by boosting efforts to achieve racial equity and serve the county’s most vulnerable neighbors, especially those most affected by the pandemic. By investing nearly $2.5 million more in parks and cultural amenities; in services for senior citizens and for young people involved in the youth justice system; in combating homelessness; in public libraries; and in employees, the county is making further progress towards achieving equity and improved community health.
Analysis
Preemption: Local governments have wide leeway to create strategic plans, design and structure their budgets - tax and sales revenue restrictions aside - and implement training and department-wide requirements and priorities.
Local government dynamics: The Milwaukee County Board has 18 members each representing a county district. The finance committee makes changes to the County Executive’s recommended budget and the full county board adopts the following year’s budget each November. The board is moderately progressive as a whole, although there is a group of board members who consistently offer progressive priorities for discussion and consideration.
Policy impact: Declaring racism a public health crisis, while important, is only a first step in actually addressing the actual crisis. Milwaukee County took action to institutionalize and codify next steps in budget priorities, county-wide training and in dismantling structures that uphold systemic racism and practices. The work is just getting started and the success depends on ongoing evaluation and accountability to meet the county’s ambitious commitments.
Last updated: January 19, 2021
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