Underlying Causes


Looking at health from a more holistic vantage point means digging into the underlying causes of health inequality. And doing just that is key to supporting patients and community members in Milwaukee and throughout the state of Wisconsin most effectively, according to leaders at the Medical College of Wisconsin.

This broader view of health means gaining a better understanding of the effects of social and economic factors. The World Health Organization (WHO) defines these factors as “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” Any barriers or disparities within these aspects of health are referred to as “social determinants of health.” In Wisconsin, inequities in these determinants are exacerbated because two out of every three counties are considered medically underserved. Because of this, some positive health outcomes are seen to a lesser extent in these Wisconsin populations, creating a greater health risk for the state.

Addressing Health Inequalities in Milwaukee County

MCW is addressing these challenging trends through its community engagement mission. Community engagement leans into the process of collaborative work with underserved or underrepresented people, focusing on health empowerment, but also on the systemic and environmental causes of their reduced wellbeing. According to President and CEO John R. Raymond, Sr., MD, “We cannot say that we have achieved better health without making a serious commitment to addressing health disparities and equity in the region.” To that end, a new community engagement program dedicated to this mission launched in 2019: COME ALIVE MILWAUKEE.

COME ALIVE MILWAUKEE, the acronym for COMmunity Empowerment and Lifestyle Intervention for Ethnic Minorities, started development in 2017, according to principal investigator Leonard Egede, MD, MS, inaugural Milwaukee Community Chair in Health Equity Research, professor of medicine, chief of the division of general internal medicine, and director of MCW’s Center for Advancing Population Science.

“We spent two years conducting focus groups and interviews and immersed ourselves in the central Milwaukee community to better understand its needs,” he says. After that initial phase, the program team has begun working to reduce the burden of chronic disease and eliminate health disparities in minority communities, as well as to grow the next generation of researchers.

The Role of Social Determinants of Health

“Chronic stress drives poor health in a community,” Dr. Egede explains. “Removing one stressor, such as access to healthcare services, doesn’t take care of all things, so we must shift the paradigm to incorporate social determinants into our clinical care models.”

With support from a $2.8 million, six-year award from the Advancing a Healthier Wisconsin Endowment (AHW), COME ALIVE MILWAUKEE partners with churches and nonprofits (among others) to focus on social determinants when addressing health equity in the communities of 10 Milwaukee ZIP codes.

“We need to learn from responses to natural disasters,” continues Dr. Egede. “When aid is provided, there is no blame. Aid providers, who are there to help, address the necessities first – such as food, shelter and water. We need to treat communities with significant health disparities in the same way. Healthcare, criminal justice, housing, hunger, violence, education and faith-based initiatives need to all work together to address the stressors that lead to poor health outcomes.”

COME ALIVE MILWAUKEE’s mission is to lead this collaborative work by helping facilitate a coordinated strategy, forge partnerships and recruit experts with needed skills in community education and public health. The AHW award is the foundation for a sustained commitment to Milwaukee.You don’t change a community in three to five years,” Dr. Egede says. “Five years is just the beginning.”

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