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For years, the Milwaukee metro area has had a reputation as one of the most segregated in the United States.How did this complex problem come about, and why does it endure? How does it contribute to persistent poverty? Are there ways to break through the boundaries?WUWM seeks answers to those questions in our Project Milwaukee: Segregation Matters series.

Segregation's Impact on Metro Milwaukee's Health Disparities

Jim Moy for Sixteenth Street Community Health Centers
Sixteenth Street Community Health Center

Segregation can impact a person's body, mind and health. Not everyone has the same opportunity to be healthy in a city like Milwaukee.

Dr. Julie Schuller says the lack of access to quality healthcare and environmental factors inhibit segregated African-American and Latino populations from living healthy lifestyles.

She is the executive vice president of the Sixteenth Street Community Health Centers, as well as the organization's vice president of clinical affairs. Sixteenth Street's health clinics, spread throughout Milwaukee’s south side and inner city, serve some of the city’s poorest and most segregated residents.

READ: Data Draws Link Between Metro Milwaukee's Segregation and Poverty

Chronic health problems - such as obesity, diabetes, heart disease and hypertension - are endemic to Milwaukee's African-American and Latino populations.

"The rising obesity levels in our population are very, very concerning," Dr. Schuller says. "Because there are disparities between segregated populations and also because the health effects of obesity are significant in terms of developing both diabetes and hypertension - two chronic diseases that are very prevalent in peoples of color."

Impact of Environmental Factors

According to the University of Wisconsin Population Health Institute county health rankings, 50% of factors affecting your health are social determinants.

Credit University of Wisconsin Population Health Institute

Dr. Schuller notes that segregated neighborhoods often have little access to fresh healthy food and many people may not feel safe enough to exercise outside of their homes. Chronic stress - attributed to violence, financial concerns, racism - experienced by these communities can also influence disease patterns and contribute to health disparities.

"I think the science is just emerging on that that is proving what we know from sort of a gut sense, that chronic stress is detrimental to people's health," she says.

Impact of Lack of Healthcare

Credit UW Population Health Institute
The blue map displays Wisconsin’s summary ranks for health factors. The results are based on weighted scores for health behaviors, clinical care, social and economic factors, and physical environment. Milwaukee county is among those ranked lowest in the state with 71 points.

Access to quality healthcare is most important when it comes to maintaining a person's health. "We need to be able to provide the right care in the right place at the right time, and having coverage and having locations available is critically important to that," Dr. Schuller says.

There's simply a lack of easily accessible doctors' offices located in areas of poverty.

"Often times in inner cities, we don't see as many doctors and doctors' offices as we need in order to take care of the population that's living there," she explains. "Not only do we need doctors' offices, but we need those offices to have appointments that are available to patients."

The increase in the number of people seeking care in emergency rooms for conditions that are more appropriately cared for in primary care offices, Dr. Schuller says, points to our lack of good access for people.

A Bright Spot

Lake Effect's Mitch Teich with Dr. Cynthia Haq and Doctor Michelle Buelow of the TRIUMPH program.

One group working to train and place doctors in medically underserved urban communities in Wisconsin, and beyond, is TRIUMPH, or Training In Urban Medicine and Public Health.

Credit Jim Moy for Sixteenth Street Community Health Centers

TRIUMPH was established to recruit and prepare community-engaged physicians. The training includes placing medical students, in their clinical years, in Milwaukee's urban communities. This gives the students a diverse educational experience, as well as allows them to develop skills needed for the community and public health sphere.

"Most people, when they think of doctor shortages think of rural areas," says Dr. Cynthia Haq, a professor of family medicine and population health sciences at the UW-Madison School of Medicine and Public Health. "It's surprising to find out that here in Milwaukee, the biggest city in Wisconsin, we actually have a shortage of primary care physicians to provide basic healthcare services for a majority of the population."

While the absolute numbers of Milwaukee County shows no shortage of physicians, the zip code level reveals that many communities are without access to a doctor. This is due, in part, to health systems that once served poor communities moving to more affluent communities, where they can garner a greater profit, Dr. Haq says.

Dr. Michelle Buelow, associate director of the TRIUMPH program based at the 16th Street Community Health Center, says that learning about and addressing the specific needs of a community while in medical school is a unique opportunity most medical students do not get. "I'm still constantly learning through TRIUMPH and it's informing my practice at my clinic right now."

The Underlying Issue

"As the leader of a health clinic, I feel it's incumbent on us within the health clinic to do as much as we can to lift people out of poverty."

Ultimately though, Dr. Schuller says the underlying problem impacting health issues in Milwaukee is poverty. While she admits that poverty is complex and multifaceted, doctors need to do their part in lifting people out of it - whether it is through health education, helping people obtain the tools that they need or advocating on their behalf for issues related to Medicaid.

"I think that the value of a culture is reflected in how good we are to each other, and so we need to come together to help lift everyone out of poverty so we can all live healthy lives," Dr. Schuller says.

For more on this topic, explore our Project Milwaukee: Segregation Matters series.

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