Turning the ship: making the shift to a life-course framework.

Turning a ship requires small but steady and deliberate efforts over time. During the past 9 years, Wisconsin's Maternal and Child Health (MCH) Program has begun to utilize the life-course perspective as its framework for guiding efforts around women's health, early childhood systems, children and youth with special health care needs, chronic disease integration, and elimination of racial and ethnic disparities in birth outcomes. In collaboration with many state and national partners, Wisconsin's MCH Program has integrated the life-course perspective into efforts that include the following: increasing professional and public awareness of the framework; creating focus groups and social marketing campaigns in communities most affected by health disparities; expanding preconception and women's health initiatives; integrating with traditionally "non-MCH" programs such as chronic disease programs; and shifting Title V resources from provision of individual services to assurance of effective early childhood systems. Wisconsin's implementation of the life-course perspective has not been without challenges, but opportunities have also been identified along the journey. Initial efforts focused on training and supporting partners in their understanding and application of the life-course framework, and a train-the-trainer model was discovered to be key to achieving these goals. We took care to engage special populations and their advocates and to work closely with local communities. We hope that the lessons we have learned in this process will provide guidance for others as they work to incorporate life course into their MCH work. The life-course perspective has helped us to inform partners, policy makers, and funders of the need for a new approach in addressing racial and ethnic disparities in health.

Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality.

Objectives: This study aimed to identify community-level actions to decrease racial disparities in infant mortality (IM). Design: Six urban multidisciplinary teams generated ideas for decreasing racial disparities in IM using a mixed methods concept mapping approach. Participants rated each idea as to its necessity and action potential and grouped ideas by theme. A cluster analysis produced a series of visual representations, showing relationships between the identified actions and the clustering of actions into themes. Multidimensional scaling techniques were used to produce analyses describing the necessity of and action potential for implementing the proposed ideas. Participants identified actions communities could take to decrease racial disparities in IM and suggested applications of the knowledge gained from the mapping process. Results: Participants produced a total of 128 actions, within 11 thematic clusters, for decreasing racial disparities in IM. The thematic clusters contained a range of elements designed to promote knowledge and understanding of the relationship between health and racism; improve educational systems and community opportunities; facilitate community-driven health promotion, marketing, and research; improve health services for women; address physical and social environments that impact community health; prioritize resource allocation of community-based services; institutionalize strategies that promote equity across all systems; and create and support legislation and policies that address social determinants of health. Correlation coefficients of the clusters ranged from 0.17 to 0.90. Average necessity ratings ranged from 2.17 to 3.73; average action potential ratings ranged from 1.64 to 3.61. Conclusion: Findings suggest that thematic clusters with high action potential usually represented ongoing community activities or actions communities could easily initiate. Community size, existing programs, partnerships, policies, and influential advocates were among the factors cited affecting feasibility of implementation. Clusters with lower action potential require broader, longer term, policy, institutional or system-wide changes, and significant resources. High necessity clusters often contained actions perceived as essential for change, but sometimes outside of a community's control. Participants identified a number of practical actions that were considered to hold potential for individual, community, and institutional changes which could result in decreasing racial disparities in IM.

Forward for women's health: the state of women's health in Wisconsin.

Because of the magnitude of women's health issues within the larger context of public health and healthcare systems, this paper was written to help define the current status of women's health in Wisconsin. Utilizing critical women's health areas identified by the Wisconsin Women's Health Foundation and the Wisconsin Division of Public Health, 16 specific measures of women's health were chosen for this analysis. The most recent data available for each measure were collected with Wisconsin data being compared to national averages as well as to Healthy People 2010: Objectives for Improving Health targets. Wisconsin women fare better than national averages in nine of the selected health measures; however, there are still many improvements to be made in order to meet Healthy People 2010 targets. The areas where the most improvements are needed include binge drinking, tobacco use, diabetes, and stroke mortality. Other significant findings include the lack of uniformly collected data in the areas of domestic violence, osteoporosis, and mental illness.