HomeMy WebLinkAbout1-3-24 DRAFT CHA 2023 (2)DRAFTCommunityHealthAssessment
Winnebago CountyPublic Health
December 2023
Winnebago County has many rich natural
resources identified by Native Peoples,
including timber, minerals, prairie, and
waterways. Oshkosh, the largest city and
county seat, is named after Chief Oshkosh, a
great leader of the Menominee Nation who
fought back against forced relocation and
shared ideas of sustainable forestry.
The Menominee Nation continues to manage
one of the most sustainable forests in the
country, revered and studied for land
management techniques that were passed
down from Chief Oshkosh.
We take this time to acknowledge that
we are currently residing on the
ancestral and unceded lands of Ho-
Chunk and Menominee people.
Winnebago County is named after the
historic Winnebago Tribe, known today
as the Ho-Chunk Nation. We honor
their enduring relationship with this
land and express our gratitude for their
stewardship. We also recognize the
ongoing struggles that Indigenous
communities face due to historical and
ongoing injustices.
(1)
(2)
Tribal Nations
The United States, as a settler colonial society, focused on the dissolution of Indigenous
languages, cultures, and nations for more than 100 years until the passage of the 1975
Indian Self-Determination and Educational Assistance Act.
In spite of oppression, Tribal Nations, like the Menominee and Ho-Chunk Nations, have
endured, honoring their cultural and linguistic heritage.
(3)
(2)
(3)
Image Source: 4
Winnebago County: People, Land, & Water
Image Source: 5
Image Source: 6
Economic Stability..............................................................................................................11
Health Care Access and Quality..........................................................................38
Social and Community Context.........................................................................32
Neighborhood and Built Environment &
Natural Environment......................................................................................................17
Education Access and Quality.............................................................................28
Health Behaviors & Health Conditions
& Health Outcomes............................................................................................................44
Introduction
Winnebago County Demographic Snapshot......................................10
Where do we go From Here....................................................................................51
References...................................................................................................................................53
Table of Contents
Pages
1............................................................................................................
...........................................................................................................................2
Terms and Definitions
Who is this for?
Models for Community Health
Where We Live, Learn, Work, and Play
Community Input
Differences in Community Experiences
Ongoing Impacts of COVID-19: National
Ongoing Impacts of COVID-19: Local
Community Systems and Assets
........................................................................................3
..........................................................................4
....................................................................................................................5
.....................................................................6
....................................................................7
...........................................................................8
....................................................................................9
Appendix.......................................................................................................................................59
Terms and Definitions
Community conditions: The conditions in the environments in which people are born, live,
learn, work, and play that affect a wide range of health, functioning, and quality-of-life
outcomes and risks.
Disproportionately impacted populations: Populations exposed to longstanding inequities
that have systematically undermined the physical, social, economic, and emotional health of
the specific group. Racial and ethnic minority populations and other population groups bear
a disproportionate burden of disease or condition
Health disparity: A particular type of health difference that is closely linked with social or
economic disadvantage. Health disparities adversely affect groups of people who have
systematically experienced greater social or economic obstacles to health based on their:
racial or ethnic group; religion; socioeconomic status; gender; mental health; cognitive,
sensory, or physical disability; sexual orientation; geographic location; or other characteristics
historically linked to discrimination or exclusion.
Health equity: Attainment of the highest level of health for all people.
Health inequity: The uneven distribution of social and economic resources that impact an
individual’s health.
Racial disparity: The imbalances, that stem from historical policies and practices rooted in
racism, that are evident in every domain: economic stability, housing, education, access to
care, criminal justice, and health outcomes, that adversely affect groups of people based on
their race or ethnic group.
Racism: A system of structuring opportunity and assigning value based on the social
interpretation of how one looks (which is what we call “race”), that unfairly disadvantages
some individuals and communities, unfairly advantages other individuals and communities,
and saps the strength of the whole society through the waste of human resources.
1
Source: American Public Health Association (7)
Who is This For?
Since 1993, Wisconsin statutes require local public health departments to complete a regular
community health assessment (CHA) and to develop and implement a community health
improvement plan (CHIP) to address the priorities of those who live there and are served by
that health department. In compiling the CHA for the county, there was intentional thought
about the audience and who would benefit from reading this report. This report is for all in
Winnebago County. If you enjoy our parks or are proud of the community partnerships, this
assessment reflects that experience. If you know the frustration of trying to find child care or
have concerns about your income or expenses, others have experienced these issues too. If
you are anxious about housing, health care access, or economic stability, this assessment is
for you. Great care was placed on making this digestible and visually helpful as you read. You
may find the information illuminating and validating to your own experience as a member of
Winnebago County.
Scan Me
Who is This For?
2
Your feedback, both on the report itself and your thoughts on our
community, is important. The more people we hear from, the more
we can all work together to continue to make Winnebago County a
great place to live. If you would like to provide your thoughts, please
scan the QR code or visit: https://wchd.pub/chafeedback
Winnebago County Public Health covers all of Winnebago County except for the portions of
the City of Menasha and City of Appleton that fall within the county border. Those cities have
their own health departments. The data provided in this report primarily represents the full
county.
What influences health behaviors and
health outcomes?36
30%
Health Behaviors account
for just 30% of health
outcomes. Often choices
are a result of the
community conditions.
Community Conditions
refer to where we live,
learn, work, and play and
account for 70% of health
outcomes.
Community Conditions
Health Behaviors
70%
Models for Community Health
County Health Rankings and Roadmaps
The County Health Rankings Model illustrates that policies and programs play an important
role in influencing health factors that in turn shape the community's health outcomes.
Health outcomes are more influenced by zip code (where we live) than
genetic code.
Where we live influences our health because health disparities are founded on a complex
interplay of economic, educational, social, racial, and environmental factors. To improve
health outcomes, we must look beyond health care and health behaviors. We must examine
the systems and community conditions that impact health. This report aims to do just that.
3
(8)
What Influences Health?
Economic stability is defined as having the resources needed to live a healthy
life.
Education access and quality refers to improved educational opportunities
and helping children and adolescents do well in school.
Neighborhood and built environment includes housing, transportation, and
broadband services, as well as the natural environment.
Health care access and quality means access to comprehensive, high-quality
health services.
Social and community context refers to the relationship people have with
the places they live, work, and play. Strong community connections -
including civic engagement and employment - are important for well-being.
Where We Live, Learn, Work, and Play
Healthy people are a result of healthy communities. Healthy communities are
achieved by intentional efforts to assure the conditions and resources are
available for everyone to achieve their optimal health and well-being --
regardless of their race, ethnicity, income status, gender, age, sexuality,
abilities/disabilities, educational level, or experience with the criminal justice
system.(10)
Community Conditions (9)
4
This symbol
voices the
experiences
our community
members
shared.
Community Input
Focus groups were held with community members connected to
the following organizations:
Day by Day Shelter
LEAVEN/Casa Hispana
Oshkosh Area Community Pantry
People of Progression
Reach Counseling
REAL Oshkosh
SEPO Zambia
Solutions Recovery Inc.
Focus Groups
In addition to data, this assessment includes multiple perspectives
and experiences from Winnebago County residents. Focus groups
were held with disproportionately impacted populations in our
community who typically are not provided the opportunity to have
their voices heard. With help from community partners, more than
100 community members representing a variety of experiences and
backgrounds participated in focus groups.
Assessing health from different angles is
important because society does not treat people
equally and people have a variety of backgrounds,
life experiences, cultures, physical abilities, and
attributes. (11)
Diverse Perspectives
We thank our community partners who organized these
conversations and thank our community members for their
willingness and vulnerability in sharing their stories and
experiences.
5 Image Source: 12
Differences in Community Experiences
The Community Health Assessment must include an examination of disparities between
subpopulations and the factors that contribute to health inequities. While overall people like
living here, people also expressed the negative aspects of living here. Focus group
participants who are Black/Brown/African/Immigrant/Refugee experience racist practices in
places of employment, school systems, housing, policing, and healthcare.
(13)
There was emphasis across multiple focus groups on the criminal justice
system failing to support people. Formerly incarcerated individuals have
greater difficulty finding housing, employment, access to medical
treatment, and often experience periods of homelessness.
Among all focus groups, there were positive comments about the
programs and services in Winnebago County and insights about the
limitation of these services not reaching all that need them. Focus group
responses reflected a lack of trust towards institutions, especially
government and public systems.
People of color addressed community safety. They shared their
experiences of discrimination by law enforcement, fear that they are
under surveillance, and fear that reporting substandard housing
conditions will cause retaliation. Living with constant fear for one's
safety and the safety of loved ones causes stress and anxiety.
Black/Brown/African/Immigrant/Refugee participants shared what they
liked about living here: the peace and quiet, the opportunities for their
children, learning English, meeting other families with diverse
backgrounds, and being together with their family members.
Black/Brown/African/Immigrant/Refugee communities were specifically
asked to participate in focus groups and to share their experiences
about living here. Findings from the focus groups are shared throughout
this document.
Not all subpopulations were represented in focus groups. We
acknowledge our limitations in reaching diverse populations
throughout the county.
6
More than one-third of households that
include anyone with a disability used up
their savings during the pandemic.
Source: Robert Wood Johnson Foundation (15)
The COVID-19 pandemic has had unprecedented, widespread impacts on households across
America, raising concerns about our ability to weather long-term health and financial harms.
Key findings from a nationwide poll, "The Impact of Coronavirus," identify the enormity of
need across the nation.
Ongoing Impacts of COVID-19: National
(14)
Communities Hit Hard by the Pandemic
More than 4 in 10 rural households (43%) have lost jobs or businesses, or have faced
wage loss or cuts in work hours.(15)
(15)Nearly half of households (46%) report facing serious financial problems.
During COVID-19
More than half of Latino, Black, and
Native American households
report facing serious financial
problems during the pandemic.
Source: Robert Wood Johnson Foundation (15)
Financial struggles these
families experienced include
paying credit card bills, loans,
utilities, or rent.
7
0%10%20%30%40%
29%
29%
17%
37%0%25%50%75%
37%
55%
60%
72%
36%Using up savings
No prior savings
Problems paying utilities
Problems affording food
Latino households
Black households
Native American households
Asian households
White households
More than 6 in 10 households (63%) that include
anyone with a disability report facing serious
financial problems.(15)
Local support systems were stretched thin and needs/gaps widened.
Economic
Service sector and other low wage workers
were identified as most impacted during
COVID-19.
Loss of wages caused housing instability,
food insecurity, and child care issues.
Households with young children needed
an adult at home during the day.
Many people experienced isolation,
loneliness, and the stress of the unknown.
Elderly people struggled with isolation
and fear.
Parents struggled to make ends meet.
Children lacked the connection to fellow
students.
Mental Health
Technological
Access to adequate technology was a
challenge.
High-speed internet became a
necessity.
Libraries were closed limiting internet
access for school, work, and other
needs.
Over-burdened
Systems of Support
Medical
Procedures, follow-up appointments,
and wellness checkups were delayed.
Delays have an impact on health
conditions and diagnoses, which can
cause future issues.
Ongoing Impacts of COVID-19: Local
Increase in Local Needs
In 2021, the Fox Valley Community Health
Improvement Coalition, a collaboration of
health care organizations and public
health departments in Calumet,
Outagamie, and Winnebago Counties,
conducted 56 interviews with
stakeholders representing a variety of
sectors, locations, and populations.
(16)
8
People are nice, helpful, welcoming
Great doctors
Quiet
Low crime
Good play areas for kids
Free events in summer
Hometown feel
Farmer's Markets
People are friendly
Good schools
Parks
Close to the lake
Community events
Parks are handicapped accessible
Libraries
Services
A community health assessment (CHA) is a collaborative process to collect information that
shows a comprehensive picture of the community’s health. The CHA is used to identify gaps
and opportunities to improve the health of the population and is the basis for priority
setting, planning, program development, policy changes, coordination of community
resources, funding applications, and new ways to collaboratively use community assets. A
community asset (or community resource) is anything that can be used to improve the
quality of community life.
The thumbs up symbol throughout this report highlights a community
asset. Below are some of the community assets identified by focus
group participants:
Systems are an interplay between policies, infrastructure, spending decisions, human
actions, and intangible things like trust and goodwill. During the coronavirus pandemic, the
fragility of systems was exposed. The health care system, the educational system, the
employment system, etc. became overwhelmed and lacked resilience. (17)
The Role of Systems
(19)
9
It is important to focus on systems when assessing community health because the
role of systems plays a much bigger part in a person's health rather than individual
behaviors.(18)
Community Systems and Assets
Youth (under 18)Adults (18 and older)
0%25%50%75%100%
American Indian/Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
Some Other Race
Two or More Races
White
Total
Population 171,304
Race
Ethnicity 3% of the adult population identify as Hispanic or Latino
8% of the youth population identify as Hispanic or Latino
Age
Sex 49% - Female; 51% - Male
Urban/Rural 86.6% - Urban; 13.4% - Rural
Languages
6% of the population 5 years and
over speak a language other than
English at home.
<5 5-17 18-24 25-44 45-64 65+
30%
20%
10%
0%
10
25%
12%
15%
5%
26%
17%
Spanish, Swahili, Dari, Karen,
Mandarin, Vietnamese,
Kinyarwanda, Urdu, French,
Nepali, Hmong, and Arabic are
some of the common languages
spoken in our community.
<1%
3%
4%
1%
6%
84%91%
2%
1%
<1%
<1%<1%
4%
2%
Demographic data pulled from 2021 American Community Survey 5 year estimate (20)
Winnebago County Demographic Snapshot
Source: 2021 ACS 5 year estimate (22)
Only 27% of households in Winnebago County
earn more than $100,000 annually.
$0 $20,000 $40,000$60,000 $80,000
Calumet
Outagamie
Brown
Fond du Lac
$ per Hour # of Working Adults Total Annual Income
Living Wage $24.64 2 $102,502
Minimum Wage $7.25 2 $30,160
0%10%20%30%40%
Under $50k
$50k-$100k
$100k-$200k
Over $200k
$78,453
$72,695
$66,390
$63,938
$67,080
Winnebago County has the lowest median
household income compared to similar
surrounding counties.
Source: 2021 ACS 5 year estimate (22)
Higher Income is
Associated with
Better Health
Living Wage Calculation
The living wage is a calculation of an
hourly rate that an individual must
earn to support themselves and
their family without community
assistance. Living wage estimates
include typical family expenses
including food, child care, medical,
housing, transportation, and other
necessities.(23)
A family of four in Winnebago County
would need two adults each working
a full-time job earning $24.64 per hour
in order to earn a living wage. (23)
Achieving economic stability for
one's self and family is primarily
about income and wealth. Income
provides economic resources that
shape options for housing,
education, child care, food, and
more. Wealth - the accumulation of
savings and assets - helps cushion
and protect in times of economic
distress.(21)
11
39%
34%
5%
22%
Winnebago
Wisconsin
Cost of Living
Economic Stability
$68,799
Source: Data Commons - ACS 5 year estimates (24)
Average life expectancy at birth for the Black
community in Winnebago County is the
lowest compared to other races and
ethnicities in the county.
Source: Mind Your Wellness Survey (27)
LGBTQ+ individuals in the Fox Valley are
disproportionately paid less than non-
LGBTQ+ individuals.
Black children are disproportionately
experiencing poverty in Winnebago
County.
Source: County Health Rankings (25)
'11 '12 '13 '14 '15 '16 '17 '18 '19 '20
$80,000
$60,000
$40,000
$20,000
$0 0%20%40%60%
0 25 50 75 100
LGBTQ Non-LGBTQ
0%25%50%75%
Economic Impact of Disparities
Income inequality is NOT due to a lack of work ethic or work hour differences
between groups. Policies and practices, such as tax policies that favor the wealthy,
are linked to the widening wealth gap. (26)
In Winnebago County, the Black and Hispanic
communities are disproportionately impacted by a
much lower median income compared to other races
and ethnicities.
12
American Indian$75,313
White $60,909
Asian $59,886
Hispanic or Latino$49,375
Black or AfricanAmerican$26,822 White
Hispanic or Latino
Black or African American
Asian
All
Source: County Health Rankings (25)
White
Hispanic or Latino
Black or African American
Asian
All
79 years
84 years
74 years
82 years
79 years
9%
14%
59%
18%
12%
$150,000 or more
$110,000 to $149,999
$80,000 to 109,999
$50,000 to $79,999
Less than $50,000
5%
3%
8%
10%
67%
29%
18%
19%
14%
14%
Economic Stability
Housing Child
care Food Transportation Health
care Technology
% Increase
2007-2021 53%46%23%27%59%44%
Yearly %
Increase 3.1%2.8%1.5%1.7%3.3%7.6%
Why Can't Families Afford Basic Needs?
Basic Needs
Community focus group theme: People are experiencing
financial difficulties and struggle with basic needs related to
food, housing, clothing, and other necessities. This is particularly
felt by single mothers.
The cost of household essentials increased faster than other goods and services from 2007 to
2021, which continues to impact lower-income households more harshly than middle and
high-income households. National data shows how much costs have increased overall
during the last 14 years and each individual year.
(29)
(30)
13
11% of households live in poverty and an additional
22% are ALICE households (Asset Limited Income Constrained,
Employed).
ALICE households earn more than the federal poverty level
but not enough to afford the basics. (28)
Economic Stability
1 in 3
Households struggle to
cover their basic needs.
Community focus group theme: Child care is expensive and
difficult to find. As a result, parents' ability to work is impacted.
Providing high quality care is expensive.
If the child care provider raises the cost,
it becomes unaffordable for parents.
Full time infant care costs average
$12,695 a year while toddler care is
about $10,326 a year at a child care
center. Home care is slightly less.(33)
Wisconsin child care providers'
average yearly income is $23,650, less
than $12/hour (living wage is $24.64).
Only a small percent receive benefits
through their employer.(32)
Compensation
Foundation for a Quality Child Care System
High Cost of Raising Children
Child care is an essential industry interconnected to the health of the community. Parents
need child care so that they can work, be productive, and build successful careers to support
their families. For employers, insufficient child care results in lost revenue and increased
hiring costs. The economic impact of child care problems on parents and employers
subsequently causes lower tax revenues, increasing pressure on all taxpayers. Child care
challenges have a ripple effect, costing Wisconsin's economy $1.9 billion annually.(31)
Affordability
Quality
The connections among child care quality, affordability for parents, and compensation for
providers makes fixing the child care system challenging. All three areas must be
strengthened for quality child care programs to survive, but improvements to these systems
are complex and require funding to implement necessary changes.(32)
14
Economic Stability
of a single parent's income is
spent on child care
of a single parent's income is
spent on housing29%
of children live in a household
headed by a single parent31%
42%
In Winnebago County, males have a much
higher median income compared to females.
Source: Data Commons - ACS 5 year estimates (24)
Total
businesses
Men-
owned
businesses
Equal
ownership
of men &
women
Women-
owned
businesses
2,648 1,419
(54%)
830
(31%)
399
(15%)
Unequal Opportunities
Winnebago County Business Owners (2017)
Community focus group theme: People of color said they are
stuck – that they get overlooked for promotions and have limited
prospects for opportunities, professional growth, and
development.
Child care was a challenge for parents before the COVID-19 pandemic and has only
become more difficult since.
Lack of child care options impacts women more than men. Women are two times
more likely than men to either reduce their work hours or quit a job because of child
care costs or quality.(34)
Single parent households in
Winnebago County face
significant cost burdens.
(36)
Business ownership is
defined as: 51% or more of
the stock or equity in the
business. Data does not
include farms.
Only 5% of businesses are
minority owned.
(37)
15
'11 '12 '13 '14 '15 '16 '17 '18 '19 '20
$40,000
$30,000
$20,000
$10,000
$0
Male$39,645
Female$27,041
(36)
(35)
Economic Stability
Example of the Benefits Cliff for an Oshkosh
Family with 1 Working Adult and 2 Children
(July 2022)
In this example, a $0.97/hr raise results in a
net loss of $407 monthly, making the family
worse off financially due to a pay raise.
Community focus group theme: People
are frustrated and confused with the
link between the food assistance they
receive and changes in their
employment. When they get a small
raise or pick up additional hours, they
see a decline in food assistance –
rendering the small increase in wages
not a financial gain.
FoodShare
BadgerCare
Medicaid
Housing
Child Care
Energy Assistance
WIC
Social Security
Transportation
Wisconsin Works
Qualifying for assistance programs is
difficult and maintaining benefits is
complicated, creating problems for
families. An increase in wages affects
all programs individually, resulting in
a significant loss of benefits. Losing
benefits without having enough
wages to offset poses a challenge to
families trying to get out of poverty.
The Complexityof Assistance
Benefits Cliff
Insufficient increases in wages can
have devastating effects on families
who receive assistance like FoodShare
and BadgerCare. Public assistance
programs are designed to give a family
less as they earn more, which can lead
to small pay increases causing a
complete loss of benefits. This loss of
income is called a benefits cliff and
often leaves families financially worse
off than before they received a raise. A
2021 Point-in-Time capture from
United Way for Winnebago County
showed over 16,000 families were
ALICE households, many of whom
were affected by the benefits cliff.(28)
16
Current $0.97/hr Raise
Monthly Income
Child Support $187 $187
Wages $2,571 $2,729
Monthly Benefits
FoodShare $369 $20
Energy Assistance $72 $0
Child Care $78 $138
Housing $204 $0
BadgerCare Eligible Ineligible
Monthly Total
Income + Benefits $3,481 $3,074
Economic Stability
Housing is affordable when people can
consistently pay for housing and meet
other needs for themselves and their
families. Affordable housing creates
more stable housing.
Stable housing allows people to
choose when and why to move.
People who have stable housing
are more likely to have improved
health outcomes, employment,
and education. Children in stable
housing are less likely to repeat a
grade and more likely to graduate
high school.
Neighborhood and Built Environment
Quality housing provides a safe and
healthy living environment that is
structurally sound and free from hazards.
Stability
Health is impacted by the affordability, quality, and stability of housing.
Quality
Poor quality housing includes the presence of lead, mold, asbestos, poor air quality,
overcrowding, building security, and the ability to lock doors and windows. These exposures
contribute to chronic disease, injury, asthma, and impaired cognitive development. Low-
quality housing drives people to move more frequently.
Stability
When people are forced to move, it can lead to job loss, making it harder to afford housing
and increasing the likelihood of moving into low-quality housing. People who have stable
housing are more likely to have improved health outcomes, employment, and education.
Children in stable housing are less likely to repeat a grade and more likely to graduate high
school.
Affordability
When rents are high compared to how much people earn it can lead to eviction,
homelessness, or doubling up (when multiple families live together in a space).
Affordability
Impact of Housing
Quality
(38)
17
Year Studio/Efficiency One Bed Two Bed Three Bed Four Bed
2023 $712 $739 $954 $1,289 $1,502
2022 $639 $689 $889 $1,197 $1,419
2021 $529 $591 $759 $1,025 $1,246
Source: 211 website (41)
Data represents April 14, 2022-April 14,2023 Source: 211 website (41)
Data represents April 14, 2022-April 14,2023
Housing & Shelter are top requests for
211 services in Winnebago County.
Of the Housing & shelter requests, rent
assistance is the most requested service.
0%10%20%30%0%10%20%30%40%50%
United Way 2-1-1 is a free, confidential information and referral service for anyone to
call, text, chat, or search for health and human services. Services are available 24/7.
High Cost of Housing
The state of WI is experiencing a housing shortage and needs at least 140,000 units
between 2020-2030 to keep up with demand.
High-interest rates have reduced new home construction.
Affordable housing is difficult to find for young people as the aging population retires but
remains in their homes.
High demand and low supply influence price.
Why is Housing so Expensive?
Housing and Shelter are the Most Requested Community Needs to 211
Rent has increased between 20% - 35% in the past two years according to the Winnebago
County Fair Market Rent (FMR). FMR is a function of Housing and Urban Development
(HUD) and is not reflective of current rent prices.
(39)
(40)
18
Housing & shelter
Healthcare & COVID-19
Mental health & addictions
Transportation assistance
Utilities
28.9%
13.4%
11.6%
11.1%
10.7%
Rent assistance
Low-cost housing
Shelters
Landlord/tenant issues
Home repair/maintenance
Mortgage assistance
44.5%
24.3%
20.1%
4.2%
3.1%
2.7%
Neighborhood and Built Environment
Evictions can stay on
record with the courts for
20 years, which can be
used by landlords to deny
rental applications.
Wisconsin landlords may evict tenants for nonpayment of rent or a violation of
the lease agreement. Landlords must provide proper notice to tenants, which is
typically 28 days, before the tenant has to vacate their unit.
The Stress of Housing
Source: Wisconsin Department of Administration Eviction Data Project (43)
Number of evictions filed each year in Winnebago County
Community focus group themes:
Some full-time workers are unable to find housing.
If a renter does not have immigration documents, landlords have
charged double rent and security deposit up front.
Eviction records are a real obstacle to acquiring housing, and renters
can be unjustly evicted. Renters may not even know they have an
eviction on their record.
Any felony record makes it challenging to find a place to rent.
There is a fear among renters that if they complain about conditions
in their unit, the landlord will raise their rent or evict them.
19
'16 '17 '18 '19 '20 '21 '22
750
500
250
0
535 462
601
734
587632 634
Neighborhood and Built Environment
The pandemic produced eviction moratoriums to help citizens maintain housing. The
moratorium prevented landlords from removing tenants for a limited time. As these expired,
there has been greater housing stress.(42)
Oshkosh Area Community
Pantry has seen a 112%
increase in new registrants in
2022 compared to 2021.
26 Grocery Stores 4 Farmer's Markets
55 Convenience Stores 101 Fast Food Restaurants
10 Dollar Stores 189 Full-Service Restaurants
Oshkosh Area Community Pantry
Household Usage by Race/Ethnicity
Source: Oshkosh Area Community Pantry (45)
Each summer, FoodShare and the Women, Infant, Children (WIC) programs
supplement benefits with Farmer's Market vouchers.
0%25%50%75%
White
Hispanic or Latino
Black or African American
Asian
American Indian/Alaska Native
Food Environment
Food outlets refer to where people obtain their food; food retail venues, where food is
purchased to prepare and eat from home, or from food service venues, where food is
consumed away from home. People with low incomes often face barriers to healthy food
options due to overrepresentation of fast food and convenience stores.
(44)
Number of Food Outlets in Winnebago County
Food insecurity is the lack of reliable access to
food, whether due to financial limitations,
transportation, or distance to a food outlet.
Some people do not have access to full-service
grocery stores and rely on convenience stores
or other places.
Convenience stores may have higher food
prices, lower quality foods, and less variety
than grocery stores.
Food Insecurity
36% of the population
is obese (46)
8% of the population
is food insecure and
has limited access to
healthy foods (46)
20
1%
6%
12%
4%
63%
(44)
Neighborhood and Built Environment
Monthly total for FoodShare
benefits in Winnebago County
$2.5
million
March 2023
$4.5
million
February 2023
Source: WI DHS FoodShare Program (47)
Increased Benefits During the COVID-19 Pandemic
Source: WI DHS FoodShare Program (47)
FoodShare enrollment numbers in Winnebago County more
than doubled from December 2020 to January 2021.
Community focus group theme: The ending of all of the pandemic
assistance is having a greater impact on community members more
than the pandemic did.
Starting March 1, 2023, benefits returned to pre-pandemic status, resulting in a decrease in
dollar amount on FoodShare benefits; however, need has remained high. (48)
FoodShare is an assistance program to help families afford food. To be eligible, a family's
monthly income needs to be at or below 200% of the federal poverty level (FPL) and takes
into account household size. During the pandemic, more residents became eligible for
benefits due to job loss and decreased wages. Federal changes increased the amount of
benefits families received to help offset the loss of income. (47)
The closer the
family is to the
income limit, the
less benefit they
receive (Benefits
Cliff). The
minimum amount
of benefits for 2023
is $23/month.
21
Jan 20 Jul 20 Jan 21 Jul 21 Jan 22 Jul 22 Jan 23
20,000
15,000
10,000
5,000
0
6,666
16,987
Neighborhood and Built Environment
Neighborhood and Built Environment
Reliable transportation means either
public transit or a personal vehicle is
available when needed.
Affordable transportation can refer to
the costs associated with owning a
vehicle or paying for transit or ride
services such as taxis, Uber, or Lyft.
Affordable
Reliable
Accessible transportation, whether
by car, bus, or sidewalk, is used by
everyone – with or without disabilities
– and does not have barriers.
Accessible
Importance of Transportation
Transportation decisions affect everyone by influencing where they live, how they can get to
work and school, whether they can easily access health care and other essential services,
how they socialize with family and friends, and ultimately, if they can thrive in their
environment.
22
Accessible, Affordable, and
Reliable Transportation isEssential for Everyone
(51)
(52)
(51)
(51)
Broadband and Technology Access
According to 2018 data from the U.S. Census Bureau, nearly 370,000 Wisconsinites, 6.6% of
the state population, did not have an internet subscription in their homes. This included
more than 82,000 Wisconsinites under the age of 18. Students without reliable internet
access risk falling behind in classes, potentially widening existing socioeconomic and racial
disparities. Statewide, 13.6% of black residents and 11% of Hispanic/Latinx residents lack
broadband access. For white residents, the statewide average is 5.8%.
7.3% of households in Winnebago County are without an Internet
subscription (50)
(49)
Neighborhood and Built Environment
23
Wisconsin’s cities, villages, and towns have faced increasingly difficult fiscal decisions in
recent years as their two primary revenue sources, local property taxes and state aid, have
been subject to tight constraints. In recent months, rising inflation has added another major
budgetary pressure. As a result, many municipalities have been forced to reduce public
transit services.
Affordability
Accessibility
A challenge in accessible transportation systems is its design. The system needs to be
accessible to all through various pathways, such as: audio announcements for people with
visual disabilities; curb-cuts for sidewalks to increase accessibility for wheeled devices; and
bus stops located in useable place and designed for weather events.
Reliability
Communities need reliable, timely transportation options. A limited public transit system
places a higher burden on low-income households and on people who cannot drive.
Winnebago County residents currently face reliability issues with public transit:
Limited hours of service and routes prohibits reliance on public transportation,
especially for 2nd and 3rd shift employees.
Rural areas have limited options for public transportation.
There is no public bus transit on Sundays.
Challenges of the Transportation System
(54)
(52)
In 2006, the Wisconsin state legislature passed a law taking away driver's
licenses from people who did not have a valid Social Security number. The result
of this policy puts undocumented workers in the difficult position of providing
essential services, especially in the agricultural industry, and taking on great
personal and family risk.(53)
Community focus group theme:
There is an assumption that everyone should have a vehicle;
however, some people cannot afford a vehicle or are unable to
drive.
Transportation options are limited and there is desire to see bus
service go later and be available on Sundays.
Student bussing program with Go Transit has had positive impacts on
students' school attendance, access to school and social activities, health
care, jobs, and household money savings.
8,000
2020
87,000
2021
142,000
2022
24
Expanded Student Bussing
Neighborhood and Built Environment
There are two independent transit systems, Valley Transit serving the Fox Valley including
Appleton, Neenah, Menasha, and Fox Crossing, and GO Transit serving the City of Oshkosh.
The gap in transit between the two systems was covered by Route 10, an inter-city service
that connected Oshkosh to Neenah and Valley Transit. In 2023, to reduce costs, the Route 10
connector was changed to an on-demand service between these systems, costing the rider
$5.00 each way.
The on-demand service may be cost prohibitive and can be difficult to access. Riders
must call to schedule a day in advance.
The change to Route 10 eliminated public transit service that provided access to the
northern part of Oshkosh, including the Winnebago County Jail. This creates a safety
issue for those needing to walk to the closest bus stop as there is no sidewalk along a
busy traffic corridor.
Gap in the Transit System in Winnebago County
In February 2020, the City of Oshkosh, Oshkosh Area School District, and private funders
approved a pilot program to provide free bus service to public and private K-12 students
through GO Transit.
Student Bus Ridership has Increased with Pilot Program
GO Transit buses have become an effective and increasingly popular means of transportation
for K-12 students and their families in Oshkosh. Limited bus hours and cost were common
challenges shared by students and parents/caretakers. (55)
Very Good Moderate Unhealthy for Unhealthy Very Unhealthy Hazardous sensitive groups
The US Environmental Protection Agency's (EPA) Air Quality Index (AQI) provides
standardized color codes for forecasting and reporting daily air quality.
Air quality advisories are historically uncommon for Winnebago County. However, changing
climate conditions has resulted in more attention to air quality. The Wisconsin Department
of Natural Resources (DNR) issued air quality advisories throughout the 2023 summer.
Sensitive groups, which include people with heart or lung disease, older adults, children,
those who are pregnant, and those who work outdoors, are most at risk for adverse health
effects.
Air Quality Advisories
Air Quality
Emergency Preparedness
Disasters can have severe economic consequences for communities. Investing in
emergency preparedness can help communities mitigate the financial impact of disasters.
Preparedness measures help safeguard businesses, local industries, and employment
opportunities. Moreover, communities with robust disaster preparedness are more likely
to attract investments and maintain economic stability.
Potential Hazards for Winnebago County
Severe weather: extreme heat and cold, flooding and drought conditions, and storms
causing power outages
Cyber attacks
Disease outbreaks
(56)
25
Due to Canadian wildfires, between June 1-
August 31, 2023, air quality was reported as
unhealthy or unhealthy for sensitive groups for
9 days.(57)
Natural Environment
The County’s natural environment, lakes, rivers, parks, green space, trails,
and outdoor recreation provide opportunities to interact with nature.
Woodlands, Wetlands, and Waterways
Community focus group theme: Community members
love the parks and the lakes in our county.
Winnebago County is rich in its natural environment:
11,600 acres of forested land, about 4% of Winnebago County
53,271 acres of wetlands, mostly in the western and northern areas, including: Lake
Poygan, Rush Lake, Rush/Waukau Creek, and the Fox, Rat, and Wolf Rivers
91,000 acres of surface water, which is the largest area of inland surface water of any
county in Wisconsin
The county is entirely within the Fox-Wolf River Basin and contains a network of lakes,
rivers, and streams that make up the ‘Winnebago System
The system of lakes is known as the “Pool Lakes” and includes:
Lake Winnebago
Lake Butte des Morts
Lake Winneconne
Lake Poygan
26
Water Quality
Winnebago County is one of the areas in the state that relies on a surface water system in
addition to groundwater. Over 200,000 people get drinking water from Lake Winnebago.
Municipalities treat and monitor the water supply, following requirements that come from
the Safe Drinking Water Act (SDWA), to check for threats including:
Lead and copper due to corrosion in plumbing systems
Viruses and bacteria, which may come from sewage treatment plants, septic systems,
agricultural livestock operations, and wildlife
Fertilizers, pesticides, or other chemicals applied to land near water source
Chemicals from manufacturing operations
(58)
(59)
(58)
Natural Environment
Amount Activity
770 Miles Bike & pedestrian facilities: bike lanes, trails & sidewalks
55 Miles Bike lanes
114 Miles Trails
200 Miles Snowmobile trails
124 Designated Parks
22 Schools participating in Safe Routes to School*
Natural Environment
Source: Wisconsin Dept. of Natural Resources (61)
Urban Tree Coverage in Winnebago
County
0%10%20%30%
19%
17%
26%
9%
19%
Winneconne
Oshkosh
Omro
Neenah
Menasha
*Safe Routes to School (SRTS) Program empowers local communities and school districts with resources to
increase the appeal, safety, and practicality of walking and biking to school for students.
Tree Canopy
Urban areas represent densely developed territory
and encompass residential, commercial, and other
non-residential urban land uses. To qualify as an
urban area, the territory identified must encompass
at least 2,500 people.
Recreational Opportunities
The Winnebago System is known throughout the Midwest as a great fishing area for walleye,
northern pike, white bass, and lake sturgeon. The county accounts for:
513 acres of State Fishery Areas
58 boat launches
(60)
27
Winnebago County Urban Tree Cover: 17% (62)
Trees provide many benefits, which is why
communities often seek to expand their tree canopy.
Increasing the tree canopy can be accomplished by
planting more trees and more importantly, properly
caring for current trees.(61)
Source: East Central Wisconsin Regional Planning Commission
Source: WI DPI WISEdash (66)
*2019-2020 scores were not completed in the spring due to the COVID-19 pandemic.
The percent of third grade students who could read proficiently declined during the
COVID-19 pandemic.
Until the end of third grade, most students are
‘learning to read.’
Beginning in fourth grade, students begin
‘reading to learn.’
Learning to Read by Third Grade is Critical for Student Education
Quality Education
Students who are not reading at grade level by
third grade begin having difficulty
comprehending the written material that is a
central part of the educational process in the
grades that follow. Meeting increased
educational demands becomes more difficult
for students who struggle to read.(64)
Wisconsin has the highest
racial disparity in 4th
grade reading compared
to all other states (65)
28
'17-18 '18-19 '19-20*'20-21 '21-22
75%
50%
25%
0%
Winneconne 54%
Neenah 42%Omro 38%
Menasha 29%Oshkosh 25%
68%
54%
46%
35%36%
Education shapes opportunities, employment, income, and is key to lifting
people out of poverty. Factors that impact well-being, including access to
health care, safe housing, and livable wages, all increase as a person
obtains higher levels of education. (63)
Early Literacy
Education Access and Quality
Education Access and Quality
0%10%20%30%40%
Source: 2021 ACS 1 year estimate (70)
Educational attainment plays an important
role in health by shaping opportunities,
employment, and income. Cost is the most
significant barrier to accessing post-high
school education.
Access to Education
30%of Winnebago County residents
aged 25 or older have a bachelor's
degree or post-graduate degree,
slightly lower than the state
average (33%)(67)
29
Some other race
Two or more races
White
Hispanic or Latino
Black or African American
Asian
31%
22%
11%
7%
24%
26%
The Wisconsin Grant provides financial assistance to
undergraduate residents enrolled at least half-time in degree
or certificate programs at all Wisconsin universities, colleges,
and technical schools.
(71)Need-Based Financial Aid
Lower-income students have lower college graduation
rates than their higher-income peers.
State funding for financial aid has not kept pace with
student demand following economic recessions, which
disproportionately affects older adult students.
There are racial disparities in who has
received a bachelor's degree or higher.
Community focus group theme: Refugee and immigrant adult
community members expressed struggles with accessing local learning
opportunities. People reported barriers related to traveling, attending
online, or attending during traditional work hours.
Adult Literacy
Today’s jobs require literacy and numeracy skills beyond the basic levels. In Wisconsin,
one in seven adults struggle with low literacy and almost one in four struggle with basic
math. As the demand for technical skills continues to grow, the ability to perform math
and comprehend written material will become crucial. Wisconsin counties with at
least 15% of the population having below basic literacy levels also tend to have poorer
health, economic, and educational outcomes.
(67)
(68)
(69)
% of population aged 25 and older
with bachelor's degree or higher
(5)
Winnebago County
has local options for
higher education
Education Access and Quality
Appleton (A)Fond du Lac (F)Neenah (N)Oshkosh (O)Wisconsin (W)
Black Hispanic Two or more races White
75
50
25
0
Educational System Disparities
In [educational] disparities by race, Wisconsin is the worst state in the nation...these
disparities cannot be explained away by poverty; after controlling for economic
disadvantage, the gap persists. In fact, on average, Black students who are not
economically disadvantaged score lower than white students who are.
We are failing our students of color, and one factor in that failure is in the language we
use to describe it. The word achievement places both the possibility of success and
blame for failure on the child, and that is not where it belongs.
Dr. Jill Underly, State Superintendent April 19, 2022(72)
30
Rates of suspension (per 100 students) are higher among students of color compared to
White students, with Black students having disproportionately higher rates of suspension.
Rate of suspension (per 100 students)
A: 11
F: 19 N: 24
O: 67
W: 45
A: 6 F: 3 N: 8
O: 31
W: 11
A: 3 F: 3 N: 4
O: 12
W: 4A: 10 F: 5
N: 12
O: 39
W: 14
Source: WI DPI WISEdash (66)
Community focus group theme: Black/Brown students are being
excluded from educational environments, whether through
suspension, expulsion, or time spent in the principal's office,
detention, or other isolated settings.
“Opportunity gap” draws attention to the conditions and obstacles that young students face
throughout their educational careers. It therefore accurately places responsibility on an
inequitable system that is not providing the opportunities for all kids to thrive and succeed.
Opportunity Gap
(73)
Education Access and Quality
Race/Ethnicity in
Oshkosh Area School
District
% of total
students
(9,202)
# of teachers of
listed race
% of total staff
of listed race
(1,262)
Black or African American 7.1%2 0.5%
Two or More Races 7.1%3 0.4%
Hispanic or Latino 7.2%1 0.5%
White 70%753 97%
In 2023, the Oshkosh Area School District hired a Director of Diversity,
Equity, and Inclusion to oversee the District's equity efforts. In the past few
years, the Neenah Joint School District also added a Diversity Coordinator in
response to having a disproportionate number of students of color receiving
discipline or having an Individualized Education Plan (IEP).
Oshkosh and other surrounding school districts in the county are seeing an increase in the
diversity of their student populations. As these increases continue, there is an ask of the
districts to hire more staff that represent these growing demographics within the schools.
Representation by teachers that identify as a person of color is a national struggle, with only
one in five teachers identifying as a person of color across the US.
Increasing the racial and ethnic diversity of educators serving students in public schools is a
promising and vastly underutilized strategy. Research has shown the importance of a diverse
teacher workforce. However, the pathway to increase the diversity of educators is complex
and will require investments by policymakers and advocates.
Students who identify as a person of color benefit from having teachers that
look like them, which leads to an increased likelihood of graduating from
high school or enrolling in college. (74)
31
(74)
Teaching Staff and Under-Representation
Source: WI DPI Staff Reports (75)
Social and Community Context
Structure Function Quality
Social Connectedness
People have profound relationships with the places they live, learn, work, and play.
Community factors such as social connectedness, social support, and a sense of belonging
influence these relationships.
Social connectedness is the meaningful relationships and bonds with those around
them, including peers, families, and communities.
Social support is the relationships that help one feel cared for, valued, and loved.
Belongingness comes from being respected and valued, while having meaningful voice
and opportunity to contribute and participate in community systems and structures.
Communities where residents are more connected with one another fare better on several
measures of population health, community safety, community resilience when natural
disasters strike, prosperity, and civic engagement.
Community focus group theme: There are a lack of activities for some
members of the community. Older community members want more
evening activities and people experiencing homelessness have no
where to go on Sundays.
(76)
(77)
32
The 3 Vital Components of Social Connection(78)
The number and variety
of relationships and
frequency of
interactions.
Examples: household
size, friend circle size,
marital/partnership
status
The positive and
negative aspects of
relationships and
interactions.
Examples: relationship
satisfaction, relationship
strain, social inclusion or
exclusion
The degree to which
relationships serve
various needs.
Examples: emotional
support, mentorship,
support in a crisis
Social and Community Context
33
The lack of social connection can have significant economic costs to individuals,
communities, and society. National data shows significant impact about the lack of social
connection.
Economic Cost of Social Connection
In the US, stress-related absenteeism attributed to loneliness costs employers an
estimated $154 billion annually.
Social isolation among older adults accounts for an estimated $6.7 billion
annually in excess Medicare, largely due to increased hospital and nursing
facility spending.
A lack of social connection is associated with increased risk of heart disease,
stroke, anxiety, depression, and dementia.
(78)
Current Trends Show Decline in Social Connection & Trust
Changes in key indicators, such as individual social participation, demographics,
community involvement, and use of technology over time, suggest both overall societal
declines in social connection and that, currently, a significant portion of Americans lack
adequate social connection.
Trust in each other and major institutions is at near historic lows. Polls conducted
in 1972 showed that roughly 45% of Americans felt they could reliably trust other
Americans; however, that proportion shrank to roughly 30% in 2016. (78)
Anyone of any age or background can experience loneliness and isolation, but some
groups are at higher risk than others. Not all individuals or groups experience the factors
that facilitate or become barriers to social connection equally. Some people or groups are
exposed to greater barriers.
(78)
Groups at Highest Risk for Social Disconnection(78)
Those with poor physical or mental health
Those with disabilities
Those experiencing financial insecurity
Those who live alone
Single Parents
Younger and Older Populations
LGBTQ+ persons
Those from ethnic and racial minority
groups
Rural Residents
Victims of Domestic Violence
Those who experience discrimination or
marginalization
Some individuals are at higher risk for loneliness and isolation, such as:
Social and Community Context
Racism and Discrimination
34
Focus groups participants were asked if they experienced racism and discrimination. The
answer was yes. They experience exclusion and a lack of belonging. They experience
mistreatment by those they do not know in the community on a day-to-day basis, including
interactions at work, in schools, in housing, in neighborhoods, and at stores.
At work when someone messes up, they always
blame me because I don't have the language to
defend myself. It's exhausting.
It's mentally draining to be mistreated each day
at work and to know there is nothing I can do
about it without risking my job.
As for promotions at work, I watch them offer
promotions to my white co-workers first. And
the few times they eventually gave me a shot
(after exhausting everyone else), the
percentage of raise was smaller than what had
been offered to my co-workers.
Work
The neighbors call the police on the
kids when they are just playing with
each other and being kids. It makes
me uncomfortable, especially as the
kids get older.
Neighborhood Home
The landlords don't respond to our
problems. We've waited weeks for
leaks to be fixed, we have water
coming from the ceiling, but no
response from the landlord.
The landlord threatens us if we call
the police.
School
The problems our black
children have been
having is just too much.
Our kids come home with
bruises, but nothing is
communicated from the
school. Yet when our kids
misbehave, they threaten
expulsion.
Participants Shared Their Experiences of Racial Profiling in Their
Daily Interactions
Social and Community Context
In 2021, nearly half of all Middle School and
High School students in Winnebago
County experienced significant problems
with anxiety (past 12 months).
Middle High
All Female Male
50%
40%
30%
20%
10%
0%
In 2021, around one-third of all Middle
School and High School students in
Winnebago County did not feel like they
belong at school.
School Belonging
2017 2018 2019 2020 2021 2022
40
30
20
10
0
Middle High
All Female Male
75%
50%
25%
0%
Mental Well-Being
The 2021 YRBS data shows youth are
struggling with their mental health. Girls
have higher anxiety than boys in both
middle and high schools. Rates of
anxiety do not significantly differ across
grades within middle school or grades
within high school. (79)
The 2021 Youth Risk Behavior Survey (YRBS)
displayed gaps in connection and
belonging in schools. 56% of high school
students who identify as Lesbian, Gay,
Bisexual, or Transgender (LGBT) do not feel
like they belong at school compared to only
31% of Straight students.(79)
Deaths by suicide in Winnebago County
Source: Youth Risk Behavior Survey (79)Source: Youth Risk Behavior Survey (79)
Source: Winnebago County Medical Examiner's Office (81)
35
36%37%31%
43%
25%30%42%
64%
51%62%
39%33%
Death by Suicide
Death by suicide can serve as an important measure of the mental and economic health of a
county. Some risk factors include: mental health conditions, prolonged stress, and stressful
life events. Community risk factors such as discrimination and lack of access to healthcare
can also increase risk. Protective factors include access to mental health care and feeling
socially connected in a supportive community.(80)
Social and Community Context
Community focus group theme: Access to community resources
and services is difficult for individuals with a criminal history.
Basic Needs
Housing
Transportation
Employment
Education
Ability to Build Wealth
Black/African
American Rate White Rate Black/White
Disparity Ratio
Wisconsin 485 43 11.3
US 315 72 4.4
Juvenile Arrests
Juvenile arrests add insight into policing, local laws, and community and family support.
Youth who are arrested and incarcerated can face disproportionately higher rates of
sickness, including infectious disease and stress-related illness.
In 2019, juvenile arrests in Winnebago County were 38 arrests per 1,000 youths, higher
than the national average of 24 arrests per 1,000 youths.
In Wisconsin, Black youth are at least 10 times more likely to be held in placement as
white youth.
Juveniles who are incarcerated can see an impact on factors that contribute to health
such as housing, employment, wealth, and educational opportunities.
(82)
(82)
36
Criminal Justice System
Race Disparities for Youth Held in Placement per 100,000 (83)
The adult prison population is increasing. This can be
attributed, in part, to Wisconsin's Truth in Sentencing
statute. The statute ensures those tried as adults and
convicted of a felony resulting in incarceration serve
100% of their sentence. Truth in Sentencing created
a new form of community corrections called
extended supervision. If someone violates the terms of
their supervision, they are returned to prison and must
serve the entirety of the original sentence. Extended
supervision rules can make integrating back into the
community difficult. For example, approval is needed
prior to making a work or address change.
(84)
(83)
Social and Community Context
While people cannot control their environments and the
challenges within them, positive relationships at home, work,
and in the community can help cushion negative impacts.
These social supports are critical for improving health and well-
being.(85)
Racism
Over
Policing
Unstable
HousingIsolation
Risk Factors
Poverty
37
Community Safety
Community safety has a major impact on a person's health and well-being. Accidents and
violence affect health and quality of life in the short and long-term for community members
both directly and indirectly affected. Additionally, living in unsafe neighborhoods can cause
chronic stress, accelerate aging, and harm health.
Different groups experience life in their communities differently. Racism, stress, and
targeting from specific systems like law enforcement, the judicial system, and child
protective services make some populations feel unsafe.
(85)
(86)
Residents feel
connected to each
other and are involved
in the community
Access to safe,
stable housing
Families have
access to
economic and
financial help
Violence is not
tolerated or
accepted
Protective Factors
Health Care Access and Quality
Facilitates entry into the health care system. People without health insurance are
less likely to receive medical care and more likely to have poor health status.
Having a usual source of care is associated with adults receiving recommended
screening and prevention services.
Ability to provide health care when the need is recognized. Timely delivery of
appropriate services can help manage chronic conditions.
The health care system requires infrastructure to support a capable, qualified,
and culturally competent workforce.
Access to Care
The U.S. has one of the most complex health insurance systems compared to other
high-income countries, with coverage eligibility depending on factors such as
employer, income level, age, and health care needs.
38
Timeliness
Workforce
Coverage
Services
Access to health care means having the timely use of personal health services to achieve the
best health outcomes. There are four components to this:(87)
(88)
While the Affordable Care Act (ACA) has reduced the number of uninsured people to
historically low levels and helped more people access health care services, too many people
in Winnebago County remain uninsured.(89)
Community focus group theme: There are often long waiting periods to get
an appointment, especially for mental health and dental services.
BadgerCare Plus (Wisconsin Medicaid): for low income adults, parents, and children
Employer-based: employees share costs with employer
Health Insurance Marketplace (HealthCare.gov) and the private market
Medicaid: for people with disabilities under 65 who qualify
Medicare: 65 or older
Military
Types of Health Insurance in Wisconsin
7,533 or 4.5% of Winnebago County residents did not have health
insurance in 2021 compared to 12,522 (or 7.7%) in 2011 (90)
Health Care Access and Quality
Medicaid Recipients Struggle to Access Dental Care
Only 25% of Winnebago County Medicaid recipients utilized their
dental benefit compared to 29% of recipients across Wisconsin.
Only 17% of Winnebago County Medicaid recipients received
preventive dental services.
In 2020, Winnebago County Medicaid recipients had 652 emergency
department visits for (non-traumatic) oral health, a rate higher than the
state.
Oral Health and Dental Coverage
39
Lack of appointments and long wait lists prevent Medicaid recipients from accessing
dental care.(94)
0 5 10 15 20 25
With very few dental providers in
Winnebago County accepting
Medicaid, access to dental care for
those with Medicaid is very limited.
Source: Partnership Report (94)
25 dentists
2 dental offices
8 dentists
Partnership (Winnebago, Outagamie, Waupaca)
Tri-County Dental Clinic (Calumet, Outagamie,
Winnebago)
Private Dentists (Located in Winnebago)
Tri-County Dental provides oral
health care to residents in
Calumet, Outagamie, and
Winnebago counties whose
access to dental health care is
limited. When school is not in
session, the mobile clinic makes
stops at the Boys & Girls Club,
COTS, St. Joe's Food Pantry,
Oshkosh Area Community
Pantry, Apricity, and Harbor
House.
Large employers are more likely than small ones to offer dental benefits. High-wage workers
are also more likely to receive a dental benefit than low-wage workers. Dental benefits (not
insurance) covers some procedures in full, partially, or not at all. Medicare does not cover
dental care except if related to a medical procedure such as surgery.
Poor oral health is associated with an increased risk of chronic conditions like heart disease
and diabetes, increased use of medical devices, reduced quality of life, and fewer
employment opportunities. (91)
(92)
(93)
Health Care Access and Quality
Community focus group theme: There is a lack of diverse and culturally
responsive care among mental health providers.
Behavioral Health Care
40
(95)
Substance Use Disorder Treatment
A Substance Use Disorder (SUD) is a mental disorder that affects a person's brain and
behavior, leading to their inability to control their use of substances like legal or illegal
drugs, alcohol, or medications. Timely and affordable access to treatment for both adults
and children continues to pose challenges for SUD.(97)
(96)
Barriers to Treatment (97)
There are long wait lists for services and access to
dual diagnosis (mental health and substance use)
treatment.
Due to insurance policies, people are frequently
unable to access the level of treatment their
assessment recommends until they fail out of lower
levels of treatment.
Insurance companies can terminate treatment
authorization before completion.
Gaps in communication across treatment, mental
health, primary care, and other key agencies are
apparent in many overdose deaths.
Nearly half of all Americans will have a behavioral health issue in their lifetime, from a mood
disorder to a substance use problem. Behavioral health care encompasses a wide variety of
interventions delivered by many different types of providers. In the U.S., nearly all these
providers are in short supply.
The scarcity of behavioral health professionals is affecting people’s ability to get timely care.
This is reinforced by historical underinvestment in behavioral health care by public insurance
programs, private insurers, and employers — including lack of coverage and low
reimbursement rates. In 2021, fewer than half of people with a mental illness were able to
access timely care. Accessibility was even lower for those with substance use disorders.
Behavioral health workforce shortages disproportionately impact people who:
Live in rural areas
Are covered by Medicaid
Are people of color, non-English speakers, and LGBTQ communities - the demographics
of the behavioral health care workforce do not reflect the people they serve
The WeHeart YouApp helpsconnectpeople withSUD andtheirfamilies toservices andrecoverycoaches.
Health Care Access and Quality
Employee Contributions Employer Contributions
Total Annual Premium
'13 '14 '15 '16 '17 '18 '19 '20 '21 '22
25,000
20,000
15,000
10,000
5,000
0
41
High Cost of Health Care
Most health insurances require payment of a deductible, coinsurance, and copays for
medical services and prescriptions. A serious injury or illness can cost thousands of dollars
out-of-pocket to meet these deductibles and other cost-sharing requirements. For people
with a chronic illness, even smaller copays and other cost-sharing expenses can add up to
unaffordable amounts.
(98)
Nationally, the annual premium for individual coverage has risen
more than $225 per year on average, and family coverage has risen
more than $700 per year on average from 2010 to 2022.(100)
Common Health Insurance Terms and Definitions:
Premium: the amount an individual and/or employer pays each month in exchange for
insurance coverage.
Deductible: the amount an individual needs to pay each year before the insurance
company will start to pay its part.
Co-insurance: the amount an individual pays to share the cost of covered services after
the deductible has been paid, usually a percentage. For example, the insurance company
pays 80% of the claim, the individual pays 20%.
Co-pay: a flat fee for certain medical expenses (e.g. $30 for every visit to the doctor), while
the insurance company pays the rest.
Out-of-pocket max: the maximum amount an individual pays for medical care per year.
(99)
The average annual family premium per enrolled Employee for
Employer-based Health Insurance in WI.
Employer
Contributions
$17,027
Total Annual
Premium
$22,664
Employee
Contributions
$5,637$3,897
Source: Kaiser Family Foundation (101)
$16,665
$12,768
Health Care Access and Quality
During the pandemic, the federal government allocated funding for states to expand
Medicaid (including BadgerCare) in order to ensure access to health care. BadgerCare
increased benefits, provided automatic re-enrollments, and had less stringent
qualifications. In March 2023, federal support of the enhanced coverage expired, resulting
in many no longer eligible for Badgercare.
There was a 60% increase in Winnebago County's
BadgerCare enrollment from January 2020 to January 2023.
Source: WI DHS BadgerCare Enrollment Data (103)
30,510
19,057
Jan 20 Jul 20 Jan 21 Jul 21 Jan 22 Jul 22 Jan 23
40,000
30,000
20,000
10,000
0
Wisconsin is 1 of only 10
states that has not adopted
Medicaid expansion.
42
People who have insurance but cannot afford to seek care because of the costs are
considered under-insured. They may not be able to afford the deductible for themselves
or family members or other expenses such as prescription medication.
Other reasons for being under-insured may include:
Cannot afford health insurance; considered “affordable” if the monthly amount or
premium is less than 9.1% of family income
Does not work full-time; employer plans are pro-rated for part-time employees
Works seasonally, works in the “gig-economy,” or cash-based economy
Does not qualify for BadgerCare Plus; generally at or below 100% FPL (Federal Poverty
Level) FPL for family of 4 is $2500/month or an hourly rate of $14.42. (102)
Under-Insured and Unaffordable
BadgerCare Enrollment
The coverage gap exists in states that have not adopted the ACA Medicaid expansion for
adults who are not eligible for Medicaid coverage or subsidies in the Marketplace.(104)
Coverage Gap
(104)
(104)
Health Care Access and Quality
High health care
costs including:Hospital stays Surgeries Medications
Health insurance
coverage gaps
including:
High deductables Coinsurance and
Copayments
Out of pocket
maximums
Lack of price
transparency
leading to:
Cost of medical
services unknown
Complex billing
process
Billing errors difficult
to fix
Debt collection
practices
resulting in:
Hospitals selling
debt to collection
agencies
Hospitals &
collection agencies
suing patients in
court
Judgements that
garnish patient
wages
Poor creditscore
Higherinterest rates
Increase in stress &chronic disease
Struggleto paybills
Barrier to healthcare
Coverage that is
unaffordable or
insufficient can
harm physical,
mental, and
financial health.(106)
Impact of Medical Debt
43
Medical Debt
Despite over 90% of the United States population having some form of health insurance,
medical debt is a persistent problem. More than 100 million people, or 41% of American
adults, struggled to pay medical bills in 2022.
(98)
(105)
(107)
(106)
(105)
Factors that Contribute to Medical Debt
(106)
$922
11.5%
is the median amount of medical
debt in Wisconsin (106)
of Wisconsin residents have
medical debt in collections (106)
Health Behaviors
Nutrition Tobacco/Vaping Alcohol Substance UsePhysical Activity Sexual Activity
Community Conditions and Resources Influence a Person's Choices
The Economic Case:
It makes good economic sense for employers to
invest in employees. Employers can build a culture
of health through actions such as:
Create incentives
Encourage walking breaks/walking meetings
Adopt family-friendly policies, e.g., paid time off
Provide a match for health savings accounts
Contribute to gym memberships
Physical Activity & Nutrition
Increasing opportunities for exercise and access to healthy foods in neighborhoods, schools,
and workplaces can help children and adults eat healthy meals and reach recommended
daily physical activity levels.
Community Conditions that Support Physical
Activity:
Safe and accessible sidewalks and trails
Well-maintained playgrounds and parks
Walkable destinations-schools, grocery stores,
and shopping
Public transit
Bike-friendly streets
(109)
.
13% of high school students
reported they did not exercise in
the past week (112)
19% of adults report no leisure-
time physical activity (110)
8% of people do not have a
reliable source of food (110)
Health behaviors are actions individuals take that affect their health, such as: diet and
exercise, tobacco use, alcohol and drug use, and sexual activity. These are determined by
many complex factors, including the choices available in the places we live, learn, work, and
play.
44
Health Behaviors
Community focus group theme: Alcohol is everywhere. Many community
events revolve around alcohol. There is a need for more family-friendly and
alcohol-free events.
415 Liquor licenses were issued in
Winnebago County in
2020-2021.(116)
Winnebago County issues the
7th most liquor licenses of any
county in the state.(116)
7th
Tobacco & Vaping Use
Youth
34% of Winnebago County high school students
who are smokers tried cigarettes by age 13.
26% of Winnebago County high school students
have tried vaping/e-cigarettes.
(112)
(112)
Adults
Nearly 1 in 5 Winnebago
County adults report smoking
cigarettes.(110)
Tobacco use is the leading cause of preventable disease, disability, and death in the US.
Youth who start using substances at a younger age are more likely to suffer from a substance
use disorder, a mental health condition, and social isolation. The word "tobacco" on this page
refers to commercial tobacco, as opposed to the traditional, Native American tobacco.
(111)
Youth, LGBTQ+, low-income, and black communities have been aggressively targeted by the
tobacco industry through tailored campaigns of their tobacco and nicotine products. In
recent years, significant work has been done to reduce access to products, restricts flavors,
increase the age limits, and update smoke-free laws to include e-cigarettes. (113)
The alcohol environment is influenced by
availability (locations to buy alcohol), affordability
(prices are low), attractiveness (advertisements to
young people), and acceptability (social norms).
Municipalities control the number of liquor
licenses issued. The more licenses that are issued
increases availability of alcohol.
(114)
(115)
Alcohol Use
Youth
28% of Winnebago County high school
students who have drunk alcohol report
trying alcohol by age 13.(112)
Adults
27% Winnebago County
adults report binge drinking
or heavy drinking.(110)
45
Health Behaviors
Access to culturally responsive, timely, and appropriate sexual and reproductive health
information is important for everyone. Youth specifically need information from people
they trust to make informed decisions.
0 10 20 30 40
Source: County Health Rankings 2022 (110)
Teen Pregnancy Rates by
Race/Ethnicity (2014-2020)
# of births per 1,000 females aged 15 - 19
12
12
9
30
37
Black/African American
Asian
Any Race
Hispanic
White
Teen Births
Mothers who give birth during their teen years face
more barriers that affect their health and well-
being than those who give birth later in life.
These impacts include:
Lack of community support
Less likely to finish high school and pursue
post-secondary education
Less earning potential
Mental and physical stress
Struggle to find affordable, quality child care,
and suitable transportation - further hampering
options for education or employment
46
Reproductive and Sexual Health
Birth Outcomes
'18 '19 '20 '21 '22
25
20
15
10
5
0
Winnebago13 cases per 1,000people
Wisconsin 17 cases per 1,000people
Source: Wisconsin PHAVR Report (117)
Chlamydia case rates for those aged 15-19
remain high despite recent decreases.
15
20
Access to Sexual Health Education
Not all school districts provide students with
the education needed to make fully-informed
decisions about their bodies and relationships.
The absence of important topics such as
consent, LGBTQ+ education, and safe practices
results in misunderstanding and stigma.
Accurate, inclusive, and proper guidance can
help equip students for a healthy approach to
their sexual well-being.
Low birthweight is defined as infants weighing
less than 2,500 grams, or 5.5 pounds, at birth.
In 2020, low birthweight babies accounted for
6.9% of all births in Winnebago County, or 118
infants.
Risk factors for low birth weight:
Infection during pregnancy
Substance use
African-American background
Previous pregnancy with a low-
birth-weight baby
(118)
(119)
(118)
Health Outcomes
Winnebago
County Wisconsin United States
Adults that consider their own
health as poor or fair 12%12%12%
Number of poor physical health
days during previous 30 days 3.2 3.2 3.0
Number of poor mental health
days during previous 30 days 4.3 4.4 4.4
47
Health Outcome indicators show how well people live (quality of life) and how long people
live on average within a community. Health outcomes are influenced by community
conditions and health behaviors. (120)
Quality of Life
Quality of Life represents the well-being of a community and emphasizes the importance of
physical, mental, social and emotional health from birth to adulthood. Quality of life data
communicates how people perceive their health, whether they feel healthy and satisfied. It is
important to understand the perceived physical and mental health of a community so
patterns can be identified and inequities between groups of people can be addressed. Data
can also help identify risk factors and policies that address those risk factors. (119)
Community Conditions Can Cause Poor Health
Good health or poor health is the result of a
complex interplay of economic, educational,
social, racial, and environmental factors. To
improve health outcomes, communities must
look to the conditions that cause the most
harm.
Once ignored or regarded only as secondary influences on health and disease,
community conditions are now accepted as a fundamental cause of illness,
including both communicable and chronic diseases. (122)
Source: County Health Rankings 2023 (121)
Health Outcomes
Winnebago County US
0%5%10%15%20%25%30%
Arthritis
Depression
Asthma
Diabetes
Cancer*
COPD
Coronary Heart Disease
Stroke
Winnebago County
48
Chronic Disease
Chronic diseases are defined broadly as conditions that last one year or more and require
ongoing medical attention or limit activities of daily living or both. (125)
Communicable Disease
Communicable diseases are contagious and can be transmitted from one person, animal,
or other source to another through various means. These diseases are caused by infectious
agents such as bacteria, viruses, fungi, parasites, or prions and can spread through direct
or indirect contact, airborne particles, contaminated food or water, or vector organisms
like insects.
Preventing communicable disease involves a combination of personal hygiene practices,
vaccination, public health measures, and community cooperation. Prevention is a shared
responsibility that involves individual actions as well as collective efforts within
communities and across nations that protects individuals and entire populations.
(123)
(124)Top reported communicable diseases in 2020-2022
Source: CDC Places (126)
*Living with cancer, excluding skin cancer
The pattern of chronic disease in Winnebago County is similar to the US
25.2%
26.1%
10.5%
7.5%
6.0%
5.9%
22.5%
8.6%
2.9%
9.7%
7.0%
6.4%
6.1%
19.5%
11.3%
3.3%
Wisconsin
COVID-191.Chlamydia2.Gonorrhea3.Influenza4.Hepatitis C5.
COVID-191.Chlamydia2.Gonorrhea3.Lyme Disease4.Influenza5.
Health Outcomes
49
Impact of Community Conditions
Premature Death in Winnebago County
Leading causes of death under age 75 in
Winnebago County 2018-2020 (110)
Number ofDeaths
Cancer 506
Heart Disease 257
Accidents 156
Chronic lower
respiratory diseases 91
Intentional self-harm 76
Length of Life
Length of life is the time between birth and death. Investigating length of life among
population groups can explain differences in health outcomes and life expectancy. There
are stark racial disparities in premature death rates in Winnebago County, specifically among
the Black population.
(110)
Most chronic diseases are considered preventable by adopting a healthy lifestyle. However,
research shows people with greater income, more educational attainment, and more
resources have higher chances of surviving preventable causes of death, such as chronic
diseases. These resources were not considered protective if the cause of death was less
preventable. Resources consisting of money, knowledge, power, prestige, and social
connections are vital to longevity. People without these resources have poor health
outcomes and earlier death.(122)
Community focus group theme: People are having to choose between
buying food for their family or addressing their health care needs.
Death rate per 100,000 people
All Asian Black Hispanic White
250
200
150
100
50
0
Heart disease death rate by
race/ethnicity for Winnebago
County residents aged 35-64
Source: CDC Heart Disease Dashboard (127)
59.0 52.0
205.8
43.0 59.2
Health Outcomes
Causes of Death
50
From 2018-2022, Neenah and Oshkosh had higher overdose death rates (119
deaths per 100,000 and 118 deaths per 100,000, respectively) than the county as
a whole (91 deaths per 100,000). (128)
'12 '13 '14 '15 '16 '17 '18 '19 '20 '21 '22
50
40
30
20
10
0
Drug Overdose Deaths
An increase in fatal and non-fatal
overdoses has been attributed to
drugs laced with fentanyl
(including methamphetamine,
cocaine, pressed pills, and
heroin). Fentanyl was responsible
for 24 of the 37 (65%) overdose
deaths in 2022. With the right
community support and
resources, overdose deaths are
preventable.Source: Winnebago County Overdose Fatality Review Annual Report (128)
In 2022, there were 37 overdose deaths in Winnebago
County.
(128)
28 29 27 28
34
24
13
20
37 41 37
Top Causes of Death - 2020
12
22
14
33
37
36
71
151
164143
142
61
41
36
28
23
16
15
Heart diseases
Cancers
Accidents (unintentional injuries)
Chronic lower respiratory diseases
Cerebrovascular diseases (stroke)
Alzheimer's disease
Diabetes
Intentional self-harm (suicide)
Chronic liver disease and cirrhosis
Winnebago County Wisconsin
Source: WI DHS WISH (129)
Age-adjusted death rate
(deaths per 100,000 population)
Top Causes of Deaths
In 2020, the majority of deaths in Winnebago County were a result of heart diseases and
cancers.
Where Do We Go From Here?
Where How
51
There are widely varying
experiences in the community. This
report has identified profound
disparities, specifically among:
People with low income
People of color
People previously incarcerated
People who identify as LGBTQ+
What Know What Affects Health
70%
of health outcomes are
determined by
community conditions
Focus on Areas of Greatest Need
Who Collaborate to Maximize Efforts
Use Multiple Strategies that
Impact Community Conditions
4 Considerations to Improve Health and Well-Being for All
Invest in Our Community
Plan and implement
collective action to create
positive ripple effects
Connect with public
health to get involved in
next steps
(130)
Source: CDC Community Health Improvement Navigator (130)
Adam BellCorelli East Central WI
Regional Planning Ryan Rasmussen Oshkosh Area
Community Pantry
Karl Buelow Day By Day Shelter Traci Raymond ThedaCare Rural Health
Initiative
Kristal Coats Ascension Mushe Subulwa SEPO Zambia
Jennifer Considine UW Oshkosh
Communication Dept Joe Vanevenhoven Ascension
Rev. Amy Engebose St. Paul Lutheran
Church, Neenah Madeline Breager
Danielle Florence
Susan Garcia Franz
Heidi Keating
Sarahjean
Schluechtermann
Winnebago County
Public Health StaffMaryCarmen Fabian Reach Counseling
William Green Fox Valley Technical
College
Brian Harbison Fox Crossing Fire
Department
Additional contributions by staff from the
following organizations:
City of Menasha Health Department
Oshkosh Area School District
Oshkosh United Way
UW-Extension Winnebago County
Winnebago County Supervisors
Kevin Kropp UW Oshkosh Intern
Angie Lee City of Oshkosh, DEI
Committee
Katie Olson ESTHER
We would like to extend our sincere appreciation to all Winnebago County Community
Health Advisory Team members.
Winnebago County CHA Advisory Team
52
1.
2.
3.
4.
5.
6.
https://wisconsinfirstnations.org/ho-chunk-nation/
https://tribalrelations.wisc.edu/
https://www.thenorthwestern.com/story/news/local/oshkosh/2021/11/08/chief-oshkosh-statue-plaques-
aim-address-historical-inaccuracies/6283688001/
https://wisconsinfirstnations.org/map/
https://commons.wikimedia.org/wiki/File:Map_of_Wisconsin_highlighting_Winnebago_County.svg
https://wisconsindot.gov/Documents/travel/road/hwy-maps/county-maps/winnebago.pdf
References
53
Terms & Definitions
Models for Community Health
Where We Live, Learn, Work, and Play
Winnebago Co People, Land, Water
7.https://apha.org/-/media/Files/PDF/webinars/2021/Advancing_Racial_Equity_Discussion_Guide.ashx
8.https://pubmed.ncbi.nlm.nih.gov/27513279/
9.
10.
https://www.astho.org/globalassets/toolkit/astho-health-equity-policy-toolkit.pdf
https://www.apha.org/What-is-Public-Health
Community Input
Difference in Community Experiences
Ongoing Impacts of COVID-19
11.
12.
https://csteachers.org/stories/identity-markers-equity-in-cs
http://www.lgbtiqintersect.org.au/learning-modules/identity/
13.https://pbswisconsin.org/news-item/convictions-bar-wisconsinites-from-many-jobs-making-re-entry-a-
real-struggle/
14.
15.
https://www.cdc.gov/policy/polaris/tis/systems-problems/index.html
https://www.rwjf.org/en/insights/our-research/2020/09/the-impact-of-coronavirus-on-households-
across-america.html
Community Systems and Assets
17.
18.
19.
https://www.cdc.gov/policy/polaris/tis/systems-problems/index.html
https://www.rwjf.org/en/insights/blog/2015/03/investing_in_systems.html
https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-
resources/identify-community-assets/main
20.https://data.census.gov/
Community Data Snapshot
16.https://cms5.revize.com/revize/menasha/Health/FV%20Health%20Needs%20Assesssment%20Key%20I
nformant%20Summary%20(1).pdf
Economic Stability
References
54
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-
factors/social-economic-factors/income?
https://data.census.gov/
https://livingwage.mit.edu/counties/55139
https://datacommons.org/place/geoId/55139
https://www.countyhealthrankings.org/explore-health-rankings/wisconsin/winnebago?year=2023
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450438/
https://www.newmentalhealthconnection.org/wp-content/uploads/2023/05/MYWS-Recommendations-
Report-2023.pdf
https://cdn.ymaws.com/www.unitedwaywi.org/resource/resmgr/alice/fact_sheets/winnebago_county__
alice_2023.pdf
https://cdn.ymaws.com/www.unitedwaywi.org/resource/collection/43E6EC24-E027-4746-9F04-
560DF5565E56/Wisconsin_ALICE_Report,_2020.pdf
https://cdn.ymaws.com/www.unitedwaywi.org/resource/resmgr/alice/2022-
23_report/23alice_essentials_index_nat.pdf
https://strongnation.s3.amazonaws.com/documents/1598/05d917e2-9618-4648-a0ee-1b35d17e2a4d.pdf?
1674854626&inline;%20filename=%22$122%20Billion:%20The%20Growing,%20Annual%20Cost%20of
%20the%20Infant-Toddler%20Child%20Care%20Crisis.pdf%22
https://supportingfamiliestogether.org/about-us/why-early-childhood/
https://economicdevelopment.extension.wisc.edu/articles/windicators-volume-3-number-5-are-the-
kids-alright-women-work-childcare/
https://data.census.gov/
https://www.childcareaware.org/our-issues/research/ccdc/state/wi/
https://www.census.gov/quickfacts/fact/table/winnebagocountywisconsin,US/PST045222
https://cdn2.hubspot.net/hubfs/3957809/2019%20Price%20of%20Care%20State%20Sheets/Wisconsin
%20County.pdf?
__hstc=122076244.448e4b2efc91b12e5a7eddff281c9573.1652900187022.165%203507750922.16536005303
52.4&__hssc=122076244.1.1654097647229&__hsfp=4062656471&hsCtaTracking=d365b7c0-d1b1-4998-
902e-4fb33ce51341%7Ca5e4b419-5c79-4527-830e-dbace5c585ce
Neighborhood and Built Environment & Natural Environment
References
55
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
https://humanimpact.org/wp-content/uploads/2020/02/HHI_Report_FinalWeb.pdf
https://www.huduser.gov/portal/datasets/fmr/fmrs/FY2023_code/select_Geography.odn
https://www.forward-analytics.net/wp-content/uploads/2023/01/A-Housing-Hurdle-Report.pdf
https://wi.211counts.org/
https://theconversation.com/cdc-eviction-ban-ended-by-supreme-court-4-questions-about-its-impact-
answered-by-a-housing-law-expert-166926
https://doa.wi.gov/Pages/Wisconsin-Eviction-Data-Project.aspx
https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/food-
insecurity
Data provided by the Oshkosh Area Community Pantry
https://www.countyhealthrankings.org/explore-health-rankings/wisconsin/winnebago?year=2023
https://www.dhs.wisconsin.gov/foodshare/rsdata.htm
https://www.dhs.wisconsin.gov/news/releases/011223.htm
https://wispolicyforum.org/wp-content/uploads/2020/05/Focus_COVID_Internet_Access.pdf
https://data.census.gov/
https://www.apha.org/-/media/Files/PDF/pubs/Transportation_Health_Community_Driver.ashx
https://naric.com/?q=en%2FFAQ%2Fwhat-accessible-transportation
https://docs.legis.wisconsin.gov/2005/related/acts/126
https://wispolicyforum.org/research/a-tuf-dilemma-over-local-transportation-funding/
https://www.co.winnebago.wi.us/sites/default/files/uploaded-
files/Student%20Transit%20Report_FinalwithAppendices.pdf
https://www.cheme.engineering.cmu.edu/news/2021/11/08-dep-declares-code-orange.html
https://www.iqair.com/us/usa/wisconsin/oshkosh
https://www.co.winnebago.wi.us/sites/default/files/uploaded-files/winnebago_county_lwrmp_2021-
2030_final_version.pdf
https://www.ci.neenah.wi.us/wp-content/uploads/2023/05/Water-Quality-Report_22_5_11_2023-for-
website.pdf
https://www.ecwrpc.org/wp-content/uploads/2023/05/ECWRPC-State-of-the-System-Report-2022.pdf
https://www.ecwrpc.org/wp-content/uploads/2019/05/2019-Winnebago-County-CORP.pdf
https://dnr.wisconsin.gov/topic/urbanforests/ufia/canopygoals
https://wi-dnr.maps.arcgis.com/apps/View/index.html?appid=c85ffcd7a1514c0780bd75159caf204b
References
Education Access and Quality
56
Social and Community Context
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
https://publichealth.tulane.edu/blog/social-determinant-of-health-education-is-crucial/
https://eric.ed.gov/?id=ED517805
https://www.nationsreportcard.gov/profiles/stateprofile/overview/WI?
cti=PgTab_GapComparisons&chort=1&sub=RED&sj=WI&fs=Grade&st=MN&year=2019R3&sg=Race%2FEthni
city%3A%20White%20vs.%20Black&sgv=Difference&sgvs=desc&ts=Single%20Year&tss=2019R3&sfj=NP
https://wisedash.dpi.wi.gov/Dashboard/dashboard/22275
https://wisconsinliteracy.org/find_literacy_program/statistics.html
https://map.barbarabush.org/assets/cards/BBFFL-Literacy-Card-WI.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326385/
https://data.census.gov/
https://www.rand.org/pubs/research_reports/RR3057-1.html
https://dpi.wi.gov/news/releases/2022/racial-disparities-and-our-collective-will
https://www.teachforamerica.org/one-day/top-issues/why-we-say-opportunity-gap-instead-of-
achievement-gap
https://files.eric.ed.gov/fulltext/ED626477.pdf
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
https://planh.ca/take-action/healthy-society/inclusive-communities/page/social-connectedness
https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-
devastating-impact-epidemic-loneliness-isolation-united-states.html
https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
https://dpi.wi.gov/sspw/yrbs/online
https://www.cdc.gov/suicide/factors/index.html
Winnebago County Medical Examiners Office
https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-
factors/social-economic-factors/community-safety/juvenile-arrests?anchor=data-methods&selected-
tab=methods&year=2023
https://www.sentencingproject.org/fact-sheet/black-disparities-in-youth-incarceration/
https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-
environment
https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-
factors/social-economic-factors/community-safety?
75.https://publicstaffreports.dpi.wi.gov/PubStaffReport/Public/PublicReport/StaffByEthnicityAndGenderRe
port
https://justicelab.columbia.edu/sites/default/files/content/Wisconsin%20Community%20Corrections%2
0Story%20final%20online%20copy.pdf
References
Health Care Access and Quality
57
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/access/elements.html
https://www.commonwealthfund.org/publications/issue-briefs/2022/sep/state-us-health-insurance-
2022-biennial-survey
https://www.commonwealthfund.org/publications/journal-article/2020/feb/aca-at-10-years-effect-
health-care-coverage-access
https://data.census.gov/
https://show.wisc.edu/study-cost-lack-of-insurance-coverage-are-primary-predictors-of-poor-oral-
health/
https://www.webmd.com/health-insurance/dental-insurance-overview
https://www.aarp.org/health/medicare-insurance/info-2022/dental-coverage.html
Partnership Community Health Center Community Needs Assessment 2022
https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-
health-workforce-shortage
https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
https://www.co.winnebago.wi.us/sites/default/files/uploaded-files/2021-
2022_winnebago_ofr_annual_report_final.pdf
https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/
https://www.wpshealth.com/resources/customer-resources/health-insurance-terminology.shtml
ttps://www.americanprogress.org/article/health-insurance-costs-are-squeezing-workers-and-
employers/#:~:text=According%20to%20the%202022%20Kaiser,2010%20to%20%247%2C911%20in%2
02022.&text=Over%20the%20same%20period%2C%20family,percent%2C%20from%20%2413%2C770
%20to%20%2422%2C463.
https://www.kff.org/other/state-indicator/family-coverage/?
activeTab=graph¤tTimeframe=0&startTimeframe=9&selectedRows=%7B%22states%22:%7B%22wiscons
in%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
https://coveringwi.org/learn#Badgercare
https://www.dhs.wisconsin.gov/badgercareplus/enrolldata.htm
https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-
many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/
https://www.pewtrusts.org/en/research-and-analysis/articles/2023/07/19/how-state-courts-can-help-
address-americas-medical-debt-problem
https://kffhealthnews.org/news/article/diagnosis-debt-investigation-100-million-americans-hidden-
medical-debt/
https://www.commonwealthfund.org/blog/2019/hospital-price-transparency-making-it-useful-patients
References
58
Health Behaviors & Health Conditions & Health Outcomes
Where Do We Go From Here
130. https://www.cdc.gov/chinav/docs/chi_nav_infographic.pdf
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-
factors/health-behaviors/diet-and-exercise?year=2023
https://www.countyhealthrankings.org/explore-health-rankings/wisconsin/winnebago?year=2023
https://www.cdc.gov/tobacco/data_statistics/index.htm
https://dpi.wi.gov/sspw/yrbs/online
https://www.dhs.wisconsin.gov/tobacco/index.htm
Julia Sherman, the retired coordinator for the Wisconsin Alcohol Policy Project in Wisconsin
(https://www.wpr.org/wisconsins-drinking-problem-doesnt-stem-cultural-heritage-expert-says)
https://www.mcw.edu/-/media/MCW/Departments/Comprehensive-Injury-Center/WI-Alcohol-Policy-
Project/Measuring-Alcohol-Outlet-Density-in-Wisconsin-Does-Your-Community-Have-a-Problem.pdf
https://dhsgis.wi.gov/DHS/EPHTracker/#/all/Alcohol/alcoholIndex/NOTRACT/Alcohol/alcoholIndex2
Wisconsin PHAVR Reports (no link)
https://www.stanfordchildrens.org/en/topic/default?id=low-birthweight-90-P02382
https://www.dhs.wisconsin.gov/wish/index.htm
https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-
outcomes?
https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-
outcomes/quality-of-life?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328595/
https://www.dhs.wisconsin.gov/disease/communicable.htm
https://www.co.winnebago.wi.us/sites/default/files/uploaded-
files/4th%20Quarter%202022%20Report.pdf
https://www.cdc.gov/chronicdisease/about/index.htm
https://places.cdc.gov/?view=county&locationIds=55139
https://www.cdc.gov/dhdsp/maps/hd-stroke-mortality-dashboard.htm
https://static1.squarespace.com/static/637b92dbd2b49a79c0b8f44e/t/649f2113b4a4cb7d192ae208/16881
50301549/2022-2023+-+Winnebago+OFR+Annual+Report+-+Final.pdf
https://www.dhs.wisconsin.gov/wish/index.htm
June-July 2022
Outreach to community partners to form the community health assessment advisory team,
inclusive of populations disproportionately impacted
First meeting with the advisory team, level setting to understand the purpose and process
of the CHA
Develop and review charter and agree on process for community health assessment: County
Health Rankings Take Action Cycle with a focus on social determinants of health model
from Healthy People 2030
Aug-Dec 2022
Held monthly advisory team meetings covering the following topics and issues:Provide guidance on County Health Rankings data Discuss Winnebago County data that stood out, how we compared to other countiesPublic health staff gathered and shared additional secondary data from various sourcesDiscussion around who is disproportionately impacted in our communityDiscussion around most important indicators and what data is missingDiscussion and feedback around narrative and plain language for community tounderstand the assessment report
Jan-April 2023
Created and shared preliminary draft on social determinants of health indicators andnarrative with advisory teamWith advisory team, planned primary data collection; focus groups, and who to prioritizehearing fromDevelop focus group process with ESTHER and focus group questionsPublic health grant funding shared with ESTHERFunding included incentives for focus group participantsIdentified advisory team members to facilitate focus groups with specific populations
May-June 2023
Public health staff and advisory team members conducted focus group sessions to hearfrom disproportionately impacted populations in Winnebago CountyAnalyzed focus group data and determined themesIncorporated focus group themes into CHA report
July-Sept 2023
Met with advisory team to share results from primary data collection and feedback onnarrativeIncorporate advisorty team feedback
Oct 2023
Met with advisory team to share final draft of the completed CHA Discussed next steps with determining priorities and CHIP
Nov 2023 Final edits to the CHAStarted drafting CHA summary
Dec 2023 Published Community Health AssessmentShared Community Health Assessment with the community
59
Appendix - Methods