Fiscal Facts by Wisconsin Policy Forum

As municipal public health agencies in Milwaukee County face evolving expectations and a generational test from a global pandemic, an assessment of future challenges suggests it may be appropriate to consider options to improve the structure for delivering these services.

Those options include expanding Milwaukee County’s role to supplement that of municipal departments, greater collaboration and sharing among existing departments and departmental consolidation.

Early in the COVID-19 pandemic, an operational center was formed consisting of emergency management and public health officials from Milwaukee County and its 11 municipal health departments, as well as from health systems, academia and the business community. This Unified Emergency Operations Center, or UEOC, helped coordinate the region’s pandemic response — yet also raised questions about the need for ongoing coordination and potential structural change going forward.

Toward that end, Milwaukee County commissioned the Wisconsin Policy Forum to produce a report examining the current structure for public health services in the county and possible opportunities for improvement.

Per state law, Milwaukee County is unique among Wisconsin’s 72 counties in having responsibility for public health services assigned to municipal governments. Most other counties have a single department housed in the county government. Exceptions include the joint city of Madison-Dane County model; and a two-department model in Racine County in which one department serves the city of Racine and another housed in county government serves most other municipalities.

Many public health agencies also are adapting to a new “Public Health 3.0” model that urges moving beyond traditional “direct service” activities like immunizations, inspections and response to disease outbreaks, to a broader array of activities, in conjunction with outside stakeholders, to address “social determinants of health” such as housing, transportation and access to healthy food.

This transition can be challenging given resource constraints and an affinity for traditional approaches. Any further move toward this model may require an increase in financial and staff resources, and more county and state participation.

Moving forward, options for policymakers to consider include maintaining the status quo, creating a Milwaukee County public health advisory body or a formal support role for the county, sharing staff between departments or adopting a two-department consolidation model or a less comprehensive consolidation blueprint.

Eight public health officers from Milwaukee County municipal health departments agreed to be interviewed for the report, and their comments suggest some steps already taken by the departments have laid footings for improved coordination. Municipal, county and state officials, area health systems and community stakeholders are now free to consider these and other options, to determine which (if any) they would like to explore in greater detail.

This information is provided to Wisconsin Newspaper Association members as a service of the Wisconsin Policy Forum, the state’s leading resource for nonpartisan state and local government research and civic education. Learn more at