It is estimated that medical care accounts for only 20 percent of modifiable health outcomes, while social determinants drive the remaining 80 percent. The acknowledgment of the social determinants of health has encouraged a focus on upstream strategies aimed at improving health outcomes for everyone in the US. Yet, the social determinants model has continued to hold structural racism as a single determinant rather than recognizing it as a root cause that shapes inequities across all of the social determinants, including education, economic instability, and neighborhood environment. As a result, policy strategies have often failed to address the existing laws that underpin inequities. In the past two years, however, local governments have begun to lead the way in explicitly recognizing that racism is a public health crisis that requires policy actions beyond those taken to date. 

This project will evaluate the impact of resolutions declaring racism a public health crisis on subsequent policy development and implementation, asking: 

  1. How has the resolution declaring racism a public health crisis impacted local policy development and implementation in Milwaukee County, WI?  

  1. What enabling factors and barriers have staff in leadership positions across government agencies within Milwaukee County experienced as they have sought to fulfill the policy vision outlined in the resolution?  

  1. Nationally, to what extent have local and state health departments in jurisdictions with these resolutions engaged in further policy action to address structural racism?  

Findings will determine the impact of resolutions and help shape the direction of future policy and advocacy work, as well as provide lessons for how governments can work to ensure their resolutions have the best chance of successfully improving racial equity in their jurisdiction.