Wisconsin State Health
Improvement Plan
2023-2027
Summary

P-01791 (02/2023)

Contents
Foreword........................................................................................................................... 3
Developing the 2023-2027 Wisconsin State Health Improvement Plan .................................... 4
Community Partners ....................................................................................................... 4
Local and Tribal Health Departments ................................................................................ 4
Institutional Partners....................................................................................................... 52023-2027 Wisconsin State Health Improvement Plan (SHIP) Framework ............................... 5
Foundational Shifts ......................................................................................................... 6
Institutional and systemic fairness ................................................................................ 6
Representation and access to decision-making ............................................................... 7
Community-centered resources and services .................................................................. 7
Priority Areas.................................................................................................................. 8
Social and community conditions .................................................................................. 8
Physical, mental, and systemic safety ...........................................................................10
Person and community centered health care .................................................................11
Social connectedness and belonging ............................................................................11
Mental and emotional health and well-being .................................................................12
Implementing the 2023-2027 Wisconsin State Health Improvement Plan ...............................13
Principles of SHIP Implementation ..................................................................................13
SHIP Implementation Next Steps ....................................................................................14
Partnerships and engagement .....................................................................................14
Objectives, strategies, and measures ...........................................................................14
Using the State Health Improvement Plan ...........................................................................142

Foreword
The spotlight on public health has perhaps never been brighter, and the need for meaningfulimprovement has never been more evident. The COVID-19 pandemic laid bare cracks in our systems thatcannot be solved by doing business as usual. At the same time, communities have shown that they haveknowledge, skills, and experience that are vital to maintaining and improving individual, community, andpopulation health. The Wisconsin Department of Health Services (DHS) State Health Improvement Plan
(SHIP) lays out an ambitious roadmap to guide actions across sectors in order to address public healthneeds in ways that will help all Wisconsinites chart their course to better health and thriving
communities. When the basic needs of people and communities are met, they can better prevent andrecover from challenges to their health and well-being. This SHIP contains a wider range of opportunities
for improvement, from upstream policy, systems, and environment change to downstream individual
factors.
The SHIP lays out a pathway for Wisconsin to improve the health and well-being of its people andcommunities. This plan satisfies requirements under state law (Wis. Stat. § 250.07(1)(a)) that DHS produce
a public health agenda for the people of Wisconsin at least every 10 years. In addition, this five-year plan
fulfills the requirement of the Public Health Accreditation Board to maintain Wisconsin’s status as one of
40 states to have an accredited state health department.
This SHIP is a living document that will grow with our work together. It is designed to be adaptable toindividual communities while providing guidance on state-level goals for health improvement.
Additionally, over its five-year life span it will evolve with Wisconsin’s changing public health landscape.
This initial summary describes the community-centered SHIP development process, and the principles
and framework upon which a more detailed implementation plan will be built.
To the hundreds of community members and leaders, public health partners, health care practitioners,
state staff, and many more, we cannot thank you enough for your time and contributions to this workand this report. This plan is dedicated to you. Public health improvement succeeds when it is a sharedeffort to ensure a vibrant future for all Wisconsinites.

Paula Tran
State Health Officer
Wisconsin Department of Health Services3

Developing the 2023-2027 Wisconsin State Health Improvement Plan
The 2023-2027 Wisconsin State Health Improvement Plan (SHIP) builds on the work of the 2017-2022
State Health Improvement Plan Transitional Report, as well as recent publications like the UW-Madison
Population Health Institute’s Population Health and Equity Report Card, Minority Health Report, and theGovernor’s Health Equity Council recommendations executive summary. These documents ask us toconsider and address the root causes of health and well-being outcomes and inequities. The development
process for the 2023-2027 SHIP centered the lived expertise and voices of community members fromacross the state to create a roadmap to improve the health and well-being of all Wisconsinites. This SHIP
development process is more purposefully and deeply rooted in community knowledge and perspectives
than in any previous SHIP. It builds on the hundreds of data points and voices of thousands of
Wisconsinites through the State Health Assessment (SHA) development process. Additional input fromlocal and tribal health departments, state agencies, health care organizations, and other institutional
partners shaped the framing and structure of the SHIP framework. Ultimately, this plan reflects thehealth and well-being experiences, needs, and hopes of diverse groups of Wisconsinites. This SHIP laysout a roadmap for community health improvement in Wisconsin and a plan for long-term pandemic
recovery.
Community Partners
To meaningfully center the needs of members of Wisconsin communities, SHIP development began andended with community conversations. The series of community conversations focused on understanding
what factors impact the health of Wisconsinites and how they experience those factors, as well as theassets of communities.
The initial rounds of SHIP development conversations included representatives of community-basedorganizations reflecting a diverse group of Wisconsinites, including rural, urban, immigrant, Black,
Hispanic, LGBTQ+, disabled, and other communities. Participants reflected on an initial set of priority
areas developed through more than 70 community conversations held in 2019 during the SHA process.
Community members described how their priorities evolved since 2019, especially throughout the COVID19 pandemic and changing economic and social landscape. Their updated set of priorities laid thefoundation for conversations with additional groups of partners.
After further partner conversations, described below, the SHIP development process concluded withadditional community conversations. These conversations ensured that the final SHIP framework still
accurately reflected the health and well-being priorities shared by community members in the initialrounds of conversation.
Local and Tribal Health Departments
Wisconsin’s local and tribal health departments are essential partners who understand the health andwell-being, hopes, and concerns of their communities, as well as how the SHIP may be most useful totheir work and that of local partners. In a series of Community of Practice conversations, intended topromote collective learning and improvement, local and tribal health departments considered how thepriorities described by statewide community members aligned with the issues they’ve heard expressed bytheir own local community members. They also shared opportunities for how the SHIP may best be
framed to support the development of their own community health improvement plans to address root
causes of health related to their own priorities.
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Institutional Partners
Community partners strongly expressed that effectively improving health and well-being in Wisconsin will
require collaboration and alignment for a common purpose across many different agencies and sectors.
Building this alignment requires reaffirming existing partnerships, as well as developing new relationships
and ways of working together. Most organizations currently work relatively independently. DHS, state
health-related councils and advisory bodies, other state agencies, health care systems, public healthfunders, and others contributed feedback on the foundational shifts and priority areas described in theSHIP. They also suggested ways to align their work with the SHIP to break down silos, coordinate
strategies and activities, and achieve more improvement together than we could separately.

SHIP Framework
Wisconsin communities have diverse strengths as well as diverse needs to improve health and well-being.
It would be impossible to create a comprehensive one-size-fits-all framework. The 2023-2027 SHIP
framework reflects the health needs and hopes most strongly and frequently expressed by Wisconsinites
in a series of conversations. With an ultimate vision that all people and communities in Wisconsin havethe opportunities and supports they need to reach their full potential. The framework centers changing
policies, systems, and environments to improve health and well-being. It also features an aspirational,
ideal-state framing of the improvements that are needed. Rather than solely focusing on the problems tobe solved, the framework describes what communities would look like when we succeed in improving thefactors that affect health and well-being.
Many of the foundational shifts and priority areas described in this framework are areas that are not
traditionally addressed by public health agencies. Housing, child care, community resources, and thesystems that affect access to decision-making, for example, are currently addressed by other sectors.
However, the direct links between these factors and health have become increasingly clear.
In public health we often reference the parable of the river. In this story a person sees several people ina river struggling to swim to shore. A crowd of rescuers gathers to help, but no matter how many people
they pull from the river, more keep coming. So, the person walks upstream and sees that people are
falling into the river because the bridge to cross it has fallen down, and they understand that to truly
solve the problem they don’t just need more rescuers; the bridge needs to be repaired too.
Similarly, we know that, while they are also absolutely needed, recruiting more health care workers
alone, for example, is not enough to permanently improve the health and well-being of Wisconsin
communities. We must work upstream to fundamentally improve our environments (the bridge), policies(how the bridge was designed, built, and funded), and systems (how it was decided how, where, and bywhom the bridge was designed and built in the first place) that affect health.

52023-2027 State Health Improvement Plan (SHIP) Framework
VISION: All people and communities in Wisconsin have the opportunities and supports theyneed to reach their full potential

Priority areas

Foundational
shiftsInstitutional and systemic fairness
Representation and access to decision-making
Community-centered resources and services

Social andcommunity
conditions- Economic
well-being- Supportive
systems of care
- Healthy housing

Physical,mental, andsystemic safety

Person andcommunity
centered healthcareSocialconnectedness
and belonging

Mental andemotional
health andwell-being

Foundational Shifts
Foundational shifts are the fundamental changes we must make in the way we do the work of publichealth to effectively and sustainably address and improve the health and well-being of all Wisconsinites.
For example, to achieve a key factor for health such as economic well-being for all, institutions andsystems must fairly support and address the needs of Wisconsin’s diverse individuals and communities.
And for health care to be truly person- and community-centered, all groups must be represented in andhave access to the spaces in which decisions that affect their health are being made. Foundational shifts
are difficult to define and measure but should be prioritized regardless, both for their own sake and toensure there is a strong base upon which sustainable improvements further downstream can be made.
Institutional and systemic fairness
Members of many Wisconsin communities described the ingrained structural barriers they experience
when interacting with systems and institutions and accessing services, which in turn create inequitable
health outcomes. These systems and institutions include health care, education, the civil and criminal
legal systems, employment, and more. Some of these structural barriers are deeply rooted, like theforced removal of Native Americans from their land and discriminatory lending practices such as redlining. These aspects of our state’s and nation’s history continue to cause harm in Black and Native
American communities in Wisconsin. Other structural barriers, such as housing rental and mortgage
application requirements or city zoning policies that affect where transit hubs and grocery stores arelocated, are more modern and have similar impacts.

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By contrast, institutional and systemic fairness may look like:-Communities are supported in ways that take into account current and historical systems andpolicies that have created disparities in health and well-being behaviors and outcomes
New policies and systems address disparities in resource allocation across communities

Representation and access to decision-making
One of the clearest themes that arose in the SHIP community conversations was the need for individuals
and communities to have the power to influence the decisions being made that affect their health andlives. Having a more diverse group of problem solvers at decision-making tables, including those actuallyliving in and experiencing the negative effects of current systems, policies, and environments, will
improve how responsive the decisions being made are to the needs and desires of the community.
Inclusive decision-making can make actions taken more likely to effectively address intended issues, andless likely to have unintended negative effects.
Community members suggested several ways representation and access to decision-making could look inpractice, including:-Community-based leadership and advocacy receive long-term support and investment
Decision-making authority shifts from high-level policy-makers to the community level wheneverpossible, and community voices are always meaningfully included in the decision-making process
Trusting relationships exist between traditional decision makers and community members
Communities use assets-focused approaches to build on their wisdom, experience, and strengths

Community-centered resources and services
In conversations, communities expressed that they best understand their own situations and needs, andthey have the skills and knowledge to address those needs themselves if adequately supported andresourced to do so. Every community in Wisconsin is unique. No single policy or service will beappropriate for all communities across the state. Community-level decision-makers have the greatest
insight into their community’s needs as well as their knowledge and ability to problem solve. Communities
have untapped talent and skills that are not being utilized. Supporting communities by investing in themand giving them more control over resources, service design, and implementation can yield more efficientand effective improvement.
Centering community-based resources and services may look like:-Communities receive sufficient, sustainable, flexible, and easy-to-use funding to address theirneeds
Resources and services offered are easily accessible to and meet the unique needs of all who
need them, regardless of identity, language spoken, mental or physical ability, location, etc.
Resources and services offered are adapted to the specific needs and practices of individual
communities
Resources and services offered are coordinated with one another and wrap around the complete
needs of individuals and communities

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“Health equity begs us to be more insightful and creative about the ways we use funding andresources…we want our communities to own public health,” - Community conversation participant

Priority Areas
Priority areas are the issues Wisconsin community members raised as being the most important factors in
improving their health and well-being. Many of these priorities are outside the current scope of publichealth, but we know have clear impact on health outcomes. The COVID-19 pandemic, for example, shone
a light on the effects of housing, employment, and social support on how individuals, families, andcommunities were able to respond to and protect themselves from the virus and its larger societal
impact.
Priority areas are more concrete and further downstream than foundational shifts, but still require
collective effort to improve. They may be addressed through collaborative, community-centeredpartnerships of state and local public health organizations, community-based organizations, policymakers, health care organizations, and others. These partnerships will help to develop specific objectives
and strategies to shift policies, systems, and environments that affect the priority areas identified bymembers of the Wisconsin community.
Social and community conditions
Social and community conditions, also called social determinants of health are the conditions in theenvironments where people are born, live, learn, work, play, worship, and age that affect a wide range ofhealth, functioning, and quality-of-life outcomes and risks. 1 There are many social and community
conditions that affect health and well-being. Wisconsinites identified three as being most impactful on
their lives: economic well-being, supportive systems of care, and healthy housing.
Economic well-being
Wisconsinites shared a range of concerns regarding their individual and community economic security
and success. These include availability of family supporting jobs and wages; paid family and sick leave;
accessible, affordable education and job training; and help understanding and resolving medical andother debt.
••

Eleven percent of households in Wisconsin live below the federal poverty line and another 23%
of Wisconsin households earn more than this but cannot afford basic household necessities. 2
Seventy-seven percent of working Wisconsinites do not have access to paid family leave, and
61% lack access to unpaid family leave. 3

1Social Determinants of Health, Healthy People 2030

2

Wisconsin 2020 state report, United for ALICE

3

Working parents who are eligible and can afford FMLA unpaid leave by race/ethnicity, Data Diversity

Kids

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•

The median annual income of white households ($66,073) is more than double that of Blackhouseholds ($32,857) in Wisconsin 4, and the urban per-capita income is 15.5% higher ($57,586)
than rural per-capita income ($49,842). 5

Economic well-being is closely associated with health and well-being. 6 Income, for example, is associatedwith the health outcomes, such as the frequency of chronic health conditions in a community, as well as
life expectancy. Economic status and health can also interact to create a health-poverty trap, where low
economic status contributes to poor health, and poor health perpetuates low economic status.
Supportive systems of care
Wisconsin community members identified a wide gap between child care and other care (part- or fulltime care for children and adults who need help with daily activities of living) that is available in theircommunities and the care that is needed. Their concerns include the affordability and appropriateness ofcurrently available care (how well available care matches the care that’s needed), as well as the need formore care options. Location of care options is also important, especially for those who live in ruralcommunities and those who commute using public transportation.
•••

Fifty-four percent of Wisconsinites live in a child care desert where there are significantly morechildren in need of child care than available child care spots. 7
Infant care for one child costs 18.5% of the median family income in Wisconsin; affordable carecosts less than 7%. By this standard, only 6.5% of Wisconsin families can afford infant care. 8
Eighty-five percent of Wisconsinites who rely on direct care services to lead safe and healthy
lives cannot find enough direct care workers to cover all needed shifts. 9

Systems of care directly affect the health and well-being of those being cared for by safely providing
needed care. Additionally, they indirectly affect the health of individuals and communities by impacting
employment stability, social connectedness, and mental and emotional health and well-being.
Healthy housing
Housing is a basic need for all. Housing needs of communities in Wisconsin often do not match the
housing and related resources that are available. Community members described healthy housing as
housing that is affordable, stable, safe, and meets the needs of those who live there. Housing that meetsthe needs of all Wisconsinites may mean many things, including that the housing is located near goodjobs, that there is enough space for the individuals who live there, that it’s multigenerational, or that it isphysically accessible and supportive for people with mobility concerns. Current and historical policies in
Wisconsin make it more difficult for some groups to secure healthy housing, resulting in ongoing

4

Median income in the past 12 months, American Communities Survey

5

Population, Income, Food Insecurity, Education, and Employment, USDA Economic Research Service

6

Health, Income, & Poverty: Where We Are & What Could Help, Health Affairs

7

Wisconsin Childcare Deserts, Center for American Progress

8Child care costs in the United States- Wisconsin, Economic Policy Institute9

Wisconsin’s Direct Care Workforce Crisis, Survival Coalition of Wisconsin Disability Organizations
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disparities in rates of homeownership, eviction, experiences of homelessness, childhood lead exposure,and more.
•••

Twenty-one percent of homeowners and 42% of renters in Wisconsin spend more than 30% of
their monthly income on housing. 10
Seventy-two percent of white Wisconsin households own their homes, while only 41% of
Hispanic households and 26% of Black households own their homes. 11
More than 350,000 homes in Wisconsin have potential lead-based paint hazards that are harmful
to health, especially in children. 12

Housing may affect health directly by, for example, being free of pollutants and lead. Housing may also
indirectly affect health through factors like location and accessibility by facilitating economic well-being,social connectedness, access to education, access to nearby health care services, and more. Healthy
housing is an important contributor to the overall social and economic vitality of a community.
Physical, mental, and systemic safety
Safety means many different things to different people. It manifests uniquely across Wisconsin’s diverse
communities, and different people need different conditions to feel safe. In community conversations,Wisconsinites shared concerns about physical, mental, and systemic safety. To them, physical and mental
safety include protection from the bodily and psychological effects of interpersonal violence, including
firearms and other weapons, intimate partner violence, and violence based on race, ethnicity, gender, orother personal characteristics. The mental safety aspect of this priority area also includes the need for a
trauma-informed approach to violence prevention and individual and community healing. Systemic safety
is closely tied to the institutional and systemic fairness foundational shift and includes protection fromharm caused by policies or systems, based on race or ethnicity, gender or sexual identities, immigration
status, or other characteristics. Criminalization of mental illness and addiction is one way current systems
and policies harm health and people.
•••

Thirty-six percent of Wisconsin women and 32% of Wisconsin men experience intimate partner
physical violence, intimate partner rape and/or intimate partner stalking in their lifetimes. 13
Nearly one in four Wisconsin students reports being bullied at school. 14
The rate of incarceration among Black Wisconsinites is 12 times that of white Wisconsinites, thesecond highest disparity in incarceration rates between these two groups in the U.S. 15

Physical violence, including firearm-related incidents, directly impacts physical health through the injuries
or death they may cause. The after-effects of this physical violence, as well as mental and systemic
violence, can affect mental health, causing conditions including anxiety and depression. These mental

10

Selected housing characteristics, American Communities Survey

11

Racial disparities in homeownership extend beyond Milwaukee, Wisconsin Policy Forum

12

American Healthy homes survey Lead and Arsenic Findings, US Dept. of Housing and Urban

Development
13

Domestic violence in Wisconsin, National Coalition Against Domestic Violence

14High School Youth Risk Behavior Survey, Centers for Disease Control and Prevention

15

The Color of Justice: Racial and Ethnic Disparities in State Prisons, The Sentencing Project10

health issues may in turn cause additional physical health issues, like high blood pressure, poor immune
function, and more. 16
Person- and community-centered health careCommunity partners shared several ways in which current health care systems and institutions, including
mental health, dental, and vision care, do not adequately meet their needs. They expressed a desire forcare that is accessible financially (including insurance and options for non-insured individuals) andphysically (in terms of location, transportation options, and other physical barriers). Many community
members stated that their communities need more care options and systems that are inclusive of andresponsive to cultural and other identity-specific needs and preferences. They said that when theyreceive care from providers who share their identities it makes the patient-provider relationship more
effective at addressing their needs and improving their health and well-being outcomes. The need for
improved long-term care options also arose repeatedly in conversations. Additionally, Wisconsinites said it
is essential that our complex insurance and health care systems are made easier to navigate andunderstand.
•••More than 8% percent of Wisconsinites did not receive needed medical care in the past 12
months because of cost. This proportion is higher (up to 19.3%) for non-white Wisconsinites. 17
Thirty percent of Wisconsinites who are not U.S. citizens do not have health insurance. 18
Rural Wisconsin counties have only 5.7 dentists per 10,000 people, while urban Wisconsin
counties have 7.7 dentists per 10,000 people. 19

Health care systems and institutions have clear direct links to the health and well-being of communities.
Whether an individual can afford and access care that meets their needs when and where they need it
has an immediate effect on health outcomes. Upstream factors such as policies that affect cost of care,insurance access, location of health care services, which types of services are offered, and more are also
critical to the health and well-being of individuals and communities in Wisconsin.
Social connectedness and belonging
Both before and during the COVID-19 pandemic, Wisconsinites expressed a desire for their communities
to be more socially connected. This includes individual and group, virtual and face-to-face social
interactions, community events, and celebrations for all ages. It also includes civic engagement, such as
voting, participating in local government processes, and being a community advocate. Community
partners said they want their communities to be more inclusive of and welcoming to people of all
personal characteristics and abilities.

16

The Effects of Violence on Health, Health Affairs

17

Behavioral Risk Factor Surveillance Survey 2020, Centers for Disease Control and Prevention

18

Selected characteristics of health insurance coverage in the United States, American Communities

Survey19

Dentists per 10,000 people for metro and nonmetro counties, 2020- Wisconsin, Rural Health

Information Hub

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•
•
•

Twenty-three percent of Wisconsinites report that they only sometimes or never get the socialand emotional support they need. 20
Fifteen percent of Wisconsinites aged 15 years or older and 29% aged 65 years or older live
alone. 21
Sixty-one percent of eligible Wisconsinites voted in the 2020 elections, including 75% of white
Wisconsinites, 44% of Black Wisconsinites, and 42% of Hispanic Wisconsinites, and 42% of
Asian Wisconsinites. 22

Social connection and belonging impact health in many ways. Socially connected communities create
more opportunities for mental and physical activity, keeping minds and bodies healthier and safer. In awell-connected and welcoming community, people are also more likely to notice when someone else isunwell and needs support to improve their health and well-being. This priority area also includes being
able to leverage the collective power of connected communities to create change, aligning it closely withthe representation and access to decision-making foundational shift. This may enable communities tomore successfully influence the creation of policies and building of systems and environments that canpositively impact their health.
Mental and emotional health and well-being
While mental and emotional health and well-being have long been high priorities in public health, during
the COVID-19 pandemic mental health, substance use, and other topics closely related to emotional wellbeing, became especially urgent to address. Wisconsinites described the need for mental health and wellbeing to be addressed in broad ways, including both prevention and treatment services, to be moreaccessible and affordable, and for this issue to be addressed across the life span. They also stressed theimportance of mental health care that is responsive to their cultural context and delivered by careproviders from their own communities.
•••

Forty percent of Wisconsinites experienced poor mental health at some point during the pastmonth. 23
Sixty-six of Wisconsin’s seventy-two counties contain a mental health professional shortage
area. 24
In 2021, there were 1,401 opioid-related deaths and 4,258 opioid-related hospital visits in
Wisconsin. 25

Mental health is increasingly being treated as equally important to physical health, which is an important
shift in thinking and practice. This includes mental health parity, an important policy change that requires
large group insurance plans to offer more equal mental health and physical health benefit coverage.
Mental health is meaningful independently, and as a factor that influences physical health. Poor mental

20

Behavioral Risk Factor Surveillance Survey, Centers for Disease Control and Prevention

21

Selected social characteristics in the United States, American Communities Survey

22

Voting and registration in the election of November 2020, United States Census Bureau

23

Behavioral Risk Factor Surveillance Survey, Centers for Disease Control and Surveillance

24

Health professional shortage areas: mental health, by county 2022- Wisconsin, Rural Health

Information Hub
25

Dose of Reality: Opioids Data Summary Dashboard, Wisconsin Department of Health Services
12health is associated with greater use of tobacco, alcohol, drugs, higher rates of suicide and accidents, 26
as well as decreased school performance and lost productive workdays, which are factors in economic
well-being. 27 Wisconsin must support the whole health of individuals, families, and communities throughthe creation of policies, systems, and environments that seek to improve mental health.

Implementing SHIP
The SHIP framework described in this report is not an endpoint. Now that the necessary foundational
shifts and priority areas have been identified, it is essential to outline how improvement will be made oneach. As this happens over the coming months, and new processes, partnerships, and actions begin, theSHIP will continue to grow and evolve. Importantly, the process will remain community-centered as
stakeholders collaborate to put the SHIP into action.
Principles of SHIP Implementation
There are several principles upon which the SHIP implementation plan will be built. These principles arenecessary to ensure sustainable improvement for all Wisconsinites.

Partnership

The SHIP is not a roadmap only for state government-based public health, but for
all of Wisconsin. It was developed through partnership and, in order to beeffective in improving the health and well-being of all Wisconsinites, must be
implemented in partnership. Community-based organizations, local and tribal
health departments, health care organizations, funders, state agencies, academic
partners, and others all have important roles to play to ensure meaningfulprogress is made to further the SHIP’s foundational shifts and make improvementin the priority areas.

Policy, systems,
and environmentchangeHealth and well-being outcomes are largely influenced by factors outside ofindividual genetics and choices, and outside the medical system. Health is a
product of the policies, systems, and environments in which a person orcommunity lives, and only by addressing those external, upstream factors cansustainable improvement be made.

Whole-systems
approach

Health and well-being cannot be wholly improved by any one sector alone.
Sustainably and comprehensively improving health and well-being will require
working across sectors (health care, housing, transportation) as well as acrossstakeholder types (state government, local government, private industry) toaddress the whole system in which individuals and communities live.

Shifting
narratives

Given the whole systems approach required to do this work, it will be necessary to
expand the popular understanding of what creates health. Many of the dominantnarratives or embedded cultural stories in our communities (the self-made man orpulling oneself up by one’s bootstraps) emphasize the importance of individual
factors or behaviors on well-being outcomes. Public health and its partners must
instead work to transform leading narratives around the importance of working
collectively and changing policies, systems, and environments to improve
individual and community health and well-being.

26

Physical morbidity and mortality in people with mental illness, British Journal of Medical Practitioners

27

Lost productivity among full-time workers with mental disorders, Journal of Mental Health Policy andEconomics

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SHIP Implementation Next Steps
Partnerships and engagement
Building on the successful collaboration in the SHIP framework development phase, continued
partnership and engagement will be needed to create an implementation plan. This implementation plan
will strongly reflect the needs and strengths of Wisconsin’s communities and be inclusive of all partner
types. This will include collaborations based on the priority areas, partner sectors, or programmatic areasof focus; trainings to build capacity; and more. One example of a current partnership space upon which
momentum will be built is the community of practice for local and tribal health departments, which meets
monthly to share issues and experiences and to learn together.
This invitation to join the SHIP implementation planning process is open to all current and potential
future partners. An all-in approach is necessary to sustainably improve health and well-being throughprogress across the foundational shifts and priority areas.
Objectives, strategies, and measures
For each foundational shift and priority area a set of objectives, strategies, and measures will be
developed. These will be generated through collaboration with community, governmental, and otherinstitutional partners.

Objectives

Specific goals or aims that would indicate improvement in each foundational shift
and priority area

Strategies

Policies, programs, or other actions intended to address the objectives

Measures

Qualitative and quantitative methods to track the progress of actions (process
measures) and community-level health and well-being changes (outcome
measures) related to the objectives and strategies

Using SHIP
This SHIP framework and forthcoming implementation plan are intended to be living documents thatstakeholders may use to take on health and well-being improvement work in their own communities inways that are responsive to their specific needs. Partners are encouraged to align their own priorities andefforts to those described in the SHIP. They may also use the SHIP as a supporting document when
advocating for policy change, applying for project funding, and more. The upstream factors described inthis SHIP are relevant across geographies, economic sectors, public health topical areas, and more.
Making and clarifying these connections will be an important component of implementing the SHIP.
Through annual updates and other iterative revisions, the SHIP will also regularly respond to the everchanging contexts in which Wisconsinites live. Continuous engagement and partnership will be importantto keeping the SHIP relevant and helpful to communities. You can access all SHIP related documents on
the Wisconsin State Health plan website.

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