2. Source: www.CountyHealthRankings.orgwww.CountyHealthRankings.org

3. Social Ecological Model Urie Bronfenbrenner, 1979

4. Physical Environment- Housing & Transit Source: Milwaukeens.org; Photo by Brendan O’Brien Milwaukee Co Transit System Bus route map Childhood lead level elevation 624 children, 3.2% prevalence Vehicle ownership 20%-73% varies by neighborhood Data sources: City of Milwaukee lead poisoning prevention program; University of Michigan Transportation Research Institute

5. Physical Environment- Air Asthma Implications 21,757 ED visits for asthma 2012-14 #1 in state for asthma hospitalizations, and #2 for asthma ED visit rate Pediatric asthma costs $10 M annually Data Sources: 2012-2014 Wisconsin Emergency Department Visit Files, Office of Health Informatics. WI asthma statistics, https://www.dhs.wisconsin.gov/asthma/facts.htm; www.pediatricasthma.org https://www.dhs.wisconsin.gov/asthma/facts.htm www.pediatricasthma.org Data Source: American Lung Association, http://www.stateoftheair.org/http://www.stateoftheair.org/

6. Data source: COMPASS http://gis.milwaukee.gov/website/compass/viewer.htmhttp://gis.milwaukee.gov/website/compass/viewer.htm Social Factors: Exposure to Stress

7. Opportunities Use of health impact assessments Health in all policies approach Cross-sector collaboration Source: www.charmeck.orgwww.charmeck.org

8. Changes in health Changes in risk factors and protective factors Environmental shift (i.e. policy) Changes in change agents Develop needed community capacity Community awareness of issue TARGETED ACTIONS Racial & Ethnic Approaches to Community Health (REACH) Meister JS, et al. Prev Chronic Dis 2005. Adapted from CDC Photo Source: www.urbanmilwaukee.comwww.urbanmilwaukee.com

9. Amani Community Partnership

10. Contact Veronica Gunn, MD, MPH Vice President, Population Health Management & Payment Innovation vgunn@chw.org