1. Health of Wisconsin: Report Card 2016

2. Grading Health
Wisconsin’s grade for health is based on two ways of measuring health:
1) length of life and
2) quality of life
We measure length of life by examining death rates. We examined death rates for four distinct age groups:
Infants (less than 1 year old)
Children and young adults (ages 1-24)
Working-age adults (ages 25-64)
Older adults (ages 65 and over)
We measure quality of life by measuring self-reported unhealthy days for working-age and older adults. We report the mean (average) number of unhealthy days reported per month. The numbers are based on adult (age 25+) respondents’ answers to two questions about their health in the past month:
1) how many days was your physical health poor?
2) how many days was your mental health poor?
Data on quality of life is not available for the two younger age groups: infants and children and young adults.

3. Grading Health Disparities
In order to present a complete picture of health in Wisconsin, we developed a health disparity grade based on the health of different groups of people. To do this, we examined the health of subgroups of the population within each life stage based on four characteristics: Gender Geography Socioeconomic Status Race/Ethnicity To measure the disparity among subgroups, we compared the health grade of each Wisconsin subgroup to the grade of the healthiest subgroup of the same age in Wisconsin.
Geography was broken down by level of urbanization, Urban Metro (Milwaukee County), Large Suburban Metro, Smaller Metro and Rural, an adaptation of the CDC classifications.
Socioeconomic status was measured by level of education attained.

4. Grading Methods
In order to give Wisconsin and its residents grades for the health outcomes of death and unhealthy days, we created grading scales. We looked at health data within each life stage for each of the 50 states to compare each state’s rate to the average for the specific life stage (see figure on slide for an example for child and young adult death). Next, we assigned cutoff points for grades based on distance from the average (i.e., based on standard deviations from the mean).
We determined a grading scale using this approach for each combination of outcome (death and unhealthy days) and life stage. The exact cutoff points for grades for each outcome/life stage combination are provided on future slides. We used these outcome/life stage cutoff points to assign grades for each population subgroup.

5. Infant Health Summary
Wisconsin receives an overall health grade of C and a health disparity grade of D for infant health. Wisconsin ranks 26th nationally for its infant death rate.

6. Infant Health by Gender
 Death Rate
Percent of Population
Death Rate
(Per 1000)
Grades
Infants (< 1 year)
100%
5.9 C
Gender
Male
51%
6.1
Female
49%
5.6
Wisconsin’s overall infant death rate is 5.9 deaths per 1000 live births. However, reporting only the state value does not account for gender differences. The male infant death rate is slightly higher than the female infant death rate. Both genders receive a grade of C for infant death rate.
Grade Cut-off Values for Infants (per 1000):
A (<4.4)
B ( )
C ( )
D ( )
F (>7.8)

7. Infant Health by Mother’s Education
 Death Rate
Percent of Population
Death Rate
(Per 1000)
Grades
Infants (< 1 year)
100%
5.9 C
Education of mother
High school or less
37%
7.5 D
Some college/technical school
31%
5.8
College graduate
33%
3.7 A
Wisconsin’s overall infant death rate is 5.9 deaths per 1000 live births. This overall state value does not show differences among socioeconomic groups. Here, we use educational level of the mother as a substitution for socioeconomic status.
Infants who are born to more educated mothers experience a lower death rate. Infants whose mothers are college graduates fare the best (3.7 deaths/1000 births), followed by infants whose mothers have some college or technical school (5.8 deaths/1000 births). Infants who are born to mothers with a high school degree or less have the highest death rate (2X greater than infants born to college graduates), and this group receives a D. There is a large gap in infant death rates based on mother’s education, showing Wisconsin is not adequately promoting health among all infant subgroups.
Grade Cut-off Values for Infants (per 1000):
A (<4.4)
B ( )
C ( )
D ( )
F (>7.8)

8. Infant Health by County
 Death Rate
Percent of Population
Death Rate
(Per 1000)
Grades
Infants (< 1 year)
100%
5.9 C
Type of county
Large Urban Metro
(Milwaukee County)
23%
8.6 F
Large Suburban Metro
15%
4.6 B
Smaller Metro
37%
5.3
Rural
26%
5.2
Wisconsin’s overall infant death rate is 5.9 deaths per 1000 live births. Reporting the state value alone does not show geographic differences. Infants who are born in Milwaukee County experience higher death rates compared with infants born in rural, non-urban, and suburban counties. Wisconsin receives a failing grade for promoting health among infants in Milwaukee County.
Grade Cut-off Values for Infants (per 1000):
A (<4.4)
B ( )
C ( )
D ( )
F (>7.8)

9. Infant Health by Race C Infants (< 1 year) F B Grades 100% 5.9
 Death Rate
Percent of Population
Death Rate
(Per 1000)
Grades
Infants (< 1 year)
100%
5.9 C
Race/ethnicity
African American
10%
13.8 F
Asian 2%
6.5
Hispanic/Latino
4.8 B
American Indian 1%
8.1
White non-Hispanic
76%
Wisconsin’s overall infant death rate is 5.9 deaths per 1000 live births. Reporting the state value alone does not show differences among different racial and ethnic groups. White and Hispanic/Latino infants experience the best health outcomes as measured by lowest death rates. Wisconsin receives a grade of B in those subgroups. However, there is room for significant improvement as Wisconsin continues to fail in its efforts to promote health for infants who are African American or American Indian.
Grade Cut-off Values for Infants (per 1000):
A (<4.4)
B ( )
C ( )
D ( )
F (>7.8)

10. Wisconsin receives a barely passing grade of D for its efforts to promote the health of infants whose mothers have no education beyond high school. Wisconsin continues to fail in its efforts to promote health for African American and American Indian infants, along with those who live in Milwaukee County.

11. Child & Young Adult Health
Overall, Wisconsin receives a health grade of B and a health disparity grade of D for child and young adult health. Wisconsin ranks 15th nationally for child and young adult death rates.

12. Child & Young Adult Health by Gender
 Death Rate
Percent of Population
Death Rate (Per 100,000)
Grades
Children and Young Adults (1-24)
100%
33.9 B
Gender
Male
51%
45.6 D
Female
49%
21.7 A
Wisconsin’s overall death rate is 33.9 deaths per 100,000 children and young adults (ages 1-24). However, this overall state value does not account for gender differences. Male children and young adults have a death rate that is more than twice that of females. Wisconsin receives a D for promoting health among its male children and young adults. Wisconsin receives an A for promoting health among its female children and young adults, with a death rate of 21.7 deaths per 100,000 children and young adults.
Grade Cut-off Values for Children/Young Adults (per 100,000)
A (<27.1)
B ( )
C ( )
D ( )
F(>50.1)

13. Child & Young Adult Health by County
 Death Rate
Percent of Population
Death Rate (Per 100,000)
Grades
Children and Young Adults (1-24)
100%
33.9 B
Type of county
Large Urban Metro
(Milwaukee County)
18%
40.4 C
Large Suburban Metro
15%
36.4
Smaller Metro
42%
27.9
Rural
25%
38.1
Wisconsin’s overall death rate is 33.9 deaths per 100,000 children and young adults (ages 1-24). The overall state value does not show differences by type of county. Children and young adults living in Milwaukee County have the highest death rate compared to those living in large suburban metro, smaller metro, and rural communities. Wisconsin receives a C for promoting child and young adult health among all county subgroups except for smaller metro, which receives a B.
Grade Cut-off Values for Children/Young Adults (per 100,000)
A (<27.1)
B ( )
C ( )
D ( )
F(>50.1)

14. Child & Young Adult Health by Race
 Death Rate
Percent of Population
Death Rate (Per 100,000)
Grades
Children and Young Adults (1-24)
100%
33.9 B
Race/ethnicity
African American 1%
52.7 F
Asian 4%
16.2 A
Hispanic/Latino
10%
32.9
American Indian
64.8
White non-Hispanic
75%
32.0
Wisconsin’s overall death rate is 33.9 deaths per 100,000 children and young adults (ages 1-24), but this overall state death rate does not show differences by race/ethnicity. American Indian children and young adults have the highest deaths rates of any racial or ethnic group with available data. Wisconsin fails in promoting health among this American Indian and African American subgroups. Wisconsin receives an A for promoting health among Asian children and young adults, who have the lowest death rates compared to the other subgroups. The death rates for African American and American Indian children & young adults are over three times higher than the death rate for the best subgroup (Asian).
Grade Cut-off Values for Children/Young Adults (per 100,000)
A (<27.1)
B ( )
C ( )
D ( )
F(>50.1)

15. Wisconsin is failing in its efforts to promote health for children and young adults who are American Indian and African American. Wisconsin has significant room for improvement in child and young adult health among males, and those living in Milwaukee, rural, and large suburban metro counties.

16. Working-Age Adult Health
Overall, Wisconsin receives a grade of B for the health of working-age adults, but receives a grade of C for health disparities. Wisconsin ranks 13th nationally for its death rate and 22nd for unhealthy days.

17. Working-Age Adult Health by Gender
Death Rate
Percent of Population
Death Rate (Per )
Grades
Working-age Adults (25-64)
100%
289 B
Gender
Male
50%
358 C
Female
219 A
Unhealthy Days
Unhealthy Days per Month
6.4
5.8
6.9
Wisconsin’s overall death rate is 289 deaths per 100,000 working-age adults (ages 25-64). This overall state value does not show differences in death rate and unhealthy days among genders. Working-age adult men have a death rate that is more than 50% higher than the death rate for working-age women. Wisconsin receives a C for promoting health among working-age males.
Wisconsin’s working-age adults report an average of 6.4 unhealthy days per month, which has increased since Working-age adult women experience 1.1 more unhealthy days per month compared to men, resulting in the grade disparity between genders.
Grade Cut-off Values for Working-Age Adult Death Rate (per 100,000)
A (<238)
B ( )
C ( )
D ( )
F (>450)
Grade Cut-off Values for Working-Age Adult Unhealthy Days (per month)
A (<5.9)
B ( )
C ( )
D ( )
F (>9.3)

18. Working-Age Adult Health by Education
Death Rate
Percent of Population
Death Rate (Per )
Grades
Working-age Adults (25-64)
100%
289 B
Education
High school or less
37%
470 F
Some college/technical school
34%
276
College graduate
30%
206 A
Unhealthy Days
Unhealthy Days per Month
6.4
7.9 C
6.6
4.0
Wisconsin’s overall death rate is 289 deaths per 100,000 working-age adults. However, this overall state death rate does not show socioeconomic differences. Working-age adults that have the least amount of education, specifically some high school or less, experience substantially higher death rates (over 2X more than those with a college degree). Wisconsin receives a grade of F for not adequately promoting health among working age adults with a high school or less education.
Wisconsin’s working-age adults report an average of 6.4 unhealthy days per month. Working-age adults that have the least amount of education, specifically some high school or less, have the highest number of unhealthy days per month (almost 2X more than college graduates).
Grade Cut-off Values for Working-Age Adult Death Rate (per 100,000)
A (<238)
B ( )
C ( )
D ( )
F (>450)
Grade Cut-off Values for Working-Age Adult Unhealthy Days (per month)
A (<5.9)
B ( )
C ( )
D ( )
F (>9.3)

19. Working-Age Adult by County
Death Rate
Percent of Population
Death Rate (Per )
Grades
Working-age Adults (25-64)
100%
289 B
Type of county
Large Urban Metro (Milwaukee County)
17%
398 D
Large Suburban Metro
16%
233 A
Smaller Metro
42%
267
Rural
26%
296
Unhealthy Days
Unhealthy Days per Month
6.4
8.3
5.8
6.1
6.0
Wisconsin’s death rate is 289 deaths per 100,000 working-age adults. Wisconsin working-age adults report an average of 6.4 unhealthy days per month. Working-age adults living in Milwaukee County have the highest death rates and number of reported unhealthy days per month (8.3). Wisconsin receives a D for not adequately promoting health among this subgroup. Milwaukee’s death rate is almost double that of large suburban metro counties. Smaller metro and rural counties, who make up 68% of the Wisconsin population, receive a grade B and have slightly worse numbers than large suburban metro counties in death rates and unhealthy days per month.
Grade Cut-off Values for Working-Age Adult Death Rate (per 100,000)
A (<238)
B ( )
C ( )
D ( )
F (>450)
Grade Cut-off Values for Working-Age Adult Unhealthy Days (per month)
A (<5.9)
B ( )
C ( )
D ( )
F (>9.3)

20. Working-Age Adult Health by Race
Death Rate
Percent of Population
Death Rate (per )
Grades
Working-age Adults (25-64)
100%
289 B
Race/ethnicity
African American 6%
591 F
Asian 2%
179 A
Hispanic/Latino 5%
193
American Indian 1%
604
White non-Hispanic
85%
275
Unhealthy Days
Unhealthy Days per Month
6.4
10.0
4.1
8.6 D
5.9
Wisconsin’s death rate is 289 deaths per 100,000 working-age adults. Working-age adults who are American Indian or African American have the highest death rate per 100,000. Death rates for these groups are almost 3X higher than Asian and Hispanic/Latino working age adults and over 50% higher than working age whites. Wisconsin receives a F for failing to promote health among the American Indian and African American subgroups.
Wisconsin’s working-age adults report an average of 6.4 unhealthy days per month. Working-age adults who are African American, Hispanic/Latino, and American Indian have the highest reported unhealthy days per month. Wisconsin receives a F for failing to promote health among African Americans; Hispanic/Latino and American Indian subgroups are not far behind, both receiving a grade D.
Grade Cut-off Values for Working-Age Adult Death Rate (per 100,000)
A (<238)
B ( )
C ( )
D ( )
F (>450)
Grade Cut-off Values for Working-Age Adult Unhealthy Days (per month)
A (<5.9)
B ( )
C ( )
D ( )
F (>9.3)

21. Working Age Adult Health (25-64)
Wisconsin is failing in its efforts to promote health for working age adults who are American Indian and African American, as well as those with a high school or less education. Wisconsin has room for improvement in working age adult health among males and those living in Milwaukee county

22. Older Adult Health (65+) Health Grade B-
Overall, Wisconsin receives a grade of B- for the health of older adults. Wisconsin ranks 24th nationally for older adult death rates and 17th for unhealthy days. Wisconsin receives a grade of D for health disparities among older adults.

23. Older Adult Health by Gender
Death Rate
Percent of Population
(Per )
Grades
Older Adults (65+)
100%
4301 C
Gender
Male
44%
4969 F
Female
56%
3817 B
Unhealthy Days
Unhealthy Days Per Month
6.1
5.4 A
6.7
Wisconsin’s death rate is 4,301 deaths per 100,000 older adults (ages 65+). This state value does not show gender differences. Older men have a substantially higher death rate per 100,000 people compared to women. Wisconsin receives a F for failing to promote health among older men.
Wisconsin’s older adults report an average of 6.1 unhealthy days days/month. Older women report a higher number of unhealthy days per month compared to men.
Grade Cut-off Values for Older Adult Death Rate (per 100,000)
A (<3738)
B ( )
C ( )
D ( )
F (>4952)
Grade Cut-off Values for Working-Age Adult Unhealthy Days (per month)
A (<5.9)
B ( )
C ( )
D ( )
F (>8.8)

24. Older Adult Health by Education
Death Rate
Percent of Population
(Per )
Grades
Older Adults (65+)
100%
4301 C
Education
High school or less
57%
4502
Some college/technical school
22%
4087 B
College graduate
21%
4823 D
Unhealthy Days
Unhealthy Days Per Month
6.1
6.9
6.0
4.3 A
Wisconsin’s death rate is 4,301 deaths per 100,000 older adults (ages 65+). Older adults with a high school or less education and those who are college graduates have the highest death rates. There is much room for improvement in health promotion efforts for older adults.
Wisconsin’s older adults report an average of 6.1 unhealthy days days/month. Older adults with the least amount of education, specifically with some high school or less have the highest number of unhealthy days per month. Wisconsin receives a C for not adequately promoting health among this subgroup. Higher levels of education correspond to having more self-reported healthy days per month.
Grade Cut-off Values for Older Adult Death Rate (per 100,000)
A (<3738)
B ( )
C ( )
D ( )
F (>4952)
Grade Cut-off Values for Working-Age Adult Unhealthy Days (per month)
A (<5.9)
B ( )
C ( )
D ( )
F (>8.8)

25. Older Adult Health by County
Death Rate
Percent of Population
(Per )
Grades
Older Adults (65+)
100%
4301 C
Type of county
Large Urban Metro
(Milwaukee County)
13%
4561 D
Large Suburban Metro
16%
4144
Smaller Metro
39%
4250
Rural
32%
4342
Unhealthy Days
Unhealthy Days Per Month
6.1 B
6.8
6.2
5.7 A
Wisconsin’s death rate is 4,301 deaths per 100,000 older adults (ages 65+). This overall state value does not account for geographic differences. Older adults living in large urban metro Milwaukee County have the highest number of death rates and receives a D for not adequately promoting health among this subgroup. Other types of Wisconsin counties (large suburban metro, smaller metro, and rural) do not perform much better, all receiving a C for death rates.
Wisconsin’s older adults report an average of 6.1 unhealthy days days/month. Those older adults living in large urban metro Milwaukee County report the highest number of unhealthy days per month. All older adults receive a grade of B for the number of unhealthy days reported per month, except for those living in rural counties who receive an A for reported unhealthy days.
Grade Cut-off Values for Older Adult Death Rate (per 100,000)
A (<3738)
B ( )
C ( )
D ( )
F (>4952)
Grade Cut-off Values for Working-Age Adult Unhealthy Days (per month)
A (<5.9)
B ( )
C ( )
D ( )
F (>8.8)

26. Older Adult Health by Race
Death Rate
Percent of Population
(Per )
Grades
Older Adults (65+)
100%
4301 C
Race/ethnicity
African American 3%
5040 F
Asian 1%
3108 A
Hispanic/Latino
2646
American Indian
6140
White non-Hispanic
94%
4296
Unhealthy Days
Unhealthy Days Per Month
6.1 B
8.0 D
8.6
7.5
7.6
6.0
Wisconsin’s death rate is 4,301 deaths per 100,000 older adults (ages 65+). The overall state value does not show racial/ethnic differences, so we have broken down death rates and number of unhealthy days by race/ethnicity. Older adults who are African American and American Indians have the highest death rates. Wisconsin receives a F for failing to promote health among these two subgroups.
Wisconsin’s older adults report an average of 6.1 unhealthy days days/month. Older adults who are African American and Asian have the highest number of self-reported unhealthy days. Wisconsin receives a D for failing to promote health among these subgroups.
Grade Cut-off Values for Older Adult Death Rate (per 100,000)
A (<3738)
B ( )
C ( )
D ( )
F (>4952)
Grade Cut-off Values for Working-Age Adult Unhealthy Days (per month)
A (<5.9)
B ( )
C ( )
D ( )
F (>8.8)

27. Older Adult Health (Ages 65+)
Wisconsin is failing in its efforts to reduce death for older men, older American Indians, and older African Americans. Wisconsin receives a barely passing grade of D for its efforts to reduce death for older adults who are college graduates or living in Milwaukee County. Additionally, Wisconsin receives a barely passing grade of D for its efforts to promote health-related quality of life for older adults who are African American or Asian.

28. Health Grade Changes Since 2013
Wisconsin’s grade for overall health has remained a B-.
Death rates have improved in all groups except working age adults, but our progress has not outpaced that of other states.
The health disparities grade has remained a D.
Substantial gaps remain between the healthiest and least healthy subgroups in the state’s population. This indicates Wisconsin needs to do more to reduce health disparities.

29. Summary Grades

30. Funding for this project was provided by Wisconsin Partnership Program, University of Wisconsin School of Medicine and Public Health

31. Contact Information University of Wisconsin Population Health Institute Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health 575 WARF Building 610 Walnut Street Madison, WI