1. Wisconsin Department of Health Services January 2014 P-00522U Healthiest Wisconsin 2020 Baseline and Health Disparities Report Socioeconomic Status

2. SOCIOECONOMIC STATUS Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Key points Data Demographic and socioeconomic data Access to health care Overall health and mental health Risk behaviors Chronic disease outcomes Reproductive and sexual health References Links to additional reports and resources Contacts Chapter Outline Chapter outline 2

3. SOCIOECONOMIC STATUS Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track the progress on objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf Report overview 3

4. SOCIOECONOMIC STATUS Report Format Full Report Format: PDF Intended use: reference document Chapters Format: Annotated PowerPoint slide set Intended uses: presentations to –Decision-makers –Service providers –Community leaders –The public Sample annotated slide Report overview 4

5. SOCIOECONOMIC STATUS Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes Report overview 5

6. SOCIOECONOMIC STATUS Report Outline: Detail Section 3: Health focus areas Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas Access to health services Report overview 6

7. SOCIOECONOMIC STATUS Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

8. SOCIOECONOMIC STATUS Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non- Hispanic. Report overview 8

9. SOCIOECONOMIC STATUS Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach Report overview 9

10. SOCIOECONOMIC STATUS Key Points The poverty rate in Wisconsin increased from 2006 to 2010. Education and income are correlated. The higher the level of education in a population, the higher the level of income, for both males and females. On average, Black, Hispanic, and American Indian adults in Wisconsin have lower levels of education and income compared to White and Asian adults. Differences within groups, particularly Asians, may be masked by aggregate data. Key points 10 Access to health care

11. SOCIOECONOMIC STATUS Key Points: Compared to adults with higher levels of education and income, adults with lower levels of education have: –Less access to health and dental care, higher utilization of the emergency room, lower rates of prenatal care, and lower rates of cancer screening. –Higher rates of risk behaviors including binge drinking, obesity, and tobacco use and exposure. –Higher rates of poor physical and mental health. –Higher rates of chronic diseases such as asthma, diabetes, heart disease, high cholesterol and blood pressure, stroke, and arthritis. Key points 11

12. SOCIOECONOMIC STATUS Demographic data 12

13. SOCIOECONOMIC STATUS Source: American Community Survey, 2006-2010. Poverty rate (percent living below the federal poverty level), Wisconsin, 2006-2010 Demographic and socioeconomic data 13

14. SOCIOECONOMIC STATUS Percent of the population living in poverty, by county, Wisconsin, 2006-2010 Source: American Community Survey, 2006-2010. 14 Demographic and socioeconomic data

15. SOCIOECONOMIC STATUS Median household income by race/ethnicity, Wisconsin, 2008-2010 Source: American Community Survey, 2008-2010. 15 Demographic and socioeconomic data

16. SOCIOECONOMIC STATUS Median earnings in the previous 12 months, adults ages 25 and older, by sex and educational attainment, Wisconsin, 2010 Source: American Community Survey, 2010. 16 Demographic and socioeconomic data

17. SOCIOECONOMIC STATUS Educational attainment of adults ages 25 and older, by race/ethnicity, Wisconsin, 2008-2010 Source: American Community Survey, 2008-2010. 17 Demographic and socioeconomic data

18. SOCIOECONOMIC STATUS Educational attainment of Wisconsin adults, ages 25 and older, by level of urbanization, 2007-2011 Source: American Community Survey, 2007-2011. 18 Demographic and socioeconomic data

19. SOCIOECONOMIC STATUS Income distribution among Wisconsin adults by level of urbanization, 2007-2011 Source: American Community Survey, 2007-2011. 19 Demographic and socioeconomic data

20. SOCIOECONOMIC STATUS Rate of living with a disability, Wisconsin adults ages 18-64, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline only dataset 20 Demographic and socioeconomic data

21. SOCIOECONOMIC STATUS Access to health care 21

22. SOCIOECONOMIC STATUS Lack of health insurance coverage among Wisconsin adults ages 18-64, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Access to health care 22

23. SOCIOECONOMIC STATUS Public health insurance coverage and inadequacy of health insurance among children ages 6-17, by highest education level of adult in household, Wisconsin, 2011-2012 Source: 2011-2012 National Survey of Children's Health. Access to health care 23

24. SOCIOECONOMIC STATUS Age-adjusted rate of use of and barriers to health care among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Access to health care 24

25. SOCIOECONOMIC STATUS Lack of routine preventive medical and dental care and unmet medical and dental needs among children, by poverty status, Wisconsin, 2011- 2012 Source: 2011-2012 National Survey of Children's Health. Note: Estimates were not available for all groups. FPL is the Federal Poverty Level, based on household size and income. Access to health care 25

26. SOCIOECONOMIC STATUS Lack of access to care within a medical home among children, by poverty status, Wisconsin, 2011-2012 Source: 2011-2012 National Survey of Children's Health. Note: FPL is the Federal Poverty Level, based on household size and income. Access to health care 26

27. SOCIOECONOMIC STATUS Emergency room utilization among Wisconsin residents, by poverty status, 2008-2010 Source: Wisconsin Department of Health Services, Family Health Survey, 2008-2010. Access to health care 27

28. SOCIOECONOMIC STATUS Percentage of births to mothers who received prenatal care during the first trimester, by maternal education level, Wisconsin, 2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. Healthy growth and development 28

29. SOCIOECONOMIC STATUS Health risk factors 29

30. SOCIOECONOMIC STATUS Vaccination coverage with selected vaccines among adolescents ages 13-17, by federal poverty level (FPL), Wisconsin and the United States, 2011 Access to health care Source: National Immunization Survey for Teens, 2011. Note: * To protect against tetanus, diphtheria, and pertussis. ** To protect against meningococcal disease. 30

31. SOCIOECONOMIC STATUS Rates of influenza and pneumonia vaccination among older adults (ages 65+) in Wisconsin, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Access to health care 31

32. SOCIOECONOMIC STATUS Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Alcohol and other drug use 32

33. SOCIOECONOMIC STATUS Age-adjusted rate of low vegetable consumption among Wisconsin adults, by education level, 2009 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Data from 2009 only. Nutrition 33

34. SOCIOECONOMIC STATUS Breastfeeding initiation by maternal income, Wisconsin, 2009-2011 Source: Wisconsin PRAMS, 2009-2011. Division of Public Health, Department of Health Services. 34 Nutrition

35. SOCIOECONOMIC STATUS Age-adjusted rate of physical inactivity among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset Physical activity 35

36. SOCIOECONOMIC STATUS Age-adjusted rates of tooth removal and dental visits in the past year among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Tooth removal question asked in 2008, 2010, and 2011. Dentist visit question asked in 2008 and 2010. Oral health 36

37. SOCIOECONOMIC STATUS Rates of HIV testing and age-adjusted risk behaviors among Wisconsin adults, by household income, 2008-2011 Reproductive and sexual health Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Testing rates are not age-adjusted; rates of exposure to high-risk situations are age-adjusted. 37

38. SOCIOECONOMIC STATUS Age-adjusted rates of smoking among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Tobacco use and exposure 38

39. SOCIOECONOMIC STATUS Rates of secondhand smoke exposure among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: The “smoking at work” question was only asked in 2009 and 2010. Tobacco use and exposure 39

40. SOCIOECONOMIC STATUS Age-adjusted rate of seat belt non-use and rate of fall-related injuries among Wisconsin adults, by household income, 2008, 2010, 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were asked in 2008, 2010, and 2011. Rates of seat belt use are age-adjusted; rates of fall-related injury are not age-adjusted but are limited to the population 45 and older. Injury and violence 40

41. SOCIOECONOMIC STATUS Health Outcomes 41

42. SOCIOECONOMIC STATUS Age-adjusted rates of physical health among Wisconsin adults by income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline only dataset Note: Physical health and limited activities questions were only asked in 2009-2011. 42 Physical health Nutrition

43. SOCIOECONOMIC STATUS Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by household income, 2008-2011 Chronic diseases Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. 43

44. SOCIOECONOMIC STATUS Age-adjusted rates of heart attack and stroke among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Chronic diseases 44

45. SOCIOECONOMIC STATUS Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by household income, 2009 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions only asked in 2009 and 2011. 45 Chronic diseases

46. SOCIOECONOMIC STATUS Cancer screening among Wisconsin adults, by education level, 2008 and 2010 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were only asked in 2008 and 2010. 46 Chronic diseases

47. SOCIOECONOMIC STATUS Age-adjusted rate of arthritis among adults, and percent of those with arthritis whose activity is limited due to joint pain, by household income, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Arthritis question was asked in 2009-2011. Question about limited activity due to joint pain was asked in 2009 and 2011. 47 Chronic diseases

48. SOCIOECONOMIC STATUS Age-adjusted rates of asthma among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Environmental health 48

49. SOCIOECONOMIC STATUS Percentage of lead poisoning (10 mcg/dL or greater) among tested children under age six, by Medicaid enrollment, Wisconsin, 2010 Source: Wisconsin Department of Health Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP). Environmental health 49

50. SOCIOECONOMIC STATUS Age-adjusted rate of frequent mental distress among Wisconsin adults, by household income, 2009-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Question asked in 2009-2011. Mental health 50

51. SOCIOECONOMIC STATUS Age-adjusted rate of four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by household income, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Question asked in 2010 and 2011. Mental health 51

52. SOCIOECONOMIC STATUS Percentage of children who have experienced two or more adverse childhood experiences (ACEs), by federal poverty level (FPL), 2011-2012 Source: 2011-2012 National Survey of Children’s Health. Mental health 52

53. SOCIOECONOMIC STATUS Age-adjusted rate of insufficient sleep and rate of poor emotional support among Wisconsin adults, by household income, 2008-2010 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Note: Questions were not asked in 2011. Rates of insufficient sleep are age-adjusted; rates of poor emotional support are not age- adjusted. Mental health 53

54. SOCIOECONOMIC STATUS Age-adjusted rates of overweight and obesity among Wisconsin adults, by household income, 2008-2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset. Nutrition 54

55. SOCIOECONOMIC STATUS Percentage of low birthweight (<5.5 pounds) births, by maternal education, Wisconsin, 2008-2010 Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident birth certificates. Healthy growth and development 55

56. SOCIOECONOMIC STATUS References 1.University of Wisconsin Population Health Institute. County Health Rankings 2013. http://www.countyhealthrankings.org/our-approach/ http://www.countyhealthrankings.org/our-approach/ 2.Center for Urban Population Health. Milwaukee Health Report 2011. http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 3.LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. Accessible at: http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2 0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%2 0Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 4.Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/ 5.Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf 6.United States Department of Health and Human Services (HHS). The 2011 HHS Poverty Guidelines. http://aspe.hhs.gov/poverty/11poverty.shtmlhttp://aspe.hhs.gov/poverty/11poverty.shtml 56 References

57. SOCIOECONOMIC STATUS 7.American Community Survey Glossary. http://factfinder2.census.gov/help/en/american_factfinder_help.htm#glossary/glossary.htm http://factfinder2.census.gov/help/en/american_factfinder_help.htm#glossary/glossary.htm 8.U.S. Census Bureau: http://blogs.census.gov/2010/09/23/income-vs-earnings/http://blogs.census.gov/2010/09/23/income-vs-earnings/ 9.Current Population Survey (CPS) Definitions. http://www.census.gov/cps/about/cpsdef.html http://www.census.gov/cps/about/cpsdef.html 10.Centers for Disease Control and Prevention (CDC). Health Care: See Why Being Insured Matters. http://www.cdc.gov/features/vitalsigns/HealthcareAccess/http://www.cdc.gov/features/vitalsigns/HealthcareAccess/ 11.CDC. Regular Check-Ups Are Important. http://www.cdc.gov/family/checkup/http://www.cdc.gov/family/checkup/ 12.Data Resource Center for Child and Adolescent Health. Indicator details. http://www.childhealthdata.org/browse/survey/results?q=2507&r=1 http://www.childhealthdata.org/browse/survey/results?q=2507&r=1 13.RAND Corporation. The Evolving Role of Emergency Departments in the United States. http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR280/RAND_ RR280.pdf http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR280/RAND_ RR280.pdf 14.CDC. During Pregnancy. http://www.cdc.gov/pregnancy/during.htmlhttp://www.cdc.gov/pregnancy/during.html 15.CDC. Preteen and Teen Vaccines. http://www.cdc.gov/vaccines/who/teens/for- parents.htmlhttp://www.cdc.gov/vaccines/who/teens/for- parents.html 57 References

58. SOCIOECONOMIC STATUS 16.Centers for Medicare and Medicaid Services. Immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/index.html?redirect=/immuni zations/ http://www.cms.gov/Medicare/Prevention/Immunizations/index.html?redirect=/immuni zations/ 17.CDC. Alcohol Use and Health. http://www.cdc.gov/alcohol/fact-sheets/alcohol- use.htmhttp://www.cdc.gov/alcohol/fact-sheets/alcohol- use.htm 18.CDC. State Indicator Report on Fruits and Vegetables, 2013. http://www.cdc.gov/nutrition/downloads/State-Indicator-Report-Fruits-Vegetables- 2013.pdf http://www.cdc.gov/nutrition/downloads/State-Indicator-Report-Fruits-Vegetables- 2013.pdf 19.U.S. Department of Agriculture. ChooseMyPlate.gov. http://www.choosemyplate.gov/food-groups/vegetables-amount.html http://www.choosemyplate.gov/food-groups/vegetables-amount.html 20.DHS, Wisconsin PRAMS. What Moms Tell Us: Breastfeeding (August 2012). http://www.dhs.wisconsin.gov/publications/p0/p00398.pdf http://www.dhs.wisconsin.gov/publications/p0/p00398.pdf 21.CDC: PRAMS and Breastfeeding. http://www.cdc.gov/prams/Breastfeeding.htmhttp://www.cdc.gov/prams/Breastfeeding.htm 22.Public Health Reports. Socioeconomic Status and Breastfeeding Initiation Among California Mothers. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497787/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497787/ 23.CDC. Physical Activity. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html 24.University of Wisconsin Population Health Institute. County Health Rankings, 2013. http://www.countyhealthrankings.org/our-approach http://www.countyhealthrankings.org/our-approach 58 References

59. SOCIOECONOMIC STATUS 25.CDC. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm 26.CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_fa cts/index.htm http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_fa cts/index.htm 27.CDC. Asthma. http://www.cdc.gov/asthma/faqs.htmhttp://www.cdc.gov/asthma/faqs.htm 28. CDC. Adolescent and School Health: Asthma and Schools. http://www.cdc.gov/healthyyouth/asthma/index.htm http://www.cdc.gov/healthyyouth/asthma/index.htm 29.American Lung Association. Asthma and Children. http://www.lung.org/lung- disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.htmlhttp://www.lung.org/lung- disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html 30.DHS. The Legacy of Lead: Report on Childhood Lead Poisoning in Wisconsin 2008. http://www.dhs.wisconsin.gov/lead/LegacyofLead/index.HTM http://www.dhs.wisconsin.gov/lead/LegacyofLead/index.HTM 31.CDC. Self-Reported Frequent Mental Distress Among Adults --- United States, 1993— 2001. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a1.htm 32.CDC. Adverse Childhood Experiences Study. http://www.cdc.gov/ace/http://www.cdc.gov/ace/ 33.O’Connor C, Finkbiner C, & Watson L (2012). Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Madison, Wisconsin: Wisconsin Children’s Trust Fund and Child Abuse Prevention Fund of Children’s Hospital & Health System. http://wichildrenstrustfund.org/index.php?section=adverse-childhood http://wichildrenstrustfund.org/index.php?section=adverse-childhood 59 References

60. SOCIOECONOMIC STATUS 34.CDC. The state of mental health in aging America. http://www.cdc.gov/aging/pdf/mental_health.pdf http://www.cdc.gov/aging/pdf/mental_health.pdf 35.CDC. Insufficient sleep is a public health epidemic. http://www.cdc.gov/features/dssleep/http://www.cdc.gov/features/dssleep/ 36.CDC. Health-related quality of life: Well-being concepts. http://www.cdc.gov/hrqol/wellbeing.htm#four http://www.cdc.gov/hrqol/wellbeing.htm#four 37.CDC. About BMI for Adults. http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Definition http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html#Definition 38.CDC. Is low birthweight a health problem? http://www.cdc.gov/pednss/how_to/interpret_data/case_studies/low_birthweight/what.htm http://www.cdc.gov/pednss/how_to/interpret_data/case_studies/low_birthweight/what.htm 60 References

61. SOCIOECONOMIC STATUS Centers for Disease Control and Prevention —Social Determinants of Health http://www.cdc.gov/socialdeterminants/http://www.cdc.gov/socialdeterminants/ Policy Link: http://www.policylink.org/http://www.policylink.org/ Robert Wood Johnson Foundation: o How Does Employment or Unemployment Affect Health? http://www.rwjf.org/en/research-publications/find-rwjf- research/2012/12/how-does-employment--or-unemployment--affect- health-.html http://www.rwjf.org/en/research-publications/find-rwjf- research/2012/12/how-does-employment--or-unemployment--affect- health-.html o How Social Factors Shape Health: Income, Wealth, and Health http://www.rwjf.org/en/research-publications/find-rwjf- research/2011/04/how-social-factors-shape-health1.html http://www.rwjf.org/en/research-publications/find-rwjf- research/2011/04/how-social-factors-shape-health1.html o Why Does Education Matter So Much to Health? http://www.rwjf.org/en/research-publications/find-rwjf- research/2012/12/why-does-education-matter-so-much-to-health-.html http://www.rwjf.org/en/research-publications/find-rwjf- research/2012/12/why-does-education-matter-so-much-to-health-.html Links to additional reports and resources 61 Links

62. SOCIOECONOMIC STATUS National Association of City and County Health Officials (NACCHO)— Health equity and social justice: http://www.naccho.org/topics/justice/http://www.naccho.org/topics/justice/ Unnatural Causes: http://www.unnaturalcauses.org/http://www.unnaturalcauses.org/ UW Madison Population Health Institute: http://uwphi.pophealth.wisc.edu/http://uwphi.pophealth.wisc.edu/ World Health Organization Commission on Social Determinants of Health: http://www.who.int/social_determinants/en/ http://www.who.int/social_determinants/en/ Wisconsin Center for Health Equity: http://www.wche.org/http://www.wche.org/ Healthiest Wisconsin 2020 Crosscutting Focus Area: Social, Economic, and Educational Factors that Influence Health: http://www.wche.org/uploads/8/8/9/8/8898682/hw2020_see_profile_final_1 1.1.2013.pdf http://www.wche.org/uploads/8/8/9/8/8898682/hw2020_see_profile_final_1 1.1.2013.pdf Centers for Disease Control and Prevention (CDC). Demographic status publications: http://www.cdc.gov/hrqol/pubs/demo_status/socioeconomic.htm http://www.cdc.gov/hrqol/pubs/demo_status/socioeconomic.htm Links to additional reports and resources 62 Links

63. SOCIOECONOMIC STATUS Contacts Evelyn Cruz, Minority Health Officer Wisconsin Division of Public Health, Office of Policy and Practice Alignment E-mail: Evelyn2.Cruz@dhs.wisconsin.govEvelyn2.Cruz@dhs.wisconsin.gov Karl Pearson, Demographer Wisconsin Division of Public Health, Office of Health Informatics E-mail: KarlT.Pearson@dhs.wisconsin.govKarlT.Pearson@dhs.wisconsin.gov 63 Contacts