Chapter Outline Chapter outline Background

Healthiest Wisconsin 2020 Baseline and Health Disparities Report Demographic Overview

Chapter Outline Chapter outline Background
Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Key points Data Births, deaths, net migration and age/sex distribution Geography Socioeconomic status Racial/ethnic minority populations Foreign-born populations People with disabilities Lesbian, gay, bisexual, transgender populations References Links to additional reports and resources Contacts Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Report Overview Report overview
This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: 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: Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Report Format Full Report Chapters Format: PDF
Report overview Report Format Sample annotated slide 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 The report is available in two formats. The first, intended to serve as a reference document, is a PDF of annotated slides, as shown in this slide. The second is a series of slide sets, each of which is a chapter in the report. The purpose for providing slide sets is to foster sharing of the data in presentations to decision-makers, service providers, community leaders, and the public. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Report Outline Executive Summary Section 1: Introduction
Report overview 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 Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Report Outline: Detail
Report overview 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 care Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Report Outline: Detail
Report overview Report Outline: Detail Section 5: Data summaries by population Racial/ethnic minority populations American Indians Asians Blacks Hispanics People of lower socioeconomic status People with disabilities Lesbian, gay, bisexual, and transgender populations Geography Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Data notes Report overview
Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: 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. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Factors that influence health
Report overview Factors that influence health Social determinants of health drive at least 50% of morbidity and mortality rates.1 Social determinants of health include socioeconomic status (SES), usually measured by income, employment, education, or housing. Groups with lower SES typically have significantly shorter life expectancy, higher rates of infant mortality, higher rates of chronic disease, and significantly lower self-rated health status.2 Health inequities are costly. The Joint Center for Political and Economic Studies estimates that the combined costs of health inequalities and premature death in the United States during were $1.24 trillion.3 Further, addressing social determinants of health is an essential component of several key principles of the Public Health Code of Ethics which frame the ethical practice of public health.4 Healthiest Wisconsin 2020, the State Health Plan, lists two crosscutting focus areas: 1) Health Disparities, and 2) Social, Economic and Educational Factors that Influence Health.5 These broad focus areas have the potential to affect both the health focus area and public health infrastructure components of the plan and help set priorities in order to achieve large, equitable changes in health outcomes while saving health care dollars in Wisconsin. Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Key Points: Demographics
Overview Wisconsin’s population was 5.7 million in 2010. The birth rate declined by 7% between 2000 and 2010. The death rate declined by 15% in males and by 11% in females during the same period. The median age by county ranged from age 31 to age 51. (The median age is the age at which half the population is older and half is younger.) Geography In 2010, Milwaukee County accounted for 17% of the state’s population, 37 smaller metropolitan counties for 56% of the population, and 34 non-metropolitan (rural) counties for 27% of the population. Residents of smaller metropolitan counties had higher levels of education and income compared to residents of Milwaukee and non-metro counties. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Racial/ethnic minority populations In 2010, Wisconsin’s population was 85% White, 6% Black, 6% Hispanic, 2% Asian, and 1% American Indian. The median age (the age at which half are older and half are younger) varied by race/ethnicity; Whites: age 42; American Indians: age 30; Blacks: age 27; Asians: age 26; Hispanics: age 23. Wisconsin’s population increased by 6% from 2000 to 2010, with the largest increases in Hispanics (73%) and Asians (42%). In 2010, 13% of Wisconsin residents lived in poverty, with the highest poverty rate among Blacks (over 35%), and American Indians, Laotian/Hmong, and Hispanics (over 25% in each group). The poverty rate among Whites was 10%. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Foreign-born populations Foreign-born residents made up 5% of Wisconsin’s total population in 2010; 58% of Asians and 32% of Hispanics were foreign-born. Nearly 75,000 refugees came to Wisconsin between 1975 and More than 85% were Lao/Hmong or other Southeast Asian. People with disabilities In , 1 in 11 adults ages and 1 in 3 adults ages 65 and older was living with a disability. In , more than 1 in 4 children, ages 6-17, had special health care needs. Lesbian, gay, bisexual populations Nine percent (9%) of high school students and 2%-3% of adults identified themselves as lesbian, gay, or bisexual in Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Births, deaths, net migration, and age/sex distribution
Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Birth rate per 1,000 population, Wisconsin, 2000-2010
Births, deaths, migration, age/sex Birth rate per 1,000 population, Wisconsin, Births per 1,000 population Wisconsin’s birth rate declined by 7%, from 12.9 to 12.0 per 1,000 population, between 2000 and The U.S. birth rate declined by 9.7%, from 14.4 to 13.0 per 1,000, during the same period.6 Source: Wisconsin Interactive Statistics on Health (WISH). Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Age-adjusted death rate per 100,000 by sex, Wisconsin, 2000-2010
Births, deaths, migration, age/sex Age-adjusted death rate per 100,000 by sex, Wisconsin, Male Deaths per 100,000 population Between 2000 and 2010, the age-adjusted death rate declined by 14.6% in males (to 856 per 100,000 population) and by 11.3% in females (to 607 per 100,000 population). Source: Wisconsin Interactive Statistics on Health (WISH). Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Population by age and sex, Wisconsin, 2010
Births, deaths, migration, age/sex Population by age and sex, Wisconsin, 2010 Female Male In 2010, there were 2.82 million males and 2.86 million females in Wisconsin, a difference of about 40,000 people. However, there were 100,000 more women than men ages 65 and older, a result of the higher death rate in males throughout the life span. 2,822, Total population ,864,586 Source: Office of Health Informatics, Division of Public Health. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Births, Deaths, and Net Migration, Wisconsin, 2000-2010
Births, deaths, migration, age/sex Births, Deaths, and Net Migration, Wisconsin, Numbers of births and deaths have remained relatively constant over the past decade. Net migration reflects people entering and leaving the state. Net migration is calculated by adding the total population and births and subtracting deaths. Between 2000 and 2007, more people moved into the state to live than moved out of the state. In , net migration was negative; more people moved out of Wisconsin than into the state. 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Source: Office of Health Informatics, Division of Public Health. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Median age by county, Wisconsin, 2010
Births, deaths, migration, age/sex Median age by county, Wisconsin, 2010 The median age, the age at which half the population is older and half is younger, varies considerably by county in Wisconsin, ranging from age 31 in Menominee County, to age 51 in Vilas and Iron counties. Wisconsin’s median age is 38.5, compared to 37.2 nationally. Source: U.S. Census, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Geography Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Population by county, Wisconsin, 2010
Geography Population by county, Wisconsin, 2010 Wisconsin’s population in 2010 numbered 5,686,986. Milwaukee County had a population of nearly one million; Dane County had nearly one-half million residents; 18 counties each had between 75,000 and 250,000 residents; and the remaining counties had populations of fewer than 75,000 residents each. Source: U.S. Census 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Counties by level of urbanization, Wisconsin, 2010
Geography Counties by level of urbanization, Wisconsin, 2010 Some data in the report are shown by level of urbanization. The 2006 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties classifies all U.S. counties and county-equivalents into six levels—four for metropolitan counties and two for nonmetropolitan counties.7 For ease of interpretation in this report, these six classifications were consolidated into three categories: “large metropolitan, central,” “smaller metropolitan,” and “non-metropolitan.” In Wisconsin, Milwaukee County is the only county that is classified as “Large metropolitan, central” and therefore is labeled simply “Milwaukee County” in the figures. There were 24 smaller metropolitan counties, and 47 non-metropolitan counties. Smaller metropolitan counties: Brown, Calumet, Chippewa, Columbia, Dane, Douglas, Eau Claire, Fond du Lac, Iowa, Kenosha, Kewaunee, La Crosse, Marathon, Oconto, Outagamie, Ozaukee, Pierce, Racine, Rock, Saint Croix, Sheboygan, Washington, Waukesha, and Winnebago. Non-metropolitan counties: Adams, Ashland, Barron, Bayfield, Buffalo, Burnett, Clark, Crawford, Dodge, Door, Dunn, Florence, Forest, Grant, Green, Green Lake, Iron, Jackson, Jefferson, Juneau, Lafayette, Langlade, Lincoln, Manitowoc, Marinette, Marquette, Menominee, Monroe, Oneida, Pepin, Polk, Portage, Price, Richland, Rusk, Sauk, Sawyer, Shawano, Taylor, Trempealeau, Vernon, Vilas, Walworth, Washburn, Waupaca, Waushara, and Wood. Source: American Community Survey, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Socioeconomic status Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Socioeconomic status Poverty rate (percent living below the federal poverty level), Wisconsin, The federal poverty guidelines, a simplification of the poverty threshold, are issued by the U.S. Department of Health and Human Services and used for administrative purposes such as determining financial eligibility for certain federal programs. In 2010, poverty was determined by an individual income of $10,830 per year, incrementally increasing with increasing size of household (for instance, $22,050 per year for a household of four).8,9 The percentage of Wisconsin residents living in poverty increased from 11% in 2006 to 13% in 2010; this change is statistically significant. Source: American Community Survey, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Socioeconomic status Educational attainment of Wisconsin adults, ages 25 and older, by level of urbanization, In this chart, educational attainment is divided into three levels: less than a high school education; high school graduate to some college; and college graduate or more. Counties were divided into three levels of urbanization: large metropolitan, which in Wisconsin consists only of Milwaukee County; smaller metropolitan, which consists of 24 fringe metropolitan areas or counties with smaller cities; and 47 non-metropolitan counties, which are found in predominantly rural regions. Milwaukee County and non-metropolitan counties have significantly higher percentages of adults who have completed less than a high school education, compared to smaller metropolitan counties. Non-metropolitan counties also have a significantly lower percentage of respondents who have graduated from college, compared to smaller metropolitan areas and Milwaukee County. Source: American Community Survey, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Socioeconomic status Income distribution among Wisconsin adults by level of urbanization, In this chart, income is divided into three levels: low household income of less than $25,000 per year, middle household income between $25,000 and $74,999 per year and high household income of more than $75,000 per year. The majority of adults in each urbanization group fall into the middle income category. Milwaukee County has a significantly higher percentage of adult residents who fall into the low-income category compared to smaller metropolitan and non-metropolitan counties. A significantly higher percentage of smaller metropolitan county residents have high incomes compared to residents of Milwaukee County and non-metropolitan areas. The 2010 American Community Survey reported the U.S. median household income was $50,046 and Wisconsin’s median income was $49,001. Source: American Community Survey, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Socioeconomic status Median earnings in the previous 12 months, adults ages 25 and older, by sex and educational attainment, Wisconsin, 2010 In 2010, for both men and women, earnings increased with the level of educational attainment. Source: American Community Survey, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Poverty rate by county, Wisconsin, 2006-2010
Socioeconomic status Poverty rate by county, Wisconsin, The federal poverty guidelines, a simplification of the poverty threshold, are issued by the U.S. Department of Health and Human Services and used for administrative purposes such as determining financial eligibility for certain federal programs. In 2010, poverty was determined by a 2009 income of $10,830 for an individual, incrementally increasing with increasing size of household (for instance, $22,050 for a household of four).7 During , 11.6% of Wisconsin residents were living in poverty. The counties with the highest poverty rates were Menominee County (31.6%), and Sawyer, Milwaukee, Forest, Ashland, and Burnett counties (18.5%-20.1%). The five counties with the lowest poverty rates were Waukesha, Ozaukee, Washington, Calumet, and St. Croix (4.4.%-6.4%). Source: American Community Survey, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Racial/ethnic minority populations

Population distribution by race/ethnicity, Wisconsin, 2010
Racial/ethnic minority populations Population distribution by race/ethnicity, Wisconsin, 2010 In this report, racial/ethnic populations are mutually exclusive. Those of Hispanic ethnicity may be of any race but are identified as Hispanic. Non-Hispanics may be White, Black, American Indian, Asian or Other. The majority of Wisconsin’s population (84.8% in 2010) is White. Other racial/ethnic groups include Blacks/African Americans (6.2%), Hispanics/Latinos (5.9%), Asians (2.3%), and American Indians (0.9%). As a proportion of the total Wisconsin population, racial/ethnic minority groups increased from 12% in 2000 to 15% in 2010. Source: U.S. Census, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Percent change in population, by race/ethnicity, Wisconsin, 2000-2010
Racial/ethnic minority populations Percent change in population, by race/ethnicity, Wisconsin, Wisconsin’s population increased by 6% between 2000 and 2010, with the largest increases in the Hispanic/Latino population (73%, from 195,000 to 335,000 residents) and the Asian population (42%, from 97,000 to 137,000 residents). Source: U.S. Census, 2000 and 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Median age by race/ethnicity, Wisconsin, 2010
Racial/ethnic minority populations Median age by race/ethnicity, Wisconsin, 2010 In 2010, the median age—the age at which half of residents are older and half are younger—was 38.5 in Wisconsin and 37.2 nationally (data not shown). In Wisconsin, the median age for Blacks, Hispanics, and Asians was in the 20s. Source: American Community Survey, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Age dependency ratio by race/ethnicity, Wisconsin, 2010
Racial/ethnic minority populations Age dependency ratio by race/ethnicity, Wisconsin, 2010 The age dependency ratio expresses the relation of those typically not in the labor force (the dependent population, ages 0-14 and 65 and older) to those typically in the labor force (ages 15-64).8 The age dependency ratio is used to measure the pressure on the “productive” population (i.e., labor force); the larger the age dependency ratio, the greater the burden is on the productive population. It is important to note that these definitions do not take into account labor force participation rates by age group. Some portion of the "dependent" population, which is defined solely by age, may be employed and not necessarily economically dependent. Hispanics have the highest combined dependency ratio—66. Other racial/ethnic groups have a combined ratio between 50 and 59. While Hispanics have the highest youth dependency ratio, Whites have the highest old-age dependency ratio. Source: Wisconsin Interactive Statistics on Health (WISH). Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Poverty rate by race/ethnicity, Wisconsin, 2010
Racial/ethnic minority populations Poverty rate by race/ethnicity, Wisconsin, 2010 Total, 13% The Census Bureau uses a set of income thresholds that vary by family size and composition to determine who is in poverty. If the household income for a family or unrelated individual falls below the relevant poverty threshold, then the family (and all its members) or unrelated individual is considered to be in poverty.8 In 2010, 13% of Wisconsin residents were living in poverty. Blacks had the highest rate (39%), followed by American Indians (29%) and Hispanics/Latinos (28%). Lao/Hmong residents had a higher poverty rate (25%) than did other Asians (17%). One in ten Whites was living in poverty in 2010. Source: American Community Survey, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Median household income by race/ethnicity, Wisconsin, 2008-2010
Racial/ethnic minority populations Median household income by race/ethnicity, Wisconsin, Household income includes the income of the householder and all others age 15 years and older in the household, whether they are related to the householder or not.8 Median household income in Wisconsin varies by race/ethnicity, with Asians and Whites having the highest median incomes, and Blacks the lowest median income. The median is the amount at which half of households earn less and half earn more. Average household size in Wisconsin during by race/ethnicity is shown below10: Average household size, by Race/Ethnicity, Wisconsin, Race/Ethnicity Average household size Whites Blacks American Indians 2.65 Hispanics Asians Source: American Community Survey, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Educational attainment of adults ages 25 and older, by race/ethnicity, Wisconsin, During , racial/ethnic minority adults in Wisconsin were significantly more likely not to have completed high school than were White adults. Two out of five Hispanic adults and about one out of five Black, Asian, and American Indian adults had not completed high school. Nearly half of Asian adults ages 25 and older have at least a college education, although there is variability among ethnic groups within the Asian population (not shown). Source: American Community Survey, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Distribution of family households by race/ethnicity, Wisconsin, A family is a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family. A family household is a household maintained by a householder who is in a family, and includes any unrelated people who may be residing there.8 The distribution of family households varied by race/ethnicity. In , more than half of Black family households in Wisconsin were female-headed, about one in ten was male-headed, and one-third were married-couple households. Whites and Asians had the highest percentage of married-couple households—about 80% of family households. Source: American Community Survey, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Level of urbanization of Wisconsin residents by race/ethnicity, In , level of urbanization varied by racial/ethnic group. Two-thirds of Blacks and more than one-third of Hispanics in Wisconsin lived in Milwaukee County. Nearly one-half of American Indians lived in non-metropolitan counties. A majority of Whites and Asians lived in smaller metropolitan counties. Source: American Community Survey, . Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Black population by county, Wisconsin, 2010
Racial/ethnic minority populations Black population by county, Wisconsin, 2010 Wisconsin’s Black population, 6.2% of the total statewide in 2010, was concentrated in southeastern and southern Wisconsin and Brown County. Blacks made up one-quarter of Milwaukee County residents. Source: U.S. Census, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Hispanic/Latino population by county, Wisconsin, 2010
Racial/ethnic minority populations Hispanic/Latino population by county, Wisconsin, 2010 Wisconsin’s Hispanic/Latino population was 5.9% of the total statewide in Counties in the southeastern and east central parts of Wisconsin have the largest numbers of Hispanic residents. Source: U.S. Census, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

American Indian population by county, Wisconsin, 2010
Racial/ethnic minority populations American Indian population by county, Wisconsin, 2010 There were 48,511 American Indians living in Wisconsin in 2010, 0.9% of the state’s population. Wisconsin’s American Indian population increased by 13% from 2000 to Nationally, there was an even larger increase (27%) in people identifying themselves as American Indians, when alone or in combination with another race.11 Menominee County had the highest proportion of American Indian residents—84%—since the Menominee Indian Reservation and the county share boundaries. American Indians constituted more than 9% of residents in several other counties in northern Wisconsin, although the largest numbers of American Indian residents live in Milwaukee and Brown counties. Source: U.S. Census, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

American Indian Tribes in Wisconsin
Racial/ethnic minority populations American Indian Tribes in Wisconsin This map shows the locations of Wisconsin’s 11 American Indian Tribal Areas, including six bands of Lake Superior Chippewa (also referred to as Ojibwe). Although the Menominee Indian Reservation and Menominee County share boundaries, other Tribal Areas are spread across multiple counties. The Ho-Chunk, for example, have land in 15 different counties. Tribes are listed below with their headquarters cities. Bad River Band of Lake Superior Chippewa, Odanah Forest County Potawatomi, Crandon Ho-Chunk Nation, Black River Falls Lac Court Oreilles Band of Lake Superior Chippewa, Hayward Lac du Flambeau Band of Lake Superior Chippewa, Lac du Flambeau Menominee Indian Tribe, Keshena Oneida Tribe of Indians, Oneida Red Cliff Band of Lake Superior Chippewa, Bayfield St. Croix Chippewa Indians, Hertel Sokaogan Mole Lake Community, Crandon Stockbridge Munsee Community, Bowler Source: Great Lakes Inter-Tribal Council, Inc. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Asian population by county, Wisconsin, 2010
Racial/ethnic minority populations Asian population by county, Wisconsin, 2010 Asian/Pacific Islanders made up 2.3% of the state’s residents in The largest number of Asians resided in Milwaukee (32,300) and Dane (22,000) counties. Five percent of Marathon County residents were Asian, the highest percentage of any county in Wisconsin; 4% of the Dane, Sheboygan, and La Crosse county populations were Asian. Source: U.S. Census, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Foreign-born populations

Foreign-born percentage of the population by race/ethnicity, Wisconsin, 2010 In 2010, foreign-born people constituted 5% of all Wisconsin residents, but more than half (58%) of Asians and nearly one in three (32%) of Hispanics/Latinos. Source: American Community Survey, 2010 Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Foreign-born residents of Wisconsin by place of birth, 2010
Foreign-born populations Foreign-born residents of Wisconsin by place of birth, 2010 In 2010, 40% of foreign-born residents in Wisconsin had come from Latin America; 31% had emigrated from Asia; and 22% had been born in Europe. Source: American Community Survey, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Country of origin of foreign-born Hispanic/Latino residents, Wisconsin, 2010 In 2010, 80% of Hispanic/Latino foreign-born Wisconsin residents reported Mexico as their country of origin; 9% were born in South America, 7% in Central America, and 3% in the Caribbean. People born in Puerto Rico are U.S. citizens. Source: American Community Survey, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Country of origin of foreign-born Asian residents, Wisconsin, 2010
Foreign-born populations Country of origin of foreign-born Asian residents, Wisconsin, 2010 East Asia, 27% Southeast Asia, 45% Of foreign-born Asians in Wisconsin, 45% are from Southeast Asia (Laos, Thailand, the Philippines and other countries); 28% were born in India, Pakistan, and other South Asian nations; and 27% are from China, Korea, and other East Asian countries. South Asia, 28% Source: American Community Survey, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Refugees to Wisconsin by ethnicity, 1975 – 2010 (n = 74,504)
Foreign-born populations Refugees to Wisconsin by ethnicity, 1975 – 2010 (n = 74,504) Refugees to Wisconsin by ethnicity, language or region, (n=74,504) Hmong/Lao 79% Other Southeast Asia 8% Former USSR, Yugoslavia, Europe Africa 2% Other 3% Estimated refugees to Wisconsin by ethnicity, language or region, October September 2010 (n ͌ 2,400) East Asia 52% Near East/South Asia 29% Africa 16% Western Hemisphere 2% Eastern Europe/Central Asia 1% A refugee is a person who has been forced to flee his or her country because of persecution, war, or violence; has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group; and most likely cannot return home or is afraid to do so. War and ethnic, tribal and religious violence are leading causes of refugees fleeing their countries.12 From 1975 to 2010, nearly 75,000 refugees resettled in Wisconsin. Nearly 80% were Hmong or Lao, and 8% were Vietnamese, Cambodian, or Burmese. The most recent refugees, who arrived in , came primarily from East Asia, the Near East and South Asia, and Africa. The leading recent source countries are Burma, Iraq, Bhutan, and Somalia. More than 90% of refugees resettled since 1975 are now self-sufficient, no longer needing support.13 Refugee health screening includes screening for communicable diseases (such as tuberculosis, Hepatitis B, and sexually transmitted infections), immunizations, oral health and lead screening, blood work and evaluation of chronic conditions identified during the refugee’s overseas medical exam.14 Source: Wisconsin Department of Children and Families. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Places of initial Wisconsin settlement of refugees to Wisconsin, n = 74,504 The largest numbers of refugees to Wisconsin since 1975 were initially settled in Milwaukee County, followed by Dane, Marathon, Brown, Outagamie and La Crosse counties. Source: Wisconsin Department of Children and Families. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

People with disabilities

Percent of adults with disabilities by age group, Wisconsin, 2009-2011
People with disabilities Percent of adults with disabilities by age group, Wisconsin, Definitions of disability, and therefore estimates of prevalence of disability in Wisconsin, differ somewhat between the American Community Survey (ACS) and the Behavioral Risk Factor Survey (BRFS). The ACS defines disability as deafness or serious difficulty hearing; blindness or serious difficulty seeing – even when wearing glasses; serious difficulty concentrating, remembering or making decisions; serious difficulty walking or climbing stairs; difficulty dressing or bathing; difficulty doing errands alone such as visiting a doctor’s office or shopping. The BRFS defined disability as being limited in any way in any activities because of physical, mental or emotional problems. The current American Community Survey definition will be used in the BRFS in future years. According to the ACS, 12% of all Wisconsin adults, 9% of those 18-64, and 32% of those 65 and older have a disability. BRFS estimates are also shown in the figure because the BRFS provides related estimates of health risk behaviors and outcomes that are not available from the ACS, so it is useful to understand that, according to the BRFS, 26% of adults have a disability. Sources: American Community Survey, ; Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

People with disabilities populations
Percentage of children with special health care needs, by age, Wisconsin, The federal Maternal and Child Health Bureau defines children with special health care needs (CSHCN) as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”15 The National Survey of Children’s Health (NSCH) is a telephone survey conducted by the National Center for Health Statistics at the CDC under the direction and sponsorship of the federal Maternal and Child Health Bureau. Randomly sampled telephone numbers are called to find households with children ages 0-17; one child is randomly selected to be the subject of the interview, and the adult who knows the most about the child’s health and health care is interviewed.15 In Wisconsin, 22% of children under age 18 have special health care needs, 24% of boys , 19% of girls, and about one in four youth ages Differences by racial/ethnic group and by household income are not significant. Source: National Survey of Children’s Health, Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Lesbian, gay, bisexual, and transgender (LGBT) population
The umbrella of sexual minority includes youth and adults and addresses multiple aspects of identity and behavior16: Sexual identity: People who identify as lesbian, gay, bisexual, queer, or questioning (LGBQ). Sexual Behavior: People who have same-sex sexual contact (MSM, or men who have sex with men, and WSW, or women who have sex with women), who may also have opposite-sex contact. Sexual Attraction: People who are attracted to people of the same sex or both sexes. Gender identity: People who feel their current gender identity does not match their sex at birth (born male, identify as female; born female, identify as male; or don’t identify with either gender) and identify as transgender. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographic Characteristics
LGBT populations Demographic Characteristics Youth 9% of Wisconsin high school students in Wisconsin identify as lesbian, gay, bisexual, or unsure (2011, YRBS). 10% of Wisconsin high school students who have had sexual contact have had same-sex contact. ( , YRBS). Adults 2% of Wisconsin adults identify as lesbian, gay or bisexual (BRFS, combined cell and landline sample, ). 3% of Wisconsin adults identify as lesbian, gay, bisexual, or transgender (Gallup Poll, 2012). 5% of Wisconsin adult males, age 18 and older, are men who have sex with men, 2007 (White, 5.6%, Black, 4.3%, Hispanic, 5.3%) (Public Health Reports, 2011, V126). 10% of Wisconsin high school students who have had sexual contact have had same-sex contact. This is of the 60% of high school students who have had sexual contact. The 40% who have not had sexual contact were not included in this analysis. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Demographic Characteristics
LGBT populations Demographic Characteristics Transgender youth and adults Data on transgender adults and youth are very limited. More data are needed to understand the health of transgender-identified adults and youth in Wisconsin. Households 10,863 households (about 1 in 200) in Wisconsin contain a same-sex couple (American Community Survey, 2010). 53% of these are female couples; 47% are male couples (American Community Survey, 2010). Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Same-sex-couple households by county, Wisconsin
LGBT populations Same-sex-couple households by county, Wisconsin The U.S. Census Bureau does not collect information about individuals’ sexual orientation; however, it does collect information about same-sex couples in households. This can serve as an indicator of where lesbian, gay, bisexual and transgender (LGBT) people live in the state. In 2010, Milwaukee and Dane counties had the largest number of same-sex couples, followed by Waukesha, Kenosha, Brown, and Outagamie counties. In addition, same-sex couples make up more than 0.6% of households in Burnett, Marquette, Chippewa, Bayfield, Washburn and Jackson counties. Source: American Community Survey, 2010. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References References
University of Wisconsin Population Health Institute. County Health Rankings, Center for Urban Population Health. Milwaukee Health Report, LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057– Wisconsin Department of Health Services (DHS). Healthiest Wisconsin National Center for Health Statistics Data Brief, No. 58, Current Population Survey (CPS) Definitions, American Community Survey Glossary. U.S. Department of Health and Human Services: The 2010 HHS Poverty Guidelines. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

References American Community Survey. The American Indian and Alaska Native Population: 2010, 2010 Census Briefs. United Nations High Commission for Refugees. Wisconsin Department of Children and Families, Refugee Services Program. Wisconsin Department of Health Services, Refugee Health Program. Data Resource Center for Child and Adolescent Health: Who Are Children with Special Health Care Needs? Fenway Institute: The Fenway Guide to LGBT Health: Module 1. Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Links to additional reports and resources
Census data: American Community Survey, U.S. Census Bureau: Wisconsin Interactive Statistics on Health: Socioeconomic status: Refugees: Disability: Health and Disability in Wisconsin – Estimates from Three Population-based Surveys: LGBT: Youth Risk Behavior Survey and Sexual Minority Youth in Wisconsin: Healthiest Wisconsin 2020 Baseline and Health Disparities Report

Contacts Contacts Karl Pearson, Demographer Wisconsin Division of Public Health, Office of Health Informatics Healthiest Wisconsin 2020 Baseline and Health Disparities Report

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