Editor's note: If you have watched this or any other Wisconsin in Black & White report, please share your feed back in a survey at pbswisconsin.org/wibw-survey. Thank you.

Nathan Denzin:
Across the board, Black people in Wisconsin suffer disproportionately from bad health and/or barriers to health care. Black children in the state are four times more likely to have lead poisoning than their white peers. Also in Wisconsin, Black people die younger than almost all other races, and Black women are far more likely to die during pregnancy or in childbirth than white women. The statistics are so bad for Black people that in 2019, Milwaukee County declared racism a public health crisis.

Dr. Tito Izard:
We can say all health disparities are a direct consequence of being an American descendant of slavery.

Nathan Denzin:
Tito Izard is the president and CEO for Milwaukee Health Services, where he opened a clinic in an underserved neighborhood. He says that because racism impacts every aspect of Black Wisconsinites' life, it affects their health.

Dr. Tito Izard:
Health is, again, the narrow consequence of the condition or the environment that has been created.

Tiffany Green:
Black people, Indigenous people are disproportionately likely to be in impoverished and socially-stratified circumstances.

Nathan Denzin:
Tiffany Green is a professor for population health sciences at UW-Madison.

Tiffany Green:
We know that having unstable housing, not having enough food, being poor, those contribute to outcomes.

Dr. Jasmine Zapata:
Health is not just things that are going on in your physical body, but it is your emotional well-being, your mental well-being, your spiritual health, even your social health.

Nathan Denzin:
Dr. Jasmine Zapata is the chief medical officer for community health at the Wisconsin Department of Health Services. She says health is much more than trips to the doctor.

Dr. Jasmine Zapata:
The things that happen outside of the clinic walls have more of an impact on one's health outcomes and quality of life than the very things we do in the hospitals and clinics.

Nathan Denzin:
All of those factors outside of the clinic are known as the social determinants of health.

Dr. Jasmine Zapata:
Broadly, social determinants of health refers to non-medical factors that influence one's health outcome. Where people are born, where they age, where they grow, where they live, where they work. Things outside of the traditional medical model that we think of when we think about health outcomes.

Nathan Denzin:
When it comes to where Black Wisconsinites live, only a quarter of them own their own home, and they face one of the highest income gaps in the country, a gap that has persisted since 1968. Another important social determinant, how close you are to fresh food. Black Wisconsinites are five times more likely to live in a food desert than white residents.

Reggie Jackson:
We generally don't have control of the food that we have in our community. You know, grocery stores, full service grocery stores are oftentimes far away from our communities.

Nathan Denzin:
Reggie Jackson educates people about diversity. He says that living in a food desert means much of your food comes from gas stations or convenience stores, where the only options are highly processed.

Reggie Jackson:
People don't have access to healthy food or they can't afford healthy food.

Tiffany Green:
We didn't just come to this place where Black and Brown people are disproportionately likely to live in resource-deprived environments. It is, it's racism.

Nathan Denzin:
But despite the declaration that racism is a public health crisis, Izard says not much has been done in Milwaukee since 2019 that brings parity to health outcomes.

Dr. Tito Izard:
Making that declaration without subsequent steps though, is disingenuous. So for most people in the community, it's like, "OK, well, we hear that statement — tell us something that we don’t know already," right?

Nathan Denzin:
For Izard, the only path forward is to improve all of the determinants of health. The Madison-based Nehemiah is a community group working to take those subsequent steps.

Kim Neuschel:
When you start to shift systems, then you start to actually impact the outcomes.

Nathan Denzin:
Kim Neuschel is now the community outreach facilitator at the UW School of Nursing. When she worked as a public health nurse, she enrolled in Nehemiah's "Justified Anger: Black History for a New Day" course. The nine-week course teaches the community about race, history, and justice.

Kim Neuschel:
I think something like this course helps us zoom out and recognize that we all are who we are because of everything that came before us.

Nathan Denzin:
Neuschel said the course helped her realize the full scope of how racism has affected health care, and shifted her perspective to see patients more holistically.

Kim Neuschel:
Health care is important. Your genetic makeup is important. But significantly more important are the social, economic, and environmental factors, and these are the things that we know racism is, you know, embedded within.

Nathan Denzin:
The course also helped Neuschel's public health team find out why young Black students in one grade school were repeatedly absent from class.

Kim Neuschel:
And one of the main factors was the walking route to school didn't feel safe.

Nathan Denzin:
So the team worked to make the path safe and inviting again. First, they installed better lighting in a tunnel that felt unsafe, but then went further.

Kim Neuschel:
We raised money to respond to their idea of putting in a mural that the kids designed.

Nathan Denzin:
After adding the lights, the mural, and a few other improvements, absence rates improved.

Kim Neuschel:
And we did show at the end of that, kids' sense of safety and sense of belonging and connection both to the school as well as to their community and that walking route really shifted for them.

Nathan Denzin:
That shift brought healthy change and access to opportunity in the children's lives who now felt safe enough to walk to school every day.

Dr. Tito Izard:
It's good to become aware; it's better to actually transform that into actual actionable items. What are you specifically going to do?