COVER FEATURE

Health rankings

Marathon County typically ranks pretty high on these measures — but are they making a difference?

If someone attends enough Marathon County government meetings, there is a phrase they’ll eventually hear repeated. Repeated a lot. As in, enough times that it starts to become like a song you can’t get unstuck from your head.

It’s something they’ll hear from supervisors in making an argument, and it will go something like this “Well if we’re really aiming to be the healthiest, safest and most prosperous county in the state, then…” followed by their argument.

Th ey’re quoting the county’s mission statement. Marathon County does indeed aim to be the healthiest, safest and most prosperous county in the state.

Well, it’s defi nitely one of better ones, but the county hasn’t yet completed that mission. How do we know that?

Th e County Health Rankings and Roadmaps, a program of the University of Wisconsin Population Health Institute, every year puts together an enormous amount of data around county health measures.

All of the factors combined to give Marathon County a ranking of 16th out of 72 counties in the state. Th at’s not bad. As reported in a cover story this reporter wrote way back in 2014, Marathon County ranked 24th. So 16th is defi nitely an improvement.

So who’s No. 1? Th is year that distinction belongs to Ozaukee County. Ozaukee is north of Milwaukee County and has the city of Port Washington (think TGIF show Step by Step) and Cedarburg. Th e worst is Menomonie County, southeast of Antigo and not all that far from us.

So what is Ozaukee doing right? It has a high food environment index, low physical inactivity, and great access to exercise opportunities. It scores higher than Marathon County, which might seem odd since so many great outdoor recreation opportunities exist here. But, as CWOCC President and Health Department employee Aaron Ruff explains to City Pages, the rankings look at specifi c criteria that probably doesn’t help Marathon County because of its rural nature.

Th e county has an extraordinarily low number of teen births, few people who are uninsured, and has low ratios of doctors to residents (in other words, a high number of doctors relevant to the population).

A high number of students who graduate high school and some college, few children in poverty (3%) and next to no air pollution round out the list.

Some of these are stats Marathon County would die for.

But that said, the county has plenty of strengths that helped it rank 16th in the state.

Marathon County Health Offi cer Laura Scudiere says the Marathon County Health Department takes the results very seriously, and that they can help identify strengths and highlight areas for health offi cials to work on. “Th is shows you a lot of the social determinants and how we’re doing on them,” Scudiere told City Pages. “We’re one of the top performers and that’s a good thing.”

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Marathon County strengths

One surprise that popped out in Marathon Count was how few of its driving deaths were linked to alcohol consumption. Only 14% of those driving deaths were the result of alcohol in 2022. Th at’s compared to a whopping 36% statewide. Th at number has been coming down for more than a decade. Th e data fl uctuates a lot in the county but it has almost always been lower as a percentage of driving deaths than the state as a whole. Physical inactivity is another strength, though it’s slightly higher than the state as a whole. Just 24% of people report no leisure time physical activity. It might sound bad that nearly one quarter of the population gets no exercise, but Marathon County has the lowest percentage of inactive folks of any other central Wisconsin county besides Portage County (23%) Th e percentage of the population who is uninsured has dropped dramatically in the past decade, and is low in Marathon County compared to the rest of the state. From a peak of 11% of the population in 2012, the percentage of uninsured people dropped to 7% this year. Marathon County and the state as a whole has repeatedly outperformed the country at large in this measure. (In 2019 the United States as a whole had 11% of its population uninsured.) Th e percentage of people who completed high school Laura Scudiere (92%) was in line with the state percentage (93%) and who completed some college in the county (71% in Marathon County, 70% statewide). Unemployment in the county (5%) was much lower than the state rate (6.3%). And far fewer children were in poverty in Marathon County (8%) than in the state (12%). In Marathon County that’s been trending downward since a peak of 19% in 2010. Some other measures not highlighted by the survey’s data tool but where Marathon had far better outcomes than the state as a whole were children in single-parent households (16% in Marathon County, 23% statewide) and violent crime (115 per capita in Marathon County versus 298 statewide).

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Some challenges

Binge drinking is a problem in Marathon County as it is in Wisconsin as a whole. In both the county and the state, 25% of people surveyed reported excessive drinking. In top performing counties nationwide, that percentage is only 15%.

Marathon County Captain Ryan Weber says that while it’s tough to track specifi c numbers, anecdotally speaking, excessive alcohol can lead to lower inhibitions and an increase in crime.

In Marathon County, 32% of adults were obese (BMI of 30 or more). While 34% were obese statewide, in top performing counties only 30% were considered obese. And 17% of adults smoked; more than the 16% of Wisconsinites and 15% nationwide who do so.

One area oddly not highlighted by the comparison tool but an area where Marathon County struggles: Mental health providers. In Marathon County the ratio was 480:1; statewide it was 440:1 and top counties had ratios as low as 250:1.

Th at’s a problem, considering the increase in numbers of teens reporting anxiety, suicidal thoughts and other mental health concerns on the Youth Risk Behavior Survey done every two years. Th e trends have been getting worse since the fi rst surveys in 2015 and this year’s results, delayed due to COVID, are expected soon. Th ey are expected by most experts to show an even further decline.

What can be done? City Pages reached out to Aspirus to learn what they are working on in this area. Aspirus System Behavioral Health Director Nicki Williams says Aspirus is in the process of hiring another psychiatrist, and the health organization plans to hire more therapists in the future. “We have spent a signifi cant amount of time expanding telehealth services both through telehealth devices and video visits at home which has increased access,” Williams said in a statement to City Pages. “Th e wait time for appointments within Aspirus Behavioral Health has also decreased signifi cantly from a year ago.”

A consortium of medical professionals started a program to bring more mental health help to area schools and the Wausau School District recently passed a referendum (2021) to increase the number of mental health professionals in the district’s schools.

Scudiere says improving mental health is a priority for the county. “It continues to be a problem,” she told City Pages. Th e goal is to attract providers to the area and keep them here. North Central Health Care and Bridge Community Clinic, Scudiere points out, have sliding scale fees to help access.

Other tools around mental health are available today that simply didn’t exist 10 years ago. Applications such as BetterHealth and TalkSpace can provide aff ordable access to therapists without the need to leave one’s home. Th ere are even specialized platforms for couples or LGBTQ patients. (Also worth noting, access to those services won’t show up in the health rankings.)

Aiming for improvement

How should counties view the rankings? After all, there are a number of ways in which Marathon County could measure itself. Th e county could compare its progress over time. It could look at how it measures up against the state, and or other counties within the state. Or, it could choose to measure itself against like counties (the platform has a tool in which to do just that, with a drop-down of counties that

are of similar characteristics. Dubuque is one of those counties).

The County Health Rankings and Roadmap program generally encourages counties to try to improve their individual metrics over time, says Spatial Data Analyst Jessica Hoffedler. “We also encourage counties to look for information in existing local data sources that better capture their local health needs and opportunities for improvement that exist. But depending on a county’s goals, it might also be helpful to compare against the state averages or against nearby counties and/or peer counties that are similar based on key demographic, social, and economic indicators (this comparison is available within the “Compare Counties” tab on the measure snapshot).”

How does the county use the data? Scudiere tells City Pages it operates from a framework called Results-based Accountability. It’s the idea that simply trying hard isn’t good enough — instead, the county must use real metrics to determine how it’s doing.

Binge drinking is a good example, Scudiere says. Obviously, that’s something Health Department officials would like to see decrease. The Health Rankings provide a reliable data point to measure progress — if that progress isn’t changing over time, it’s a signal something has to change.

So it’s good that Marathon County is doing pretty well compared to other counties in the state. And not every measure is completely fair. A rural county such as Marathon County might never be the top for access to fitness facilities, just because of its large size and rural nature means it won’t fit the criteria for proximity to fitness facilities (an unmarked trail suitable for walking wouldn’t make the cut in the data, for instance).

But the data provided can help the county stop guessing about how it’s doing overall, and target areas to specifically improve, hopefully making us all healthier in the process.

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Mental health refers efers to to our our emotional emotional and and social social well-being well-being and and impacts impacts how how we we think, think, feel, feel, and and behave. behave. It plays a role in connecting with others, making decisions, handling stress, andmany other aspects of daily life. Everyone has mental health, and it deserves your attention just as much as your physical health does. It’s critical that we get the basics right, like maintaining good mental health or recognizing warning signs. Download your FREE Mental Health Toolkit to learn more!