Professor Steve Goldsmith interviews Chief Health Policy Advisor for Milwaukee County Dr. Ben Weston, who discusses how local leaders addressed systemic racism and health inequities through GIS and mapping.
In this episode Professor Goldsmith interviews Dr. Ben Weston, Chief Health Policy Advisor and Director of Medical Services for Milwaukee County. Dr. Weston discusses his roles in the county and how his team collected and mapped data to inform both COVID-19 responses and vaccination delivery, with a specific lens on health equity. As one of the first counties to declare racism a public health crisis, mapping out rates of deaths, infections, and vaccinations helped Milwaukee leaders delivery services and health care in a more equitable way.
Music credit: Summer-Man by Ketsa
About Data-Smart City Solutions
Data-Smart City Solutions, housed at the Bloomberg Center for Cities at Harvard University, is working to catalyze the adoption of data projects on the local government level by serving as a central resource for cities interested in this emerging field. We highlight best practices, top innovators, and promising case studies while also connecting leading industry, academic, and government officials. Our research focus is the intersection of government and data, ranging from open data and predictive analytics to civic engagement technology. We seek to promote the combination of integrated, cross-agency data with community data to better discover and preemptively address civic problems. To learn more visit us online and follow us on Twitter.
Betsy Gardner:
Hi, this is Betsy Gardner, Senior Editor at the Harvard Kennedy School and Producer of the Data-Smart City Pod. Since we started this podcast, we've had great support from our listeners. And to make sure that you don't miss an episode, please find us under the new Data-Smart City Pod channel wherever you listen. Make sure to subscribe so you get each episode, and thanks for listening.
Stephen Goldsmith:
This is Stephen Goldsmith, Professor of Urban Policy at Harvard Kennedy School's Bloomberg Center with another podcast that features how we're thinking about the use of data and technology to improve the quality of life in urban communities around the country. And today we're delighted to have with us, Dr. Ben Weston, who's the Chief Health Policy Advisor and Director of Medical Services for Milwaukee County and an Assistant Professor of Emergency Medicine at the Medical College of Wisconsin. Your title's almost as long as mine. Welcome.
Ben Weston:
Thank you for having me. I'm happy to be here.
Stephen Goldsmith:
We have over the years, we've written a lot actually about Milwaukee County Health Department, one of the most advanced in the country in many ways. But let's start with a little bit of background for those who may not have read everything we've written about your organization the last few years. Could you tell us a little bit about yourself and the agency itself please?
Ben Weston:
Sure. Yeah, absolutely. So, I think one important thing to note is that Milwaukee County actually has 14 different health departments and we can talk later about how that complicates things a bit but it is unusual for a county. And so, while our county works with each of those health departments, we don't have a health department of our own. Now we do have an Office of Emergency Management, we do have a Department of Health and Human Services that is deeply ingrained in the health of the community. But as we'll probably talk about with the COVID response, there's a lot of collaboration that comes with having multiple different health departments within one county infrastructure. But as far as my role in the county, I have a dual role. So, my first and longest standing role for several years now in the county is as their EMS Medical Director.
So, I'm an emergency physician by training, still work shifts in the emergency department through the Medical College of Wisconsin where my main appointment is, but then I'm contracted as the EMS Medical Director. So, I oversee our emergency services, ambulance services of our 14 fire departments in Milwaukee County. It's about a 100,000, actually now about 120,000 patient encounters a year. And then my newer role during COVID is as the Chief Health Policy Advisor for Milwaukee County. So, working on just generally, how can we strengthen the health of our community?
Stephen Goldsmith:
It seems to me like you probably have a record number of health departments per capita perhaps, before we kind of get into the dashboard and how you've used data in your COVID response, do you use GIS as a foundation to bring the data from the various health departments? How do you organize collaboration in such a kind of messy of circumstance?
Ben Weston:
I think that's been one of the main roles and in my opinion, the greatest accomplishments that we've had in this collaboration is really pulling all that data together. So, we have in Milwaukee County COVID 19 Surveillance Dashboard, pulls other data from all 14 of those health departments, all are different municipalities. We have even more than 14 municipalities into one dashboard, one map, and one singular dataset, so we can understand the trends in the county as a whole. But you can also really dig in if you want to and understand it at the municipal or the local health department level.
Stephen Goldsmith:
And when you bring the data together, it is visualized in these dashboards. What's the purpose of the dashboard?
Ben Weston:
Well, that's a good question. So, it's a multipurpose dashboard and the reason it's multipurpose dashboard is because we know now more than ever, but even when we started off that we'd have multiple different stakeholders. We'd have folks that have not spent much time at all with a graph and want to see something with very clear trend lines or a very obvious bar graph, this is larger than this. But we also know that we'd have people that are much more sophisticated with data than me, PhD, epidemiologists, and researchers, they would want to really dig into this data.
And so, when you first look at our dashboard on the main page, the primary metrics page, the first thing you see is a map of Milwaukee County. And the reason we wanted that is because just about anybody in Milwaukee County looks at that map and their eye goes right to where they live and they want to see what color the census check they live is. And so, it's a little bit familiar to people, but then surrounding that map are pretty straightforward graphs. What's the trend in cases, what's the trend in deaths, what's the trend in hospitalizations. But then as you start putting on more layers, as you start opening new tabs and working your way through the dashboard, you can get much more detail than that for people who want to.
Stephen Goldsmith:
So, just an organizational question, county has a GIS department and has you as a health policy advisor, I assume these other health departments are in independent cities. Do they also have GIS capacity? How do you think about not just the integration of the data, but the sharing of the insights across those various jurisdictions?
Ben Weston:
Yeah, well we've been lucky to have really good collaboration throughout the different health departments. We still regularly, I still regularly meet with all the health officers from the different health departments, talk about the trends we're seeing, the data we're displaying, the interventions we're having, plans for the future, learnings from the past. But to that specific question, the larger health department is the city of Milwaukee Health Department. And they have a GIS capability there as well and good data management and informatics folks. But for COVID certainly most of the GIS work, the vast majority of the GIS work has really fallen to Milwaukee County. And it's within that Office of Emergency Management, we have several data experts, several GIS experts that have been able to help us create this dashboard and continue to improve upon it.
Stephen Goldsmith:
One of the things that we wrote about before was you're evaluating vulnerability and equity, EVE Index. How does that visualization disparities drive policy decisions on the Milwaukee County?
Ben Weston:
Yeah, the EVE Model, so it's evaluating vulnerability and equity. What it basically is and we're on a podcast, we can only see so much, but if you can imagine four quadrants and on one side of that is increasing vaccination rates and along the bottom is increasing vulnerability. And so, in one quadrant you have high vulnerability, low vaccination rate or high vulnerability, high vaccination rate. Well, what we really want to focus on is that first one, so high vulnerability communities with low vaccination rates. And when we first launched the EVE Model, which breaks on these census tracks, we have 296 census tracks in Milwaukee County and it breaks them down into four colors based on those four quadrants and different shades of the color. But orange is that high vulnerability, low vaccination. And those are the communities that we wanted to focus on. And when we first launched the EVE Model, we really had a county that was either orange or the other extreme end, high vaccination, low vulnerability.
It was really the haves and the have-nots. You were orange or you were purple, but what we've done since then is really targeted those orange communities and the darker orange you are, the higher vulnerability, the lower vaccination rate, the more we're targeting those communities with messaging, with resources, with interventions. And by doing that, there's no communities that's more than a dark orange, there still are them that are this kind of medium orange color. So, we still have certainly areas to focus on. We've made major strides. We've gone from, for example, about one in 20 vaccinations, going to high vulnerability communities to about one in two vaccinations, going to high vulnerability communities as we've gone through the process here.
Stephen Goldsmith:
So, you map and analyze vaccines and probably emergency equipment as well. So, let's say you identify from your EVE index, a community that's particularly challenged in terms of income and low on vaccinations. What happens next?
Ben Weston:
Well, it depends. It depends what our goal is at that point. Now the overarching goal is always increase vaccination, specifically first dose vaccines. But for example, if we go back to April of 2021, the vaccine had come out but it was still limited who could get the vaccine. It was people who were in healthcare, it was people who were frontline workers. It was people in medical fields. And at that point, it, Wisconsin was just about to launch medical conditions, chronic medical conditions as a factor of who could receive vaccines. That was around the same time as the EVE Model came out. And so, we went to the State and we worked with the State and we said, look at this model, we did zip codes because it's easier for people to understand zip codes and census tracks. We said, we have 10 zip codes that are almost all orange on the EVE Model.
What if we made is 10 zip codes eligible right now for vaccination? That could change how we can vaccinate our community rather than going on the news and saying, well if you meet this criteria and this criteria and this criteria, you can come to our vaccination site. We can just say, if you live in these zip codes, I don't care whether you're 18 or you're 99 years old. I don't care whether you're a healthcare worker or grocery store worker, come to our vaccination site, bring your family, bring your neighbors, and get yourself vaccine. And the State agreed to do that. The way they worded it was they considered systemic racism as a chronic health condition. And so, by doing that, we opened up vaccination for these 10 zip codes. We got thousands of people. We went out three weeks out in our vaccination appointment, there was so much interest among these zip codes in getting vaccinated. So, that's one example. That's the earliest example of how we use this model to influence policy and to really change how people access the vaccine.
Stephen Goldsmith:
Are you using any tools that allow for community engagement, either in uploading comments about their own neighborhood or requesting services, or even thinking about the wisdom of crowds in terms of making observations about where vaccines should be available? Is there any interactivity to the dashboard that relates to the community as contrasted to the government agencies?
Ben Weston:
Yeah, that's an interesting question. We haven't had much interactivity with the dashboard. Now, certainly we've done efforts that go from the broad level to the granular level. So, I described the broad level of looking at zip codes and targeting an entire zip code. We've also used this to do much more granular. We looked at census tracks and found the few census tracks that were the darkest orange, the highest vulnerability to lowest vaccination, and we worked with community groups to go and knock door to door in those communities and offer. And you knock on the door, it's somebody who's from that community. They're trained in how to talk about vaccines. They talk to their own community members to their neighbors about vaccination, dispel some myths, and if they agree, then right then behind them is one of our health department vaccinators, who can then come in, vaccinate them, vaccinate their family. The neighbors can come over if they want, things like that. So, we haven't had much interactivity with the dashboard, which is an interesting question, but we have had that community level, granular intervention.
Stephen Goldsmith:
And your updates on you dashboard continue and they will indefinitely. What is a long term project or short term?
Ben Weston:
They do. So, we actually in the fall transitioned our dashboard a bit to be more longer term surveillance. So, we took out some of the more nuanced points. So for example, how quickly testing was turning around. So, there were times when testing was really tight and we'd look at what percentage of tests turn around within 24 hours or 48 hours. That hasn't been as much of an issue lately, so we took some really granular parts of the dashboard out, focused on other areas, longer term trends, and now it's really a surveillance dashboard. The nice thing about it is a lot of our dashboard right now is automated, probably 90% of the dashboard is automated, which allows us to continue daily updates. So, it updates, we don't do it on the weekend, but we do weekday updates each day of most of the data, things like the EVE Model aren't really necessary to update every day. So, we update that once a week, but yeah, our dashboard continues to be updated for the most part daily and continues to inform various stakeholders.
Stephen Goldsmith:
Last question. How do you think about the participation of third party providers? For example, we wrote about tests for lead paint being informed by anonymized ER reporting, you know better than any of us of course. I mean COVID, the bed occupancy, and the ER room was reported for purposes of allocating where ambulances would go. So, when you put together your dashboard, you have city county data. What other sources of data do you have on a regular basis?
Ben Weston:
Yeah, so you bring up a great point with hospitals. I mean, hospitals have been a major factor in the pandemic. Most of the interventions we do are to control the number of people that are in hospitals. So, we still can maintain healthcare, not just for patients with COVID but for all the other folks that need emergency department and hospitals, whether it's strokes or heart attacks or trauma. So, we have integrated our health systems into the dashboard. So, we have the number of hospitalized COVID patients in our county right now. We have the percentage of beds that are taken up by COVID patients. Again, in our previous data, we got much more granular. We looked at inpatient beds, we looked at ICU beds, we looked at ventilator capacity. We pulled a lot of that out as the pandemic has gone on and we've kind of simplified it a bit, but without a doubt, that's one of our key data points is understanding hospital data. How are hospitals affected? And it's also a metric for the severity of disease, of course.
Stephen Goldsmith:
And we have a fair number of folks who listen that are in the GIS world. What recommendation do you have to them?
Ben Weston:
Well, I'll tell you I'm not a GIS specialist. So, the way these dashboard started to be honest is a sheet of paper and me drawing on it, what I'd like the dashboard to look like, and then handing it to the experts to make it, not just look like that, but to put their influence on it and make it much more usable and much more informative. So, I don't know that I can educate your GIS experts, but what I will say is that one of the things we've tried to do on this dashboard throughout is think about and target equity. So, we're coming up on three years since Milwaukee County was one of the first in the country to declare racism a public health crisis. And what that did for us is it led us use and integrate an equity lens into every decision we make.
The typical decisions where you're going to open up a fire station, where you're going to station an ambulance, but also decisions that maybe you wouldn't think of as much. We don't have enough lifeguards, which pools are we going to open? Well, a lot of times it's the pools in the wealthier communities where the taxpayers are. We kind of flip that on its head in Milwaukee County, pools are a major resource for poor communities. It keeps kids in a safe place. It keeps families together and active. And so, we look at that through an equity lens and everything else that we do, and never has that been more relevant than during the pandemic. So, whether it's through GIS or our interventions, but I think particularly through our dashboard, right from the beginning we had race and ethnicity information on the front. And as a back in April of 2020 now, there was a Washington Post article that showed that Milwaukee County had the worst COVID disparities.
We've come a long way since then, but the worst COVID disparities in any community that was showing that data, which was few in the country at the time. But we still show the data because we thought it was important. Our county executive was behind it. He pushed hard for that. And even though the data wasn't great, he wanted it to be shown, so that we could have community of interventions. And we have, and we've improved, there's certainly more way to go, but we continue to focus on equity and being public and transparent with that equity information as we work to strengthen the health of our community.
Stephen Goldsmith:
Thank you very much. This is Stephen Goldsmith speaking with Dr. Ben Weston, Chief Health Policy Advisor and Director of Medical Services from Milwaukee County. A county that's long been a leader in terms of public health and we appreciate your insights on equity and COVID and resources and GIS. Thank you so much.
Ben Weston:
Thank you. I enjoyed talking with you.
Betsy Gardner:
If you liked this podcast, please visit our us at datasmartcities.org, or follow us @datasmartcities on Twitter. And remember to subscribe at the new Data-Smart City Podcast channel on Spotify, Apple Podcasts, or wherever you listen. This podcast was produced by me, Betsy Gardner, and hosted by Professor Steve Goldsmith. We're proud to be the central resource for cities interested in the intersection of government, data, and innovation. Thanks for listening.