In Conversation with Dr. Jeanette Kowalik: How Declaring Racism a Public Health Crisis Helped Milwaukee's COVID-19 Response
The Commissioner of Health talks about managing the city's response to the pandemic, treating racism like the crisis it is, and about her full circle journey back to the Milwaukee Health Department.
|Dan Shafer||Jul 1, 2020||2|
The Recombobulation Area is a weekly opinion column by veteran Milwaukee journalist Dan Shafer. Learn more about it here.
Dr. Jeanette Kowalik was born and raised in Milwaukee, and her first internship was at the Milwaukee Health Department. Now, she’s running the office amid multiple public health crises. Photo by Jeff Cannady, PWRFWD Media.
Subscribe to The Recombobulation Area to listen to a special audio podcast of this interview with Dr. Kowalik.
Dr. Kowalik, first I want to ask a question that I think people ask differently in this day and age: How are you?
I am extremely exhausted, but taking it one hour at a time.
So there’s a lot I want to get to in this conversation. I want to ask you about some of the specific issues with the pandemic, I want to talk about Milwaukee declaring racism a public health crisis and what that means now, I want to talk with you about you and your background, but let’s start with the COVID-19 pandemic in Milwaukee.
How is the city doing? Can you give us a status report of where we are, from a public health standpoint, at about 100 days into the emergency stage of this crisis?
So, the first case was on Friday the 13th in the month of March. We started planning for COVID maybe in February because in January, we were watching what was happening and taking the lead of the state, and the state was taking their lead from the federal level at the CDC. When we first got a case in this area, the first was in Waukesha, and our first case was someone that was tied to that Waukesha contact. In less than 24 hours, we recorded our second case which was someone who had acquired it from traveling to Atlanta. And then, we started to see this explosion of cases.
Early on in our response, the majority of cases were African-American middle aged men, and for the percentage of deaths, the majority of them were African-American. Just knowing the distribution here and seeing the disparity in cases, we were initially concerned when we saw the hotspot in the African-American community that was associated with some type of exposure. Like you normally would in public health when you see an outbreak, you see concentration in a certain area of town, you go back and start doing interviews.
I think it’s important for everyone to understand the earlier manifestation of COVID-19 in our community, but also to see what’s happening over time, that it wasn’t necessarily just associated with an event, but seeing how the impacts of racism have contributed to this disparity of COVID-19 not only in Milwaukee, but we’re seeing this in a number of cities across our country, where you're seeing the majority of cases are African-American and Latinx.
What we’re seeing here in Milwaukee is not unique. We’re seeing very similar distributions in COVID-19 infection and fatalities across the country by race and ethnicity.
You were very early on in identifying that. I feel like you were among the first in the nation to really talk about that as something that was happening in a significant way. A Journal Sentinel story quoted you on it back on March 24.
What went into gaining that understanding, how you were able to identify that disparity so quickly, and how that knowledge affected your approach going forward?
We knew early on that sharing data on race and ethnicity is important. Some folks don’t understand the significance of doing this. Any reportable disease, you always want to capture race and ethnicity.
The City and the County declared racism a public health crisis last year. That framed how we function. We’re using data to inform how we adjust our outbreak response, resource allocation, all of that. It’s not just that we made the declaration and we’re just putting our flag up saying this is what it is, there are a number of action items.
I think we all acknowledge that racism impacts health. We have health disparities, and we know that Milwaukee has had challenges with segregation over the years and we’re seeing that play out in a number of health outcomes, like lead poisoning, obesity, and violence. But to see it play out for COVID-19, where you see a very similar distribution of disease, is very disheartening. To see the patterns from Chicago and New York and L.A. and all across the country just really showed that these old policies and practices are still living on today in how the disease outbreak has manifested.
Having that declaration of racism as a public health crisis happen a year ago, it seems like what you're saying there that it really baked into the process the importance of considering race and understanding race with public health crises like this one. So, by the time you reach that point of emergency in March of this year, you were understanding that data in real time.
Having that declaration, having that information in real time, that was part of the process for the public health leadership in the city?
There was some feedback early on as we started to share this information about what’s happening, that we’re not doing enough. And our concern was, the data was fresh. But (we were) able to pivot and make adjustments quickly, (and) start working on outreach campaigns, helping get increased access to testing in those hot spot areas, and soliciting or applying for grant funds.
We (received) money from Advancing a Healthier Wisconsin to do this “STOP COVID-19” outreach campaign and that campaign focused on increasing awareness among communities of color — Latinx, African-American, as well as other groups, including refugees. Without that additional funding — $500,000 — we wouldn’t have been able to do it. We were waiting for CARES Act money, and by the time that came in, which was recently, we would’ve lost all these weeks when we could've been working on something.
From a community perspective, there’s an understanding that there needs to be action right away. Community partners have been so clutch because they have been able to move more quickly than us. Like the “Stronger Together” initiative, that’s a collaboration with over 80 African-American leaders who came together to say, “We need to do something, we need people to know this is real, that we’re being impacted the most, and we are going to take action.” That group was eventually expanded to include Latinx, which made sure things are not just translated, but are culturally appropriate and relevant, and that information is getting out to trusted partners in the community.
That data — helping drive how we make adjustments, how we target certain groups, and make sure resources are available — was extremely important. We’ll continue to mobilize forces and make sure people have what they need to fight COVID.
“The City and the County declared racism a public health crisis last year. That framed how we function. We’re using data to inform how we adjust our outbreak response, resource allocation, all of that.”
You talked about racial disparities. We’ve seen spikes in cases, and racial disparities within that, in neighboring states or other large, diverse metro areas in the region. And in Wisconsin, obviously there’s been a lot of tragedy, but it hasn’t been as pronounced as some other places, like Michigan or Illinois. Do you think addressing those racial disparities in Milwaukee is part of the reason why?
I do. When you see the disparity in Latinx or African-American communities, without any intervention or targeted efforts, your overall incidence and prevalence of COVID-19 infections and fatalities is going to increase. But once you have knowledge that you have people in your community that are being hit harder, then you do something about it. And that helps suppress or reduce the incidence. And then that ends up showing up on a macro level that you’re seeing numbers that are lower than if you didn’t do anything at all.
“We’re not allowing everything to just full-out open up again. You have to ease into these things. You can't just let everything go because we’re tired of it. COVID is still here. It’s still killing people. It’s still causing disability.”
Looking at Wisconsin within the context of the rest of the region, Wisconsin’s death rate is lower than that of many Midwestern neighbors. Why do you think that is?
Many other places had orders, too, but we were able to benefit from having a stay-at-home order earlier on. Enforcing the order, and then getting cooperation from the public following the order helped out a lot. If we didn’t have an order, if we had just said, “Oh, these are guidelines or recommendations,” I think we would have seen higher incidents of cases and fatalities, for sure.
But obviously, we had some challenges along the way — the in-person election, the State Supreme Court ruling.
Milwaukee still has an order because we have the most vulnerable population in the state because of size and diversity. By us still having an order, that’s impacting the rest of the state.
We’re not allowing everything to just full-out open up again. You have to ease into these things. You can't just let everything go because we’re tired of it. COVID is still here. It’s still killing people. It’s still causing disability.
Now, we’re seeing this increase in cases among minors. Initially, we talked about the older population, over 65, and people with underlying health conditions. And then middle-aged, people, and now youth. As we get more data about how COVID is moving throughout our community, we’re raising the alarm, saying this group is getting hit the hardest right now, take additional precautions, we’re going to provide additional resources, weather it’s testing, or masks, or providing basic human needs for people, or housing, any of those things.
Another thing we have here is an isolation facility. At Clare Hall, people who don’t have stable housing, whether they are homeless or housing insecure, they can either quarantine or isolate at that facility. We know that's a huge plus, you can’t just assume everyone has a safe place to stay that they can wait out however long their infection lasts and go back to normal. There are some hotels in the area that we have relationships with that have agreed to be sites, so we were using those facilities, too.
These are the things that a lot of people don’t think about when you think about COVID-19. You’re thinking of the clinical aspect of it, being sick, or possibly dying from it, but what do you need, what support do you need to be able to fight it and heal from it if you’re infected.
“You look at a lot of these articles, these studies showing Wisconsin and Milwaukee as the worst place for black people to live and grow up. We don't have to accept those results. It's like that because of the structures of racism.”
The crisis that’s going on with the pandemic is, as you mentioned, connected to something you had already declared a crisis in Milwaukee: Racism.
So, last year, Milwaukee became the first local government in the country to declare racism to be a public health crisis. From what I understand, you were pushing for that. What went into that push? And what has happened in the year since that declaration was made? How has that changed the City?
So, I can tell you a little bit about what that ordinance entails. It's not just saying “racism is a public health crisis,” there are some action items.
The first one is a needs assessment or environmental scan. Each city department is responsible for going through their operations and what they are doing to address equity and abolish any racist policies or practices in their shops. And then that is supposed to go to the Equal Rights Commission, and they’ll put together a report summarizing what everybody’s submitted. That’s the first step. The second step is an inclusive city organization. So, making sure that all forms of city government and all city agencies are invested in diversity. It should be from the top to the bottom of the organization. That’s the second item. For the third item, the Equal Rights Commission would draft a comprehensive report and recommendation for improving organizational practices for the city. That also includes training. This is something that the County has been doing; they've had extensive training for their staff. We were starting to touch on that, but you need the reports to guide what kind of training you need, whether it’s something like implicit bias or any other blind spots that we need to address. The fourth item is advocating for and drafting policies that will improve health outcomes -- basically, advancing social justice and addressing the individual advocacy aspect of it. We’re seeing some of this play out in many of these demonstrations and protests. And then the last one is encouraging other government entities to declare racism a public health crisis.
We’ve been successful at that, we just presented at a summit last November in Ohio. Lilliann Paine (currently Kowalik’s chief of staff, who was key to the initial push to declare racism a public health crisis) and Nicole Brookshire (director of the Office of African-American Affairs) and I presented on what we did for Milwaukee, City and County. So out of that, there were some other jurisdictions in Ohio that were able to follow through and declare racism a public health crisis. Every day, more jurisdictions are doing it.
It's not just declaring it, it’s laying out what you're going to do about it, and then there should be some resource allocation to make it happen. One issue with our (declaration) is we don’t have dedicated funding to implement the plan. But we are in talks about that, especially now with everything that’s going on. You really need someone to direct those efforts into action. You can’t just apply that to someone else’s existing job duties and think that it’s going to be high quality.
There’s been some talk from some of the leaders of the Black Lives Matter movement here in Milwaukee about declaring racism a statewide public health crisis or a statewide emergency.
What would that mean on a statewide level? Would it just be taking all the things that you said are happening in Milwaukee and bringing them to a larger scale? Is there something different involved when you’d move to a state-level decision?
So, just like COVID, when you declare an emergency, that opens up the door for access to additional resources. Like initially with COVID, we needed access to the stockpile for PPE and whatnot — unfortunately what we got was not adequate; we still had a shortage at that time — but nonetheless, when you declare an emergency at the state level, it enables the locals to have access to a number of resources that are on reserve for the state. That’s important to do.
We also know, too, we’ve been piece-mealing this work for far too long. I mentioned lead poisoning, for instance. Violence prevention. We’re dealing with the symptoms of the problem instead of just dealing with the problem. Until we address the root of the problem in current form, we’re going to continue to struggle at reducing the impacts across all these other health outcomes and areas.
It’s very encouraging now that folks are waking up and seeing how these things are connected and what we can really do to resolve these issues. It’s ingrained in so much of what we do and how we function.
You look at a lot of these articles, these studies showing Wisconsin and Milwaukee as the worst place for black people to live and grow up. We don't have to accept those results. It's like that because of the structures of racism.
“Anyone in office who is perpetrating their racism and biases, they need to step down. It’s time for new leadership.”
You wrote in response to the murder of George Floyd and what’s happening with protests in Milwaukee and across the country. I’d encourage people to read it, I thought it was a really interesting and powerful take on what was going on.
It also included a call to action in what you called “The New American System.” Could you walk me through what you mean by that?
There’s this sense of pride in being American and who we are and our democracy, which has been threatened for some time, but is threatened now more than ever. I think there’s a need for us to say, look, the system is broken. It has been broken. It has been benefitting white people, especially people with influence and resources, more than others.
And this is who we are now, we’re a diverse country, we need to be able to have access to resources and services and quality and not have to take the scraps, if you will. We need to create a new system.
Part of public health is policy, and sometimes people forget that, they think we’re just food inspection, that we’re just regulating. But no, actually we’re considered chief health strategists. That’s what public health is supposed to do. We’re supposed to help shape policy. There has to be a comprehensive approach to doing this.
So it’s just laying out, what is it that we need to be able to thrive in this country, in this city. You’re seeing have and have-nots play out, and it’s time to do something about it. I talked about a number of things with reparations. Not just with money, but things people need to live their best life, have access to high quality health services, wealth management, all of these things that have been compromised or access to these things have been reduced due to the structures of racism in our country.
And then, (I wrote about) a call for leaders to represent the community at large. Anyone in office who is perpetrating their racism and biases, they need to step down. It’s time for new leadership. If they’re not going to do that, they’re going to get voted out. We need to have a strategy to get people primed and ready to go to take over some of these elected positions. So from the Capitol in Washington to the local level, there needs to be a total changing of the guard in getting rid of all people that have been upholding these racist practices and policies for far too long.
You mentioned how pronounced the racial disparities are in Milwaukee and Wisconsin. There is such a need for change, especially here. I think this is a real moment that people want to see that change seized. Some underlying structural policy issues could be addressed by different approaches to public health or more funding for places like the Office of African-American Affairs or the Office of Violence Prevention. These are offices that activists and social justice groups have pointed to as places that should receive funding that would otherwise be going to places like the police department.
So how do you see your role as the Health Commissioner in helping push that conversation forward?
(Recognizing) the role of community in this and letting the community lead. Providing resources and access and the whole point of being at the table, that’s a big deal to be able to hear what’s being discussed and contribute to the conversation, making sure you’re representing the community. Even through the COVID response, some of the conversations that have occurred where you're like, “Wait a minute, that’s not going to fly.” You have to continue to advocate, but make sure that it’s not just you or just one, that there are multiple people at the table representing the community, and not just the same old players. We’re not going to make any change if we are still using the same recipe.
Being in this role has been a big, big opportunity for me to grow as a human being and reflect on what I’m doing and how I'm checking my privilege and how I'm stepping back and letting others lead. And I’m constantly reflecting and reevaluating who I am and how I'm contributing to what’s happening right now.
It’s a very uncomfortable space to be in many times because I'm part of the government, I'm part of what people perceive as the problem. Government should be helping and not causing more harm. Being affiliated with a local government entity which includes a variety of other players that have contributed to some of the challenges and heartache in our community is very, very challenging.
My heart is with the people. I am a Black woman. I could just be quiet and complacent and act like there's nothing going on and nothing is impacting me, which would be a total lie. It impacts me and it impacts my family and it impacts the future of this city, so what am I doing to help make it better? I constantly ask myself that every day.
So, a let’s talk for a bit about you. You were born and raised in Milwaukee, correct?
Yep! Sherman Park.
From what I understand, this move back to Milwaukee is a bit of a full circle moment for you. Could you tell me a bit about that?
About two years ago, I was living in Washington D.C., and working for a national public health nonprofit. When everything kind of hit the fan here with the Health Department, that’s when it was like, “Oh.” I’ve always wanted to be the Health Commissioner in my hometown. I knew there was a great need. Many of the relationships I developed, I maintained over the years, so as I was following what was happening, and hearing what was going on. Just kind of grappling with that, and my spirituality and faith, and this nudge of: You need to go back home. D.C. will always be there. You need to go back home and help.
I started out as an intern at the Milwaukee Health Department and eventually became a full-time employee and moved into management before I left the department in 2008. When I left, at that time, things were starting to go south. It was a very challenging place to work, a very toxic environment. But I was also focusing on my PhD program and I couldn't do both, so I had to make a decision to move out of management and take something that had a better work-life balance while I finished my degree.
But I just kind of reflected on how the department was when I was an intern and how awesome it was, and the people and the energy, I just fell in love with public health through my internship. And now, being able to come back and lead the department, I know how great it can be -- not even where it was, but exceeding where it was.
A lot of the concerns I have are related to historic disinvestment in public health. You’re only going to get what you put into it, and knowing what other cities are doing and what they’ve invested into public health, they’ve been better poised to deal with COVID-19. We were still in a rebuilding process, we reorganized in 2019, and my leadership team wasn’t even full until April of this year. I haven’t had the opportunity to really share what’s really going on because we’ve been so wrapped up in COVID. It has been very challenging, but I have faith in the department.
We definitely need better funding streams, and I'm not just talking about more grants. We need more tax levy dollars to have more flexibility to do some more nimble things instead of everything being tied to a grant and then you’re bound by the guidelines of the funder.
When did you start your career as an intern at the Health Department?
What led you to that point? What led you to pursue this type of career?
So, I’m really an artist (laughs). So that’s why I express myself with the way I dress and I accessorize, and all that stuff. But I had some brief exposures to public health through high school into my undergraduate studies. In high school -- I went to John Marshall, by the way, shoutout to the Eagles -- I was part of this program called “Crosstalks,” which is basically public health education. High school students went to educate middle school students about abstinence and not using drugs and alcohol and all of those things, the typical NBC after school special. And educating them about that, I thought, “This is kind of fun!” I really enjoyed doing this work, but I didn't know this was public health.
Then, for undergraduate, I wanted to go to MIAD and I wanted to go into art as a career, but I didn’t have the resources to do that. So, I went to UWM and found public health through the health care administration program. We had to take a course in epidemiology, and of course, you learn about the AIDS epidemic, and I thought: This is what I want to do. It was really exciting and I was really into it. So, I had to pick an internship as part of our senior year experience, and my internship was at the Milwaukee Health Department. And at the time, Dr. Seth Foley was the Commissioner, and he is amazing. I’m very grateful for having the ability to work with him. And Bevan Baker was the health operations administrator at the time, so I did work with him in the internship and learned about all the public health programs and services and management, and I thought, “This is great. I want to be the Commissioner someday.”
After I got my Bachelor’s, I ended up going to Northern Illinois University for my Master’s in Public Health and Health Promotion. I worked at the Health Department full-time while I did that part-time, which was very hard, because it wasn’t an online program, I actually had to drive down to Illinois once a week to get my degree.
It seems like you're always doing more than one thing at a time.
I’m saying! What kind of life did I sign up for? (laughs)
So, I finished that degree and then I went back to UWM to get my PhD in Health Sciences. The School of Public Health wasn’t yet established when I got in. I ended up just staying in the College of Health Sciences. I was one of three students, we were the first to get our doctorates in Health Sciences at UWM, but most of our focus was on public health.
I would imagine if I had somebody who worked in public health in my friends and family circle I would be asking them questions about issues related to the pandemic all the time. Do you have family and friends constantly hitting you up, texting you, asking what they should or shouldn't do?
All the time! And not even just family, just random people in the community who need help, and someone gave them my number or they found me on social media, and they’re like, “I have this situation and I need to run it by you. Is this right? Is this not?” So, I’m constantly providing advice and consultation to people. I definitely hear people out. There’s a lot of misinformation out there, so I’m making sure we’re providing credible information.
We know that COVID is still new so information is changing on the regular and that’s very confusing for the public. This is a new virus, a new strain, so we’re still learning about it just like you are, but we’re trying to provide you with the most current information. That’s been really challenging, and then you have these people saying, “This is a hoax! This isn’t true!” And it’s like, do you know anyone who has died from COVID? Do you know anyone who has had COVID? Because I do. It’s not a joke. It’s not a hoax.
I also want to highlight the whole mask-wearing piece. Initially someone asked if we should wear masks, and we’re like, “We’re not saying that yet,” because we were waiting for the CDC. That’s the way it works -- local, state, national. At the local level, we normally don’t just come up with stuff, we have to be in alignment with the other levels of public health systems. So when the CDC made the update about wearing masks, we’re like, “Hey! There’s an update about wearing masks!”
Really, we’re educating people on what are some things you can do to not only protect yourselves, but protect other people. I think, as a society, we’re very narcissistic and self-absorbed and social media has kind of helped with that. It’s hard for people to really take a moment to think about other folks. And that’s what the mask-wearing is all about. It shows people’s mentality, in my opinion. Are you thinking about other people or are you thinking about yourself?
This interview has been condensed and edited. Listen to the full audio here.
Dan Shafer is a journalist from Milwaukee who writes and publishes The Recombobulation Area. He previously worked at Seattle Magazine, Seattle Business Magazine, the Milwaukee Business Journal, Milwaukee Magazine, and BizTimes Milwaukee. He’s also written for The Daily Beast, WisPolitics, and Milwaukee Record.
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