Milwaukee’s Commissioner of Health Mike Totoraitis

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Photo by Tom Jenz

Commissioner of Health Mike Totoraitis

City of Milwaukee Commissioner of Health Mike Totoraitis

His father, a freelance sportswriter for the Associated Press, wanted Mike Totoraitis to also be a sports journalist, but that lasted just one Brewers game. Totoraitis’ destiny seemed headed toward public service, and he found his calling in healthcare. At only 38, with a Ph.D from the Medical College of Wisconsin, Totoraitis is City of Milwaukee Commissioner of Health. But he is no policy wonk. When we met in his office at the downtown Zeidler Building, I found him easy going, relaxed and friendly, with disarming enthusiasm. He is the type of person you would want as a co-worker.  

Totoraitis has been with the Milwaukee Health Department since September 2021, previously serving as the director of health data and evaluation when he led the epidemiologists and data team. Earlier in his career as a program supervisor at Safe & Sound, he managed community organizing work to help control crime and violence. Previously, he had worked for the Health Department as a violence prevention research coordinator in the Office of Violence Prevention.

Tell me about where you grew up, your parents, schools you attended and how you got interested in the field of health.

I grew up in Wauwatosa, went to high school at Marquette High and to college at Marquette University. I majored in criminology and law studies, but I got interested in public health through an internship my senior year at the Milwaukee Homicide Review Commission. My parents were both educators in elementary schools. They instilled in me a desire for learning. That’s been my through-line up through today, always wanting to learn more. Later on, I got my Ph.D in public community health at the Medical College of Wisconsin. Throughout my career, I’ve done a lot of work in violence prevention.

When did you become Commissioner of Health? You’ve only been at this job for about seven months.

I’ve always worked in community engagement for the city, and I was fortunate to work with people in my public health field, and they endorsed me, and then Mayor Johnson appointed me. I’m the seventh Commissioner in eight years, and there had been disorganization in our department. It is a difficult job. All that turnover has hurt the city. I am trying to restore stability. 

What exactly is the City of Milwaukee Health Department, and what are the responsibilities of the department?

Our authority is granted under city ordinance and also state statute. We oversee disease control and environmental health, tracking different indicators. Currently, we are in the respiratory season, and we monitor flu virus and Covid. We do surveillance to find out what pathogens are circulating, and what vaccines are effective. We also have mandates to improve community health assessments and design the improvement plans. We are agents of the state for food inspections at restaurants and gas stations, and for weights and measures.

How many people work at the City Health Department and what is your budget?

Two hundred-forty. Our operating budget is about $40 million. Fifty-five percent of our budget comes from grant funds, federal and state.

Let’s talk about your 2023-2028 MKE Elevate Community Health Improvement Plan, acronym CHIP.  You have described the 5-year plan, CHIP, “as a significant milestone in our ongoing efforts to improve the health and well-being of Milwaukee and our community members.” Can you elaborate on that?

The health improvement plan is state-mandated every five years through DHS, Department of Health and Human Services. CHIP details our health priorities for the coming five years. We bring key people to the table to work on these health priorities. We set targets for the different strategies. We make sure all our partners and residents know what we are working on. Covid was very hard on people. Residents lost loved ones, their mental health suffered, some lost their jobs, and their kids stayed out of school. Health care workers are burned out. I think the CHIP improvement plan will reorient us in a positive direction.    

The CHIP plan hopes to create a healthy building environment by supporting homeownership and eliminating food deserts, in other words, focusing on health equity and racism. Can you be more specific on how you will go about these goals?

Our staff will be working with our partners who specialize in the issues of homeownership and food deserts. For instance, we work with the ECO Office [Environmental Collaboration Office] under [Director of Environmental Sustainability] Erick Shambarger to examine how the food system works within our city.    

As far as home ownership, the majority of residents who do not own homes are people of color. There are reasons for this disparity. For instance, the practice of redlining. Generations of problems include the historic loss of industrial jobs, and also segregation. We are partnering with organizations and businesses who will help change that disparity in the coming five years. For example, our partners include the Department of Neighborhood Services, who does building code enforcement - and also the Home Environmental Health Division who oversees health equity including lead abatement. We have to upgrade the infrastructure of many older houses—drywall, paint, roofing, plumbing, and heating.

Some disadvantaged residents are living in a food desert, having little access to quality food markets.

I understand what you are saying. Lack of transportation is a big piece of that issue, the inability to get access to healthy food options. Also, if residents are stressed about their housing, they are not thinking much about healthy food. 

From what I understand, CHIP includes closing the gap in racial and health equity and calls for safer and supportive neighborhoods, improving maternal and child health. What is the plan to accomplish this goal?  

We partner with, for example, Froedtert and Aurora Healthcare systems. Our doula program was awarded a grant to institutionalize help with pregnancy. Doula is part of our Maternal/Child Health Branch. We are facing a fair amount of racism in healthcare provision for birthing people of color who might experience racism when seeking treatment. 

Let’s say there is a young pregnant woman in need of help. Who does she call? How does she get help from the doula program?

Currently, we are at capacity for our doula program, but we do have a waiting list. If a pregnant woman goes on our website, she will see other programs that might help such as home visits. The goal is to help women get good prenatal care and navigate the complex system. It’s all free of charge.   

You once said, and I quote, "I think our brains often default to ‘Am I sick or am I not?’ And the way public health really views what that concept of health is more holistically.” What do you mean by holistically?

The holistic concept goes back to the social determinants of health. These include access to good housing, quality food, stable transportation, neighborhood landscaping, safe playgrounds, quality healthcare, and good jobs. These are all part of holistic health. The media and even our stakeholders tend to focus on a specific issue, for instance, prenatal care or infant mortality. As for healthy food access, we have only one strategist who works in this area, and that person tries to convene outside providers to help.

I am reading from the CHIP plan—"Milwaukee has a history of systemic racism that dates back to its founding as a city. As of 2019, Milwaukee falls fourth on the list of most segregated cities in the nation. Black community members have currently and historically faced discrimination in housing, employment, education, and public services.” The City of Milwaukee declared racism a public health crisis in 2019. How is racism a public health crisis?

We are hyper-sensitive to racism as a public health crisis. Our strategic plan includes the undoing of racism. For example, birthing moms of color sometimes experience racism. Our doulas provide an advocate to help them buffer and navigate that problem, so they have successful birthing experiences. People of color have lower access to healthcare, decent housing and healthy food. A few generations ago, Blacks migrated from the south into Milwaukee for the good factory jobs. When they settled into the north side, many of the European white immigrants moved to the suburbs. Redlining added to the segregation. If you grow up in a disadvantaged zip code, your chances of moving out are slim. 

And your chances for being healthy are not good. Mayor Johnson told me that there are some Milwaukee kids who have never seen Lake Michigan. Commissioner of City Development Lafayette Crump told me that there are inner city children who have never seen Downtown.

I’ve heard that, and that lack of access affects people’s health. They don’t have equal access to quality health care. Our five-year CHIP plan has the overarching commitment to be anti-racist. 

Each goal of the CHIP plan has objectives, strategies and implementation partners like community health organizations. So far, 61 groups have signed on. The plan is a result of data collection and community outreach, including approximately 2,000 survey results from Milwaukee residents collected over the last year. Regarding this survey, I will quote what you said: “We were very intentional and deliberate with making sure we were in the right spaces to talk to the right people.” What were the right spaces and who were the right people? 

In the past year, we attended nearly 50 events in communities of color—neighborhood events, urban festivals, farmers’ markets, health fairs, Metcalfe Park, Pride Fest, Juneteenth, Heal the Hood and more. We also did broader focus groups. We wanted to find out the views of residents. In the overall survey that included all Milwaukee residents, the top five issues were: healthy foods and nutrition, crime and neighborhood safety, mental health, drug use and healthcare services. Fifty-one percent of respondents were Black. 

So, then your CHIP priorities fall under these five issues?

Yes. But each of the five falls under the three main priority areas. We call them Buckets: Safe and Supportive Communities, Healthy Built Environment and Maternal and Child Health.

Ellie Freeman is a co-chair of the Safe Communities Action Team and your community partner. Robert Walker is her co-chair. Freeman’s vision emphasizes reaching the city's youngest residents. She said, “Issues with reckless driving, kids' attendance at school. We definitely know there's something going on there.” She would like to get more adults from different walks of life involved, particularly those who had experience in dealing with disadvantages in their youth. As I see it, grants and nonprofit money are not going to volunteer street leaders who work the neighborhoods. Can you help these street leaders financially?

Traditionally, the big nonprofits and city agencies distribute their money to smaller nonprofits who have written grants to qualify to receive that money. A really small neighborhood nonprofit doesn’t have grant writers or administrators to do the financials and auditing. And the city agencies have high levels of insurance requirements. As for our grant-giving at the City Health Department, the Federal requirements for us to qualify are long and exhaustive. So, it’s challenging for small nonprofits or individuals to receive this money. 

Anything else you can leave me with?

We know that the color of our skin affects how we access different resources, partners and health systems. We’ve made health equity and racism our main theme. This will make sure we're prioritizing that issue within each of the three main categories: Maternal and Child Health, Safe and Supportive Communities, and Healthy Built Environment, which includes housing, streets and food access.