Ensuring access to public health genetic services among rural and urban residents of Wisconsin

Advances in genetics have increased demand for clinical genetic services, including screening, testing, counseling, diagnosis, and treatment. These services have historically been provided at academic medical centers, but more recently have expanded to local health departments, tribal health clinics, and the private sector. State governments have played a major role in mitigating inequitable access to clinical genetic services by using Maternal and Child Health block grant funding to support genetic outreach clinics in diverse settings. Since 1979, the Wisconsin Department of Health Services (DHS) has provided population-based clinical genetic services through a network of academic medical centers, genetic specialty clinics, and genetic outreach clinics. This paper shows how public health genetic services in Wisconsin have changed over time, as genetics has expanded to impact the lives of more patients over the life course. The challenges Wisconsin DHS has encountered include lack of provider awareness of genetic services, workforce scarcity, low levels of insurance coverage or reimbursement for genetic services, and the geographic distribution of access points. The state has sought to provide outreach services to residents of sparsely settled rural areas and racial and ethnic minority communities in urban Milwaukee. State and local health departments play an important role in protecting population health by providing care to the medically underserved in rural and urban communities. This paper focuses on the role that state and local agencies can play in mitigating unequal access to cutting edge medical innovations and reflects on the challenges they face in attempting to do so.