State of Chicago’s Healthcare System

Gold Humanism Society Lori Ann Roscetti Annual Memorial Lecture on

Ethical & Humanitarian Issues in MedicineFebruary 24, 2014Bechara Choucair, MD

CommissionerChicago Department of Public Health

@Choucair #HealthyChicago

Healthy ChicagoPublic Health Agenda• Released in August 2011

• Identifies priorities for action for next 5 years

• Identifies health status targets for 2020

• Shifts us from one-time programmatic interventions to sustainable system, policy and environmental changes

National Public Health Objectives: Healthy People 2020

• Social determinants of health is new

• Goal: Create social and physical environments that promote good health for all

Factors Influencing Health

Genetics; 30%

Medical Care; 10%

Social Circumstances15%

Behavioral Choices; 40%

Environmental Condi-tions; 5%

Health Impact Pyramid

Increasing

Population Impact

Increasing Individual

Effort Needed

Frieden T. American Journal of Public Health | April 2010, Vol 100, No. 4

Counseling& Education

Clinical Interventions

Long-Lasting Protection

InterventionsChanging the Context to Make Individuals’ Default Decisions

Healthy

Socioeconomic Factors

Healthy Chicago:Promoting Health Equity

• Improvement in the public’s health requires a commitment to health equity and the elimination of racial and ethnic disparities

• Healthy environments are key

• Persons of lower SES are often exposed to fewer factors that promote health and more factors that damage health

• Healthy choices must be easy and desirable

Social Justice and Health Disparities

• Health disparities are differences in the rate of disease, incidence, prevalence, morbidity, mortality or survival rates

• The root causes of many disparities are inequities

• U.S. history of discrimination has made race, ethnicity, sexual orientation, and gender identity determinants in access to health care and in health status

Promoting Social Justice Reduces Health Disparities

• Food Stamps (1961)

• Civil Rights Act (1964)

• Voting Rights (1965)

• Desegregation of Medical Facilities (1963-1965)

• Affordable Care Act (2010)

Gamble and Stone, U.S. Policy on Health Inequities: The Interplay of Politics and Research, Journal of Health Politics, Policy and Law, Vol. 31, No. 1, Feb. 2006

Chicago community areas by racial-ethnic group accounting for majority of residents (2010 U.S. Census)

Healthy Chicago Targets

Tob

acco U

se

Prevention Through Policy

More Smoke-Free EnvironmentsUniversity of Illinois at Chicago became a Tobacco-Free Campus for total of:• 5 smoke-free institutions of higher

learning• 6 smoke-free hospital campuses

Chicago Housing Authority designated 2 new 100% smoke-free complexes for

total of:• 610 smoke-free units in six

developments• 3,250 units of private multi-unit

housing

Chicago Recognized asPublic Health Leader in Tobacco Control

Surgeon General ties cigarettes to diseases beyond cancer

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

5

10

15

20

25

30

23.1

19.0

24.323.2

24.4

27.5

19.1

21.5 21.9 22.4

19.4 20.322.6

18.0

Chicago

Percent of adults (18 years and older)who are current smokers, Chicago,1999-2012 (BRFSS)

Increasing Access to Healthy Foods

Build Healthier Neighborhoods

Grow Food

Expand Healthy Food Enterprises

Strengthen the Food Safety Net

Serve Healthy Food and Beverages

Improve Eating Habits

Physicians in Practice:Increasing Access to Healthy Foods

Modal Hierarchy:Pedestrian First

Before After

Promoting Physical Activity

• 3,000 bikes• 300 stations• 100 more in

2014• 750,000+

trips• >1.7 million

miles

23

.

Focusing On Our Children

24

.

Focusing On Our Children

Physicians in Practice:PlayStreets

New Physical Education Policy

• Establishes high standards for physical education instruction and instructional practices for schools across the district. 

• Requires at least 30 minutes of daily physical education (or equivalent of 150 minutes per week) at the elementary school level.

• Requires daily physical education in the same time increments as other core courses at the high school level (grades 9-12). Some individual student waivers are available.

January 22, 2014Chicago Board of Health Unanimously Adopts New Physical Education Policy

ImprovingPhysical Education

Estimates of obesity prevalence for CPS students in kindergarten, 2003-12

Keep Your Heart Healthy 1,255 Screenings to Date

Service, Technology &Environmental Change

• 12 restaurants at Midway

• 9 million visitors

• 70 restaurants citywide

• Over 5,200 15-19 year old girls give birth annually (2009)

• Over 10,000 cases of chlamydia and 3,200 gonorrhea cases occur among 13-19 year olds.

Prevention Through Policy

Teen Outreach Program (TOP)

• 3,000+ students in service learning clubs

• 60,000+ hours of community service in addition to the TOP curriculum

• More than 200 TOP students trained to become Peer Health Ambassadors.

Teen birth rates by race-ethnicity of mother,Chicago, 1999-2009

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

20

40

60

80

100

120

85.280.5

76

69.365.6 64.8

61.965.1 66.1

61.457

All race-ethnicities Hispanic NH Asian NH Black NH White

Physicians in Practice:Mikva Challenge Teen Health Council

• Over 9M condoms distributed

• $36M in prevention, service and housing funding

• Network of over 70 agencies

In past 10 years,, reported HIV/AIDS cases down by 46% and 43% respectively• Youth only group continuing to see

a rise in new HIV infections.

• 84% of persons diagnosed with HIV in 2010 were linked to medical care within 3 months.

• Less than half of all people living with HIV are taking HIV medications or are virally suppressed

STI Initiative• 42 schools• 11,000+

educated• 6,915 screened

o 545 w/ chlamydia

o 137 w/gonorrhea

o 65 had both infections

Distribution of uninsured adults byrace-ethnicity, Chicago, 2010-2011

Vision Services

• 225 Schools• 21,125 Total Exams• 13,513 Total Glasses• Investment increased to $2M to

support 45,000 students in 2014.

Oral Health Services• 7% increase in students served

• 121,479 students in 595 schools

• 356,736 sealants applied

• Expansion to include CPS high schools

• 15,000 home visits conducted

• 95% of WCH clients enrolled in both WIC and Family Case Management

• ~28,000 pregnant women & infants enrolled in WIC with 125,000 visits

15th hospital in pathway

$200,000 grant to serve 1,500 women

Services, Systems &Public Awareness

Physicians in Practice:CAHISC

2012

High Risk Inspections Completed

Gains in Food Protection

.

Dr. Black to lead Carbapenem-resistant Enterobacteriaceae (CRE) Task Force launched May 2013.

West Nile Virus

• 290 traps set

• 105,085 catch basins monitored

• 33 WNV cases reported

Other Communicable Disease Control Successes

• 12 high need middle/high schools

• 788 middle school students completed program

• Parent training initiated

• 13 Youth Ambassadors trained

Teen Dating Violence

Prevention Through Partnerships

5,340 units

inspected

Environmental Health

390,439 lbs recycled in 2013

Permitting & Inspections

Preparing Together

236 trained in Psychological

First Aid

Back to SchoolImmunizations

backtoschool.cdphapps.org data.cityofchicago.org

PredictingCigarette Sales Violations

Advancing Healthy ChicagoThrough Technology

Physicians in Practice:Innovation in Public Service

"This is an important achievement and recognition that highlights the city of Chicago's ongoing commitment to health and wellness." --Mayor Rahm Emanuel

Why Healthy Chicagois Making a Difference

Humanism Compassion

Environmental Changes

Social and Behavioral

Partner Engagement

City Participation is Growing

Public Health

Public Schools

Transportation

Planning & Development

Park District

Business Affairs

Family Service

s

Mayors’ Office

Police

Disabilities

Public Housing

Law

Cultural Affairs

Public Transit

Aviation

Buildings

Facilities/Fleet

Streets & Sanitation

Healthy Chicago PartnershipsAre Primary

Put your thumbprint on policy!

How can you maximize the Impact you will have on society?

Why should you get involved?

Primary prevention part of mission?• Health care professionals have a natural incentive to

improve the health of all people and the environment in which we live.

Position to influence behavior?• It is essential to lead by example.

• People trust doctors with their lives – literally.

• People look to their doctors for health information.

• Time and time again, political polling demonstrates that doctors are among the MOST RESPECTED sources of health information, which puts you in a unique position to influence public policy.

• Healthcare system will bear burden of chronic disease.

Not feeling sophisticatedenough to play at the

State and Federal level?Work toward institutional policy

changes!

Little p: Institutional policies Worksite policies/investments NGO policies Individual school policies Norms and standards that drive other action

BIG P: Public Policy Legislation Regulations Zoning/land use Taxes Public budgets

Become a Healthy Chicago Partner• Adopt Healthy Chicago Practices

• Consider JoiningStudents for Healthy Chicago Committee

• Email us athealthychicago@cityofchicago.org

IT’S NOT JUST ABOUT INDIVIDUAL BEHAVIOR

IT’S ABOUT HOW WE BEHAVE AS A CITY

facebook.com/ChicagoPublicHealth@ChiPublicHealth

312.747.9884

www.CityofChicago.org/Health

HealthyChicago@CityofChicago.org