Commissioner Choucair presents Healthy Chicago at the Colorado Health Symposium - Start Your Engines: Driving Innovation in Health. The words "levers" and "drivers" are frequently used these days to describe strategies to achieve change in health and healthcare. Often in approaching solutions to complex problems, the hardest step is choosing which lever to pull first. Presenters share the levers they focused on to drive innovation and change. From disruptive technologies enabling better results in the healthcare delivery system, to policy and practice shifts aimed at achieving individual and community wellbeing– they provide an inspiring and thought-provoking glimpse of what our health future could look like.

1. Bechara Choucair, MD
Commissioner
Chicago Department of Public Health
@ChiPublicHealth #HealthyChicago
Policy, Systems, Environmental Change &
Technology in Chicago
August 8, 2013
Chicago Department of Public Health
Commissioner Bechara Choucair, M.D.
City of Chicago
Mayor Rahm Emanuel

2. PRESENTATION OUTLINE
1. What Influences Public Health? Policy, Systems &
Environmental Change (PSE)
2. Healthy Chicago Public Health Agenda
3. PSE Successes: Tobacco, Maternal and Child Health, Obesity,
and Adolescent Health
4. Advancing Healthy Chicago Through Technology

3. FACTORS INFLUENCING HEALTH
McGinnis et al. The Case for More Policy Attention to Health Promotion. Health Affairs, Vol. 21
(2)

4. Socioeconomic Factors
Changing the Context
to make individuals’ default
decisions healthy
Long-lasting
Protective Interventions
Clinical
Interventions
Counseling
& Education
Examples
Poverty, education,
housing, inequality
Immunizations, brief
intervention, cessation
treatment, colonoscopy
Fluoridation, trans
fat, smoke-free laws,
tobacco tax
Rx for high blood
pressure, high
cholesterol, diabetes
Eat healthy, be
physically active
Smallest
Impact
Largest
Impact
HEALTH IMPACT PYRAMID

5. POLICY, SYSTEMS &
ENVIRONMENTAL
CHANGE (PSE) •Makes default decisions
healthy
•Big impact & sustainable
•Relatively little time and
resources needed
•Engages diverse stakeholders

6. POLICY, SYSTEMS & ENVIRONMENTAL
CHANGE (PSE)
Policy- Written statement of organizational position,
decision or course of action, including ordinances,
resolutions, mandates, guidelines, & rules
Systems- Changes in organizational procedures
(personnel, resource allocation, & programs)
Environment- Physical, observable changes in the built,
economic, and/or social environment

7. PROGRAMS/EVENTS
• Short term
• Generally has beginning and
end of intervention
• Distinct target audience
• Reliant on funding or other
support for replication
• Doesn‘t impact environment
• Lessons learned can inform
policy
CHANGE IN POLICY, SYSTEMS, ENVIRONMENT
• Institutionalized
• Equitable reach
• Sustained beyond individual
champion or specific funding
• Ongoing without start and stop times
• May still need programmatic
elements to achieve desired impact
WHAT IS THE DIFFERENCE?

8. HEALTHY CHICAGO
PUBLIC 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

10. Increasing
Population Impact
Increasing Individual
Effort Needed
Smoke-free
Campuses
SHIFT TO PSE CHANGE:
TOBACCO PREVENTION
EFFORTS

11. TOBACCO USE

12. TOBACCO USE
SMOKE-FREE CAMPUSES
 3 Colleges / Universities
 5 Hospitals
 6 Behavioral health organizations
 8 Public housing developments

13. TOBACCO USE
Joint Enforcement

14. PSE CHANGE TO SUPPORT HEALTHY
MOTHERS & BABIES
15 hospitals working towards
Baby-Friendly Designation

15. PSE CHANGE IN OBESITY PREVENTION
Chicago
Streets for Cycling Plan 2020

16.  Over 200 miles of on-street
bikeways, including almost 35 miles
of barrier and buffer protected bike
lanes.
 3000 bikes to share at 300 stations
OBESITY PREVENTION

17. Dearborn Street - Before Dearborn Street - After
OBESITY PREVENTION

18. Bike Sharing in Chicago
3,000 bikes
300 stations
by the end of summer 2013
OBESITY PREVENTION

19. Health Goals
 Increase the number
of pedestrian trips for
enjoyment, school,
work, and daily
errands
 Increase the mode
share of pedestrian
trips for enjoyment,
school, work, and daily
errands
OBESITY PREVENTION

20.  13 licensed carts operating
 30 vendors trained
 30 carts planned for 2013
OBESITY PREVENTION

21. OBESITY PREVENTION

22. A Recipe for Healthy Places
•Released in January 2013
•Includes six community- based
planning strategies to support
healthy eating
OBESITY PREVENTION

23. A Recipe for Healthy Places: Strategies
1. BUILD HEALTHIER NEIGHBORHOODS: Focus planning and programs in communities with
an elevated risk for obesity-related diseases
2. GROW FOOD: Create systems of productive landscapes
3. EXPAND HEALTHY FOOD ENTERPRISES: Support businesses and social enterprises that
produce and distribute healthy food
4. STRENGTHEN THE FOOD SAFETY NET: Ensure that residents can eat well regardless of
income
5. SERVE HEALTHY FOOD AND BEVERAGES: Change the culture of eating at work meetings,
festivals, sports gatherings, community activities and places of worship
6. IMPROVE EATING HABITS: Help people discover appealing, nutritious foods
Check out the food plan - www.cityofchicago.org/hed
OBESITY PREVENTION

24. PSE CHANGE TO PROMOTE
ADOLESCENT HEALTH
The Office of Student Health & Wellness:
A Collaboration between the Chicago Department of
Public Health and Chicago Public Schools

25. ADOLESCENT HEALTH
 CPS hires chief health officer
 Dually reports to CDPH
 CDPH creates Adolescent and
School Health Office

26. ADOLESCENT HEALTH
 Revised Wellness Policy
 Competitive Foods Policy
 Expanded STI Screening
 $26M New grants
• CTG – Healthy CPS
• Teen Dating Matters
• Teen Pregnancy
• Farm to School
• Wellness Champions

27. BUILDING ON POLICY
SUCCESSES
Mayor Emanuel Takes Action to Protect
Chicago’s Kids from Menthol Cigarettes

28. BUILDING ON & ENGAGING
PARTNERSHIPS

29. Advancing Healthy Chicago
Through Technology
Data Portal – Flu App
Chicago Health Atlas
FoodBorneChi

30. Chicago Health Atlas is a . . .
collaboration
• Informatics researchers from multiple healthcare
institutions
• Chicago Regional Extension Center (CHITREC)
• Chicago Community Trust
• Chicago Department of Public Health

31. Chicago Health Atlas is a . . .
website
ChicagoHealthAtlas.org

32. Chicago Health Atlas is a . . .
database
• De-identified electronic health record data
for ~1 million Chicagoans
• In-patient and out-patient visits spanning
2006-2011
• Individual patient records matched across
institutions

33. Developing Procedures and
Best Practices
• Public health indicators from City Data Portal can be
viewed for temporal and neighborhood trends
• Incorporating CDC guidelines for classification of map
categories
• How to make metadata easily accessible to users
• How to deal with aggregated geographies and time
periods

34. Health Information Exchange
Neighborhood Pages

35. Health Information Exchange
City Level Comparisons

37. Open Data Portal
Infrastructure
Increase the
availability
of public
health data
through the
City of
Chicago
website.
data.cityofchicago.org

38. Open Data Portal
• Brief (recent) history of open data in Chicago
• Focus on public health indicator data
preparation
• Navigation of the Data Portal and apps

39. Open Data in Chicago
• May 2011
Mayoral Transition Plan
• First 100 days
Data Portal expansion
• December 2012
Open Data Executive Order

40. Public Health Context
• Most frequent requests are for statistics by
neighborhood
• Neighborhood summaries published once
every 3-4 years by paper/PDF
• Many data objects generated in response
to requests

41. Number of customized data objects released to
individuals or institutions (rather than to
public), cumulative, 2011 – May 2013

42. Discussion
• Open data initiatives prompted revisions in
epidemiologic practices
• Use of Data Portal temporally associated with
decrease in releases of customized data objects
• Epidemiologic concepts are being discussed and
implemented in the broader community

43. A Guiding Principle
• What are the data or statistics you’re
using to make decisions?
• Trust the user . . . but also document and
highlight limitations and imperfections

44. Flu App

45. FoodBorne Chicago
 Web Application Based on Machine Learning
 Mathematical algorithm
 App “taught” to ID Food Poison Tweets
 App “learns” relevant Tweets
 Collects Chicago Food Poisoning Tweets
 Human Classifier Determines Responses

46. • Actionable – Submissions are Investigated
• Sentinel for Outbreaks
• Inspection Status:
• Residents See Results Online
• Open 311
• Data Portal
• 50 Inspections Since Released
• Future: Emergency Response, Flu
FoodBorne Chicago

47. FoodBorne Chicago
RESIDENT TWEETS CLICKS & REPORTS ONLINE RESULTS

48. FoodBorne Chicago
@foodbornechi FoodBorneChicago.org

49. @ChiPublicHealth
312.747.9884
facebook.com/ChicagoPublicHealth
HealthyChicago@CityofChicago.org
www.CityofChicago.org/Health