Presentation by Commissioner Choucair at Northwestern University Feinberg School of Medicine Physician Assistant Program for a Public Health Presentation in Behavioral and Preventive Medicine I Course.

1. Chicago Department of Public Health
Commissioner Bechara Choucair, M.D.
City of Chicago
Mayor Rahm Emanuel
Healthy Chicago
August 6, 2013
Bechara Choucair, MD
Commissioner
Chicago Department of Public Health
@chipublichealth
#HealthyChicago

2. Presentation Outline
1. The Role of Public Health
2. The Healthy Chicago Public Health Agenda
3. Partnering with Healthy Chicago

3. Population Health
• The health outcomes of a group of individuals
• Focuses on improving health inequities

4. Core Functions &
Essential Services

5. 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

6. Healthy Chicago:
Promoting Public
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

8. Chicago:
Person, Place, Time
From Sampson R. Great American City. 2012; p. 105 & 106.

11. Tobacco Use

12. Tobacco Use
SMOKE-FREE CAMPUSES
 3 Colleges / Universities
 5 Hospitals
 6 Behavioral Health Orgs
 8 CHA Developments

13. Joint
Enforcement
Tobacco Use

14. Obesity Prevention
 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 by end of
summer

15. Obesity Prevention
Dearborn Street - Before Dearborn Street - After

16. Obesity Prevention
 13 licensed carts operating
 30 vendors trained
 30 carts planned for 2013

17. Obesity Prevention

18. Heart Disease
& Stroke
 Keep Your Heart Healthy initiative
 National prevention effort
 CPR training for students
CDPH, Northwestern and the GE
Foundation Team Up to Save Lives
through Innovative New Heart Initiative

19. HIV Prevention
Integrated services planning to:
 Strengthen prevention
 Increase linkage & retention to care
 Increase treatment access

20. HIV Prevention
More HIV+ MSM are:
 Aware of HIV status
 Accessing care
 Taking HIV medication

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

22. 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

23. Adolescent Health
• From 28 schools to 40+
• 6147 tested in 2011-2012
• 436 positive; 98% treated
STI Education/Screening
• 9,900 students, parents,
educators
• 12 high need middle/high
schools
• Evidence-based curricula,
social media, youth
ambassadors
Teen Dating Violence
• 4500 students in 28
schools
• 18 topical lessons
• Peer group meetings
• Community service
projects
Teen Pregnancy

24.  Outreach to CHA residents
 Partnerships to expand access
 Quality improvement initiatives
Upgraded mammography
machines
beyond p nk
Chicago
!
Cancer Disparities

25.  City partners with 7 FQHCs
 1115 Waiver granted
 CDPH public health services
remain
Access to Care

26. Access to Care
 City mental health sites consolidated to 6
 Capacity for 4,000 clients preserved
$500,000 awarded for expanded psych
services to 8 partners
CARF certification

27. Access to Care
 Oral health services expanded to
106 high schools
 Over 105,000 served in 2012-2013

28. Access to Care
 City invests $1.4M in new
vision program
 30,000 students to get
optometry exam and
eyeglasses as needed

29. Access to Care
ADVOCACYADVOCACY
CHILDREN’S INSURANCE COVERAGECHILDREN’S INSURANCE COVERAGE
COUNTYCARECOUNTYCARE
SMALL BUSINESS ENROLLMENTSMALL BUSINESS ENROLLMENT
ENROLL CHICAGO!

30. Healthy Mothers
& Babies
15 hospitals working
towards Baby-Friendly
Designation

31. Healthy Mothers
& Babies
 33% decline in teen birth rate
50% drop in smoking while pregnant
 10% increase in 1st
trimester care

32. Communicable Disease Control

33. Communicable
Disease Control

34.  Expanded environmental health unit
 $3M lead abatement grant awarded
 Asthma partnership with UIC
 600 radon kits given to residents
 92 tons of household waste collected
Healthy Homes

35. Violence Prevention

36. Public Health
Infrastructure

37. Healthy Chicago
Action Plans

38. Building on Policy
Successes
Mayor Emanuel Takes Action to Protect
Chicago’s Kids from Menthol Cigarettes

39. Building & Engaging Partnerships

40. • Population-wide impact
• Little amount of money
goes a long way
• Sustainable
Why Does the City Focus
on Creating New Policies
Not Just New Programs?

41.  Focus on broad, systemic changes, not individual
interventions or programs
 Upstream solutions to improve health outcomes for
everyone
-Addresses root causes of poor health
Policy, Systems and
Environmental Changes

42. What is the Difference?
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
POLICY OR 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
Engaging in the policy change process, medical
professionals can expand the reach, breadth, and
sustainability of their clinical practice = IMPACT

43. What is the Difference?
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

44. Policy Change Target
Neighborhood Community State National
Impact of
clinical
ractice
PopulationScale
Geographic Scale
Individual
Single Sector
Multiple Sectors
Entire Population
Impact of
clinical
practice
Healthy
Chicago Target
Impact of
policy changes

45. Put your thumbprint on policy!
How can you maximize the
Impact you will have on
society?

46. 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.

47. Not feeling sophisticated
enough 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

48. Become a
Healthy Chicago Partner
• Northwestern: Go 100% smoke-free; test new
policies that improve the food and beverage
environment; etc.
• Adopt Healthy Chicago practices
• Ask if there is an open seat on the CPS School
Wellness Committee for the school in your
neighborhood
• Email us at healthychicago@cityofchicago.org

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