transforming the health of the community snively lecture

Chicago Department of Public HealthCommissioner Bechara Choucair, M.D.

City of ChicagoMayor Rahm Emanuel

Bechara Choucair, MDCommissioner

Chicago Department of Public Health

@choucair #HealthyChicago

TRANSFORMING THE HEALTH OF THE COMMUNITY

SNIVELY LECTURE FOR UC DAVIS COMMUNITY

November 19, 2013

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

FACTORS INFLUENCING HEALTH

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

HEALTH IMPACT PYRAMID

Socioeconomic Factors

Changing the Contextto make individuals’ default

decisions healthy

Long-lasting Protective Interventions

ClinicalInterventions

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

POLICY, SYSTEMS & ENVIRONMENTAL CHANGE (PSE)

• Makes default decisions healthy

• Big impact & sustainable

• Relatively little time and resources needed

• Engages diverse stakeholders

Environment

Systems

Policy

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

POLICY, SYSTEMS & ENVIRONMENTAL CHANGE (PSE)

HEALTHY CHICAGOPUBLIC HEALTH AGENDA

• Released in August 2011

• Identifies priorities for action for next 5 years

• Identifies health status targets for 2020

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

Chicago Department of Public HealthCommissioner Bechara Choucair, M.D.

City of ChicagoMayor Rahm Emanuel

PHAB ACCREDITATION

1st Big City Health Department

toReceiveNational

Accreditation

Innovation & Change Requires a Strong Public Health Infrastructure

TOBACCO USE

TOBACCO USE

SMOKE-FREE CAMPUSES

• 3 Colleges / Universities • 6 Hospitals • 6 Behavioral Health

Organizations• 686 Public Housing Units• Over 3,250 units of private

smoke-free housing

TOBACCO USE

Joint Enforcement

Reducing Tobacco Access

and Affordability

MAYOR EMANUEL PROPOSES TOBACCO TAX INCREASE • A tax increase on all

cigarette products is one of many policy recommendations adopted by the Chicago Board of Health.

• Single most effective way to prevent kids from picking up the habit.

• City will use $2 Million to expand vision service for low-income children.

Currently, a pack of cigarettes is over $10 in the City of Chicago

Before tax: $4.00 +

Federal tax: $1.01

Illinois tax: $1.98

Cook County tax: $3.00

City tax: $0.68

MAYOR’S PROPOSED TOBACCO TAX INCREASE

Taxes Total $6.67

President Obama has recently called for a $0.94 increase in the federal tax

Tax increased from $0.98 to $1.98 in June 2012

Tax increase from $2.00 to $3.00 in March 2013

Last increase was $0.20 in 2006 under Mayor Daley

Mayor Emanuel has recently proposed a $0.75 increase in the City’s tax

Source: Campaign for Tobacco-Free Kids; Chicago Tribune

Cost breakdownFor pack of cigarettes

• Reduce youth smoking by 4.8%

• Prevent 6,400 Chicago children from picking up the habit

• Save 3,500 lives

• Save $229.33 million in long-term health care costs

TAX INCREASE WILL SAVE LIVES AND SAVE MONEY

MENTHOL USE AMONG YOUTH

Menthol

• Menthol’s minty flavor & Cooling sensation…

Attracts

• Covers up the tobacco taste…

Youth

• To reduce throat irritation associated with smoking.

If smokers begin before 18,75% more likely to smokeas adults

African AmericanYouth Who Smoke72% use menthol

LGBTYouth Who Smoke71% use menthol

Who would not be smokers!

MENTHOL USE AMONG YOUTH

If smokers begin before 18,75% more likely to smokeas adults

African AmericanYouth Who Smoke72% use menthol

LGBTYouth Who Smoke71% use menthol

MAYOR EMANUEL TAKES BOLD ACTION ON MENTHOL! • Less than 48 hours

after the FDA’s report was released, Mayor Rahm Emanuel took swift action, directing the Chicago Board of Health to seek local policy options for curbing the use of menthol cigarettes among youth.

• No other city or state has attempted to regulate the sale or distribution of menthol.

#NoMoreMenthol

TOBACCO USE

PSE CHANGE IN OBESITY PREVENTION

ChicagoStreets for Cycling Plan 2020

PSE TO SUPPORT HEALTHY MOTHERS & BABIES

15 hospitals working towards Baby-Friendly Designation

Over 200 miles of on-street bikeways, including almost 35 miles of barrier and buffer protected bike lanes.

OBESITY PREVENTION

Dearborn Street - Before Dearborn Street - After

OBESITY PREVENTION

Bike Sharing in Chicago

3,000 bikes

300 stations

OBESITY PREVENTION

OBESITY PREVENTION

14 licensed carts operating 41 vendors trained 30 carts planned for 2013

OBESITY PREVENTION

Increasing Healthy Food Access

OBESITY PREVENTION

A Recipe forHealthy Places

• Released in January 2013

• Includes six community- based planning strategies to support healthy eating

OBESITY PREVENTION

A Recipe for Healthy Places: Strategies1. Build Healthier Neighborhoods

2. Grow Food

3. Expand Healthy Food Enterprises

4. Strengthen the Food Safety Net

5. Serve Healthy Food and Beverages

6. Improve Eating HabitsCheck out the food plan - www.cityofchicago.org/hed

OBESITY PREVENTION

OBESITY PREVENTION

Obesity rates for CPS Kindergartners continues to drop!

Results include:1 in 4 (2003) 1 in 5 (2012).

1,000 more CPS kindergartners at a healthier weight

Improvements seen for every racial/ethnic group

OBESITY PREVENTION

PSE CHANGE TO PROMOTE ADOLESCENT HEALTH

Public Health Commissioner

Office of Adolescent and School

Health

Public Schools CEO

Office of Student Health & Wellness

The Office of Student Health & Wellness:

A Collaboration between the Chicago Department of Public Health and

Chicago Public Schools

ADOLESCENT HEALTH

• CPS hires chief health officer

• Dually reports to CDPH

• CDPH creates Adolescent and School Health Office

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

BUILDING ON POLICY SUCCESSES

Mayor Emanuel Takes Action to Protect Chicago’s Kids from Menthol Cigarettes

ADVANCINGHEALTHY CHICAGOTHROUGH TECHNOLOGY

WHEN THE CITY…..

CHICAGO BENEFITS FROM….

Collaborative

Innovation

PublicHealth

Academia/

Business

NonProfits/CBOs

Government

Civic Tech

Community

ADVANCING HEALTHY CHICAGOTHROUGH COLLABORATION

HACK NIGHTS

CHICAGO HEALTH ATLAS IS A

collaboration• Informatics researchers from multiple healthcare institutions

• Chicago Health Information Technology Regional Extension Center (CHITREC)

• Chicago Community Trust

• Chicago Department of Public Health

CHICAGO HEALTH ATLAS IS Adatabase

• 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

CHICAGO HEALTH ATLAS IS Awebsite

ChicagoHealthAtlas.org

OPEN DATA PORTAL

data.cityofchicago.org

APPLICATIONS USING MAPS • Local

Service for residents to find free vaccinations in their neighborhoods

• Platform Independent

Web app works on any computer Operating Systems (PC & Mac) or Mobile (iOS, Android, Windows, Blackberry)

• Retail Partnerships

Flu App has over 330 locations!

FLU SHOT FINDER BACK to SCHOOLIMMUNIZATION FINDER

• Web app 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

APP USINGMACHINE LEARNING &SOCIAL MEDIA

FOODBORNE CHICAGO

RESIDENT TWEETS CLICKS & REPORTS ONLINE RESULTS

FOODBORNE CHICAGO

BUILDING ON & ENGAGING PARTNERSHIPS

@ChiPublicHealth

312.747.9884

facebook.com/ChicagoPublicHealth

HealthyChicago@CityofChicago.org

www.CityofChicago.org/Health