Bechara Choucair, MDCommissioner

Chicago Department of Public Health

@choucair #HealthyChicago

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

City of ChicagoMayor Rahm Emanuel

Health Disparities in ChicagoInterdisciplinary Medicine III

Community Engagement and Service UnitFebruary 21, 2014

Outline

1. Healthy Chicago Public Health Agenda and Health Disparities

2. Addressing Health Disparities through Healthy Chicago Priority Areas

Healthy ChicagoPublic Health Agenda and

Health Disparities

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

IT’S NOT JUST ABOUT INDIVIDUAL BEHAVIOR

IT’S ABOUT HOW WE BEHAVE AS A CITY

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?

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)

*From Sampson R. Great American City. 2012; p. 105 & 106.

Chicago: Person, Place, Time*

Economic hardship index

by Chicago community area

(2010 American Community Survey 5-

year estimates)

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Addressing Health Disparities through

Healthy Chicago Priority Areas

Tobacco Use Disparities

• Tobacco use is the most preventable cause of death and its use is associated with many illnesses

• 18% of Chicago adults smoke (2012)

BRFSS, 2012; CDC Health Disparities and Inequalities Report– United States, 2013.

Percent of adults (18 years and older) who arecurrent smokers, Chicago, 2012 (BRFSS)

*Data not available

Highest among:

• Males• Least

educated

Percent

Percent of adults (18 years and older) who arecurrent smokers, Chicago, 2012 (BRFSS)

*Data not available

Highest among:

• Blacks & Whites

Percent

Percent of adults (18 years and older) who arecurrent smokers, Chicago, 2012 (BRFSS)

*Data not available

Highest among:

• Ages 25-45

• Ages 45-64

Percent

Percent of adults (18 years and older) who arecurrent smokers, Chicago, 2012 (BRFSS)

*Data not available

Highest among:• Low

income

Percent

*Data not available

Percent of high school students who smoked cigarettes on at least 1 day (during the 30 days before the survey), Chicago, 2011 (YRBSS)

Highest among

• Males

Percent

*Data not available

Percent of high school students who smoked cigarettes on at least 1 day (during the 30 days before the survey), Chicago, 2011 (YRBSS)

Highest among

• Hispanic students

Percent

*Data not available

Percent of high school students who smoked cigarettes on at least 1 day (during the 30 days before the survey), Chicago, 2011 (YRBSS)

Percent

Highest among

• 11th and 12th graders

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

Prevention Through Policy

Chicago Recognized as Public HealthLeader in Tobacco Control

Surgeon General ties cigarettes to diseases beyond cancer

Obesity Disparities

BRFSS, 2012; CDC Health Disparities and Inequalities Report– United States, 2013.

• Obesity increases the risk of heart disease, cancer, and stroke

• 67% of Chicago adults are overweight or obese (2009)

Percent of adults (18 years and older) who areoverweight or obese, Chicago, 2009 (BRFSS)

*Data not available

Highest among

• Blacks

Percent

Percent of adults (18 years and older) who areoverweight or obese, Chicago, 2009 (BRFSS)

*Data not available

Highest among

• HS Grad/GED

Percent

Percent of adults (18 years and older) who areoverweight or obese, Chicago, 2009 (BRFSS)

*Data not availablePercent * Data not available

Percent of adults (18 years and older) who areoverweight or obese, Chicago, 2009 (BRFSS)

*Data not availablePercent

Estimates of overweight or obesity prevalence for CPS students in kindergarten, 6th or 9th gradesby race-ethnicity, Chicago, 2010-11

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

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 Education Unanimously Adopts New Physical Education Policy

ImprovingPhysical Education

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

Before After

Promoting Physical Activity

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

2014• 750,000+

trips• >1.7 million

miles

• Heart disease and stroke are the first and fourth leading causes of death in the United States

• Death rates are especially high among men and blacks

Heart Diseaseand Stroke Disparities

Age-adjusted death rates (per 100,000)due to heart disease by race-ethnicity,Chicago, 1999-2009

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

50

100

150

200

250

300

350

400

450

329.9

303.5 296.3287.3

278.5

258.6 258.8

238.7228.8 230

220.7

All race-ethnicities NH White NH Black Hispanic United States

Age-adjusted death rates (per 100,000)due to stroke by race-ethnicity,Chicago, 1999-2009

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

10

20

30

40

50

60

70

80

60.2 59.156.9

54.8 55.4

49.4 48.3

43.446.8

44.2

40.3

All race-ethnicities NH White NH Black Hispanic United States

Keep Your Heart Healthy 1,128 screenings

• 12 restaurants at Midway

• 9 million visitors

• 70 restaurants citywide

Service, Technology &Environmental Change

Adolescent HealthDisparities• Behavioral patterns and choices in

adolescence play a role in disease risk later in life

• The large student population at Chicago Public Schools is largely Hispanic (44%), African American (42%), and low income (87% receive free/reduced price lunch), providing opportunities to promote health equity

http://www.cps.edu/SchoolData/Pages/SchoolData.aspx

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 AsianNH Black NH White United States

• 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.

HIV Disparities

• Urban areas such as Chicago have significantly higher rates of HIV than the U.S. as a whole

• Racial disparities are pronounced

HIV infection rate (per 100,000),Chicago, 2011

NH Black

NH White

Hispanic

Male

Female

United State

Chicago

0 10 20 30 40 50 60 70

Highest Among• Males• Blacks

Percent distribution of HIV infection,Chicago, 2011

> 60

50-59

40-49

30-39

20-29

< 20

Heterosexual

MSM & IDU

IDU

MSM

NH White

NH Black

Hispanic

Male

Female

0 10 20 30 40 50 60 70 80 90

Highest among

• Males• Blacks• MSM• Ages 20-29

Percent

• 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

Access to Care Disparities

• Access to care includes gaining entry into the health system, accessing a health care location where services are provided and finding a trusted health care provider

• One out of four adults in the U.S. aged 19–64 years reported not having health insurance at some time during 2011

• Access to care impacts health status, prevention of disease and disability, detection and treatment of illness, preventable death, life expectancy and quality of life

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

Chicago ArtistsHealth Care Town Hall

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

• Mother, infant, and child well-being shapes the future of public health and health disparities

• Critical areas of disparities include racial/ethnic disparities in infant mortality rates, low birth weight babies, and breastfeeding

• The U.S. ranks 49 in the infant death rate (2012)

Disparities in Mother, Infantand Child Health

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

Infant mortality rates by race-ethnicity,Chicago, 1999-2009

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

2

4

6

8

10

12

14

16

18

20

11.5

10.5

98.6

9.6

8.4 8.57.9 7.9 8 8

All race-ethnicities Hispanic NH AsianNH Black NH White United States

Percent of low birth weight births byrace-ethnicity of mother, Chicago, 1999-2009

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

2

4

6

8

10

12

14

16

10.19.7

10.1 10 10.1 10 10.2 10.29.9

9.6 9.7

All race-ethnicities Hispanic NH Asian NH Black NH White United States

• 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

IT’S NOT JUST ABOUT INDIVIDUAL BEHAVIOR

IT’S ABOUT HOW WE BEHAVE AS A CITY

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