Public Health and Vulnerable Populations

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

City of ChicagoMayor Rahm Emanuel

Healthy ChicagoPublic Health and Vulnerable Populations

July 16, 2013

Bechara Choucair, MDCommissioner

Chicago Department of Public Health

Presentation Outline

1. Public Health Overview

2. Housing, Health, and Vulnerable Populations

3. Healthy Chicago Public Health Agenda

4. Current Work and Accomplishments

Population Health

Kindig D, Stoddart G. What is population health? American Journal of Public Health 2003 Mar;93(3):380–3.

• The health outcomes of a group of individuals, including the distribution outcomes within the group

• Focuses on improving health inequities

Core Functions & Essential Services

Chicago Department of Public Health

Mission: To make Chicago a safer and healthier place by

working with community partners to promote health, prevent disease, reduce environmental hazards and ensure access to health care for all Chicagoans.

Presentation Outline

1. Public Health Overview

2. Housing, Health, and Vulnerable Populations

3. Healthy Chicago Public Health Agenda

4. Current Work and Accomplishments

Factors Influencing Health

Housing Influences Health

Pollack C, et al. Where We Live Matters for Our Health: The Links Between Housing and Health. Robert Wood Johnson Foundation. September 2008.

• Safe homes that are free from physical hazards

• Positive physical, environmental, social, and economic conditions in neighborhoods

• Housing costs less than 35% of a family’s income

Conditions within the Home

• Lead-based paint affects brain and nervous system development

• Substandard housing conditions can lead to respiratory conditions such as asthma

• Radon, pollutants, and asbestos can lead to cancers and respiratory illness

• Steep staircases, lack of security devices, and substandard heating can cause injuries

Neighborhood Conditions

• Neighborhood crime, violence, pollution• Safe places to play and exercise• Grocery stores selling fresh produce• Convenience stores, fast food outlets &

liquor stores• Employment, transportation & health care• Strong neighborhood ties and high levels of trust

Housing Affordability

• “Affordable housing” is less than 35% of income• Shortages of affordable housing limits choice of

neighborhood• High-cost housing prevents families from meeting

other basis needs, including nutrition, heat, health care, prescriptions

• Housing affordability impacts homelessness

Homelessness and Health

• Respiratory diseases, HIV/AIDS, alcohol and drug dependence, mental health problems, accidents and violence are more common

• Homes are important for overall well-being, providing a sense of security, privacy, and control

• The majority of homeless patients at FQHCs do not have health insurance or ability to pay for health care

• Life expectancy is about 30 years less for those on the streets

Poverty in Adults Connected to Poor Health Status and Health

Behaviors

• Higher rates of chronic health problems

• Higher rates of negative health behaviors

• Less likely to have access to health care and medication

In poverty Not in poverty

Depression 31% 16%

Obesity 32% 26%

Smoking 33% 20%

Uninsured 38% 14%

Can’t afford medicine

38% 17%

Data Source: Gallup-Healthways Well-Being Index, 2012

Uncontrolled Diabetes Hospital Discharge Rates, Chicago Residents, 2007

Uninsured Have Higher Rates of Morbidity and Mortality

In 2010, over 26,000 people between ages of 25-64 died prematurely due to lack of health coverage•5 times less likely to have regular source of care•4 times more likely to delay/forgo preventive care screening due to cost

o Uninsured women half as likely to get mammogram than insured

Data Source: Dying For Coverage: The Deadly Consequences of Being Uninsured. Families USA. June 2012

Uninsured Have Higher Rates of Morbidity and Mortality

• 6 times as likely to go without needed medical care• More likely to be diagnosed at advanced stage of

illnesso At least 25 percent more likely to die prematurely

• 60 percent of uninsured report problems will medical bills or medical debt

Data Source: Dying For Coverage: The Deadly Consequences of Being Uninsured. Families USA. June 2012

Racial/Ethnic Minorities More Likely to have Poor Health

OutcomesAll Cause Mortality, 2008

Race/Ethnicity Adjusted Rate per 100,000

Non-Hispanic Black 1049.3Non-Hispanic White 795.5Hispanic 499.4Non-Hispanic Asian 410.1

Data Source: Illinois Department of Public Health, 2008 Vital Statistics

Presentation Outline

1. Public Health Overview

2. Housing, Health, and Vulnerable Populations

3. Healthy Chicago Public Health Agenda

4. Current Work and Accomplishments

Healthy Chicago Policy 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

HEALTHY CHICAGOHEALTHY CHICAGOChicago Department of Public HealthChicago Department of Public Health

Infrastructure

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Healthy Chicago Partnerships

Presentation Outline

1. Public Health Overview

2. Housing, Health, and Vulnerable Populations

3. Healthy Chicago Public Health Agenda

4. Current Work and Accomplishments

Access to Care

• Provide immunizations, family case management, WIC, HIV primary care, STI testing, and mammography

• Serve mental health consumers through six clinics, prioritizing the uninsured

• Invested $500,000 for expanded psychiatry services awarded to 8 partners

• Partnered with FQHCs to provide primary care services for the uninsured

Access to Care

• Over 113,000 students from 504 schools received dental health services through school-based oral health program (2011-2012)

• New vision program will serve 30,000 students • Collaborate with state and local health authorities and

providers to promote Medicaid Expansion and the Marketplace

Patient Protection and Affordable Care Act (ACA)

• Health care reform will provide access to care for many at-risk populations o Medicaid Expansiono Health Insurance Marketplace• We are working to ensure that enrollment

agents will be available at area shelters • Health care system will be challenged to

provide comprehensive health care for formerly uninsured

• Public health will continue to address population health needs for this vulnerable group

Adolescent Health

Chicago Public Schools (CPS) Partnership•85% of CPS students receive free/reduced price lunch•Established Office of Adolescent and School Health

o Oral health, vision services, teen pregnancy, and sexually transmitted infection prevention services

•Hired CPS Chief Health Officer•Teen Pregnancy Prevention Initiative

HIV Prevention

• In 2012, CDPH and delegate agencies provided housing services to over 2,600 residents, HIV testing to 43,000 persons, and STI clinical care to 21,000 persons.

• Integrated planning for prevention, care and housing services for HIVo Strengthen prevention o Increase linkage & retention to careo Increase treatment access

Violence Prevention

• CeaseFire partnership• Domestic violence assistance• Data collection partnership with police department• Psychological First Aid training• Chicago Dating Matters Initiative, $1.75 M federal

grant

Healthy Chicago Action Plans

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