Chicago Department of Public Health Commissioner Bechara Choucair, M.D. City of Chicago Mayor Rahm Emanuel Healthy Chicago Public Health and Vulnerable Populations July 16, 2013 Bechara Choucair, MD Commissioner Chicago Department of Public Health
Jan 16, 2015
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
22
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
Obesity Prevention
Neighbor Carts
•Produce carts with whole fruits and vegetables•Vendors are homeless and at-risk individuals•At least one-half of the carts must be placed in neighborhoods underserved by grocery stores•30 carts operating by the end of 2013
Healthy Chicago Action Plans
Become a Healthy Chicago Partner
• Partner to address specific health issues or multiple Healthy Chicago priorities
• Adopt Healthy Chicago policies and practices in your agency
• Receive our monthly updates and share your ideas
facebook.com/ChicagoPublicHealth@ChiPublicHealth
312.747.9884
www.CityofChicago.org/Health