1. Chicago Department of Public Health
The Patient Population Symposium:
A Look into Health Disparities In Urban Chicago
February 2, 2013
Bechara Choucair, MD
Commissioner
Chicago Department of Public Health
@choucair on
Rahm Emanuel Bechara Choucair, MD
Mayor Commissioner

2. Presentation Outline
1. Professional Background
2. Healthy Chicago Public Health Agenda and Health
Disparities
3. Addressing Health Disparities through Healthy
Chicago Priority Areas
4. Future Work to Address Health Disparities
5. Opportunity to Engage with Healthy Chicago

3. Presentation Outline
1. Professional Background
2. Healthy Chicago Public Health Agenda and Health
Disparities
3. Addressing Health Disparities through Healthy
Chicago Priority Areas
4. Future Work to Address Health Disparities
5. Opportunity to Engage with Healthy Chicago

4. Presentation Outline
1. Professional Background
2. Healthy Chicago Public Health Agenda and Health
Disparities
3. Addressing Health Disparities through Healthy
Chicago Priority Areas
4. Future Work to Address Health Disparities
5. Opportunity to Engage with Healthy Chicago

5. HEALTHY CHICAGO
CHICAGO DEPARTMENT OF PUBLIC HEALTH
TRANSFORMING THE
HEALTH OF OUR CITY
CHICAGO ANSWERS THE CALL

6. IT’S NOT JUST ABOUT
INDIVIDUAL BEHAVIOR
IT’S ABOUT HOW WE
BEHAVE AS A CITY

7. Evolution of Healthy Chicago
2010 February – May August 2011
2011

8. HEALTHY CHICAGO
Chicago Department of Public Health
Infrastructure

9. Overall Healthy Chicago
Implementation Status

10. 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

11. 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 disparities are inequalities
• U.S. history of discrimination has made race,
ethnicity, sexual orientation, and gender identity
determinants in access to health care and in health
status

12. Promoting Social Justice
Reduces Health Disparities
• Food Stamps (1961)
• Civil Rights Act (1964)
• Voting Rights (1965)
• Desegregation of Medical Facilities (1963-1965)
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

13. All-Cause Mortality by Race/Ethnicity,
Chicago, 2008
Race/Ethnicity Adjusted Rate
per 100,000
Non-Hispanic Black 1049.3
Non-Hispanic White 795.5
Hispanic 499.4
Non-Hispanic Asian 410.1

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

17. Presentation Outline
1. Professional Background
2. Healthy Chicago Public Health Agenda and Health
Disparities
3. Addressing Health Disparities through Healthy
Chicago Priority Areas
4. Future Work to Address Health Disparities
5. Opportunity to Engage with Healthy Chicago

18. Priority: Healthy Mothers and Babies

19. Healthy Mothers and Babies
• 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 birthweight
babies, and breastfeeding
• The U.S. lags behind 46 other nations in the infant
death rate (2011)

20. Chicago Infant Mortality Rate, 2008, by
Race/Ethnicity, per 1000 Births
14 13.3
12
10
Rate per 1000
8
8
6 5.4
4.7
4
2.5
2
0
Chicago Hispanic Non-Hispanic Non-Hispanic Non-Hispanic
Asian Black White

21. Breastfeeding
• Breast-fed infants have reduced risks of many
diseases; babies and mothers experience
emotional, mental health and developmental
benefits
• Breastfeeding increases health equity
• In Illinois, breastfeeding initiation rates are
lowest for non-Hispanic blacks, those with high
school education or less, Medicaid
recipients, and WIC recipients
Pregnancy Risk Assessment Monitoring System, 2000-2006

22. Percent of Illinois Women Who Initiated
Breastfeeding, 2004-2008 Combined
100
92 98
90
90 84 85 87
80
70 64
60
52
Percent
50
Low Income
40
Higher Income
30
20
10
0
White Black Hispanic Asian
Data Source: Pregnancy Risk Assessment Monitoring System (PRAMS)

23. Baby-Friendly Hospital Initiative
• The WHO’s Baby-Friendly
Hospitals program has been
shown to dramatically
increase breastfeeding
• 15/19 Chicago hospitals are
participating
• Through 10 steps, hospitals
provide significant support
for mothers

24. Maternal and Child Home Visits
• 16,672 home visits were provided in 2011 to
pregnant women and new mothers
• Clients are educated on the most current
information on their pregnancy and well-baby care

25. Priority: Adolescent Health

26. Adolescent Health and Disparities
• 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 (45%), African American
(41%), and low income (85% receive free/reduced
price lunch), providing opportunities to promote
health equity

27. Reducing Disparities through School
Policy
• Established Office of Adolescent and School Health
• Hired CPS Chief Health Officer
• Improved nutritional standards for school meals
• Healthy snack and beverage policy

28. Teen Pregnancy
• 39% of Chicago high school students report being
sexually active (2009 YRBS)
• 2009 birth rate for 15-19 year-olds in Chicago was
57/1000
Youth Risk Behavior Survey, 2009

29. Teen Birth Rate by Race/Ethnicity of
Mother, Chicago and the United
100
States, 1999-2009
98.7
91.1
(per 1,000 females aged 15-19 years)
90 90.1 88.6 88.9 88.8
84.9 86.3
81.9 82.5 83.3
80 80.3 79.2
76.8 77.7
72.8 73.9 75
70
68.6
Teen Birth Rate
60 60.5
50
40
30
26
23
20 19.5 19.3
16.4 15.8 14.2 15 12.8 11.7 12
10
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
United States Chicago: All race-ethnicities Chicago: Hispanic
Chicago: Non-Hispanic Asian Chicago: Non-Hispanic Black Chicago: Non-Hispanic White
Births in Chicago, 1999-2009 , Chicago Department of Public Health, 2012.

30. Teen Pregnancy, STIs and Dating Violence
Initiatives
• Teen pregnancy prevention initiative
– 4500 students received curriculum and supports
(2012)
• STI screenings
– 9,215 educated; 6,147 screened; 436 identified
• Teen dating violence prevention
– 5000 youth and parents*
*anticipated 2012-2016

31. Priority: Tobacco Use

32. Tobacco Use Disparities
• Tobacco use is the most preventable cause of death
and its use is associated with many illnesses
• 21% of Chicago adults smoke (2010)
• National data show disparities across levels of
education and income, as well as increased smoking
for LGBT population
BRFSS, 2010; CDC MMWR: http://www.cdc.gov/mmwr/preview/ mmwrhtml/
mm6144a2.htm#tab

33. Percentage of Adult Cigarette Smokers,
U.S., by Education, 2010
Education Percent Who Smoke
No HS Diploma 25.1%
HS Graduate 23.8%
Some College 23.2%
Associate's Degree 18.8%
Undergraduate Degree 9.9%
Graduate Degree 6.3%
Vital Signs: Current Cigarette Smoking Among Adults – U.S., 2005-2010, MMWR,
September 9, 2011

34. Percentage of Adult Cigarette Smokers,
U.S., by Income, 2010
Poverty Status Percent Who Smoke
At or above poverty level 18.3%
Below poverty level 28.9%
Unspecified 16.0%
Vital Signs: Current Cigarette Smoking Among Adults – U.S., 2005-2010, MMWR,
September 9, 2011

35. Expanding Smoke-free Policies
Smoke-free Policy Adoption:
• Over 1,600 units of public
housing and nearly 3,250 units
of multi-unit private housing
• 6 hospital campuses
• 3 higher education campuses
• 6 substance abuse & mental
health service agencies

36. Smoking Cessation Services for
Vulnerable Populations
• Dedicated resources to support cessation of
clients/staff at smoke-free behavioral health facilities
• Prevention and cessation services for Chicago
Housing Authority residents
• Smoking cessation clinics for LGBT persons, in
partnership with Howard Brown Health Center
• Nicotine replacement therapy to nearly 15,000
persons receiving services at community health
centers and Women, Infant, and Children’s (WIC)
sites

37. New Tobacco-Related Legislation
and Enforcement
• Business license reform ordinance includes
measures to address illegal tobacco sales
-Fine increase for illegal sales
-Additional fines for repeat offenders
• City and county inspectors can write tickets for both
County and City violations at the same time
• Tobacco vending machines are now banned in
Chicago

38. Priority: Obesity Prevention

39. Obesity Prevention
• Obesity increases the risk of heart
disease, cancer, and stroke
• 33.6% of Chicago adults are overweight; 28.7%
are obese (2010)
• Racial, ethnic, income, and gender differences
for BMI
Source: BRFSS, 2010.

40. Prevalence of Obesity among Adults,
by Race/Ethnicity, U.S. and Illinois
2006-2008
40
35.7
35 33.3
30.7
30 28.7
Percentage
25 23.7 23.4
20 U.S.
15 Illinois
10
5
0
White Black Hispanic
Source: BRFSS

42. Prevalence of Obesity in 2-19 Year-Olds in
the U.S., 2009-2010
Source: Ogden et al., JAMA 2012. Online via http://www.nmqf.org/presentations/12OgdenCJCP3.pdf

43. http://www.cdc.gov/nchs/data/databriefs/db51.pdf

44. Food Access in Chicago Communities
Data provided by Chicago’s Department of Housing and Economic Development, 2012.

45. Addressing Access to Healthy Food
• Urban agriculture ordinance
• Produce carts
• Healthy corner store project
• New grocery stores in low food
access areas
• Produce added to 19 stores
• Farmer’s markets in underserved areas

46. Promoting Healthy Lifestyles
• PlayStreets provides
safe, supervised
outdoor spaces for
play and physical
activity
• Day care center
standards for
nutrition, physical
activity, and screen
time

47. Priority: Breast Cancer Disparities

48. Breast Cancer Disparities
• In 1980, breast cancer mortality rates for black and
white women in Chicago were equal (38/100,000)
• By 2005, the mortality rate of black women was
twice that of the white rate
(41.3/100,000 vs. 19.2/100,000)
• The black rate remained about constant while the
white rate declined by almost one-half

50. Three Hypotheses Explaining Chicago
Breast Cancer Disparities
• African American women receive fewer
mammograms
• African American women receive mammograms of
inferior quality
• African American women have inadequate access to
quality treatment once breast cancer is diagnosed

51. Improving Access to and Quality of
Mammography
• The Chicago Breast Cancer Quality Consortium
• The Breast Cancer Quality Screening and Treatment
Initiative
• Partnership with Chicago Housing Authority
• Training for radiology technologists

52. Addressing Breast Cancer Disparities
through Policy
• Expanding CDPH’s partnerships with hospitals
• Improving Medicaid reimbursement for
mammograms

53. Breast Cancer Disparities Surveillance
• Applied for State registry breast cancer
incidence data

54. Breast Cancer Disparities Advisory Group
• Breast cancer stakeholders provide input on our
activities
• Survivors, family members, advocates, service
providers, researchers, & media

55. Priority: HIV Prevention

56. HIV Disparities
• Urban areas such as Chicago have significantly
higher rates of HIV than the U.S. as a whole
• Racial disparities are pronounced

57. HIV Infection Rates per 100,000
population in Chicago (as of 8/25/2011)
1400
1226.2
1200
Rate per 100,000
1000
800 756.5
632.5
600
444.4 430.1
400
200
0
Chicago Non-Hispanic Non-Hispanic Hispanic Non-Hispanic
Black White Other

58. Transmission Group for HIV Infections,
Chicago, 2009
100
90
80
70
61.9
60
Percentage
50
40
30
21.2
20 12.4
10 2.1 0.6
0
Male Sex w/Male Injection Drug Use MSM and IDU Heterosexual Other

59. HIV Behavioral Surveillance
• CDPH conducts annual
behavioral surveys among
populations at increased
risk for HIV

60. HIV Behavioral Surveillance Findings,
Chicago, 2008-2011
• Young Black MSM only subgroup with annual
increases in new HIV diagnoses
• 20% of MSM in Chicago have HIV
• 59% MSM report having unprotected sex
• 53% of MSM report using illicit drugs
• Increase in awareness of HIV-infection, being in care,
and taking antiretroviral therapy between 2008 and
2011

61. HIV Prevention and Care
• Implementation of Enhanced Comprehensive HIV
Prevention Plan (ECHPP)
• Partner services and linkage to care
• Condom accessibility
• Provider training and capacity-building

62. Presentation Outline
1. Professional Background
2. Healthy Chicago Public Health Agenda and Health
Disparities
3. Addressing Health Disparities through Healthy
Chicago Priority Areas
4. Future Work to Address Health Disparities
5. Opportunity to Engage with Healthy Chicago

63. What’s Next?
• Implementation of Food Plan
• Implementation of LGBT Action Plan
• Immunizations to underserved communities
• Vision services for CPS students
• Engaging community stakeholders in policy
• Healthy CPS (Chicago Public Schools)

64. Presentation Outline
1. Professional Background
2. Healthy Chicago Public Health Agenda and Health
Disparities
3. Addressing Health Disparities through Healthy
Chicago Priority Areas
4. Future Work to Address Health Disparities
5. Opportunity to Engage with Healthy Chicago

65. Opportunity to Engage
with Healthy Chicago
• Policy: Advocacy Efforts
• Program: Grants & Partnerships
• Education/Public Awareness: Outreach Efforts

66. Twitter Chats
CDC NPIN’s #NPINChat
62,350 Twitter Accounts Reached
635,491 Total Potential Impressions
Chat served to highlight the STD
education and testing
opportunities that arise from health
department and school board
collaborations.
@ChiPublicHealth
@Choucair

67. Engage with Facebook

68. Engaging Academic Health Centers
• To understand and capitalize on the
intersection between public health and
primary care
• To explore health outcomes, community
resources and assets
• To translate research into local policy

69. Academic Partnerships
• Health-App-Chicago - Health Practices Addressing
Public Health Priorities in Chicago
• U of C’s Center for Diabetes Translational Research
Collaboration
• Northwestern University Feinberg School of Medicine
• UIC’s Institute for Health Research and Policy
• Students for Healthy Chicago

70. Students for Healthy Chicago
• Northwestern University Feinberg School of Medicine
• University of Chicago Pritzker School of Medicine
• Rush Medical College
• Loyola University Stritch School of Medicine
• University of Illinois College of Medicine
• Northwestern University School of Law
• University of Chicago School of Social Service
Administration (G-PHAP)
• The John Marshall Law School
• Northwestern University Medill School of Journalism

71. facebook.com/ChicagoPublicHealth
Gplus.to/ChiPublicHealth
@ChiPublicHealth
312.747.9884
CityofChicago.org/Health
HealthyChicago@CityofChicago.org