1. Healthy Chicago: Approach to Health Disparities
Chicago Department of Public Health
Patient-centered Medicine Scholars Program
M2 Service Learning Program Seminar
January 24, 2012
Bechara Choucair, MD
Commissioner
Chicago Department of Public Health
@choucair on
Rahm Emanuel Bechara Choucair, MD
Mayor Commissioner

2. Presentation Outline
1. Healthy Chicago Public Health Agenda
2. Addressing Health Disparities through Healthy
Chicago Priority Areas
3. Future Work to Address Health Disparities

3. Presentation Outline
1. Healthy Chicago Public Health Agenda
2. Addressing Health Disparities through Healthy
Chicago Priority Areas
3. Future Work to Address Health Disparities

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

5. HEALTHY CHICAGO
Chicago Department of Public Health
Infrastructure

6. 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

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

8. 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

11. Presentation Outline
1. Healthy Chicago Public Health Agenda
2. Addressing Health Disparities through Healthy
Chicago Priority Areas
3. Future Work to Address Health Disparities

12. Priority: Healthy Mothers and Babies

13. 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)

14. 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

15. 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
• WIC recipients
Pregnancy Risk Assessment Monitoring System, 2000-2006

16. 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)

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

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

19. Priority: Adolescent Health

20. 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 primarily Hispanic (45%), African
American (41%), and low income (85% receive
free/reduced price lunch), providing opportunities
to promote health equity
http://www.cps.edu/SchoolData/Pages/SchoolData.aspx

21. 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

22. 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

23. 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.

24. 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

25. Priority: Tobacco Use

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. Priority: Obesity Prevention

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

34. 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

35. Adult obesity rates vary by
gender, income, and race/ethnicity

36. 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

37. Child obesity rates vary inconsistently by
race/ethnicity, income, and gender
http://www.cdc.gov/nchs/data/databriefs/db51.pdf

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

39. 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

40. 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

41. Priority: Breast Cancer Disparities

42. 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

44. 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

45. 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

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

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

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

49. Priority: HIV Prevention

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

51. 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

52. HIV Infections: Method of Transmission
(Chicago 2009)
Other
1%
Heterosexual Sex
21%
MSM and IDU
2%
Injection Drug Use Male Sex
13% w/Male
63%

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

54. 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% of 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

55. 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

56. Presentation Outline
1. Healthy Chicago Public Health Agenda
2. Addressing Health Disparities through Healthy
Chicago Priority Areas
3. Future Work to Address Health Disparities

57. What’s Next?
• Implementation of Food Plan
• Implementation of LGBT Action Plan
• Immunizations to underserved communities
• Vision services for CPS students

58. What’s Next?
• Engaging community stakeholders in policy
• Healthy CPS (Chicago Public Schools)

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@ChiPublicHealth
312.747.9884
CityofChicago.org/Health
HealthyChicago@CityofChicago.org