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Webinar: Healthy Chicago for Healthy Heople 2020 State Coordinators
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Webinar: Healthy Chicago for Healthy Heople 2020 State Coordinators

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Commissioner Choucair presenting on Healthy Chicago and how it addresses the social determinants of health within Healthy Chicago, how the leadership at the top worked to accomplish Healthy Chicago, …

Commissioner Choucair presenting on Healthy Chicago and how it addresses the social determinants of health within Healthy Chicago, how the leadership at the top worked to accomplish Healthy Chicago, and a review of Healthy Chicago.

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  • --I’m going to start by talking about the development of Chicago’s public health agenda, Healthy Chicago.
    --I will then discuss the social determinants of health framework that guides Healthy Chicago.
    --Last I will give you some examples of the work that we have been doing in Tobacco Use, Obesity, and Adolescent Health.
  • The Healthy Chicago public health agenda was released in August 2011, and serves as our framework for how the Chicago Department of Public Health will lead and work with partners to improve the health and well-being of Chicagoans.
  • The importance of leadership in accomplishing major public health goals must be stressed. Leadership is central to our work, from support for funding, innovative policy and systems changes, and in creating and sustaining partnerships.
    We had the support for public health from the very top, which has been crucial in the development of Healthy Chicago and in our many accomplishments to date.
    Chicago Mayor Rahm Emanuel launched Healthy Chicago during his first 100 days of office, signifying the importance of public health to his overall agenda.
  • In early 2010 when the Affordable Care Act was signed, the President appointed a
    National Prevention Council which brought together representatives from numerous federal agencies. In turn, a Prevention Advisory Council was appointed.
    These bodies, led by the Surgeon General, issued The National Prevention Strategy in June 2011, which provided a roadmap for addressing the leading causes of poor health, and related risk factors across the country.
    At the same time, in Chicago we were hard at work on our own prevention strategy. We were excited when the National Prevention Strategy was released, as it provided strong validation for our work and we were strongly encouraged when we released our local prevention strategy - Healthy Chicago - that August.
  • As we have moved forward implementing our Healthy Chicago agenda, and with full implementation of the ACA right around the corner, we now have the opportunity to move full force from strategy to implementation.
  • Healthy Chicago lays out strategies for addressing 12 public health priorities:
     
    Tobacco UseObesity Prevention
    Health Disease and StrokeHIV Prevention
    Adolescent HealthCancer Disparities
    Access to Health CareHealthy Mothers and Babies
    Communicable Disease ControlHealthy Homes
    Public Health InfrastructureViolence Prevention
  • We developed targets for each of the 12 priorities areas that were identified from Healthy People 2020, through a review of the both historical and the most recently available data, and in consultation with the objectives of the national Healthy People 2020 plan for health improvement. Implementation strategies were identified for a 5-year period.
  • The Mayor recognized that all City departments contribute to public health. Shortly following the development of Healthy Chicago, the Mayor’s Office requested that all City Departments participate in a kickoff meeting of the Healthy Chicago Interagency Council.
    Following the end of the first meeting, many Departments had signed on to continue working with us, as needed, to support Healthy Chicago strategy implementation.
  • Here, you see the many City Departments involved in Healthy Chicago. We worked heavily with the Departments in the inner circle (dark blue) during the first year, including the public schools, Dept. of Transportation, Mayor’s Office, Department of Family and Support Services, our Dept. of Business Affairs, the Chicago Park District, and the Dept. of Housing and Economic Development.
  • We had the support for public health from the very top, which has been crucial in the development of Healthy Chicago and in accomplishing our public health goals.
  • Now I’m going to back up a bit and discuss one of Healthy Chicago’s foundations– the social determinants of health– which guided the development our strategies.
  • The development of Healthy Chicago was heavily informed by our knowledge of the factors influencing health. We know genetics and medical care, together, only account for 40% of what influences our health.
     
    Social circumstances, environmental conditions, and behavioral “choices”– choices that are heavily influenced by our social circumstances and the environment– account for the majority. These choices are heavily impacted by policy, systems, and environmental change strategies. (Good health requires individuals make healthy decisions, but there are many obstacles that can make this difficult for people).
     
  • To illustrate this concept, the U.S. Centers for Disease Control and Prevention developed the Health Impact Pyramid to describe the impact of different interventions on health. At the base of the pyramid are interventions with the greatest impact on the population. At the pyramid narrows, the interventions require more individual effort and have less population impact.
     
    Socioeconomic factors– shown at the bottom in orange– have the greatest impact on population health.
    The next greatest impact comes from changing the context to make individual’s default decisions healthy– this means we need to make it easy for people to make healthy decisions.
    For this reason, as a department, we emphasize the turquoise area (shown here) in our work– we concentrate on making environments healthier, and making it easier for people to make healthy decisions.
     
  • Here are some of Healthy Chicago’s guiding principles related to health equity and our knowledge of the social factors influencing health.
    --For each Healthy Chicago priority area, we focus the most attention on closing the gap between those populations that are healthy and those that do not fare so well.
    --Healthy environments are a very important focus of our strategies.
    --We know that persons of lower SES are generally exposed to fewer factors that promote health and more factors that damage health.
    --We strive to make healthy choices easier and more desirable for people who are most vulnerable.
  • Let me show you some examples of our Healthy Chicago accomplishments from a few of our priority areas. You will notice that much of our work is accomplished with the help of partners. You will also notice the centrality of policy, systems, and environmental change in our work, which serves to make individuals’ default decisions healthier.
    I will start with Tobacco Use.
  • I’ll talk about our smoke-free campus work first…
  • The logos here are our partners who implemented smoke-free policies on their campuses. As you can see on this slide - 3 institutions of higher learning, 6 hospitals, and 6 behavioral health agencies all implemented smoke-free campus policies last year – that’s both inside and outside of their buildings. We achieved this through a partnership with the Respiratory Health Association.
    Additionally, fthe Chicago Housing Authority—public housing-- designated four housing developments as Smoke-Free. In the private rental market, many buildings have become 100% smoke-free and the list keeps expanding as renters continue to demand this environment.
     
  • --We’ve made considerable progress in tobacco using legislation, as well. The City of Chicago and the County joined forces on tobacco enforcement; the City increased fines for illegal cigarette sales and also banned future vending machine licenses; and the State and County each passed a $1 cigarette tax increase.
    --In even more recent policy efforts, the Mayor requested the Chicago Board of Health to take action aimed at curtailing menthol cigarette use among Chicago youth. In September, our Board convened four public hearings across the city to obtain expert and community input on the best solutions for curbing menthol use among Chicago’s youth.
  • Now I will turn to our work in obesity prevention.
    This includes efforts to improve access to healthy food, decrease access to unhealthy food, and make it easier to be physically active.
  • We’re making tremendous changes to our built environment in Chicago with the goal of making Chicago the most bike-friendly city in the U.S. Our Streets for Cycling Plan 2020 released in the latter part of last year helps bring identifies a 645-mile network of on-street bikeways that will encourage all Chicagoans to ride their bikes. We are building protected bike lanes, redesign intersections to ensure they are safer for bicyclists, and improve hundreds of miles of residential streets for bicyclists, pedestrians, and the people that live on them.
  • Here is an example of our Complete Streets work—we are working to accommodate pedestrians, bicyclists, transit users, freight, and motor vehicles on our streets.
  • Through our new bike sharing program, Divvy we have over 2000 bikes to share on short trips, which can be accessed through 300 stations across the City. In the first few weeks of the launch of the bike share program, more than 50,000 trips were taken, with participants collectively riding an estimated 175,000 miles.
  • Chicago released the Chicago Pedestrian Plan last fall, the city’s first comprehensive plan that identifies infrastructure enhancements, policies and programs to increase safety, reduce pedestrian and vehicle conflicts, and make Chicago a healthier, more livable city. Improved crosswalks, signalization, and traffic-calming devices are part of the plan to provide safer intersections, corridors and neighborhood streets.
    The plan’s health goals are to increase the number of pedestrian trips for enjoyment, school, work and daily errands, and to increase the mode share of pedestrian trips for enjoyment, school, work and daily errands. We will do this, in part by developing and supporting pedestrian encouragement policies.
    Strategies:
    Foster Play Streets
    Hold more Open Streets events
    Promote Car Free Day
    Support Walk and Bike to School Day
    Implement Pedestrian Awareness Week
    Establish Pedestrian Challenge event
    Incorporate Health Impact Assessments
    Develop a Health by Design Guide
    Collaborate on Wellness Benefits
    Support aging in place
  • In 2012, under an initiative sponsored by Blue Cross and Blue Shield of Illinois (BCBSIL) and the Chicago Department of Public Health (CDPH), Active Transportation Alliance (Active Trans), Local Initiatives Support Corporation/Chicago (LISC/Chicago) and World Sport Chicago (WSC) teamed up to bring the first Play Streets events to the Chicago community. These community-driven events offered residents a unique opportunity to come together and reclaim public spaces across the city as their own through play and physical activity. We continued to hold PlayStreets events this year.
  • We are also policy to improve access to fresh produce. We worked last year with partners from Business Affairs and Consumer Protection to pass a mobile produce cart ordinance. Now, through a partnership with Neighbor Capital and Streetwise there are 13 licensed carts operating in underserved communities. 30 vendors have received training and it’s expected that by later this year there will be 30 or more produce carts operating. It’s important to note the job creation benefits of this effort: 10 new jobs have already been created, and more are expected with the program expansion this year. Much of the produce is being sold in areas of the city without good access to fresh foods.
  • While our partners are busy selling produce, City agencies continue to promote to other food access initiatives.
    These include:
    --New farmers markets – all of which accept Link cards provided to SNAP and cash assistance beneficiaries
    --A commitment from grocers to open stores in underserved communities
    --The passage of an Urban Agriculture Ordinance to promote local growers
    --The City, Chicago Public Schools and the Park District adopting a healthy vending policy.
  • One way to help improve outcomes for infants is by breastfeeding. We are increasing breastfeeding in Chicago by way of hospital policy– this policy makes breastfeeding the default option for new mothers.
     
    With federal support and in partnership with the Consortium to Lower Obesity in Chicago Children, 15 Chicago hospitals with Labor and Delivery services committed to support breastfeeding by working towards the WHO Baby-Friendly designation.
    The Baby-friendly Hospital Initiative (BFHI) works to promote, protect, and support breastfeeding through The Ten Steps to Successful Breastfeeding for Hospitals, as outlined by UNICEF/WHO. The initiative has been shown to dramatically increase breastfeeding among its patients. The 10 steps require hospitals to implement a breast feeding policy. (Mothers are given a great deal of support; hospitals do not accept formula)
    We have 15 Chicago hospitals participating so far.
  • Lastly, I will discuss our work on adolescent health.
    Much of this work began with systems change—a partnership between the Chicago Department of Public Health and Chicago Public Schools.
    In February of 2012, we were pleased to partner with Chicago Public Schools to hire a Chief Health Officer. The Chief Health Officer created a free-standing Office of Student Health and Wellness. CDPH has in turn established an Office of School and Adolescent Health. This enables us to have a much larger impact on the health of the over 400,000 Chicago Public School children.
  • A revised School Wellness Policy and a new Competitive Foods Policy were passed by the Board of Education to increase healthy food options and enhance physical activity – both through PE and recess.
     
    Wellness Policy (2012):
    Convening school Wellness Teams and regular reporting of school wellness activities
    Implementing minimum grade level requirements for nutrition education
    Requiring recess for elementary schools
    Prohibiting the use of food or physical activity as a reward or punishment
    Ensuring that students regularly participate in physical activity
     
    Competitive Foods Policy (2012):
    The policy strengthens the vending policy, promotes healthy fundraising and celebrations, prohibits food as a reward, and bans the sale of unhealthy foods by vendors on school property
     
    New grants totaled $26 million support these efforts as well as others addressing teen dating violence and teen pregnancy. CDPH is pleased to be a major partner with Chicago Public Schools on several of these new initiatives.
     
     
     
     
     
     
     
  • As I noted, our collective policy efforts have been an important part of our success. While services are always needed, I believe that more policy work is needed for us to truly become a Healthy Chicago.
     
    Chicago has said from the start that Healthy Chicago is not just about how individuals behave, but how the City behaves. With more bike lanes, food access opportunities, and breast-feeding friendly hospitals – and with less junk food, tobacco, and teenage pregnancies – I believe we are well on our way.
  • Partnerships have been key to Healthy Chicago successes. On this slide are many of the agencies we work with on Healthy Chicago priorities – Hospitals, community development corporations, public agencies, FQHC’s, universities, businesses and more – have all played an important role. But despite the many entities represented on this slide – current partnerships are not enough, and we continue to look for new partners to create change.
  • Before I close, I want to invite all of you to continue this conversation.
    I invite you all to contact me. We are continuing to look for new partners to create change in the public health and health care, to develop innovations, to share information, and to exchange ideas.
  • Transcript

    • 1. Healthy People 2020 State Coordinators Webinar November 14, 2013 Bechara Choucair, MD Commissioner Chicago Department of Public Health @choucair City of Chicago Mayor Rahm Emanuel #HealthyChicago Chicago Department of Public Health Commissioner Bechara Choucair, M.D.
    • 2. Presentation Outline 1. Development of Healthy Chicago 2. Healthy Chicago and the Social Determinants of Health 3. Healthy Chicago Progress: Tobacco Use, Obesity Prevention, and Adolescent Health
    • 3. Development of Healthy Chicago
    • 4. Healthy Chicago Public Health Agenda • Released in August 2011 • Identifies priorities for action for next 5 years • Identifies health status targets for 2020 • Shifts work from one-time programmatic interventions to sustainable system, policy and environmental changes
    • 5. Healthy Chicago Leadership • Leadership is central to accomplishing public health goals • Chicago Mayor Rahm Emanuel is a public health champion • Healthy Chicago was launched during the Mayor’s first 100 days of office
    • 6. Setting a Foundation March 2010 June 2011 August 2011
    • 7. Healthy Chicago Targets
    • 8. Healthy Chicago Leadership • Interdepartmental participation in Healthy Chicago through the Interagency Council • Mayor’s Office convened first Healthy Chicago Interagency Council meeting in 2011 • Departments signed on to work with us on Healthy Chicago strategies
    • 9. Accountability • Monthly reports are sent to the Mayor, City Council, and the public to show our progress on Healthy Chicago strategies. • Annual reports keep us publicly accountable
    • 10. Healthy Chicago and the Social Determinants of Health
    • 11. Factors Influencing Health McGinnis et al. The Case for More Policy Attention to Health Promotion. Health Affairs, 2002 Mar-Apr;21(2):78-93.
    • 12. Health Impact Pyramid Examples Smallest Impact Counseling & Education Clinical Interventions Long-lasting Protective Interventions Largest Impact Changing the Context to make individuals’ default decisions healthy Socioeconomic Factors Eat healthy, be physically active Rx for high blood pressure, high cholesterol, diabetes Immunizations, cessation treatment, colonoscopy Fluoridation, 0g trans fat, iodization, smoke-free laws, Poverty, education, housing, inequality 15
    • 13. Promoting Public 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
    • 14. Healthy Chicago Progress: Tobacco Use, Obesity Prevention and Adolescent Health
    • 15. Tobacco Use
    • 16. Tobacco Use SMOKE-FREE CAMPUSES  3 Colleges / Universities  6 Hospitals  6 Behavioral Health Organizations  686 Public Housing Units Over 3,250 units of private smoke-free housing
    • 17. Tobacco Use Joint Enforcement Mayor Emanuel Takes Action to Protect Chicago’s Kids from Menthol Cigarettes
    • 18. Obesity Prevention Chicago Streets for Cycling Plan 2020
    • 19. Obesity Prevention  Over 200 miles of on-street bikeways, including almost 35 miles of barrier and buffer protected bike lanes.  3000 bikes to share at 300 stations by end of summer.
    • 20. Obesity Prevention Dearborn Street - Before Dearborn Street - After
    • 21. Obesity Prevention Bike Sharing in Chicago Over 3,000 bikes 300 stations
    • 22. Obesity Prevention Health Goals  Increase the number of pedestrian trips for enjoyment, school, work, and daily errands  Increase the mode share of pedestrian trips for enjoyment, school, work, and daily errands
    • 23. Obesity Prevention
    • 24. Obesity Prevention  14 licensed carts operating  41 vendors trained  30 carts planned for 2013
    • 25. Obesity Prevention
    • 26. Obesity Prevention
    • 27. Healthy Mothers & Babies 15 hospitals working towards Baby-Friendly Designation
    • 28. Adolescent Health  CPS hires chief health officer  Dually reports to CDPH  CDPH creates Adolescent and School Health Office
    • 29. Adolescent Health     Revised Wellness Policy Competitive Foods Policy Expanded STI Screening $26M New grants • CTG – Healthy CPS • Teen Dating Matters • Teen Pregnancy • Farm to School • Wellness Champions
    • 30. Building on Policy Successes Mayor Emanuel Takes Action to Protect Chicago’s Kids from Menthol Cigarettes
    • 31. Building On & Engaging Partnerships
    • 32. @ChiPublicHealth facebook.com/ChicagoPublicHealth 312.747.9884 HealthyChicago@CityofChicago.org www.CityofChicago.org/Health