Healthy Chicago & A Look into Health Disparities in Urban Chicago

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Healthy Chicago & A Look into Health Disparities in Urban Chicago

  1. 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. 2. Presentation Outline1. Professional Background2. Healthy Chicago Public Health Agenda and Health Disparities3. Addressing Health Disparities through Healthy Chicago Priority Areas4. Future Work to Address Health Disparities5. Opportunity to Engage with Healthy Chicago
  3. 3. Presentation Outline1. Professional Background2. Healthy Chicago Public Health Agenda and Health Disparities3. Addressing Health Disparities through Healthy Chicago Priority Areas4. Future Work to Address Health Disparities5. Opportunity to Engage with Healthy Chicago
  4. 4. Presentation Outline1. Professional Background2. Healthy Chicago Public Health Agenda and Health Disparities3. Addressing Health Disparities through Healthy Chicago Priority Areas4. Future Work to Address Health Disparities5. Opportunity to Engage with Healthy Chicago
  5. 5. HEALTHY CHICAGO CHICAGO DEPARTMENT OF PUBLIC HEALTHTRANSFORMING THEHEALTH OF OUR CITYCHICAGO ANSWERS THE CALL
  6. 6. IT’S NOT JUST ABOUTINDIVIDUAL BEHAVIORIT’S ABOUT HOW WEBEHAVE AS A CITY
  7. 7. Evolution of Healthy Chicago2010 February – May August 2011 2011
  8. 8. HEALTHY CHICAGOChicago Department of Public Health Infrastructure
  9. 9. Overall Healthy ChicagoImplementation Status
  10. 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. 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. 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 HealthPolitics, Policy and Law, Vol. 31, No. 1, Feb. 2006
  13. 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
  14. 14. Chicago: Person, Place, Time**From Sampson R. Great American City. 2012; p. 105 & 106.
  15. 15. Presentation Outline1. Professional Background2. Healthy Chicago Public Health Agenda and Health Disparities3. Addressing Health Disparities through Healthy Chicago Priority Areas4. Future Work to Address Health Disparities5. Opportunity to Engage with Healthy Chicago
  16. 16. Priority: Healthy Mothers and Babies
  17. 17. 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)
  18. 18. Chicago Infant Mortality Rate, 2008, by Race/Ethnicity, per 1000 Births 14 13.3 12 10Rate 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
  19. 19. 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
  20. 20. Percent of Illinois Women Who Initiated Breastfeeding, 2004-2008 Combined 100 92 98 90 90 84 85 87 80 70 64 60 52Percent 50 Low Income 40 Higher Income 30 20 10 0 White Black Hispanic Asian Data Source: Pregnancy Risk Assessment Monitoring System (PRAMS)
  21. 21. 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
  22. 22. 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
  23. 23. Priority: Adolescent Health
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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.
  28. 28. 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
  29. 29. Priority: Tobacco Use
  30. 30. 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 populationBRFSS, 2010; CDC MMWR: http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6144a2.htm#tab
  31. 31. 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% Associates 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
  32. 32. Percentage of Adult Cigarette Smokers, U.S., by Income, 2010Poverty Status Percent Who SmokeAt 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
  33. 33. 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
  34. 34. 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
  35. 35. 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
  36. 36. Priority: Obesity Prevention
  37. 37. 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.
  38. 38. Prevalence of Obesity among Adults, by Race/Ethnicity, U.S. and Illinois 2006-2008 40 35.7 35 33.3 30.7 30 28.7Percentage 25 23.7 23.4 20 U.S. 15 Illinois 10 5 0 White Black Hispanic Source: BRFSS
  39. 39. Prevalence of Obesity in 2-19 Year-Olds in the U.S., 2009-2010Source: Ogden et al., JAMA 2012. Online via http://www.nmqf.org/presentations/12OgdenCJCP3.pdf
  40. 40. http://www.cdc.gov/nchs/data/databriefs/db51.pdf
  41. 41. Food Access in Chicago CommunitiesData provided by Chicago’s Department of Housing and Economic Development, 2012.
  42. 42. 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
  43. 43. 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
  44. 44. Priority: Breast Cancer Disparities
  45. 45. 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
  46. 46. 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
  47. 47. 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
  48. 48. Addressing Breast Cancer Disparities through Policy• Expanding CDPH’s partnerships with hospitals• Improving Medicaid reimbursement for mammograms
  49. 49. Breast Cancer Disparities Surveillance• Applied for State registry breast cancer incidence data
  50. 50. Breast Cancer Disparities Advisory Group• Breast cancer stakeholders provide input on our activities• Survivors, family members, advocates, service providers, researchers, & media
  51. 51. Priority: HIV Prevention
  52. 52. HIV Disparities• Urban areas such as Chicago have significantly higher rates of HIV than the U.S. as a whole• Racial disparities are pronounced
  53. 53. HIV Infection Rates per 100,000 population in Chicago (as of 8/25/2011) 1400 1226.2 1200Rate 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
  54. 54. Transmission Group for HIV Infections, Chicago, 2009 100 90 80 70 61.9 60Percentage 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
  55. 55. HIV Behavioral Surveillance • CDPH conducts annual behavioral surveys among populations at increased risk for HIV
  56. 56. 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
  57. 57. 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
  58. 58. Presentation Outline1. Professional Background2. Healthy Chicago Public Health Agenda and Health Disparities3. Addressing Health Disparities through Healthy Chicago Priority Areas4. Future Work to Address Health Disparities5. Opportunity to Engage with Healthy Chicago
  59. 59. 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)
  60. 60. Presentation Outline1. Professional Background2. Healthy Chicago Public Health Agenda and Health Disparities3. Addressing Health Disparities through Healthy Chicago Priority Areas4. Future Work to Address Health Disparities5. Opportunity to Engage with Healthy Chicago
  61. 61. Opportunity to Engage with Healthy Chicago• Policy: Advocacy Efforts• Program: Grants & Partnerships• Education/Public Awareness: Outreach Efforts
  62. 62. Twitter ChatsCDC 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
  63. 63. Engage with Facebook
  64. 64. 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
  65. 65. 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
  66. 66. 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
  67. 67. facebook.com/ChicagoPublicHealthGplus.to/ChiPublicHealth@ChiPublicHealth312.747.9884CityofChicago.org/HealthHealthyChicago@CityofChicago.org

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