Housing & Healthy Chicago

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How does housing impact health? Presentation at the Harm Reduction in the House: It Take a Village conference by the Midwest Harm Reduction Institute in June 2012

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  • So what do we do at the Chicago Department of Public Health? We are responsible for the public health of 2.7 million people. Our mission is 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. Being responsible for the health of so many means we need to prioritize our efforts and think about how we can improve the health of a large number of persons rather just the health of a few. We also need to ensure that for any investment of valuable time and resources, we get a good return on investment.
  • Our Healthy Chicago Policy Agenda has 12 priority areas: Tobacco Use:  Reduce tobacco use and exposure to second-hand smoke Obesity Prevention: Increase access to healthy food and healthy environments HIV Prevention:  Reduce the spread of HIV and other sexually transmitted infections Adolescent Health: Improve the health, safety and well-being of Chicago’s youth Cancer Disparities: Eliminate racial and ethnic disparities in cancer with a focus on breast cancer disparities Heart Disease & Stroke: Improve the heart health of all Chicagoans Access to Care: Increase access to primary care and mental health services specifically for the most vulnerable in our communities Healthy Mothers and Babies:  Improve the health and well-being of mothers and infants Communicable Disease Control & Prevention: Reduce the spread of communicable and infectious diseases Healthy Homes: Help Chicagoans create safer and healthier homes (will describe in more detail later) Violence Prevention: Reduce and prevent exposure to violence in our homes and communities with a specific focus on children Public Health Infrastructure:  Ensure that Chicago has the necessary infrastructure to effectively provide essential public health services Within these priority areas, we aim to protect the City’s most vulnerable, and to improve health disparities– we want to close the gap between those populations that healthy and those that do not fare so well.
  • Why is it that some people are healthy are others are not? This pie chart shows the factors that influence health. What is surprising to many people is that 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. (Good health requires individuals make healthy decisions, but there are many obstacles that can make this difficult for people). A person’s health is influenced by powerful social factors such as education, income, housing, and neighborhoods. Housing is a critical part of the picture– For example, our social circumstances– such as being poor– affect our housing choices, which in turn affect our environment, our access to medical care, and our so-called “choices”. (McGinnis et al, Health Affairs, Vol 22 (2)
  • Let’s look at how housing influences health. Conditions within the home and in neighborhoods, along with housing affordability, have a lot to do with health. Conditions within the Home- Homes must be safe and free from physical hazards. Poor and inadequate housing quality contributes to health problems such as infectious and chronic diseases, injuries, and poor childhood development. Neighborhood Conditions- Along with conditions in the home, the neighborhoods where homes are also have significant effects on health. This includes physical, environmental, social, and economic conditions. Housing Affordability- Affordable housing– housing that costs less than 35% of a family’s income– is also essential for good health. Affordable housing ensures that individuals and families are able to remain housed, have safe and healthy living conditions, and have enough money for food, health care, and other basic needs. Let me explain each of these influences in depth….
  • Most Americans spend the vast majority of their time indoors, and most that time is at home. Very young children spend even more time at home and are especially vulnerable to household hazards. Therefore, the conditions within the home are very important. Here are some common examples of how conditions within the home can negatively affect health: --Lead-based paint irreversibly affects brain and nervous system development, resulting in lower intelligence and reading disabilities --Substandard housing conditions such as water-leaks, poor ventilation, dirty carpets and pest infestation can lead to increased mold, mites, and other allergens, and result in respiratory illnesses such as asthma --Housing can be a source of carcinogenic pollutants – radon, tobacco smoke, pollutants from cooking with gas, and asbestos have been linked to cancer and respiratory illness --Injuries occurring at home result in ED visits and hospital admissions. Steep staircases, a lack of security devices such as window guards and smoke detectors, and substandard heating systems are among the culprits.
  • To highlight some local data related to conditions in the home, here is a map displaying the rate of elevated blood lead levels in children ages 0-6 in Chicago. (Dark blue areas are where there are more children with elevated blood lead levels) Lead is usually the result of lead-based paint that still exists in older homes, often around old windows or older enclosed porches. It is recommended that children entering daycare and kindergarten have their levels checked, and physicians are required to report the results to the State. The rates of elevated blood lead levels, even at their worst, are relatively low on this map---However, just this month the CDC lowered the recommended limit for lead exposure. The new standard, announced by the CDC recently is applicable to children under 6, and lowers the threshold to 5 micrograms of lead per deciliter of blood, from 10 micrograms per deciliter. (101,987 kids in Chicago were tested in 2010.) (FromThe Chicago Plan for Health System Improvement, 2012-2016. City of Chicago, CDPH. Data from Lead Program.)
  • The social, physical, environmental, and economic characteristics of a neighborhood affect short and long-term health quality and longevity. -There are many different facets of healthy neighborhoods, including crime, violence, & pollution; safe places to play and exercise; access to grocery stores with produce and reduced access to unhealthy foods through fast food outlets, convenience stores, & liquor stores; the ability to access employment, health care, and transportation; and strong neighborhood ties providing a sense of cohesion and social support.
  • Here’s a local example of one type of neighborhood condition that effects health. Access to grocery stores that sell healthy foods is a component of the built environment that affects health status– produce and healthy food options supports individual behavior change to prevent chronic disease and manage conditions such as diabetes, obesity, and high blood pressure. Here you see that the areas to the south and west, which are predominantly African American communities, have to travel the longest distances to get to a supermarket. (This map shows data collected by Chicago State University Neighborhood Assistance Center on distances needed to travel to the nearest large supermarket. From The Chicago Plan for Health System Improvement, 2012-2016. City of Chicago, CDPH. )
  • --Affordable housing is less than 30% of income. Low income families are more likely to lack affordable housing. An estimated 17 million households in the U.S. pay more than 50% of their incomes on housing (Joint Center for Housing Studies of Harvard University. The State of the Nation’s Housing: 2008. Cambridge MA, 2008) -- Shortages of affordable housing limit choices about where to live, often relegating lower income families to substandard housing in unsafe, overcrowded neighborhoods with high rates of poverty, fewer resources for health (sidewalks, bike paths, recreation centers, etc.) --Unaffordable housing means families often choose to pay rent/mortgage over other needs that impact health: healthy food, heat, health care, medication --And of course, a lack of affordable housing contributes to homelessness
  • How does housing affordability look locally? Here’s what it looked like in 2009, using 35% or greater percentage of income as the threshold for a “high cost burden”. The areas in dark blue are communities in which 42%-57% of households had a high cost burden. Humboldt Park (57%), West Garfield Park (55%), Belmont Cragin (52%), and Washington Park (51%) had the highest proportion of residents with a high housing cost burden. (The Chicago Plan for Health System Improvement, 2012-2016. City of Chicago, CDPH. American Community Survey)
  • What about the connections between homelessness and health? ---In 2010, the Chicago Coalition for the Homeless and UIC estimated that there were 57,379 homeless in Chicago. (The Facts Behind the Faces: A Fact Sheet from the Chicago Coalition for the Homeless. November 2011. ) ---There are high rates of respiratory diseases (TB), HIV/AIDS, schizophrenia, depression, anxiety, alcohol and drug problems, suicide, and other problems among persons who are homeless. Some problems predate homelessness and others are caused by it. Lack of shelter results in health problems due to exposure and also makes recovery from health problems slow and difficult --Homes contribute to overall well-being in other ways too– homes are secure bases; homes offer privacy; people are in control of their lives in their home -- Access to care for this population is limited. --Life expectancy is about 30 years less for persons who live on the street than for those who are housed (James O’Connell, Premature Mortality in Homeless Populations: A Review of the Literature)
  • Many people affect healthy housing and healthy neighborhoods. As with many areas of public health, the people who can best address healthy housing are often those who *aren’t* public health or health care workers. Advocates, leaders, and decision-makers, such as city planners, those working in government agencies, legislatures, school boards, employers, developers, food industry leaders, among others, all play an important role.
  • We will to work on these issues at CDPH. Healthy Homes is one of our 12 Healthy Chicago priorities. --We are transitioning Lead Prevention into a Healthy Homes program, a comprehensive approach to focus on housing hazards in a coordinated way The Healthy Homes Program addresses multiple childhood diseases and injuries in the home. The Initiative takes a comprehensive approach to these activities by focusing on housing-related hazards in a coordinated fashion, rather than addressing a single hazard at a time. The HHI builds upon HUD's successful Lead Hazard Control programs to expand its efforts to address a variety of environmental health and safety concerns including: mold , lead , allergens , asthma , carbon monoxide , home safety , pesticides , and radon . --Stop the Falls media campaign to address children falling from windows --Supported efforts to change the Torrens Indemnity Fund to access lead-based paint abatement funding --Researching new policies to reduce home hazards (such as policies related to use of indoor foggers; ensuring landlords maintain healthy homes for renters) Social policy is health policy. Fiscal policy is health policy. Education is public health. Housing is public health.
  • We also continue to address healthy neighborhoods. -- Through our Office of Violence Prevention and through partnerships, we are working to reduce community violence, domestic violence, teen dating violence, and bullying. --Anti-violence and Community Stabilization Initiative ensures City resources are targeted toward high crime areas --We are working with CPD to track childhood exposure to violence --Teen Dating Violence grant --Teen Dating Violence education, Bullying education --Safe Start Collaborative (childhood exposure to violence) --We are promoting healthy corner stores and making produce accessible --We are researching new policies that reduce access to unhealthy foods, such as zoning fast food restaurants.
  • --To create a Healthy Chicago, we all can support policies that improve social conditions. Social policy is health policy. Fiscal policy is health policy. Education is public health. Housing is public health. --We can all work together to ensure that we create healthy policies– for example, what impact will transportation or housing policies have on the health of neighborhood residents? We all must weigh in on these issues. (Health in All Policies)
  • I am grateful to each of you for joining me in creating a Healthy Chicago. Each of you, through your work with housing, homeless persons, and harm reduction, is our partner in improving the health of Chicagoans.
  • Housing & Healthy Chicago

    1. 1. Public Health Takes a Village:Chicago Department of Public Health Housing for a Healthy Chicago Midwest Harm Reduction Institute Harm Reduction in the House: It Takes a Village Conference June 14, 2012 Bechara Choucair, MD Commissioner Chicago Department of Public Health @choucair on Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
    2. 2. Presentation Outline1. Healthy Chicago2. What Shapes Health: The Importance of Housing3. Achieving Healthy Housing
    3. 3. Presentation Outline• Healthy Chicago• What Shapes Health: The Importance of Housing3. Achieving Healthy Housing
    4. 4. 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.
    5. 5. HEALTHY CHICAGO CHICAGO DEPARTMENT OF PUBLIC HEALTH TRANSFORMING THEChicago Department of Public Health HEALTH OF OUR CITY CHICAGO ANSWERS THE CALL Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
    6. 6. HEALTHY CHICAGOChicago Department of Public Health IT MATTERS Chicago Department of Public Health Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
    7. 7. A Comprehensive Public Health Agenda A blueprint for action to create: »Healthy City »Healthy Neighborhoods »Healthy Homes »Healthy People
    8. 8. HEALTHY CHICAGOChicago Department of Public Health IT’S NOT JUST ABOUT INDIVIDUAL BEHAVIOR Chicago Department of Public Health IT’S ABOUT HOW WE BEHAVE AS A CITY Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
    9. 9. IT DEMANDS THAT WE MAKE CHANGES » In Policies » In Programs » In Education
    10. 10. HEALTHY CHICAGO Chicago Department of Public HealthChicago Department of Public Health Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
    11. 11. HEALTHY CHICAGOChicago Department of Public Health MOVING TOWARD A HEALTHY CHICAGO Chicago Department of Public Health Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
    12. 12. Chicago Department of Public Health Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
    13. 13. Status of Healthy Chicago (n = 193)by Specific Priority, 2011 (4th Quarter)
    14. 14. Presentation Outline• Healthy Chicago• What Shapes Health: The Importance of Housing3. Achieving Healthy Housing
    15. 15. Factors Influencing Health
    16. 16. Housing Influences Health • 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 incomePollack C, et al. Where We Live Matters for Our Health: The Links Between Housing and Health. Robert WoodJohnson Foundation. September 2008.
    17. 17. 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
    18. 18. Elevated Blood Lead Levels ofChildren by Community Area, 2010
    19. 19. 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
    20. 20. Distance to Supermarket
    21. 21. 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
    22. 22. Percent of Households Spending ≥ 35% on Housing Costs, 2009
    23. 23. 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• Majority of homeless do not have health insurance or ability to pay for health care• Life expectancy is about 30 years less for those on the streets
    24. 24. Presentation Outline1. Healthy Chicago2. What Shapes Health: The Importance of Housing3. Achieving Healthy Housing
    25. 25. Healthy Housing is a Shared Responsibility
    26. 26. CDPH is Working to Create Healthy Homes• Developing a Healthy Homes program -Lead, mold, allergens, asthma, carbon monoxide, home safety pesticides, radon• Conducting the Stop the Falls campaign• Supported policy to fund lead abatement• Researching policies to reduce home hazards – Indoor foggers; ensuring landlords maintain healthy homes
    27. 27. CDPH is Working to Create Healthy Neighborhoods• Working to reduce community violence, domestic violence, teen dating violence, and bullying• Making healthy options the default option in all of our neighborhoods – Working to create healthier corner stores – Making produce accessible – Researching policies that reduce access to unhealthy foods
    28. 28. We All Can….• Support policies that improve social conditions– child care , schools, jobs, housing, and economic revitalization• Increase collaboration across government agencies at all levels and between stakeholders and community & private groups to make sure all policies are healthy
    29. 29. We can’t do it without you. Thank you for creating a Healthy Chicago.
    30. 30. Chicago Department of Public Health Rahm Emanuel Bechara Choucair, MD Mayor Commissioner

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