How Epidemiology Shaped Healthy Chicago

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Released in August 2011, Healthy Chicago is the first-ever comprehensive plan for public health put forth by the City of Chicago. Mayor Emanuel originally called for the formation of an agenda during his transition report and Healthy Chicago now serves as a blueprint for a focused approach by CDPH to implement policies, systems, and environmental changes to prioritize and transform the health of the city over the next five years. Epidemiologic analysis and interpretation provided a foundation for three key aspects of the plan: 1) the development of 12 priority areas; 2) the establishment of meaningful indicators for use in defining baselines and targets; and 3) the identification of data gaps that required filling for adequate evaluation and monitoring of the plan. We report on our use of methodologies from Healthy People 2020 and other references, and how Healthy Chicago has spurred innovative approaches to epidemiologic analyses using data from public school physical exams, school-based oral health encounters, and outpatient health center networks.

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  • These are two more of the programmatic strategies listed in Healthy Chicago.EPHI program established with Eric’s hiring in April 2011. The Program continues to function as an engine to generate knowledge about health and illness events, health behaviors and determinants, and health disparities in Chicago. But it also now explicitly incorporates the emerging field of public health informatics, and is tasked with facilitating and promoting the use of information technology and electronic data exchange among healthcare institutions and public health departments in order to further improved population health outcomes.When Eric took the director position, the program had two people on its staff. Over the past year and a half, we have grown the program to 5 epidemiologists and are actively seeking to expand it further through grants. But we also acknowledge that there is no shortage of experts in Chicago in the fields of epidemiology, medical informatics, sociology, and biostatistics, and that the health of Chicagoans would benefit from our partnering with these experts. One of Eric’s first activities was to establish an epidemiology advisory group to convene researchers and public health practitioners from local institutions. The purpose of the group is to get input on epi and statistical methods, encourage open discussion about CDPH approaches to take on data-related questions, and to provide a means of developing and communicating the data use and data release policies of the department.
  • One of the key links between epidemiology and the policy process is the provision of data that will engage stakeholders in decision making. The Epidemiology Program has a strong tradition of publishing summaries and reports, and Eric is charged with maintaining that strength. But with advances in technology related to the web, data analysis, and geographic information systems, it’s more important than ever that we make epidemiologic data available electronically. This allows community organizations, researchers, students, and the media more flexibility in defining and answering questions, and engaging in public health problem-solving.We currently make use of the City’s Open Data Portal to push out frequent updates of data related to births, deaths, infectious diseases, environmental health, hospital discharges, and public health assets.We understand that tabular data doesn’t appeal to all the different kinds of people who would like to use these data, so other modes of delivery, including the state of Illinois’ “IQuery” visualization tool, and a Chicago Health Atlas mapping website are also being developed.
  • Engage other local governmental agencies and private sector partners in the development and implementation of a Healthy Homes strategic plan.Transition the CDPH Lead Poisoning Prevention Program into a Healthy Homes Program, incorporating both lead and other home-based health hazards into its mission.
  • The number of people with asthma continues to grow.
  • RD–1 Deaths from asthmaRD–2 Hospitalizations for asthmaRD–3 Emergency department visits for asthmaRD–4 Asthma activity limitationsRD–5 School or workdays missedRD–6 Patient educationRD–7 Appropriate asthma careRD–8 Asthma surveillance systems
  • RD–1 Deaths from asthmaRD–2 Hospitalizations for asthmaRD–3 Emergency department visits for asthmaRD–4 Asthma activity limitationsRD–5 School or workdays missedRD–6 Patient educationRD–7 Appropriate asthma careRD–8 Asthma surveillance systems
  • Public use data set
  • Two policy and program strategies from this section of Healthy Chicago.
  • Nearly half of all age-eligible students in the targetedschools provided parental consent and received MCVvaccination. This coverage rate exceeded CDPH’s expectationsgoing into the campaign, given the traditionallylow immunization coverage rates among childrenresiding in the neighborhoods served by these schools.The word-of-mouth and media coverage of the 2 Austinadolescent’s deaths may have contributed to many adolescentsin the targeted schools identifying themselvesas members of a high-risk group for SCIMD.
  • How Epidemiology Shaped Healthy Chicago

    1. 1. ••••
    2. 2. •••••
    3. 3. HEALTHY CHICAGO CHICAGO DEPARTMENT OF PUBLIC HEALTHTRANSFORMING THEHEALTH OF OUR CITYCHICAGO ANSWERS THE CALL
    4. 4. ••••••
    5. 5. ••••
    6. 6. •••
    7. 7. HEALTHY CHICAGOChicago Department of Public Health Infrastructure
    8. 8. HEALTHY CHICAGOChicago Department of Public Health 23% 29% n=45 n=56 n=92 48% Policies Programs Education and Public Awareness
    9. 9. Infrastructure Balanced Scorecard
    10. 10. Infrastructure
    11. 11. Infrastructure
    12. 12. Stem Leaf # Boxplot 9 9 1 0 9 4 1 | 8 | 8 02 2 | 7 99 2 | 7 23 2 | 6 | 6 44 2 | 5 556667 6 | 5 223 3 | 4 559 3 +-----+ 4 0124 4 | | 3 5666799 7 | + | 3 01112233 8 *-----* 2 55669 5 | | 2 01123334 8 | | 1 568888899 9 +-----+ 1 01233334 8 | 0 6679 4 | 0 33 2 | ----+----+----+----+ Multiply Stem.Leaf by 10**+4
    13. 13. • •• • •
    14. 14. • Measure progress annually, if not more frequently
    15. 15. **Age-adjusted
    16. 16. * 2008 2009 2010*Age-adjusted
    17. 17. **Age-adjusted
    18. 18. • •• ••
    19. 19. • – –• – –
    20. 20. 200841.8 vs. 28.5 (Rate Ratio, 1.46) 38.3 vs. 25.0 (Rate Ratio, 1.53)
    21. 21. Myers C et al. Health Disparities in New York City: Health Disparities in Breast, Colorectal,and Cervical Cancers. New York: New York City Department of Health and Mental Hygiene, 2011.
    22. 22. 11 White Non-white223 Percent
    23. 23. •• – –
    24. 24. ••
    25. 25. •• Centers for Population Health and Health Disparities Meeting (
    26. 26. Average annual adjusted breast cancer mortality rate,females, by Chicago community area, 2004 - 2008
    27. 27. Average annual adjusted breast cancer mortality rate, Percent of breast cancer cases* diagnosed at distant stagefemales, by Chicago community area, 2004 - 2008 by Chicago ZIP code, females, 2004-2008 The estimate for Chicago ZIP codes is 6.2% [5.7,6.7] 11.8% [7.0,16.6] *includes in situ
    28. 28. •••
    29. 29. • ••
    30. 30. (females) (females)
    31. 31. * *Measles-containing vaccine.
    32. 32. HEALTHY CHICAGOChicago Department of Public Health
    33. 33. ••
    34. 34. •••
    35. 35. facebook.com/ChicagoPublicHealthGplus.to/ChiPublicHealth@ChiPublicHealth312.747.9884CityofChicago.org/HealthHealthyChicago@CityofChicago.org

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