University of Illinois at Chicago Patient Centered Medicine Scholars Program

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Commissioner Choucair presents Healthy Chicago to the Patient-Centered Medicine Scholars Program - M2 Service Learning Program Seminar at the University of Illinois at Chicago's College of Medicine.

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  • First I’ll provide a little background on the Healthy Chicago public health agenda. Then I will discuss our recent accomplishments and will provide disparities data where relevant. Then I want to briefly discuss next steps.
  • First I’ll provide a little background on the Healthy Chicago public health agenda. Then I will discuss our recent accomplishments and will provide disparities data where relevant. Then I want to briefly discuss next steps.
  • First I’ll provide a little background on the Healthy Chicago public health agenda. Then I will discuss our recent accomplishments and will provide disparities data where relevant. Then I want to briefly discuss next steps.
  • These are the themes that have been very important in our work: Partnerships, Policy, Technology and Public Awareness. Each of these components plays a distinctive and critical role to the success of our work at the Chicago Department of Public Health. However, one component alone does not provide a success, but it is the sum of all these components working together that has and will continue to help us transform the health of Chicago and attain our goal of making Chicago the healthiest city in the nation.
  • Partnerships play an immensely important role in all of the Department’s work. We currently are actively engaged with hundreds of different organizations.
  • And the list just keeps growing…. In a time of limited resources at the local, state, and federal levels, partnerships are especially critical to keeping our work progressing.
  • First I’ll provide a little background on the Healthy Chicago public health agenda. Then I will discuss our recent accomplishments and will provide disparities data where relevant. Then I want to briefly discuss next steps.
  • First, tobacco.
  • We’re always focused in on health disparities , which helps us to target our interventions. In adults, males, Non-Hispanic Whites and Blacks, less educated adults, persons 25-45 and those with lower incomes have a higher prevalence of smoking in Chicago in 2012.
  • Similar to what we see in adults, male HS students report higher smoking rates than females. Unlike adults, Hispanic HS students have higher levels of smoking than NH Blacks. (There were too few NH White students to produce reliable prevalence rates. )11th and 12th graders had an increased prevalance of smoking compared to 9th and 10th graders.
  • The 50th anniversary of the Surgeon General’s Report on Smoking and Health was just this month. A new report– The Health Consequences of Smoking- 50 Years of Progress– emphasizes that smoking is still a huge public health issue. Chicago was specifically recognized, however, by Secretary Kathleen Sebelius for our work on smoking. We are consistently recognized as the nation’s leader in public health efforts on tobacco use.
  • Our most recent tobacco prevention victory was earlier this month when City Council voted 45 to 4 to ban e-cig use wherever traditional tobacco products are currently prohibited.
  • Here we see that Black and Hispanic adults have higher rates of overweight or obesity than Whites and Non-Hispanics.More educated adults have lower rates of obesity and overweight than less educated. Income has a similar, though weaker relationship with weight.
  • Here is some data on overweight or obesity in our CPS students. CPS estimates that its student population is made up of 87% low-income households, with a race-ethnicity composition of approximately 45% Hispanic and 42% non-Hispanic black students. CDPH assessed over 88,000 de-identified student physical exam records of students enrolled in kindergarten, sixth grade, and ninth grade in the 2010-11 school year.The overall prevalence of overweight or obesity for these 3 grade levels was 43%. Among demographic subgroups, overweight or obesity prevalence estimates varied substantially across each grade, sex, and race-ethnicity category. Consistent with national trends, at all three grade-levels the prevalence of obesity and overweight in Hispanic and non-Hispanic black students was higher than in non-Hispanic whites and non-Hispanic Asian/Pacific Islanders.Also consistent with childhood growth patterns and trends seen in national data, overweight or obesity prevalence was higher among sixth graders (48.6%) and ninth graders (44.7%) than in kindergartners (36.5%).
  • More recent CPS data shows that obesity rates among CPS’s youngest students are decreasing. Over the past 10 years, obesity rates in kindergarten-aged students have dropped from 24% to 19.1%.In 2003, nearly one in four students was obese by the time they entered school. By 2012, that number had fallen to less than one in five. This means that over 1,000 children started the school year in 2012 at a healthier weight than they would have in 2003.And it is essential to note that this decline is being felt by all racial and ethnic groups, including African American and Hispanic children, who have historically had disproportionately high rates of obesity.
  • Our efforts on obesity focus on making it easier to eat healthy foods and be physically active….
  • Chicago Streets for Cycling Plan 20202012 citywide network plan of 600 miles of bike facilities Safe and comfortable for all ChicagoansFocus on protected bike lanes and neighborhood greenways
  • Here is some heart disease data. Heart disease is the leading cause of death in Chicago and the US.Though heart disease mortality is higher in Chicago than the US, both Chicago and the US had similar rates of decline between 1999 and 2009, about 32-33%.In Chicago, NH Blacks have the highest rates of heart disease mortality compared to Hispanics and NH Whites, but this group also saw the largest decline in Chicago, 43% drop from 1999 to 2009.
  • Stroke is the 3rd leading cause of death in Chicago and 4th in the US.Stroke mortality rates are similar in Chicago and the US, both experiencing similar levels of decline with heart disease mortality between 1999 and 2009, about 33-37%.In Chicago, NH Blacks have the highest rates of heart disease mortality compared to Hispanics and NH Whites. NH Blacks and Whites experiences very similar rates of decline in stroke over time, while Hispanics only decreased by 14%.Also, of note, although Hispanics comprise approximately 29% of Chicago’s population,this racial-ethnic group accounted for just 10% of 2009 deaths. This “Hispanic mortality advantage” is not unique to Chicago, having been observed on a national level with several theories put forth to explain it. These include factors related to social support, acculturation, the “healthy migrant effect,” return migration (i.e., the “salmon hypothesis”) and misclassification of ethnicity on death certificates.
  • One aspect of adolescent health we are interested in is the teen birth rate. The teen birth rate decreased 33% from 1999 to 2009, but Chicago’s rate is still one-and-a-half times that of the United States. As you see here, teen birth rates for Hispanics and NH blacks are higher than those in NH Asians and NH whites.
  • Chicago, like most other large urban areas in the United States, continues to have significantly higher rates of HIV diagnoses than the country overall. Racial/ethnic disparities in Chicago are significant and stark.Rates of new HIV diagnoses in 2011 in Chicago were highest among NH Blacks: more than double that of Hispanics, and over three times higher than that of NH Whites. New HIV infection rates are also higher in men.
  • The burden of new HIV infection is among men having sex with men, NH Black, and under 30.In 2011, male-to-male sexual contact was the leading mode of transmission (69%), followed distantly by heterosexual contact (21%).While males account for 81% of all 2011 HIV infection diagnoses, this percentage varies by race/ethnicity. Among NH Black diagnoses, 75% are males, compared to 93% for Whites, and 86% for Hispanic men.Among females, heterosexual contact accounts for 86% of all HIV infection diagnoses in 2011 for all race/ethnicity groups. In 2011, 74% of new female HIV infections were among NH Blacks.
  • Access to care is of course affected by health insurance. Populations more likely to be low-income such as Hispanic and NH Black have higher rates of uninsured, because most health insurance is through employers, so these groups primarily work without insurance benefits, or insurance was too costly for them.We think the Affordable Care Act will make a significant difference in the proportion of people, overall, without insurance.(506,371 total)
  • We are helping people enroll in health insurance through our Enroll Chicago! Program….As of November, 125,000 applications submitted to state for approval. Officials say the expansion will generate $468 million next year for the county’s health programs, reducing the burden on taxpayers.
  • Infant mortality is considered an indicator of population health. In Chicago, the infant mortality rate has remained relatively stable since 2006 at about 8 deaths per 1000 live births.Although this infant mortality rate is higher than the U.S. rate (6.4 per 1,000 in 2009), Chicago’s rate has decreased by more than 30% since 1999, while the national decrease has only been by 10%. Despite this decline, disparities in infant mortality rates persist in Chicago and nationally.The infant mortality rate for non-Hispanic blacks was 3 times higher than for non-Hispanic whites, and more than twice as high as for Hispanics in Chicago during 2007-2009. And while infant mortality rates decreased by 29% or more for Hispanics, NH Whites and NH Asians, the decrease seen in NH Blacks between 1999 and 2009 was only 21%.
  • Low birthweight (< 2500 grams or 5 lbs, 8 oz) and preterm birth (<37 weeks) are associated with infant mortality. Low birthweight births have remained relatively unchanged between 1999 and 2009, hovering around 10%.Chicago has a higher rate of low birthweight than the US. NH blacks had the highest rate of low birthweight births (14.7%), about double that of Hispanics and NH whites. Similar trends are seen at the national level.
  • In June 2013, the Illinois Department of Public Health amended the Illinois Administrative Code Section 693.130. The amendment allows minors 12 years of age or older who may have come into contact with a sexually transmitted infection (STI) give consent to medical care or counseling related to the diagnosis, treatment, or vaccination against an STI. This means that minors 12 years and older are now able to consent to vaccinations for HPV if they are seeking STI treatment.
  • Assessments to determine compliance two days a week.
  • On June 5, 2013, Chicago became one of the first U.S. cities to pass a comprehensive bed bug ordinance, which will go into effect on December 23, 2013University of IL Asthma grant $4M to test asthmas interventions – including home visits to address asthma triggers.
  • Pharmaceutical drop boxes are now available at all Chicago police stations to allow citywide accessibility for the proper disposal of expired and unused prescription and over-the-counter drugs.  Since 2008, the drop boxes were located in just five police stations…
  • Another strategy of Healthy Chicago is to increase the availability of public health data through the City’s website.To that end, we now make use of the City’s Open Data Portal to push out frequent updates of indicator data related to births, deaths, infectious diseases, environmental health, hospital discharges, and public health assets.The way it works, we don’t provide any data directly to the Chicago Health Atlas website; the developers subscribe to our feed on the Data Portal, and can update their views with new data as it becomes available.
  • 1 of 22 health departments in the country accredited. This is an outstanding achievement for our department but our work has just begun. Being accredited means that we continue to strive to improve our work and to ensure we are always meeting PHAB standards.
  • Despite our successes to date, our work is far from complete…. This slide lists a few of the additional objectives we are working to accomplish.
  • University of Illinois at Chicago Patient Centered Medicine Scholars Program

    1. 1. City of Chicago Mayor Rahm Emanuel Chicago Department of Public Health Commissioner Bechara Choucair, M.D.
    2. 2. • • • •
    3. 3. Partnership Policies Public Awareness Technology
    4. 4. Total Male Female NH White NH Black • • Hispanic Less than HS HS or GED Some post HS • College Grad 18-24 • 25-44 45-64 65+ < $15,000 $15-$34,999 $35,000-49,999 > $50,000* 0 *Data not available 5 10 15 20 25 30 35
    5. 5. Percent of high school students who smoked cigarettes on at least 1 day (during the 30 days before the survey), Chicago, 2011 (YRBSS) Total Male • • • Female NH White* NH Black Hispanic 9th Grade 10th Grade 11th Grade 12th Grade 0 *Data not available 2 4 6 8 10 12 14 16 18 20
    6. 6. • • • •
    7. 7. Total Male Female White Black Non-Hispanic Hispanic Less than HS HS or GED Some post HS College Grad 18-24* • • 25-44 45-64 65+ < $15,000 $15-$34,999 $35,000-49,999 > $50,000 0 *Data not available 10 20 30 40 50 60 70 80 90
    8. 8. January 22, 2014 Chicago Board of Health Unanimously Adopts New Physical Education Policy • • •
    9. 9. • • • • •
    10. 10. 450 400 350 300 329.9 303.5 296.3 287.3 250 278.5 258.6 258.8 238.7 200 228.8 230 2007 2008 220.7 150 100 50 0 1999 2000 2001 2002 2003 All race-ethnicities 2004 NH White 2005 2006 NH Black 2009
    11. 11. 80 70 60.2 60 59.1 56.9 54.8 55.4 49.4 50 48.3 46.8 44.2 43.4 40.3 40 30 20 10 0 1999 2000 2001 2002 All race-ethnicities 2003 NH White 2004 NH Black 2005 2006 Hispanic 2007 United States 2008 2009
    12. 12. • • •
    13. 13. 120 100 80 85.2 80.5 76 69.3 65.6 60 64.8 61.9 65.1 66.1 61.4 57 40 20 0 1999 2000 2001 All race-ethnicities 2002 Hispanic 2003 2004 NH Asian 2005 NH Black 2006 NH White 2007 2008 United States 2009
    14. 14. • •
    15. 15. • • •
    16. 16. Chicago • • United State Female Male Hispanic NH White NH Black 0 10 20 30 40 50 60 70
    17. 17. Female Male Hispanic NH Black NH White MSM IDU MSM & IDU Heterosexual • • • • < 20 20-29 30-39 40-49 50-59 > 60 0 10 20 30 40 50 60 70 80 90
    18. 18. • • • • • • • • • o o o
    19. 19. • • • • • •
    20. 20. • • • • • • • •
    21. 21. 20 18 16 14 12 11.5 10.5 9.6 10 9 8.6 8.4 8.5 2004 2005 7.9 7.9 8 8 2006 2007 2008 2009 8 6 4 2 0 1999 2000 2001 All race-ethnicities 2002 Hispanic 2003 NH Asian NH Black NH White United States
    22. 22. 16 14 12 10.1 10 9.7 10.1 10 2002 2003 10 10.2 2004 2005 10.1 10.2 9.9 9.6 9.7 2008 2009 8 6 4 2 0 1999 2000 2001 All race-ethnicities Hispanic NH Asian NH Black 2006 NH White 2007 United States
    23. 23. • • •
    24. 24. 2012
    25. 25. • • • .
    26. 26. • • • •
    27. 27. Predicting Cigarette Sales Violations Back to School Immunizations
    28. 28. • • • • • •
    29. 29. @ChiPublicHealth facebook.com/ChicagoPublicHealth 312.747.9884 HealthyChicago@CityofChicago.org www.CityofChicago.org/Health

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