1. How Healthy Chicago is Addressing
Chicago Department of Public Health
Health Disparities in Chicago
February 26, 2013
Bechara Choucair, MD
Commissioner
Chicago Department of Public Health
@choucair on
Rahm Emanuel Bechara Choucair, MD
Mayor Commissioner

2. Slide Disclosure
I have no relevant financial relationships with the
manufacturer(s) of any commercial product(s) and/or provider(s)
of commercial services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use of a
commercial product/device in my presentation.

3. Presentation Outline
1. Healthy Chicago Public Health Agenda and Health
Disparities
2. Addressing Pediatric Health Disparities
-Healthy Mothers and Babies
-Adolescent Health
-Obesity Prevention
-Tobacco Use
-Violence Prevention
3. Future Work to Address Pediatric Health Disparities

4. Presentation Outline
1. Healthy Chicago Public Health Agenda and Health
Disparities
2. Addressing Pediatric Health Disparities
-Healthy Mothers and Babies
-Adolescent Health
-Obesity Prevention
-Tobacco Use
-Violence Prevention
3. Future Work to Address Pediatric Health Disparities

5. HEALTHY CHICAGO
CHICAGO DEPARTMENT OF PUBLIC HEALTH
TRANSFORMING THE
HEALTH OF OUR CITY
CHICAGO ANSWERS THE CALL

6. HEALTHY CHICAGO
Chicago Department of Public Health
Infrastructure

7. 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

8. 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

9. 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 Health Politics,
Policy and Law, Vol. 31, No. 1, Feb. 2006

10. 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

12. Chicago: Person, Place, Time*
*From Sampson R. Great American City. 2012; p. 105 & 106.

14. Presentation Outline
1. Healthy Chicago Public Health Agenda and Health
Disparities
2. Addressing Pediatric Health Disparities
-Healthy Mothers and Babies
-Adolescent Health
-Obesity Prevention
-Tobacco Use
-Violence Prevention
3. Future Work to Address Pediatric Health Disparities

15. Priority: Healthy Mothers and Babies

16. 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. infant mortality rate is higher than the
average of 16 other industrialized countries
Source: IOM, 2013. http://www.iom.edu/~/media/Files/Report%20Files/2013/US-Health-International-Perspective/
USHealth_Intl_PerspectiveRB.pdf

17. Chicago Infant Mortality Rate, 2008, by
Race/Ethnicity, per 1000 Births
14 13.3
12
10
Rate 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

18. 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

19. Percent of Illinois Women Who Initiated
Breastfeeding, 2004-2008 Combined
100
92 98
90
90 84 85 87
80
70 64
60
52
Percent
50 Low Income
40 Higher Income
30
20
10
0
White Black Hispanic Asian
Data Source: Pregnancy Risk Assessment Monitoring System (PRAMS)

20. 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

21. Maternal and Child Home Visits
• 16,859 home visits were provided in 2012 to
pregnant women and new mothers
• Clients are educated on the most current
information on their pregnancy and well-baby care

22. Priority: Adolescent Health

23. 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

24. 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

25. Teen Pregnancy
• 38% of Chicago high school students report being
sexually active (2011 YRBS)
• 2009 birth rate for 15-19 year-olds in Chicago was
57/1000
Source: Youth Risk Behavior Survey, 2011

26. Teen Birth Rate by Race/Ethnicity of
Mother, Chicago and the United States,
100
98.7 1999-2009
91.1
(per 1,000 females aged 15-19 years)
90 90.1 88.6 88.9 88.8
85.2 84.9 86.3
81.9 82.5 83.3
80 80.5 80.3 79.2
76 76.8 77.7
72.8 73.9 75
70 69.3 68.6
Teen Birth Rate
65.6 64.8 65.1 66.1
60 61.9 61.4 60.5
57
50
48.8 47.7
45.3
43 41.6 41.1 41.9 42.5 41.5
40 40.5 39.1
30
26
23 19.5
20 19.3
16.9 16.4 17.5 16.4 15.8
12.8 14.2 15 12.8
10 11.4 10.7 11.7 12
8.6 9 8.5 8 8.1
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.

27. Teen Pregnancy & STIs Initiatives
• Teen pregnancy prevention initiative
– 4500 students received curriculum and supports
(2012)
• STI screenings
– 9,215 educated; 6,147 screened; 436 identified

28. Priority: Obesity Prevention

29. Obesity Prevention
• Obesity increases the risk of heart disease,
cancer, and stroke
• Racial, ethnic, income, and gender differences
for BMI
Source: BRFSS, 2010.

30. Prevalence of Obesity in 2-19 Year-Olds in
the U.S., 2009-2010
Source: Ogden et al., JAMA 2012. Online via http://www.nmqf.org/presentations/12OgdenCJCP3.pdf

31. http://www.cdc.gov/nchs/data/databriefs/db51.pdf

32. Food Access in Chicago Communities
Data provided by Chicago’s Department of Housing and Economic Development, 2012.

33. 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

34. 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

35. New Obesity Report is Coming Soon
• New report on child and
adolescent overweight
and obesity among CPS
students will be released
soon
• Kindergarten, grade 6,
grade 9
• 2010-2011

36. Priority: Tobacco Use

37. Tobacco Use Among Youth
• Tobacco use is the most preventable cause of death
and its use is associated with many illnesses
• 18% of U.S. high school students smoked one or
more cigarettes in the past month (2011)
Source: Youth Risk Behavior Surveillance, 2011, Chicago

38. High School Students who Smoked One or
More Cigarettes in Previous Month, by
Race/Ethnicity, U.S., 2011
Race/Ethnicity Percent Who Smoke
White, Non-Hispanic 20.3%
Multiple Race, Non-Hispanic 18.1%
Hispanic 17.5%
Black, Non-Hispanic 10.5%
Source: Youth Risk Behavior Surveillance, 2011

39. Cigarettes and Chicago Youth, 2011
• 2011 Youth Risk Behavior Surveillance Survey
• 13.6% of high school students smoked at least one
day in the previous month
• 30.1% of current smokers obtained their own
cigarettes by buying them in a store or gas station
Source: Youth Risk Behavior Surveillance, 2011, Chicago

40. 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

41. 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
• Parochial schools and 3 higher
education campuses
• 6 substance abuse & mental
health service agencies

42. 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

43. Priority: Violence Prevention

44. Violence Prevention
• Gun violence disproportionately affects
disenfranchised communities
• In 2011, 11% of Chicago high school students
reported missing school in the last 30 days due to
safety concerns
Source: 2011 YBRS

45. Working to Reduce Community Violence
• Partnership between CDPH, Chicago Police
Department, and Ceasefire
– One-year pilot in 3rd and 10th police districts
• Community Anti-Violence Restoration Effort (CARE)
– Strategic deployment of law enforcement and
resources to address violence and crime
– Strategies: community-based prevention, youth
intervention, and response
• National Forum on Youth Violence Prevention
– 2012 Plan

46. Addressing Childhood
Exposure to Violence (CEV)
• Partnering with CPD to expand data collection on
scope and types of CEV
• Supporting Chicago Safe Start, a city/state
collaborative working to prevent & reduce childhood
exposure to violence, raise awareness & build
services
• Updating CEV curriculum
• Developing violence prevention ambassador
campaign

47. Teen Dating Violence Prevention
• Chicago is one of four cities implementing a CDC
teen dating violence prevention initiative
• 11-14-year-olds
• Curricula are currently being used in 3/12 schools
• 5000 youth and parents will receive the training
(2012-2016)

48. Preventing Bullying
• Convening 15-agency bullying prevention workgroup
– Strengthen partnerships, support data sharing and
identify pathways to reduce bullying
– Promote the inclusion of at-risk populations
– Launched bullying prevention webpage

49. Presentation Outline
1. Healthy Chicago Public Health Agenda and Health
Disparities
2. Addressing Pediatric Health Disparities
-Healthy Mothers and Babies
-Adolescent Health
-Obesity Prevention
-Tobacco Use
-Violence Prevention
3. Future Work to Address Pediatric Health Disparities

50. What’s Next?
• Implementation of Food Plan
• Immunizations to underserved communities
• Vision services for CPS students

51. What’s Next?
• Engaging community stakeholders in policy
• Healthy CPS (Chicago Public Schools)

52. facebook.com/ChicagoPublicHealth
Gplus.to/ChiPublicHealth
@ChiPublicHealth
312.747.9884
CityofChicago.org/Health
HealthyChicago@CityofChicago.org