Bechara Choucair, MDCommissioner

Chicago Department of Public Health

@ChiPublicHealth #HealthyChicago

Policy, Systems, Environmental Change & Technology in Chicago

August 8, 2013

Chicago Department of Public HealthCommissioner Bechara Choucair, M.D.

City of ChicagoMayor Rahm Emanuel

PRESENTATION OUTLINE

1. What Influences Public Health? Policy, Systems & Environmental Change (PSE)

2. Healthy Chicago Public Health Agenda

3. PSE Successes: Tobacco, Maternal and Child Health, Obesity, and Adolescent Health

4. Advancing Healthy Chicago Through Technology

FACTORS INFLUENCING HEALTH

McGinnis et al. The Case for More Policy Attention to Health Promotion. Health Affairs, Vol. 21 (2)

Socioeconomic Factors

Changing the Contextto make individuals’ default

decisions healthy

Long-lasting Protective Interventions

ClinicalInterventio

ns

Counseling & Education

Examples

Poverty, education, housing, inequality

Immunizations, brief intervention, cessation treatment, colonoscopy

Fluoridation, trans fat, smoke-free laws, tobacco tax

Rx for high blood pressure, high cholesterol, diabetes

Eat healthy, be physically active

Smallest

Impact

Largest

Impact

HEALTH IMPACT PYRAMID

POLICY, SYSTEMS & ENVIRONMENTAL CHANGE (PSE)

•Makes default decisions healthy•Big impact & sustainable •Relatively little time and resources needed•Engages diverse stakeholders

POLICY, SYSTEMS & ENVIRONMENTAL CHANGE (PSE)Policy- Written statement of organizational

position, decision or course of action, including ordinances, resolutions, mandates, guidelines, & rules

Systems- Changes in organizational procedures (personnel, resource allocation, & programs)

Environment- Physical, observable changes in the built, economic, and/or social environment

PROGRAMS/EVENTS

• Short term• Generally has beginning

and end of intervention• Distinct target audience• Reliant on funding or

other support for replication

• Doesn‘t impact environment

• Lessons learned can inform policy

CHANGE IN POLICY, SYSTEMS, ENVIRONMENT

• Institutionalized• Equitable reach• Sustained beyond individual

champion or specific funding• Ongoing without start and stop

times• May still need programmatic

elements to achieve desired impact

WHAT IS THE DIFFERENCE?

HEALTHY CHICAGOPUBLIC HEALTH AGENDA

• Released in August 2011

• Identifies priorities for action for next 5 years

• Identifies health status targets for 2020

• Shifts us from one-time programmatic interventions to sustainable system, policy and environmental changes

Increasing Population

Impact

Increasing Individual Effort Needed

Smoke-free Campuses

SHIFT TO PSE CHANGE: TOBACCO PREVENTION EFFORTS

TOBACCO USE

TOBACCO USE

SMOKE-FREE CAMPUSES 3 Colleges / Universities 5 Hospitals 6 Behavioral health organizations 8 Public housing developments

TOBACCO USE

Joint Enforcement

PSE CHANGE TO SUPPORT HEALTHY MOTHERS & BABIES

15 hospitals working towards Baby-Friendly Designation

PSE CHANGE IN OBESITY PREVENTION

ChicagoStreets for Cycling Plan 2020

Over 200 miles of on-street bikeways, including almost 35 miles of barrier and buffer protected bike lanes.

3000 bikes to share at 300 stations by end of summer.

OBESITY PREVENTION

Dearborn Street - Before Dearborn Street - After

OBESITY PREVENTION

Bike Sharing in Chicago

3,000 bikes

300 stationsby the end of summer 2013

OBESITY PREVENTION

Health Goals Increase the

number of pedestrian trips for enjoyment, school, work, and daily errands

Increase the mode share of pedestrian trips for enjoyment, school, work, and daily errands

OBESITY PREVENTION

13 licensed carts operating 30 vendors trained 30 carts planned for 2013

OBESITY PREVENTION

OBESITY PREVENTION

A Recipe for Healthy Places

•Released in January 2013•Includes six community- based planning strategies to support healthy eating

OBESITY PREVENTION

A Recipe for Healthy Places: Strategies

1. BUILD HEALTHIER NEIGHBORHOODS: Focus planning and programs in communities with an elevated risk for obesity-related diseases

2. GROW FOOD: Create systems of productive landscapes

3. EXPAND HEALTHY FOOD ENTERPRISES: Support businesses and social enterprises that produce and distribute healthy food

4. STRENGTHEN THE FOOD SAFETY NET: Ensure that residents can eat well regardless of income

5. SERVE HEALTHY FOOD AND BEVERAGES: Change the culture of eating at work meetings, festivals, sports gatherings, community activities and places of worship

6. IMPROVE EATING HABITS: Help people discover appealing, nutritious foods

Check out the food plan - www.cityofchicago.org/hed

OBESITY PREVENTION

PSE CHANGE TO PROMOTE ADOLESCENT HEALTH

The Office of Student Health & Wellness: A Collaboration between the Chicago

Department of Public Health and Chicago Public Schools

ADOLESCENT HEALTH

CPS hires chief health officer Dually reports to CDPH CDPH creates Adolescent and School Health Office

ADOLESCENT HEALTH

Revised Wellness Policy Competitive Foods Policy Expanded STI Screening $26M New grants

• CTG – Healthy CPS• Teen Dating Matters• Teen Pregnancy• Farm to School • Wellness Champions

BUILDING ON POLICY SUCCESSES

Mayor Emanuel Takes Action to Protect Chicago’s Kids from Menthol Cigarettes

BUILDING ON & ENGAGING PARTNERSHIPS

Advancing Healthy ChicagoThrough Technology

Data Portal – Flu App

Chicago Health Atlas

FoodBorneChi

Chicago Health Atlas is a . . .collaboration

• Informatics researchers from multiple healthcare institutions

• Chicago Regional Extension Center (CHITREC)

• Chicago Community Trust

• Chicago Department of Public Health

Chicago Health Atlas is a . . .website

ChicagoHealthAtlas.org

Chicago Health Atlas is a . . .database

• De-identified electronic health record data for ~1 million Chicagoans

• In-patient and out-patient visits spanning 2006-2011

• Individual patient records matched across institutions

Developing Procedures and Best Practices

• Public health indicators from City Data Portal can be viewed for temporal and neighborhood trends

• Incorporating CDC guidelines for classification of map categories

• How to make metadata easily accessible to users

• How to deal with aggregated geographies and time periods

Health Information Exchange

Neighborhood Pages

Health Information Exchange

City Level Comparisons

Open Data Portal

Infrastructure

Increase the availability of public health data through the City of Chicago website. data.cityofchicago.org

Open Data Portal

• Brief (recent) history of open data in Chicago

• Focus on public health indicator data preparation

• Navigation of the Data Portal and apps

Open Data in Chicago

• May 2011Mayoral Transition Plan

• First 100 daysData Portal expansion

• December 2012Open Data Executive Order

Public Health Context

• Most frequent requests are for statistics by neighborhood

• Neighborhood summaries published once every 3-4 years by paper/PDF

• Many data objects generated in response to requests

Number of customized data objects released to individuals or institutions (rather than to public), cumulative, 2011 – May 2013

Discussion

• Open data initiatives prompted revisions in epidemiologic practices

• Use of Data Portal temporally associated with decrease in releases of customized data objects

• Epidemiologic concepts are being discussed and implemented in the broader community

A Guiding Principle

• What are the data or statistics you’re using to make decisions?

• Trust the user . . . but also document and highlight limitations and imperfections

Flu App

FoodBorne Chicago Web Application Based on Machine

Learning Mathematical algorithm

App “taught” to ID Food Poison Tweets

App “learns” relevant Tweets Collects Chicago Food

Poisoning Tweets Human Classifier Determines

Responses

• Actionable – Submissions are Investigated

• Sentinel for Outbreaks

• Inspection Status:• Residents See Results Online

• Open 311• Data Portal

• 50 Inspections Since Released

• Future: Emergency Response, Flu

FoodBorne Chicago

FoodBorne Chicago

RESIDENT TWEETS CLICKS & REPORTS ONLINE RESULTS

FoodBorne Chicago

@foodbornechi FoodBorneChicago.org

@ChiPublicHealth

312.747.9884

facebook.com/ChicagoPublicHealth

HealthyChicago@CityofChicago.org

www.CityofChicago.org/Health