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Commissioner Choucair presents Healthy Chicago at the Colorado Health Symposium - Start Your Engines: Driving Innovation in Health. The words "levers" and "drivers" are frequently used these days to describe strategies to achieve change in health and healthcare. Often in approaching solutions to complex problems, the hardest step is choosing which lever to pull first. Presenters share the levers they focused on to drive innovation and change. From disruptive technologies enabling better results in the healthcare delivery system, to policy and practice shifts aimed at achieving individual and community wellbeing– they provide an inspiring and thought-provoking glimpse of what our health future could look like.
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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
www.CityofChicago.org/Health