Local Public Health in

Uncertain Times

Julie Morita, MD
Commissioner
Chicago Department of Public Health
 Agenda
I. What the Affordable Care Act has meant to Local Public Health
HPV Case Study
II. A New Direction for Public Health
Progress Made
Disparities Still Exist
Healthy Chicago 2.0
III. The Impact of Current Federal Policy
ACA Repeal
Immigration
Environment
IV. Conclusion
The Medias role
V. Questions
What the Affordable Care Act has
Meant to Local Public Health
 Access to Better Healthcare
More people insured
20 million in US
300,000 in Chicago

Departure from fee for service model

Payment for quality vs quantity of care

Sharper focus on preventative care

 ACA:
Prevention & Public Health Fund
CDC: 13% of budget (FY2017)

Chicago: $12 million (2013-2017)

Reduction of lead hazards
Detection and control of infectious disease
outbreaks
Protecting the public from vaccine preventable
diseases
 Preventing Human Papillomavirus
Infections among Chicagos Adolescents
 HPV Infections, US
Almost all females and males would be infected
79 million currently infected
14 million new infections/year

Annual new cancers

Males: 12,002
Females: 20, 413
Jemal A et al. J Natl Cancer Inst 2013;105:175-201
HPV4 routinely recommended
for females HPV4 routinely
recommended for males

2006 2009 2012 2014

HPV4 permissively HPV9 vaccine

recommended for males routinely recommended for all
adolescents
Vaccine Coverage Levels among 13-17 years olds,
2006-2012

Tdap

MCV4

>1 HPV (girls)

3 HPV (girls)

>1 HPV (boys)

3 HPV (boys)

Source: MMWR. 2013;62;685-93

Stakeholders
Print/Outdoor Radio/TV

School-Based

Social Media
#UCanStopHPV
 Healthcare Provider Education

Office-based training
Participating clinics (75)

Large group training

In-person and webinar training (22)
Participants: >2,000
 HPV Vaccine Coverage, Females, 13-17 years,
Chicago, 2011-2014
NIS Teen Data

100

90
Healthy People 2020 Target: 80%
80

70
20%
Percent vaccinated

60

50
16%
40

30

20

10

0
HPV 1 HPV 3

2011 2012 2013 2014

A new direction for public health
 Teen Birth Rates, Chicago, 2000-13
90

80
Births per 1,000 females aged 15-19

80.5
70

60

50

40

30 35.5

20

10

0
2000 2002 2004 2006 2008 2010 2012

Source: IDPH, Division of Vital Records, Birth Certificate Files, 2000-2013

 New HIV Diagnoses, Chicago, 2000-14
2000

1800
1832
1600
Number of new HIV infections

1400

1200

1000

800
973

600

400

200

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Source: CDPH, HIV Surveillance Files, 2000-2014 Source: Youth Risk Behavioral Surveillance System, 2001-2013
 Percent of Teens Smoking,
Chicago, 2001-13
30

25
Percent of HS Students

20
24.7

15

10
10.7
5

0
2001 2003 2005 2007 2009 2010 2013

* Significant
Source: difference
YRBS, Illinois Youth Survey, 2001-2013 Source: Youth Risk Behavioral Surveillance System, 2001-2013
 Percent Uninsured, Chicago, 2010-14
25

20
20.8

15
Percent

14.3

10

0
2010 2011 2012 2013 2014

Source: US Census, American Community Survey, 1-year estimates, 2014 Source: American Community Survey, 1-year estimates, 2014
Disparities Persist
Social Service vs Health Service Expenditures, Organization
for Economic Co-operation and Development (34 countries)
Welcome Chicago
ACHIEVING HEALTH EQUITY
1. Partnering Together
2. Leveraging Data
3. Focusing on Root Causes
 GOAL
Improve Chicagos built environment and transportation

Objective
Increase the percentage of adults who walk, bike
or take public transportation to work by 10%

Strategies
Investments in bicycling
Investments in public transit
Elimination of traffic fatalities
ADDRESSING
Pedestrian plan
ROOT CAUSES
Most bike friendly city in the US, 2017

Bike share program: Divvy

Complete Streets
Lakefront trail separation
 Investments in mass transit
Modernization of tracks, signals,
switches, and cars

Union Station
Terminal improvements include art
projects that include community
Coalition for a Better Chinese
Community: Assessment of
community for infrastructure
improvements to improve walkability
 Federal policies force
local public health to redirect

ACA repeal/replace

Immigration policy

Environmental policy
 Protecting Prevention

Senator Richard Durbin Senator Tammy Duckworth

Illinois Illinois
Protecting Immigrants
Protecting the Environment
 2017 ENERGY STAR:
Partner of the Year Award
Protecting the Truth
 Conclusion

Federal policy impacts local public health

Recent federal policy changes required

public health to redirect our efforts

Local public health can provide stories

about the impact of policy changes
Questions