Adonis Diaries

Future of public health: From a Commencement address in Chicago

Posted on: May 27, 2011

What is the future of public health in Chicago?

Commissioner Choukair said in the commencement address: “During my tenure at the Chicago Department of Public Health, which has been about a year and a half so far, I have stressed the importance of focusing on public health strategies that effectively address the actual causes of death, rather than what is found on a death certificate.

Groundbreaking work done by McGinnis and Foege at CDC in the early 1990’s, and fine-tuned since then, demonstrated that the actual causes of death are largely related to individual health behaviors and social circumstances — not genetics, not access to health care.

Dr. Thomas Frieden, Director of CDC, looked at these, took it all in, but then went further and asked:  “now that we have a better understanding of the actual causes of death, how can public health, charged with improving the health of the population, best intervene?”

The most effective interventions, at the base of the pyramid, address the social determinants of health and the way that our society is structured.  Taking this approach to heart, I challenged our team at the Chicago Department of Public Health to develop a draft of a public health agenda that best meets this current understanding of effective public health interventions. And while our emphases have been near the bottom on the pyramid, I recognize that there is a need for effective programs at each level.

If you follow Chicago government, you might know that Mayor Emanuel committed to releasing a public health agenda for the City of Chicago in the next 100 days.  Our public health agenda is a blueprint for action intended to serve as a framework for a focused, yet comprehensive, approach to how the Chicago Department of Public Health will lead and work with partners to improve the health and well-being of the people in Chicago.

Our public health agenda:

  • identifies priorities to guide our public health work over the next five years;
  • sets measurable targets, achievable by 2020, to improve the health and well-being of Chicagoans;
  • sets policy, programmatic, educational, and public awareness strategies that can be measured and monitored; and
  • serves as a vehicle to engage communities, partners, and other public health stakeholders in health improvement efforts.

The priorities presented in this agenda were identified through an assessment of public health data and resources, as well as current or potential stakeholder involvement. Reflecting a multi-tiered public health approach, for each priority area, this agenda presents strategies organized into three sections:

  • ·      Policies, including regulatory changes and laws that will be pursued to improve the public’s health;
  • ·      Programs and services that will be delivered, and
  • ·      Education and public awareness

I am sure it is no surprise to anyone if I share our priorities with you. I am talking about Obesity Prevention, Tobacco Use, HIV Prevention, Teen Pregnancy Prevention, Cancer disparities with a use case on breast cancer disparities in Chicago. I am also talking about heart disease and stroke, about violence prevention and about access to healthcare among others.

These are exciting times in Chicago. In 97 days, our City will have a clear public health agenda. We will have a focused set of priorities. We will make our targets public. We want the public to hold us accountable.

Chicago invests around $200M every year in our public health system. We owe it to Chicagoans to do our best to stretch those dollars and get the best return on investment. This is my commitment to you today. As you get ready to start the next phase in your career, I call on all of you to join me in this journey. I guarantee you it will be a lot of hard work but a lot of fun and we will get a healthier city.

 There are many ways to have an impact on health:

  • ·      Treating the sick –
  • ·      Preventing the illness in the first place through screenings
  • ·      Population-based prevention strategies

I hope in your work in public health, regardless of the setting, you keep in mind the concept of the “third revolution” (Breslow) in public health. Now that we have made significant progress in addressing communicable disease (first revolution) and made progress in chronic diseases (second revolution), we are poised to embark on the third, where communities are healthy and the goal is promoting health and not just preventing disease: “Health promotion reaffirms considering not only how to avoid being sick, a negative concept, but also how to expand the potential for living, a positive view: The main difference between health promotion and disease prevention is the premise of health promotion regarding health as a resource of everyday life”.

We all know the impact of clinical medicine on public health.  To promote health, we need to think beyond just clinical medicine. We have to be involved in social policy.  All social policy is public health.  Fiscal policy is health policy.  Education is public health. Housing is public health.

Perhaps in your schooling, or on your own, you saw the film “Unnatural Causes: Is Inequality Making Us Sick?” Through four hours of excellent documentary film making, it makes crystal clear what needs to change in our society if we are going to be truly healthy:

  • ·      It’s less poverty
  • ·      It’s quality housing
  • ·      It’s quality education
  • ·      It’s viable communities filled with resources geared to the needs of the particular population

I grew up in Lebanon in the midst of a civil war. I saw the impact of violence on individuals, on families, on community and on the whole country. I suffered the impact of violence myself.  I saw the impact on my own family, in my own community.

In medical school at the American University of Beirut, I spent time seeing patients in Palestinian Refugee camps in Beirut. I talked to so many people who lived their whole lives in an environment where I might not choose to live.  I saw firsthand the impact of forced migration on health.

In Houston, at Baylor College of Medicine, I trained in a community health center serving mostly Mexican immigrants who struggled to make a decent living. I learned about homelessness by providing clinical services to people living in shelters, under bridges, in cars and on the streets.  I saw firsthand the impact of poverty and lack of housing on individuals.

In Rockford, at Crusader Community Health, I served as a medical director of a community health center network. I learned about more migrant communities. I learned more about public housing. I learned more about HIV/AIDS.  I saw firsthand the impact of poverty on different communities.

At Heartland Alliance for Human Rights and Human Needs, I worked with immigrants and refugees on the North side of Chicago. I also worked with many of the Heartland Alliance global health team:

  • ·      the team working on HIV Prevention among Men who have sex with men in Nigeria
  • ·      the team working on sexual and gender-based violence in Sulaymaniyah, Iraq,
  • ·      the team working on torture and trauma treatment in Momostenango, Guatemala
  • ·      the team working on Maternal Child Health in Patzcuaro, Mexico
  • ·      the team working on child soldier reintegration in Srilanka

I visited with some of these sites and learned from the Heartland staff and most importantly I learned from the participants in these programs.  What I learned from all of these experiences is simple.

To empower individuals to achieve their human rights, and to empower communities to achieve their potential, we cannot think about health care alone. We have to think about healthcare. We also have to think about housing. We have to think about economic security. We have to think about legal protections.  This is what public health is all about.  This is what we need to address as public health people.

I hope that with your public health education and approach you will keep in mind that a healthier society is a society where healthier choices are the default choices.  A healthier society is a society where children have good schools to attend, and safe neighborhoods to play in.  A healthier society is a society where parents have enough resources to provide their children with a rich experience in life.

What do you need to do to be a better person?  What will you do to build a healthier society?  How can you contribute to social justice?  What role will you play to advance human rights?  Join me today in dreaming big for our communities.  I always did. I always will.

Note:  This is the third part of a commencement address of Chicago Commissioner Choukair.

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adonis49

adonis49

adonis49

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