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Posts Tagged ‘Bechara Choucair

A few “leaders” are Not about to take Covid-19 pandemics with a high level of seriousness

As COVID-19 surges in the US, are we all willing to take it seriously?: Opinion

We can control the path of this deadly, destructive virus.

In the United States we’ve learned that collective and individual action can slow the spread of COVID-19.

The progress seen in New York — which recently reported zero deaths on a given day — proves we can control the path of this deadly, destructive virus.

Despite these pockets of incremental progress, we’ve also learned that dealing with COVID-19 is a marathon, not a sprint, and that we, as a country,  are falling short of what’s needed to slow the spread of the virus and safely inch back to normal.

Initial shelter-in-place orders helped temporarily slow the spread, but upended our lives, closing schools and workplaces across the country.

Shelter-in-place allowed the health care system to prepare for a surge and was meant to buy precious time to develop and implement an effective contact tracing strategy as well as build a high-volume testing capacity that could have helped limit the virus’ spread.

Most of that, sadly, did not happen.

With the virus surging at ever-higher levels, we are on the brink of blanket restrictions that protect our health but also harm our economies and our psyches.

With nearly 140,000 people in this country dead from COVID-19, and potentially hundreds of thousands more suffering the long-term health impact of this still-baffling disease, can we all finally agree to make the investments needed for America to vigorously respond to this pandemic?

Build the public health infrastructure now

We have to develop a robust public health workforce that will allow us to contain the spread of COVID-19.

Other countries, including New Zealand and Taiwan that have beaten the virus or slowed its spread, already had the teams and infrastructure in place from their responses to past epidemic diseases.

In the U.S., decades of disinvestment created a frayed and disjointed infrastructure that didn’t stand a chance against COVID-19.

The cost to create the public health workforce of high-volume testers, contact tracers, support systems to enable isolation, coordinated lab facilities and vaccinators is unavoidably huge and dwarfed by the economic fallout of a prolonged pandemic that will occur if we do not invest in these solutions now.

Do the advance work

This critical infrastructure is needed right now to stop the spread.

And when a vaccine is developed, it will be needed even more to assist with distribution, administration and further containment.

We are already hearing rumblings about limitations of distributing a vaccine. Will there be enough glass vials to accommodate the billions of doses needed globally, or will they fall short the way testing swabs are today?

Additionally, an effective vaccine does Not guarantee eradication of COVID-19.

Research is now showing that antibody-based immunity may only last for a few months after recovery for some people, leaving victims potentially vulnerable to reinfection.

We must imagine that any vaccine could require periodic booster doses.

What would that look like in the U.S. for a population of 330 million people? We may need to create permanent COVID-19 centers where Americans can receive these frequent injections.

These are the types of issues we need to think about now, so we can get ahead of problems instead of continuing to play catch-up, with devastating consequences.

Communicate honestly

Perhaps the greatest travesty of this pandemic has been the mistrust and skepticism toward the scientific and public health communities sown through politicization and misinformation about the novel coronavirus.

The facts are simple: this disease does not discriminate based on political party, or whether you believe in it. Testing is essential to uncover cases and does not “create” new ones.

For the greater good, we must not only back down from the rhetoric, we have to redirect tremendous resources into communicating to the public the truth about the virus and the effective, proven steps everyone can take to reduce its spread.

Public health campaigns work. According to the Centers for Disease Control and Prevention, more than 1.8 million smokers attempted to quit smoking because of its nine-weeks long 2014 “Tips From Former Smokers” campaign.

With the viral nature of today’s mass communication channels we can save lives if we can first undo the harm that misinformation has already caused and replace those messages with ones that will save lives.

Think about the power of the ALS ice bucket challenge. Now the message to get out is about wearing masks.

Physical distancing. Washing hands. Staying home if you’re ill. These steps are all slightly inconvenient but simple to execute and hugely effective — if we can convince people to do them.

We should not fool ourselves that COVID-19 may be the last pandemic in our lifetimes.

A functioning society, for the foreseeable future, will necessarily include the public health professionals who can identify, isolate and mitigate this virus and potentially others.

No level of normal will be possible without that vital change.

Dr. Jay Bhatt is a practicing internist, an Aspen Health Innovators Fellow, and an ABC News contributor.

Dr. Bechara Choucair is a physician and chief health officer at Kaiser Permanente. His book, “Precision Community Health: Four Innovations for Well-being,” was published in May.

MORE: How New York has been able to keep coronavirus at bay while other states see surges

MORE: COVID-19 antibodies may fade in as little as 2 months, study says

Re-inventing Public Health: Covid-19 inequity

COVID-19 and inequity — public health needs a third revolution

For many Americans, George Floyd’s murder ignited a new level of momentum to confront police violence against people of color.

The COVID-19 pandemic — which is killing black Americans at nearly two and a half times the rate of whites — has put a spotlight on our nation’s shameful racial divide in public health.

While the first and second public health revolutions vastly extended life expectancy by making strides against communicable disease (cholera, typhoid and dysentery) and chronic illness (heart disease and diabetes), racial gaps (and minority ethnic groups) remain a persistent contributor to negative health outcomes.

In a nation with growing economic disparities, scarred by centuries of systemic racism, the third revolution in public health must address the root causes of our remaining pervasive health inequities — poverty, pollution, housing, food security and other basic needs.

Since our systems have resulted in these issues disproportionately impacting communities of color, we need to conceive, develop and implement solutions that prioritize the wellbeing of people and communities that have been overlooked for far too long.

COVID-19 and inequity — public health needs a third revolution

It’s a daunting task, to be sure. But, with an approach I call precision community health, we can target our limited resources to be effective at addressing the most urgent public health inequities, while also supporting the eradication of racism throughout our society.

Investment is needed in public health systems, including state-of-the-art data collection and communications tools.

With these we can collect granular data on everything from asthma rates to housing conditions and police violence, broken down by race and income.

That data can then be transformed into knowledge to guide decision-making.

We can leverage social media and other communications strategies to deliver precisely targeted messages to ensure people have information they need, when and where they need it, to make informed decisions for themselves and their loved ones.

We can also invest in people by creating a national Public Health Corps, similar to AmeriCorps.

Recruitment could start with our country’s community health workers, our invaluable set of frontline public health workers who are already trusted members of the communities we serve today.

But importantly, these workers’ expertise and training can also build equity in communities today, by linking people to resources on housing, food security, employment and more.

Community health workers are also uniquely positioned to have an immediate impact on the spread of COVID-19 by performing the critical task of contact tracing — reaching out to those who test positive for COVID-19, helping them identify others they may have been exposed, then supporting them through quarantine and testing.

For any of our efforts to succeed, we must account for and honestly confront the distrust many people feel in our public institutions.

In this time of massive societal upheaval, we have a tremendous opportunity to shift our focus and resources to fully embrace public health solutions. But our field will need to reckon with our own painful history of systemic racism to realize our full potential.

If we are to continue making the breakthroughs that improve and extend lives as public health has done for decades, we must embrace the moment we are in.

It’s time to rethink public health by understanding the inequities that are making people sick and targeting resources where they are needed most.

Bechara Choucair, a family physician by training, was commissioner of the Chicago Department of Public Health from 2009 to 2014.

He is currently senior vice president and chief health officer at Kaiser Permanente and author of “Precision Community Health: Four Innovations for Well-being.”

Note: My Daydreaming health re-structuring project



The 5-year journey as Chicago Department of Public Health: Bechara Choucair, M.D.

In the U.S., we tend to believe our health is largely a result of our genes and our personal choices. But, as research shows, health is most influenced by our environment.

You could say our ZIP code has more to do with our health than our genetic code.

Though I will soon step down as commissioner of public health, it is this reality that first led me to this job — if we can improve the health of a neighborhood, we can improve the health of our residents.

posted this Dec. 30, 2014

5-Year Journey: One Blog 

Mayor Rahm Emanuel understands this. When he first took office, he directed the Chicago Department of Public Health (CDPH) to create a comprehensive public health agenda for the entire City.

That plan, Healthy Chicago, provides 200 strategies to build healthier neighborhoods, which will in turn provide our residents — especially our youth — with more opportunities to get and stay healthy.

And it’s working.

Since launching Healthy Chicago, we have reported declines in childhood obesity rates and teen smoking rates while making real progress in our fight to close breast cancer disparities. There is more work to do, but we are moving in the right direction across the board.

We know that 90% of adult smokers started when they were minors.

So Healthy Chicago includes a series of initiatives aimed at discouraging our children from ever lighting their first cigarette.

We increased the city’s cigarette tax because
research shows that increased cost is the single most effective way to prevent kids from picking up the habit

We supported the regulation of e-cigarettes, ensuring these products are not physically accessible to youth and championed a new ordinance restricting the sale of flavored tobacco — including menthol — within 500 feet of schools

This effort is paying off. Earlier this year, the Centers for Disease Control and Prevention released new data showing that less than 11% of Chicago high school students reported smoking in 2013 — a historic low and five points below the current national average. The CDC also reported that Chicago’s adult smoking rates have hit a new record low of less than 18%.

While it is critical that we reduce the number of tobacco users in Chicago, addressing this challenge alone will only get us so far. It is just as important to encourage all residents to adopt healthier lifestyles across the board.

Over the last 3 years, we have worked to reduce childhood obesity.

We have expanded the number of bike lanes across the city and launched one of the nation’s premier bike sharing programs. The CDPH also launched PlayStreets to provide nearly 27,000 Chicago children and their families more opportunities to get outside and play in their own neighborhoods.

We are also working to keep our children healthier when they are in school.

We guaranteed recess for every student, strengthened nutritional standards in our cafeterias and expanded our free dental and vision programs. Last school year we provided an Action Plan for Healthy Adolescents, dental exams and cleanings for 113,000 students and distributed nearly 30,000 pairs of eyeglasses.

By helping our children today, we are creating a healthier future for tomorrow.

One of the most important ways to protect the health of our children and every Chicago resident is by protecting the air we all breathe in every neighborhood of our city.

Mayor Emanuel fought to shut down the two remaining coal power plants in the city and joined the CDPH to issue the most comprehensive set of regulations to cut down on the harmful emission of petroleum coke on the city’s southeast side.

We also launched innovative programs like FoodBorne Chicago, using Twitter to identify and respond to potential cases of food poisoning. Partnering with the University of Chicago, we have developed a new way to identify and repair homes most likely to have children exposed to lead-based paint.

We also made changes that seemed controversial at the time but are starting to pay off today.

This includes reforming the city’s mental health and primary care programs. With mental health, we consolidated our clinics ensuring they had the staff and resources to serve uninsured residents.

We also secured $14 million in funding to strengthen the overall mental health infrastructure, including $4 million for children’s services on the South and West Sides.

With primary care, we transitioned city clinics to non-profit partner organizations which have expanded services, improved the quality of care and increased patient visits by nearly 70 percent in the first year and a half — all while saving taxpayers an additional $12 million.

That is why we were honored as the 2014 Health Department of the Year by the National Association of County and City Health Officials. And that is why the CDPH will continue to move the needle forward.

Serving as Chicago’s health commissioner has been a profound honor and the highlight of my career. I am proud to say I leave behind a department that is stronger than it was when I arrived and a city that is healthier. There is no greater job satisfaction than that.

All Time top posts

I selected the posts that registered over 2,000 hits since Sept 18, 2008. Since then, I posted so far 4,900 articles.

Note that my articles on Sex and Nude are rare, but these key words draw the most browsing.

December 12, 2014,

All Time

Title Views
Home page / Archives More stats 97,223
Sex Preparations before wedding night More stats 37,703
Nude dancing in Louvre Museum Square: Proud “Arab” women atheists? More stats 16,307
Arab Sex Art More stats 13,379
Who planned the 9/11/2001 attack on Twin Towers?? More stats 9,761
Viva in the nude ski Lebanon. Jackie Chamoun photo shoot: Before heading to Sochi Olympics More stats 9,402
Clinical medicine versus public health? What Dr. Bechara Choucair said? More stats 7,249
Proper fasting is a cure-it-all medicine: No food, plain water. What’s your protocol? More stats 6,162
Privately owned Federal Reserve Bank: How the Rothschild family controlled the printing of the Dollars? More stats 5,078
Al-Walid Bin Talal: Biography of a multi-billionaire More stats 4,512
Can you list 10 different types of wars? Are there “good wars” for mankind? More stats 4,385
“Opus Pistorum” (work of the miller) by Henry Miller, (porno) More stats 3,730
“I heard the owl call my name” by Margaret Craven More stats 3,609
Temporary marriage contracts: Sigheh and city of Mashhad (Iran) More stats 3,356
I like this Girl More stats 3,283
Simon Bolivar (1783-1830): “Slavery is the worst human indignity”. Biography More stats 3,245
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How human parts are disposed of in hospitals? And why experiment are done exclusively on male rats? More stats 2,905
About More stats 2,602
“Season of Migration to the North” by late Tayyeb Saleh More stats 2,441
Human Types: Essence and the Enneagram. Part 1 More stats 2,429
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Indeed, Why the “Arabs” in the US are the most educated and the richest? Part 2 More stats 2,071
Islam is one of the “heretic” Christian-Jewish sects: A challenge… More stats 1,986

Sign Up for Obamacare: Flagging Down the 200,000 uninsured health Taxi Drivers

Dan Ware has been driving a taxicab in Chicago for more than a decade, but he still doesn’t have what many jobs offer: health insurance.

“I’m without health coverage,” he says.

 posted this March 4, 2014

Flagging Down Taxi Drivers To Sign Up For Obamacare

And that’s not unusual, says Chicago Public Health Commissioner Bechara Choucair. “What we know in Chicago is that around 70% of taxi drivers are uninsured,” Choucair says.

That means about 8,000 cabbies could be eligible for coverage under the Affordable Care Act.

Nationwide, there are more than 200,000 taxicab drivers, and so in a few big cities — including Chicago — supporters of the Affordable Care Act are working to recruit them to sign up before this month’s open enrollment deadline.

Choucair says a couple of years ago, a study showed taxi drivers in Chicago had plenty of health problems, largely due to the long hours they spend behind the wheel.

“They don’t eat as healthy, they don’t exercise as much and those are definitely risk factors for diabetes, for heart disease, for strokes,” Choucair says.

Add to that chronic back issues that can come from sitting and health problems caused by traffic accidents.

Enrollment workers in Chicago are signing up taxicab drivers for Obamacare at the facility where cabbies obtain or renew their city chauffeur’s license.

“We’ve been enrolling an average of between 5 to 9 people on site,” says Salvador Cerna, an outreach manager for the state. He says others make appointments to get help enrolling, and there are plenty here who want assistance.

Ejaz Waheed has gone without health insurance for nearly a decade. “Back until 2005, I was with a regular job, so I had it. Then I became self-employed and I lost insurance,” he says.

Ghulam Memon began driving in 1994 and shares a similar story. “My wife has Medicare and Medicaid both because she’s 65-plus. I’m like 60 years, and I don’t have anything,” Memon says.

So he’s exploring his options, as is Orkhan Askarov, 24. Askarov was applying for his first taxicab license, and he says he’ll also apply for health insurance “and guarantee that if anything [happens] to me I’m going to be [in] good hands.”

The nonprofit Enroll America is running similar cabbie programs in Austin and in Philadelphia. The group’s president Anne Filipic says it’s trying different ways to reach out to the uninsured as the March 31 deadline nears.

“Our focus right now is an all-hands-on-deck effort to get the word out. We know that a lot of people still don’t have all the facts and don’t know, for example, that financial assistance is available, so we want to meet them where they are and get them the information that they need,” Filipic says.

In Philadelphia, where there are about 5,000 taxi drivers, many cabbies are getting their information at the headquarters of the Taxi Workers Alliance of Pennsylvania. President Ronald Blount says until now many simply couldn’t afford health insurance at all.

Most drivers in Philadelphia are earning less than $5 per hour. They are working 12 to 16 hours per day, 6 to 7 days per week,” Blount says.

He calls the Affordable Care Act a godsend and says about 700 taxi drivers have already signed up there. “Drivers were finding plans as cheap as $35 to $60 per month, and that’s something they can afford and these are really good health plans,” Blount says.

And that’s a boon for many cabbies who may take an easier route and seek out medical help early for any of the ailments that come from driving a taxi.

E-cigarettes? Should Electronic cigarettes Be Regulated as Cigarettes?

Electronic cigarettes are designed to look like cigarettes. They are labeled and marketed like cigarettes. They contain nicotine like cigarettes. And it is addictive to nicotine. And kids will get hooked to its usage, if unregulated…

Electronic cigarettes now come in dozens of flavors like passion fruit, cotton candy, bubble gum, gummy bear, Atomic Fireball, and orange cream soda.

These kid-friendly flavors are an enticing “starter” for youth and non-smokers, increasing nicotine addiction and frequently lead to use of combustible cigarettes.

What do you think is Big Tobacco next step? Producing real tobacco with preferred flavors that the youth were hooked to?

Should they be regulated like cigarettes?

, Commissioner, Chicago Department of Public Health, posted this Dec. 2, 2013

Should e-cigarettes be regulated as cigarettes?

I think so.

Like other gateway products Big Tobacco has masked to entice its next generation of smokers, e-cigarettes follow suit as its popularity with youth nationwide more than doubled from 2011 to 2012.

Ten percent of our students have already used these addictive products — and they have only been on the market for a few years. This meteoric rise in popularity among youth is concerning.

It is also the main reason Mayor Rahm Emanuel has introduced a new ordinance to regulate e-cigarettes as tobacco products.

Simply put, kids should not have easy access to e-cigarettes any longer.

Right now in Chicago, a 14-year-old can walk into a store and purchase an e-cigarette with no question asked. This is unacceptable.

Retailers should be required to have a tobacco-retail license in order to sell e-cigarettes, which would place these products behind the counter with the other tobacco products and out of arms reach of our children.

The government has a duty to protect children from ever picking up a nicotine habit. The preventive action Mayor Emanuel is a long-term investment in the health and well-being of Chicago’s youth.

Some might argue that e-cigarettes should not be regulated because they are safer than regular cigarettes.

While it’s true that they may be safer than regular cigarettes, they have not been proven to be safe.

The truth is e-cigarette companies have not provided any scientific studies or toxicity analysis to the FDA to show that e-cigarettes pose any reduced health risk over conventional cigarettes, nor have they demonstrated that e-cigarettes are safe.

Laboratory tests have found that the so-called “water vapor” from some e-cigarettes can contain nicotine and volatile organic compounds like benzene and toluene; heavy metals like nickel and arsenic; carbon compounds like formaldehyde and acrolein, in addition to tobacco specific nitrosamines.

No federal regulations have been imposed on e-cigarettes, which means that there currently are no restrictions on ingredients manufacturers can or cannot use and no restrictions on the kinds of chemicals they can emit into the indoor environment.

Until more is known about these products, limiting their use in indoor areas is just good common sense.

I am also concerned that widespread use of e-cigarettes is re-normalizing smoking in our society, which in turn, makes this a very pertinent public health issue.

E-cigarettes intentionally were developed to mimic the act of smoking. This distorted reinforcement of smoking as cool and acceptable sends the wrong message to our youth and undermines the existing smoking bans put in place to protect the health of the public.

In Chicago, smoking rates are lower than ever. This progress is a direct result of life-saving policies like the Chicago Clean Indoor Air Act. Health advocates worked tirelessly to ensure we all have the right to breathe clean in-door air. We’re not turning our backs on their hard work to promote clean air.

Our residents expect a healthy environment when they walk into a restaurant, bar or theater. We can’t allow any regression in our progress to change the landscape of public health by reverting back to a culture we’ve worked so hard to change. We need to, and can do, better for the children in our city.

Chicago’s new ordinances are part of an overall comprehensive strategy to reduce the negative consequences tobacco use has on our youth.

With the introduction of these expanded tobacco-control policies, Mayor Emanuel is inspiring cities across the nation to take action to ensure that residents avoid preventable disease and live healthy and productive lives.

Follow Bechara Choucair, M.D. on Twitter:
Note 1:  I am a smoker and have reduced my addiction to 10 cigarettes a day. I have no intention of quitting going cold turkey: I figured that the real psychological benefits I get from smoking, taking a real break and letting my my mind wander now and then, far surpass the physical harm.
If I live much longer, cigarette smoking is a sure death, but I can die any time from non-smoking related diseases or traffic accidents, or slipping and falling, or many unsafe usage of ill-designed products….
Most of those who quit smoking love to approach a smoking person for the smell: This is an aphrodisiac smell to them, far more potent than whatever perfume can offer.
Note 2: The fact that:
1.  “No federal regulations have been imposed on e-cigarettes, which means that there currently are no restrictions on ingredients manufacturers can or cannot use and no restrictions on the kinds of chemicals they can emit into the indoor environment…” and
2.  The act of mimicking  smoking by youth as a cool behavior is a dangerous trend.
Note 3: As long as E-cigarette is not harming the people surrounding the smoker or ruining the environment, I don’t believe it should be banned as regular cigarettes in close environment.  The activists should focus on banning the harmful added ingredients in the E-cigarette.

Heart Attack? Your Smart Phone Might Just Save Your Life

Many of us regularly use technology to simplify lives. Our smart phones allow us to check email, text our friends, and do very important work on Facebook and Twitter.

Did you know that your cell phone could save your life? I’ll tell you how.

Bechara Choucair, M.D. and Commissioner, Chicago Department of Public Health, posted this Feb. 15, 2013:

A few facts straight from the CDC.

1. Every year, 935,000 Americans have a heart attack.

2. Heart disease is the leading killer of both men and women in America, accounting for roughly one in four deaths.

3. And on average, 5,500 Chicagoans die of heart disease each year.

The Million Hearts Campaign was launched in 2012 by the Department of Health and Human Services (HHS) with a goal of preventing one million heart attacks and strokes by 2017.

The HHS put out a call to developers seeking a mobile application to help people track their cardiac health status.

The best app would “help consumers take a heart health risk assessment, find places to get their blood pressure and cholesterol checked, and use the results to work with their health care providers to develop a plan to improve their health“.

The competition was fierce with developers from far and wide throwing their hat in the ring.

After a rigorous evaluation period, the winner was chosen. Heart Health Mobile, an iPhone app, was created by the Marshfield Clinic Research Foundation (you can download the app here for FREE).

The app is incredibly simple to use. You can get a good assessment of your heart risk in about 1 minute, with a list of area clinics to call for follow-up care.

The pilot campaign for the Heart Health Mobile app is launching in five cities this month: Chicago, Baltimore, Tulsa, Philadelphia, and San Diego.

Download the app for free and take responsibility for your Heart Health today!

Don’t forget to let me know what you think. You can always Tweet @ChiPublicHealth with feedback as well.

For more by Bechara Choucair, click here.

For more on heart disease, click here.

A few comeback Schools recess? Spilling-over financial transactions recesses?

Schools in the USA eliminated recess decades ago and shortened the lunch period to 20 minutes:  teachers take their lunch at the end of the day. Why should anyone be obligated to eat in such as rush? What could be the reasons behind shortening students’ time in school?

Apparently, school teachers wanted classes to be over and quickly out of the confinement in school premises; it is kind the teachers were feeling schools are prisons, and worse, living among turbulent kids who do not appreciate the hard work teachers are sacrificing for developing kids’ minds…But what about the well-being of kids, physical, emotional, and mental?

In universities, classes are no longer than 45-minute, on the assumption that people are unable to focus beyond that time constraint, as if people ever focused more than 5 minutes at a time.  And most university students select courses to fall  in 3 days or 2 days a week…However, school kids have to attend successive classes without any recesses so that teachers get off schools early on to tend to better chores…

Working parents surely prefer their kids to stay in school the longer, until they are back from standard work-days. For example, parents are willing to pay daily fines for late pick up of their kids, as long as reasonable money fines is the sole incentive…

Extending school day is never a problem to kids, as long as many recesses are available to play and have fun.  Kids love to play with kids, and returning home too early is liable to spending far more time in front of the TV or playing Nintendo-kind of games…

In Lebanon schools terminate before 3 pm, though they take two recesses: one of 15 minutes at 10:30 and lunch break of 30 minutes.   I don’t think that is satisfactory for kids.  The backpacks of children are growing heavier and I could not raise my niece backpack with both hands.  Every year, as schools open after 3 long summer months, mothers and dailies and news media remind school management of the growing back pain and deformed spine of children:  Lebanon does not enjoy a true State of citizenship to remedy to people’s complaints…

Three decades ago, we enjoyed two long recesses and we played volley ball and…I didn’t participate in collective games because I wore corrective glasses and had suffered disastrous consequences when I did.  In the few games, “my teammates” made sure I never touch the ball, and covered whatever positions I was supposed to fill…what of my totally uncoordinated movement…

As long as teachers are not paid enough to seeking another part-time job to make ends meet, what other alternative incentives could be offered teachers to accept extended school-day for the benefit of kids?

REBECCA VEVEA ( wrote in  “Recess Is Making a Comeback in Schools”: “Restoring recess is part of a broader health push by parents, advocacy groups and some Chicago city officials to bring more exercise and better nutrition to both schoolchildren and preschoolers. Why not extend the push to middle school and high school students? Are they eligible to seeking part-time earning jobs?

The Department of Chicago Public Health first set preschool health standards in 2009, and some preschools and day care centers have already adopted them. Bechara Choucair, the city’s health commissioner, said that the department would begin enforcing the new requirements in November but that it had not yet determined how.

Beginning in November, the city’s Department of Public Health will require children who attend preschool or day care centers in Chicago to spend less time in front of television or computer screens — 60 minutes or less — and more time, at least an hour a day, participating in physical activity”.

At snack or meal time, milk cannot have a fat content higher than 1 percent, unless a child has written consent from a doctor. Only 100 percent juice can be served. In Chicago, 22% of children are overweight before they enter school, more than twice the national average, according to research compiled by the Consortium to Lower Obesity in Chicago Children, a group of organizations and health advocates.

Tracy Moran, a researcher at the Erikson Institute, a graduate school focused on early childhood development and education, said: “The requirements were important for young children to develop healthy lifestyles to prevent conditions like high cholesterol, Type 2 diabetes and hypertension. The lack of recess could certainly stunt any progress made early on.”

For example, last spring, the parent organization Raise Your Hand campaigned to have teachers vote on waivers that would move their lunch period back into the middle of the school day. The change allows students to have 45 minutes to eat lunch and go outside for recess.

(Again, why only 45 minutes? Why not at least two recesses of 45 minutes?  Why the entire problem should revolve around teachers being anxious to be over with and out of school premises?  Shouldn’t school reform include ways of making teachers happier and more welcoming of extended school-days? In what ways will teachers regard schools a fun and enjoyable environment?)

Chicago Mayor Rahm Emanuel is currently offering to give up to $150,000 in discretionary money and a roughly 2% raise for teachers to any school that lengthens its day by 90 minutes. The extended time could include a 45-minute block for recess and lunch. So far, teachers at nine schools have voted to accept that offer.


Clinical medicine versus public health? What Dr. Bechara Choucair said?

From the Commissioner of public health of the city of Chicago in his Commencement Address at Feinberg School of Medicine at Northwestern University on May 4, 2011

Any intersection between clinical medicine and public health?

Clinical medicine and public health are often seen separate.

We often understand these two words as different disciplinary silos in which many of us spend entire careers. Ted Schettler, the Science Director of the Science and Environmental Health Network, frames both disciplines with respect to focus, scale, ethics, education and the nature of the science.

1. Focus: Clinical medicine focuses primarily on the individual, while public health focuses on the community.

2. Time frame: Relevant time frames in Clinical Medicine are usually single lifetimes, while public health thinks in terms of generations.

3. Ethics: From an ethics perspective, clinicians advocate for individual people. Public health practitioners advocate for the community, for a group of people.

4. Rights: In clinical medicine we focus on individual rights of a patient. In public health, we think about human rights, social justice, and environmental justice.

5. Education: From an education perspective, in clinical medicine we focus on the biomedical model with more emphasis on cure than prevention (although this is shifting now). In public health, we learn more about sociology, epidemiology, cultural anthropology, economics and more.

Think for a moment about the evidence of the science.

In clinical medicine we love to talk about controlled, double-blind clinical trials. We don’t find that type of approach often in public health.

Clearly, there are differences: differences in focus, differences in scale, differences in ethics, differences in education and differences in the nature of science.

But the reality is that the health of the individual and the health of the community are inter-related and inter-dependent. Maintaining two disciplinary silos is NOT the answer.

Bridging the gap is critical if we are serious about improving the quality of life of our residents.

Bridging the gap starts with education.

We have to enhance the understanding of public health principles among our students in the clinical field and we have to enhance the understanding of clinical medicine principles among our public health students.

Bridging the gap happens in research. We have to expand our research portfolio to focus on health disparities and other population level research.

Bridging the gap will not be successful unless we translate what we learn in research all the way into public policy.

And finally, it is people like you, like the faculty here and like me, who will take the lead in bridging this gap.

The good news is that here in Chicago, there are great people who have done great work in bridging this gap. I am forever grateful for their contributions.

At the Chicago Department of Public Health, we are exploring how to fully exploit the intersection of public health and medicine. We are excited about having the opportunity to use, as the foundation of such efforts, the proliferation of HIT initiatives, particularly in under served communities.

A major federally-funded initiative to help us achieve this goal is CHITREC, housed here at Feinberg and funded through stimulus funds (American Recovery & Reinvestment Act).

CHITREC (Chicago Health Information Technology Regional Extension Center) provides technical assistance to primary care providers serving predominantly uninsured, under insured, and medically under served populations in developing an Electronic Health Records system that will improve health outcomes.

CHITREC is collaboration between Northwestern University and the Alliance of Chicago Health Center Services, a health center-controlled network. It builds upon extensive collective Electronic Health Records implementation and clinical informatics experience.

We anticipate that as the participating providers come on line, there will be wonderful opportunities to use the wealth of data available through an Electronic Health Record to measure population health and be able to pinpoint where particular interventions are needed to improve outcomes.

Other federal funding, including the 2010 Patient Protection and Affordable Care Act, has provided additional opportunities for investments in the electronic data infrastructure supporting population health. Chicago Department of Public Health (CDPH) is positioned to become a leader in the public health applications of Health Information Technology. Current CDPH activities include:

  •  Funding of 26 acute care hospitals in Chicago to assist in their efforts toward establishing capacity to transmit data of public health significance to CDPH;
  • Partnering with the Centers for Disease Control and Prevention (CDC), GE Healthcare and the Alliance of Chicago in a pilot evaluation the feasibility of targeted, pubic health-oriented clinical decision support for ambulatory providers, delivered at the point of care through Electronic Health Records;
  • Supporting Stroger Hospital of Cook County and two major Federally Qualified Healthcare Center (FQHC) networks (ACCESS Community Health Network and the Alliance of Chicago) in their efforts to establish robust transmission of immunization administration data to the Illinois immunization registry;
  • Engaging with the Illinois Office of Health Information Technology in statewide efforts to build a sustainable Health Information Exchange (HIE);

Feinberg PPH: Commencement Address given by Bechara Choucair, May 4, 2011

Note: Dr. Bechara Choucair is Commissioner of public health of the city of Chicago.  I liked his Commencement Address at Feinberg School of Medicine at Northwestern University and decided to publish the speech and three sections of the speech on

This speech covered all the grounds and it is impressive.  I found it acceptable to edit out sentences that are not closely related to the subject matter in order to shorten the message.




May 2021

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