Adonis Diaries

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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.

Chicago: Short history of public health

Part of Commencement Address given by Dr. Bechara Choucair to Feinberg PPH, May 4, 2011

“Today is about you. You decided to invest in your education. You decided to focus on public health. You worked hard. You read many articles.

I am sure you wrote many papers. You participated in many work-groups. You sat for many exams. You gave many presentations. It is all paying off today.

Brief description of the history of public health in Chicago.

The population-based approach of public health has had a tremendous impact on the health of our communities for almost two hundred years.  In Chicago, the formal establishment of public health took place in 1834, when the Board of Health was established to fight the threat of cholera.

During this Early Sanitation era, sanitation and quarantine were our best tools for fighting disease. The first sanitation regulations were passed and required all men over 21 years old to help clean the city’s streets and alleys.

We conducted home visits to persons with infectious diseases and boarded ships in Chicago’s harbor to check on the health of crewmen.   Our deepest public health roots can be traced to disease control.

The earliest public information efforts starting in the 1850’s. 

The efforts in the era of sanitary reform, focused heavily on sewers, water and food and dairy. During this period, the Health Department issued regulations governing the drainage and plumbing of new buildings (1889); we initiated meat inspections at Chicago’s Union Stock Yards (1869), and full milk inspection activities began (1892).

We saw some of our highest death rates during this era due to diphtheria, typhoid and scarlet fevers, measles and whooping cough. Using his regulatory authority, the health commissioner at the time, Dr Oscar Coleman De Wolf, required the reporting of contagious diseases by physicians in 1877.

By 1887, our advancements in medical understanding helped us see that typhoid would continue to kill, unless we stopped the flow of contaminated water into Lake Michigan–the source of the water we drank, the water we cooked with, and the water in which we bathed.  Building the 28-mile Sanitary and Ship Canal, which reversed the flow of the Chicago River by 1900, was a major medical/public health intervention.

With the advent of the Hygiene Movement (1880’s-1950’s), and the continued advances in understanding disease and medical practice, the focus of public health shifted to individual hygiene and medical care, particularly children’s health.

In 1890, a Chicago child had only a 50% chance of reaching 5 years of age. By 1900, the odds of surviving to age 5 had increased to 75%.

In 1899, with the support of 73 physician volunteers, the City initiated its first campaign against infant mortality.

Service delivery focused on the provision of dental services in schools in 1915, public health nurse home visits to infants in 1925 and educational campaigns against venereal disease in 1922.   These remain among our priorities today.

The early public health nurses at work.

The nurses “finders of sick infants” would seek out sick babies and refer them and their mothers to Tent Camps, where they would receive medical treatment and hygiene education.

In 1956,  516 persons were stricken with polio. Public health authorities assigned 90% of the city’s health workers to reach a goal of one million inoculations in 2 weeks. One year later, Chicago had only 28 cases, and in 1959 when the U.S. went through a record- breaking year for polio, Chicago had only one case.

The 1950’s saw the beginning of dramatic growth in medical interventions which prompted the era of health care services. During this time, the delivery of personal health care services, primarily to low-income populations, was becoming the primary public identity of public health in Chicago.

In 1959, the Health Department opened the Mid-South Mental Health Center, the first of what would become a network of community mental health centers by the early 1970’s.

The first half of the 1970’s  saw the development of several Department neighborhood health centers, under the federal Model Cities Program.

The first of our centers, in the Uptown community, was established in 1970. On this slide, you can see our clinics in Lakeview, and the 1987 groundbreaking for the expansion of our West Town clinic.

The 1960’s and 1970’s brought significant changes at the federal level as well. The passage of Medicare and Medicaid in 1965 greatly expanded access to care for some of our most vulnerable populations.

Since that time, CDPH has greatly expanded its capacity in Epidemiology, Policy, Planning, Resource Development, and more recently, Information Technology, while maintaining its efforts in critical public health functions such as disease prevention and control, and in the last decade, emergency preparedness.

Note:  This article is part of the Commencement Address at Feinberg School of Medicine at Northwestern University, delivered by Dr. Bechara Choucair, Commissioner of public health of the city of Chicago.  This speech covered all the grounds and it is impressive.

Houston, Texas

 

I was called from Houston, Texas, to aid in the organization of a party.  I purchased a beat up car just to move to Houston.  It was a long drive of 20 hours at night and my first alone; that was courage or desperation which ever you decide.  I slept in temporary comrades’ places, because I had no money to rent.  Many knew me very well though I had no recollection (read my section on faulty memory).

Within three months of search and applications I worked with a crane production industry.  I got the job after I attended an evening meeting and barbecue with the association of the University of Oklahoma graduates in Houston; a rich corporate member recommended me to this company.   

I was dismissed within 3 months because I felt out of place and not given any encouragement within my field.  Actually, this position was supposed to be a temporary job before being sent to Iran with the mother company Schlumberger, specialized in equipments for oil production.

During my three months job my old car broke down several times and I spent the last dollar saved on shabby repairs and felt frustrated and disoriented.  After being fired I worked in small jobs like waiter in rush lunch hours in Downtown Houston and then in fast food restaurants and then in a Lebanese restaurant.

I got involved in Lebanese party politics in Houston and supposedly was the main coordinator among the “leftist alliance”, an amalgam of parties.  There was this group of three members that insisted of an equal authority with no responsibility for participating in activities and demonstration; the supposed leader of this group ended up disseminating horrible calumnies on me; I suspect that a terribly jealous member of our party coordinated the calumnies with him. Then I was lured by someone within my party (the same infamous “comrade”) to forge a US passport because he said it worked without any problems with others through US acquaintances. I fell into the trap of this bad intentioned comrade and was caught because the forged application as a born US citizen, supposedly emanating from a nearby town, was obviously not professional and the copy of birth certificate was not up-to-date by any long shot.  I was convicted by a grand jury and spent a week in jail. I experienced this kind of life confinement that was not terrible since I managed to borrow books and I am not picky with food; I had some money which allowed me to purchase cigarette and share them with my cellmates; I recall that I was allocated the upper bunk and my mates respected a reading guy and didn’t bother me.  The worst part is the humiliation afterward.

I was released after the intervention of our ambassador in Washington DC.  I was supposed to owe $300 for a lawyer.  The party had to sort of “excommunicate” me and strip me of my responsibilities.  I spent a month with a lovable older comrade from Venezuela, of Lebanese origin, who was in Houston for complete health check up (many thanks to this Samaritan).

My brother-in-law, an officer in the Lebanese army sent me a new Lebanese passport because the previous one was confiscated. I went to the immigration office to give notice of my departure and they had “misplaced” my file; a judge had to verbally “record” my testimony; most probably my case was one of thousands that indicted many prominent personalities and my file was to be lost.  I spent a few days in Chicago with Nicholas and toured his university; I experienced snowy Chicago and the biting winds on the water front of the lake.  I returned to Lebanon in Christmas of 1979.


adonis49

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July 2020
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