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.