On April 14, HC3 co-produced the inaugural event of MATTER's new series Advancing Health Equity. Chicago Department of Public Health Commissioner Dr. Allison Arwady gave a keynote presentation, after which Chicago Community Trust CEO Dr. Helene Gayle moderated a fireside chat about the key components of health equity and how technology has contributed to the gaps in health care.
Allison Arwady, MD, MPH, Commissioner, Chicago Department of Public Health
Helene Gayle, MD, CEO, The Chicago Community Trust
ARWADY TALKS USING TECHNOLOGY TO ADDRESS HEALTH DISPARITIES | Health News Illinois, April 15, 2021 | Link to Article
Watch the Recap | Link to YouTube
What makes any Chicagoans healthy is less about access to health care and more about the decisions we make that help eliminate barriers and create a community where everyone has a fair and just opportunity to be as healthy as they can be.
Social determinants of health (SDoH) – racism, poverty, discrimination, people not having power or a voice, lack of access to housing or living in an unhealthy environment, not having access to employment opportunities – have more impact than access to health care in and of itself.
The Chicago Department of Public Health (CDPH) creates a new plan every five years to define health outcomes and sets indicators to measure success in reaching improved public health goals. When CDPH created their latest plan six years ago, they began to emphasize healthy equity by examining indicators to determine disparities.
Some health conditions and obstacles are rooted in race, ethnicity, disability, as well as access to resources like education, food, and housing. For example, HIV rates are much higher for Black Chicagoans, Latinx men are the least likely to be insured, and the LGBQT group have higher rates of smoking. Moving toward a healthier Chicago can only happen if we address the access issues for all of these groups.
One year ago, CDPH published the Healthy Chicago 2025 plan which was purposely focused on equity –
creating equal access and ensuring that resources were allocated according to highest need. This new plan specifically looks at the life expectancy gap and how the city can address the fact that not every Chicagoan has an equal opportunity to be healthy. Black Chicagoans live nine years less than white Chicagoans. Some of the main drivers of the life expectancy gap are chronic diseases, gun-related homicide, infant mortality (which is one of the most sensitive indicators of how healthy a society is), HIV positive rates, and opioid overdose. We believed asking why these disparities exist was a starting point toward health equity.
When the COVID-19 pandemic began, CDPH delayed the implementation for Healthy Chicago 2025. When CDPH did have the opportunity to launch the new plan, everyone was already talking about how COVID-19 was showing up more in disparate communities. As we studied the incidence patterns, we found that that crowded housing, the inability to work from home, and other factors caused higher cause rates. The pandemic brought these issues to forefront and put more attention on public health in terms of policies, systems, and the environments that are the key contributors to living as healthy as possible.
When the COVID-19 vaccine began to roll out, we identified access barriers by conducting a neighborhood ranking based on who would be least likely to receive the vaccine. CDPH was able to use anonymous cell phone data to track people’s activities and see what areas of the city people were able to stay or work from home. We also reviewed where COVID-19 had the most impact and used that index to drive vaccine roll out. We overdelivered and focused on outreach in specific communities to try to achieve an equitable vaccine roll out.
Technology has played an important role and COVID-19 has pushed the health department to modernize our approach. We need to implement some of the learnings we had from advancing our technologies during this time to other facets of public health. For example, how can we use technology to leverage data and see where, lead poisoning is most common, identify where the lead is, and eliminate it?
In Chicago there are many community-based organizations and health care providers that are creating initiatives to address some of the socioeconomic inequities. For example, some hospitals have taken a more strategic approach to hiring in order to offer economic opportunities to disadvantaged people from within the communities they serve.
CDPH does not have any control over housing or economic decisions; however, there is a lot of opportunity to ask, “What are potential health impacts?” and “How can we take that lens and use it to create healthier environments?” every time we develop new policies. It is important to consider public health implications in all policy decisions. Working on equity will not hold us back, it is just about making space to have a different kind of conversation to make sure that there are voices at the table that might not otherwise be there.
How do we think about integration more? We should always start with defining our goals. If a goal has been set without a health equity lens, see how you can bring that lens in without disrupting work. One example of this is food. Chicago itself does a lot of contracting and purchasing of food, and of course we have to continue doing that. However, we can also choose to buy food in a way that is more local, supporting the city and regional food industry structure and driving development in healthy ways. Several agencies have done a lot of work to do more of this.
In terms of technology innovation and design, you should have serious conversations with the people that will be using the technology to determine how it will fit into other existing structures. Rather than having preconceived notions, really listen to see what will help those you are trying to assist. There is a gap between people who need care and connecting to them and using technology could fix this gap.
In New York, at the start of the pandemic there were hospitals that were completely full, but other hospitals had empty beds. They were not connected with each other so there was no way to send patients to a hospital that did have room. And even now with the COVID vaccine technology advancements, there are so many apps for scheduling, reporting, or finding information, but this has not been very successful because people have navigated these different technology mediums and platforms just to set up an appointment. We need to look at this moment as an opportunity to think about how we create structures that allow health records to connect across systems and allow information while protecting privacy to be able to better support care.
Before the pandemic, Chicago had never used a cloud service. With the onset of COVID-19, there was so much data being monitored that it would take our epidemiologists sometimes up to seven hours just to run the daily updates. That pain point was big enough that it pushed us to make the transition. We worked with Rush and other partners to build the technology necessary. This freed up time for more advanced work and reporting.
A lot of time is invested in repeatedly solving the same problem. We did have the opportunity to work with large players like Google and Salesforce. However, in the absence of a larger national strategy for vaccine rollout, everyone has been solving the same problem individually.
With the vaccine rollout, many major pharmacies are national with their own system, the health and hospital systems have their own network, and providers have another system. In the future, hopefully people will think not just about developing a program but making sure that there it is interoperable across many systems, including older populations.
Academic institutions are another critical partner on this journey to health equity because they often have more resources than the health department. Partnering with people doing their doctoral work and research focused on furthering health goals – especially equity specific ones – are helpful, especially when the objective and timeline can be used in real time to make sure their innovations are created within a timeframe that works for us.
CDPH has also done work internally to put race equity at the center of their operations. They repurposed a position to create a Chief Race Equity Officer and also worked to ensure it was possible to pay interns. Most people cannot afford to work for free, so if you don’t offer pay you are denying a significant population an opportunity to learn and work.