On Tuesday, December 14 HC3 hosted a Transformation Series State of the State conversation focused on building a healthier Chicago. Allison Arwady, MD, MPH – Commissioner of the Chicago Department of Public Health CDPH) – provided the keynote address on how HC3 can enhance CDPH’s Healthy Chicago 2025 vision to promote optimal health and well-being for our local communities. Following her presentation, Meghan Phillipp, Executive Director of HC3, moderated a fireside chat to provide members and partners to explore opportunities HC3 members and partners to engage in addressing the collective challenges and to identify opportunities for systemic improvements to health care access and coverage.
Allison Arwady, MD, MPH, Commissioner, Chicago Department of Public Health
Dr. Allison Arwady, MD, MPH, is the Commissioner of the Chicago Department of Public Health (CDPH). Dr. Arwady started at CDPH in 2015 and served as Chief Medical Officer before being confirmed by the City Council as Commissioner in January 2020. As Chief Medical Officer she oversaw the disease control, environmental health, emergency preparedness, and behavioral health divisions. She has worked on disease outbreaks, immunization promotion, tuberculosis response, lead poisoning prevention, substance misuse, and more. Prior to CDPH, she worked for the U.S. Centers for Disease Control and Prevention (CDC) as an Epidemic Intelligence Service officer. In that role, she focused on outbreak response, including international work on Ebola and Middle East Respiratory Syndrome. While based at the Illinois Department of Public Health, she responded to disease outbreaks across the state. She has a bachelor’s degree from Harvard University, a master’s degree in public health from Columbia University, and completed medical school and clinical training at Yale University. She is a board-certified internal medicine physician and pediatrician and continues to see primary care patients weekly.
Meghan Phillipp, Executive Director, HC3
COVID-19 PANDEMIC GIVES CHICAGO OPPORTUNITY TO PUT RACIAL EQUITY PLAN INTO
PRACTICE, ARWADY SAYS | Health News Illinois, December 17, 2020 | Link to Article
Watch the Recap | Link to YouTube
Presentation Slides - 12.14.2020
The COVID-19 pandemic has been an opportunity to stress test CDPH’s plans. CDPH has already been aligning Healthy Chicago 2025 values with their COVID-19 response efforts (e.g., testing, outreach, vaccine distribution planning, etc.). This year, CDPH has intently focused on race equity in Chicago.
COVID-19 has demonstrated some of the major disparities and health inequities that exist in our system, with 40 percent of deaths having been among Black-non-Latinx populations. Additionally, the positivity rates of COVID-19 are twice as high in the predominantly Latinx communities. The city-wide positivity rate over the past seven days is 12.9 percent while the rate on the southwest side – a predominantly Latinx community – has increased from 20 percent to 26 percent. Occupation and crowded homes are two of the greatest factors causing these higher positivity rates.
Life expectancy varies widely based upon ethnicity. One of the main tenants of the Healthy Chicago 2025 plan is to close this gap by targeting its drivers – chronic disease, homicide, infant mortality, HIV, and opioid overdoses – and the social and environmental issues that compound these problems. CDPH has outlined four activities to achieve that goal:
· Improve systems of care for populations most affected by inequities
· Further the health and vibrancy of neighborhoods
· Strengthen community capacity and youth leadership
· Transform policies and processes to foster anti-racist, multi-cultural systems
In addition to these key activities, there are seven different priority areas:
· Food Access
· Public Safety
· Neighborhood planning and development
· Health and human services
· Public health system organization
Different focus areas will be prioritized and aligned with populations experiencing inequities throughout the city. Dr. Arwady noted that CDPH doesn’t own most of the areas where inequities need to be addressed, which is why community partnerships are of critical importance. As we look forward to opportunities like vaccine distribution, CDPH intends to rely on zip code data to identify critical areas to help determine equitable distribution, create priority areas, and advance future initiatives for designated communities.
Moderated Discussion Meghan Phillipp: What are some of the major differences in the implementation of Healthy Chicago 2025 to the previous Healthy Chicago 2.0 plan? Allison Arwady, MD, MPH: Public health departments are required to create a plan every five years. The Healthy Chicago 2.0 plan was the first time we used data and acknowledged health equity, which helped us track health indicators and define successes across different demographics. Amid COVID-19, we turned a lot of attention toward internal processes and hired a deputy commission focused on race inequity.
M: How are initiatives filtering down to each community? A: Community advisory boards in different areas convene people who have issue-specific interests. We have been able to share data in each region and develop plans that align with our plans. We are also trying to be much more targeted in getting input from communities to address their needs based on data collected.
M: CDPH has moved away from being a clinic operator and is reliant upon partnerships with community entities. Given that there are so many disparate hospital systems, what is the city doing to be the mediator and facilitator of some of these plans? A: CDPH still provides direct clinical services (e.g., mental health, STI, TB) but most of our clinical work is in collaboration with community organizations and local health systems. COVID-19 has instigated us all to collaborate and coordinate better together. Chicago hospitals have stepped up in amazing ways and have been in regular communication with CDPH and one another. Data is helping us better understand what is happening across the whole system (e.g., knowing when a hospital is going to run out of beds). CDPH acts as a neutral “regulator” to help with the logistics, meaning that we provide guidance, but we do not regulate hospitals. For example, CDPH is currently ensuring that the COVID-19 vaccine is available to all 34 hospitals (despite differences in capacity and storage) and providing guidance on prioritization so each hospital can make informed decisions.
M: What are the opportunities for public and private partnerships to achieve these goals?
A: Any institution that is not already connected to Healthy Chicago 2025 can contact Genny Turner, the lead for Healthy Chicago partnerships and collaborations, at firstname.lastname@example.org. There will be a lot of opportunities to partner, especially around messaging for the vaccine. We will need trusted health care and community workers in certain zip codes to answer questions and talk about the vaccine. Ensuring that everyone is accessing resources, working from the same “playbook” but adaptable to communities and needs. Individuals can visit the “Protect Chicago” tab of the CDPH website to learn more about individual opportunities to support (e.g., volunteering) and sign-up for our regular updates.
M: What are some of the things you are doing to make sure there is a focus on equitable distribution of the vaccine?
The city will begin vaccinating later in the week. We are expecting that the federal government will provide additional funding for vaccine outreach, communications, logistics, etc. because it’s a huge operation. There will be formal communications partners that will be responsible for reaching out to different populations. February will probably be a vaccine-focused month. Not all Chicagoans will be excited about taking the vaccine because of unfortunate and true history about experimentation in the Black community. However, we did see more racial diversity among participants in the vaccine trials compared to other states. Overall, surveys show that Black Americans are less likely to be willing to take the vaccine, but education plays a significant role as well. Our outreach will focus on reaching all Chicagoans at their level of health literacy and on fostering trust through collaboration with trusted voices within these communities.
M: What are some of the most daunting challenges that you foresee? Are there opportunities to help?
A: Healthy Chicago 2025 is not meant to just be CDPH-focused; it relies on the help of all Chicago organizations. Some of the biggest challenges we believe need to be addressed are violence, infant mortality, and chronic disease. It is a very destabilizing time for health care in general. We are trying to think more creatively about how to address some of these systemic health issues. We also need to consider more long-term investments in our communities, like economic opportunities, education, and other social programming opportunities.
M: What are we going to do better to continue to prepare for the worst (more waves, another pandemic)?
A: Chicago was probably the most prepared of any major city in the country, and yet it still wasn’t enough. A lot of the logistical coordination was pretty strong, but we are still heavily underinvested in public health. All of the work around preparedness ultimately falls to the public health sector, and we need to think not just about logistical things like having stockpiles of PPE, but also more strategies around supply chain, interoperability, and data collection. COVID-19 has highlighted a major need for a change in payment models and coordination, as well as strengthening the safety net.