There's been a lot of talk recently about how public health systems and primary care health professionals need to work together to solve the health problems our communities face. But is it actually happening?
Carolyn Lopez, M.D.
My hometown of Chicago would answer that question with a resounding "yes!"
Not long after Rahm Emanuel -- whose father and brother are physicians -- was elected mayor in 2011, the city launched Healthy Chicago. The initiative brought together stakeholders from around the metropolitan area to create a public health agenda and set priorities, such as curbing tobacco use and reducing obesity rates. It's important to point out that the stakeholders weren't just the usual suspects from the health care community, but also included nontraditional partners such as technology firms, philanthropic groups and faith-based organizations. Healthy Chicago generated dozens of strategies to address its priorities, and it made its goals public as a way of inviting accountability.
One of the leaders of this effort is a family physician. Bechara Choucair, M.D.,(www.cityofchicago.org) is commissioner of the Chicago Department of Public Health (CDPH) and has stood at the forefront as the city has made this cross-cutting health issue a priority. He recently held multiple meetings with AAFP staff to discuss how the city is pushing the envelope on public health policy.
Perhaps the best example of these efforts addresses tobacco regulation. Chicago has raised its tax on cigarettes to reach a combined federal, state and local tax of $7.17, pushing the total cost of one pack to $12 or more. That's a steep price for any consumer, but especially for youth, who are particularly price-sensitive.
The tax policy in Chicago is working. The city's smoking rate among high-school students, which was 13.6 percent in 2011, has fallen to 10.7 percent; this represents a 20 percent decline in just two years. That bodes well for future smoking rates, too, because 80 percent of adult smokers start at age 18 or younger. If we can keep kids from starting, we'll have fewer adult smokers and a healthier population.
FP Bechara Choucair, M.D., Chicago Department of Public Health commissioner, discusses city smoking regulations during a recent news conference. The city has passed multiple ordinances to regulate combustible and electronic cigarettes. Family physician Carolyn Lopez, M.D., president of the Chicago Board of Health, is at far right.
In addition, the Chicago City Council has passed a law restricting sales of flavored tobacco and menthol cigarettes within 500 feet of a school. That is the first time in the nation's history that menthol has been included in laws that regulate flavored tobacco. The measure is likely to bring a disproportionate benefit to black neighborhoods, where tobacco companies price menthol products more cheaply to get kids hooked. Chicago has also ensured that electronic cigarettes -- another "starter" product for kids -- will be treated like combustible cigarettes by barring sales to minors, making them available only behind the counter at retail stores and barring use of the products in public indoor facilities.
Throughout the development of these regulations, the physician community has been present, providing input and putting pressure on aldermen to change "no" votes to "yes" votes. The CDPH Board of Health includes two family physicians, and it has conducted town hall meetings about menthol.
In addition, the e-cigarette ordinance was helped considerably by a last-minute push involving Chicago's family physicians. Together with many of our partner organizations (including the Illinois AFP), I held a press conference immediately before a meeting of the City Council, which was scheduled to vote on the ordinance. We strategically held our press conference in an area the aldermen had to walk through to get to the vote. Many aldermen ended up changing their vote from no to yes, and the ordinance passed(www.cityofchicago.org) by an overwhelming majority.
Family physicians are partnering directly with the city on tobacco quitlines. Patients who express an interest in quitting during an office visit with a physician will now be called by the quitline rather than having to make the call themselves. We expect that this exercise in strong coordination will impact thousands of Chicagoans.
Tobacco isn't the only area in which primary care physicians can play a role. They are also working with public health officials on a program to improve nutrition and combat obesity. The city identified neighborhoods that were considered "food deserts"(www.cityofchicago.org) because of a lack of grocery stores and has created kiosks that feature low-cost, fresh produce and placed them near federally qualified health centers. Physicians can write prescriptions for fresh produce and advise patients to visit the kiosks, which accept food stamps. These kiosks are supplementing a broader effort in which retailers have committed to opening more than a dozen new stores in food deserts, and the city is connecting small corner stores with fresh produce distributors so they can offer shoppers healthier choices.
The steps a city can take to improve public health are limited only by imagination and its willingness to change. Chicago alone has done the following:
- converted a car lane in the heart of the city to a two-way bike lane to encourage exercise and provide a place to do it;
- identified neighborhoods with high obesity rates and provided children with safe places to play through the PlayStreets program;(www.cityofchicago.org)
- partnered with a technology firm to use analytics to identify restaurants that are most likely to fail health inspections (the city also encourages consumers to take to Twitter to report possible violations); and
- brought many competing health care systems together to share clinical data, creating a huge database for researchers.
An expanded model of the database was recently funded through a new $7.8 million grant from the Patient Centered Outcomes Research Institute.
Family physicians can go beyond the exam room to make a difference in the health of communities by communicating -- and collaborating -- with public health officials. What innovative steps is your community taking to improve public health?
To find out more about Healthy Chicago, you can follow the Chicago Department of Public Health on Twitter @ChiPublicHealth and on Facebook(www.Facebook.com). Carolyn Lopez, M.D., is president of the Chicago Board of Health and a former speaker of the AAFP Congress of Delegates.
Carolyn Lopez, M.D., is president of the Chicago Board of Health and a former speaker of the AAFP Congress of Delegates.