A unified vision of health equity in Chicago — understanding the countless factors that lead to persistent health disparities as well as developing strategies to overcome them — was the focus of the second IPHAM Population Health Forum, where scientists and community partners presented and discussed their work in a variety of areas.
The forum, held December 9 and attended by faculty, staff, students and community partners from Feinberg and beyond, was hosted by the Institute for Public Health and Medicine (IPHAM).
The event kicked off with a presentation from Allison Arwady, MD, MPH, commissioner of the Chicago Department of Public Health (CDPH). Arwady outlined the Healthy Chicago 2025 initiative, a cross-organizational effort to identify and stamp out causes of health inequity in the Windy City.
“We’ve been moving more and more upstream, talking about living conditions, the racial life expectancy gap and what we can do from a policy perspective to start addressing those problems,” Arwady said. “It can be a hard conversation but we think it’s important.”
An essential part of this conversation is falling life expectancy — life expectancy in the U.S. has declined over the past three years, and this trend was recently measured in Chicago as well, according to Nikhil Prachand, MPH, director of Epidemiology at CDPH.
“To see a decrease in life expectancy in a highly industrialized, modern day and age is really unusual. We were surprised to actually see it in Chicago,” Prachand said.
This further complicates the attempt to rectify gaps in racial life expectancy — the long tail of discriminatory housing policy and poverty can be difficult to quantitatively measure, but Prachand believes integrating data from multiple levels can help produce a better picture of the chief causes of these disparities.
“The same way we think about nutrition, diet, exercise or smoking behaviors, we have to start thinking about sidewalk quality and commuting times,” Prachand said. “For example, access to groceries needs to be in our standard measurements of health data that we monitor in the state.”
The keynote presentation — introduced by Ronald Ackermann, MD, MPH, director of IPHAM and senior associate dean for Public Health — showcased this harmonic approach to measuring and influencing public health.
According to Ana Diez Roux, MD, PhD, MPH, dean and distinguished university professor of Epidemiology at the Dornsife School of Public Health at Drexel University, one of the field’s recent successes has been the expansion of the conceptual framework for health disparities, moving beyond the traditional biomedical and individual approach. Recognition of pathways — the disparate determinants of health like behavior, stress or environmental exposure — has allowed scientists to gain a more sophisticated understanding of the inputs of health.
“These pathways are multiple and change over time and from place to place,” Diez Roux said.
These influences gradually build up, creating a rich history that influences the daily lives of citizens and their descendants, she said.
“This is not just about one’s life course, but we’ve been also able to identify intergenerational influences,” Diez Roux said. “The idea that health disparities are driven not only by individuals, but various levels that influence and affect those people.”
The afternoon poster session showcased a range of projects, including an evaluation of a simple pediatric appendicitis surgery pilot program, led by Martha Conley-Ingram, MD, a research resident in the Department of Surgery. In the past, an appendectomy was usually an inpatient procedure, but the field has had a growing realization that an overnight stay may not be necessary, according to Conley-Ingram.
“We’ve learned over time that you’re can have a little flexibility and that children will actually heal very quickly when it’s simple as opposed to when it is perforated appendicitis,” Conley-Ingram said.
Conley-Ingram and her collaborators took stock of current workflows to measure where clinicians diverged in handling the procedure and wrote new protocols to standardize a simple appendectomy as an inpatient procedure. After evaluation, they found that rates of infection or unmanageable pain remained the same, pointing to the new workflow’s effectiveness.
“In addition, having parents feel comfortable and satisfied with option care of their kids at home is also a positive outcome that we’ve had out of this,” Conley-Ingram said. “I think dispersing evidence-based recommendations throughout pediatric surgery is relatively easy because you have a small network and everyone knows each other.”
Ackermann is also a professor of Medicine in the division of General Internal Medicine and Geriatrics and Endocrinology, and a professor of Medical Social Sciences.
Poster Awards
- First place: Leslie Helmcamp, associate director of policy at Strengthening Chicago’s Youth at Ann and Robert H. Lurie Children’s Hospital of Chicago, “Addressing Violence through a Community Centered Approach.”
- Second place: Victoria Wee, research assistant, “Racial/ethnic differences in mental health treatment plans in a perinatal collaborative care program.”
- Third place: Maryann Mason, PhD, research assistant professor of Pediatrics and Preventive Medicine, “A Data Driven Intervention for Preventing Drug Overdose Fatalities in Urban Areas: A case study illustrating the use of Illinois Statewide Unintentional Drug Overdose Reporting System (L-SUDORS) data.”