Assessment of the Public Health Effect of Social Systems in Chicago

Public health incorporates social systems/social enterprise to fulfill a condition in which people can be healthy. It involves the assessment of the population, creating strategies to improve society's health, and provide the services necessary to maintain their health. A portion of assessment involves looking at the factors that contribute to the outcome, such as the social determinants of health, which involve a person's neighborhood, income, and family history.

Chicago is one of the most beautiful cities in the United States. Chicago is home to 552 parks, 15 beautiful beaches, 200 theatres, and 200 art galleries (City Hall, n.d). Some of their beautiful landmarks including the Willis Tower, Navy Pier, John Hancock Center, and the Tribune Center, will not be found anywhere else in America (City Hall, n.d). There are 669 k-12 schools for students to go to, the best pizza and hot dog in the nation, and 36 annual parades for community events (City Hall, n.d). Chicago seems like an ideal community to live in with 55% of the people being African-American, 37% being Latino, 7% being Caucasian, and less than 1% being Native American or Eastern Islander. With all of the beauty of this city, there are some great disparities that plague this city.

Chicago is a great city with many beautiful sites, but there is some parts of Chicago that need improving, including the poverty, overpopulation, and education. The percentage of people in poverty in Chicago is 35%. That is approximately 1.82 million people are in poverty, an astounding poverty size. Hopefully, the poverty rate will decrease as the number of big businesses born out or into Chicago increases. In the city of Chicago, there are 5.2 million people, one of the most densely populated cities in the United States, and more people are migrating to Chicago every year.

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If a big part of the population is living below poverty, there is no need for an increase in population, because that would lead to an increase in the population living below the poverty level, and it is high enough now. In addition, 30.5% of the population do not have a high school diploma. That means that 30% of the population is uneducated with little skills. All of these conditions can cause major problems for any city. Some areas of Chicago are in worse conditions than others. Parts around Lake Michigan appear to be less impoverished than areas more central Illinois, in particular regions in Northwest Chicago. Let us take a look at the disparity in a nearby neighborhood.

Many visitors observing Chicago arrive at Chicago Midway International Airport. Many travelers use traveling sites, news broadcasts, and census tracts to find out more information about the areas they are traveling to. A census tract is a small, statistical subdivision of a county updated by local participants in the Census Bureau's Participant Statistical Areas Program (U.S Census Bureau, 2012). The city of Chicago is located in Cook County, Illinois. The area surrounding the airport is the 6202 census tract, which is filled with many disparities.

One of the main disparities is the lack of medical facilities. In this area, there are only one animal hospital (Abbot Animal Hospital), one human hospital (Holy Cross Medical Center) and one federally qualified health center (the Macneal Clearing Clinic) to treat the inhabitants that live in the 6202 census tract. Federally qualified health centers are public and private non-profit health organizations that receive funding under the Section 330 of the Public Health Service Act (County Health Rankings, 2013). The physicians are allowed to treat their patients regardless of their ability to pay (U.S Department of Health and Human Services, n.d.).

These health centers must serve a medically underserved population, demonstrate good financial and clinical management, and adjust fees based on the patient's ability to pay in order to receive funding (U.S Department of Health and Human Services, n.d.). Federally Qualified Health Centers in high need urban and rural areas are often called community health centers (U.S Department of Health and Human Services, n.d.). Not all of the health centers that help patients are federally funded (U.S Department of Health and Human Services, n.d.). There are nearly 100 health centers throughout the United States that qualify as federally qualified health centers but do not receive funding from the government (U.S Department of Health and Human Services, n.d.).

These centers are called Health Center Program look-a-likes (U.S Department of Health and Human Services, n.d.). The Macneal Clearing Center is a federally qualified center, the only one in the area. There are 185 clinics in Chicago, 385 clinics in Illinois, and 6,804 clinics nationwide. One clinic and a hospital to treat 2,223 people is a disparity.

Many areas have more than two places where patients can go to get treatment. These areas are said to have more accessible health care means than others (Aday & Andersen, n.d.). Access of care is defined as the availability and health systems resources in an area (Aday & Andersen, n.d.). Rural, Urban, and Suburban residents do not have equal access to care (Aday & Andersen, n.d.). Rural areas do not have enough medical professionals, facilities, and the ability to pay for care (Aday & Andersen, n.d.). Urban areas have better access of care, compared to rural areas (Aday & Andersen, n.d.). Urban areas have closer facilities and enough medical personnel, but many urban areas are densely population and few doctors (Aday & Andersen, n.d.).

Many doctors often live in suburban areas and would rather work closer to their homes (Aday & Andersen, n.d.). More doctors are also choosing to specialize now than choosing to family practice, because of fear to make house calls and not having private physicians (Aday & Andersen, n.d.). In addition, many patients in urban areas do not have health insurance and would benefit more from having these health clinics, but often times situations are not that simple (Aday & Andersen, n.d.). Often times, people that do not have insurance cannot afford it (Andersen & Newman, 1973). Many people who do not have insurance do not go to the hospitals, because they know they will not get seen without insurance. This reluctance can lead to a number of medical issues.

Lack of medical care is linked to an increase in mortality rates; However, the mortality rates have decreased across all diseases within the last century (Andersen & Newman, 1973). The mortality rates of tuberculosis, influenza, and pneumonia have declined since the start of the 20th century (Andersen & Newman, 1973). This decline is due to a number of public health efforts, increased technology presence, and the growing use of hospitals (Andersen & Newman, 1973). Public health has provided sanctions for companies, use of antibiotics for these diseases, and immunization programs to vaccinate children at a young age (Andersen & Newman, 1973).

Technology has provided researchers with tools to create these vaccines that are being used by doctors all over the world on their patients, but if the patients do not go to the hospitals to get the vaccinations, then these diseases will continue to show up in the population (Andersen & Newman, 1973). These diseases could have been erased from the population if patients were to monitor their health and get their children vaccinated, but insurance and culture interferes with the goal at hand. These mortality rates may have decreased in the population, but the mortality rates of heart disease, diabetes, and stroke are on the rise.

Heart disease and stroke are the leading causes of death in the world (Mackay, Mensah, Mendis, Greenlund, & World Health Organization, 2004). They account for 1/3 of all deaths (Mackay, Mensah, Mendis, Greenlund, & World Health Organization, 2004). 75% of these deaths occur in poorer regions of the world (Mackay, Mensah, Mendis, Greenlund, & World Health Organization, 2004). A number of factors contribute to this disparity, including high blood pressure, high blood cholesterol, tobacco use, physical inactivity, unhealthy diet, and obesity (Mackay, Mensah, Mendis, Greenlund, & World Health Organization, 2004).

These factors resulted from obesity, hypertrophy, family history, and unhealthy lifestyles starting with social pressures and mass advertising (Wilson et al., 1998). Many of this issues were not as widespread in the past than now, because of the addition of mass production and dangerous chemicals being added to the food to preserve and create more taste. In addition, many of those affected do not have health insurance and do not go to the hospitals to get treatment. In Southwest Chicago near Midway airport, the death rate among people with heart disease is approximately 202 per 100,000 people.

In other words, approximately 4.5 people die each year from heart disease. That is 4.5 out of 2,218 people die each year (0.02 percent of the population). This is equal to the annual death rate of heart disease in Chicago at 0.02%, but 10,503 people die from heart disease out of the total population of 5,181,910. The death rate for the city of chicago is also 202 per 100,000 people. The annual death rate for the state of Illinois is 25,354 out of 12,787,914 people, which is approximately 0.00198% of the population. This is down from 0.002% of the city of chicago. The annual death rate for the United States is 605,315 out of 308,486,831 people, which is 0.00196%. The death rate is 197.5 per 100,000, which is down from 202 per 100,000 in Chicago.

When looking at strokes in the Midway airport area, there are no statistics for the area. There are statistics for Chicago. The death rate for stroke in Chicago is 40 per 100,000 people, which is approximately 0.0004%. The annual death rate for strokes in Chicago is 2,081 out of 5,181,910 people. The death rate for the United States is 42.9 per 100,000, which is approximately 0.000429%. This percentage may be higher than Chicago, because there are some parts of the nation, like Texas and Mississippi, where the obesity rates are extremely high and are somewhat considered food deserts. A food desert is a place that does not have a grocery store in the area or very few.

Places like Texas have many fast food restaurants but few grocery stores. In the area near Midway airport, there are many fast food restaurants and very few grocery stores, because airports have many fast food restaurants to accommodate the travelers that do not have enough time to cook anything or sit as a chef prepares a meal. Diabetes is not too far from the list of leading causes of death in seventh place (American Diabetes Association, 2014).

Diabetes is a disease where the body does not have enough insulin to take the sugar molecules into the cells. When a person has diabetes, there is a lot of sugar in the blood, because either the insulin is not being produced in the body or the rate at which insulin is being produced is not as quick as the sugar intake. Often times, individuals with diabetes must inject themselves with insulin to put the sugar into the cells. Often times, overeating and overfeeding can lead to the adaptation of diabetes. In many cases, diabetes rates are higher in lower income areas, because good quality, nutritious foods are often very expensive. Individuals that do not have a large income do not have access to those foods and can only get machine-made, cheap foods. Many of these foods are high in fats and sugar.

This sugar gets into the bloodstream and can change the physiology of a person's body, often times causing hypoglycemia, hypertension, strokes, and kidney disease (American Diabetes Association, 2014). As mentioned before, there are not as many grocery stores as fast food restaurants. Based on this information, it is assumed that there is a high diabetes rate as well. There is no information on the diabetes statistics for the area, but there is information on the diabetes rates of Chicago, Illinois, and the United States. In Chicago, 8.3% of the adult population has been diagnosed with diabetes per 100,000.

There are 328,064 currently living with diabetes in the Chicago area, out of the 3,859,576 adult residents in the city, or 0.085% of the population. The age-adjusted rate for Illinois is approximate 8.67%. The population living with diabetes in Illinois is 873,757 people out of 9,429,505 residents. The number of residents in this region of the nation is lower than the nation's average. In the United States, the are approximately 23 million people living with diabetes out of the 234 million people, which is approximately 0.09% of the population living with diabetes. Some areas like Texas and Alabama have high rates of hypertension and obesity. These are risk factors for diabetes. The diabetes rates of these states are assumed to be high based on the high factor rates.

These diabetes, stroke, and heart disease rates can be adjusted if more patients were to go to the hospital. The physicians in the hospitals may be able to create personalized plans to improve the person's overall health and decrease their likelihood of developing these diseases. There have been advances to providing care for those that cannot afford it.

One intervention that is helping to lower the mortality rates of these diseases is the retail clinic program (County Health Rankings, 2014). Stores like CVS, Rite-Aid, Target, and Walgreens are providing health care services at a cheaper rate than many hospitals (County Health Rankings, 2014). These stores offer treatment for sore throats, skin conditions, screenings for diabetes and heart disease, immunizations, and pregnancy tests (County Health Rankings, 2014).

The prices are posted on their individual websites and inside the stores, so the individual can save for the procedure (County Health Rankings, 2014). Retail clinics are often open for longer hours and are mainly located near urban communities (County Health Rankings, 2014). These retail clinics increases access to care for patients, reduce healthcare costs, and reduced emergency room visits (County Health Rankings, 2014).

Another intervention that is used is telemedicine (County Health Rankings, 2014). Telemedicine uses technology to deliver consultative, diagnostic, and health care treatment services via videoconferencing, transmission of still images, remote monitoring of vital signs, or other modalities (County Health Rankings, 2014). Patients that require frequent monitoring benefit best from telemedicine (County Health Rankings, 2014). This program increases access to care, health outcomes, mental health, decreases mortality, and increases medication adherence (County Health Rankings, 2014).

Lack of medical care is also linked to poor prenatal care. A woman must go to a physician to receive prenatal vitamins full of folic acid, iron, and calcium for a good birth; however, a woman's low socioeconomic status is associated with low physician visits and can cause low birth weight and infant mortality. In the area near Midway airport, 91% of the babies born in the area had low birth weights, compared to 9.1% in the city of Chicago, 8.4% in Illinois, and 8.2% in the United States. There are no statistics for infant mortality for the area, but 0.007% of the babies in chicago die between birth and 1 year old. This percentage is equal to the infant mortality rate for the state of Illinois at 0.007% and higher than the United States at 0.0065% of all babies being born. There have been a few programs created to help mothers maintain their health and have a smooth delivery.

CenteringPregnancy is a model of group care that provides health assessment, education, and I support (County Health Rankings, 2014). These groups consisted of approximately 8 to 12 women of similar ages helping each other to create successful birth terms (County Health Rankings, 2014). The curriculum of these programs consist of care skills, facilitated discussion, and support networks that help these women through their transition to motherhood (County Health Rankings, 2014). The program consist of 10 meetings with evaluations to help those individuals that are knowledgeable of prenatal care (County Health Rankings, 2014). This concept is similar to a course only for pregnant women (County Health Rankings, 2014). This "course" has had a good impact on the nation's health including improved prenatal care, birth outcomes, and patient satisfaction (County Health Rankings, 2014).

Mobile reproductive health clinics are medical vans with clinicians that offer reproductive health services, including pregnancy tests, pre and postpartum care, STI screening, and health education (County Health Rankings, 2014). These vans are equipped with laboratories, clinicians, education rooms, waiting rooms, and private exam areas (County Health Rankings, 2014). Sometimes, the clinic refer patients to social services for situations outside of their domain (County Health Rankings, 2014). These mobile health clinics have benefited the health community by improving prenatal care and reducing preterm births (County Health Rankings, 2014).

Public health involves the assessment of the population, creating strategies to improve society's health, and provide the services necessary to maintain their health. Part of assessment is trying to determine the social determinants of health surrounding an individual in order to create a personalized intervention to help them and others. Southwest Chicago is one of the areas ridden with disparity. Part of this disparity is limited access to care for the 2,223 people of the community surrounding Midway airport.

Limited access to care can lead to increased mortality rates among diseases and poor prenatal care. Programs like retail clinics, telehealth, CenteringPregnancy, and Mobile health clinics have been created to combat these struggles of the community. With more programs like these and an increased effort from the public health community, the nation's health may be able to change into the way it is suppose to be.

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