Chicago Health Atlas

Healthy Chicago 2.0 and the Chicago Health Atlas

Kyla WilliamsMarch 29, 2016

This morning marked the launch of Healthy Chicago 2.0: Community Health Assessment and Improvement Plan, by our partner, the Chicago Department of Public Health.

Here’s their overview:

This plan, Healthy Chicago 2.0, is utilizing the Mobilizing for Action through Planning and Partnerships model, which was developed by the Centers of Disease Control and Prevention (CDC) and the National Association for County and City Health Officials. Healthy Chicago 2.0 is a four year plan that will outline goals and strategies for Chicago Department of Public Health (CDPH) and public health stakeholders to implement and work towards improving the health of Chicago residents and communities.

Here’s a link to the entire plan.

Today, in concert with CDPH, we’re launching the Healthy Chicago 2.0 section of the our Chicago Health Atlas website. This section allows CDPH to publicly display progress of 75 indicators for plan goals.

Here’s how CDPH describes it:

The Chicago Department of Public Health (CDPH), in collaboration with the Partnership for Healthy Chicago, completed a comprehensive community health assessment in 2015. From these findings, CDPH, the Partnership, public health stakeholders and community residents identified 10 priority areas to focus community health improvement efforts on over the next 4 years. These priority areas include both health outcomes and social determinants of health, as well as public health infrastructure elements like partnerships and data:

Expanding Partnerships and Community Engagement

Improving Social, Economic and Community Conditions

Improving Education

Increasing Access to Health Care and Human Services

Promoting Behavioral Health

Strengthening Child and Adolescent Health

Preventing and Controlling Chronic Disease

Preventing Infectious Diseases

Reducing Violence

Utilizing and Maximizing Data and Research

After completing the community health assessment, CDPH convened ten action teams to develop specific goals, objectives and strategies to address each priority. These goals, objectives and actionable strategies form Healthy Chicago 2.0, Chicago’s four-year community health improvement plan. In total, Healthy Chicago 2.0 outlines 82 objectives and over 200 strategies to help reach 30 goals. In order to measure progress towards each goal, CDPH and action team members identified 75 indicators to serve as annual benchmarks towards our 2020 targets.

The indicators have been categorized into the following sections: Overarching Outcomes, Access, Community Development, Education, Behavioral Health, Child & Adolescent Health, Chronic Disease, Infectious Disease and Violence. Explore the indicator table below to learn more about what CDPH and our partners will be monitoring towards the goal of achieving health equity in Chicago. Check back regularly for implementation updates and the status of each indicator as new data becomes available.

Take a look at the indicators here and, as always, with any questions.

Healthy Chicago 2.0: Health Action Plan Marshals Community, Data to Target Root Causes

Stephen RynkiewiczOctober 12, 2015

Chicago’s public health goals are shifting toward battling crime, tenement housing and other stubborn social concerns. Nearly a year of data-driven community discussions have led the city’s health professionals to look beyond their traditional roles treating infections, substance abuse and other conditions.

“There are chunks of population in Chicago that are just suffering tremendously, and we just aren’t targeting our resources in the right way,” says Jaime Dircksen, deputy commissioner of the Chicago Department of Public Health. “We started this process with equity in mind, and with the goal of achieving equity across the city. I think having that lens really led to people feeling comfortable talking about some of the causes of these problems.”

Attacking these problems meant coming up with an approach other city departments would support in their own programs. Now the Healthy Chicago 2.0 plan is being circulated in City Hall for unveiling in late fall. Its priorities emerged in a community-driven process, developed for public health agencies with the federal Centers for Disease Control and Prevention.

“This plan is not the health department’s plan, it’s the city’s plan. Everyone plays a role in improving the health of the city,” Dircksen says. “We will be meeting with city department heads to make sure they understand what’s being put forth in the plan and will champion the plan. Then we’ll convene the interagency council of city agencies and share with them the draft of everything,. We’re identifying the opportunities where we can create synergy. “

Data to the people

Some 800 people contributed to the goal-setting process, a quarter of them in 10 working groups that set objectives and strategies. A data-intensive approach kept this potentially unwieldy goal-setting effort on track.

Percent of live births in which mother began prenatal care during 1st trimester, 1999 – 2009 (Chicago Health Atlas)

Public-health staffers gave work-group volunteers a thick stack of statistics on births and deaths, hospitalizations and personal habits. They mapped health outcomes by neighborhood, conducted survey research and adopted novel ways to probe the underlying causes of chronic diseases.

Finally, they faced down the realities of an austere 2016 city budget. The health department controls only $149 million directly, a 4 percent cut. Most of that is set aside for AIDS, women’s and children’s health, mental-health and emergency services.

“There’s a strong paradox constantly at work,” says Nikhil Prachand, the health department’s director of epidemiology and public health informatics. “It’s impossible to narrow down the priorities, but if you don’t have a lot of money it should be easy to narrow down the priorities. “

Smart Chicago will play a role in measuring the plan’s success. The city will use the Chicago Health Atlas website to mark progress toward goals for 2020.

“We will have a dashboard of indicators monitoring every action area,” Dircksen says. A website update will “really dive deep into community area data so that the community can see progress,” she says. “Community-based organizations can use it as a resource for funding opportunities and monitoring their own work.”

Planning began last year with surveys in English and Spanish, asking broadly about a healthy environment. Residents across the economic spectrum united around safety and access to healthy food as citywide needs. Yet there wasn’t much agreement on neighborhood needs.

In areas under economic stress, crime emerged as the top priority. In affluent areas – nearly half the sample – respondents were more concerned about the built environment as a local issue. The widest gulf was in access to education, based on agreement with statements like, ”Schools in my neighborhood have what they need to provide a high quality education.”

Tackling broader issues like safety, Dircksen argues, takes “understanding that people aren’t going to parks because they don’t feel safe, they’re not well lit, there’s trash all over the place, that’s where the gang violence happens — then thinking out how to respond to those issues.”

Percent of occupied crowded housing units, 2007-2011 (Chicago Health Atlas)

Root causes

Five panels probed more deeply into the equity questions. “They did a focus group with our hotline volunteers to hear the stories they’ve heard,” says John Bartlett, executive director of the Metropolitan Tenants Organization. “And they asked about their lives also, because many of them are tenants.“

University of Illinois at Chicago students scored the responses, along with content from a half-dozen StoryCorps oral histories. They found common themes – problems navigating mainstream society and a sense of powerlessness. Again, health issues were linked to larger social problems.

“For example, mold will trigger asthma,” Bartlett says. “We are continually counseling parents whose children have uncontrolled asthma, informing them of steps they have to take to get their landlords to make the environment safer for their kids. Oftentimes landlords can be recalcitrant about that.

“We will inspect units for things like paint dust, and if there is, work with the health department to get a city inspection and encourage families to get their kids tested,” he adds. “And bedbugs are definitely a stressor in people’s lives. They blame themselves, but it’s not anyone’s fault. These creatures are just hitchhiking all over the place.”

The next step was to share the results with local health advocates. Many were frustrated at the lack of money, equity, attention and political will to take on core issues. And they saw traps ahead for clients navigating Affordable Care Act enrollment and mental health clinic closures.

“We were happy because the city was making efforts to be accessible and to be inclusive of the disabilities community,” says Gary Arnold, spokesman for Access Living, which hosted one of the advocate forums.

Local Pubic Health System Assessment (Chicago Department of Public Health)

Opportunities and threats

In one exercise, service providers scored the local health system using a CDC-approved framework. Working groups saw electronic health records posing opportunities for data sharing and monitoring, and threats from uneven adoption and stale information.

Health advocates saw new communication tools as potential threats, raising access barriers or triggering changes in brain development and socialization. But technology also was part of the solution: Ideas included wrist monitors, health provider networks and a 2-1-1 phone line to take health and human service calls.

“We ended up with 50 priorities, and they’re all very important,” Dirksen says. Grouping them yielded a more workable list of 16 themes, which were ranked by public and private stakeholders in the Partnership for Healthy Chicago. The city convened 10 expert panels this summer to draft objectives and strategies in key areas.

HEALTHY CHICAGO 2.0 ACTION AREAS

Access to healthcare and human services

Behavioral Health

Chronic disease prevention and control

Community development

Data & Research

Education equity

Infectious Disease

Maternal, Infant, Child and Adolescent Health

Partnerships and Community Engagement

Violence and Injury Prevention

“The first thing is laying out the roadmap then creating the will to fund it,” says Bartlett, who joined the community development team. “If we’re serious about having a healthier Chicago we need to look at prevention. All the departments dealing with housing should be on the same page looking at health as part of the decision-making process. How do we make sure Chicago housing is affordable and healthy? It’s not good to have only one without the other. “

Distributed network

The teams will reconvene next month to draft detailed plans. Eight final themes will mirror the action areas, with data and engagement as strategies throughout. “We can’t do any of this work without having the data to inform it, the research to gather additional data – and it’s an all-hands-on-deck effort,” Dircksen says.

Data will help make the case for funds, and track whether they’ve been spent wisely. “Community development is focused primarily on capital improvements – improving CTA stations, rehabbing schools, building structures,” Prachand says. “We have been able to assess the health of the city’s commercial areas and offered a number of metrics. We can monitor over time and give feedback whether these capital improvement projects and grand plans are having some impact on people. “

The plan calls for more community input, in projects such as locating new Divvy bike stations on the South Side. “How do you know where the next best place is? Not necessarily by looking at a map,” Dircksen says. “They have to talk to the community leaders and stakeholders. We’re talking about the public health planning and transportation planning worlds coming together, and working together to identify mutual benefit and priorities.”

The city will count on private agencies to take on some of the burden. “Funders are wholly committed to obesity, metal health, access to care, violence prevention,” Dircksen says. “They appreciate and understand housing is health care. But then they’re giving across the city, not making a great impact, and not necessarily using evidence-based strategies. How do we work with them to make sure they understand what the evidence is and what does work, and concentrate their efforts in places or with populations which we know need the most?”

“It’s our job to mobilize and motivate the community to be a part of this,” she adds. “By 2020 we expect to achieve all the things we’ve laid out. I think with this process we will have a lot of engagement come launch because people will have been involved throughout the process. There’s a lot of evidence that when you engage people from the very beginning, they’re more likely to buy in, they’re more likely to act.

“If we don’t address environment and community conditions and access to care, we’ll never be able to impact the lives of people,” she adds. “At the forefront we will focus on those root causes of why folks are overweight, why they’re smoking, why they aren’t caring for their chronic conditions or their mental illness, or why pregnant moms can’t get prenatal care or can’t deliver a healthy baby.”

Health Advocates Weigh Data, Equity in Obesity Targets

Stephen RynkiewiczSeptember 28, 2015

Health workers review the Consortium to Lower Obesity in Chicago Children policy agenda on Sept. 16, 2015.

Health workers review Consortium to Lower Obesity in Chicago Children policy agenda.

Childhood obesity is a stubborn problem to reverse in communities starved for cash. In a new five-year plan, Chicago health advocates put a priority on targeting funds and tracking results.

“We are not seeing significant improvement in disparities,” dietitian and food consultant Tracy A. Fox told the Consortium to Lower Obesity in Chicago Children. The group outlined its policy agenda at a Sept. 16 meeting.

A decades-long rise in obesity rates has leveled off at 17 percent, according to Centers for Disease Control and Prevention data. “It’s a plateau at an insanely high rate,” Fox said.

The overall trend also disguises rising obesity rates among minorities. “For African-Americans in particular we are seeing pretty significant increases. So I think we have our work cut out for us,” she said.

“As you discuss your policy agenda for this coalition, I would think about always viewing what you’re doing through the lens of how this would impact disparities,” Fox advised. “If you’re going into a middle- or upper- income school and you’re making significant changes, that’s really cool and that’s really nice. But are you then widening the gap between what’s happening in the city with African American and Latino kids and white middle- and upper-income kids?”

The group is refocusing priorities as both city and state lawmakers consider one of its initiatives, a tax on sugary beverages.

“There’s an argument to be made, if you’re just looking to lower consumption, then where that money goes is maybe not as important as just raising the price of soda,” said executive director Adam Becker. Still, the group is pushing for proceeds to benefit public health instead of sweetening general revenues.

“The feasibility is not really a question anymore,” Becker said. “It’s more the political will.”

The City Council health committee in September considered a penny-an-ounce tax. But its chair, Ald. George Cardenas (12th Ward) has not committed to advancing the plan. A state tax on distributors gained Chicago and suburban sponsors but has not advanced in the Legislature.

“It shows momentum,” said Elissa Bassler, chief executive of the Illinois Public Health Institute. “It’s being seriously considered as a source of revenue to improve health and invest those revenues into health initiatives.”

As new policies gain traction, data analysis has emerged as a priority. “Just because a bill got signed into an act or an ordinance passed doesn’t necessarily mean the things you intended to have happen are indeed happening,” Becker said. “A lot of the real hard work comes when you have to then monitor where things are going.”

Obesity and overweight in kindergarten, 6th and 9th grades, 2012-13 (Chicago Public Schools)

Obesity and overweight pupils in kindergarten, 6th and 9th grades, 2012-13 (Chicago Public Schools)

For example, Illinois requires schools to take body-mass measurements, but the consortium wants the data tracked to identify areas in need. In the latest review of Chicago Public Schools data, roughly half of students were overweight or obese in 11 of Chicago’s 77 community areas.

The coalition of public-health advocates wants to build on recent legislative victories. Childcare centers in Illinois now must meet standards on physical activity, nutrition, screen time and breastfeeding. The group seeks to extend the licensing requirements to child-care family homes.

Less sugar and fat are now required in subsidized school food programs, along with more vegetables, fruits, whole grains, lean protein and low-fat dairy. The consortium wants to maintain the higher standards and expand a federal summer nutrition program, which reaches only 15 percent of eligible children in Illinois.

“We work a lot in school breakfast,” said Bob Dolgan, executive director of the Greater Chicago Food Depository. “And it’s surprising even in low-income school districts how few administrators think about the fact that they have children coming to school without a meal and not eating until lunchtime. How can they possibly concentrate and excel in school without a meal?”

The group also pledges to spread novel ideas such as doubled food stamp benefits at farmers’ markets, a loan pool to build grocery stores in food deserts, and a “baby friendly” designation for hospitals that support breastfeeding.

And it advocates plans to encourage recreation and make streets safer. “In the first several iterations of the transportation bill, there’s been a big shift of more money for walking and bicycling,” said Melody Geracy, deputy executive director of the Active Transportation Alliance. “It is still a microscopic grain of sand in terms of the overall transportation budget. Still, it’s a target” for cost-cutters, Geracy said.

The group’s five-year plan retools an agenda set at a 2010 conference of local advocates. Policy-focused members shared a draft this spring with the group’s executive committee. Becker said national advisors provided details on policy specifics. Lurie Children’s Hospital, where the consortium is based, checked for conflicts with its own positions.

“You all as a city are probably farther ahead than a lot of even big urban cities in terms of really trying to come together with a unified agenda,” Fox told the group.

The policy document says political support is “particularly threatened” for federal health supports such as Racial and Ethnic Approaches to Community Health. The CDC program pays for health screening in Chicago minority communities.

She advised local advocates to talk up their victories. “The more evidence base you have, the better,” she noted, but success stories from the front lines are more likely to engage lawmakers.

Local policy strategists suggested that closing gaps in outcomes will require wider access to preventive care. “Reducing disparities isn’t the same as creating equity,” said Joseph Harrington, regional health officer for the Illinois Department of Public Health.

Chicago Hospitals Win $8.75 Million to Launch Data Network

Stephen RynkiewiczAugust 25, 2015

A data-sharing network of 10 Chicago hospitals could make medical research more reliable and less expensive. It’s a big-data project that keeps patients records locked up, but lets researchers search for trends.

An $8.75 million grant will fund the three-year launch of the Chicago Area Patient-Centered Outcomes Research Network. Awarded July 21, the contract taps money set aside in the Affordable Care Act for medical research.

Terry Mazany, The Chicago Community Trust

“What’s unique about CAPriCORN is that it brings together these 10 institutions that historically have been competitors, or at least disinterested in each other,” says Terry Mazany, chief executive of The Chicago Community Trust and the project’s principal investigator. (The trust is also a Smart Chicago funder.)

“This brings them together in a very formal organization across the entire region,” Mazany says, “with a patient population of upwards of 5 million patients potentially available for research, and in particular a patient population that is very diverse.”

The Chicago network and clinical networks in 10 other regions will allow health advocates to monitor even rare conditions and prove how well current treatments work.

Their first test will be Duke University’s nationwide study to prove whether taking children’s aspirin to prevent a heart attack is as effective as an adult dose, which carries potential side effects. Researchers in Chicago and five other cities will study 20,000 at-risk heart patients, a large sample size that allows fine-tuned analysis.

Richard Kennedy, Loyola University Chicago

“They contacted us and said, you’ve got the numbers that we need, would you be able to participate?” says Richard Kennedy, vice provost for research and graduate studies at the Loyola University Chicago health sciences division in Maywood. “We had a significant number of patients that would fit nicely in the cohort.” Kennedy and Frances Weaver are Loyola’s head researchers for the data network.

Hospitals now are collaborating on how to conduct the trial and manage the data. Other studies will track obese patients after bariatric surgery and children on antibiotics to treat immune disorders. Mazany sees Chicago hospitals as active participants. “When the national level is looking at need and expertise in an area, we have a far broader and deeper bench than any of the other systems,” he says. “That’s a real strength.”

In a $7 million startup phase, CAPriCORN built out a system to connect the medical centers without exposing patient information. The next phase explores its real-world uses, as well as a funding model that puts patients’ interests first.

The aspirin study “is going to answer a question of great clinical concern,” Kennedy says, “but the importance is truly we’re testing the infrastructure we’ve been building for the past 18 months. All right, you’ve put together what seems to be a very impressive informatics system with all the security we would want for our patients. Now let’s see if it works.”

Privacy starts with keeping personal identifiers off the network. Researchers query data in a small, separate access layer, with names and addresses reduced to a cryptographic hash. “We’re currently having it validated by a security firm that’s one of the top in the region to make sure it protects subjects,” Kennedy says.

A novel algorithm links the anonymous patients’ records across all hospitals, giving public health researchers a more reliable count of how common their condition is and where to find hot spots. “You have the ability to look for rare diseases and aggregate an adequate sample size to do statistically significant studies,” Mazany says.

“There’s a next step in some of the research designs,” he adds. Instead of just counting how many patients share a condition, studies that pass an ethics review will reach out to them.

“Let’s say you’re looking at exploring treatments for sickle cell, and you’re specifically looking at teenagers as a population,” he explains. “Then you can do a query to identify the total population and where they’re distributed among institutions.”

Hospitals then can ask patients to join clinical trials that will log treatment details. “It still protects patient privacy but is able to more efficiently identify candidates for the research study,” Mazany says.

Researchers see the network as low-cost way to recruit trial subjects. “Instead of tens of thousands of dollars per participant, then it’s dollars per participant,” Mazany says. “You leverage the efficiency of large data systems so each researcher doesn’t independently have to enroll institutions.

“What makes this in someone’s interest? Lowering the cost of research, speeding up research, creating greater effectiveness. Those three standards are part of a health system that’s learning and evolving rapidly.”

The focus likely will improve data handling as well. “One interesting byproduct could be if there is unevenness across institutions that may become apparent,” Mazany says.

Research on the network will be subject to more thorough advance review. “It’s patient centered,” Loyola’s Kennedy says. “It includes a lot of patient input into the design of the study, the importance of the study to the subjects, the patients, the community.”

Like other clinical trials, research must pass muster with an institutional review board. Feedback also comes from a doctor-patient advisory panel that includes advocates for treating asthma, arthritis and other diseases.

“There’s also a pastor’s group on the South Side that’s very active,” Mazany says. The advisory group “totals about 30 people — it’s a pretty large group.”

The extra review should put important research on a fast track, and prime doctors and patients to follow its recommendations.

“Oftentimes research truly answers medical questions for the people that ran it, yet the results don’t get distributed and implemented as well as we would like,” Kennedy says. “We hope that by engaging the community and the patients – and the clinicians who are taking care of those patients – the results will be implemented much more quickly, because they will be designed in part by input from these subjects.”

The aspirin study also will look into the benefits of mobile health devices. A University of California-San Francisco team will give some participants apps to send reminders and record activity. In Chicago, Kennedy says investigators are considering how they might manage frequent readings from blood sugar monitors in a diabetes trial.

The network is “more open and accessible for that type of data collection,” Mazany says. “Who knows where that will lead as far as the efficacy of the research?”

Hospitals will have to consider a long-term funding model after federal funding runs out in 2018. “We’ve been contacted by an industry sponsor, who would very much like to think that there was a Chicago network they could access without working individually with the 10 institutions,” Kennedy says “That’s going to take some time to create that kind of trust.”

Mazany wants to make sure patient advocates can propose research on the network, but they’ll need to be thoroughly vetted. “They’ll come up with their own queries, but there won’t be an open-data hack night,” he says. “There are just too many privacy and security concerns with these types of data. But in a sense, the hack night would be communities and patients identifying questions that could interrogate data sets through the mechanism of the queries.”

The network has no data portal, but researchers will be encouraged to find ways to show their work outside of medical journals. That may include websites such as Smart Chicago’s Chicago Health Atlas, a past collaborator with hospital networks.

“The Health Atlas is an example of a good partner both on the front end of identifying important trends in the data that can help to frame priorities, and then on the back end as a distribution system for communications outward,” Mazany says. “I look for the Health Atlas to be a very valuable partner, but none of this has been formalized.”

The big-data approach also might spread beyond hospitals. “I don’t know how that’s going to play out,” Mazany says. The network already includes community health centers that store electronic health records centrally. He envisions opening up the network to more health providers.

“That line of thinking is an exciting frontier,” Mazany says. “Right now everybody is up to their necks in alligators draining the swamp. The analogy with Walt Disney envisioning Disney World and Florida in the midst of the swamp I think is appropriate here. We have a vision and are laying the infrastructure to have arise a Magic Kingdom.”

Community Health Workers Teach Asthma Patients to Breathe Easier

Stephen RynkiewiczAugust 24, 2015

Kimberly Artis, community health educator

When an asthma patient showed her inhaler, Kimberly Artis was encouraged, at first.

“She shook the medicine up and I’m thinking in my head, OK that’s good,” says Artis, a community health educator with Sinai Health System in Chicago. “The next thing she did was take a cleansing breath, and I’m like, that’s even better because most people don’t do this.”

Then the patient sprayed the inhaler over her shoulder and took a breath of the room air, and Artis knew why this patient wasn’t getting better. “If the doctor asked her if she was taking her medication, she would have said yes, because she thought she was doing it correctly,” Artis says.

Artis was hired to help patients in their own homes, and to keep them out of emergency rooms. Outreach workers like Artis have helped Sinai cut return visits. Sinai, which includes Mount Sinai, Holy Cross and Sinai Children’s hospitals, estimates the visits save $3,200 per patient, more than $5 for every dollar spent. Now the technique is spreading to treat other environmental health conditions in underserved neighborhoods.

Asthma affects 9.1 percent of Chicago adults, compared with 8 percent nationwide. It’s one of the top 10 reasons Chicagoans land in the hospital, with 7,325 hospital cases in 2012, according to a Chicago Department of Public Health analysis of state records.

“We’ve been working to address asthma disparities in the communities we serve on the West Side of Chicago since 2001,” says Helen Margellos-Anast, Sinai’s senior epidemiologist and asthma program director. “We focus on helping people understand what asthma is, recognizing it early in its trajectory – understanding these are the early symptoms, and I have to treat them now.”

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Private Data and Public Health: How Chicago Health Atlas Protects Identities

Stephen RynkiewiczJuly 14, 2015

Public health information is anonymous. In the day of the data breach, identity theft and wearable health trackers, data scientists have procedures in place to keep it that way.

“Health information presents a huge risk,” says security researcher Larry Ponemon. In a report for the Medical Identity Fraud Alliance, he estimates that 2.3 million Americans have been victims of medical identity theft.

The biggest danger to consumers comes from others using their insurance or other identification to run up medical bills. “You want to take whatever steps you can to protect yourself,” Ponemon says. “In the hands of a criminal, that could be really valuable.”

Data provided to researchers, such as the statistics in the Chicago Health Atlas, are stripped of private data beforehand. What’s left is information designed to compare groups, not individuals.

The goal in data handling is to make sure identities can’t be guessed.

“There is a difference between privacy and security issues,” says Brad Malin, vice chair of biomedical informatics at Vanderbilt University School of Medicine in Nashville. Malin advised on safe handling of atlas data.

“The power of opening up the data is giving people some quick intuition about issues that deserve study,” Malin says. “You can take diabetes and look for a correlation where there are food deserts.”

Chicago Health Atlas: Adult diabetes rates, 2006 through 2012.

The Chicago Health Atlas maps shows high diabetes levels across a large swath of Chicago’s South and West sides. Hospital records suggest the highest prevalence in North Lawndale’s 60623 ZIP code, with the most hospitalizations. An animation shows hospitalizations year by year, with the highest recent rate in Calumet Heights’ 60619 area.

Before giving statistics to outsiders, hospitals remove names and other identifiers, such as birthdays or treatment dates. “You may see residents of one neighborhood with an increased chance of having that diagnosis,” Malin says, “but this system will not allow you to drill down on any factors. There’s no individual-level data.

Health workers also withhold unique cases, where a patient might be identified from a combination of sources and guesswork. “We did not investigate rare disorders in the Health Atlas,” Malin says. “You never disclose information on less than five people.”

This can be a sticky issue for agencies that tackle public health emergencies. In a privacy panel at last fall’s Chicago School of Data conference, City of Chicago informatics project manager Matthew Roberts noted that information like date, sex, county and age might be enough to reveal the identity of a West Nile virus victim.

“If you take a look at the obituaries in a small county,” Roberts said, “for any of those given days where the date of death was mentioned, you could pretty quickly figure out who was the 84-year-old male who had died from disease x.”

Federal guidelines recommend making some data more general to protect privacy. In a case like a West Nile virus death, health workers will giving an age range, or a wider area such as northern Illinois.

Data mining also figures into how much information is released. Health workers consider whether identities can be pieced together from multiple sources. That’s a real danger in data breaches: Hackers mine social media profiles to work up enough information to make a false credit application or tax refund filing.

To study medical outcomes by neighborhood, several years of data might be combined to cut the chances that individuals might be re-identified.

“It’s safety in numbers,” Malin says. “You put your faith in that a certain number of individuals are enough to protect the anonymity of everyone in the group. As you get more specific, the risks go up.“

Still, there are dangers to being profiled as a group. Chicago community activists fought for years against insurers identifying whole neighborhoods as bad risks. Battles against home insurance redlining ultimately were resolved in court.

Health care reform bans insures from denying coverage for pre-existing conditions. However, the Affordable Care still allows higher rates by location. The rules require broad areas, no smaller than an entire county. But higher costs still may keep some insurers out of urban areas.

“What are the risks? It’s not quite clear,” Malin says. “In this situation the dangers are group-based. The regulations are defined with respect to individuals. “

Citizens give up bits of their privacy every day to stores or websites tracking their habits, with few complaints if it keeps prices low. But we treat medical care as a public good. We accept that some small piece of our health interactions are for the greater good, whether it’s teaching interns on hospital rounds or stopping infectious disease outbreaks. Our medical care is confidential, but not exactly secret.

“For 150 years, there’s been the expectation that medical information will be used for the public benefit,” Malin says. “In any teaching hospital, or any for-profit hospital for that matter, the information can be reused, unless you decide to be an anonymous patron who pays out of pocket.

“At the end of the day it’s a risk-utility tradeoff,” Malin says. “Unless somebody is actually harmed, they’re not going to see this as a risky situation. These are questions on the table as we move into a data-based society.”