Let’s Grow Together in Health and Well-Being:

The Boykin Plan to Revitalize Public Health in Cook County

“For he who has health has hope; and he who has hope, has everything.”

Owen Arthur – former Prime Minister of Barbados

Since March 2020, the people of Cook County have suffered immeasurable losses from the COVID pandemic.  We have grieved collectively while watching more than 15,000 residents lose their lives to the virus, which has upended our county’s health and mental well-being.  Our public health system groaned under the heightened pressures to provide crisis care to the neediest among us.  Doctors, nurses and emergency responders rose to new heights of excellence in service, but they were pushed to the limits because the County was not prepared to handle the crisis.

Two years into the pandemic, we are fortunate that the number of deaths and hospitalizations have declined and mask mandates have been lifted.  We can use this moment to pause and reflect on the challenge ahead in restoring Cook County’s health and well-being. What stands out clearly is that the pandemic has laid bare glaring disparities in the health and well-being of many communities. Our underserved communities suffered the highest rates of death, hospitalization and COVID infections.  Many children lost up to two years of social and emotional development due to school lockdowns, distance learning, and uprootedness in their daily activities and family lives.

We may not be able to put Humpty-Dumpty back together again, but we can pursue good health and well-being by ending isolation, restoring community trust, and tackling the major public health issues in front of us: shattering levels of gun violence, mental health deterioration, poor nutrition and obesity.

The ruin of a nation begins in the home of its people. This African proverb captures our moment perfectly and the challenges that lie ahead. From the ruins of COVID, we shall build healthier families and a better-run county health system.

The state of public health in Cook County: Not Good

By various measures, the state of Cook County’s health is poor.  Under President Preckwinkle’s watch, Cook County lags way behind the other 101 counties in Illinois in three of six critical measures: clinical care access and quality, social and economic factors and physical environment.  For two other measures–length and quality of life–Cook County ranks in the middle of the pack.  For only one measure—health behaviors—Cook County ranks among the top tier counties in terms of performance.[i]

Table 1 shows how Cook County ranks compared to the other 101 counties in Illinois on six measures in 2022.

Table 1

Cook County’s Rank Among Illinois’s 102 Counties:

Health Outcomes and Factors Measures

Health factor measures include:

  1. Health behaviors: Tobacco use, diet and exercise, alcohol and drug use, and sexual activity
  2. Clinical care: access and quality of care
  3. Social and Economic: educational levels, employment and income, family and social support and community safety
  4. Physical environment: Water and air quality, housing and transit

Health outcome measures include:

  1. Percentage of premature deaths (i.e. – prior to age 75)
  2. Quality of life: physical and mental health stress; diabetes levels

Health Rankings of Six-county Metro Area

In the six-county Chicago metro area, Cook County ranks last on all six of the above mentioned measures.  Table 2 shows the rankings for each county.

Table 2

Health rankings of six-counties in Chicago metro area[ii]

CountyOutcomesFactors
Cook66
DuPage11
Kane45
Lake32
McHenry23
Will54

Hypertension, Diabetes and Obesity in Suburban Cook County

Residents of Cook County have high rates of hypertension, diabetes and pre-diabetes, and obesity, as shown below in Table 3.

Table 3

Suburban Cook County Residents with Specific Health Conditions
ConditionNumber% of population
Hypertension615,33634.51%
Diabetes176,6809.91%
Pre-Diabetes194,56910.91%
Obesity/ Overweight1,180,56766.21%
Source: IDPH, Behavioral Risk Factor Health Survey, Suburban Cook County, Round 6 (2015-19)

Staggering levels of Gun Violence

More than 1,000 residents of Cook County were killed by gun fire in 2021 alone, thereby, shattering domestic tranquility and upending our common defense.[iii] Bullets kill indiscriminately. Too many families have been left traumatized by the loss of a loved one caught in the crossfire between armed assailants.

High Cost of Mismanagement in Cook County Health and Hospitals Systems

As the health of our residents has stagnated, Cook County has paid hundreds of millions of dollars in damages to resolve medical mismanagement issues.

  • Between 2012 and September 2016, there were 41 lawsuits at Cook County Health and Hospitals System, resulting in settlements totaling $80.5 million.[iv]
  • In October 2018, a nearly $4 million settlement was made for a lawsuit related to an allegedly botched heart surgery at Stroger Hospital.[v]
  • In September 2019, a $3 million settlement was made to the family of a woman who died after surgery on her adrenal glands and kidney.[vi]
  • In December 2019, a $14 million settlement was made with the family of a girl who suffered brain damage due to the poor care her mother received while in labor at Stroger Hospital.[vii]
  • In February 2022, a $6.75 million settlement was made to a former patient of Stroger Hospital who was left paralyzed because doctors failed to treat a spinal condition.[viii]

In addition, the County has squandered money by rewarding preferred developers. The County was negligent in the build-out and leasing of the Blue Island Health Care Center, according to the Office of the Independent Inspector General (OIIG).  Due to managerial sloppiness,  Cook County Hospital “paid $1,853,992.69 in extra scope of work above and beyond the purchase price.”[ix]  This is money that could have been used to provide services to the people of South Suburban Cook County.

COVID Mismanagement

The costs of mismanagement were especially on display during the height of the COVID pandemic. In the six-county Chicago metro area, Cook County has had the highest death rate from COVID—1.27% of all cases.  Table 4 provides the breakdown by county.

Table 4

The mismanagement was due to a leadership vacuum, unprepared County hospitals, and lack of contractual and personnel oversight.

1. Leadership Vacuum

As the pandemic was crystalizing, Cook County Health and Hospital Systems and the Cook County Department of Public Health had leadership vacuums.

  • In November 2019, the Board of Cook County Health voted to oust, the CEO of the county’s health arm.   He was not replaced until October 2020, when the current CEO took the helm.
  • In February 2020, the health system’s chief financial officer, was dismissed.[x]
  • On April 3, 2020, President Preckwinkle fired the head of the Cook County Department of Public Health, at the moment the pandemic was entering its first high volume of transmissions stage.[xi] Two medical officers on staff were made co-leaders of the department on an interim basis. 
  • In April 2020, the President promised to fill the position permanently.  She said, “Hopefully that will conclude shortly. And needless to say, that’s the first priority”[xii] It took two years to fill that promise.
  • On May 11, 2022, Preckwinkle finally appointed a new Dept. of Public Health Chief.

2. Provident Hospital Not Prepared for COVID

In times of crisis and heavy utilization, hospitals are expected to rely on  “crisis standards of care: To provide emergency care to the neediest patients.  For a two-week period in April 2020, the emergency room at Provident Hospital on Chicago’s South side was shut down, purportedly to prepare the room for social distancing.  At the time,  “Cook County Health Systems has said that closing the ER was unavoidable due to an anticipated rise in COVID19 cases in which Provident’s ER was not physically designed to accommodate.”[xiii]. No other hospital in Cook County had to shut their emergency room for reconfiguration.  

3. Lack of Adequate Contractual and Personnel Oversight for COVID services

According to the Cook County Office of the Independent Inspector General (OIIG), the contract review process was flawed when the County agreed to house sick COVID patients at a hotel.[xiv].  The County agreed to provide guest rooms, food and beverage services for COVID patients and staffed the facility with a county employee. OIIG found that the employee was known to be abusive toward patients; the facility failed to provide 136 daily activity reports, which made it difficult for the County to track the need for vital medical equipment for patients.  Also, invoices submitted by vendors did not go through adequate review and due diligence.  Per the OIIG, “questions could have been raised regarding the hours worked by one individual 24 hours per day, 7 days per week and whether paying $195,029.70 for salary, meals, and hotel services, was prudent and a good use of government resources.”[xv]

Managerial incompetence at this level can never be tolerated.  As President, I will ensure that effective compliance and oversight processes are put in place for all contracts and personnel assignments.

BOYKIN PLAN TO REVITALIZE PUBLIC HEALTH IN COOK COUNTY

As President, I will make family and community health the keystone of the Cook County Health and Hospital Systems mission.

Recently, Cook County received $1 billion in federal money through the American Rescue Plan Act of 2021.  The once-in-a-generation windfall presents a golden opportunity for Cook County to bring healthy family and community development into focus.  As President, I will use those funds to confront gun violence, reinforce social and emotional health, and promote good nutrition throughout Cook County.

To meet these goals, I support a three-tiered strategy:

  • Nurturing our children and families
  • Restoring our community health
  • Reforming management of the Cook County Health and Hospitals System


Nurturing our Children and Families

1. Create Cook County Child Care Planning Council

The mission of the Cook County Child Care Planning Council would be to support development of a child care delivery system that offers safe  high quality, culturally sensitive, affordable child care to Cook County for families who need it.  The system would allow for  parental choice and would be supported by strong partnerships with public and private resources.

The Council would consist of members from the community, public health professionals, educators and health and nutrition specialists.  The Council will work to build social connectedness, and cultivate collaboration in neighborhoods, schools, and workplaces in underserved communities throughout Cook County with the goal of confronting gun violence, reinforcing social and emotional health, and promoting good nutrition throughout Cook County

2. Create Family, Friends and Neighbor Network for Families without Access to Child Care

Only about a fourth of children countywide having access to licensed child care.  The other three quarters of children are cared for in their homes by caregivers. There are 402,885 children age 5 and under in Cook County, including Chicago.[xvi]  As of June 2021, there are 1,246 licensed child care centers in Cook County serving children under age 5, with slots for 101,051 children in Chicago and suburban Cook County.  Also, there are 2,689 licensed family care homes in Cook County serving 2,153 children.[xvii]

I call for creation and funding of the Cook County Family, Friends and Neighbor (FFN) Network to support those who care for children in their home.  The FFN Network would help caregivers better understand how they can foster a child’s healthy development through various activities. The Network, under the guidance of the of the Child Care Planning Council, would sponsor various and frequent activities for children from 10 months to 5 years old.  The activities would include participation in play groups where children can learn skills such as active listening and empathy.  FFN would help caregivers learn valuable skills on everything from social-emotional development to early childhood safety, to preparing nutritional and healthy foods, to promoting exercise and physical fitness, and for professional development.

Restoring our Community Health

The doctors, nurses and emergency responders, whose professionalism was unmatched during the heights of the pandemic, are among the most committed employees in Cook County government.  They are heroic, as well as stretched to the limit providing emergency and critical care at Stroger and Provident Hospitals, as well as county clinics.  They need assistance from the community to bring health back to our residents.

  1. Create Community Health Worker Corps

I call for the establishment of a Community Health Worker (CHW) corps in Cook County.[xviii] CHWs will provide outreach, education, referral and follow-up, case management, advocacy, and home visiting services. They may work autonomously in the community, but will be accountable to the Public Health Department. Their services will be provided to underserved communities and to individuals at high risk of hypertension diabetes, and obesity. CHWs often work with individuals at risk for or suffering from chronic diseases such as diabetes or cardiovascular disease.

As President, I will work to create a Community Health Worker corps.

2. Create Community Violence Prevention Corps

For more than 90 years, governments at all levels in the United States have invested in job training and development programs. Each approach shares similar goals—to increase employment opportunities for underserved individuals by improving their knowledge, skills and ability and integrating them into productive society. The major difference between programs is the mix of public and private options used for realizing the goals.  

The time has come for Cook County and non-profit organizations to redeploy job training and employment resources to underserved communities affronted by violence. I call for the creation of a Cook County Community Violence Prevention Corps. Inspired by the federal Works Progress Administration (1935) and the Comprehensive Employment and Training Acts (1973), the Prevention Corp will train and employ, unemployed breadwinners and youth from at-risk families to serve as community relations specialist The individuals will be trained in techniques of conflict resolution, mediation, de-escalation, and related skills. They will be employed by participating public and private agencies.

For more information about the Boykin plan to stop the violence, see https://richardboykinforcookcounty.com/public-safety-plan/

Reform-oriented Management of the Cook County Health and Hospitals System

As President, I will recruit an executive and top-level management team that supports the strategic priorities of improving behavioral and public health and  how to manage large, complex organizations.  The strategic priorities are:

  • Improving the surveillance and tracking capacity of the Department of Public Health in preparation for the next public health emergency.
  • for the community violence prevention corps program, the community health workers program, and the Child Care Planning Council.
  • Developing and executing an implementation plan for reducing the high levels of obesity and poor nutrition in Cook County.

My executive and management team will be expected to demonstrate a high-level of competency in eight areas.

  • Data analytics and assessment
  • Policy development and program programming
  • Communication skills
  • Health equity
  • Community partnership skills
  • Public health sciences
  • Budget and finance, and
  • Leadership and systems thinking.

I will hold all levels of Management accountable, whether supervisory, departmental or executive, for understanding the Cook County Procurement Code, the basics of contract compliance, and the internal control processes under their purview to ensure that services are delivered effectively, efficiently and with full awareness of costs.

Conclusion

The public health system needs to be revitalized in Cook County. As President, I will work to create a public health system in Cook County that provides all families and communities with  access to safe and effective care.  I will work diligently toward building a system that brings equitable care and health outcomes to all residents of Cook County.


Endnotes

[i] University of Wisconsin School of Medicine and Public Health, https://www.countyhealthrankings.org/explore-health-rankings/rankings-data-documentation.

[ii] https://www.countyhealthrankings.org/explore-health-rankings/rankings-data-documentation

[iii] Cook County Medical Examiner’s Office, March 3, 2022, online search.  That is the first time the Office has seen more than 1,000 homicides in1994

[iv] https://www.modernhealthcare.com/article/20161227/NEWS/161229965/the-cost-of-malpractice-cases-at-chicago-s-two-public-hospitals-160-mCillion-and-counting. Accessed 5/14/22

[v] https://www.chicagotribune.com/politics/ct-met-cook-county-lawsuit-settlement-20181017-story.html. Accessed 5/14/22

[vi] https://chicago.suntimes.com/city-hall/2019/9/3/20848154/cook-county-finance-committee-approve-3-million-settlement-medical-malpractice-case#:~:text=The%20Finance%20Committee%20of%20the%20Cook%20County%20Board,after%20surgery%20on%20her%20adrenal%20glands%20and%20kidney.. Accessed 5/14/22

[vii] https://chicago.suntimes.com/2019/12/18/21028507/cook-county-committee-approves-medical-malpractice-settlements. Accessed 5/14/22

[viii] https://www.chicagotribune.com/news/breaking/ct-medical-malpractice-suit-cook-county-stroger-20220210-imwedgg3pjgg5oe5pe4tlejp4y-story.html.  Accessed 5/14/22

[ix] OIIG, Quarterly Report, 1st quarter 2022, p. 2.

[x] https://ndigo.com/2020/04/05/why-was-dr-terry-mason-fired/.  Accessed 5/12/22

[xi] The CEO had worked at Cook County Health since 2009, and as its Chief Operating Officer since 2013.   Prior to that, he was Commissioner of the City of Chicago’s Department of Public health for four years.

[xii] https://news.wttw.com/2020/04/11/2-doctors-take-helm-during-coronavirus-pandemic-turnover-cook-county

[xiii] https://windycitytimes.com/m/APPredirect.php?AID=68322.  Accessed 5/12/22

[xiv] OIIG, Quarterly Report, 1st Quarter 2022,  pp. 7-13

[xv] Ibid., p. 13

[xvi] https://www.actforchildren.org/about/research-data/data. Accessed 5/16/22

[xvii] https://www.actforchildren.org/about/research-data/data. Accessed 5/16/22

[xviii] See “Community Health Workers Strategy” at www.countyhealthrankings.org.