Okay, we're gonna get started.

With the hour having to reach one o'clock, I'd like to call to order the meeting of the Cook County Health and Hospitals Committee roll call.

Thank you, sir.

Commissioner Aguilar.

Commissioner Aguilar is absent.

Commissioner Naya.

Commissioner Britton is absent.

Commissioner Daly.

Commissioner Dagnan.

Commissioner Gaynor is excused.

Commissioner McCasco.

Commissioner Miller.

Miller here.

Commissioner Moore.

Commissioner Marita.

Present.

Commissioner Kevin Morrison.

Commissioner Sean Morrison is excused.

Commissioner Scott is absent.

Commissioner Stamps.

Present.

Commissioner Trevor.

Here.

Commissioner Vasquez.

And Mr.

Chair is present.

Let me revisit those that did not respond.

I have an absent for Commissioner Britton.

Excuse for Commissioner Gaynor.

Absent for McCasco.

Thank you.

Commissioner McCasco is present.

Absent for Commissioner Moore.

Excuse for Commissioner Sean Morrison and absent for Commissioner Scott.

Chairman, you do have a quorum.

Any remote participation requests?

There is no re uh request for remote.

Any additions to the agenda?

I have no changes to your agenda, sir.

We have a supplemental.

There is a supplemental for item number 1736.

Thank you.

That's 26-1736 supplemental agenda item.

That's a resolution calling for the United States federal government to require insurance coverage for colorectal cancer screenings for individuals under 45.

Okay.

Public speakers.

Chairman, we have a total of five speakers.

Please be reminded of the public speaking rules.

George Blakemore, followed by Sandy Norman.

Thank you.

Good afternoon to the empty seats.

Citizens are not present.

The bureaucrats are here because they are getting paid.

If I would do a little survey, how many people that here that are citizens of Cook County?

I know the bureaucrats are citizens.

I'm talking about with interest to just come to the meeting.

All these people that are here are being paid.

What motivates you, Mr.

Blake Moore?

I have a long history of civic duty at Cook County Hospital.

I've been a patient there.

But Madam Prattwick says these are citizens.

They are residents.

They are not supposed to get in front of me and black people who are U.S.

citizens.

So it's very important for me to come to these meetings.

They can save millions and millions of dollars by making every employee, the employer use the health and hospitals system.

What are you saying, Mr.

Blake Moore?

They they have a cat lag.

Blue Shield and Blue Cross insurance and the hospital.

Everyone who works.

Everyone who works for Cook County should use the county health and hospital system.

And all of you.

And what's the grievous act that's happened?

These illegals when they go and work on those jobs and have an accident.

And the units not covering them.

They're not part of the union.

Why would they go to Cook County Health and Hospital system to the liberal comprehensive health care for its citizens?

So it's very important for men in the Bakemore caliber to come to these meetings.

He's very astute for government.

I ran against Fifth Man too.

And he got he did no campaign in a nothing.

And he got elected.

The whole system is broken.

They steal the election.

And time is expired.

Sandy Norman is next.

Sandy Norman is not available.

Dr.

Mark Clifton, followed by James P.

Finnisk.

Then Robert Holeb.

If you're in the room, the first one, please come to the mic, Dr.

Mark Clifton.

Thank you.

And Sandy Norman is no show.

Good afternoon, everyone.

Especially the commissioners, members of the Health and Hospitals Committee.

Thank you for the opportunity to speak today.

In my work, I have reviewed many federal, state, and local assessments of mosquito control programs.

And I think this report, in my experience, is among the most thorough and well-executed evaluations I've ever seen.

I think it reflects significant stakeholder engagement, careful analysis, and most importantly for me, an expert-led process provides a clear roadmap for strengthening mosquito and vector control across suburban Cook County.

The report's most important conclusion is that vector-borne disease is becoming an increasingly important public health challenge.

As climate change extends mosquito seasons, invasive mosquito species continue to spread, insecticide resistance becomes more common, and tick-borne diseases continue to expand.

Protecting our communities will require continued investment in surveillance, preparedness, and evidence-based mosquito and tick management.

On behalf of the North Shore Mosquito Abatement Districts and Illinois Vector Disease Abatement Network, I want to express our full support for this report and its recommendations.

We are committed to implementing these recommendations that apply to our district and to working collaborative collaboratively with Cook County Department of Public Health, our fellow mosquito abatement districts, municipalities, and regional partners to strengthen coordination, improve preparedness, expand surveillance, and share data that will better protect the residents of Cook County.

So this report represents an important opportunity to strengthen our regional public health system, and we appreciate the leadership of the Cook County Board and Cook County Department of Public Health in undertaking this important work.

Thank you for your time and your continued commitment to protecting the public health of Cook County residents.

Thank you.

Thank you.

Next speaker, James P.

Thinnis.

And after Mr.

Thinness is Robert Holeb.

Hello, my name is James Thenish.

I'm the director of Northwest Mosquito Abatement District.

Northwest Mosquito Abatement District covers Northwest Cook County.

It covers 242 square miles.

I've been doing mosquito abatement work for over 40 years for the district.

I want to uh put my support into this um report that was presented here or will be present presented here to you today.

And I want you to know that our district cooperate fully with any um future workings with the Cook County Department of Health.

Thank you.

Thank you, sir.

Robert Holeb.

Robert, are you in the room?

Robert, are you connected virtual?

If you hear me, turn your camera on and your mic.

Uh-huh.

I see you connected, sir, but we can't hear.

So adjust your mic, and I'm going to go to one speaker and then come back to you.

Jeff Cohn.

Uh-huh.

You may begin.

Good afternoon, board.

And thank you for the opportunity to come down and to lend our support for the Cook County assessment that was done on the mosquito abatement districts.

I am the interim executive director for South Cook.

I have been working with South Cook for over a year to help improve the operations and execution of the services on behalf of the stakeholders in 340 square miles that the South Cook County Mosquito Abatement District serves.

We are in full support of the report that was completed in the analysis that was completed by Cook County.

We thank them for the report.

It was one of the most objective reports that has been done and rendered on the South Cook County Mosquito Abatement District.

It is a tough job, as many people know, but is a job that the report actually states is one that we should leave intact and improve the operations and also expand the services that we are providing to stakeholders to other communities that do not have a mosquito abatement district provider.

So we look forward to working again with the must uh with the um Cook County Department of Public Health to improve services overall.

Thank you very much for allowing me the opportunity to come before you today.

Would you add Commissioner Aguilar to the role, please?

Thank you, sir.

And um Robert Holop, can you hear me?

Can you have uh camera turned on?

We still can't hear you, sir.

Robert Holup.

Okay, sir.

I'm gonna advise you this.

If you can hear me, we'll put this number in the chat as well.

312 603 6127.

That's the um phone number to my office.

If you would like to provide a written testimony, we could provide it to the board and attach it to our meeting record.

Again, um 312 603 6127.

In this team's chat is also a phone number to call.

If you do and are able to connect via team's phone, then we will call you again.

I hope that helps.

312603 6127.

If you want to leave a written, um, somebody will take that from you, or the phone number in the team's chat, and we'll call you back.

Chairman, I'm sorry, but we're not able to hear Mr.

Robert Holup.

But that does conclude our list of speakers for this meeting.

Thank you, and thank you to our public speakers.

Vice Chair Anaya now moves approval of item two six one nine eight six minutes from the meeting of the Health and Hospitals Committee held on June 9, 2026, seconded by Chairman Daly.

All those in favor say aye.

All opposed in the opinion of the chair, the ayes have it.

I'm gonna bundle the following items.

Vice Chair Anaya now moves to receive and file item two six-1274, a behavioral health report presented by the Cook County Public Defender, moves to defer item 23-3815, an update from the CCH and CCPDH or DPH, excuse me, on their COVID-19 and other diseases of concern immunization and mitigation plans in suburban Cook County moves to approve item 26-1611, a semi-annual disparities report by Cook County Department of Public Health.

Moves to approve item 26-1731, the Cook County Department of Public Health's report titled An Assessment of Mosquito Abatement Activities in Suburban Cook County and moves to receive and file item 26-1735, a resolution calling for a hearing of the Health and Hospitals Committee regarding the increased rate of colorectal cancer in populations under 45.

Seconded by Chairman Daly.

All those in favor say aye.

Aye.

All opposed.

In the opinion of the chair.

The ayes have it.

We'll now start with our presentations.

First presentation will be the five minutes.

Okay, I'll add that.

Let me add to the bundle one more item, which is Vice Chair Naya moves to receive and file item two six-1736, which is a resolution calling for the United States Federal Government to require insurance coverage for colorectal cancer screens for individuals under 45.

So with that addition, uh there's a motion made by uh Vice Chair Anaya, seconded by Chairman Daly.

All those in favor say aye.

All opposed.

Yes.

Approved.

We're gonna do it again.

So we have one addition to the motion, and that'd be item 26-1736, which is a resolution calling for the United States federal government to require insurance coverage for colorectal cancer screens for individuals under 45.

That is a motion to approve.

Motions are made and bundled by Vice Chair Anaya, seconded by Chairman Daly.

All those in favor say aye.

All opposed.

The opinion of the chair, the ayes have it.

Now let us start with our presentations.

First presentation will be item 261274 behavioral health report presented by the Cook County Public Defender.

Please turn on your camera.

I heard your mic, if you could turn on your camera as well.

Thank you, Brittany.

Yes, can you see me?

We can.

You may begin.

Okay.

All right.

Thank you for having me here today.

Um, so I am presenting on the behavioral health support that is offered through the Cook County Public Defender.

Um I have had the honor of presenting to you all in the past, uh, but just kind of want to review uh some historical information about the behavioral health services and really highlight some key and distinguishing features of our operations.

Um in 2019, with the support of the board, uh, the Cook County Public Defender's Office created a mental health resource unit that included myself as a licensed clinical psychologist as well as four to five mental health clinicians who are licensed clinical social workers.

Um we really defined our behavioral health services provided by this team as being um clinical consisting of clinical assessments, uh consultative services, and case management services.

Um two years ago, the public defender's office decided to take the mental health support that's provided and bring them under one umbrella of client support services with the mitigation specialists in our office as well as the case workers in our office.

Um both of those uh job titles existed previously, um, but all of these kind of like human service specialists were scattered about the office, so we created one department to bring everybody under one umbrella so that we were able to increase our service delivery.

Um, make sure that we are given that we're such a limited resource, we're a fairly small team.

Um, the total right now, it sits about 20 people, but that is for the Cook County Public Defender's Office.

So we represent, as you know, tens of thousands of cases a year.

Um, so we are really a limited resource, but creating one department uh allowed for us to be more intentional about who is being assigned to certain cases to address the client and the attorney's needs.

Um creating one department also allowed us to increase collaboration amongst those of us specialists and professionals who are more so in the human services, um, so that we're able to have support in one another, but also have a management structure that is specific to our training and skill set.

Uh, with that, client support services is you know currently designed to support the office's mission towards providing holistic defense.

So, you know, as the Cook County Public Defender's Office, we are certainly committed, and our main priority is to providing excellent legal representation, but we also acknowledge that there are a number of biopsychosocial factors that influence individuals' interactions with the criminal legal system.

The client support services is really put in place to meet those needs, help the attorney represent those specific needs and maybe barriers within the community in their legal representation, and for us to um you know be able to provide ongoing support to our clients, identifying certain barriers and needs within the community and adjusting their service linkage plans to really you know set them up in the community in a way that will reduce the likelihood of them coming back into the criminal legal system.

Um, so we are uh an internal resource, um, and we are designed to assist the attorneys and the clients.

We receive referrals directly from the attorneys.

Um there are some outside agencies, judges, etc., who are maybe familiar with our services who might encourage the attorneys to enlist our support, but we really are designed to be an internal resource within the public defender's office.

Uh we are not treatment providers again in the next slide.

Again, in the next slide, I'll talk about the specifics of the behavioral health support that we provide, but we do not provide direct treatment at this time, with the exception of our freedom defense and the trauma recovery specialists that we have in both Austin and Roseland through a grant program.

As I mentioned earlier, we are members of the defense team.

I will say a very unique and distinguishing feature of our behavioral health support is that we are positioned in a way that allows us to have contact and provide support to the client at various stages of the legal process.

So there's a common gap in services is between detention and release back to the community.

Our client support services team is able to make contact and reach into the jail to support our clients and follow them as they reintegrate into the community.

It's a real advantage, and why I say it really meets a gap, is that again we're able to really kind of adapt and tailor the service plan to make sure there's a goodness of fit and ensure that you know follow-through with services is met while they proceed through their legal process.

Lastly, you know, we really emphasize collaboration.

So we are constantly, you know, making contact with community providers, making sure that we're familiar with the services available in different areas and some of the you know unique services that are provided at different agencies so that we are really able to meet our clients' need in an effective way.

We also work collaboratively with a number of justice partners.

So around the behavioral health support that we provide, um, as I mentioned earlier, we're we specifically provide consultative clinical and case management services.

Um so that consultative piece is really around the support that we're able to provide to the attorneys, providing them with education and resources to help enhance their defense with clinical services.

I really that primarily refers to assessment services.

So we do a number of mental health screenings, we put together treatment plans, we put together psychosocial reports to really represent the clients' specific mental health history and needs.

That can be linkage to mental health providers, substance abuse treatment, but it also could be to you know job training or helping individuals get set up with you know Medicaid or certain benefits that they may need in the community.

So these are our numbers that we presented in this last report.

I do think I misunderstood the changes in the resolution.

Um so with the next report, I will be presenting data over the 12-month period.

Um, but the information that I pulled together for this report was still for that semi-annual setup.

So for Q1 and Q2, these are our totals.

Um, in addition to the specific behavioral health services that we provide, um, I wanted to highlight that we also represent individuals in mental health court.

So at the time of this report, we represented 126 clients in mental health court.

Um, but most importantly, I wanted to highlight the pretrial mental health screening initiative that we put in place within Q1 and Q2 up until April 20th.

Uh, we had identified 247 clients as having reported specific mental health concerns and mental health needs.

Um, what we have been doing is we were we've been piloting a project with our mental health team where we flag any client initial interview where there's an indication that there are mental health needs.

Um we've been reaching out to the clients, so whether they're in jail or we're cold calling them and the community, we've been doing outreach to see if they need any additional support or linkage to mental health services.

We are looking at how we can expand our caseworker service, and I will switch slides because this goes into this.

Um, we are looking to see how we can expand our caseworker services and the on the adult criminal side so that you know we can enhance some of that first appearance or that initial contact support that we're able to provide.

So the project that we were piloting really required us to, like I said, either reach into the jail or cold call people after we've had contact with them and some time had passed.

So again, I think there was a natural gap in service, a connection that happens.

So we're looking to see if we can you know put case workers in place so that at that point of the initial interview, we're able to sit with them right then and do those like basic needs assessments and identify treatment providers in the moment and help them get linked at the time we have first contact with them.

So there's not such a lag in the services.

Um that is one of our priority initiatives uh that we are working on going into the next year.

Uh we of course are still you know really trying to develop and grow client support services and see how we can enhance our service delivery for mental health mitigation and case workers.

Um, and as always, we are looking to increase our collaboration.

With that, that is all I have.

If there are any questions, I'll be happy to take those.

Thank you.

Commissioner Trevor.

Thank you, Chair.

Um, I uh was just curious if you could maybe give a little bit of detail how you interact with uh uh the uh services that are provided at CERMAC.

Yeah, so we work with the staff over at CERMAC quite often.

Um again, uh the mental health resource unit started in 2019, so I will say our relationship was established at that time.

Um so we have fairly good rapport, and I would say they have familiarity with our services and vice versa.

Um so what we see often are points of collaboration between us and SERMAC are if there are individuals who have any kind of like imminent risk uh or like well-being techniques, then we will be able to flag that for the CERMAC staff, um, and they will follow up with the client.

If there are certain clients um who are perhaps in need of like psychiatric follow-up, we'll also reach out to them for that.

Um, but then we have been seeing lately that a number of individuals are in need or their presentations are chronic to the point where they it's probably most appropriate that they go into some sort of um like mental health nursing home, and so we work hand in hand with to facilitate that process.

They have to take on the task of getting them a maximum or a past screening, um, but then we provide them with support and additional outreach to nursing homes to get that placement done for the client.

All my questions, thank you.

Any other questions, comments?

Hearing none, seeing none, thank you for the presentation.

Okay, thank you.

All right, next up uh item 23-3815, an update from CCH and Cook County Department of Public Health and their COVID-19 and other diseases of concern, immunization and mitigation plans in suburban Cook County.

And the presentation will be by Dr.

Rubin.

Thank you so much, Mr.

Chair.

Uh introduction by Dr.

George.

Uh I think Dr.

Rubin needs no introduction.

Um, so I'm gonna turn it over to her and uh let her do what she does best.

Thank you.

Thank you.

So this is for our quarterly report.

Um, I guess the slides need to be there.

We go.

Excellent.

So this is our quarter three report.

Um next slide.

And this is what we're gonna be talking about today.

There are actually many uh unfortunately many circulating communicable diseases that we wanted to give very brief updates on.

You can see the list there, and I will run through them quickly and then of course happy to entertain any questions.

Next slide.

Okay, this is again sort of the basic um uh initiatives or or guiding principles for our health department, and you can see that this work fits into many categories in terms of protecting health, preventing disease, informing and engaging our communities, and using our data appropriately in that communication.

And especially for this purpose is we're talking about uh disease control, emergency preparedness, certainly vaccinations and control of communicable diseases.

Next slide, please.

Next.

Okay.

So first, starting with this is our usual dashboard, looking at the tripartite respiratory diseases that we look at on a daily basis, COVID-19, influenza, and respiratory since the virus.

And as you can see that all three of them, we are at the minimal level, which is amazing.

Usually this time of year, we begin to have a little hint that there might be a rise in COVID.

We tend to get a late mid to late summer surge in COVID, and so far the signals for that are fairly weak.

So we may even avoid that.

Just as this past summer, flu was much more of a threat to the community's health than COVID-19.

It had settled down.

So next slide, please.

Next.

Measles, yeah.

So measles isn't going away anytime soon.

This is mainly driven by decrease in vaccination coverage in our population, though Illinois is still pretty good in vaccinating.

Um we are pretty good in vaccinating our children, but we need to keep it up because we need to have 95% of everybody vaccinated to have what we call herd immunity.

Um there are outbreaks of measles across the world all the time, and so when we have travelers coming to our country, um, either residents of the United States or foreign visitors that have been to areas with measles, they bring it back with them.

And then if we don't have the community level of protection that we need with vaccination, we see measles uh outbreaks.

Um next slide.

So to illustrate this, there was a case of measles indeed in an international traveler coming to Chicago last month.

And even though they were in Chicago, they exposed people at O'Hare Airport as well as a health care facility.

And our jurisdiction in Suburban Cook, we are responsible for doing case investigation and surveillance and monitoring quarantine for anybody who is staying or living in the suburban area.

So from this one case, we had 21 suburban contacts.

So you can imagine with measles, one case of measles, 21 contacts.

So the amount of time and energy and staff resources this takes is quite tremendous for even just one case.

It's not like one case of influenza.

One case of measles is a tremendous effort on our part to make sure that we find out an immunization status of anybody who has been exposed, and if they are immune, either through vaccination records or through a blood test, then they are good to go.

If they have no uh documented history of immunization, they have to be quarantined for 21 days.

We quarantine them with an official order.

We also try to provide them with appropriate resources as possible to maintain that quarantine, which can be quite difficult as you can imagine for many individuals.

Um we are close to that end of that 21-day period, so hopefully, this particular measles case and the subsequent uh surveillance necessary will be over, but we are on alert for the next one.

Next slide.

Okay.

Next slide.

So our community immunization program.

This is more for back to school in our third quarter report, though we do vaccination clinics, uh pop-up clinics throughout the year.

And just for review, last summer, we uh completed 30 school and community-based events between June and October, and we are planning the same for this year again for at least 30 events, and we are in process.

We're in the middle of that right now, and we provide school uh immunizations and adult immunizations are also available.

So if you're unsure of your immune status, you need that MMR because you're not sure you got it as a child, we will take care of you, right?

So it's not just for children, but it is certainly focused on children.

So let's say children and their guardians and parents as well.

Next slide, please.

Okay, so this is the uh schedule of our vaccination clinics, at least running through mid-umust.

We have many more coming up.

You can go to our immunization clinic website, which will be coming up, but there is an event calendar that is on our website at uh cookcounty public health.org, and this is up there.

And our first event is coming up in Cicero just in a couple of weeks.

And as you can see, our communications unit sends out emails and other kinds of announcements to commissioners and other officials to a press release, and we have significant social media that we push out to make sure people are aware of when and where these clinics are happening.

Next slide.

And it's all free, by the way, no charge.

Okay, next slide.

Okay, so federal updates.

This mainly refers to what we call ASIP, which is the advisory committee for immunization practices.

And it's a federal committee that basically has been decimated by the current federal administration, replacing scientific experts in the fields of vaccination and vaccine preventable diseases and being many of them being replaced by individuals who don't have that same base of knowledge.

And right now the committee is sort of in flux.

And at the end of June, it was actually canceled the meeting.

And at that same time, Secretary Kennedy put in place a new charter for the committee that basically potentially allows him to unilaterally change vaccination policy and guidance coming out of the federal government without even having a strong committee behind him.

So more to know about that, but luckily we are in a great state of Illinois where the Illinois Department of Public Health as well as local health departments have maintained appropriate guidance for vaccination coverage and what vaccinations are required at what ages based on the science.

And that is not a major change from what we had over a year ago.

So we have not changed those standards according to any newer guidance from the federal government.

We have maintained the strong immunization standards in this state.

Next slide, please.

Okay.

West Nile virus.

Yes, mosquitoes.

And you will learn more about that later today in a report coming up.

So right now the risk of human West Nile virus in our immediate suburban jurisdiction and also the city is still considered low.

But we are seeing more positive pools of mosquitoes this time of year than we have since 2004, which means we are seeing the West Now virus showing up in mosquitoes, not in people yet, but in mosquitoes in our jurisdiction.

And that is obviously concerning because if you have the mosquito rate infected mosquito pools going up, we are going to potentially be seeing more cases.

And nationally we are experiencing the most cases of West Nile virus at this time of year since 2020 since 2004.

Now maybe there will be an early peak and it will go down.

We can't say yet.

But we are hoping this is not going to be horrible West Niel virus season, but we are bracing ourselves to respond to that if necessary.

Next slide.

Next slide.

MPOX.

So MPOX, formerly called monkeypox, it's a viral disease spread primarily through close prolonged physical context, skin-to-skin contact with a person that has been infected with it.

And the important thing about this, even though MPOX is now become endemic, we see it on and off throughout the year, much more in the city than in the suburbs.

We see about 10% about what the city sees, but nonetheless, what's concerning is that there are different, we call them clades, C L A D E.

They're sort of like different strains of MPOX.

And the one that we were seeing most currently traditionally, let's say over the last several years, is CLAD two.

Now we are seeing CLAD one.

We had one case of a person who is not a traveler from the areas of Africa where CLAD one are endemic, but we saw somebody get CLAD one who had no history of travel or contact with somebody who had traveled, at least that we could know of.

And this was in the city of Chicago.

And so this means that our alert, our skeeter meter, so to speak, for MPOX is at high alert because the CLAD one is much more creates much more serious of an illness than CLAD II, generally speaking.

Okay.

Next slide.

Ebola.

Okay.

So as we know, um Ebola is caused by a group of viruses known as orthoebola viruses.

And these viruses can cause very serious illness that without treatment can cause death.

And there isn't specific treatment for the latest, there isn't treatment.

There is a vaccination, but not for the latest circulating strain of Ebola.

But there is supportive care.

And if people are have good medical supportive care in hospitals, if they have serious cases of Ebola, then their chances of survival are relatively high.

But if you're living in a part of the world or even in our communities where people do not have access to good medical care, then it can be a very serious or fatal disease.

So people with Ebola can may start getting sick two to 21 days after contact with the virus, but on average symptoms start about eight to ten days after exposure.

And we have what are called dry symptoms and wet symptoms.

And the first phase is the dry symptoms, cough, fever, muscle aches, pain, and fatigue.

And then as they become sicker, they typically progress to so-called wet symptoms, which can be diarrhea, vomiting, and then unexplained bleeding.

You get this hemorrhagic fever.

Next slide.

So since May 15th, the WHO and the CDC are responding to an outbreak of Ebola in the Democratic Republic of the Congo and Uganda.

And to date, no cases of Ebola have been diagnosed within the United States.

And the overall risk to American public and travelers remain low.

And the Cook County Department of Public Health activities include what's listed here on the slide is that we are doing a lot of education.

O'Hare Airport is not one of the designated airports where high-risk individuals will be coming through.

We have been monitoring low-risk individuals, monitoring them by doing check-ins through an app that we use or phone calls to make sure that none of them have developed fevers, and we monitor them for 21 days.

And we are coordinating, of course, with IDPH as well as the CDC for this latest bundig buggyo virus, which is this particular latest strain of Ebola.

There are two designated hospitals in our area, Luri Children's for children that might become infected and need medical care or testing, and Rush University for adults.

So even if we have somebody who is suspected who needs testing, they will go to those sites to get the appropriate tests to confirm or not that they have Ebola.

Next slide, please.

So like I had mentioned, Chicago Airports are not designated as Ebola screening sites.

I'm not exactly sure why.

I guess I'm grateful for that, but I'm not exactly sure why.

And it's not spread one final thing is that it's not spread through the air.

So people are not contagious before symptoms begin, which is very good to know.

That you can't get it by just being next to somebody who tomorrow develops symptoms.

Next slide.

Okay, so for health care providers in Suburban Cook, we are providing guidance and we will and what we are doing is we are, besides monitoring individuals that are exposed, we have we work with any medical providers and facilities throughout our jurisdiction.

And if somebody is under quarantine, not quarantine, excuse me, under observation for Ebola, and they develop symptoms, we will facilitate notifying EMS and the receiving health care facility and making sure they get transferred if necessary appropriately to Russia lorries.

And so we provide that.

We are available 24-7, and the phone number is there on the slide.

And the final slide on Ebola is looking at our social media and what we're trying to do in terms of communication with our communities, our health care providers, our EMS, and obviously our regular uh residents of the community.

Okay.

Next slide, please.

New world screw worm.

Yeah, uh there's been lots of questions about that.

It's not really a concern in Illinois.

We do not have the New World Screwworm.

We call it a screw worm, but it's actually a larvae of a fly.

Okay.

So it's and the larvae which we have of regular flies we call maggots, right?

And maggots, people may not may not realize, but maggots mature and turn into house turn into flies, right?

And so the larvae for this screw worm lives on dead tissue, living tissue as opposed to dead tissue, which is what maggots generally live on.

Um so they primarily affect livestock and other warm-blooded animals, but can occasionally infect humans, because indeed we are warm-blooded animals.

Um it was eradicated in the U.S.

in the 1960s, but it recently has re-entered the United States from Mexico and Central America into Texas and into New Mexico, the risk is extremely low.

It's generally usually a mild self-limited disease.

Um the way they control it and hopefully eradicate in the Southwest before it even reaches the Midwest, is that they introduce sterile flies into the populations, so then uh they overtake the population, so they no longer can reproduce.

So the flies that can reproduce die off, and they are replaced by sterile flies of this particular strain of fly, the screw worm fly.

Okay, next slide.

Finally, cyclosporiasis.

And it took me a long time to learn how to pronounce that.

Well done.

Yeah.

Um they check, they they sort of, you know, testing that in medical school year pronunciation.

Um cyclospories, and it's an inspection of the small intestine that causes what we call an explosive diarrhea.

It is carried in infected water, like waterways, um you can be swimming in it, for example, and it's usually infected by human feces.

So being careful about going to those indoor water parks, for example.

Um it generally then gets into produce that has been contaminated by contaminated water.

Um so ways to potentially uh prevent this very uh uncomfortable disease.

Most people don't die from it, but you can get extremely dehydrated and may need reho may need hospitalization, especially in young children.

And so they say you're to scrub fruits and vegetables under running water for about a minute before cutting, eating, or cooking, cooking kills it.

So cooking vegetables as opposed to eating raw vegetables and salads might be a good idea for a while.

Don't buy the bagged lettuce.

Um I don't want to say don't buy it, but be cautious about it.

Wash the uh produce.

That doesn't mean that it eliminates, but it rate greatly decreases the uh parasite.

The the parasite are these um spores, and they have this hard shell on them.

So they're hard to sort of wash away because they cling to the food.

Um wash your hands before eating or preparing food.

Wash your hands with soap and water before you wash off your produce before you prepare your meals.

And drink safe treated water when you are traveling.

Next slide.

Um we have had no cases in suburban Cook County, but there are cases in Illinois.

And Michigan is widespread with cyclosporiasis.

So please be cautious and careful.

And they haven't yet identified exactly what food sources have been contaminated.

So we need to be careful about all our fruits and vegetables at this point, but especially greens and lettuces are of concern.

Okay.

And that is it for the uh infectious disease update.

Thank you.

Chairman Daly.

Thank you, Mr.

Chairman, and thank you for the presentation.

During the uh presentation, you went very went through the various uh vaccinations.

Is shingles part of that, or is that totally uh shingles vaccinations can someone need shingle shots.

Can you prepare is it not available through the I don't think that we have shingles shots that we can give at our pop-up clinics.

Um but shingles is very important for middle-aged and older adults to get.

I can certainly check to see whether you know the mobile clinics that we work with, whether they could potentially stock it with shingles, but I am not aware that we have shingles vaccine available.

And you've seen a in the vaccination.

Have you seen a decrease in any children in their vaccination?

Actually, luckily and surprisingly, we have seen a slight increase in vaccination coverage, especially amongst our children, right.

And that's, I mean, to the credit, to the credit of all of you and the health departments in supporting, you know, and and the state really supporting strong vaccination coverage, yes.

Despite the literature coming from the Federal Government.

Thank you.

Other comments, questions?

Commissioner Trevor.

Thank you, Chair.

You know, we've talked a couple of times today about the effects of climate change.

Um I was looking at the uh shift that you are seeing uh with respect to detection of West Nile virus in pools.

Um I've also seen a lot of news coverage about the increase of tick-borne diseases as well, um, which is actually a personal concern of mine having been diagnosed last year with what was likely a tick-borne illness.

Or tick, whatever.

Um I'm wondering if you are tracking the frequency of that and whether or not you are seeing the same sort of shifts as you are seeing with with West Nile virus.

Um we are seeing more ticks, but whether they are ticks that can carry Lyme disease, um, there's only we haven't seen an increase in Lyme disease in our particular part of the country.

Um, but we have been seeing more ticks, but not all ticks can carry Lyme disease.

But this is something that we are certainly following.

All right, thank you.

Commissioner Trevor, uh, Kieran Joshi, Chief Operating Officer, Cook County Department of Public Health.

You'll be hearing more about this later in terms of uh the threat that climate change poses in its uh influences on vector-borne diseases.

So thanks.

Other comments, questions?

Hearing none?

Seeing none?

Thank you, Dr.

Rubin.

And now we will pivot and we'll go to item 261611, semi-annual disparities report by Cook County Department of Public Health, Dr.

Rupe.

Yeah, thank you.

Um the next report, and I'm also introducing my colleague uh Felipe Tentec Montizans, who is the main uh leader of this program.

So we can bring up the slides and we will have the disparities report.

Okay.

And we there is a program that we have that has been in development and evolution over the last eight years or so, talking about uh healthy workers and healthy work.

So we have what we call our healthy work initiative, and that's what we will be focusing on with this report.

I will be giving a brief background, and then Felipe will describe the program to you.

Next slide, please.

Okay.

So it's interesting that if you are a public health professional, you learn about workers' health and safety and work as a social determinant of health when you go to public health school.

But it's not something that is always considered core to address by a governmental public health department.

So we wanted to try to bridge that gap.

Um we are one of maybe a handful of health departments across the country that are addressing workers' health and safety and looking at work as a social determinant of health.

So the slide that is up there now is more of just a theoretical conceptual framework for how we think about work.

And work is core to our lives.

Everybody works at some point in their life, and you can even say that school is preparation for work.

So either you're being prepared for work or you do work, or you're being retired from work.

So work is central to our lives.

We spend at least a third of our day, if not more, at work, most of us.

And if you call school work, it could be even more than that, right?

So we have to look at work as being central.

And in the far right, far left box, we look at employment conditions and placing them in a larger social context determined by socioeconomic as well as political conditions, and those shape the distribution of different employment conditions across various social stratifiers such as gender and sexual orientation and age and race and ethnicity and migration and immigration status.

And further upstream, we have to look at the technological changes that have occurred that were only accentuated under COVID, where all of a sudden we move from an in-person workplace to a virtual workplace, working remotely.

And now we're sort of in a situation of having many workers being hybrids, spending part of the day working remotely, part of the day in the office.

But then we, of course, have our essential workers that need to be in the workplace all the time.

And then we have people who work completely remotely.

And this changes the entire dynamic of relationships between employers and employees, between who's responsible for providing safety in the workplace and maintaining healthy conditions so people can thrive throughout their working years.

And so ultimately this works its way upstream, and we have inequities in health and well-being because when we have these changes in work arrangements or accentuation in the extremes, we have more and more people working in what we call precarious situations, which is what we're going to be talking about, that particular population of workers that we'll be addressing through this program.

Next slide.

So first of all, what is precarious work?

The United States government under the Bureau of Labor statistics refers to precarious work frequently as contingent work.

So you might see those terms interchangeable, but the data that we receive that we can get out of national data sets will mainly refer to things as contingent work.

So what is precarious work?

It's work that's insecure, it's unstable.

So it could be you're on call.

You only work when somebody calls you in to work.

You don't work full-time.

Um so you don't receive the benefits that are required for working full-time.

You also don't have a living wage, not just a minimum wage, but a living wage where you're able to live and support yourself and your family.

And so you don't, and so people that are living and working in economic uncertainty, and these are also the individuals that are more likely to be exposed to dangerous and hazardous uh conditions in the workplace.

Um it's also rife for being exploited, as we know for many of our immigrant populations and the exploiting uh nature of some of their labor.

And uh let's move on to the next slide.

You can see here 30 to 50 percent of all jobs can be classified as being uh precarious employment.

So why are we focusing on it?

Because it has many negative impacts on our health and our families and our communities.

Um increased discrimination on the job and limited control over workplace conditions.

Um precarious workers are more often denied health insurance, retirement, vacation, paid sick leave benefits, difficulty paying for basic necessities and accessing child care so that they can work.

And that results in higher levels of workplace stress and higher amounts of dangerous conditions in the workplace.

Also, many workers that are precarious work more than one job to make ends meet, and both or more of their one or more of their jobs are precarious.

Next slide.

So precarious work is contingent work, as I mentioned before, and this illustrates again a slide that I won't go through, we already sort of addressed, but on the left are standard employment arrangements, and these are non-standard arrangements.

Um this illustrates who are these contingent workers.

Many of them are young workers, 16 to 24, so they might be students, which is also the largest bar.

They're enrolled in school, and you also see higher bars amongst people that have less than a high school diploma, as well as Asian and uh Hispanic or Latinx populations tend to be more likely in the contingent workforce.

So this is very concerning that we see disparities in populations that tend to be uh underserved populations to begin with.

Next slide.

Okay, another graph.

You also see the occupational distribution.

So, what kinds of jobs are more likely to be contingent or precarious versus non-contingent, and you see in the first bar the orange management professional and uh related conditions are generally non-contingent, right?

But then you go to service occupations, and then you also look at natural resources, construction, and maintenance occupations, and they are produ they have a higher number of people that are contingent considered contingent or precarious workers.

Next slide.

So there's disparities in work arrangements by income for contingent workers, which we are aware of.

And so basically what this is saying is that you look at the middle bar.

It says workers with income below 200 percent of the federal poverty level that you will see that they have the highest rate of working in nonstandard work at their main job, which is 36 percent of workers who are working below the poverty line, umstandard work, and many of them have nonstandard work as their second job, which is the 8.4 percent.

Okay.

So this looks at the people are working more than one job to make ends meet, and many of their jobs, at least one of them, are considered precarious.

Next slide.

Okay, so what to illustrate here?

I know it's small type, but it's basically shows that um in the red box there is this is looking at insurance coverage by occupation.

And the bottom set of blocks under red include building and grounds, cleaning and maintenance, food prep and service related construction, and farming, fishing, and forestry.

These are the groups that have the lowest number, uh lowest percentage of health insurance, and also the highest percentage, and these are workers, mind you, that are on public insurance, which means Medicaid, or Medicare if they are older.

And so these are workers that are on Medicaid because their income is so low, they don't get insurance as part of their jobs, and they uh qualify for public uh insurance.

Okay, next slide.

Um adverse health effects.

We see all of these adverse health effects in people that are struggling to make ends meet with the kind of job that they have.

So you can get stress and anxiety, obesity, diabetes, hypertension, heart disease, low birth weight, premature death, heat-related illnesses, and frostbite, which means working in extreme temperatures.

These are people that tend to be uh low-wage workers that are working in harmful conditions and have no choice but to have that kind of a job.

Next slide.

So these are maps of suburban Cook County, and you don't need to see the fine print, but I will just read to you the titles, and these are to show that these maps look fairly similar.

And in this first slide, um I am uh comparing uh poverty rates, which is at the bottom, which are concentrated predominantly uh in the Southland as well as other areas, and comparing that uh to uh heart failure and adult obesity.

So you can see more heart failure and more obesity in the same areas that you have people with the highest rates of poverty.

Next slide.

Similar comparison, the bottom box is looking at unemployment, and that corresponds, again, concentrated predominantly in the Southland, but there are other pockets in the nearwest side as well as other sporadic spaces.

And the highest rates of unemployment are correlated with similar rates of asthma and lower life expectancy.

All right.

So next slide.

Um now I'm gonna turn it over to what we're trying to do to address these disparities and inequities in our suburban area through our healthy work initiatives.

I'm turning it over to Felipe.

Hi, good afternoon.

Good afternoon.

So I'm really uh happy to be here to present to you all.

Um it's always great to talk about solutions.

And uh so one of the key uh things that I'd like to just really elevate is that this is a co-led and co-created uh approach uh that we're looking to address systemic change.

So that's uh sometimes a lot of jargon, but you know, at the end of the day, uh there's not one way uh to solve these challenges that we're facing.

But the the goal kind of standard of approach is to go to those that are most affected by these challenges.

So we went to precarious workers and precarious work representing organizations and uh started with them right away.

We met with uh several colleagues in different parts of government and different areas uh within academia, those that study these areas and develop this partnership.

So next slide.

Uh we established these statements uh as a collective group.

I won't read through all of it, but I'll just say primarily our mission is focused not just on workplaces themselves, but creating a foundation for healthier lives and stronger communities across Cook County.

Um some key points of that is addressing the systemic barriers, so identifying what they are and uh focusing on those that disproportionately impact marginalized workers.

Um primarily one of the main mechanisms we we we want to do this through is protecting individuals, families, and communities from unsafe and unstable work.

Next slide.

And our vision to do this is um supporting uh communities uh by systems that are justice oriented, community led, and structurally accountable.

So I won't read through all these bullet points, but I I will highlight um one area that I think is a little different than approaches across the country is that we're really meeting uh these communities and workers um at the forefront.

We're and we're we're doing this together uh by doing joint decision making and collective governance, which um is is is as we all you know here is can be challenging.

Um but that's one of the things I want to highlight with this this partnership is that um we have a bold vision because the challenges that we see are systemic, and together we know that we can build a future where healthy work is a standard and not necessarily an exception, right?

So, next slide.

So bridging across government partners, uh power building uh worker focused focused organizations and research and development institutions.

We've uh set a collective strategies which focus on raising the consciousness of the general um public, uh collective fundraising, bringing in more funds to allocate for the types of changes that our partners are um advocating for, and uh getting also strategic investments uh for longer term change.

So these are uh kind of four boxes of the types of organizations and partnerships that we have.

I won't read through all of them, but primarily uh a lot of our key partners that represent uh uh precarious work uh are called worker centers.

Um we also have worker and immigrant focused organizations and alliances that we've teamed up with and um several uh academic institutions, uh two highlighted here, uh UIC Center for Healthy Work and the Great Lakes Center for Occupational Health and Safety have been uh foundational uh centers for for quite some time, and so we look to them for a lot of expertise and advice on uh understanding more of the systemic challenges that come in our way.

And then starting off with government partners, our natural uh ally and um partner was the Cook County Department of Human Rights and Ethics, uh, mainly because they are uh one of our main um enforcement agencies that that has the most crossover with creating healthy work and conditions.

Next slide.

So as I said, uh we've we've come together over the last few years and developed a series of strategies and uh they focus in these three major areas, um, which is really establishing a shared analysis between the several different partners, meaning government, worker center organizations, and our compliance partners.

Uh we decided as a group that co-enforcement is an area that we would like to focus and really use as a model where government agencies work with community-based organizations to enforce labor standards and investigate workplace violations, and especially moving away from complaint-driven uh approach to more of a prevention uh focused approach.

And uh third kind of area of focus is where we do a lot of outreach and education.

Uh and this goes directly to workers that then go into their work, their workplaces, they get trained uh and and uh get leadership training as well as identification and prevention training.

Um we're really uh excited is this merging of uh know your rights, uh knowing your rights on the job, but also merging that with occupational health and safety.

Please uh next slide.

We've uh done maybe painstaking on too much, but we we really wanted to take from a global national and state and regional level of alignment.

So we uh went to quite a few ends to make sure that strategically, as we move forward, we are also in alignment with a lot of strategies that were going on at multiple levels of practice.

And so um I won't uh speak to all of these, but I will highlight that um as part of something that's more local and regional, we're also very aligned with the equity fund uh and um receive some funding through that uh to to actually execute upon activities for the healthy work initiative.

Next slide.

And so just to briefly highlight our role, uh primarily we've been able to be uh uh main funder and bring in different funding resources to uh all our partners and to the strategic efforts we've moved forward.

We administer the program, which means we develop and monitor progress for and how hold multiple contracts.

Um we coordinate stewardship and leadership meetings with all partners, um, and we're developing several different website and other uh administrative type tasks to move the the program forward.

In addition, we've been thinking about how while we might not be an enforcement agency within work and labor, how we might utilize what we already have in existing capacities uh to support this work in one area is through our environmental um department.

Uh we have sanitarians that go out and monitor uh different um work uh well they inspect they inspect different locations, and so while they're not looking at labor law, there's a lot of correlation between occupational health and safety and environmental health.

And so we've done training and uh with with all our sanitarians, and as well as we've um provided all of them with OSHA uh labor law posters to provide to employers so they are able to put that up and be in general compliance as well.

Next uh slide.

And then specifically more of kind of the activities that have been carried out in in co-enforcement is just identifying agrarious work conditions, labor violations, assisting with reporting to appropriate regulatory agencies, and improving coordination so that precarious workplaces are held accountable.

Um more importantly, we've done more proactive outreach and education to employers to prevent violations from happening in the first place.

And um some areas of kind of outputs that we've seen is just we've conducted municipal interviews to one thing we did see is that a lot of municipalities don't necessarily uh know about this as an issue, and so we're trying to identify areas where we can strengthen relationships.

And uh also uh coordinating across the state, county, um uh federal levels to to different agency partnerships for collective enforcement.

Next slide.

Just kind of high-level output, just metrics that we've been recording.

As you can see, uh, we've been able to reach as a collective uh almost 400,000 um workers that have been reached, educated or trained.

Um I think roughly speaking, if you take the population of Cook County and you take about that 30 to 50 percent ratio, that's about 1.7 million workers.

So you can do the the math there, but uh I think that's a pretty good outreach uh effort on on our partners on our behalf to reach these work workers that have um not been able to get this type of um information in the past.

And so next slide.

I'll just end quickly with you know what how is this actually improving lives?

Um primarily by creating safer work uh for essential workers through PPE distribution, cleaning supplies that we've handed out.

Uh in several cases, there's been um violations that have won back pay for workers, particularly we have a case that just recently happened where 250,000 was awarded to several workers uh whose wages were lowered during COVID, um and that took about six years just to get past.

So we're really happy for for those types of outcomes.

And um some other areas that um I think uh are interesting is that several workers um in their workplaces have created health and safety committees, and that's typical of more of a unionized workplace, but in 99s that's not common.

So uh we're seeing increases in in these types of results.

Um and obviously in the end of the day, strengthening relationships across communities and workplaces is vital.

Um with that, I will um end the presentation.

So thank you.

Thank you.

Commissioner Stamps.

Thank you, and thank you for this comprehensive report.

Um, thank you for this focus on workers.

I'm just curious, uh, as you may know, many fields, many professions have been this declassified as professional, um, starting with educators, of which I am a proud member and and taught uh for 25 years.

How do you think this declassification is going to impact what you're calling um these uh workers?

I'm sorry, uh the the precarious the precarious workforce.

And I was also curious about the impact or the description of precarious workforce on women, specifically black women.

And how do you think this declassification for careers, careers that are dominated primarily by women, like education, nursing, social work, is going to impact this precarious workforce?

You know, I think what it's going to be going to result in is de-education of our population, and especially in the areas that you just mentioned.

I think that nursing just this past week, the nursing profession was able to become reclassified as a profession that can then get the higher limit of educational grant loans for higher education.

That's where the cuts have been mainly been.

But even if you get considered a profession and get that higher level of grants or aid allowed, it's still been cut overall.

And this has been, it's going to be horrible, I think.

It means that people aren't people, especially women and people of color, people that generally have not had access to higher education or to entering certain professions without significant financial aid, will not be able to go on to four-year colleges or universities.

In fact, impacting, maybe not nursing, we'll see, but they said, but even that higher level, uh to be trained as a doctor, now the higher limit will maybe cover a year.

I mean, then you've maxed out.

You know, and similarly for nursing, maybe you can go through two of the of the three-year nursing and then you're out.

You know, you won't have enough money to continue or complete your education.

Um, you know, that's a very um I I thank you for that question to bring up that relationship, because if we can't fund and support education for individuals to enter uh professions, then um everybody's gonna suffer.

Any follow-up?

It just um I guess you know, I've been um on this quest um to get us to begin thinking about things um with the lens of solidarity and just proactiveness on what I'm deeming is the war on women.

I just continue to see so many of the career pathways that are being uh demonized and vilified and cut to shreds, are also not coincidentally careers that are female dominated.

Um not necessarily related, but just I think it's cause for concern that uh you should be reading in the paper very soon.

CPS will be cutting nearly a a thousand jobs, primarily classroom teachers.

Um that makes our classrooms more unsafe, that makes our communities more vulnerable.

That is also talking about many women, many of them who are heads of household, and there's gonna be a significant cut to pair of professionals, a lot of those women who live in the communities in which they work.

And so I want us to begin to expand the way that we are having these conversations to talk about the long-range impact, but more importantly, to talk about what is going to be our collective defense against this attack on us and on careers where we are having scores of people locked into precarious work, where we are slowly descending into uh folk being just a labor force and stuck there, like we're creating our own kind of caste system with the uh declassifying professions and making it uh financially impossible if not undesirable for higher education and thereby higher mobility and the ability to move your families and your children out of poverty.

So I want us to just kind of be thinking and be mindful about that and be more um introspective and and expand how we're having these conversations and the frequency in which we're having these conversations so that we can collaboratively uh be thinking about how we organize against it, how we fight against it, how we continue to amplify folks' lives and work in these spaces.

I think that we're just in a very dangerous place that will become even more so if we are not uh aggressively amplifying it.

Like we're having this conversation now in this room that's way more empty than it should be for such an important conversation, and I just don't think many of the the folk that are about their business working every day are even thinking about the way you've laid out this precarious workforce, and to even see themselves in that category and see um how fragile it is and how because of it, you know, your your family can just be turned upside down, and then now we're talking about all of the other rippling effects that it has on our neighborhoods and community because of what's happening in the workforce.

Um what I did not see, but it could have been because I was multitasking, so I'm not gonna put that on you, uh, is also the further impact of AI on even the precarious workforce.

So you have even folks in precarious workforce situations like at Amazon or all these other places that are now, you know, we know there's going to be automated.

And even so many other places, even in professional careers like in law, where the reliance on AI is going to be amplified.

So I think even in places that we thought were formerly safe jobs or good jobs, like you being this amazing attorney.

Um I know someone that works for rooters, and they're talking about the prompts that they're writing right now for law for AI.

And so you're going to see a decline in some of these even top-level uh positions.

So I just want us to, again, I'm curious about the expansion of this conversation and the other careers that might be at stake, and of course, our fight to address it.

Okay.

Commissioner Aguilar.

Thank you, Chairman.

I was looking at the uh the map you're showing about some of these discrepancies in the Western suburbs.

My question is, have you are we working with local municipalities?

Uh are they assisting the Cook County Health in addressing some of these uh discrepancies?

I know one experience I had when it was an issue in my area, and the municipality was not very cooperative, and it was a health issue, and thanks to Cook County Health and other organizations we addressed it.

So, how is that relationship built with local municipalities to address these discrepancies that you described earlier?

Yeah, I would I would say we're we're I'm not gonna say in the beginning, but we're we're at the initial stage of developing stronger relationships, because what we've seen, I think I think one way to look at it is when earn sick time and and uh paid sick leave.

Uh paid sick leave was passed at the county level, how many municipalities opted out was a great showing of kind of the awareness, right?

So we started kind of from that vantage point of well, that seems to be the general consensus is uh they're not necessarily either knowing or on board, so how do we develop uh relationships in a longer term base?

So we're actually just starting those relationship building exercises for lack of better word.

And um the first part was actually doing outreach and um uh understanding what what uh municipalities might be more open to this dialogue, because of course we don't have all the resources in the world.

Uh so we have to kind of start where where those that might be more interested in the conversation first and then kind of expand out to those that might be uh less interested, right?

But over time, our hope is to to develop a strong relationship to see that there is a strong correlation between health outcomes and and and labor conditions, economic conditions, um, and that we're a resource to help build that with them.

So I I don't have like an easy answer to that other than the same we're building.

Yeah, yeah, I experienced some resistance, but you know, I guess it's just a matter of communication, but sometimes maybe they fail to see there's a there's a serious situation going on in their community and they don't want to face it.

But uh if we can just continue working with some municipalities and trying to convince them that this is the direction we're to go.

All right, thank you.

Madam Secretary, would you add Commissioner Moore to the role?

Yes, sir.

Thank you.

Commissioner Trevor.

Thank you, Chair.

Um I've been looking particularly at page three, uh, not only in terms of how you've drawn it, but also uh thinking about what's about to happen with Medicaid and redetermination and the work requirements and everything else.

And I think before even going there, I think one of the comments that I've got about this is you know, it's really important to recognize that not only is work a s uh a social determinant of health, but health is a social determinant of work.

And what may put somebody along with all of the other conditions that that might plant you in a position where you your your work situation is precarious, health is one of them.

So uh and on top of that, if you add in the um the necessity to go through this redetermination uh uh process in order to even get access to health insurance.

And particularly this could be problematic if you realize that even getting a diagnosis is probably uh correlated to your work status.

So in order to get a diagnosis, you need to be able to go see a doctor, which means you have to have the resources to do so, which means you even, you know, for instance, have the ability to take the time away from work to go to the doctor's office.

Um then your situation at work then determines whether or not you have access to health insurance.

So you create this this feedback loop that makes it this a hole that's even harder to crawl out of, basically.

And I'm wondering whether or not you've thought about that in terms of how you might want to sit, let's say, for instance, model this and track this, that there is this sort of feedback mechanism between health and work.

Yeah, no, thank you for those comments and the question.

And yes, sure, um, we understand that it is sort of a loop, as you say.

Uh you're sick, so you can't work, and then you are uh more likely to be in poverty, or you get ill or sick on the job because of the job, or you can't get the diagnosis because you can't take the time off, and you're in a kind of a job that doesn't allow paid sick time, et cetera.

Um as you've said, this will be highly accentuated with the hundreds of thousands of people in the state of Illinois that are going to be dropped off of the Medicaid roles as we speak, right?

That's happening right now.

Uh and I think what we'll be doing, and we can certainly try to track this as best we can, but I mean we we're sort of in the what would you say, we're sort of in the peachy dish.

You know, we're right here with with Cook County Health.

We're going to be seeing more and more people coming to our institutions for health care because they have lost their Medicaid.

Um even though we will help them to try to get them redetermined and back on the Medicaid roles, um, that's going to be very hard.

And that also means that our own, the publicly funded health medical system is going to be even more overburdened because we will get less Medicaid reimbursement because we're seeing a higher proportion of people that have nothing, not even publicly funded insurance.

So indeed, this is so intertwined with employment and um and what's happening.

And so to your point, this is something that we need to uh bring into the conversation and to understand that this is a dynamic that is part of what we're talking about.

And just to follow up on that, uh, in terms of the the priorities that I see in this report, um I didn't really I think there are two ways that this needs to be integrated.

One is that help with redetermination needs to be woven into the whatever processes we have.

But also if part of what we're doing at the county level is to work with employers to hold them accountable in terms of uh following labor laws, or even to think about policies that might be put in place to try and work with employers to get their employees in a situation where either they're they're qualifying for health insurance through their employers, or making sure that they're getting those 80 hours a week or they're making the minimum amount of dollars that they need to qualify for that redetermination.

It seems to me that you know, in uh weaving that into the processes that are in these and goals that are in this report is is something that's really necessary.

Yeah, no, I totally agree.

In fact, there's one part of the report um or of our program that we didn't emphasize, but a an environmental scan, at least the first phase of it has been done mainly with our partners at um UIC School Public Health.

Um they interviewed many um some municipal leaders as well as others to see to ask exactly those questions.

I mean, what is it that they know about precarious work, including things about do their employers and their jurisdictions provide health insurance for their employees?

And we need to further that um scan.

We could only have funding sort of for the first phase, and we're hoping to continue that if we find additional funding.

Um but the idea and and what Felipe was saying earlier is that we need to be more um have more partnerships from employers or from the municipalities where they have their businesses.

Um the whole thing that our sanitarians, our inspectors are doing in terms of placing the labor law, know your rights kind of posters into workplaces, the State of Illinois requires that.

And employers have been actually quite open in posting them because they know they are supposed to.

And when our inspectors go around and they don't see one there, um they ask for it to be posted, and it does get posted in the spot where the workers have their breaks or the sink or the locker room or whatever.

So it's not like we have even gotten pushback from employers to make sure that their workers do indeed know their rights.

Now, does that mean that that is going to result directly in decreased violations and better benefits?

Probably not.

But it's it's sort of the first step of awareness, and we need to go further.

And I know that we would certainly be happy in working on any sort of uh you know, county legislation are working on state legislation to try to strengthen these kinds of relationships and laws.

Thank you so much.

Commissioner McCaskill.

Thank you, Chair.

Um, just one question uh or one request.

As you look at how you are going to move forward with addressing many of these issues in the mapping, it showed that the majority of the issues were in the Southland area.

However, in the content, it always says suburban.

So I want to make sure that as we move forward that we're actually targeting the areas that are actually being impacted greatly, especially as you indicated, Felipe.

I am not pronounced.

Yeah, Felipe.

As uh you indicated, making sure that we are prioritizing because so often we are hosting um issues that pertain to the Southland and the loop.

And we're not coming from Harvey, Markham Park Forest to hear these comments or participate in these meetings all the way in a loop.

So bring the issues and the concerns to the actual communities, and we have more than enough space.

And if you need space, let us know.

And I believe the commissioners will accommodate.

Thank you.

Chairman Daly.

Thank you, Mr.

Chairman, and thank you for this presentation.

I would assume that, and you mentioned the paid leave and family leave individuals opting out.

Uh part of that was I think the education as well of it.

And I think that's very important, Philip.

And thank you for this.

Um I'm sure many of these issues could affect county government, county employees as we look at outside people, we also have to look internally.

But again, that was not part of the mission, part of it, I don't believe.

But I think as we learn from this, uh, we should expand.

But you mentioned maybe some legislation.

Would that be in reference to the posting?

Uh I know the state requires the posting of the uh no your right.

What type of legislation would you be looking at?

Well, I mean, uh, there's one thing that we are trying to develop, um, looking, for example, workers that work in extreme temperatures.

And there's a state legislation about that right now that our partners um especially are very our workers centers and um are very strong about because this affects warehouse workers, you know, the environmental uh buildings and grounds, you know, anybody that does, you know, snow removal, that kind of stuff.

And so in the winter and then working in the sun.

So this is just one example of the kind of legislation that it would be very helpful to be able to present to you all and to see whether we could get support for things that we have to do.

But the so that would not be part of the initial one from the state about would this be an additional advice?

This is something that is that is being proposed right now.

Oh, okay.

Okay.

So that's something that is in the works right now.

And when I was talking about legislation, it was saying is that is that if there's other kinds of legislation that might be helpful, we would be happy to be engaged with you on that.

Thank you very much.

Okay.

Dr.

Rubin, Felipe, thank you.

Let's now pivot and go to item 261731, the Cook County Department of Public Health's report titled An Assessment of Mosquito Abatement Activities in Suburban Cook County, Dr.

Joshi.

Thank you so much, Mr.

Chair, and uh good afternoon, Commissioners.

Um we're going to be presenting uh a report uh on the uh mosquito abatement districts in suburban Cook County and really more broadly uh mosquito abatement activities in suburban Cook County.

This is pursuant to uh a resolution that you all passed that was co-sponsored by Commissioner Degnan and uh Madam President in September, which in which we were directed, C C D PH was directed to assess mosquito abatement across suburban Cook County and make recommendations uh for governance and uh uh service consistency.

Uh this report um this this resolution in turn was prompted by uh past OIIG investigations and a civic Fed report.

Um this report was shared with you previously uh when it was released.

It is a very detailed report.

Um so if you heard a thud in your inbox oh a month ago, it may have been uh this report.

Uh the folks who worked on that report were um colleagues from the UIC Institute for Healthcare Delivery Design who are here with me today uh to provide an overview.

Um so we've got uh Katrina Whelan, Katie Koshansky, and Ann Coth all from IHDD.

Uh before I turn it over to Katrina, I also wanted to acknowledge my colleagues from the uh four suburban Cook County mosquito abatement districts, two of whom um James Thenish and Mark Clifton are here in the room today and provided public comment, um, along with Jeffrey Cohn and Bob Holeb.

Uh I want to uh express my gratitude and my appreciation for them uh for both their contributions to the report as well as um their uh uh ongoing commitment to coordination um as we look at implementing some of the recommendations in the report.

Thank you.

Over to you, Katrina.

Thank you for that introduction.

And I think we can go ahead to the next slide if that's possible.

And we can go to the next one as well.

Thanks.

So, as Dr.

Joshi mentioned, the final product of this assessment was a report as well as this presentation.

Um in doing this assessment, we spoke with more than 30 stakeholders, including each of the districts and other sort of stakeholders in in the space, including the forest preserves, um, scientists and others.

Um we can go on to the next slide.

So just to sort of set the context here, right?

Um the mosquito abatement districts, which were the um focus of this assessment, are independent special purpose units of government.

There are four of these local governments within Cook County.

Um they have dedicated and independent budgets with um dedicated property tax levies.

They vary in size geographically, their budgets correspondingly are different sizes and vary from two to five million dollars.

Um each of these districts is governed by a board of trustees.

Those boards have five members or five seats, I should say, and those trustees are appointed by the board by the Cook County Board president with the advice and consent of the board.

Um and although they're called mosquito abatement districts, these districts have authority to um address other disease-carrying vectors, including ticks and and rats in some cases.

Um we can go ahead to the next slide.

So here's a map of these districts just to set the geographic scene.

Um for context here, the the southernmost district, which is light green on the map, is South Cook County, which is the largest geographically.

Um, the dark blue is Displains Valley Mosquito Abatement District.

The orange is Northwest Mosquito Abatement District, and the light blue is North Shore Mosquito Abatement District, which you'll you'll notice in the map as of last year includes a portion of Lake County on the northern edge there.

Um and there are some areas which in this map are in yellow and in purple, which are outside of each of those districts and also outside of the city of Chicago.

And we'll talk a little bit more about that in a moment.

So we can go on to the next slide.

Um sort of to have the the bottom line up front here.

Here are the main takeaways from the report, which um we'll go into more depth on in the presentation in a moment.

Um the first high-level takeaway upstream of the rest of these takeaways here is that mosquito abatement is a critical public health service to guard against rising threats.

And we we heard earlier in this meeting about um West Nile virus in particular, and a short mention of ticks.

Um each of these things are uh critical public health threats, and with the advent of or with climate change, the uh mosquito season has lengthened and allowed mosquitoes um to breed for for more of the year, and also allowed new invasive mosquito species which are capable of carrying new and scary diseases to enter this region.

The second point here is that at a high level, the four districts assessed in our report align with best practices in mosquito management, and we'll talk about that in more detail in a moment.

And the third point here is well, the districts generally align with best practices.

There is a more notable disparity between the parts of Cook County which are covered by any district and those which are not covered by any district.

And then we believe that disparity to be larger than disparities between districts themselves.

And the fourth point here is about desolution.

As part of this assessment, we considered various structural scenarios, different reform options.

One of those reform options was total desolution of each of these districts.

And as part of the Cook County post-desolution would absorb the service provision tasks which these districts currently provide.

And we concluded in this report that desolution is unlikely to reduce costs or improve service.

And we considered other scenarios as well, which we'll talk about later in this presentation.

And finally, we do make several non-structural recommendations in this assessment, which do not require dissolution or consolidation, and have sort of a shorter timeline for seeing operational improvements.

And in this turquoise box on the side, you'll see sort of a summary of those recommendations of the scenarios recommended.

The first is the set of high-impact non-structural improvements, which emphasize coordination between the different mosquito abatement entities, board accountability, and other smaller sort of operational improvements.

And the second recommendation in tandem with the first is to encourage the districts to annex some of those areas in the map, which are currently not covered by any district.

And just a note on implementation.

As we said, a lot of those high impact improvements have to do with coordination.

The vision is that CCDPH would move from a role where they're providing service directly to a small portion of the county to a role where they are primarily doing coordination, data sharing, and the like.

Great, I'll take it from here.

So let's talk a little bit about mosquito abatement as a public health service.

So the focus of these districts really is public health.

They provide an important service against growing threats to public health.

And I know this was really an area of interest from the presentation earlier today, so you've already heard a bit about it.

But first, as we know, districts are monitoring and mitigating risks associated with mosquito-borne viruses, including West Nile virus in St.

Louis encephalitis.

And this is important because as we've discussed, due to climate change, Chicagoland is seeing new mosquito species capable of carrying new diseases, which obviously is alarming.

Chicago land is also facing new threats associated with tick-borne disease as we've discussed.

And this is a growing area of concern.

And despite the name of mosquito abatement districts, I want to remind all of us that districts are also doing tick-focused work as well.

In addition, growing insecticide resistance makes facing these challenges increasingly difficult.

And the report dives in detail on the threat of insecticide resistance.

Surveillance is really required to understand and respond to the threat of insecticide resistance, and I'll speak more about that now.

So we can move on to the next slide here.

So I want to spend a minute discussing what mosquito abatement districts do.

And it's a lot more than just spraying adult aside to kill mosquitoes, as some residents of suburban Cook County may believe.

Districts really run six core functions.

So first here we have surveillance.

They monitor mosquito and tick populations through things like trapping and lab testing that help inform us of public health risk.

It's what enabled the slides in the presentation from earlier today.

Next, there is control, which is applying treatment to control larva and adult mosquitoes.

And the reason they're doing control is not focused on eliminating nuisance mosquitoes, though that's a nice outcome of the work that they do.

It's really to limit the spread of vector-borne disease.

So again, this is a public health function.

Then we have reporting and compliance, where they report surveillance data to the state and share information with other entities.

We have strategy, which includes things like long-term planning and setting policies, and then last, uh in addition, we have public engagement, which includes kind of two things, both engaging the public through proactive outreach and education, and then also responding to service requests that members of the public make for mosquito abatement services.

And then lastly, they manage the day-to-day administration of operating, as you'd expect.

We can move on to the next slide, which takes us to diving into our report findings.

Thank you.

So the gold standard in this field for a public health approach to mosquito borne disease is something called integrated mosquito management, also known as IMM.

And IMM is what national mosquito abatement experts recommend, including the American Mosquito Control Association.

And it's the framework that we use to evaluate the districts in this report.

So with IMM, instead of applying adult to side on a set schedule, IMM programs use surveillance data.

So things like trap counts, disease testing of mosquitoes, et cetera, to decide when and where intervention is actually needed.

And when they do treat, they start with the least harmful methods.

So this includes things like source reduction, which is eliminating mosquito breeding sites, targeting mosquito larva using larvacide before those mosquitoes become adults, and then only using adulticide as kind of a last resort.

And this matters because indiscriminate spraying can both drive up insecticide resistance and waste resources, which matters from a cost perspective.

And I just want to clarify when I say insecticide resistance, it's when mosquito populations are repeatedly exposed to the same adulticide or larvacide chemicals, and then they gradually develop genetic traits that allow them to survive when treated, making those chemicals ineffective over time.

And resistance testing done by the districts here today has found that this resistance is already a growing risk when it comes to the mosquito populations present in suburban Cook County.

So this insecticide resistance is a real concern.

But basically, here our districts are using IMM to try to suppress mosquito populations before they threaten public health, which is really the goal.

Next slide.

So after careful analysis, as Katrina shared, we found that broadly the four districts are doing their jobs well.

They're all running evidence-based IMM programs to different degrees, and they know their local territories quite deeply.

And they're all conducting the core activities that national experts consider best practice.

And two of the four, North Shore and Northwest are nationally recognized for their scientific leadership.

So this is really not a story of a broken system, as some prior reporting may have suggested.

And that said, there is some meaningful variation between the districts, particularly around newer capabilities like tick surveillance as we've discussed and insecticide resistance testing.

And we have recommendations in the report accordingly to help narrow these differences.

And I'll call out one difference in adherence to IMM between the districts is that South Cook County does rely more on adult aside treatment as requested by the community members and has a little bit of a less defined action threshold policy than other districts, which is a little bit less strongly aligned with IMM principles.

Great.

I'll pass it over to Katrina to talk about district boundaries.

We can go ahead to the next slide and to the map on the next slide as well.

So just to revisit this map for a moment to talk in a little bit greater detail about those areas in Cook County which lie outside of the four districts.

One, of course, is the city of Chicago, with the exception of the portion south of 87th Street, which is actually mostly inside South Cook County's mosquito abatement district in light green.

Other than that, we have the area that's sort of in yellow and in purple, and those areas lie outside the city of Chicago, outside the four districts, and are sort of of two types in purple.

We have Stickney Public Health District, which as its own local health district provides its own mosquito abatement services from the district, and then broadly the rest of that area sort of in yellow outside the districts is served directly by CCDPH through a private contractor.

CCDPH receives a grant from IDPH, and that grant money primarily goes towards this private contractor, which does testing as well as insecticide control work.

And we can we can go on to the next slide, then I'll pass it back to Katie.

Great.

So equity of service was something we really wanted this report to take a careful look at.

And again, what we found was that the biggest inequity in suburban Cook County's mosquito control system is actually not between the four districts, but between people who are served by a district and people who are not served by a district.

So residents outside district boundaries are getting essentially a patchwork of services.

Some are receiving services through CCDPH, some from municipalities, some are getting them through private vendors, and those outside of districts often aren't receiving service that follows the IMM principles that I shared with you.

So for example, they may spray adult insecticide without doing any surveillance, or they may not educate the public around things like source reduction.

And that kind of stuff makes a meaningful difference in the disease risk for that community.

And a study from the National Association of County and City Health officials, NATO, backs this up.

So mosquito control districts significantly outperform other operator types on delivering core capabilities.

That's the graph you see on the screen here.

And that includes local health departments.

So the bottom line is that where you live in suburban Cook County does meaningfully affect the quality of mosquito protection you receive, but that difference has less to do with differences between district and more to do with whether or not you're served by a district.

And moving on to the next slide, just as a quick reminder here, CCDPH's role in all of this is really to cover the areas of suburban Cook County that aren't inside a district's boundaries and aren't served by another local health department.

To reiterate, the majority of CCDPH's direct factor control work is carried out through a contract with a private vendor, not by C C DPH staff themselves, and this is largely funded by a state grant.

I'll pass it to Katrina to talk about the report recommendations.

Sure.

And we can go on to the next slide and then to the next one as well.

So as part of this assessment, as we mentioned at the very beginning, we assessed various structural scenarios for change, which are outlined on the slide here.

The level of service provision and baked into that is quality of service as well as consistency of service, cost effectiveness, feasibility, and then also timelines.

So on what timeline could we expect improvements.

So the first scenario here in the first leftmost column are high impact improvements.

So these are the primarily coordination and operational improvements that we mentioned at the beginning, and we'll look at these in a greater detail in a moment.

These are recommended, these are uh recommendations that we think we could implement through an IGA and on a shorter timeline, so then some of these more dramatic structural changes.

Um the second recommended scenario, also in green here, is that the districts annex some of that non-district area, so those are those areas in yellow and purple in the map, which are um served by a very variation of entities, in some cases C C DPH, other districts, or in some cases also by municipalities.

Um then the last three scenarios here we we did not ultimately recommend, but we did consider in the assessment.

One is that a district could annex another district, one or more districts.

This is sort of um this is a little bit less feasible in part because districts can only annex contiguous districts.

Um that's a consideration from a feasibility standpoint.

Um, but we also considered uh that this situation that this scenario would be unlikely to increase service quality and would be highly disruptive and not um uh uh cost effective.

Um that's similar to the second two scenarios here, number four and number five.

One is that the districts um be consolidated into Cook County, so these districts would not exist as independent governmental entities, instead, Cook County would absorb the tax levy and also the service provision.

Um then the fifth is similar, except in this case the districts would be fully dissolved, including their tax levies, and and under this scenario, the the county board could act um unilaterally.

Um but for these last three scenarios, we we concluded that they were less feasible and would not result in um cost savings or service improvements.

And we can go on to the next slide and actually next slide as well.

Thanks.

So this slide here goes through some of the specific improvements that we recommended in that first scenario.

I won't go through each of them in turn here, but I'll just note that the a bulk of these of these improvements um have to do with coordination across the different entities in the mosquito abatement landscape.

So that includes all four of the districts, the forest preserves, of course, CCDPH, um DPH, and any other municipalities, um townships, or other entities as long as they are providing any form of mosquito abatement service.

Um other recommendations have to do with education and outreach.

Um CCDPH does some of this already, and coordination would sort of enable a more effective campaign around education.

We have a slate of recommendations around district board accountability, which includes prioritizing filling, board seats on these four district boards, as well as holding those specific trustees accountable once they're in those seats.

And then we have a group of recommendations that have to do with scientific and operational improvements on the sort of second row down here, including increased preparedness for rising threats such as ticks and new invasive mosquito species.

And with that, I will I will we can go on to the next slide and that'll conclude our presentation.

Thank you.

Thanks.

Thank you so much.

So I did see a few hands.

McCaskell and then Dagnan.

Thank you, Chair, and thank you very much for such a thorough report.

This was one of the um first issues I received when I was uh appointed to the board.

So I'm glad to see thank you, Dr.

Josie, for following this up with the Southland um abatement district.

If we were to uh um absorb some of the areas that need to be annexed, is there any budget analysis to identify how they would be supported in that effort?

Yeah, so um I will say uh firstly, um uh having discussions about annexation is gonna be very high on our list of initial priorities.

And um I think that really needs to happen in collaboration um with the mosquito abatement districts that would be doing the annexation.

So I just want to make that point.

Uh with respect to revenue, um the each of the mosquito abatement district boards has the authority to levy a tax, and um as areas would be annexed, they would be eligible uh for the revenue that would flow from a portion of the property tax uh to the covered residents.

Don't say tax tax is a bad word right now.

Um button.

I let it select revenue.

But thank you for that.

And then also one of the concerns was um so I'm glad that you able you were able to identify the actual best case scenarios, practices, and recommendations because consolidation did not seem like a good fit or um dissolution, nor did either of those.

So is there going to be a follow-up to this report?

Because there was a a long gap in years of the reporting from when there was an issue to this report here.

So what are we going to do to make sure that we're having um it doesn't even have to be consistent, but more frequent um reporting on how the mosquito abatement districts are actually doing?

Sure.

So um the mosquito abatement districts are required to file a report with the Illinois Department of Public Health on an annual basis.

So there is some mechanism for you know ensuring accountability there for my part.

I'm happy to keep this board updated as our work with coordination proceeds.

Think in more robust, like the report that we just received.

So there was the report that said all of the issues and concerns that that were currently existing.

I believe that report was from 2021 or so there were several reports that were done.

Um there was an Office of the Inspector General report as well as a report from the Civic uh Federation.

Okay.

So this type of report that we received today, which is more of a more comprehensive, let me put it that way, of all of them in compass.

Is this something that only happened as a result as a resort uh as a result of wanting to see what direction to go in, or is this something that we can expect to see again maybe in two years, in three years?

Something this comprehensive, I would say, given the resources that are required, is sort of a one-time thing, responsive to the resolution that you all had had passed in September.

Um but again, Commissioner, I you know, uh I would want to be as transparent with you all as possible.

And if there's an interest in a want to hear more about this set of issues, we're more than happy to provide updates on a regular basis, as you know, um as Dr.

Rubin just presented our our quarterly uh infectious disease report.

We could I could see a future in which we potentially uh roll um some of the reporting about this into that report.

Totally.

Thank you for that.

Yeah.

Thank you, Chair.

Thank you.

Commissioner Dagnan.

Thank you, uh, Chair, and thank you, uh Dr.

Joshi for being here and for uh the vendors that assembled this report.

So I think if we all recall, I drafted this resolution to ensure that Cook County was taking a critical look into mosquito abatement operations throughout Cook County to look for areas where improvement was possible.

State law allows mosquito abatement districts to operate and it gives structure to them.

And as of now, there are, as we found out today, four main districts.

The City of Chicago operates independently, and then there are other areas that either operated by Cook County or just maybe don't have really any operations in them, leaving those folks at risk.

So I'm grateful to the work done to highlight the areas for structural change and to merge some of the smaller areas into the larger one, giving everybody an opportunity for mosquito abatement services.

But this report does stop short of advocating for the phased merger of all mosquito abatement districts into one another.

In some of the other parts of the country, there are up to four different counties that operate under one mosquito abatement district.

And while that may not be appropriate for the seven counties around Cook, I think it is appropriate for Cook.

I believe that four separate districts operating with different governance teams with different operational outcomes leads to a result where some constituents are left out.

Some constituents are getting better services than others.

And merging all districts into one would allow for a board to be created with experts from all areas of the county.

So all are represented.

One district would need one director who would then lead that team to ensure that all constituents would have the same excellent service.

One district would hasten identification of problems, streamline appropriate solutions, and lead to better communication with the county's department of public health, leading to less risk of mosquito and tick-borne illnesses.

One district would not reduce the number of staff in those roles.

That would either remain or be improved.

As we heard earlier today, the percentage of West Nile virus infected mosquitoes are increasing, and reports were just published in the state that half of ticks tested in the Midwest carry that bacteria that causes Lyme disease.

Nor would it be super easy.

But instead, it would allow the district to ask for resources if they need it because their data would be collated.

It would be convincing and able to reflect a request where that need is the highest.

This all at a time where climate change is extending the season where mosquitoes and ticks are active.

And it's not only a human health issue, as some of the reports have lately stated in the press, it's an issue for those with pets.

The report is a great start to improving some of the governance issues, but I think it stops short of true operational change, which is what I was hoping to see in this space when I filed the resolution.

So the mosquito abatement districts can on their own choose to merge into one another if they have contiguous borders.

There is a path to that.

And I ask that the ones that are here today and that are doing this great work take the meaningful steps to look at that and to do just that to make Cook County a safer place.

So thank you very much for your attention to this.

Thank you.

Thank you.

Yes, Commissioner Chairman Daly.

Thank you, uh, Madam Chair.

And let me thank you for this presentation as well as the work that the mosquito abatements do.

This is an outline.

It shows positive things that have occurred and issues that we should address.

Thank you very much.

Thank you.

Commissioner Kevin Morrison.

I don't know if uh you'd be able to answer this specifically when it comes to tick bites, but uh Google states that uh if you are bid by a tick, the use of Dossies doxycycline uh actually could assist in not contracting Lyme disease.

I'm gonna get back to you on that one.

Okay.

Yeah.

Thank you.

Seeing no other questions.

Thank you so very much.

Appreciate the report.

Um we will continue with our next item.

Uh that item is uh 26 uh 1735.

This is a hearing of the uh resolution calling for a hearing of the Cook County Board Um board's uh health and hospitals committee regarding the increased rate of uh colon rectal uh cancer rates in populations under 45.

I will ask Commissioner Kevin Morrison um to give us some background before we go to presentation.

I believe we have Dr.

Gandhi here for presentation.

Hi, how are you?

Yeah So uh can you kick us off uh Commissioner Kevin Morrison?

Thank you so much, and I know we have another advocate as well, and I believe uh uh Chairman uh Lowry mentioned that uh uh Dawn Schneider could come up to the dais as well because uh she will be speaking on this as well if you would like to come up, Don.

Um thank you.

Uh so just want to say good afternoon, everyone.

I want to start by thanking everyone that has come uh to give testimony at this hearing, as well as all of my colleagues uh for taking this issue seriously.

Uh, for decades, colorectal cancer was considered a disease that primarily affected older adults.

Uh, that is no longer the reality as more and more young adults are being diagnosed with colorectal cancer, often far too late for the best possible outcomes.

Colorectal cancer is the third most commonly diagnosed cancer in the United States and the second leading cause of cancer related deaths among both men and women.

The American Cancer Society reports that one in five new diagnoses now occur in someone under the age of 55 and is now the leading cause of cancer related deaths in young adults.

Uh most insurance plans only require uh to cover routine colorectal cancer screenings beginning at age 45.

That leaves many younger adults facing thousands of dollars in out of pocket costs or waiting until symptoms appear.

This hearing will shed light on the issue uh on this issue and the needs uh we should be taking uh to address this crisis.

Uh we have an amazing county health expert, Dr.

Gandhi, with us today to help us learn more about what our doctors are seeing here in Cook County and across the nation.

And we also have an amazing volunteer with the colorectal cancer alliance, Don Schneider, who can speak to her lived experience with the disease.

So I want to thank uh you all for being here today, and I look forward to the discussion.

And with that, I will pass it on to Dr.

Gandhi.

Thank you.

Thank you so much.

My name is Dr.

Seema Gandhi, and I want to extend my thanks to Commissioner Morrison and to the entire Cook County board uh to allow me to speak today on the topic of the rising rates of colorectal cancer, especially among young adults.

Um, as an introduction to my qualifications, I'm an interventional gastro neurologist for roughly the past 15 years, and I'm very proud to serve Cook County Health as the medical director of the digestive and metabolic metabolic health service line.

Um part of my role, obviously, as a clinician is to perform colonoscopies and see patients for screening colorectal cancer, which is really one of our uh major goals as gastro neurologists, and really the reason that the whole profession was born is essentially to provide screening for colorectal cancer.

So today I'll speak a little bit about it if you want to pull up the presentation.

Next slide.

So colorectal cancer is a rapidly growing crisis in younger adults.

It is now the leading cause of cancer death in men under the age of 50 and the second leading cause of uh death in win in women under the age of 50.

Historically, rates of cancer of patients greater than 50 previously were decreasing in survival was actually uh increasing as well, which is great.

However, early onset colorectal cancer, which is defined as colorectal cancer diagnosed before the age of 50 has been rising steadily for decades and more recently has increased even more dramatically.

It now represents about 14% of all colorectal cases in the United States.

And for adults under the age of 50 rates are falling, but for those with um for those with early onset colorectal cancer, there's been a 40% increase.

Those born in the 1990s, just as a comparison.

So those of us who are born in the 1990s or later have a fourfold higher risk of colorectal cancer than those born in the 1960s, which can't be said for many cancers, which is why this is so alarming.

Next slide.

The current guidelines for screening for colorectal cancer recently shifted from 50 to 45.

You may have reminded uh recall that from several years ago.

Essentially, all task forces and colleges and um the American Cancer Society agreed that 45 was now the new starting age for colorectal cancer screening.

And what we recommend as a gastroenterologist is what's called a high quality colonoscopy.

This is what we call the gold standard.

It allows us to do both detection of polyps as well as removal of polyps.

So polyps are what precedes colon cancer.

We don't just wake up with cancer, they are abnormal growth that usually take years to progress into a cancer.

And the goal of a colonoscopy is to find them when they're like these mushroom-like growths and then cut them out before they become a cancer, or hopefully um diagnose cancer at an earlier stage.

Unfortunately, most other exams that we get by seeing a doctor, like a blood test or CT scan, can actually miss colon cancers.

So without a colonoscopy, we really don't know what we have inside of our colon without looking.

The other options can include an annual fit test, which is a stool-based test, or a flexible sigmoidoscopy, which is only a partial look at the col at the colon, only the very distal or left side of the colon.

So really not a complete examination.

This recommendation is not necessarily for those that are at increased risk.

Maybe patients who specifically have a family history or other illnesses that put them at higher risk.

Next slide.

So this slide really demonstrates how this has taken a national platform.

This was actually published in the New England Journal of Medicine about three years ago, and it illustrates what a sharp spike there has been in the rise of colorectal cancer in patients under the age of 50 in the United States.

And we're seeing these rates not just in the US and essentially all Western societies around the world.

But it really was one of the first times that this topic became discussed on a national platform.

And unfortunately, four years later, the crisis is just continuing.

Next slide.

So as I mentioned, what are things that we can do for colon cancer?

There are many options, and the best and the most recommended is a colonoscopy.

Obviously, I'm biased because this is what I do every day, but it really is the best way to be able to not just find colon cancer.

Our goal is to prevent colon cancer.

Nobody wants to get a mammogram, a pap smear, or an X-ray, hoping they find the cancer.

We obviously want to find it when it's precancerous and hopefully an intervention can be done to prevent it.

Colonoscopies are extremely effective.

They have a sensitivity of about 95%.

So that means that if a hundred people go in for a colonoscopy, 95% of the time we find the polyps that will turn to cancer and we're able to get them out.

There is a 5% miss rate, meaning, unfortunately, for 5% of patients, we may not find every polyp.

That doesn't mean they'll all turn to cancer, but no test is perfect.

It is the best by far.

We're really good at finding polyps, particularly as they get bigger.

One centimeter is really the cutoff we look at, and that's close to 95%.

If you have a completely normal colonoscopy, meaning your doctor found no polyps whatsoever, and there was a very good prep, you don't need to get another one for 10 years.

But even getting one colonoscopy in your life significantly reduces your risk of ever having colon cancer in your life.

An option that might be an alternative to that is a flexible sigmoidoscopy.

It is not the recommended gold standard.

We don't really perform many of these, and really I see them in use in communities that just don't have access to a gastroeneurologist.

If you're in a rural or very remote area or you just lack specialists, there's a nationwide shortage of gastroenterologists.

So there are communities that are more rural and remote that can't access gastroenterologists that have non-specialists like primary care doctors or surgeons doing flexible sigmoidoscopies, which is still better than nothing.

It's best used every five years and in conjunction with other testing like fit testing.

Next slide.

So I mentioned this a few times.

It's called fit testing, and this is a stool test.

So this is something that we actually kind of commonly use in Cook County Health and is actually used very, very well around the world in many public health communities and safety net hospitals similar to Cook County Health.

It is actually quite good at detecting polyps, but even better at detecting cancer.

So it's obviously not a perfect screening exam because it's better at detecting cancer than polyps, but it does allow us to detect patients, period.

So if your fit is positive, we know that this is a patient that really needs to get screened at that point.

It's not really a screening, but really needs to get a colonoscopy.

And we usually triage these patients to be done more urgently than others.

And so this is something that we would recommend to be done every single year because over time it captures patients.

So you may have a fit that's negative three years in a row, and if by the fourth it's positive, your doctor should counsel you that at this point there's a high likelihood there's something in your colon, and you really shouldn't defer getting a colonoscopy anymore.

One of the newer tests that we do that's stool-based is called a cola guard plus, and it's actually quite sensitive as well at detecting precancerous lesions.

It actually relies more on technology looking at abnormalities of the DNA within the stool, and it can help risk stratify patients even more.

It is a little more expensive than a fit, so we have to make sure that patients qualify through their insurance to get it, but it is another option.

Next slide.

One of the newer tests that just got FDA approved, it's called a Garden Shield.

It's a cell-free DNA blood test.

Some people call this a liquid biopsy.

It's kind of a cool name, but basically it's a blood test that especially looks for colon cancer.

So it's an excellent idea, and it's kind of cutting edge this idea that you can get a blood test and be screened for cancer.

That being said, it is definitely a work in progress.

The numbers are not as impressive as the other tests by any means.

So it only has a 13% sensitivity for precancerous lesion and 83% sensitivity for colorectal cancer.

So if you are someone who's absolutely adamant against getting a stool test, you don't want to get a colonoscopy, but you think you might still want to get screened.

This is a good test, but it's perfect, it's not a replacement for a colonoscopy.

The nice things about it is it's approved for both CMS and FDA, and recently in the last month, United Health Group actually approved its use as well.

And this is actually an interesting idea because as we enter the age of screening patients for diseases younger and younger, we have to think of screening tools that may be accessible to larger groups of patients, larger groups of people in larger communities, and a blood test is something that could potentially do that because it doesn't require a specialist like a gastroenterologist.

Anyone can get their blood drawn almost anywhere, and we would send it to any specific lab that runs this test.

So it is limited in its ability to detect precancerous lesions, but the benefit of it is that a blood test is something that's very easy to draw.

Next slide.

So everyone might be wondering why is this happening?

Why is it that we're having increased rates of colorectal cancer?

And obviously, the answer is it's multifactorial.

We're seeing trends in public health that are probably coalescing to create a perfect storm for increasing not just colon cancer, but also rates of metabolic diseases.

And so, not to you know harp too much on rates of obesity.

Um, I really do have to emphasize that the leading ideas and hypotheses of why this is happening is the most data that supports this is really supportive of the idea of our diet.

Our diet and our lifestyle are really the cause of why this is happening.

Um there are other specific data points, sorry for the small text, but specifically a Western dietary pattern.

Um, looking at fast food is a huge issue, really overly sweetened beverages.

Um, there is data and science behind that in drinking beverages that are sweetened with high fructose corn syrup or too much sugar.

These things all do increase our risk for cancer, as well as obesity, metabolic syndrome, diabetes, heart disease, liver disease.

And there is actually strong evidence that it's associated with colon cancer as well.

Obesity in general, so being obese does increase our risk for colon cancer, and actually also with morbid obesity, we find that patients with morbid obesity have lower access to care to getting a colonoscopy because it's harder to do procedures on patients that are more obese.

You have to also have higher sedation requirements and more monitoring, so it needs to be done with an anesthesiologist.

So all these things are barriers to better better care.

Smoking is also a huge risk factor, sedentary behavior, so that is a huge one because sedentary behavior and lifestyle is now our norm compared to 30 or 40 years ago.

We are not a walking community.

We don't necessarily emphasize exercise as a community.

It's not something that is a part of our normal lifestyle.

And in conjunction with a very high calorie diet, high fat and high sugar diet, those things are probably contributing to our higher rates of colon cancer.

Alcohol consumption is also related to many cancers.

I can't say our alcohol use as a community is higher than maybe three or four decades ago, but it is something to know about.

Next slide.

So some of the newer ideas is gut microbiome.

So if you've heard anything about it, the gut microbiome has been investigated, not just for colon cancer, but for inflammatory disorders, even psychiatric disorders and movement disorders like Parkinson's, Alzheimer's, all sorts of diseases can be related to the microbiome.

And there's research done even here in Chicago and many of the academic medical centers looking at how the gut microbiome can actually increase your risk for colon cancer.

We've known for decades that certain people with colon cancer actually specifically get infected or are found to have infections of specific bacteria, and that's after we they've been diagnosed, or it may be the way we know they have the diagnosis.

But what if our microbiome in our childhood and teens and 20s are actually increasing our risk of colon cancer?

And so that's being investigated.

There have been several bacteria that have been identified, and then obviously microplastics.

So I think it's commonly known now that microplastics exist and that there is a huge risk in terms of how they disrupt our endocrine function and chemical balance within our body.

It may impair our mucosal barrier function within our gut, and that can cause chronic inflammation.

It's really not well understood or proven, but it is a very tangible hypothesis.

Another idea could be circadium rhythm disruption.

So that means looking at people that have inverse sleep cycles, maybe night shift workers.

A lot of healthcare workers are in that in that boat.

And so that is something that's being investigated, as well as early antibiotic exposure.

Next slide.

So there are things that we can do.

I don't want to paint a doom and gloom picture because there are many things that are protective against getting colon cancer.

And these are things that we should think about, especially as we are approaching the knowledge that younger patients are at high risk.

So it's never too early to start a moderate to vigor vigorous exercise schedule because this is very protective.

It actually reduces your risk anywhere from 29 to 66% risk reduction in many studies, a high vegetable consumption, maybe not during a cyclospora outbreak, but in general, high vegetable consumption is definitely associated with a risk reduction of colon cancer, and that might be multi-mefactorial.

It could be because of the vitamins that we get from vegetables and fruits.

It could be because of the higher fiber content that we get, and it also may be because of the lower calorie intake.

So if we're eating a diet full of vegetables as compared to fast food, there are many benefits to eating vegetables and fruits over highly processed foods.

Having an adequate vitamin D level, which is very apropos for Chicago, many of us are vitamin D deficient just because we don't get much sunshine for about six months of the year.

And then also avoiding processed meats and red meats.

So you may not be aware, but processed meats like sausage, like the Chicago hot dog, which I mean, I'm a true Chicago and I love my Chicago hot dog.

But unfortunately, processed meat is actually now what's labeled as a WHO class one carcinogen.

So it's known to cause cancer, it's known to cause gastric and colon cancer.

Not to say you should never have processed meat or red meat, but just be aware that it does increase our risk, just like alcohol of colon cancer and other cancers.

And it could be one of the factors why younger people are getting cancer.

Our access to red meat is higher than it ever was in the 1960s.

Red meat was an expensive and special treat in years past, and now I think it's a part of almost everyone's diet on a multiple times a week basis because it's cheaper and more accessible, but it may be highly processed.

Next slide.

So how we move and what we eat really, really matters.

So we can also avoid sugar sweetened beverages.

There's data that even shows that possibly beverages with false sweeteners like Splenda and all of those other sweeteners, even though they don't have calories, they can still disrupt our gut microbiome.

So avoiding any sugar and these sugar substitutes may be very important.

Having a healthy BMI is so important for so many reasons.

But childhood and adolescent obesity is at the highest rates that they ever were.

Avoiding a dietary Western dietary pattern is really important.

Eating foods rich in folate, so green leafy vegetables is very important.

Antioxidant-rich foods, once again, vegetables and fruits, our fruits and vegetables that are pigmented, that are orange, that are red, like raspberries, like carrots, and then also calcium.

So dairy has actually been shown to be mildly protective against colon cancer.

That if you have diet full of dairy like cheese, yogurt, and milk, actually can protect us against colon cancer as well.

Next slide.

And who is the most vulnerable?

So of course, there are disparities among all of our racial, ethnic, and geographic groups, and unfortunately, non-hispanic black populations have the highest rate of colorectal cancer incidence, about 34 to 59% more likely to die from colon cancer among all age groups.

Now, this isn't just for young patients.

This is true for all age groups, and that's why it's especially important for us at Cook County Health to know this, because that's the population we serve.

So even after adjusting for all age, sure.

No, please microscope.

Oh, okay.

Sorry about that.

Um, even after we age adjust, African Americans are still at higher risk, and that may be multifactorial.

Um I'm just surmising what the data has said, but essentially lower access to good care, um, uh less interest in getting colonoscopies and also delayed colonoscopies.

African Americans are also at higher risk for getting diagnosed with colon cancer at later stages.

So it's really important that we're aware of this disparity.

This disparity also exists among Latinos.

So Latinos actually are at highest risk for early onset colon cancer.

So when we talk about the group that's highest risk, it's actually Latinos that are young.

And for whatever reason, they are showing the highest rates of colon cancer under the age of 45.

Also American Indian or Alaskan Native Indians are high at risk of early onset colon cancer as well.

Next slide.

Rural populations also have higher risk of early onset colorectal cancer, as well as understanding that racial minorities, as I mentioned, are more likely to be diagnosed at a younger age, so ages 20 to 29, and when they're diagnosed at a later stage of cancer.

And this may be because they have a more aggressive histologic subtype.

So it's very important to get a good family history, but also going to the next slide to be aware of this because we should talk about how and if screening should change.

Obviously, that's beyond the scope of this particular meeting.

This is something that's being discussed among cancer societies, among gastroneurologists, because changing screening is something that is obviously a huge paradigm shift, and the question needs to be asked of how do we how do we do this in a cost-effective and a meaningful way?

Um, because to add millions of people more on a colonoscopy list may not be feasible, but there have to be ways for us to bridge this gap.

Only 37% even now of adults age 45 to 49 have even gotten their colonoscopy, and that is multifactorial.

There is limited access to care.

There's a nationwide shortage of gastroneurologists.

It is difficult to get booked for a colonoscopy in many communities because they're booked out for so long.

And there's also a lack of recognition among young patients that they need to get a colonoscopy.

They may not know that they're due for screening at 45.

So primary care doctors and all clinicians need to be able to communicate better with their patients about this.

Next slide.

So there are some new screening modalities that have recently been included and approved, as I mentioned, like next generation DNA stool testing like COLOGARD Plus, and that specifically looks at DNA within the stool, and it can be done every three years.

Um, that can be sent by your primary care doctor, and that's a stool test.

There's also blood-based cell-free DNA tests.

So if you don't have an interest in doing a stool test or a colonoscopy, you can get your blood drawn and be tested.

Once again, it's not the best in terms of sensitivity.

Um, but if you decline all other tests, this is the recommended test that you should get done.

Next slide.

And so, what are some strategies that we should think about to be able to approach this public health problem that's nationwide?

Um, there's not necessarily screening changes universally, but what we can do is a risk-stratified approach.

And so the most important thing I think is to find our high-risk individuals and get a detailed family history and specifically look at modifiable risk factors.

So, looking at our patients that have those risk factors of obesity, smoking, metabolic syndrome, and anyone who has high risk symptoms, regardless of age, should get a colonoscopy.

So if you are having symptoms of changes in your weight, blood in your stool, change in your stool caliber, abdominal pain, you should see your diet your doctor and ask for a colonoscopy.

Um, you should have a prompt evaluation.

So early colon cancer patients may not know that they have alarm symptoms, and so they need to be aware of the symptoms.

They shouldn't ignore symptoms, they should not be falsely reassured.

Um, and they really have to be their own advocate.

I think clinicians also have to have a low threshold regardless of age.

Unfortunately, we do diagnose patients in their 20s with colon cancers not infrequently.

I see it probably every once every month or so, and they're in the 30s and 40s, even more commonly.

So we don't know what we don't know.

That's a saying in medicine that if you don't look and investigate, you don't know what you're dealing with, and unfortunately, someone can have a stage four cancer and have totally normal testing in terms of blood tests and even a CAT scan.

We wouldn't know unless we do a colonoscopy.

We shouldn't assume that it's hemorrhoidal bleeding or some other benign cause.

Next slide.

So, in summary, we want to make sure that we have patients be aware of what alarm symptoms to look for so that they can seek medical care without delay.

Providers also need to be aware of this rising epidemic so that they don't dismiss symptoms and do less than the gold standard, which is a colonoscopy.

They should get an urgent colonoscopy referral and get a high quality colonoscopy.

If a colonoscopy is refused by patients, we can offer non-invasive testing, and that can be counseled with a gastro neurologist.

And although there are no current recommendations for your universal screening for patients under the age of 45, there is some literature to support the use of fit in large metropolitan areas and safety net hospitals.

Next slide.

So how are we approaching this problem at Cook County Health?

We offer FIT testing to patients through their primary care providers or clinicians.

We have an open access colonoscopy system, which means that patients can actually get an order for a colonoscopy without ever seeing me or any other gastroenterologist.

If you see your cardiologist for your annual visit or your primary care doctor, or even your physical therapist, any of them can place an order for a colonoscopy, which means that there's less delay for them to get their procedures.

We offer screening colonoscopies for anyone 45 years or older.

And for those at any age, we do colonoscopies if you endorse an alarm symptom, and that can be scheduled more urgently without the need of being seen by a specialist.

Next slide.

So this is just some of the data that we have from Cook County Health that I pulled for the last five years with the help of the partners I work with in Cook County Health in our endoscopy labs and specifically looking at our demographic of our patients.

Our patients do kind of fit the high-risk ethnicities of African Americans and Latinos.

And I just wanted to demonstrate that we do have a lot of patients that are in that age range of uh 45 and less, although the majority of patients that get colonoscopies are older.

Next slide.

And once again, you can see our rates or our volumes rather of uh colonoscopies that we've completed at Cook County Health have been rising steadily throughout the years through increased opera um increased and improved operations within um our labs, and we've also opened a second lab in Cook County Health to offer more colonoscopies.

Next slide.

Um and this is just some data on um communities that have used fit in terms of outreach to reach more patients in terms of um being able to get them in for a colonoscopy so they're prompted to get their testing in patients even less than 45.

Um next slide.

I just wanted to send a special thanks to all of my colleagues in the division of gastroneurology, colorectal surgery who perform these colonoscopies with us every single day, Monday through Friday, um, and all of the leadership that I work with that have been able to allow us to offer such excellent colon cancer screening initiatives through Cook County Health.

And I'll take any questions if you have any.

Commissioner Daly, follow by Commissioner Moore.

Thank you, Madam Chair.

Doctor, thank you for the presentation.

I would just urge everyone on this board to listen to your body.

I two two, three years ago, I had some issues I know, which totally no.

And my doctor said do it colonoscopy, and they didn't.

Oh, I was fortunate they found it very early.

So no chemo, no grid issues.

So any it is a it is very hard to go through, but it's one night or two bottles or whatever.

And I would urge every member on this board, but also anyone listening to do yourself.

And uh hopefully it would be part of the expand the I know we do breast uh as well as prostate screening.

Maybe we could expand it to co uh uh colonoscopies, yeah, cook county use for your birthday.

Do yourself a favor.

So just members pay for the public listening.

No, you know your body, you have to be your advocate.

And not only this issue, but any issue that affects you.

Thank you very much.

Thank you.

Commissioner Moore, let's don go before we continue with cancer questions so that way.

It's fine.

She, I mean, she has more of the they're asking medical questions, so I think it's fine.

Like, I don't mind waiting a minute.

It's more of an example story, probably anyway.

Let's let's share thank you for your patients.

Thank you for your question.

Can we have her?

Can we have a share um her experience quickly and then we'll go to your questions?

Commissioner Moore.

Thank you.

Sure.

Um, I'll try to go fast because I know everyone's been here a while.

I'm here more as a personal example, uh, like the living example, I guess.

Um, but in the short frame, I have familial history with colorectal cancer.

Um, so I was doing the maths.

I'm getting old myself, so 35 years ago, uh my dad was diagnosed at 52.

So at that point he was eligible for screening.

Um, I would say 35 years ago, most people probably weren't getting screened at 50, so he was one of many that were not screened at 50.

And he um passed away at 53, which again is not uncommon when you are finding it younger.

52 was actually pretty young back 35 years ago.

Um, so I had it on my radar, obviously.

It is a familial thing.

And when you talk about the open access idea, I think the first person who told me about screening was my OBGYN.

I don't think a GP ever told me.

Um, but she was like, How old are you?

You know, what is your family history?

And so I knew at 42 I was supposed to get screened.

At 40, I had some symptoms, which now I think was because I had three kids, I think that it was um stress.

But I was lucky again, it was my OBGYN who actually wrote the script, and I got a colonoscopy.

So when I went in for my colonoscopy, and I was 40, um, they found multiple polyps, but one was massive.

Um, to the point where I said earlier, um, the the doctor performing it gave me like the face, you know, the I'm really sorry to tell you, you have this massive polyp, it's not good.

Um, but you know, it was Friday, so they're like, have a good weekend, you know, we'll we'll get back to you with results in a couple of days.

And I spent just days panicking, right?

Like, what is our financial situation?

How is my husband gonna raise three kids by himself because he can't?

Right.

So, like, how are we gonna do all these things?

And it ended up actually not being cancerous, so technically here we're fine.

Um, but I did call my sister after I got the you know, everything is fine, and said, Hey, I was supposed to get screened at 42, which is your age also, um, and she was six years younger than me, so she was 34.

And I said, but they found this massive polyp.

And I don't know at 42 what would have actually happened.

I mean, I don't feel very good about that outcome.

So I said, talk to your doctor and say, hey, my sister got screened at 40, and I think she should have gone earlier than 40.

When should I go?

And the doctor actually literally laughed and said, Oh my gosh, like you're 34 years old.

You don't have to worry about it.

We've almost a decade to worry about it.

Um, you know, relax, we'll talk about it another time.

And she was diagnosed at 38 with stage four of colon cancer and passed away at 39.

Um when you look at some of the other you know things that we hear about and talk about, I think the the numbers are obviously interesting.

I'm now a volunteer with the colorectal cancer alliance, and I can't explain how many young people that I'm meeting.

And I know there's obviously a lot of statistics too.

My sister was a marathon runner.

Um, I wouldn't say she was vegan, but not a big um meat eater, not a big soda drinker, did enjoy occasional beer, um, but didn't fit you know, normal BMI.

Uh my dad was skinny, uh, diabetic, didn't eat a lot of junk food again, maybe the beer drinker, um, but that's the only link.

Um, there is no genetic link in my family, so neither one of them um we were predispositioned, and neither am I.

Um, my most recent colonoscopy, which was two years ago, they found 15 polyps, and I've had four so far.

So my next one is next year.

Um, I get them every three years because of family history.

So with me, I feel like if I had waited until 50, even to backtrack.

So I turned 45, the year the date changed to 45.

Um, and I actually had a colonoscopy scheduled in November.

My sister was diagnosed in like August that same year.

Um, and the day before my colonoscopy, they called me and canceled it because my insurance uh wouldn't approve it.

So I don't know why, because I had family history and I was 45, but I didn't get back in then until January while my sister was undergoing chemo and was stage four, so that was also a very stressful time period.

But one of the things I think is interesting when we talk about timing is one of the one of the things that kind of triggered the movement to 45, and again, it was kind of in process, but um many of you probably remember the Chadwick Bozeman story, right?

And so he was actually 43 when he passed, 38 or 39 when he was diagnosed.

So the the age moved to 45, but he was 39 when he was diagnosed.

Um, the other one we keep hearing about right now is um James Vanderbeek, he was 46 when he was diagnosed.

So if he got a colonoscopy at 45, would things have been different?

Maybe.

I mean, there was a year um gap in there.

So the the screening thing does make a really big difference, but also that you know there are there are a lot of telltale signs.

Don't do this, don't do this.

But I'm meeting marathon runners, active people, you know.

Um, the other thing I'm seeing a lot because of the my relationship is a lot of um young mothers who are getting misdiagnosed.

Um it's getting wrapped up is postpartum you know issues, so obviously your stress, obviously, your stomach hurts, like you just had a baby and your whole body is different.

And so I've met at least five women who were diagnosed with children under one year old at stage four.

I met a sister of one because she didn't she didn't make it.

So she left a two-year-old baby, um, she was diagnosed at 38 also.

So there, you know, there are so many different variables.

Um, but the one thing that keeps kind of connecting it is this the screening element really does make a difference.

And if I had waited till 50, like I I don't think I would be sitting here that statistically, especially because there's obviously something not right with my family, many things, but the colon cancer is obviously uh one of the things.

And you know, with my sister, there was no opportunity for earlier screening.

But if she if they just said when she was 34, you know what?

Let's just do it.

Why not?

Your sister had a bad, you know, experience at 40.

Maybe we'll do it at 35.

I'm I think she would have been here too.

So if my dad had got screened in 50, would he would he still be here?

Maybe, right?

And so the screening thing, I think, is a thing that always comes back to me, but 45 is is just like a baseline for now.

There definitely needs to be other options in the fit test, I know is a really big movement now, and we see that a lot in other countries too, where like everyone's just getting mailed them to their homes.

And here we have to fight for a colonoscopy still at 45.

So thank you so much for sharing.

I know, Commissioner Morton, you had some comments as well.

I want to thank both of you for your testimony.

Um that's a powerful statement, what you just said.

Um, Doctor, thank you for your presentation on such a serious topic.

First, I'd like to know if I could get this presentation electronically and in print.

Um I want to share it with many people in my community.

It's concerning that these screenings are showing positive results in much younger people.

Um still do not classify colonoscopy as a standard of preventive screening for average risk of individuals.

And I think what you said was uh amazingly powerful, and I don't know if everybody heard you, you know, and I want to repeat uh one of the things that you said that it's not just a barrier to or lack of education, it's not just a lack of uh uh want uh to have the screenings, but it's about insurance coverage.

Um I myself recently was denied a colonoscopy at U of C.

And I have a history.

My father has colon cancer, right?

And uh and I am of age.

I don't like to admit it, but I am of age.

Yeah, so why was I denied uh a colonoscopy?

So I left there and went to Cook County, and they gave me a colonoscopy.

So there are more barriers than we want to admit.

Uh it's not just uh people who don't want to go.

Um the insurance says they won't cover it.

You know, uh it is something that we definitely need to fight against, and it's definitely something that should be covered at early as 40 years old.

And I used to hear stories of um African American and Hispanics uh needed to be uh screened earlier than the average white person.

Earlier than the 45 because they're higher risk.

They need more aggressive community outreach and support.

Traditionally, in these patients um that are higher risk, unfortunately, what we see is that they're the underrepresented minorities that have lower access to good health care.

And they're the ones that are at more risk for the cancers or whatever, you know, medical um ailment it may be, and in this case, colorectal cancer.

And so that's the saddest part is we see our patients on the south side that are serviced for us by Cook County at Stroger as well as Provident, yet they have the most difficulty coming in.

They have the most difficulty having the social support to have a ride to get a colonoscopy to get the prep to pay for the property.

To get a ride home.

To get a ride home from the colonoscopy to drink the PrEP at home because they may be a fall risk and they don't have social support, or even to literally to pay for the PrEP.

So there are real social determinants to of health, is what we call it.

Social determinants of health dictate how well you will get health care.

So even if all things were the same and your risk of colon cancer was the same, it's not the same.

Because if you're coming from a community that can't necessarily um support you and you don't come from the same economic background or same health literacy background, you're already in a situation where you're more likely to get diagnosed later and less likely to get good care even after you're diagnosed.

And that's why it's so important for us to service those areas the most in terms of as we build our program for colon cancer screening at Co.

County Health, we really are focusing on looking at the areas that are most underserved and focusing our outreach in ways to help them.

So I can never change insurance companies as a single person, but what I can change are things that might make it easier for patients to be able to get a free prep to you know figure out can are there ways investigate, are there ways to get escorts or rides for patients so that if they don't have family or friends that can do that on a work day?

Or if you get denied, what can we do?

Well, maybe we could do a fit test.

And if your fit is positive, then your insurance will pay for it.

Right.

So there are ways, or if you tell me you have symptoms, now it's not a screening exam.

It is an exam for a specific reason of symptoms, abdominal pain, bleeding, whatever the symptom may be.

And so I think as a clinician, we have to be aware of these things because not only does your patient have to advocate for themselves, I have to advocate for you too to fight the system that in many ways are not really geared necessarily to better your health.

They're try to reduce health care costs so that they don't have to pay for a colonoscopy sometimes is how it feels.

So I'm sorry you had such a difficulty in getting it.

I'm glad you got your colonoscopy done, and I hope you had a good experience at Cook County Health.

I think that one of the most important things is is understanding that it's not enough for us to show up and do the colonoscopy.

We have to think about it holistically, and we do in terms of how easy it is for a patient to actually get to the cue to getting a colonoscopy, getting the prep for the colonoscopy, getting home from the colonoscopy, the whole system needs improvement, right?

So and that's just here in Cook County.

Obviously, nationwide, those things are bigger and um bigger problems, but I think that's particularly in our communities because we have such a high rate of colon cancer and um underserved patients, especially in our South side, we do need to come up with ways to better serve that area.

Yeah.

And you know, you talked about, and I can't remember the name of it, but there was the box that they send to your home, take a stool sample.

So it's a fit test, and we do utilize them a lot at Cook County Health.

And I will say it's not a perfect solution, right?

In my heart, could I w I wish everyone could get a colonoscopy?

But in reality, it's not possible.

It's just not feasibly possible for every single patient to get their colonoscopy because there aren't enough gastroneurologists.

That's not a Cook County problem.

That's a nationwide problem.

So, and maybe not every patient even wants one.

So the important thing is is that we offer multiple ways to screen, and a fit is the most cost-effective way to doing it.

There are studies out of not just Chicago, but in LA, there's a big study, China, Taiwan, um, and another one I want to say out of Japan, where they do math screening, like you were mentioning, where they literally mail it out.

One study is 20,000 patients, and essentially they say, do this card, or I'll schedule you for a colonoscopy, mail back the card if it's possible positive, I'll schedule you for a colonoscopy.

And the point isn't actually for them to do the card and to make a hundred percent compliance with the card.

The point is to get patients to do something, right?

It's to just trigger the idea of, okay, now I have to do a colonoscopy, or I don't want to do a stool test.

I will do one of them.

And so, in a way, you've kind of tricked the community into doing some type of a testing because that's better than nothing.

So the fit test, is it is it accurate?

I mean, so it's it's not perfect.

It's actually really good at screening cancer.

So it's not a perfect test, right?

It's better at screening stage one and two cancer.

The sensitivity for polyps is actually not in the 90s or you know, a hundred, it's closer, it's ranging anywhere from 30 to 70 percent.

But it is good.

Just anecdotally, I will tell you that if your fit is positive, you probably do have polyps, but unfortunately, sometimes we find cancer too.

So at least it brings you up to the high priority list of patients that need to be scheduled, not six months from now.

They need a spot now.

Do we at Cook County send out those fit tests?

We don't mail them out, but we offer them.

We don't do like mass mailings, is that your question?

We don't do mass mailings.

What we do is offer them to anyone.

So if you are seeing your physical therapist for back pain, or if you're seeing your podiatrist, you can get a fit test from any of them.

So you can ask them for a fit test, and you can even get your referral for a colonoscopy.

So that's what I mean when I say we have an open access endoscopy center.

Any provider can order that.

I didn't know that.

Any provider can order it, and in fact they do.

I almost never, I I say I, like my division of gastroneurology, we almost never see patients in our clinic for screening.

We just see them when they arrive for screening, which is a more efficient use of our time so that our time can be spent doing the screening rather than sitting down and talking to you about screening, you could do that with your primary care doctor when you see them for your other medical illnesses, and then by the time you see me, you're using my expertise as an endoscopist to get a good colonoscopy and get all those polyps taken out entirely.

So that's our program.

Okay.

I didn't know that.

Thank you.

Last question, and um this may not be the question for you, but I'm gonna put it on the record is I want to know if uh Cook County uh care is paying for uh screening for patients under 45.

I'm sorry.

I think care would cover, but the age is I believe 45 to 75.

I believe they do.

Yeah, 45 years.

So part of my job as the director is um covered working with prior authorizations and the process for prior authorizations, and my understanding is those with county care can get them 45 for a screening indication.

You can also get a colonoscopy for um what we call an alarm symptom.

So if you say I have blood in my stool and you're 28, you get a colonoscopy.

You're 18 and you have whatever symptom, you know, that meets the criteria, you can still get it and it'll be covered.

That's my understanding.

I I want to thank the chair.

I think this was an amazing presentation, probably the best I've had in a long time.

So thank you so much, you commissioner.

Lastly, is there someone from your office that could come out into the community and talk to people about screening?

I'd be happy to.

Oh, you're awesome.

Thank you.

Thank you.

Commissioner Trevor.

Thank you, Chair.

Um, first of all, I want to thank my colleague for bringing this up.

I also come from a family with uh extensive history of colon cancer.

My mother, uh, my cousin and an uncle all had it um and it was either the direct cause or contribute to contributing part of the cause of death.

I also have a cousin right now who is uh very recently diagnosed with the disease as well.

Um but I wanted to um elaborate on the question that um Commissioner Moore asked about insurance or the statement.

One of the things that I I you know we we need to realize is that insurance companies, yes, they may deny it, but also the other issue that with some of these diagnostic some of these tests, these screening tests is that um particularly if you're high risk, they may be coded as diagnostic as opposed to screening, which means that the people that um are getting these tests end up with a very large bill sometimes uh in order to do it, which may be and it it isn't even necessarily that you got a positive test before.

In some cases, um uh the uh uh test might be coded as diagnos diagnostic if you fall into a high risk category.

Um and I'm wondering and I my guess is it's not uh it's not a direct issue so much with um county care uh because uh of um I don't think there's a deductible with that plan, but if you're on, let's say, for instance, one of the uh ACA plans with a very high deductible that could pose a very, very huge barrier uh to being screened, uh is that if if you fall into a category where they're not gonna treat it as a screening test, it might be subject to your deductible.

Um I was just wondering if you could perhaps confirm that in fact there are no deductibles there that people um seeking uh um colonoscopies would face in county care.

I am not a representative of county care, so I cannot confirm that.

I wish I could give you more data on that, um, but I can find the answer for you and get back to you.

Yeah.

And also just uh since we're talking about making this available to people under 45, uh I you know I just want to highlight that this is something that it's regulated at a level higher than Cook County, and it's something we need to advocate for.

Uh and also it's not just for for colonoscopies, a lot of tests, like for instance, I ran into this coding issue with a mammogram of a number of years ago where I went for my routine, what I thought was my routine annual mammogram.

Uh it was coded as diagnostic because I had had an abnormal one several years in the past and got a surprise very large bill for it.

Um so it's something that that I think needs state attention on state regulation.

Thank you.

Commissioner, we'll have county care follow up with you.

Okay.

Uh Commissioner Kevin Moore.

Thank you.

Um I want to thank you both uh for being here and uh for participating in today's hearing.

You know, the impetus uh that sparked my interest in wanting to move this forward is not only the fact that I'm a news junkie, so I've seen over the last several years the uh vast increase of uh colorectal uh cancer diagnoses in uh younger individuals, or the fact that I was born in 1990, so I particularly fall into the one of the higher risk categories uh because of all the food experimentation that has been placed on me.

Um but also recently uh one of my close friends who's 36 uh had some abnormalities, they did a test.

Um, they realized there was a polyp, so that she luckily under her uh health coverage was able to get okay for a colonoscopy.

And during that, not only did they find the polyp that was initially uh found, but a incredibly large precancerous uh mass as well.

And so uh I'm grateful it was found uh that it was precancerous, and that my friend uh hopefully will have many, many year more years of life, but it is definitely uh concerning uh to see uh this vast increase in uh in younger adults.

Uh so uh just making sure that we are spreading uh the word is incredibly important.

Now I did have a question based on what you were saying, Dr.

Gandhi.

Um, when when you are released from having a colonoscopy, do you need I know you need someone to drive you, but do you need to have someone who's gonna be with you on your return home?

You do.

So when you get a colonoscopy, at least in our country, you get moderate sedation at least or some type of anesthesia.

In other countries, people do colonoscopies regularly completely awake.

We generally don't, rare exception we might.

Um anytime you receive anesthesia, it is one of the anesthesia protocols through our like larger anesthesia regulatory bodies that you were required to have some type of an escort.

Just like if you get your wisdom tooth extracted, they'll never let you go home by yourself, right?

You may feel normal, but your reflexes are poor, and so you might step off the curve and get hit by a bus, right?

So those are things that really do happen.

I have had patients who argue and they slipped on an ice patch on their way walking to the door using a Medicar.

So it is actually um regulated, and at Cook County Health we do require it, and I think every hospital and endoscopy unit I know in Illinois requires it.

Um when we break that rule, we open ourselves up to lawsuits, honestly, and it's not safe for patients.

Keep in mind that you may have gotten sedation.

I had my colonoscopy.

I felt so normal afterwards.

Um I even forgot I got my colonoscopy and went to the gym, and I probably shouldn't have done any of those things.

But I felt so good.

Um now, if you may be someone who metabolizes more slowly, um, it may not be a great idea.

You're supposed to have an escort, they are required usually to meet you.

Some labs will wheel you down to your car and your escort can be in the car.

We require our escorts to come up and meet us.

Um after you leave the lab, no one knows what happens to you, right?

Does your escort drop you off at home in your home by yourself?

Um that's the point where you make responsible decisions best you can.

It's just for your safety.

Well, and and the reason why I ask that is I know that through Cook County Health, you could schedule a ride.

Um so uh the escort portion, you know, if they have a plan escort to get them uh home and hopefully uh observe them for a while until they're uh uh uh you know the all clear.

Uh could they schedule the ride at least to get to the appointment as long as they have an escort scheduled uh now you've opened the can of worms.

Sorry?

You've opened the can of worms.

This is a huge issue.

So we have so many patients that unfortunately don't have community support, right?

Um patients that just say, I don't feel like telling my family, and I you know, we reassure them we will not tell them anything, but they really just don't want anyone to know.

They may not have any co-workers, and so you don't have to arrive with an escort.

You could take the L there, you can walk there.

Um, but when you leave, you have to have an escort.

Uh so any of those like Cook County rides or even an Uber is not technically an escort.

Right.

So they can get the Cook County ride to the two there.

They can come however they want.

They can walk, they can take a lift, they can take the bus.

It's the issue is leaving, and technically, these drivers, like an Uber Lyft or a Cook County ride is not technically an escort.

It's a basic one that you can oh I'm not done yet.

Thank you though.

Oh, I'm almost uh no, I appreciate that.

Uh okay, so uh almost done with my questions.

So uh it absent having a family history, um, you know, typically health insurance will start covering at 45.

Um I I think you mentioned uh that like the stool samples, the the other testing, you could have that before 45 if there's uh you can get fit tested technically, it's it's indicated for 45 and after.

There is just research being done currently on the use of fit prior to 45.

So I don't know if it'll be covered by insurance, but I think that if you have so the differences between what someone used as diagnostic versus screening, not to get too medical, but if you have a symptom, this is a diagnostic exam.

If you are asymptomatic and just 45, it's a screening exam.

If you're you sound like you're very young, I don't know my math off the top of my head, but you might be okay.

So you're 36.

So if you had a symptom, this is a diagnostic exam and it should be covered by your insurance.

Now, what if you were to say I'm having X, Y, and Z symptom that sounds a lot like colon cancer, but you say, gosh, I really just don't want a colonoscopy.

It would not be unreasonable for you to get a fit test.

Okay.

To say if it's positive, then maybe doctor, you could change my mind and I'll do the colonoscopy.

Um, but in terms of mass screening, it's not technically approved by the FDA at this point.

Okay.

I appreciate that.

And that goes for all the other tests that are on the market.

Um so Gardant Shield is approved only after patients, so that's the blood-based liquid biopsy test.

It is approved for patients once they've um refused all others, but once again, as I mentioned several times, because the sensitivity is really low.

It's only about 13 and a half percent.

So I don't know if you'd feel very reassured by that.

It's better than nothing, but it's not as good as the others.

I appreciate that.

Thank you so much, Doctor.

Commissioner Stamps, then more thank you both for your testimony.

Thank you for for sharing such personal stories with us and my condolences.

Thanks.

Do you?

I was curious.

This is actually more of a question for uh the chair.

Is there an opportunity to um fold in the colorectol screening under the other bodies of screenings that we have at Cook County, like the mammogram one and the prostate one?

Um and if so, is there an opportunity to more widely share the uh the fit test, like the accessibility to the fit test that that you've discussed.

And like uh Stanley, I like the information to share with the community.

So to answer the question about expanding the birthday health screening program, we are having conversations about doing just that.

As you recall, we passed a national version of that, including lung.

So we're having discussions about lung screenings, and we're gonna add colorectal screenings.

We're gonna have that conversation.

I'll report back.

But I want to underscore in between or in the interim, we at at Cook County are uh providing colorectal cancer screenings.

We're also doing it as part of a state effort.

So I don't want anyone to think they've got to wait.

And I want to in fact encourage everyone to not only get an annual physical, but make sure you're getting your screenings as well.

As I said earlier when we spoke uh at the outset of the day at the press conference.

But for early detection, uh I wouldn't have known I've had cancer twice, and I wouldn't be standing here.

But we are looking at expanding that program, but we do have other initiatives already in place providing colorectal cancer screen.

I uh want to thank you for that.

And um, I'm really curious, I don't is real late, but what is really um just so obvious to me is the connection between our diet, the changes in uh how food gets approved in America opposed to other places, and then our um uh the the health implications of poor diets um in America as opposed to other countries, what we're approving, what other countries are not approving the intake of these foods on um oftentimes poor people because it's cheap and it's it's ridiculous uh how much food costs if you want to eat well or better.

Um if you're trying to feed, you know, it's just the connections between these poor health outcomes and poverty, essentially.

Because if I'm trying to stretch a dollar, then yes, I'm buying hot dogs, right?

Opposed to whole foods and vegetables because I'm just trying to make sure I got I feed whoever in this home.

Right?

Um and and you know, if you look at so many, it's too many documentaries to even talk about um how our food is grown, treated, processed in this country.

Um as we were talking, I was like, well, the baseline would be that you got to actually care about the people.

Um and and it's just so many, you know, there's just too much evidence to the contrary about how we feel in America about Americans down to what we're eating.

Um so anyway, again, thank you and any information that we can take to community, um, especially as what people can do to participate in their own health from food, nutrition preparation to the fit I would be interested in.

So thank you so much.

Thank you.

Commissioner Moore.

Thank you.

I'm just wanted to uh I just wanted to uh address something that uh Commissioner Morrison brought up.

My experience when I take someone to your office is that they won't start the procedure until I identify who the person is that's with me.

Yeah, they won't even if you don't have a pickup.

Right when you arrive in any endoscopy unit, they start to register you with your ID.

And usually the first question is is who's your escort?

And if they're not there with you, they get the phone number, and then someone makes a call to say, Hi, you know, John Smith is here.

Can you confirm you're his escort?

He should be done around one o'clock.

You'll be ready to come up here.

Is that correct?

No medical information is ever shared about what the test was, what the results are, but yeah, it's usually confirmed.

That is the protocol in most likely.

Yeah, I thought I I thought they had to be with you when you arrived.

Um some units may require it, but I think these days most units don't.

They don't want a waiting room, especially with COVID.

We stopped allowing people waiting, and it's kind of shifted the need for people to be in person.

In the past we had, and now we're perfectly fine with a firm confirmed phone call, and I think most labs are that way.

Um it's just easier.

And then lastly, um I didn't hear you differentiate the difference between men and women.

Are more men needing this or is it equal between men and women?

So colon cancer rates are roughly equal among early onset.

I don't think there's much of a gender disparity.

Um I could only comment that I think that there is a gender disparity in terms of um ignoring symptoms.

T men tend to ignore symptoms more.

There's not, I can't think of a study off the top of my head with this, but in general, awareness and early action is something that's really important.

And I think in general, women tend to let me say, listen to their body more and probably don't delay care or ignore ignore symptoms, but there is no documented number.

That's a that's the little boy Superman syndrome.

We I think it to be fair, I think if anyone is 20 to you know 35 or even 40, we tend to think we're invincible.

It's easy to think we're never gonna get cancer, let alone at 25.

Who would ever think that they would get cancer?

And so unfortunately, that's I think the hardest barrier with this disease is that patients can't believe it, so they delay coming in.

And then unfortunately, the saddest thing is clinicians don't believe it.

And if clinicians don't believe it, all I can say is is find a new clinician.

Yeah, find a different clinician who will believe you, go to a gastro neurologist, we'll always believe you.

Almost every person I'm talking to has been turned away at least by their first by their first contact.

Almost every single one of them.

Um I I hope it wasn't every single one.

But in general, if you see a gastro neurologist, we love scoping.

We love doing a good colonoscopy.

It is our job.

So I think by the time you make it to a gastroenterologist, you should be able to get screened.

But ideally in large safety net hospitals and and communities like Cook County, we rely on open access for providers to send patients without having to be seen by a GI doctor because it delays care sometimes.

Because access to a GI doctor can sometimes be months of waiting.

And those months are long if you have cancer.

So I would say just be aware of your symptoms and seek urgent you know, colonoscopy.

Thank you, Dr.

Gandhi.

Um, one thing I would add really quick, so I know there's a couple of you know requests for community information, and again, I I don't work for them, but I volunteer with the colorectal cancer alliance.

They will send if we can get a volunteer out there, they'll send a volunteer to your community event, but they will also send marketing materials.

Um they will help work on creating a program for you too if it needs to be more customizable.

So and it's one of the things I know that they're working on more now is trying to create more snippet, ready to go kind of stuff so we can kind of hit larger um on the education.

We've been doing a lot one-on-one individuals, but the need is getting bigger than the people.

So in in the Chicago Land area, there's probably five of us that are really on the boots hardcore.

So we can't do everything, but we are trying to get you know much more material so we could send things to you and say this is how you teach us that this is you know, information you could hand out, what kind of population are you talking to, but um talking to them.

They're always willing, especially to work with larger organizations, municipalities, cities, hospitals.

Like they can create a whole program for that.

Chairman Daly.

Thank you, Mr.

Chairman.

Just say uh, doctor, I just want to thank you.

Your statement about any provider could issue a you know, could get a colonoscopy.

But uh also you touched on do it for your family, because genetically they did not find it.

So I'm very lucky, and I had to exp it to let my kids know.

But do it for yourself, number one, but also your family.

Your body, you have a problem with your body, listen to it and get if the doctor isn't listening, then go to a new doctor.

And one of the issues too is that people don't talk about it with their own families.

Yeah.

So they don't share with their own family, and then people don't know their own family history, so they don't know to tell their own provider, so then they don't know when they're supposed to get screened.

No family history.

There is stigma with colon cancer, unfortunately.

Um I don't know why.

There was with breast cancer too.

So I mean, the goal is eventually we would surpass that, and it won't be an issue.

Well, yeah, it it's unfortunate because with younger patients, we have to get over the stigma because the idea of not being comfortable enough to talk about bowel symptoms.

Yes.

Um, they can't be ignored.

So Commissioner Sniffs.

Real quick, I just want to say I am a patient at the camera.

Yeah, yeah, my day get the call and say somebody company did you like all of those votes?

Yeah, are in place.

It all worked.

And I strongly encourage all the time.

Oh, I'm glad you had a good experience.

Thank you for that.

Thank you for that.

And thank you for a great presentation.

Thank you.

We appreciate you.

Thank you.

Okay, we have one last bit of work to do, and thanks to all of you for hanging in there.

We have a supplemental agenda item, which is 26 real quick before lives.

Pardon me?

You vote real quick.

Oh, we're already voting.

But I just wanted to shine a light on it.

This is a resolution calling for the United States federal government to require insurance coverage for colorectal cancer screenings for individuals under 45.

And Commissioner Kevin Morrison, I wanted to have you speak to it.

Thank you so much, uh Mr.

Chairman, and thank you for your support from day one in not only having the hearing we had today, but also your support on this resolution.

Um as I said, the statistics are alarming.

Uh it is not only important that we uh further uh inform our communities uh of uh uh of the fact that younger individuals that this is the highest um type of cancer that young adults are dying from.

Um and often when it comes to young adults, it's found way too late.

Uh and so I do think our federal government needs to adjust the timeline where health insurance will cover this.

Uh and I I strongly recommend anyone with symptoms.

You know, we've you know, I I I've seen it myself with other types of preventative care doctors uh like like we heard from the story of her younger sister.

Uh you know, come back in ten years.

Um so the fact that we need to be stronger advocates of ourselves with some medical professionals is also something that we need to share.

You know, as Chairman Daly said, listen to your body.

Uh but uh I I hope my colleagues will support me uh in calling on our federal government to lower the age and make sure that uh coverage is more available uh for individuals to get screened uh and make sure uh that this type of life-saving preventative care is more readily available to our population.

Thank you.

Well, thank you.

And if uh you have not already done so, I think this is uh exactly the type of resolution we should be bringing before NACO.

All right, as we as we go forward.

Uh, relative to this item, any questions or comments by any of the uh commissioners.

All right, hearing none and seeing none.

We have voted on all these items.

We have no further business before this committee.

It is so it moved by the vice chair, seconded by Commissioner Vasquez.

We're adjourned.

Thank you.