At the Forefront Live: A Healthier South Side
February 20, 2019
Coming up on At the Forefront Live, a healthier south side — we'll talk with physician experts about the current state of health in our Southside communities. Residents in these areas face higher than average rates of diabetes, heart disease, high blood pressure, and other health issues. What is being done to help and what do residents need to know? That's next on At the Forefront Live.
Physicians Edwin McDonald, Doriane Miller, and Monica Peek join us to discuss health disparities and improving health for Southside residents. Over the next half hour, we'll take your questions live. So start typing in the comments section, and we'll get to as many as possible.
We want to remind everyone that today's broadcast is not designed to take the place of a consultation with your doctor. So first of all, welcome to the program. Thanks for being here today.
Yeah, thanks for having us.
So let's just jump right into the questions. We've got a lot. And we actually had quite a few questions in advance from somebody looking at the Facebook page.
So that's a neat thing. I don't know if we've never had that before, but we appreciate it. So again, type your questions in.
We'll get to as many as possible over the next half hour. Let's start with what are some of the health concerns that South Side residents disproportionately face in comparison just with other areas of the city. Who wants to jump in on that one?
So I'm a general internist for primary care, and the patients that I see on the south side of the city have illnesses like high blood pressure, diabetes. Asthma is certainly that I see something quite a bit and also sometimes mental health issues too. So my patients oftentimes suffer from issues around depression and anxiety.
And these are issues that we see a higher prevalence of in this area of town. Is that correct?
Quite a bit, quite a bit. As a matter of fact, there are a number of studies that are going on within the University of Chicago to look at some of the ways that people who live on the south side of Chicago experience what's known as a health disparity, a difference in health and well-being, and compared to the white population. So that's something we see a lot.
So what are some of the social factors that determine the health of a community and its residents? I know there are a lot of different points that impact people, but what are some of the things, in your opinion, that really have a major impact?
You know, one of the things that I think people tend to think is having a doctor is the only thing that has to do with having good health. But if you could bring up the graphic that I provided for you, it actually gives a very nice description of what types of things are the real determinants of health. And frankly, it's not so much about having a doctor or medical care. Medical care only takes up between about 10% to 20% in terms of what constitutes overall health and well-being.
But personal behavior has something to do with it. Genetics, what you inherit from your mother or your father-- that also has a lot to do with your overall health and well-being. But some of the things that we see, particularly on the south side of Chicago, have to do with social circumstances-- issues around sometimes people not having the resources that they need in order to support their health. And then finally, environment.
So when we talk about social circumstances and environment, those two seem to be the two major factors that can potentially be manipulated. What exactly are they, and how do we work to making that better?
You know, one of the factors that I think is critical in terms of social circumstances is education. And one of the things that we've seen through studies is that someone who has a higher education level tends to have higher, better health. And it has to do with income and access to services. But also, people tend to smoke less. They drink less alcohol and also have healthier behaviors.
One of the things —
— that I would add — part of the piece of that pie was that 40% had to do with behaviors. And I would argue that those behaviors are also driven by people's social circumstances, and so that they don't happen in a vacuum. And so the environment in which people live largely determines the behaviors in which they'll behave in — and so that where people live, work, and play will determine the kinds of food that they have access to, whether or not it's safe to go out and exercise, many of the other things that they will be able to do to promote their health or to not be able to promote their health and engage in health-promoting behaviors. And so those two things are tightly linked. And so when we look at a community, we're looking not just at the people in those communities but the physical environment and the social environment in those communities and how well they're able to support or not support their residents to live healthy lifestyles.
Well, you know, I think that's an excellent point because even when you're driving, if you get much out of — very far out of Hyde Park — [INAUDIBLE]
Not very far at all.
— grocery stores.
There just aren't very many grocery stores. And the grocery stores that you do happen to see oftentimes are not — maybe not quite exactly what you would hope for from a healthy standpoint and that sort of thing. Now it's interesting.
We shot some video over the summer, in fact, at one of the community gardens. And somebody made a comment to me at one of these community gardens that really stuck with me. A lot of the residents in that specific neighborhood didn't have good transportation.
So they couldn't go to a grocery store and get fresh fruit. So the — fresh food. So the community garden was kind of a lifeline for them, but not everybody has that as a resource either. So it really makes it tough for people to get good food.
And I know that's a big issue with what you do, Dr. McDonald, as well because healthy eating is something you're very involved in.
Yeah. So for me, I run a weight management clinic. So I'm on the south side. I'm here in the hospital.
A lot of what you said about behavior I see every single day. So a lot of food choices are really driven by a lack of choices and lack of access to healthy food. So for me, when I see someone in clinic and I have to navigate physical activity, navigate diet, I have to really address some of these social determinants.
A lot of people live in neighborhoods where they literally do not feel safe exercising. And they may not necessarily have money to go to the local gym or to go even to the local YMCA or the park district because a lot of these resources are not necessarily free. But what is free is the just being outside. But if being outside is not a safe environment, what choices does someone have? So that's what I help with.
It's interesting as well because as you're well-aware, and I think you've said on this program before, weight has such a significant impact on health just across the board. And if folks are not in good shape from a weight standpoint, it really impacts in many different ways.
Yeah, so there's definitely a lot of various conditions associated with extra weight gain. So diabetes would be one of them, high blood pressure, metabolic syndrome, fatty liver disease, joint pain. Sometimes we can also see coexisting depression, anxiety. So weight is one of those things that — it's a condition that really requires a multidisciplinary approach to managing it.
So we do have some questions that have come in from viewers. I'm going to get to some of those if I can make my computer work here. First question — what do you believe to be your organization's strategies and strengths in addressing specific health needs of a diverse population? Because I know U Chicago Medicine is pretty heavily involved in trying to make a difference with health on south side because this is our neighborhood. Can you expand on that, anybody?
Yeah. Millie, you start because you work the urban health initiative.
Thank you. So the urban health initiative is actually designed to address many of these issues around health and well-being for people who live on the south side of Chicago. An example of a program that's specifically designed to address the health disparity or higher rates of asthma in children is the University of Chicago's pediatric asthma center. We do this program in partnership with another community hospital, but we have community health workers that can work with families-- so children and their parents or caregivers — around ways in which they can actually have better outcomes, stay out of the emergency room with asthma attacks, and to teach them how to do a better job in terms of managing their environment because as we know, it's not just about taking the medication.
But also, when we think about some environmental causes, it's about thinking about your home. Are there things in there that might trigger asthma? So I think that that's one strong example of a way in which University of Chicago Medicine and the urban health initiative is addressing this question.
And why is asthma such an issue in this community?
Oh, I think that there are multiple issues around asthma and why it tends to be more of an issue in the community, one of which is that we have issues around air pollution. Particularly in the summertime when we get ozone action alert days, many of the poorest communities on the south side of Chicago are actually very close to our expressways. And so if you think about a lot of the pollution that's coming from cars, kids being outside when they can, and breathing in that air, that can be an issue.
Internal environment can make a difference as well, and so thinking about dust mites that might be in the home or other things for people who may not necessarily have access to appropriate extermination services. And so sometimes we think about bugs in the home. Sometimes we think about droppings from rodents in the home being things that can sometimes trigger asthma.
And Dr. Peek, I know diabetes research is what's near and dear to your heart.
Can you talk just a little bit about issues with diabetes on the south side? And again, what are we seeing and how can we fix this?
Right. So diabetes is a problem that disproportionately affects African-Americans, low income persons, other marginalized groups in the country, including those of us in this city. And their hot spots in Chicago, primarily are those on the south side and on the west side. And so we at the University are trying to do a lot to work specifically with our neighbors and our patients that are here on the south side of Chicago.
And so there's a program called the South Side Diabetes Projects. So it's www.southesidediabetes.org for anyone who's interested. And we have been doing this program for 10 years now.
And we work with patients. We work with doctors. We work with other health centers.
We work with a number of community based organizations like our farmer's market, like the grocery stores that are available in areas — so Save-A-Lot, other grocery stores, Walgreens — that is available and provides fresh fruits and vegetables when other grocery stores may not be in that neighborhood in a food desert location. We work with the Chicago Health Department, with their free prescriptions, as you were mentioning, for park districts. So the park district is a low cost intervention, but for some people, that cost may be still prohibitive. And so we work with a number of people within the city to find resources and make them more accessible to people who live on the south side and are trying to find more ways to manage their diabetes in their day to day life.
That's great. And those are all, I think, fantastic programs. Let's talk about some of the other ways to address health differences experienced by south side residents. And Dr. McDonald, if you want to kind of kick us off. In particularly, I think when we talk about diet and food deserts, that's interesting to me because we hit-- we touched upon that briefly, but there are some real areas in this community that just are not served adequately by a good grocery store.
Yeah, definitely. So there's a study back in 2006 by a woman named Mari Gallagher who essentially defined food deserts in Chicago. And what the study revealed was that essentially, almost all the food deserts in the city of Chicago are located in African-American neighborhoods, like 100% of them. So they were either on the south side or on the west side.
Now ultimately, when it comes to food deserts, it's one of the terms that is somewhat kind of falling out of favor nowadays because it's really not the reality of some of these neighborhoods. The reality is that there's plenty of food in these neighborhoods. It's just not necessarily healthy food.
So these areas, especially on the south side, are actually inundated with unhealthy food. There's more accessibility to this unhealthy food compared to the healthier food. So one of the newer terms that people are now using to describe some of these areas are food swamps. So it's a swamp when it comes to unhealthy food, and people have a lot of access to it.
So one solution to the problem, yes, is getting more grocery stores into some of these neighborhoods. But ultimately, that's not the sole solution by itself. That's just one piece of the puzzle.
So in Philadelphia, they actually attempted to do that. So they went to underserved areas, and they put up more grocery stores. And then they looked to see if it had impact on the blood pressure of the residents, the weight of the residents in those neighborhoods, and also whether or not people actually went to the grocery stores and made healthier choices. And what they found was it didn't impact any of that.
Now conservative outlets looked at that as if there is no reason to put grocery stores in those neighborhoods. But when I see that information, I just see that that's not the sole piece of the puzzle because if there's no educational component, it's hard to change behavior. So one of the things that I try to do, I try to provide that educational component. Hence, I do cooking classes and give lectures and get in the community and teach. As a matter of fact, literally after this, I'm going to be doing a cooking class in a hospital for Medicare patients.
So having a grocery store is one thing. But then, like Dr. Peek said access is another thing. If the grocery store is there and people can't afford the groceries, just because it's there doesn't mean, you know, people can actually utilize it. So now we have to figure out to make sure that people actually have the resources to actually go to the new grocery store that's in that neighborhood.
And I think you made an excellent point with education, the educational piece, because even if you do have a grocery store, if people eat processed foods — and the over-processed stuff is probably the worst for you, I would imagine.
And but it's — you know, if you're used to it, it's easy, and that's what you've eaten.
And I do want to point out one thing. When it comes to processed foods, that's really an American issue. That is not solely a Southside issue.
And the USDA did a study where they actually looked at the percentage of calories that come from ultra-processed foods for the average American. And they broke it down by ethnic group. So for the average American, 6 per of our calories come from ultra-processed foods.
And what I mean by ultra-processed, these foods contain, you know, chemicals and ingredients that aren't even really food to begin with. These are really industrial ingredients that you can't have access to at a local store. Like, for instance, if I wanted to go home and make whatever commercial sweet that people love, like, I can't get yellow number 5 and some of these industrial dyes. Like, I don't have that in my cabinets, nor can I go to the grocery stores to buy that.
But that's what's in the food that we eat. So what they found was for the average American, 60% of our calories came from ultra-processed food. When they looked at African-Americans versus Caucasians, they found that there was no difference — no difference.
Yeah, I was just going to say I would bet $1 that if you looked at a study in rural areas, rural America, you would find exactly the same thing as far as the processed food situation because that's just what people do.
Yeah, and rural areas also can be considered food deserts. So if, you know, there's a grocery store, you know, 20 miles away from someone and they don't necessarily have access to a car, they live in a food desert even though there may be farms surrounding them.
Another question from one of our viewers — what sort — this is from Veronica. She asks, what sort of options does a senior citizen without insurance have? And that again is a challenge because if you — you know, what do you do if you're in a situation like that? How do you afford healthy food?
Does she mean for medical care?
Well, that's a good question. It's kind of an open ended — senior citizen. Yeah, I guess she does say insurance. So maybe for medical care and — yeah.
Mm-hm. So despite large gaps in the safety net within Chicago, we at least have a safety net. So I moved here from a city that had no public hospital. And so we had very few community health centers.
We actually had one where I worked. And we had no public hospitals. So at least there are a number of networks of community centers.
There are several charity hospitals. There are Stroger hospitals where people can at least go for medical care and know that they will be charged on a sliding scale fee or no charge at all if you don't have insurance. And so there are options for people who are in this country who don't have insurance and have places to go for medical care if you're in a city like Chicago.
And so there are still barriers to access. You know, we have not solved the health care crisis, certainly, and there are attempts to erode the gains that we've made with the Affordable Care Act. But if you are a senior and don't have health insurance, there certainly are options for places that you can go to get medical care.
Dr. Miller, can you tell us a little bit more about the Urban Health Initiative and some of the outreach efforts that happen?
Certainly. One of the programs that I described a moment ago, the Pediatric Asthma Center, is actually part of the outreach that we're doing within the urban health initiative. But we also are able to provide community-based programming that can address many of the issues that we've talked about a moment ago.
We've had the opportunity to have Dr. McDonald participate in one of our community grand rounds lectures in which we go into community sites, and we have University of Chicago faculty members on the same platform as people in the community that are addressing issues around health and well-being. The events themselves are planned by community members along with support from University of Chicago faculty and staff. The program is in its ninth year of operation, and we've had topics as broad as looking at issues around healthy eating and healthy living.
We've had people to come in who have been able to address a lot of the issues around nutrition but also things like, how do you raise healthy teenagers in the 21st century? What about positive parenting? How do you address issues around violence in the community, keeping your kids safe. How do you address issues around work, and how does work contribute to health and well-being? So again, we really do think about health in the broadest sense, that it is the complete presence physical, mental, and social well-being and not just what we're able to provide through health care.
This question is open to anybody or all of you. Tell us about some of your work, your own work and research, that you've done to address some of these health disparities.
So the diabetes program that I was telling you about earlier, the 10 year project that's based here at the University of Chicago, is actually a research project. And so we're not testing drugs or anything. We're just trying to find solutions that are effective.
And so everything that we do from our food prescription program to our mobile texting program to our patient education classes that we've rolled out into church communities, all of those are testable interventions with hypotheses that we collect data about. And we've been fortunate to have very creative teams that have patients on them and community members so they're well-informed. And we've been finding solutions and strategies that work.
So people are doing better about managing their diabetes. Their diabetes is getting improved. And so we're hoping that will translate over time into fewer complications and fewer hospitalizations. And so those are — that's a body of work that is not just helping people here on the south side but is being used as a model nationally for other cities and other countries. We've been invited to go to South Africa and New Zealand and the Netherlands to talk about what we're doing here at the University Chicago that can be done and translated in other settings.
That's pretty impressive. How do people — if somebody wants to learn more, if they want to attend a class or something like that, how do people find out about this?
On our website.
Great, and we will put these links up in the comments section as well. So you don't have to write any of this down or anything if you're watching. We'll put these up afterwards so people can find this information. And Dr. Miller, I'm curious again. Same question — what kind of work are we seeing here?
So one of the projects that I've been working on, which is sponsored through both the Urban Health Initiative and also through other funding, is something called ECHO Chicago. It stands for Extensions in Community Health Outcomes. And what we do is that we train providers in the community that work at community health centers to address some of the issues that trouble patients that don't have insurance or may only have Medicaid for insurance in order to provide them with better health through health care.
So it's almost as if they're doing a virtual consultation with specialists here at the University of Chicago in a telemedicine format. They join us about once a week in order to learn a little bit more about the care of things like anxiety, depression, serious mental illness, the care of high blood pressure, and other conditions so that patients can receive care in the settings that they're normally accustomed to in community health settings. And it helps to provide the providers with a lot better information on how to care for these patient.
I'm so glad you brought up mental health issues because that's such a stigma obviously attached to many mental health challenges. And it's difficult, I think, to find care, oftentimes. There are fewer mental health care providers possibly than other health care providers. What kind of help is there for residents that specifically have mental health issues or are worried about that?
Well, one of the things that we're building through our behavioral health integration series within ECHO Chicago is working with health centers and the existing staff. So customarily, these are either family physicians, advanced practice nurses, also known as nurse practitioners, and social workers to train them how to both identify and do a better job in treating patients that have anxiety, depression. And now we're actually running a research study on the care and treatment of patients who may have serious mental illness, and so thinking about conditions like bipolar illness or schizophrenia and how that care can take place both identifying it but also care within the primary care setting, and then partnership with other community mental health organizations.
And I imagine medication is also an issue there as well. If you have folks that can't afford medication, particularly in situations like that, it's a real problem.
It can be a real problem. We try to work with the sites on ways in which they can select the appropriate medication for their patients in a cost effective fashion.
What a tremendous service that is. And Dr. McDonald, I know you — you talked a little bit about some of your nutrition classes, and you're getting ready to do one today. So you do a lot of community outreach through those classes.
And what kind of response do you get from people? Are they are they excited to learn? You know, is this new to the folks or not?
So people are very excited to learn, and people are also excited to share their experience.
So there are a lot of people who do have experience cooking. So it's not like people just never cooked before. So in any given class, I may have someone who's been the matriarch of the family who's been cooking, you know, for years and taught by their grandparent and so on and so forth.
Or I may have someone who's never really cooked a meal, you know — a man who's recently divorced, who's on his own doesn't really know what to do. So when we do a cooking class, it's really a communal event, to some degree. And right now, I'm running a project with the Comprehensive Care Center where I created their nutrition curriculum.
And the goal of the curriculum is really to try to educate people about the US dietary guidelines and use nutrition classes and cooking to see if we can actually get people to be more adhered to some of those guidelines. So I really just provide some of the information and also give people recipes, especially low cost recipes, that most people may have access to. And I really demonstrate not only just the recipes but also the techniques.
So when I went to culinary school myself, there was a big emphasis on not necessarily being reliant on recipes but understanding the techniques, which means you have the skills to just cook. So I show people the techniques that they could apply to anything that they want to do without needing any recipes. And that's really having a true understanding what it means to cook.
What about seniors when it comes to nutrition? Because one of the things that has always kind of struck me — I've got elderly parents and —
— my mother has dementia and Alzheimer's. So she doesn't obviously cook anymore, and my father never really did. And it's pretty obvious now. He's put on a lot of weight and, again, probably kind of what we were talking about earlier, eating the prepackaged stuff and that sort of thing. So is there help for seniors that need to learn this as a new skill?
Yeah. So the class I teach is specifically for seniors. So you have to be a Medicare patient, actually, to qualify for the class.
So seniors, I mean, there are some specific issues that may involve seniors. So sometimes as we age, we develop difficulties chewing in terms of poor dentition. So some of those issues need to be addressed because people can't have foods with, like, harder textures. And then some people can develop conditions where there is difficulty swallowing associated with some of those conditions. So when people are developing feeding difficulties, they do require some physicians to actually identify why they're having those troubles and specifically modify their diet based upon whatever the underlying reason is.
Very interesting. Dr. Miller, I think this one is for you. Are you seeing an increase in post-traumatic stress among youth impacted by violence?
Absolutely. We are seeing youth who come into the medical center and also youth in the community that have been impacted by violence. And actually, one of the programs that I have been working on in conjunction with the Logan Center for the Arts and Urban Gateways is designed to address that program.
The program is called WRAP. It stands for the Wellness Recovery Arts Program. We've been doing this program for a couple of years. And we bring kids in from schools within the Chicago area that have been exposed to violence in one way or another to work with trauma-informed teaching artists in order to express some of the concerns that they have had around their feelings and frustrations and the experiences that they've had. Very successful program — we received funding through the University of Chicago to actually expand the program last summer, and we're going to continue doing that over time.
That's fantastic, and I know we have programs within the hospitals themselves too to help kids that are impacted in one way or — either of victims of violence, or maybe they've witnessed something. And it's got to be pretty tough.
And can I add one more thing about trauma?
Trauma is one of those things that really impacts everyone.
It really does. And in my weight management clinic, I see it every single day. So whenever I see a patient, one of the first questions I ask really tries to get to the bottom of, you know, when people started gaining weight.
I try to identify some of the factors that contribute to weight gain. And some of those factors are beyond just what we're eating. You really have to get to the root cause of some of the behavior. And oftentimes, people bring up episodes of trauma.
And the trauma can be sexual trauma, which unfortunately does happen. Or it could be trauma to a loved one. So I've seen plenty of people who've had children who passed on due to violence. And that was the root cause for some of the behaviors that led to weight gain.
So people started to rely on comfort food just to feel better, just to help get through the trauma. So it is a very complicated issue, and it's not something that just solely affects kids. It affects families. It affects neighbors. It affects everybody.
So we are nearing the end of our half hour. This went quickly.
It certainly did.
So I'd like to get some closing thoughts. And Dr. Peek, if we could start with you, you know, how do we move forward as a community, as a society, to try to make some of this better?
Yeah. I think that we're good time and space for that — that as a country, we are looking more towards activities and programs that bring the medical centers out into the community and the communities into the medical centers, trying to integrate medical and social needs of patients all at the same time. And we're certainly starting to do that here. And so I think there's a lot of hope for our ability to really address some of the root causes of disparities with health care teams being a key part of that solution.
It's about partnership. In addition to having physicians here who are interested in promoting health and well-being, we need to know from you, as community members, what kinds of things you think are of highest priority? Because it may not necessarily be the kinds of things that we work on here at the University of Chicago. But we have wonderful resources and opportunities to partner together to figure out how we can tackle some of these really tough problems in our society.
I agree with everything my colleagues have said, and I would also add empowerment. So with those partnerships, I want to see people to feel empowered to go into the communities and also partake in improving the care of their own communities as opposed to me as a physician being the one who dictates everything that should be done. I want people to have the skill set and the tools to take care of things on their own to the best of their ability.
All great information.
Thank you, guys. Appreciate it.
That's all the time we have for on At the Forefront Live today. I want to thank our viewers for their great questions. And if you want more information about some of the health topics we discussed on today's program, you can visit our website at uchicagomedicine.org.
And we will put some of those links in the comments. So we'll make sure we get that in there as well. Or you can call 888-824-0200 and join us for our next At the Forefront Live. That's Thursday, February 21.
That's when we'll discuss head and neck cancer and some of the latest treatments that are available. Also check out our Facebook page for future At the Forefront Live dates and subjects. Thanks for watching. Have a great week.
Many African Americans living on Chicago’s South Side suffer from chronic health issues such as diabetes, heart disease and high blood pressure. We spoke with UChicago Medicine community health physicians and experts Doriane Miller, MD, Edwin K. McDonald IV, MD, and Monica Peek, MD, MPH, to discuss what it will take to create a healthier South Side.
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