Community research maps out South Side resources

There are as many liquor stores and bars as primary care clinics, almost twice as many food pantries as large grocery stores, and twice as many dialysis clinics as weight loss centers on the South Side of Chicago New research from the University of Chicago Medicine inventories community assets on Chicago's South Side and documents how they differ compared to a proposed national framework for population health improvement. The study, published this week in the American Journal of Public Health, also offers the first identification and classification of thousands of community assets in a 62-square-mile region encompassing more than 19 of Chicago's 77 neighborhoods.

This study is the latest effort by a group of UChicago Medicine researchers to promote healthy communities by mapping, cataloging, and providing South Side residents information on available resources within the community. Health statistics on the South Side are typically grimmer than other areas of the city. The University of Chicago Medicine's most recent Community Health Needs Assessment shows increased rates of cancer, diabetes, obesity, and asthma on the South Side. Other work looking at average life spans show residents living in the South Side neighborhood Washington Park have an average of 69 years, while residents eight miles north in Chicago's Loop have an average of 85 years.

"Our lab is motivated around the concept of engineering solutions to injustices in partnership with the people who are suffering the injustice," said Stacy Tessler Lindau, MD, associate professor of obstetrics/gynecology and medicine-geriatrics at the University of Chicago.

Lindau is director of the South Side Health and Vitality Studies at the University of Chicago. Her research group led development of MAPSCorps (Meaningful, Active, Productive Science in Service to Community), a program that provides work experience for local high school students who are paired with college-age adults to survey and map businesses and organizations that serve the public. Previous work from Lindau's group showed that the best available information sources failed to capture as many as 40% of South Side resources.

"If you want to find a resource in the Loop, you Google it. If you want to find all the resources in higher-poverty communities, you really don't have a reliable information source," said Lindau. "So the people who most need those resources and information don't have it and there is a mismatch between the need and the quality of the information. We've been trying to narrow and close that gap by working together with people from across our community."

Identifying and categorizing community assets

The 2011 "intersectoral health system" model advocated by the U.S. Institute of Medicine (IOM, now the National Academy of Medicine) identified a set of seven sectors that represented "powerful actors" for health within a community, including the clinical care delivery system, community, governmental public health, employers/businesses, media, education and government agencies. In the proposed system, these sectors would be coordinated by a government public health agency.

"We wanted to know how the intersectoral health system idea looks on the ground with real local data," said Lindau.

After MAPSCorps youth mapped more than 8,000 businesses and organizations providing goods and services on Chicago's South Side in 2012, Lindau and colleagues compared these data to IOM's model for population health improvement. The researchers translated the model by first tackling how to determine what businesses and organizations belonged in which sector, while adding some new sectors to the model to account for other important resources.

"The people working toward better health and vitality in this region are inspired by the idea of an intersectoral health system. We believe that healthcare alone can't do it we need to be working together across sectors of society and, as a starting point, we need to know where and what the assets are," said Lindau.

Results revealed an imbalance in the types and proportions of South Side community assets. Among them: There are as many liquor stores and bars as primary care clinics and nearly twice as many food pantries as large grocery stores. There are also nearly as many dialysis clinics as there are eye clinics. They found only five weight loss centers in an area where a study found that nearly 55% of people ages 35 and older are obese.

One of the most notable findings was the difference between the "powerful actors" envisioned by the IOM framework and the dominant assets on the South Side of Chicago. For example, there was very limited physical presence of government public health and the media in the region.

"We need to look together with our public health leaders at the city, county, and state level to understand who will coordinate the intersectoral health system and how does a large, highly populated geography like the South Side of Chicago best engage with the public health coordinators, even if they are not physically located in this region," said Lindau.

Optimistically, the study showed there are hundreds of places for social gathering, arts and entertainment, child care, and social services, assets that can have positive health and social impacts.

Linking patients with community health assets

Lindau is director of CommunityRX, a program supported by a Healthcare Innovation Award from the Centers for Medicare & Medicaid Services, a technology that can be used to connect patients with various community services they may need. The program allows health care providers to "prescribe" an individually tailored list of nearby community resources based on the diagnosis in a patient's electronic medical record. For example, the program might list nearby weight loss or child care facilities.

"We have taken the data about the resources in the community and made it possible for those resources to talk to the electronic medical record," Lindau said. "So patients get referrals to local community organizations that support wellness and other basic needs, helping patients take care of their health above and beyond what the doctor can do."

Lindau started a company, NowPow, to commercialize the idea. Headquartered on the South Side of Chicago, NowPow purchases community resource data from MAPSCorps and 'e-prescribes' community resources by integrating with electronic medical record platforms, enabling patients to use local businesses and grow the local economy.

This study did not investigate the quality of resources in the community or test solutions for the South Side's resource disparities. The team hopes that by building on the conceptual work from IOM, their approach can be a blueprint for other communities working to implement a cross-sector health system that engages the local players within their community for the betterment of the community.

"As other communities develop their resource data infrastructure they now have a template for how to plan their own intersectoral health system," said Lindau. "Our work describes a large scale local effort, including youth, to translate the IOM vision for population health improvement to the real world. We present findings that we hope will accelerate and benefit the effort in other cities and regions."