Researchers and Community Members Unite to Promote Good Health

The University of Chicago Medical Center and the Kovler Diabetes Center are proud to support the South Side Health and Vitality Studies (SSHVS).  We spoke with the Director and Principal Investigator , Stacy Tessler Lindau, MD, MAPP, to learn more about this incredible program.

What are the South Side Health and Vitality Studies?

The SSHVS are a family of inter-related studies designed by university researchers working with community leaders to produce knowledge that people can use to improve our lives, our health, and the vitality of our communities. We are focusing on generating knowledge that leverages the places that provide goods, services and jobs for the South Side and that leverages communication technology access and use.

What is the Center for Community Health and Vitality?

The Center for Community Health and Vitality (CCHV), led by Dr. Doriane Miller, works to provide community members with evidence-based knowledge about health and vitality issues prioritized by the community. The SSHVS is generating important, useful knowledge for the Center’s activities in the community.

Why are these initiatives important for the South Side of Chicago?

Chicago is one of the greatest cities in the world, with tremendous potential and will for growth. But poverty and health inequities are very real issues here that limit the ability of individuals to reach their full human potential. These initiatives complement those in other parts of our city, such as the work of west side communities with the Sinai Urban Health Institute, or the investments by the MacArthur Foundation in the Local Initiatives Support Corporation/New Communities Program. In these examples, health and community development organizations are working with other sectors, including the City leadership, to solve previously intractable problems with innovation based on evidence.

How will the CCHV and SSHVS achieve these goals?

We are part of a larger effort, the Urban Health Initiative (UHI), led by Eric Whitaker, MD, MPHExecutive Vice President, Strategic Affiliations and Associate Dean, Community-based Research. Our vision is that the South Side of Chicago will be a model of excellent urban health by 2025. We have created a working model, a playbook so to speak, for our work, called an Asset-Based Community-Engaged approach. First, before we build more or invest more, we figure out what we have. The asset census project, led by Daniel Johnson, MD and myself, takes an electron microscope approach to community assets. This project, which creates jobs for high school students and other community members, generates the most comprehensive data available about community assets. Anyone with an internet connection can use this information – and it’s already been used by more than 10,000 people for practical and research purposes. Early next year, we will launch a population health study to begin to understand what kinds and distributions of built assets appear to promote or be protective for health. In addition to research, the UHI focuses in two other areas that align with the core mission of our medical center: patient care and education. Through the SSHVS Collaborative, UHI is linking South Siders to primary care providers working together in a newly formed healthcare system. The South Side has never had a coordinated system of health care. There are also many educational initiatives, including training our medical students to work with our surrounding communities and providing incentives for promising residents from our training programs to stay and practice on the South Side.

Who is involved in these initiatives?

It’s fair to say that hundreds of people are involved in these initiatives, including university faculty, staff and students working alongside community leaders and residents. We even have faculty from other universities and leaders in the public sector working with us.

Where will these initiatives take place?

These initiatives are taking place on Chicago’s South Side, a 34 community-area region that comprises the primary service area of the medical center.

What is your role with SSHVS and its initiatives?

I am Director and Principal Investigator of the SSHVS.  I lead a major component of the research and discovery for the UHI. I am also a practicing gynecologist with experience working at one of the South Side Healthcare Collaborative federally qualified health centers, university student care, and now providing care for women in our community with cancer and sexuality concerns.

How prevalent is diabetes in the South Side community?

Unfortunately, we know of no current data to answer this question. First of all, many people (perhaps as many as half) who have diabetes do not know they have it. They are undiagnosed. The best available data on diabetes prevalence come from the National Health and Nutrition Examination Survey (NHANES), but these only generalize to the level of Cook County and we have reason to believe diabetes rates may be higher here than in wealthier parts of the county. Estimates of diabetes prevalence from clinical data only tell us about the proportion of people in the health care system who have diabetes, not about those who don’t have health insurance, don’t use health care, or who have undiagnosed disease. If the South Side looks like the rest of the county or nation, rates are going up. Among older adults, rates of diabetes may be higher than 30% if we include those with undiagnosed disease.

What is SSHVS doing specifically for the diabetes community on the South Side?

Our approach has not been disease-specific. It is holistic. We are interested in knowing globally what we can do to create an environment where people are healthier and have fewer opportunities to develop disease. That being said, much of the data and work we are doing is of direct relevance to diabetes; it is a good example of a highly preventable, costly, environment-sensitive disease that could be impacted should the UHI work prove effective. We are working with diabetes experts at the Kovler Center, including Graeme Bell, PhD, Monica Peek, MD, MPH, Marshall Chin, MD, Doriane Miller, MD and others to ensure that the knowledge we generate is relevant for stemming the tide of diabetes and diabetes risk in our community.

We are providing data to the CCHV for its evidence-based programming and to other researchers and policy makers who are using the data in ways that should buffer against forces that are promoting diabetes in our community. Looking at our asset census data, we find that there are more than 8 times as many fast food restaurants as there are weight loss facilities per 10,000 population in our communities. And there are as many dialysis centers as there are weight loss facilities. How many pounds could be lost or gym memberships could be supported for the cost of just one patient per year on dialysis? This is the kind of question we have to be asking. Dialysis centers are big business and they go where the disease is. Studying the asset environment gives us empirical data about the distribution of disease in our communities.

What’s been the most interesting or challenging aspect of this initiative, for you personally?

I was at a meeting of the Robert Wood Johnson Clinical Scholars Program this week. I, along with Eric Whitaker and others working on similar efforts around the country, was a Clinical Scholar at the University of Chicago in 2000-02. The Clinical Scholars program has remained an important intellectual home and inspiration for me throughout my career. It has given me the skills and affirmed the values that make it possible to think big and to overcome institutional and societal barriers to solving big problems. At this meeting and other venues where smart people are working hard to solve health inequities and improve community health, I have realized that our biggest challenge is translation. How do we take the kind of research that gets people promoted in academe and make it align with the kind of knowledge and discovery that can transform a whole community?

There was a panel discussion at the RWJ meeting about workforce reform and what should be done to ensure that we have the right mix of people providing health care for the future. I asked the panel to imagine that a large urban community, say the South Side of Chicago, was working together toward the vision that we would become a model of excellent urban health by 2025. I asked them, based on all their work and expertise, to advise me on how we can ensure we have the right work force to provide basic health care for our 800,000 person population. The responses illustrate the challenge before us: a physician on the panel said I should look around the world (nowhere in particular), because we don’t have an answer to this question in the U.S. A medical school dean said “I applaud your megalomania.” A nurse dean emeritus on the panel pointed me toward restrictive regulation in Illinois that prevents nurses from practicing at the top of their skill set and suggested we work on changing that policy. So we have a very long way to go, not enough time, and we have to really think way outside box. I was looking for something much more concrete.

I’m a gynecologist, so I’m working beyond my formal training in asking these questions. If I don’t know something, I assume someone else does. How can we not have an answer to a community that simply wants to know how many doctors, nurses, dentists, social workers, and health outreach workers it needs to provide the basic services for its citizenship? One person commented that workforce planning is anti-American. Can we realize the vision of excellent urban health in a high poverty community without violating the basic principles of our democracy? Do we have the knowledge to do this? Are the research questions being asked at the right level with the population or the profession at the center of inquiry? These are the challenges.

Stacy Tessler Lindau, MD, MAPP, Director and Principal Investigator of the SSHVS

We are working on launching a new cohort study in two epicenters on the South Side – one a predominantly African-American region, the other a region with a large Hispanic population. This study will provide us with the deep dive into understanding how the built assets in the community are being used to stay healthy, get healthy and manage disease and how people are using communication technology to access assets in the community or beyond. We are also hoping to collect biological information that will give us much-needed insight into the prevalence of undiagnosed disease and disease risk.

We thank Ms. Lindau for taking the time to answer our questions.  To learn more about the SSHVS, please visit their website.