Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=214860
Story Retrieval Date: 12/12/2013 6:16:45 PM CST
Samantha Andreacchi & Kimberly Shine/MEDILL
This is the first in a series of stories about combating diabetes on Chicago’s South Side.
Diabetes strikes African-Americans on Chicago's South Side at twice the national average. An innovative program strikes back with fresh food options, health care and exercise to combat the high prevalence of the disease.
The prevalence of Type 2 diabetes is a staggering 19.3 percent in this community—triple the city's average.
This diabetes crisis in Chicago is worsening as obesity rates rise and formidable barriers in many South Side neighborhoods make the illness particularly difficult to self-manage, said Dr. Marshall Chin, professor of Healthcare Ethics in the Department of Medicine at the University of Chicago.
“Unless we do a better job bringing the disease under control and preventing it, a lot of people will suffer,” Chin said.
To combat the epidemic, Chin and Dr. Monica Peek helped spearhead a South Side diabetes program aimed at empowering those living with Type 2, or adult onset, diabetes to start living healthier lifestyles. Peek is the associate director of the Chicago Center for Diabetes Translational Research at the University of Chicago.
The program is partnering with stores and food pantries in food deserts to offer healthy food options. It is also involving neighborhood clinics and exercise programs. Now four years old, the program continues to expand partnerships with community leaders, churches, businesses and exercise facilities.
Those interested in participating can visit one of the six health clinics, attend upcoming events, or contact community organizations involved in the program. For more information, visit http://southsidediabetes.com and click on the Google map below for clinic locations.
“We need to marshal the resources of both the healthcare system as well as the community because if people are going to do well from diabetes, they need to have a healthy lifestyle,” Chin said.
Chicago was chosen as one of five cities nationwide to participate in the Alliance to Reduce Disparities in Diabetes, a national initiative developed and funded by the Merck Foundation to enhance the quality of diabetes health care and empower patients with the disease through national, regional and community-based efforts.
The Merck Foundation committed $15 million to the five-year program, which runs through the end of this year. Each alliance committee serves low-income and under-served populations with a high prevalence of Type 2 diabetes.
The University of Michigan's Center for Managing Chronic disease coordinates the Chicago program, called Improving Diabetes Care and Outcomes on the South Side of Chicago.
Funding from the National Institutes of Health will support the Chicago area program beyond 2013, Peek said. She said additional grants will be sought as well.
One barrier for diabetics is the lack of more nutritious food in food deserts, urban areas with little or no access to fresh produce or large grocery stores. The gap makes it difficult for people in these communities to find healthy food options, Chin said. As a result, they often turn to quick-and-easy alternatives such as fast foods, which often have high fat content.
“It’s really critical that we do a better job as a society of developing healthy food options,” Chin said.
There is also a general mistrust of physicians among many African Americans, which is typically passed down through generations, Peek said.
“People’s world views are shaped not only by their personal experiences but also the experiences that are handed down to them,” she said. “I may be affected by things that happened to my grandmother even though they didn’t directly happen to me.”
This, combined with the lack of healthy food alternatives, hinders people from proper diabetes prevention and education, including ways to effectively manage the disease.
“We know that the way that patients and doctors talk to each other have implications for people’s health, “said Peek.
But even those living in areas with insufficient diabetes care resources should still feel like they can reach out to physicians for support.
“If patients are more actively involved in their care, if they can understand what the treatment plan is, if they feel like they can trust their physicians, these things have also been associated with better adherence to care,” she added.
Diabetes can cause a variety of medical complications, including gout, blindness, kidney failure and heart disease, Chin said.
“People who live in predominantly African-American neighborhoods in Chicago have about five times the rate of leg amputation from diabetes as those patients who live in predominantly white neighborhoods,” he said.
Diabetes can damage nerves and blood vessels, causing poor circulation in feet and legs. In the most severe cases, amputation may be required.
“So we realize diabetes is a major problem,” he added.
“Any ways or opportunities that we can find for people and their doctors to come together in a partnership" can improve people’s health, she said.
While the exorbitant cost of diabetes health care and medication may seem like an obvious factor preventing those with diabetes from getting the care they need, there are still high-quality health care options for those who cannot afford specialized treatments, Peek said.
“A lot of medical care is costly, but Chicago is actually unique compared to a lot of other cities,” Peek said. “There are just a lot of community health centers whose mission it is to provide health care for people who don’t have any insurance and for people who have Medicaid.”
As a result, patients can still get high-quality diabetes care and qualify for Medicaid and the prescriptions they need, she said. The program and clinics will help people qualify, Peek said.
“It’s always sort of a challenge to not only motivate people to engage in lifestyle behaviors but then to identify resources and make sure their communities are optimally conducive to that,” Peek said.
To address these issues head on, Chin and Peek have merged community initiatives with integrated healthcare.
“We’re partnering with six clinics on the South Side, as well as related community organizations in those areas,” Chin said.
Participating organizations to provide fresh food options include Walgreens, Save-A-Lot, a local farmers market, the K.L.E.O Community Life Center, and a number of church organizations.
The farmer’s market and Walgreens offer healthy food options, Chin said.
“And we’ve been giving our patients food coupons to help encourage them to have these healthy fruits and vegetables in these food desert areas,” he added.
Hands-on training is also an important component of the program. For example, community members can attend the “Shop right, eat right!” grocery store tour at Save-A-Lot Grocery Store in the Kenwood neighborhood. Once a month, a registered dietician walks with participants through the store teaching them how to read food labels and uncover the healthiest options.
For a list of tour dates, visit the Improving Diabetes website at http://southsidediabetes.com or call 773-702-2939 to RSVP for upcoming tours.
The K.L.E.O. center in Washington Park also offers a monthly food pantry that not only provides healthy food options but also offers those with diabetes an opportunity to meet with physicians. The pantry is open the first Wednesday of every month from 2:00 p.m. to 4:00 p.m.
“We partner with them during the food pantry where we’ll do health screenings for diabetes or high blood pressure screening, we’ll link patients who don’t have a medical home to an existing clinic, and then we’ll teach cost-tailored recipes using the food that will be given out at the pantry at that time,” Chin said.
But getting South Siders to exercise can be difficult, especially since their neighborhoods aren’t always safe, Peek said.
So, Chin and Peek want to start building strong partnerships around physical activity and interventions, similar to the ones they have built around food options with organizations like K.L.E.O.
“We want to be able to do similar partnerships…so it can become easier for people to exercise. We’re continually trying to create opportunities,” she added.
Recreation centers including the YMCA and other places are low-cost community resources and would be good places to seek exercise programs, she said.
Despite the programs current successes in program networking, Chin said there is still more to do locally and nationally. It could all start with shared-decision making.
“It’s been found that team-based care —involving a doctor, a nurse, an educator, a social worker, community health worker— is often the most effective way to care for patients with diabetes,” he said.
As heart disease remains the number one killer of people with diabetes, Chin said as a whole, the system must improve.
But instead of awaiting this change, Chin challenges those with diabetes to get involved and become their own solution.
“Too often people are passive with their doctors and nurses. People need to become educated about their condition, ask a lot of questions and then participate with their doctors and nurses in a…decision-making process to figure out what works best,” he said.
Chicago clinics participating in the diabetes care program on Chicago's South Side