November 4, 2010
After a Study, Healthy Changes Block by Block
By JESSICA REAVES

Seven years ago, Leony Calderón felt much older than her 30 years. “My joints hurt so much, it was hard to go up stairs,” Ms. Calderón said last week at her office at the Greater Humboldt Park Community Diabetes Empowerment Center. Dangerously overweight, she stopped menstruating, had high cholesterol and was pre-diabetic. She knew something had to be done.

Humboldt Park, where Ms. Calderón lives and works, is the heart of Puerto Rican life in Chicago. It is also, as researchers from the Sinai Urban Health Institute discovered, the site of a full-blown diabetes epidemic. A survey conducted by Sinai and local community leaders from 2000 to 2006 showed that 21 percent of Puerto Ricans in Humboldt Park were diabetic, compared with 4 percent of Mexicans living in the same neighborhood and 11 percent of Puerto Ricans in New York City.

The alarming findings could have easily faded from public view. But this information was hardly academic. It was the product of a 500-question survey written in consultation with community leaders, conducted by local residents and intended to promote a healthier lifestyle. Those factors, said Steve Whitman, director of the institute, set the survey apart from other urban-health initiatives.

The results resonated within the community, Ms. Calderón said, in part because people trusted their interviewers. “It’s always easier to talk to a friend or a neighbor about something personal like health,” she said.

Mr. Whitman said that because the community felt ownership of the data, residents were more compelled to act on it.

“We showed up at a meeting after the results came out, and we thought maybe there would be 50 people there,” he said. “Instead, 700 people showed up.”

That enthusiasm has inspired an array of community health initiatives, including improved produce selection and availability at local markets and free diabetes screenings at a local health center.

“People have been talking about racial and socioeconomic inequities in health forever,” said Ami Shah, a senior epidemiologist at the institute. “But having these numbers that are personal, relevant, local — people start to react and respond in a new way.”

Knowing that a problem exists, of course, is only one step. The challenge for underserved communities like Humboldt Park is to keep it from getting worse.

“You can get a patient the exams they need for their diabetes, but in order to bring things under control, they have to exercise and eat the right food,” said Romana Hasnain-Wynia, director of the Center for Healthcare Equity at Northwestern University Feinberg School of Medicine. “They need to feel safe walking outside, and they need grocery stores where they can buy fruits and vegetables.”

Those are a few of the issues Humboldt Park activists hope to address with a new program called Block by Block. Part health-education campaign, part epidemiological survey, Block by Block encompasses the 72 blocks of Humboldt Park and offers residents free cooking instruction, support groups and exercise classes.

Ms. Shah, along with Mr. Whitman and Maureen Benjamins, is co-editor of “Urban Health: Combating Disparities with Local Data.” Clunky title notwithstanding, the book, which was published in October by Oxford University Press, is engaging, detailing the key public health findings from eight years of individual interviews in eight diverse Chicago communities.

As the Sinai data have shown over the past few years, Humboldt Park is not the only neighborhood in the Chicago area facing serious public health problems. Researchers found that 40 percent of adults in North Lawndale smoke, compared with 20 percent nationwide and citywide. And though 25 percent of children in the United States are obese or overweight, two-thirds of the children in the survey communities fell into those categories. Obesity is a particular challenge, investigators discovered, in the Orthodox Jewish community of West Rogers Park.

The specifics of the Sinai approach — change-oriented and invested in the fate of a neighborhood — are distinctive, but they also reflect a sea change in the overall strategy of public health professionals, said Janine Lewis, executive director of the Illinois Maternal and Child Health Coalition, a nonprofit advocacy organization in Chicago.

“I think the field is becoming more responsive to the idea of community-based participatory research,” Ms. Lewis said. “Those of us in the field realize that community members are experts on the needs and gifts in their communities, and should be consulted” at every phase of research.

This approach, she added, not only helps investigators devise more meaningful questions, but also means residents feel a part of the process and motivated by the results.

That sounded right to Ms. Calderón, who sees the impact of those results first-hand, every day. Now 50 pounds lighter, Ms. Calderón is the physical activities coordinator for Muévete (Movement), a component of Block by Block. She teaches an overflowing slate of weekly fitness classes at the Humboldt Park Field House and at the Diabetes Empowerment Center, including three dance-aerobics classes and two yoga sessions.

Because of her weight and her family history, Ms. Calderón is still pre-diabetic, but is healthier in nearly every way measured by the Sinai health survey.

This is precisely the kind of result Mr. Whitman said he and his colleagues had hoped for — and the reason for the Sinai approach to public health research.

“Lots of people analyze and demonstrate health disparities,” he said. “The point is to fix them.”

jreaves@chicagonewscoop.org