issue Summer 2021

Partner for Health Equity

By Judy Masterson, Photos by Michael R. Schmidt
Waukegan residents in ZIP codes 60085 and 60087, disproportionately low income people of color, according to the U.S. Census, bear the brunt of fine particle and groundwater pollution from a coal-fired power plant that sits on the shore of Lake Michigan.

When epidemiologist and Chicago Medical School Assistant Professor of Medicine Maureen Benjamins, PhD, looks at ZIP codes, she sees a picture of health disparities that she is trying to upend.

Across the nation, in Lake County and in Chicago, where Dr. Benjamins oversees a longstanding partnership between the Chicago Medical School and the Sinai Urban Health Institute (SUHI), ZIP codes are proxies for health, longevity and a host of social risk factors. They also reveal racial and economic segregation that, studies show, result in concentrated areas of low public investment, high poverty and poor health. ZIP codes also show how COVID-19 has taken a greater toll on low-income Black and Latino communities, which have suffered disproportionately high rates of infections and deaths.

“Lake County is one of the most disparate counties in the state of Illinois,” said Dr. Benjamins, a senior research fellow at SUHI. “The COVID pandemic has pushed to the fore the underlying inequities that have been there all along — not because of race, because of racism. It’s important to get granular with local data — neighborhood and ZIP code data — to tailor and target interventions accordingly.”

Health department data plotted on interactive health maps for two neighboring communities reveals a ZIP code tale of two cities. RFU’s home community — ZIP code 60064, where 28% of the population is Black and 33% Latino — has the highest number of people in the county living below the federal poverty level at 30.8%, and the highest rate of obesity at 35.7%. Immediately south of the university, in ZIP code 60044, just 4.8% are poor and 14.6% obese. Residents in 60044, who are 92% white, live on average more than 10 years longer than their neighbors to the north.

The College of Nursing will include a nursing education-to-employment pathway for underserved youth hailing from the highest hardship index ZIP codes in Lake County. This pathway is intentionally designed to improve two key SDOH — access to education and health literacy.

“The truth is we have structures that support the development of disease in our underserved communities,” said Sandra Larson, PhD, CRNA, interim dean of the planned College of Nursing. “If 85% of health is determined by social factors, then the solution to population health demands a redesign of our payment systems and models of care. New models of care must educate, empower and facilitate a community’s capacity to maintain optimal health across the life span.

“So we need to keep working to understand the social determinants of health (SDOH) and ask ourselves as an academic institution, ‘How can we continue to intensify our work with the community to improve the social determinants?’”

The College of Nursing will include a nursing education-to-employment pathway for underserved youth hailing from the highest hardship index ZIP codes in Lake County. This pathway is intentionally designed to improve two key SDOH — access to education and health literacy.

The university has long worked toward improved health equity on many fronts, collaborating on numerous strategic educational partnerships, curricular innovations, and community health outreach and cultural awareness initiatives in its neighboring underserved communities. When the university’s mobile health clinic, dubbed “the Care Coach,” discovered resistance to COVID testing in local schools, it launched an education program led by its bilingual clinic manager — a nurse practitioner from the community.

Now RFU is adding a crucial piece: community-based research. The university intends to leverage and synergize its grassroots health equity efforts with the addition of a new program in epidemiology. The highly-collaborative research initiative will engage new and existing partners who are already working to systematically identify, prevent and eliminate health disparities in local underserved communities. The recruitment of a research-oriented epidemiologist is underway.

Students evaluate an area resident during a community health screening event held at Foss Park in North Chicago.

“A dedicated faculty member devoted to community-based research — focused on root causes, prevention and data collection — can help us make positive, sustainable change among our neighbors and even at the policy level,” said Executive Vice President for Research Ronald Kaplan, PhD. “We want to listen to and work with communities to research the issues — the barriers and opportunities — and to develop strategies aimed at improving health and access to care. We need to research the effectiveness of those strategies. It’s not enough to know what the problems are. We have to know if attempted interventions are effective. That’s the power of research.”

Dr. Benjamins directs an intensive summer internship program for medical students focused on health equity research. There has been a surge of student interest in the program, which looks behind ZIP codes at structural factors and SDOH like the built environment and neighborhood. The work has resulted in several papers and community-driven interventions staffed by community health workers, including several in response to high rates of asthma, diabetes and breast cancer in Black and Latinx neighborhoods.

“There have been decades of work on this, but in a lot of places, including Chicago, racial inequities are getting worse,” said Dr. Benjamins, whose soon-to-be-published book, “Unequal Cities: Structural Racism and the Death Gap in America’s Largest Cities,” includes a review of the history of efforts to address inequities. “That shows that what we’ve been doing has not been working. The more RFU’s new epidemiologist and research program can be collaborative with community groups and driven by priorities from the community, the better. It’s a different model than clinical research or bench science. It can be a lot messier and slower, but it’s the only way to go.”