Black Chicagoans have a life expectancy of only 69.8 while other residents can expect to live 81.2 years, according to city statistics from 2022.
When you break it down by ZIP code, the gap is even wider. In the West Garfield Park neighborhood on Chicago’s West Side, residents’ life expectancy is less than 69 years, while those living in the Loop—the city’s central business district—typically live 85 years.
In an ongoing initiative seeking to close these gaps, the community engagement staff from Rush University Medical Center collaborated with representatives of the Alive Faith Network of more than 150 Chicago churches. That collaboration, known as Heart 2 Heart, resulted in a pilot program in which participants with uncontrolled hypertension lowered their systolic blood pressure by an average of almost 10 mm/Hg.
A reduction of 10 mmHg in systolic BP is associated with a 28% reduced risk of heart failure, 27% risk reduction for stroke, 20% for major cardiovascular events, and 17% for coronary heart disease, according to Elizabeth B. Lynch, PhD, a professor in the Rush Department of Family and Preventive Medicine and research director of the Alive Faith Network.
The health of residents on Chicago’s West Side is jeopardized by upstream factors such as poor access to health care, poverty and systemic racism which has left the area historically under resourced, and by downstream factors such as lack of exercise, poor diet and a mistrust of the health care system.
“Elimination of upstream causes is necessary to achieve social justice and health equity,” Lynch and colleagues wrote in the journal Prevention Science. “However, in the short term, targeting downstream factors such as blood pressure control may be one of the most immediate ways to reduce cardiovascular mortality and improve life expectancy among African Americans.”
Rush University Medical Center is part of the Rush University System for Health, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
This panel shows community health worker Anthony Hixson on a home visit, from a work by comics journalist Josh Neufeld, republished with permission by The Journalist’s Resource.
Food labels reveal health hazards
To build on existing relationships of trust, Rush and the Alive Faith Network organized BP screenings inside churches. They also recruited and trained community health workers from church congregations who then visited study participants in their homes and at church and counseled them on medications, diet, and action plans for their health.
Trainers included a primary care physician, a nutritionist and a nurse. They received 50 hours of in-person training and about 20 hours of online instruction.
The 79 study participants recruited from seven Alive Faith Network churches had an average of 7.5 visits with community health workers over six months.
The three community health workers encouraged participants to see their physician if they continued to have high BP readings despite taking their medication as directed. They discussed how to read and understand food labels to reduce sugar and sodium consumption. They also advocated boosting vegetable and whole-grain consumption and lowering intake of sugar-sweetened drinks.
Nutrition information on menu items from popular fast-food restaurants in the neighborhood was also distributed to study participants.
“The CHWs [community health workers] would give people a sense of what exactly they're eating and how much sodium was in it—and people didn’t really realize it before,” said Lynch, who is a professor of family and preventive medicine at Rush.
“Then another thing we focused on a lot was vegetables,” she added. “We created this list of all the vegetables we could think of and the CHW would go down the list and ask, ‘Which vegetables do you like?’—and then we encouraged them to eat more of those.”
The community health workers would also help study participants to understand the impact of their diet on their BP, as well as the importance of taking their medications as prescribed.
“We would also really work hard with them to link their own blood pressure readings to what they're eating and other behaviors—whether it's medication adherence or whatever,” Lynch said. “It was fairly new for people to be monitoring their own blood pressure in that way, but we tried to use that to teach them how their blood pressure is affected by different behaviors.”
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Familiar faces bring better health
BP readings taken by community health workers and by the study participants themselves were reviewed by a physician who would recommend changes in medication or a primary care visit if the levels were suboptimal.
One community health worker was lauded for going above and beyond these duties. And his activities included plumbing and carpentry work during his visits.
“The CHW position did a couple things for the church—No. 1, it provided presence and availability,” said Steve Epting Sr., pastor at the Hope Community Church.
“One of the things that happens when we work in the community is that research is not always understood, and medical conditions and concerns are not always completely understood,” he added. “But because our CHWs were available and present at the churches, when the need was greater, they were there. They were able to provide that context and direction during times of need.”
Secondly, Epting said, the community health workers were in constant communication with study participants, so trust was built between them that translated into trust in the project.
“Those two things were great assets to the work,” he explained. “They became familiar faces and were building relationships.”
Epting noted that he once weighed more than 300 pounds, but has shed 90 of those excess pounds. That weight loss boosted his health and made him an effective advocate for the work of the Alive Faith Network, which is to improve the well-being of members of the Black community.
While community health workers helped participants take their medication as prescribed, they were not always successful in getting their fellow church members to change their diet. The study notes, however, that they were valued contributors to the effort.
“Nearly all participants agreed that the CHWs helped them address intervention targets and provided benefit” that complemented the physician care they received, the study says. “Participants agreed that they participated in the program because it was in their church, that other church members supported them, and that the program was a worthwhile use of church resources.”
Read about the AMA’s commitment to eliminating Chicago’s life-expectancy gap. The AMA is working with the organization West Side United, Rush and other health care partners to improve residents’ health in 10 Chicago neighborhoods.
Learn about the AMA’s 2024-2025 strategic plan to advance health equity.
