Rush University Medical Center has been awarded a $10 million grant from the National Institutes of Health (NIH) to establish the Rush Center for Urban Health Equity. The aim of the Center is to find ways to promote changes to eliminate the disparities in heart and lung disease affecting inner city residents, in particular those who are low-income persons of color.
"Health disparities have persisted or worsened in the past two decades, despite efforts to narrow the gap. In Chicago alone, if the mortality rate for blacks was the same as for whites, then 4,000 fewer black people would die each year," said Lynda H. Powell, PhD, the director of the Center and the chairperson of the Department of Preventive Medicine at Rush. "We must find a way to change this situation."
The Rush Center for Urban Health Equity is based on the principle that continued documentation of avoidable deaths and disabilities from health disparities in observational studies in insufficient. Instead, the Center is dedicated to preventing health disparities by conducting rigorous behavioral clinical trials and testing interventions across the spectrum from children to the elderly. These interventions, if effective, will have an immediate impact.
The first three research projects will focus on heart failure, depression, and pediatric asthma with co-morbid obesity.
A clinical trial led by Powell and Dr. James Calvin, director of the Section of Cardiology at Rush, aims to reduce repeated hospitalizations in low-income heart failure patients by improving doctor's prescription of evidence-based medicine and patients' adherence to the medicines that have been prescribed.
A second study, the BRIGHTEN Heart (Bridging Resources of a Geriatric Health Team via Electronic Networking - Heart) program will use "virtual" teams to coordinate care for older adults with co-morbid depression and metabolic syndrome. The study will be led by Dr. Steven Rothschild, associate center director and a family practice physician at Rush, and Erin Emery, PhD, director of Geriatric & Rehabilitation Psychology at Rush.
A third clinical trial is one of the first attempts to simultaneously control both asthma and obesity in high-risk children. The team, led by Dr. Molly Martin, a pediatrician and assistant professor in the Department of Preventive Medicine at Rush, has developed strong partnerships with local organizations in the Humboldt Park neighborhood with the aim of targeting the influences of schools, family and caregivers on weight and self-management of asthma.
Community partnerships are at the core of the Center's vision and values. Residents will become active participants in the design and conduct of all of the interventions to improve their health.
"It's critical to develop and conduct these programs in the community where people live in order to promote sustained change. Studies conducted at hospitals or research labs may produce short-term results, only to see those changes reversed when people return to the challenging environments within which they live," said Rothschild.
The Center will involve a dynamic multi-disciplinary team representing basic and clinical research, cardiology, behavioral sciences, gerontology, endocrinology, epidemiology and pulmonary medicine to address risk a variety of levels of risk factors, including the community, family, social network, and individual psychology and risk behaviors.
"Efforts to isolate a single risk factor and to intervene on it alone have had only modest effectiveness. Our Center has convened a group of medical and social science investigators and community residents to provide a multi-level approach to address the many simultaneous contributors to these disparities," said Powell.
Unique to the Center is the involvement of a specialist in post-traumatic stress, Stevan Hobfoll, PhD, professor and chairperson of the Department of Behavioral Sciences at Rush.
Although research on health disparities has at times focused on major life stress, there has been relatively little focus on traumatic stress. Low income and ethnic minority populations are much more likely than higher income and majority population members to be exposed to traumatic stressors, such as murder, serious injury, sexual or physical assault.
"Major life and traumatic stressors may both indirectly affect physical health through their influence on behaviors, including drug and alcohol use, smoking, sleep disturbances, avoidance of exercise, as well has directly affect health by compromising the immune system or inflammatory responses," said Hobfoll.
The Center will place a priority on training the next generation researchers who will foster health equity in the future. This will include supporting initiatives in Chicago Public Schools to promote health careers and progression to college programs with minority serving institutions such as Chicago State University and Malcolm X College. Training fellowships and post-doctoral training will also be offered.
"Progress on health disparities has been slow in the United States. In fact, in Chicago black/white health disparities continue to get worse over time," said Powell. "We refuse to sit idly by and watch this happen. We want to eliminate the health disparities that are cutting short the lives and livelihoods of our family, friends, and neighbors."
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