On a sunny Wednesday morning on Chicago’s West Side, a few dozen neighbors mingle outside the Harmony Community Cares food pantry before it opens. Inside, volunteers finish filling boxes, bags and shelves with fresh and nonperishable foods.
Upstairs, a half dozen medical students set up tables and chairs that will turn a bright, airy community room into a mobile clinic, with stations for checking blood pressure, blood sugar and cholesterol levels and for counseling people on what those numbers mean. At the same time, two of their classmates head outside to invite pantry visitors to have their health vitals checked and to speak with a heart doctor.
The screenings are the result of a challenge cardiologist Danny Luger, MD, put to his students: Heart disease and related chronic conditions usually are preventable by adopting healthy habits and managing risk factors. But how do you help people who don’t know they are at risk or what to do about it?
Uncovering hidden risks
Luger and four of the Rush Medical College students decided to test an idea: set up free health screenings at a food bank. They asked the Beyond Hunger pantry organizers to let them ask people who were picking up food whether they would like to talk to a cardiologist and learn about their risks for heart disease.
“Food pantries serve people who lack access to healthy food they can afford, and such food insecurity itself contributes to chronic health conditions,” Luger says.
What began with one visit less than three years ago has grown into monthly clinics at four Chicago-area sites, where more than 650 people have been screened. The Cardiometabolic Health Initiative is a model program with a student-led board of directors and a roster of 100 volunteers that includes social workers, counselors, community health workers, dietitians, nurses, doctors and students from across Rush University.
Silent but destructive conditions
At the Harmony food pantry in North Lawndale, first-year medical student Alyssa Kohler talks with the morning’s first visitor, Atia Breen, to collect her medical and family health histories. Kohler wraps a blood pressure cuff around Breen’s right arm to take the first of three readings.
“My blood pressure is normal,” Breen says with surprise. “I’m taking my medication regularly.”
The students will measure key markers:
- Weight, waist and neck circumference to determine BMI
- Blood pressure
- Cholesterol levels
- Blood sugar levels
Before they leave, participants have their results and a conversation with a cardiologist. They also are asked about their access to housing, health care, safety, transportation and other social determinants of health and connected with resources that may help.
Those who are identified with a high risk for cardiometabolic diseases are offered a pathway to support, including connections to primary and cardiovascular follow-up care, lifestyle counseling and crisis counseling as needed.
Numbers worth knowing
Each measurement collected helps to uncover hidden conditions that quietly eat away at health: high blood pressure, high blood sugar, unhealthy cholesterol and obesity. Alone or collectively, they silently cause damage that leads to heart disease and stroke, Type 2 diabetes, kidney and liver disease and other chronic diseases.
Whether the numbers indicate a problem or not, knowing them can help prevent or manage these cardiometabolic conditions, says Luger, who leads the Rush Center for Prevention of Cardiovascular Disease.
“High blood pressure is one of the most damaging conditions, and one of the least noticeable,” he says. “Once you know you have high blood pressure, you can take steps to bring it down to normal, check it regularly and control it.”
If blood glucose levels are elevated, there are medications and lifestyle changes that can bring them down before they reach the tipping point that leads to diabetes, he says.
Who gets the chance to be healthy?
Family history plays a part in cardiometabolic health, but lifestyle is a greater factor. Where someone lives and how easily they can find a job, affordable housing and healthy food greatly affect their lifestyle. People who are struggling to afford food and shelter or lack access to jobs, transportation and other necessities are at higher risk of chronic illness and have fewer options to prevent and manage them.
This is starkly visible on Chicago’s West Side, where the average life expectancy is as much as 20 years shorter than it is for people who live in other, more affluent, neighborhoods. This life expectancy gap is primarily driven by cardiometabolic diseases.
Diane Carioscio, the food pantry coordinator at Harmony, praised the Rush team for serving people in an underserved neighborhood.
“It’s wonderful to have someone come and partner alongside us and work with us toward giving people opportunities to improve their health,” she says.
The Cardiometabolic Health Initiative is reaching food-insecure residents in other neighborhoods as well, with monthly events at Marillac Saint Vincent in East Garfield Park, El Mercadito Nourishing Hope in Humboldt Park and Beyond Hunger in Oak Park.
It’s poised to expand, says Maya Mikos, a first-year medical student and head of operations. Students from another medical college plan to join Rush’s program and staff an additional monthly clinic.
It’s an experience Mikos highly endorses. Besides the skills she is developing by leading the program, she’s learning about herself and her city. The Chicago native volunteers at three pantry clinics a month, where she is getting to know the neighborhoods and the people who live there.
"When I am practicing as a physician one day, I want to be connected to the patients I see, just as I am here," she said.
Beyond the numbers
As people learn about their health and how to manage it, their participation provides valuable data on food security and health.
Already, the students have presented their findings at conferences and in published articles. The journal Nature published their study about the prevalence of diabetes, awareness of high blood glucose, and the challenges of managing it.
“Initially, we focused on identifying high-risk populations,” Luger said. “Now we’re starting a clinical trial to see if our interventions reduce risk scores.”
With funding from the Physicians Association Foundation, the program will provide free ongoing health coaching and follow-up screenings to 200 food pantry participants. The students will track progress after three months and after six months, studying the impact of health coaching.
Truman Steele, who is in his second year of volunteering in the clinics, is excited to add health coaching to his work. The connection with patients gives meaning to long hours of book study and abstract clinical discussions.
It’s especially motivating when he sees a test result spark action.
“They’ll say, ‘Oh, my cholesterol is high? What can I do about it?’ ” Steele says. Those are the most rewarding. “I might have reversed something.”
