Assessing chronic disease in the St. Louis region

Groundbreaking study on African-American health in St. Louis, ‘For the Sake of All,’ releases final brief

Heart disease, cancer and diabetes are chronic diseases that account for $1.1 billion in hospital charges, affecting many individuals and families. The need to better understand these issues is examined in a policy brief titled “Chronic Disease in St. Louis: Progress for Better Health.”

Written by Bettina F. Drake, PhD, assistant professor of surgery in Public Health Sciences at the Washington University School of Medicine in St. Louis and Keith Elder, PhD, associate professor and chair, Department of Health Management & Policy for the College for Public Health & Social Justice at Saint Louis University, this is the fifth and final brief of a multidisciplinary study called “For the Sake of All: A Report on the Health and Well-Being of African Americans in St. Louis.”

Progress was assessed by comparing benchmark goals set by Healthy People to the actual changes in heart disease, cancer and diabetes death rates achieved between 2000-2010. The city of St. Louis, St. Louis County and the state of Missouri met and exceeded the Healthy People goal of a 20-percent decrease in deaths from heart disease by 2010.

The numbers were less encouraging when it came to cancer and diabetes.

St. Louis city and county and Missouri all failed to meet the goal of a 21-percent decrease in cancer death rates between 2000-2010, but some progress is being made. However, when compared to whites, African Americans have seen less progress in cancer death rates.

For diabetes, the goal was a 43-percent decrease in death rates between 2000-2010. Focusing on diabetes death rates in the city alone, there was an increase in death rates of 2.2 percent among African Americans, compared to a nearly 2-percent decrease in death rates among whites. Neither St. Louis County nor the state met the goal for diabetes.

“Chronic disease has been a critical issue for African Americans for quite a while,” Elder said. “They tend to develop them earlier and have greater complications from them.”

The factors that cause these disparities in chronic diseases are linked to lack of opportunity to make healthy lifestyle choices based on differences in schools, workplaces and neighborhoods.

For example, in a recent survey, a higher percentage of white residents than African Americans in the St. Louis region consider their neighborhood safe and find it easy to buy foods. This relates to chronic disease because people who feel unsafe in their neighborhoods are less likely to spend time playing, exercising or actively commuting outside. Additionally, when it is challenging to buy healthy food, healthy food choices are limited.

“One of the best strategies to address chronic diseases is prevention — things that can be modified such as diet and behavior,” Elder said. “But without explicit health policies, it’s hard to address the factors that cause the disparities in chronic diseases.”

“The good news is that St. Louis has a number of dedicated community organizations that are committed to making significant improvements in health rates,” Drake said.

Elder and Drake lay out a two-fold strategy for improvement.

The first is to expand partnerships and embed health in all policies:

  • Enhance partnerships across hospitals and public health agencies;
  • Incorporate health components into stages of policymaking, planning and program development.

The second is to invest in chronic-disease prevention and management:

  • Improve and increase the awareness of healthy lifestyle programs;
  • Fund recreation centers, parks, adequate lighting and the replacement of vandalized amenities in neighborhoods;
  • Attract grocery stores with financial and regulatory incentives to sell quality food in convenient distances to areas with poor access to healthy foods.

Overall, researchers argue that chronic diseases are of major concern, affecting us all in terms of a crippled economy, with consequences including missed school and work days, lost productivity and high health-care costs. A healthier workforce in the St. Louis region would mean a more productive local economy, a decrease in health-care spending, and, ultimately, a decrease in chronic diseases among all.

The “For the Sake of All” study is funded by the Missouri Foundation for Health and includes faculty from WUSTL and SLU. WUSTL’s Institute for Public Health, the Brown School’s Policy Forum, The St. Louis American newspaper and the online news site St. Louis Beacon are partners as well.

The participating scholars from Washington University, in addition to Drake, are:

  • Jason Q. Purnell, PhD, assistant professor at the Brown School and lead researcher on the project;
  • Melody S. Goodman, PhD, assistant professor of surgery in Public Health Sciences at the School of Medicine;
  • Darrell L. Hudson, PhD, assistant professor at the Brown School; and
  • William F. Tate, PhD, the Edward Mallinckrodt Distinguished University Professor in Arts & Sciences and chair of the Department of Education.

In addition to Elder, the Saint Louis University faculty partner is

  • Keon L. Gilbert, DrPH, assistant professor at the College for Public Health & Social Justice.

To read the full brief, as well as to learn more about “For the Sake of All,” visit