Karen Larimer, Ph.D. - Assistant Professor, School of Nursing. Acute care nurse practitioner. Fellow at the American Heart Association.
Can you talk about your work with the American Heart Association (AHA)?
Our focus at the American Heart Association is health promotion, cardiovascular health, and the reduction of death and disease from cardiovascular causes. The organization itself is mainly composed of volunteers in the healthcare field. The AHA brings together people who really care about cardiovascular disease, and also business partners and private individuals who care about what’s happening with heart disease.
The American Heart Association is so broad. We focus on everything from funding new research to engaging with communities and funding community initiatives. We also participate in advocacy and fundraising for support groups. It’s a spectrum of services and initiatives.
At the AHA, we always say, “What is your why?” Why are you invested in reducing cardiovascular disease? For some people, it might be because their father died early in life. We hear many of those stories. For me, it’s because I’ve worked in cardiovascular healthcare for twenty-plus years and I’ve seen people die when it was preventable. My goal is to look at what’s causing heart disease and figure out how we can better address those causes.
We know that heart disease is the number one cause of death in the United States. While it doesn’t always get the brightest spotlight, it probably should.
How do you believe government policies can promote health?
One of my biggest passions is advocacy on a policy level. There’s definitely a place for one-on-one teaching, community outreach, lecturing, and educating healthcare providers. But I also like to work with legislators and communities in creating policies that will develop a culture of health. That’s a concept that is advocated by the Robert Wood Johnson Foundation, American Heart Association, and Centers for Disease Control.
I’m currently teaching a class that works with communities to develop a culture of health. If children in these areas don’t do as well in school or graduate high school, they can fall into a cycle of low self-worth and low motivation. They may not be able to get a job or adequate healthcare. They may not have a community that’s robust with adequate grocery stores and options for physical activity. The cycle goes round and round where you have a community that’s not only economically poor but also poor in health and poor in quality of life.
According to one study, if you travel down the CTA Green Line and go into Garfield Park, there’s as much as a ten-year difference in life expectancy over three train stops. If you go down the Red Line between Washington Park and Hyde Park, there’s also another ten-year difference.
The last class I taught focused on global health in developing countries. If we looked at Afghanistan, we expected their life expectancy would be much lower. Afghanistan doesn’t have basics like infrastructure, but we also see huge disparities within our own city and county. It’s not just Chicago. We see it in places like New Orleans and areas of California. We see disparities all over the country.
There are all sorts of interventions that can reduce the risk of cardiovascular disease. I spent the last year working on the sweetened beverage tax. Ultimately, the Cook County Board decided to repeal.
We made economic projections that showed if you implement a sweetened beverage tax, you’ll decrease consumption, and by reducing consumption you improve those outcomes of obesity, and people with lower obesity rates have improved cardiovascular health.
But that wasn’t an intervention that was appealing enough for people. There’s a debate about this, but we can’t be afraid to have those kinds of discussions. The American Heart Association is not afraid to have those discussions.
The perception of health underlies everything. If you don’t have health, you don’t have anything. We call it “health in all policies”.
Communities that have adopted policies like the sweetened beverage tax have seen positive changes. We tax cigarettes, and it makes a huge difference. Consumption among adolescents has decreased incredibly. In Chicago, we have one of the lowest rates of adolescents taking up the smoking habit, which is directly related to the fact that it’s 15 bucks a pack. Most kids can’t afford that. They’re not going to do it. When you develop a smoking habit earlier in your life, it’s much harder to change later on.
There was some debate, but the soda tax initiative is not going away. I’m not going to stop. At the very least, it raised the awareness of the issue that children consume immense amounts of non-nutritive sugar through sweetened beverages, and it’s incredibly unhealthy for them.
Can you talk about your work with healthcare startups?
One company I work with, physIQ, is all about predictive analytics. Prediction and prevention is the beauty of artificial intelligence, machine learning, and big data. Between all three of those things, you get a wealth of information, and you are better able to predict and prevent. I’m working with one company that uses a biosensor patch that goes on a patient’s chest. It continuously monitors and transmits the patient’s vitals to a smartphone app and then through its analytic platform. The analytics create a model for what’s normal for the patient based on their own physiology. When that changes, the healthcare team sees it through a web portal.
When I was working with a patient in the past, I would say, “Oh gosh, Mr. Jones, your swelling in your feet and your blood pressure has gone up, and you can’t breathe. I think you will probably go to the hospital in a couple of days with heart failure.” There’s probably not a lot I can do to stop a hospital visit at this point. But if there were clear metrics that could predict that earlier, then you could potentially reduce the severity. Possibly no hospital, no severe event.
Predictive capability and proactive action can drive healthcare costs down. If you could avoid the hospitalizations and emergency interventions that are terribly expensive, that’s what will save money. It can also make life better for the patient.
As a nurse practitioner, I always tell people that you could give me 20 patients who are pretty sick and I could probably keep them out of the hospital. I would be calling them every day and asking them how they are doing. I would tweak things here and there. But that’s not scalable.
But as a nurse practitioner with access to this new technology, I could monitor up to 500 or 1,000 patients. Perhaps the system pings me on a dashboard and notifies me when individual patients are getting into trouble because they are wearing a patch that regularly transmits their vitals, and I receive that data. There’s potential for massive scalability. The credit is really to the engineers who are doing the coding and developing of this incredible innovation.
How have you worked with local communities when it comes to cardiovascular health?
I like to work in the area of cardiovascular disease and cardiovascular health promotion. I have looked at it from the technology side and policy side. I also look at it from the community engagement and assessment side.
When I did my early work and my dissertation, I assessed cardiovascular risk in Berwyn and parts of Cicero. I looked primarily at a Mexican-American population and evaluated the cardiovascular risk of the people in those communities. As healthcare practitioners, we can make claims about different race, ethnicity, age, gender, and behavior patterns. We need to either validate or reject those assumptions. We have to do that before we can develop interventions. Otherwise, the arrow isn’t going to hit the right target.
When I went into that community, I did a multi-pronged process for assessment. I looked at the social and physical determinants of health. I talked to individuals and looked at the community, and drove up and down the streets. I went into the churches and schools. I met with legislators. I got to know the area and its people.
I learned what makes a difference in cardiovascular health is those that “have” versus those that “have not.” A large number of individuals in these communities were uninsured or underinsured. Preventive care wasn’t even on the radar. People said they couldn’t afford it, and how could they when they were worried about feeding their families? Many community members didn’t care at all about proactive, preventive care; they were just trying to find a job or keep their house.
My research reinforced the idea that health doesn’t exist in a bubble. It’s defined in the context of your lived environment. If the economy isn’t good, it’s hard to think about how you’re going to be proactive with your health. If you don’t have access to adequate healthcare in your community, how are you going to seek out preventive care? If healthcare isn’t available in a language you understand, how does that work?
What makes the School of Nursing’s service learning approach such a good fit with DePaul?
When I came to DePaul, it felt like such a good fit since the mission of the university is that humanistic approach. By focusing on communities, you can take that approach. It’s not about telling people how things should be. Instead, I examine how things actually are for people, and what I can do to facilitate their quality of life in their lived environment in partnership with them. And that’s what we do at the School of Nursing.
When I teach, I don’t use a lot of examples in textbooks. Instead, we talk about the people that we met and served out in the neighborhoods. I like to ask the students questions. Where did you go today? What happened in your service organization? Let’s talk about those real-life examples.
All of our nursing students have their entire program embedded in community-based service learning. Connecting with local communities and neighborhoods has been fun for me, and I feel supported by the university since that’s their mission, and I think the students really enjoy it.