The Deadly Difference

Black women in Chicago are far likelier to die of breast cancer than white women, resulting in a disparity that's nearly double what it is nationally. This pattern of racial inequality shows up locally with other diseases—evidence that Chicago is failing at narrowing its racial divide in health. Why? And what must be done?

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The people pouring their energy into the breast cancer task force know they can't fix poverty and racism and the ills that flow from them anytime soon. But there's plenty they can fix. They hope their cross-institutional, multidisciplinary approach to the breast cancer problem will serve as a model for fighting other health disparities in Chicago, such as for diabetes and asthma.

Simply making better use of the funds and facilities already available locally would be a step in the right direction. "We have significant resources, but we need to streamline and allocate them more efficiently," says Adrienne White, vice president of health initiatives and advocacy for the American Cancer Society's Illinois division. The problem, says the UIC's Richard Warnecke, is that the various public and private health care organizations "operate independently, and nobody has tried to organize them."

The task force's emphasis on improving quality of care also has the potential to act as a rising tide, lifting other boats. "We know that if you can improve quality of care by measuring it, being transparent, being better at what you do, then you can reduce racial disparities," Ansell says. "The solutions are out there. But we have to view ourselves as part of the problem."

Finding those solutions will require better coordination and communication between public and private sectors—cooperation that has not come naturally to local health care institutions in the past. "What Chicago has not done is choose to begin to work as one community to solve this problem," says Kevin Weiss. "That will require civic and public leadership." Similarly, delivering greater equality in health to all citizens—such as by implementing reforms in the county health system—will take the kind of leadership local politicians have long seemed allergic to. "There's going to have to be some political will to make changes," says Marcus.

Given those hurdles, what's to prevent the breast cancer task force's recommendations from disappearing into the void of good intentions gone nowhere? "We're hoping there's a moral imperative—that we see the urgent state of affairs and do something about it," says Monica Peek. "The question is, are people willing to do the right thing?"

If defenders of the status quo need any further spur to action, perhaps they need look no farther than Martha Haley and her book of remembrance. Knowing that her time is running short, Haley has arranged for another woman in her support group to take over the job of adding photos and recollections of the dead after she is gone. Some fine day, there should no longer be a need for such an agonizing chore.