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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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Sinai’s Steve Whitman holds a chart showing how breast cancer mortality rates diverged in Chicago starting in the early 1990s. For white women the rate began to drop; for black women it stayed unchanged. “We’ve arranged things in this country so that the darker your skin, the shorter your life will be,” Whitman says.

It would be terrible enough if breast cancer were the only disease that discriminated so unfairly. But it is not. From heart disease to HIV, depression to diabetes, minorities in Chicago, as well as throughout the United States, suffer higher rates of illness than people of European descent. “It’s hard to name a [health] condition where these disparities don’t exist,” says Steve Whitman, director of the Sinai Urban Health Institute, on Chicago’s West Side.

The good news is that overall health has generally improved among all racial and ethnic groups over the past few decades. And because health has improved more for minorities than for whites on many measures, the country has made strides toward closing its racial divide in health. A study by the federal Centers for Disease Control and Prevention, for example, revealed a narrowing of racial disparities nationwide on 11 of 14 health status indicators in the 1990s, and a widening on just three.

The bad news is that the gaps remain stubbornly wide, and that Chicago is out of step with the country in narrowing disparities. To gauge this city’s progress, Whitman and his colleagues at Sinai Urban Health Institute gathered Chicago-specific epidemiological data on the same 14 categories measured by the CDC. And they found that on 11 of the 14 measures, the gap between blacks and whites got wider in the nineties, largely because blacks locally did not show as much improvement in health as whites did (Hispanics and other ethnic groups were not included in the findings). “There is something about black and white health outcomes in Chicago that is going in exactly the wrong direction,” concludes David Ansell, chief medical officer at Rush University Medical Center.

Because standardized data on racial and ethnic health disparities in specific cities are not readily available, it’s hard to know exactly where Chicago ranks among its urban peers. “If you line up the 50 biggest cities, different ones will be worst on different measures,” Whitman says. “I don’t know what we’re uniquely bad at.” Still, over the past several years Whitman’s organization—the research arm of Sinai Health System, which operates Mount Sinai Hospital—has conducted a number of other studies in Chicago that, taken together, paint a disturbing picture of a city in which poor and minority populations bear an undue burden of preventable disease, suffering, and early death. If the city’s black population enjoyed the same level of health as its white population, Sinai researchers contend, the average African American in Chicago would live eight years longer than he or she does today. Meanwhile, 4,000 fewer local African Americans would die each year—an annual toll that surpasses all U.S. military deaths thus far in Iraq.

“If a Martian landed in Chicago and you walked down the street and told him that, on average, this person is going to live eight years less than that person, the Martian would say, ‘How in the world do you know that?’” Whitman says. “And I’d say, ‘It’s simple: We’ve arranged things in this country so that the darker your skin, the shorter your life will be.’”

If Whitman is right—that our racial divide in health results from the way we’ve arranged things—it seems at least possible that we can rearrange things to close it. That is the big idea behind several initiatives now under way in Chicago. It’s too early to say whether any of these efforts will make a dent in the problem. And no one underestimates the difficulty—the causes of disparity are dauntingly complicated, inadequately understood, and resistant to easy fixes. “There’s no magic bullet,” says Marshall Chin, an associate professor of medicine at the University of Chicago who studies racial and ethnic disparities in medical care. But perhaps now there is hope that real progress is within reach.

“Long term, I think we can look forward to the elimination of health disparities,” says Jim Webster, a professor of medicine at Northwestern University’s Feinberg School of Medicine and president of the Chicago Board of Health. “Given the data we have and what we know about prevention, I think that 20 years from now we’ll be able to say, We had a big problem, and we fixed it.”

Reaching that goal, though, will require an unprecedented degree of cooperation among health care providers and a level of leadership from our public servants that, so far, has been as elusive as a cure for the common cold. The question is, will the right people be listening?

 

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