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Ask a dozen experts what causes health disparities and you may get several dozen explanations—starting with “Nobody really knows.” The hypotheses include myriad social, financial, and cultural barriers to medical care, poor quality of care, racial segregation, lousy schools, fear, ignorance, rat- and roach-infested substandard housing, an “apartheid” health care system—separate but unequal, poor health education, deficits of “cultural competence” and sensitivity among care providers, shortages of doctors and medical facilities in blighted communities, lack of diversity among the ranks of health care workers, misguided public health policy emphasizing treatment over prevention, havoc wreaked on genes by a stressful urban environment, breakdown of the traditional family, crumbling of the public health infrastructure, complexity in navigating the health care maze, and much more. Instead of asking what causes health disparities, a better question might be: What doesn’t?
Many experts agree, though, that the problem essentially stems from a few root causes: poverty and historical patterns of racism. From where he sits on the West Side of Chicago, Steve Whitman is reminded daily of the impact of poverty and race on health. Out the window of his office at Mount Sinai Hospital, he sees an unending river of human misery flowing from largely African American North Lawndale and predominantly Hispanic South Lawndale—adjoining neighborhoods on the city’s West Side in which poverty and poor health form a menacing tag team. Median household income in these communities is well below that of the city and the country, and perhaps half of the adult population are without any kind of health insurance. Lacking basic coverage, many people simply go without regular primary care and thus fail to get needed tests and follow-up care as well. Often it is only when illness sets in and symptoms become acute that they seek help at a place like Mount Sinai Hospital—a nonprofit provider that offers care regardless of a patient’s ability to pay—and by that time it may already be too late (nationally, uninsured adults with cancer, for example, are 25 percent likelier to die than cancer patients with health coverage, according to Baylor College of Medicine’s Intercultural Cancer Council).
The distress of the underprivileged and underserved gnaws at Whitman. He sees health disparities as “a terror visited on black people,” and society’s failure to remedy the problem a form of racism. “I hate racism,” he declares. “I hate unfairness. It dehumanizes all of us. As a white person, I understand how much I and most other white people benefit from it, and I hate that as well.”
Whitman and other researchers connected with Sinai deserve credit for raising awareness about local health disparities. In addition to the epidemiological studies, they have conducted extensive, face-to-face surveys of residents in a handful of city neighborhoods—five of them predominantly poor and minority—showing a strong correlation between socioeconomic status, race or ethnicity, and health. On virtually every measure, people in the survey’s one middle-class white community (Norwood Park, on the Northwest Side) fared better than people in the five poorer minority communities on the South and West sides (African American North Lawndale and Roseland, Hispanic South Lawndale and Humboldt Park, and racially mixed West Town). Among the findings:
- Forty percent of adults in North Lawndale lacked any form of health insurance—which sounds bad enough, but when one crosses into South Lawndale, the rate jumps to 56 percent.
- The death rate from diabetes among Puerto Ricans in Humboldt Park and West Town was more than twice those of Chicago and the United States, and was believed to be the highest recorded anywhere in the country. Meanwhile, the rate among black residents in the survey was also extraordinarily high, at almost double that of whites locally and nationally.
- Some 34 percent of the Puerto Rican children in the study had asthma, the highest rate recorded anywhere in the country, prompting Whitman to dub Chicago “the asthma capital of the United States.” Meanwhile, 25 percent of African American children had asthma, much of it going untreated. By contrast, 10 percent of children nationwide suffered from the condition.
The list of health calamities did not end there. Heart disease, various forms of cancer, arthritis, and other afflictions that can be prevented through a healthy lifestyle and regular primary care—or effectively managed if detected early and treated—are also cutting a swath through these communities. The survey turned up pockets with extraordinarily high percentages of hypertension, tobacco addiction, and obesity, including what Whitman says are the highest levels of childhood obesity ever measured anywhere—no surprise, given that large areas of the South and West sides lack adequate recreational options and qualify as “food deserts,” places so bereft of decent grocery stores that it is easier to buy french fries at a nearby fast-food restaurant than to get fresh produce from a grocer that may require several bus rides to reach.
Some of the findings—such as those for diabetes and pediatric asthma—garnered local headlines and certainly created the impression that Chicago is in the throes of “a regional health care crisis,” as Rush’s David Ansell puts it to me. And undoubtedly these findings offer a vivid and startling snapshot of health conditions in some of Chicago’s neediest communities. But does that make Chicago any more awful than any other place?
“I’d be careful about claiming things are worse here,” cautions the U. of C.’s Marshall Chin, director of Finding Answers: Disparities Research for Change, a program funded by the Robert Wood Johnson Foundation that seeks to improve the quality of health care for racial and ethnic minorities. “You’d be safer saying disparities in Chicago are comparable to those in other big cities.” Still, in dozens of interviews for this article, no one I spoke to disagreed with the basic thrust of Sinai’s research. “The point is that this is an unacceptable level,” Chin says.