Chicago’s death gap and health care inequality: David Ansell – Health Care News

on May27

26 May 2017 | 2:22 pm

Dr. David Ansell has spent about 40 years working at three hospitals within a 2-mile stretch on the Near West Side, treating patients and serving in various management roles.

He can’t shake the inequity he’s witnessed among his patients over the years, and how it’s contributed to their health. Consider this: The life expectancy for someone in the Loop is 85 years, but less than 5 miles west it plummets to 69 years.

The disparity between rich and poor is a national phenomenon. In Ansell’s new book, “The Death Gap: How Inequality Kills,” (University of Chicago Press) he uses Chicago as a lens to explore what’s fueling the divide.

“We have concentrated poverty in these neighborhoods,” explains Ansell, 65, senior vice president of community health equity at Rush University Medical Center.

Also this: a legacy of discriminatory lending, centralized public housing and a lack of jobs.

Crain’s recently chatted with Ansell, who spent 17 years at the Cook County Health & Hospitals System, then a decade at Sinai Health System before heading to Rush in 2005. In his 2011 book “County: Life, Death, and Politics at Chicago’s Public Hospital,” he documented his tenure at Cook County Health, one of the largest public health systems in the nation and a renowned training ground for physicians. Here’s an edited transcript of the conversation.

Crain’s: What do you hope to accomplish with your new book?

Ansell: One is to understand that these giant life expectancy gaps exist, really where you have great wealth juxtaposed along great poverty. Two, that it’s structural. We seek to explain this through people’s beliefs, their culture; their behavior, what they do; their biology, their genes. It’s actually in the way we structure society. You have high concentrations of poverty and high concentrations of affluence. We’re segregated racially and we’re segregated economically. We need to reinvest in these neighborhoods. We need equitable health care.

Q: What are some potential ways to bridge this gap?

A: I call for some of the work that’s going on in Chicago, such as what we’re doing at Rush, for example, in partnership with Cook County Health, University of Illinois at Chicago, Presence Health and Lurie Children’s Hospital (among others). We gathered hospitals together to say what more can we do to hire locally, to create career paths, to purchase locally, to invest locally, and to volunteer locally, so we can actually reinvest in these communities that have fantastically great potential, but have historically been disinvested in.

Read more: The psychology of Chicago violence: Why so many young men pull the trigger

Q: Describe some of the highlights of your book.

A: I talk about how the Metropolitan Chicago Breast Cancer Task Force was created here to eliminate disparities. As a result, the black/white mortality gap for breast cancer victims in Chicago decreased: The black mortality rate dropped 14 percent, and the white mortality rate by 8 percent. The mortality gap was due to the lack of access to quality mammography and poor processes around the diagnosis and treatment of breast cancers. We have to understand that the root cause is inequality.

I also talk about the success in Chicago of getting undocumented people access to organ transplants, and I talk about the trauma center on the South Side.

Q: Activists spent years calling on University of Chicago Medicine to re-open its long-shuttered adult trauma center. They won the fight, and the center is expected to debut in spring 2018. How does their plea underscore inequities in health care?

A: Without an activated community, without social movement, we will never get to equality. In this community, this was a link to historical injustices being recapitulated in the present. When I write about the trauma center, I talk about the history of U of C on the South Side of Chicago.

Q: Did anything surprise you during your research?

A: We have a legacy of structural racism in this country and in this city that goes sort of unspoken and unnoticed. What really surprised me was, when I got to Rush after 27 years at a safety net hospital on the same street, the lack of appreciation of what actually goes on in say Lawndale or Garfield Park. It was almost as if we don’t see the people in these neighborhoods or these neighborhoods for the vibrancy and the assets that they have. I talk about the lack of empathy that we have that’s likely responsible for this great polarization.

Q: Your book comes out as President Donald Trump proposes a national budget that slashes programs for the poor, including a more than $600 billion cut to Medicaid over the next decade. This is in addition to any cuts House Republicans have pitched in their replacement of the Affordable Care Act. What kind of impact could this have on Chicago?

A: It essentially reverses the gains made under the Affordable Care Act. The ACA has many limitations, but it’s undeniable that it’s had the benefit of insuring many more people.



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