CHICAGO — Ben Jones huffs slowly down Cottage Grove Avenue on a summer Saturday on Chicago's South Side. He has asthma, and the summer heat isn't helping his condition as he heads home with a plastic bag of groceries and water from a gas station seven blocks from his apartment.
“Sometimes the food is real bad,” he said. “You have to cook it right away.”
Chronic health problems and a lack of access to fresh food are not problems unique to this and other Black neighborhoods in the nation’s third-largest city. But both help explain this city’s bleak disparities in life expectancy — an issue that leaders are vocally linking to Chicago’s segregated past as much as to its challenging present.
Racism is a public health crisis, Mayor Lori Lightfoot declared last month, just days after a new report showed that the gap in average life expectancy between Black and non-Black residents of the city had increased to nearly a decade: 71.4 years compared with 80.6 years. That number put Black Chicagoans further below the national average for African Americans, which was 75.3 years in 2017.
Locally, the gap has been widening since 2012. The report by the Chicago Department of Public Health listed chronic disease as the leading factor, followed by homicide, infant mortality, HIV and other infectious diseases, and opioid overdoses. Black infants are three times as likely to die in their first year as non-Black babies, the report noted. Opioid-related overdoses among Black residents are three times those among non-Black residents. And the disparity in homicide rates is even greater, with the overall rate for Black Chicagoans nine times that of non-Black Chicagoans.
“We are calling ‘the village’ to action,” the report’s authors wrote. “Members and allies of the Black community . . . must join forces to address and eliminate these critical health inequities and their underlying causes. Only then, will the color of the person’s skin no longer determine how long they live or their quality of life.”
With her statement, Lightfoot (D) went further than any of her predecessors in connecting current racism to the city’s historic segregation.
“Naming it and saying it gives us an opportunity to address it once and for all,” she told reporters. In doing so, Chicago joined cities including Milwaukee, Denver and Boston, which have taken similar positions.
Many of the issues here date to the Great Migration, the period between 1916 and 1970 when more than 600,000 Blacks fleeing the South relocated to Chicago. Racially restrictive real estate covenants excluded them from buying or renting homes in certain neighborhoods, resulting in sharp divisions of the South and West Sides from the rest of the city in patterns that remain. Long-standing public disinvestment and the closure of steel mills and manufacturing centers have left those predominantly Black communities vulnerable to blight and crime.
“One’s Zip code is as important to one’s health as one’s genetic code,” said Marc Gourevitch, who leads the Department of Population Health at NYU Grossman School of Medicine. “Those lack of resources are the basic determinants of health.”
The latest health department report found a gap of 14.6 years in life expectancy between certain Chicago neighborhoods, with residents of West Garfield Park, which is majority-Black, living an average of 68.5 years compared with 83.1 years for residents in Edison Park, which is mostly White. A 2019 NYU report that looked at census tracts found an even bigger gap and ranked Chicago’s racial disparity as the worst among 500 U.S. cities.
Understanding how historic racism contributes to health disparities is critical, in the view of Chicago’s public health commissioner, Allison Arwady. It moves the conversation from personal responsibility, long the traditional narrative in public health, to “calling out the truth of what is in the data,” she said in an interview last month.
“For a number of years we in public health have been particularly focused on the fact that it is not just access to health care that drives most health-care outcomes,” said Arwady, whose department hired its first “chief racial equity officer” last fall. “There’s been strong drumbeat that asks about the structural decisions that we have made as a society that have set up inequities. In the U.S., if you were to be honest about that, you have to start with race.”
The factors cited in the department’s new report are all integrally tied to life expectancy, agreed Jamila Taylor, the health-care director at the Washington-based Century Foundation, a liberal think tank.
In what becomes a vicious cycle, psychological stress from such disparities “breaks down immune systems and makes us more susceptible to disease,” said Taylor, who is Black. “Dealing with daily trauma has wear and tear on the body. People say Black people are more likely to have certain health conditions because they are more likely to be overweight. But the reasons are not just physiological. [They’re] also mental.”
On the city’s West Side, Benjamin Murphy blames the coronavirus pandemic and social unrest from the past year for the sharply increased stress he feels day-to-day. He lost his job when the catering company where he worked went bankrupt last summer, and he remains unemployed. At 53, he’s dealing with weight problems and high blood pressure, which complicate the bus ride he must take to buy food several miles away. The Dollar Tree store to which he used to walk for groceries was torched by looters last summer.
“I try to get out the house twice a day just to get fresh air and sun. Otherwise, I’d be in worse shape than I feel now,” Murphy said.
The pandemic is likely to further exacerbate the gap in life expectancy, nationally and locally, because of the disproportionately high number of cases in African American communities. In February, the U.S. Centers for Disease Control and Prevention released provisional data for the first half of 2020 showing that life expectancy for Black Americans nationally had fallen to 72 years at birth compared with 74.7 years the previous year.
Theresa Andrasfy, a researcher at the School of Gerontology at the University of Southern California at Los Angeles, expects the pandemic’s death toll to reduce the life expectancy of Black Americans by more than two years. A recent study she co-wrote concluded that the pandemic would “reverse over 10 years of progress made in closing the Black-White gap in life expectancy.”
Chicago data show that Black residents accounted for 43 percent of hospitalizations and 40 percent of deaths related to covid-19 in the city.
As the virus ravaged the South and West Sides last year, Lightfoot’s administration created a Racial Equity Rapid Response Team to direct resources into neighborhoods where cases were surging. The team, a coalition of city officials and community and hospital leaders, deployed resources for phone banks, virtual town halls, vaccination drives and mobile testing sites.
Arwady said those efforts will be a model for the city’s ongoing outreach. Nearly a third of Black residents have no health insurance, far more than the percentage of uninsured White residents, which makes obtaining health care even more difficult. The public health department is using nearly $10 million of federal covid-19 relief funding to create six “Healthy Chicago Equity Zones” that will offer pop-up vaccination sites, food pantries and health care, along with other services, in targeted neighborhoods.
“We know it needs to be hyperlocal because of these racial disparities we saw from very early on,” Arwady said. “Covid taught us to be more nimble and to make different resource decisions based on direct community input. We want to take that energy into that next space.”
One of the nonprofit organizations providing coronavirus awareness on the South Side is the Greater Auburn-Gresham Development Corp. Its chief executive, Carlos Nelson, said he considers the Lightfoot administration’s focus on racial inequities “profound.” His organization, an equity-zone partner with the city government, is providing contacts and support for residents needing vaccines, as well as affordable Internet access and healthful food.
“We have to strike now that the iron is hot,” he said.