How race and class affect health is demonstrated by a single statistic: Black women are 40 percent more likely to die from breast cancer than white women, though they develop it at the same rate. As David Ansell — a longtime doctor in low-income communities of color in Chicago — proves in his new book, The Death Gap, Black women die more often from breast cancer because they are more likely to have radiologists rather than specialists read their mammograms, and radiologists are more likely to miss tumors. In wealthy white areas, longevity reaches the top of the charts, while in impoverished, nonwhite ones, longevity tumbles. The rich live longer than everybody else, and one reason is better health care.
“If being uninsured was a cause of death, it would be the tenth most common one in the United States,” Ansell writes. It’s up there with mass incarceration and poverty. Living in an impoverished area causes stress. And stress kills.
Residing in a poor district also increases the chance of violent traumatic death, as Veronica Morris Moore and Victoria Crider, two former activists in the South Side group Fearless Leadership by the Youth (FLY), know very well. For years, residents of color on Chicago’s South Side had no trauma center. Gunshot victims died in ambulances en route to hospitals across town.
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After years of grassroots organizing by FLY and other groups, the University of Chicago hospital announced it would open a trauma center, but as Ansell writes, the fight is still on: “In Chicago in the last few years, health activists…have demanded the preservation of the public mental health system (unsuccessful), the preservation of access for the undocumented to transplant lists (partially successful), the creation of a trauma center on the South Side (successful) and the closing of an asthma-causing coal-fueled power plant (successful).”
Writing in an email to Truthout, Moore reports that though many Woodlawn residents cannot afford good health care and are uninsured, the new trauma center is one of the busiest in the city, “despite being open for less than a year.”
Crider told Truthout, also in an email, that she understands what Ansell means about inequality being a killer. “I grew up poor and…have seen people in poorer situations. Not having access to basic things…causes people to go into survival mode. The South Side is in crisis. Our mental health clinics have been closed, we live in a food desert, hospitals are understaffed, and the staff there are overworked.”
She says many of the answers are clear: “Stop closing schools, mental health clinics, cutting funding for small community hospitals, invest in grocery stores, after school and before school programs, affordable day care centers and more. Take people out of survival mode, give them resources and watch them go far.”
FLY’s 2015 fight for the trauma center involved civil disobedience in the form of direct action, blocking traffic on Michigan Avenue’s swanky Magnificent Mile. The death of youth leader Damian Turner from a stray bullet sparked this protest. Turner died during the ambulance ride across town to the nearest trauma center. Though this occurred some years earlier, Moore cited it as a reason for FLY’s action.
As Moore wrote at the time, “I volunteered my body for the human chain…because I am committed to pressuring the University of Chicago to reopen its level 1 trauma center.” Moore argued that the cost was not insupportable and that when the university claimed it was, it revealed its attitude that “Black lives don’t matter.” A related issue was that if the university continued to expand into Woodlawn, it should respond “to the demands and real life needs of my community.”
That an entire, large, poor district lacked a trauma center is not, unfortunately, unusual. Hospitals, like neighborhoods, are redlined, based on whom they serve. Hospitals in low-income communities of color cannot get necessary loans and often must cut services or close.
“In Chicago in the 1970s and 1980s, fourteen neighborhood hospitals closed, many in redlined black neighborhoods,” Ansell reports. Affluent Hyde Park, with a life expectancy fourteen years longer than low-income Washington Park next door, did not lose its hospital.
At the direct action on the Magnificent Mile, the protesters were arrested. Crider attributed their gentle treatment by police to many white women participating. Protesters also staged a sit-in at a university building. Officials had the Chicago Fire Department destroy a wall in order to arrest the protesters. According to a report at the time, “the sit-in caused no harm. It had prevented no one from leaving the building and had damaged no property, but the university was willing to tear its own walls out to put an end to it.”
Ansell’s axiom, “where you live dictates when you die,” applies to the low-income South Side neighborhood where he works, Lawndale, which encapsulates “the story of rising inequality and premature death in American’s abandoned neighborhoods.” He cites “high rates of diabetes, hypertension, heart disease and depression” in poor areas.
At two Lawndale hospitals, “the mostly poor patients dying there donate…organs used in transplantation at the wealthier transplant centers across the city.” Yet, Ansell writes, in his twenty-seven years at Lawndale hospitals, “not one of my patients – or those of my colleagues – ever received a life-saving transplant.” Low-income undocumented residents have had to struggle relentlessly even to be considered eligible for transplants. At one county hospital serving a poor community, Ansell recalls, “not once did one of my patients who needed a joint replacement for debilitating arthritis get one.”
Regarding life expectancy, the U.S. sits at the bottom of the list of developed countries. The diseases and premature mortality of the poor are, as Ansell quotes Dr. Paul Farmer, “biological reflections of social fault lines.” Or, as Ansell writes, “nationwide each year more than 60,000 black people die prematurely because of inequality.” Low-income white “deaths of despair” also exemplify these social forces. “The gap between the U.S. county with the highest life expectancy and the one with the lowest life expectancy is between thirty and thirty-five years.”
In Chicago’s wealthy Loop neighborhood, life expectancy is 85 years, compared to the expectancy of 72 in the impoverished Lawndale neighborhood next door, Ansell writes. Everywhere the poor live shorter lives: Men in the Pine Ridge Reservation in South Dakota have an average life expectancy of 48; among poor whites in McDowell County in West Virginia, Ansell reports, life expectancy approximates that in Iraq.
The Death Gap cites the three B’s – beliefs, behavior and biology – as the wrong explanations for health and life expectancy differences. In a food desert in a poor area, people can only buy what is available. If that means lots of sugar, salt and additives in highly processed convenience store food, the consumers don’t have much choice; they have little access to healthy food. Similarly, Ansell argues that the high child mortality rates from asthma within Puerto Rican and Black communities on the South Side are not genetic but were “traced back to a coal-burning power plant on the city’s Southwest side.”
The lead-polluted drinking water in Flint, Michigan, also exemplifies environmental racism. So does the contaminated drinking water in Newark, New Jersey. As Ansell argues, “a person’s zip code can be more influential than his or her genetic code” in determining longevity.