Citing a widening life expectancy gap between Black Chicagoans and other groups in the city, Mayor Lori Lightfoot last week called systemic racism a “deadly” public health crisis that has exacted a “devastating toll on the health and wellbeing of our residents of color” and pledged to combat inequality in the city.
“We can no longer allow racism to rob our residents of the opportunity to live and lead full, happy and healthy lives” Lightfoot said.
But while experts applaud Lightfoot for naming the issue, they say more significant, sustained action will be needed to truly address the crisis in the city – and some community leaders and experts are questioning whether she is doing enough.
“We’ve got to approach it with urgency and much more resources than have been brought to bear up to this point,” said Dr David Ansell of Rush University Medical Center, a leader in health equity and author of The Death Gap, which examines life expectancy disparities in Chicago and across the nation.
“Health inequities are inherently unjust, and because they’re unjust, there’s an urgency to fix them,” Ansell told the Guardian. “We can’t do it quickly enough.”
The comments from Lightfoot came on the heels of an alarming report by the city’s department of public health, which found that the average lifespan of Black Chicagoans is 71.4 years, compared with 80.6 years for other residents – a 9.2-year life expectancy gap researchers say is driven by a higher prevalence of chronic and infectious diseases, higher infant mortality rates, the opioid crisis and gun violence.
In part thanks to the coronavirus pandemic, which disproportionately impacted communities of color, the disparity is likely to get worse.
“Many health outcomes among this population are worse compared to other race groups in Chicago,” according to the report, which was produced by the Health Equity Index Committee, a working group composed of five Black women. “Overall life expectancy among Blacks is decreasing, and the gap between the life expectancy of Blacks and non-Blacks is widening.”
The racial life expectancy gap is nothing new, nor is it unique to Chicago, as Dr Selwyn Rogers, founding director of the University of Chicago Medicine Trauma Center and a leading public health expert, told the Guardian.
“Racism and discrimination are still prevalent,” Rogers said. “The longstanding impact of things like redlining and economic disinvestment in communities of color persists, and we see the evidence of that here in Chicago.”
The disparities can seem especially stark in Chicago, one of the most segregated cities in the United States.
While the nine-year difference in average lifespans of Black and non-Black residents here is disturbing enough, the inequalities can become even more pronounced when broken down by neighborhood.
For instance, according to a paper co-authored by Ansell published last month in the New England Journal of Medicine, the life expectancy gap between residents of Chicago’s Loop, the city’s main commercial district that boasts a median household income of nearly $110,000, and East Garfield Park on the city’s West Side, whose median household income is about $23,000, is a staggering 14 years.
Lightfoot, the city’s first Black woman to serve as mayor, has pledged to work to address the root causes of inequality in Chicago.
Last year, City Hall launched the Healthy Chicago 2025 initiative, aimed at bridging the stark life expectancy gap that Lightfoot described as “unacceptable” within five years. Meanwhile, as the Covid-19 crisis raged in the city, officials specifically targeted vulnerable communities with access to testing and vaccines.
“These are the communities most burdened by Covid,” Chicago’s vaccine chief, Tamara Mahal, told the Chicago Sun-Times in February, “and this is a way for us to lower those rates.” And, as Lightfoot vowed last week to “address the racist policies that have wreaked havoc on our Black and Latinx communities”, she announced she was putting $9.6m in Covid relief funding toward establishing health equity zones, mostly on the South and West sides, which will use “hyper-local strategies” to improve health outcomes.
The mayor does not operate in a way in which it appears she hears, respects, values, the voices of the communityJitu Brown
But some community leaders in Chicago question Lightfoot’s commitment to addressing systemic racism, and have suggested that some of her policies – including on policing, education and the environment – are making matters worse.
“The mayor we have in place now says a lot of the right things, but does not operate in a way in which it appears she hears, respects, values, the voices of the community,” said organizer Jitu Brown, a member of the Chicago Health Equity Coalition that fought to save the safety-net Mercy hospital from closure. “She’s saying one thing, but doing something completely different.”
Brown noted that neighborhood disinvestment, school closures and under-resourced classrooms, and other longstanding issues have continued under Lightfoot, and called for real action to address the needs of marginalized communities.
“She does exactly what Rahm Emanuel would have done. She does what Daley would have done. So how is she different?” Brown said, referring to Lightfoot’s predecessors. “If they don’t want to engage with people closest to the pain, they don’t want to bring those people closer to the power.”
Meanwhile, experts say that closing the life expectancy gap will mean taking a far more aggressive, “multi-pronged” approach to combating racism in the healthcare systems and at the policy level.
“It’s going to take disease-by-disease, condition-by-condition targeted interventions,” Rogers said. “It will require us reimagining how we address social factors that drive health outcomes … It’s going to take an equity lens in all of our policies, in policing, the law, and health.”
“We can’t keep doing the same things that we’ve been doing and fix the issue,” Rogers added.
Current efforts haven’t matched the broad scale of the problem, Ansell said, noting that Chicago suffers roughly “3,500 excess Black deaths” a year due to inequities in the health system.
“That’s just about a World Trade Tower disaster in Chicago for Black people in Chicago every year for as long back as we’ve counted it,” Ansell said. “The scale of this is huge.”
Ansell applauded Lightfoot, who wrote the foreword to the re-release of his book, for describing racism as the public health crisis it is. But, he said, that should only be the beginning.
“You get one point in the world for pointing out the problem, and a hundred points for fixing it,” Ansell said. “It’s time to fix it. We don’t need more data. We don’t need more reports. We don’t need a rehashing of the past. We need to take concrete steps into the future. In the end, it comes down to human capital, social capital and financial capital. We certainly have the means to do it in this country.”