The Death Gap

We hear plenty about the widening income gap between the rich and the poor in America and about the expanding distance separating the haves and the have-nots. But when detailing the many things that the poor have not, we often overlook the most critical—their health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. In nearly four decades as a doctor at hospitals serving some of the poorest communities in Chicago, David A. Ansell, MD, has witnessed firsthand the lives behind these devastating statistics. In The Death Gap, he gives a grim survey of these realities, drawn from observations and stories of his patients. While the contrasts and disparities among Chicago’s communities are particularly stark, the death gap is truly a nationwide epidemic—as Ansell shows, there is a thirty-five-year difference in life expectancy between the healthiest and wealthiest and the poorest and sickest American neighborhoods. If you are poor, where you live in America can dictate when you die. It doesn’t need to be this way; such divisions are not inevitable. Ansell calls out the social and cultural arguments that have been raised as ways of explaining or excusing these gaps, and he lays bare the structural violence—the racism, economic exploitation, and discrimination—that is really to blame. Inequality is a disease, Ansell argues, and we need to treat and eradicate it as we would any major illness. To do so, he outlines a vision that will provide the foundation for a healthier nation—for all. As the COVID-19 mortality rates in underserved communities proved, inequality is all around us, and often the distance between high and low life expectancy can be a matter of just a few blocks. Updated with a new foreword by Chicago mayor Lori Lightfoot and an afterword by Ansell, The Death Gap speaks to the urgency to face this national health crisis head-on.

Across the United States, Black people have shorter life expectancies than white people—reflecting structural racism and deep-rooted drivers of population health. But are some cities more equal than others? The elimination of racial and ethnic inequities—differences that are avoidable, unnecessary, and unfair—has been one of the overarching health-related goals of the United States for decades. Yet dramatic differences in health outcomes between Black people and white people persist, rooted in structural and social determinants of health. Nationally, a Black baby can expect to live four years less than a white baby. But mortality outcomes and inequities vary widely across cities. In Washington, DC, for example, the average life expectancy for Blacks is twelve years less than that of whites. But in other cities, mortality differences between races are less striking or nonexistent. If health equity can be achieved in some cities, why not all? This is arguably the most important health equity issue of our time. In Unequal Cities, Maureen R. Benjamins and Fernando G. De Maio gather a team of experts to explore these racial inequities, as well as the ten-year gap in life expectancy between our healthiest and unhealthiest big cities. Rigorous analyses give readers access to previously unavailable data on life expectancy, mortality from leading causes of death, and related Black-white inequities for the country's 30 biggest cities. The theoretically grounded essays also explore how characteristics of cities, including their levels of income inequality and racial segregation, impact overall health and Black-white inequities. The first book to specifically examine racial health inequities within and across US cities, Unequal Cities offers a social justice framework for addressing the newly identified inequities, as well as specific case studies to help public health advocates, civic leaders, and other stakeholders envision the steps needed to improve their cities' current health outcomes and achieve racial equity. A powerful call to action for health equity advocates and city leaders alike, this book is essential reading. Contributors: David Ansell, Darlene Oliver Hightower, Jana Hirschtick, Sharon Homan, Ayesha Jaco, Emily LaFlamme, Brittney S. Lange-Maia, Kristin Monnard, Nikhil G. Prachand, Pamela T. Roesch, Michael Rozier, Nazia Saiyed, Eve Shapiro, Abigail Silva, Veenu Verma, the West Side United Metrics Working Group, Ruqaiijah Yearby

We hear plenty about the widening income gap between the rich and the poor in America and about the expanding distance separating the haves and the have-nots. But when detailing the many things that the poor have not, we often overlook the most critical—their health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. In nearly four decades as a doctor at hospitals serving some of the poorest communities in Chicago, David A. Ansell, MD, has witnessed firsthand the lives behind these devastating statistics. In The Death Gap, he gives a grim survey of these realities, drawn from observations and stories of his patients. While the contrasts and disparities among Chicago’s communities are particularly stark, the death gap is truly a nationwide epidemic—as Ansell shows, there is a thirty-five-year difference in life expectancy between the healthiest and wealthiest and the poorest and sickest American neighborhoods. If you are poor, where you live in America can dictate when you die. It doesn’t need to be this way; such divisions are not inevitable. Ansell calls out the social and cultural arguments that have been raised as ways of explaining or excusing these gaps, and he lays bare the structural violence—the racism, economic exploitation, and discrimination—that is really to blame. Inequality is a disease, Ansell argues, and we need to treat and eradicate it as we would any major illness. To do so, he outlines a vision that will provide the foundation for a healthier nation—for all. As the COVID-19 mortality rates in underserved communities proved, inequality is all around us, and often the distance between high and low life expectancy can be a matter of just a few blocks. Updated with a new foreword by Chicago mayor Lori Lightfoot and an afterword by Ansell, The Death Gap speaks to the urgency to face this national health crisis head-on.

The amazing tale of “County” is the story of one of America’s oldest and most unusual urban hospitals. From its inception as a “poor house” dispensing free medical care to indigents, Chicago’s Cook County Hospital has been renowned as a teaching hospital and the healthcare provider of last resort for the city’s uninsured. Ansell covers more than thirty years of its history, beginning in the late 1970s when the author began his internship, to the “Final Rounds” when the enormous iconic Victorian hospital building was replaced. Ansell writes of the hundreds of doctors who underwent rigorous training with him. He writes of politics, from contentious union strikes to battles against “patient dumping,” and public health, depicting the AIDS crisis and the Out of Printening of County’s HIV/AIDS clinic, the first in the city. And finally it is a coming-of-age story for a young doctor set against a backdrOut of Print of race, segregation, and poverty. This is a riveting account.

Inequality kills. Both rich and poor die younger in countries with the greatest inequalities in income. Countries such as the United States with big gaps between rich and poor have higher death rates than those with smaller gaps such as Sweden and Japan. Why? In this provocative book, Richard Wilkinson provides a novel Darwinian approach to the question. Wilkinson points out that inequality is new to our species: in our two-million-year history, human societies became hierarchical only about ten thousand years ago. Because our minds and bodies are adapted to a more egalitarian life, today's hierarchical structures may be considered unnatural. To people at the bottom of the heap, the world seems hostile and the stress is harmful. If you are not in control, you're at risk. This is a penetrating analysis of patterns of health and disease that has implications for social policy. Wilkinson concludes that rather than relying on more police, prisons, social workers, or doctors, we must tackle the corrosive social effects of income differences in our society.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

In The Purpose Gap, Patrick Reyes reflects on a family member's death after a long struggle with incarceration and homelessness. As he asks himself why his cousin's life had turned out so differently from his own, he realizes that it was a matter of conditions. While they both grew up in the same marginalized Chicano community in central California, Patrick found himself surrounded by a host of family, friends, and supporters. They created a different narrative for him than the one the rest of the world had succeeded in imposing on his cousin. In short, they created the conditions in which Patrick could not only survive but thrive. Far too much of the literature on leadership tells the story of heroic individuals creating their success by their own efforts. Such stories fail to recognize the structural obstacles to thriving faced by those in marginalized communities. If young people in these communities are to grow up to lives of purpose, others must help create the conditions to make that happen. Pastors, organizational leaders, educators, family, and friends must all perceive their calling to create new stories and new conditions of thriving for those most marginalized. This book offers both inspiration and practical guidance for how to do that. It offers advice on creating safe space for failure, nurturing networks that support young people of color, and professional guidance for how to implement these strategies in one's congregation, school, or community organization.

Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.