Health Care’s Role in Addressing Structural Violence

david-ansell-towerBy David Ansell, MD

A 14-year life expectancy gap separates Hyde Park, the home of the University of Chicago, and the neighborhood of Washington Park to its west. You can walk half a mile across the park and find yourself in a neighborhood with a life expectancy lower than Bangladesh. Take the Green Line six stops from the Loop to Pulaski, not far from Rush University Medical Center, and life expectancy plummets 16 years.

These excess deaths are occurring primarily in high-poverty, predominantly black neighborhoods. While an epidemic of gun violence contributes to these lifespan gaps, heart disease and cancer are responsible for more than half the premature deaths.

These deaths have deep roots in the social and political relationships that have governed life in Chicago for 100 years. To resolve these alarming survival gaps, we have to treat the root causes of hardship and poor health in our abandoned neighborhoods.

Structural violence is a term used to describe the social arrangements that put individuals and populations in harm’s way. The arrangements are structural because they are embedded in the political and economic organization of our city. They are violent because they cause injury and early death to individuals in our most disadvantaged neighborhoods.

Growing wealth inequality, poverty, institutionalized racism, educational inequity and lack of job opportunities rank high among the structural causes of Chicago’s neighborhood survival gaps. Chicago ranks among the top 10 cities in the United States in income inequality, third in poverty, and first in black poverty rates. Half of Chicago’s children live in neighborhoods of low childhood opportunity.

The list goes on. Any solution to Chicago’s lifespan gaps has to address poverty and racism as causes of health inequity.

We have a unique opportunity to ameliorate these structural causes of low life expectancy. In March, Mayor Rahm Emanuel and the Chicago Department of Public Health released a four-year health plan called Healthy Chicago 2.0, which provides a 10-point road map to improving life expectancy — the project’s top health goal. One critical priority area is expanding health care access.

Equally as important is community engagement and improving the built environment of our neighborhoods through economic development, housing and education initiatives. These will require new partnerships between community groups, government, business and the health care community.

For Chicago hospitals, these partnerships require a mission shift beyond direct service delivery to new, neighborhood-focused “anchor missions.” Hospitals are among the largest employers and purchasers of services in Chicago. They are in a unique position to partner with the community and the city. Hospitals such as Rush — which has a logo in the form of two anchors — can be anchors for neighborhood economic development to combat the poverty that leads to hardship and early death.

David A. Ansell is senior vice president for system integration at Rush University Medical Center. This post is adapted from an article published in Crain’s Chicago Business.

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