By Fernando De Maio, PhD, Patricia O’Campo, PhD, David Ansell, MD, MPH, and Raj C. Shah, MD
Health inequities — differences that are avoidable, unnecessary and unjust — are a striking feature of cities in the United States, including Chicago. While it is true that all of our city’s 77 communities have experienced an improvement in some key health indicators over the past three decades, inequities between communities have grown over this time.
New research from the Center for Community Health Equity — a collaboration of Rush University Medical Center and DePaul University — explores the prevalence of low birth weight deliveries in Chicago communities. (Our study defined this prevalence as the percentage of live births at less than 2,500 grams, or roughly 5.5 pounds.) This statistic is an important indicator of population health and is widely used to study the health effects of racism.
Good health, as we have seen again and again, is a product of social justice, and Chicago’s deep-rooted racial/ethnic segregation harms the health of its residents. Across Chicago communities, the proportion of low birth weight is 10 percent, with the best-off communities near 3 percent and the worst-off communities approaching 20 percent. Segregation plays an important role in explaining these differences: The most highly segregated African-American communities, among them Avalon Park and Washington Heights, have the most prevalent low birth weight rates. Accounting for 70 percent of the differences between communities are segregation, unemployment and low educational attainment, which are factors that all highly correlated with low birth weight.
This research then examined the same indicator in communities in Toronto, a racially diverse city about the same size as Chicago. There, we found very different results. In Toronto, the best-off communities had a low birth weight prevalence of about 3 percent, comparable to the best-off neighborhoods in Chicago. But in Toronto, the worst-off communities fared much better, with a low birth weight prevalence of only 11 percent. In Toronto, there was no link between segregation and low birth weight, even though many communities in Toronto struggle with unacceptably high levels of unemployment and low educational attainment.
How Chicago, Toronto differ
Why the difference between the two cities? There are three possible reasons. First, Canadians have universal single-payer health care that allows women access to better care throughout their lives and around the time of their pregnancies. What’s more, some emerging initiatives within health care settings in Toronto provide assistance to patients that directly addresses low income or precarious housing.
Second, Canadians have more accessible municipal public services — think public transportation. There’s also a stronger social safety net, including the educational system, that allows poor and minority women greater social mobility than those in the U.S.
Third, racial discrimination is less pronounced and has fewer poverty-inducing consequences in Toronto. Job market opportunities are more equitably distributed, and social exclusion — the systematic marginalization of groups from rights, opportunities and resources — is less prominent.
Inequity ‘not inevitable’
For those of us in Chicago, this reveals an important lesson: Racial inequity in birth outcomes is not inevitable.
Chicago’s new public health plan, Healthy Chicago 2.0, lays out an ambitious equity-based agenda, one that calls for health improvements in high hardship areas. The plan rightly focuses on root causes, or what social epidemiologists call the “causes of the causes” — the social and structural conditions that determine a population’s health. However, structural racism in Chicago neighborhoods could threaten progress, as could national policies, such as Republican efforts to repeal the Affordable Care Act that will make access to health insurance and medical care more difficult for poor minority women. A repeal will likely mean that without specific new interventions, these Chicago racial inequities in birth outcomes are likely to persist.
If we are to improve community health in Chicago, we need to learn lessons from what cities such as Toronto have done, prioritizing equity in health and investing in the health of all residents.
Fernando De Maio, PhD, is an associate professor in the Department of Sociology at DePaul University and co-director of the Center for Community Health Equity. Patricia O’Campo, PhD, is a professor at the Dalla Lana School of Public Health at the University of Toronto and a research scientist at the Centre for Urban Health Solutions. David Ansell, MD, MPH, is a professor in the Department of Internal Medicine, senior vice president for Community Health Equity at Rush University Medical Center and a member of the Center for Community Health Equity. Raj C. Shah, MD, is an associate professor in the Department of Family Medicine and the Rush Alzheimer’s Disease Center at Rush University Medical Center. He also serves as a co-director of the Center for Community Health Equity.
This article originally appeared in slightly different form in Crains Chicago Business and is republished here by permission.