Low Birth Weights Tell Troubling Tale of Two Cities

birth-weight-disparitiesBy 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.

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Obamacare: More Success Than Failure So Far

peter-butlerBy Peter W. Butler, MHSA

More than six years after it was signed into law, the Affordable Care Act continues to arouse strong opinions and strong objections. Consider, for instance, the viewpoint made clear by the title of a Sept.11 Chicago Tribune editorial, “Why Obamacare Failed.”

Simply dismissing the ACA as a “failure,” however, is not supported by the facts when considered in the context of what Obamacare, as the ACA is more widely known, set out to accomplish. According to the obamacarefacts.com website, the goal of the Affordable Care Act is to “give more Americans access to affordable, quality health insurance and to reduce the growth in U.S. health care spending.”

Although some of the editorial made valid points about problems with state health insurance exchanges (marketplaces), especially in Illinois, the exchanges are a small part of Obamacare. The Tribune editorial board appears to have reached its conclusions based on premium increases and the limited number of choices available on the state exchanges.

How the ACA has helped

This view ignores a wide array of peer-reviewed data that examines the full impact of the ACA. These data and evaluations present a health care system that is performing much better than it was prior to the enactment of the ACA.

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‘We Can Do More’ to Address Gun Violence

gun-violence-2By Steven Rothschild, MD

This week, the American Medical Association called for urgent action on a growing epidemic in the U.S. In doing so, the AMA joined several other professional societies in declaring that we can no longer continue to ignore a health problem that killed over 30,000 Americans last year (including 1,500 children) and disabled countless more. They cite strong evidence for interventions that have been consistently shown to save lives, but which are not being implemented.

What is this public health problem? AIDS? Cancer? Zika virus? No: It is gun violence.

This past weekend, all of us were horrified by the mass murder at the Pulse nightclub in Orlando. The motivations of the gunman remain unclear, and we may never know whether this was due to homophobia, terrorism, mental illness or a combination of all three. What we do know is that 49 young people were robbed of their lives in a matter of minutes.

We also know that, here in Chicago, since the start of 2016 over five times that many people — 265 as I write this — have been killed with guns. Colleagues in the Rush emergency room tell me that so far this year they have seen more patients with gunshot wounds than ever before.

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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.

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Reginald ‘Hats’ Adams, 1940-2015

hats-adams

Reginald “Hats” Adams planned to be a pool shark after he was expelled from high school. While he spent the next several years winning money with his pool stick, Hats ultimately devoted more than half a century to improving the health, well-being and education of Chicago youths like himself.

The director of the Department of Community Affairs at Rush University Medical Center since 1980, Hats died on Friday, after a lengthy illness, in his home in Country Club Hills with his wife by his side. He was 75 years old.

“Years ago, Rush grappled at times with how best to serve our community and most effectively relate to our many community stakeholders. Hats was invaluable in these efforts,” says Larry Goodman, MD, Rush’s CEO. “More than anyone I know, he has helped Rush focus on those things that are important and make a real difference.”

“My history with Hats went back 33 years, and I was his boss on paper for quite a few of those years, but it was Hats that guided me rather than the other way around,” adds Peter W. Butler, president of Rush.

Throughout his Rush career, which began in 1968, Hats paid particular attention to the educational concerns of minority students. Thanks to his efforts, in 1990 Rush launched its Science and Math Excellence (SAME) Network in response to the low science, math and reading test scores in Chicago schools in the area surrounding Rush.

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Join Rush in Celebrating Our Community Engagement

community-service-fbBy Marilyn Wideman

Rush University Medical Center is well-known in our community, but our community engagement remains one of Rush’s best-known secrets. To recognize and celebrate this work, Rush is hosting our inaugural Community Health Improvement Week.

All members of the public are welcome to join us between May 4 and 7 for a series of panel discussions, poster presentations and a keynote and awards session. You can register to attend the events here.

While Rush cares for patients from throughout the Chicago area, and even throughout the world, the main communities we serve are our neighbors on Chicago’s West Side, where Rush chose to remain even after other hospitals left during social unrest in the 1960s. This community includes the East and West Garfield Park, North and South Lawndale, and West Side and Lower West Side and West Town neighborhoods.

These are neighborhoods that struggle with high rates of poverty, crime, and the disparities in health that accompany them. Working amid these neighborhoods ensures that we at Rush see these problems, and our community engagement has developed in response to them.

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Taking Pride in Health Care Equality

Brad Hinrichs_2012By Bradley G. Hinrichs

American hospitals and clinics, including Rush University Medical Center, are increasingly committed to equality for their LGBT patients and staff, according to a report based on a national survey released in July by the Human Rights Campaign Foundation, the educational arm of the nation’s largest LGBT civil rights organization.

A record total of 718 health care facilities nationwide (an increase of 153 percent in participation relative to the 2012 survey) have explicitly pledged themselves to equal treatment for LGBT patients. That number includes 121 of the nation’s 151 Veterans Health Administration medical centers, compared to just one VHA participant in the 2012 survey. That’s great progress!

We at Rush can be very proud of our organization’s record on the Healthcare Equality Index, the annual survey administered by the HRC Foundation. We have participated in this assessment of our policies and practices for the last five years, and have achieved a perfect score each of those years on the four foundational criteria for equitable LGBT care. This has led to our recognition as a “Leader in LGBT Healthcare Equality” for the fifth year in a row; a distinction achieved by no more than four other health care facilities nationally. These key criteria include providing equitable treatment to LGBT patients and families, nondiscrimination policies for LGBT patients and employees, visitation policies granting same-sex partners and parents the same consideration and rights as different-sex partners and parents, and training in LGBT patient-centered care for key leaders as well as caregiver staff.

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