Life expectancy in Oak Park and River Forest is 83 years. But cross Austin Boulevard into the Austin neighborhood of Chicago and life expectancy plummets to under 72. 

While headlines portray Austin as an epicenter for Chicago’s violence epidemic, the life span gap between Austin and Oak Park result from excess cases of heart disease, diabetes and cancer. 

In my new book, The Death Gap: How Inequality Kills, I explore how neighborhood conditions foster ill health and premature mortality — not only in Chicago, but across the nation. These statistics on early death reflect averages, but every death is a person, and the book is a call to action for all of us to do more for America’s forgotten neighborhoods.

My observations of my patients’ lives led me to write The Death Gap. I have practiced internal medicine at three hospitals within two miles of each other along Ogden Avenue in Chicago: Cook County Hospital for 17 years (Now John H. Stroger Hospital of Cook County), Mount Sinai Hospital for a decade, and for the past 12 years at Rush University Medical Center. 

I call my experiences and those of my patients, “one street, two worlds.” The patients at County and Sinai were poor, largely minority, uninsured or underinsured. Technological advances and capital for infrastructure investment available at well-endowed health systems like Rush are often beyond reach for doctors and patients who find themselves in safety-net hospitals like County and Sinai that do their best, but have more limited operational and capital resources simply because they serve poor people. But it’s not just hospitals serving the poor that are different. The neighborhoods of concentrated poverty and segregation, where my patients lived, fostered ill health.

Why do people in Austin and in most other African American neighborhoods of Chicago (and across America) die earlier than their wealthier neighbors in Oak Park or the Loop? In The Death Gap, I propose that structural violence is the true cause of the dramatic racial differences in death rates across U.S. neighborhoods. 

It is structural because it is rooted in past and present social, economic and racial inequality. It is violence because it harms people, causing premature illness and death.  

But premature mortality is not just an issue of racism and urban black, high-poverty neighborhoods. Non-college educated white men and women across America, having experienced wage stagnation and social status loss, have had rising mortality rates since the turn of the 21st century — a phenomenon seen nowhere else in the developed world.

In The Death Gap, I tell the stories of real people. My patients lived in high-poverty neighborhoods. I met Windora Bradley at County Hospital when we both were 27 years old. In contrast to my life of middle class comfort in Oak Park, Windora, a school cafeteria supervisor, lived in impoverished Humboldt Park where, despite her best efforts, her life was punctuated by neighborhood violence, family tragedy and personal health problems. These struggles cumulated in a debilitating stroke that left her unable to speak. 

Through the lens of Windora’s illness, I deconstruct the widespread view that illness and premature death result from some combination of the Three Bs: Beliefs, Behaviors or Biology. I explain how neighborhood conditions — concentrated poverty, structural racism and the social gradient — cause disease and early death along racial and socioeconomic lines.

Finally, I offer solutions to the problem of “death gaps.” First, I advocate for a single-payer, improved Medicare-for-All health financing system. Countries that have these systems of health-care delivery have narrower death gaps between the rich and the poor.

Second, I call for a reinvestment in these high poverty neighborhoods in jobs and educational opportunities by anchor institutions, such as hospitals, businesses and industry that have contributed to the historic disinvestment in these neighborhoods.

Finally, I call on all of us to invest our human capital into these neighborhoods to break down the perception and empathy barriers that keeps residents of neighborhoods of concentrated affluence from caring about those suffering at the bottom of the social gradient.


David Ansell will be speaking about his new book at the Oak Park Public Library on Wednesday, Aug. 23 at 7 p.m. He is also the author of “County: Life, Death, and Politics at Chicago’s Public Hospital”. 

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