Dr. David Ansell is a top executive at Rush University Medical Center. His focus is on community health and system integration for the medical center. As a long-time Oak Parker, Ansell is also actively involved at Rush Oak Park Hospital and has been active in health-related activism in the village including the successful effort to ban smoking in public places nearly 15 years ago.
Ansell is a physician, social epidemiologist and author whose 17 years working at Cook County Hospital inspired his memoir and social history, County: Life, Death, and Politics in Chicago’s Public Hospital. Ansell’s latest book is titled The Death Gap: How Inequity Kills, and through West Side United — a collaborative of health care institutions, residents, educators, non-profits, businesses, government agencies and faith-based institutions that work, live and congregate on Chicago’s West Side — he works to address those inequities on a holistic level. Ansell answered our questions about his research and what he sees as the solution. Below is an edited version of his comments.
Q: What inspired you to write about the Death Gap?
A: For the past 41 years, I’ve been a doctor in Chicago on the West Side. What I noticed is that my patients seemed to have a burden of disease and maybe died earlier than people elsewhere. It really seemed there was something about their neighborhoods. It’s not just the three B’s: belief, behavior and biology. I worked at Cook County Hospital for years, then at Mt. Sinai, and then came to Rush. I noticed over the years that your zip code can mean more than your genetic code. When your opportunity for social mobility and wealth development are diminished, and when you get more exposure to the toxic effects of poverty and racism, you get bad outcomes.
Q: What statistics informed your book?
A: In general, life expectancy in the U.S. is going up, but there are very large gaps that still exist. Chicago has among the largest in the U.S. The gap between the Loop and the South Side could be 25 years. In River Forest, the life expectancy can be in the 90s and in Garfield Park, it’s in the 60s. Between Oak Park and Austin, there’s an approximately 11-year life expectancy gap. Sixty percent of the premature mortality gap can be attributed to cancer and heart disease. This is where the neighborhood factor comes in. Austin is almost as big as Evanston, but has no good grocery store. People are literally dying because of the way we organize the city. I call it structural violence.
Q: What are you seeing as some of the root causes of the disparity?
A: Looking at the West Side communities, between 1970 and 2010, in these neighborhoods, capital and wealth have been removed. There’s been a 9 to 1 capital investment in white neighborhoods compared to black neighborhoods since the 1970s. We will never achieve health without wealth.
What makes the most difference in peoples’ lives and children’s lives is the ability to have social mobility. Where you grow up poor makes the biggest difference in life-time earnings. Neighborhood matters. Social conditions probably account for 40 percent or maybe more of the gaps in life expectancy.
Q: What can you do to reduce the death disparity?
A: We created an entity called West Side United, a racial health equity collaborative. We named 10 West Side neighborhoods and partnered with eight hospitals including Rush Oak Park and West Suburban Hospital.
There’s no pill you can take to add life expectancy. The most effective way is to improve neighborhoods. We are taking a holistic approach with West Side United, looking at economic vitality, education, food access, transportation, violence and health. The goal is to reduce the overall life expectancy gap by 50 percent by 2030.
Q: How has living in Oak Park informed your mission?
A: A lot of my insights come from living in Oak Park. I’ve lived here 34 of my 41 years in Chicago. I’ve driven west across the West Side and asked myself what makes a community healthy? When you drive into Oak Park from Austin, there’s all these trees, there’s people walking, there’s a gathering place in Ridgeland Commons and our parks.
When you move to Oak Park, you’re told to live west of Ridgeland, which is code in Oak Park to live away from Austin. As a society, we hold a collective mental map, so neighborhoods declined in the past because of our attitudes toward them. Sociologically, what makes a neighborhood go bad is attitudes that people have towards neighborhoods, impacted by racism and immigration. It’s so important to call out structural racism as a cause of the death gap. Oak Park gave me great insight into the issue.
Because the problems are inherently structural, not biological, we can change them, but we have to invest in these communities financially.