David A. Ansell - The Death Gap: How Inequality Kills

MARTIN LUTHER KING JR.

We all die. But tens of thousands of Americans die too early. These early deaths are not random events. These deaths strike particular individuals who live in particular American neighborhoods. And while we know that people die of cancer, heart disease, and so on, this killer isnt one that we can treat with drugs, therapy, or surgery. This killer is inequality.

This is a book about inequality and its impact on longevity. Inequality triggers so many causes of premature death that we need to treat inequality as a disease and eradicate it, just as we would seek to halt any epidemic. This is bigger than a war on cancer. It requires reassessing who we are as a country and as a people. It requires that we take action against a host of offenses that rob people of their dignity and their lives.

This sounds amorphous and abstract. But it is very concrete and specific. Inequality is all around us, as are the deaths it causes. We witness it along one Chicago street.

Ogden Avenue cuts a diagonal swath across the crisscross monotony of Chicagos street grid. This major thoroughfare began as a Potawatomi trading path that tracked from Lake Michigan through nine miles of mud, muck, and prairie to the Des Plaines River banks in the present-day town of Riverside. The Des Plaines pours into the Illinois River, which in turn flows into the Mississippi and on down to New Orleans and the Gulf of Mexico. White settlers planked the path over in the early 1800s as a defense against persistent, gluelike mud, and the City of Chicago paved it in the early 1900s. Ogden Avenue later became a critical Midwest link in the famous Route 66, a highway that connected the East and West Coasts in the early twentieth century.

Although Ogden Avenues glory days have faded, the neighborhoods it traverses offer a lens onto the impact of inequality. Ogdens four-lane asphalt, peppered with potholes, slices through an incredible diversity of neighborhoods, connecting wide-lawned western suburbs to the edge of the steel- and glass-towered Gold Coast and to some of the lowest-income, most economically distressed communities in the country. The marginalized residents of these communities dont just have different lifestyles, they have different lives: most critically, people who live in those western suburbs and on the Gold Coast live significantly longer than the people in the struggling neighborhoods in between. A twenty-minute commute exposes a near twenty-year life expectancy gap.

In my three-plus decades as a doctor who practiced along Ogden Avenue, I learned a simple truth. Where you live dictates when you die. This is not just true in Chicago. Every region in the United States has a street or highway like Ogden Avenue. Travel Third Avenue in New York thirty blocks from the Upper East Side to Harlem, and lose ten years of life.

A drive along Ogden Avenue gives us a curbside view of high-mortality In the 1990s, developers razed these flophouses to erect new apartments and loft buildings catering to young professionals and aging baby boomers moving in from the suburbs.

Southwest on Ogden from the former Skid Row neighborhood is the vast West Side ghetto. It is no different from many other inner-city neighborhoods in America, with empty lots interspersed with graffiti-marked, boarded-up businesses, the blinking red neon arrows of liquor marts, iron-barred currency exchanges, catfish joints, and storefront churches on crumbling sidewalks. There are no signs of that ancient prairie trail here except the occasional black-eyed Susan that emerges in the late summer through sidewalk cracks. The mortality rate here is among the worst in the city, and the nation.

Just before Ogden enters the run-down neighborhoods of Chicagos West Side, it passes, in quick succession, the three hospitals where I Next you see, kitty-corner to the western edge of Rush, the old Cook County HospitalCounty, as the doctors called itwhere generations of the uninsured and the down-and-out sought medical care. Old County, a squat, two-block-long, eight-story behemoth, now sits abandoned, boarded up and bedraggled. An eight-foot-high chain-link fence surrounds Countys main entrance to keep homeless squatters from seeking shelter underneath its faded blue canopy. Its ailing yellow-brick-clad beaux-arts facade is adorned with three-story pairs of fluted ionic columns, multicolored terra-cotta cornices, sculpted faces of roaring lions and cherubs. Once an architectural gem, it is now covered in soot and held together by netting and stainless-steel straps.

When I was twenty-six years old, medical diploma in hand, I traded the lush green hills of Upstate New York for the asphalt and steel of Chicago to work at this legendary training ground for generations of doctors and nurses. I intended to stay for just three years, but the human drama and misery I witnessed compelled me to remain longer. I practiced there for seventeen years. In 2002, County was shuttered by hospital officials and replaced by the John H. Stroger Jr. Hospital, a chunky structure that sits right behind old County and serves the same population of the poor, the unwanted, and those with no other medical options.

Those two hospitals kitty-corner from each other expose the extremes of health care in America: a beautiful and expensive institution where the finest care is available, and another that has struggled at times to provide even the most basic care to poor people. My understanding of the contrasts between life and death in rich and poor patients have been deepened by my years at County and Rush. But another Ogden Avenue hospital provides a third perspective on how survival gaps have become ingrained into neighborhoods and the institutions that serve them. Continue another eight-tenths of a mile down Ogden Avenue and a railroad viaduct looms into view, spanning the roadway. Painted on it is a blue-and-white advertisement for the Sinai Health System, whose flagship institution soon appears on the left.