Chicago: Health Gap Widens Between Blacks, Whites

Health Study For Chicago: Health Gap Widens
Between Blacks, Whites
Problem is worse in Chicago than nationwide,
Sinai Urban Health Institute study says.
A new study finds a widening gulf in the health status
of blacks and whites in Chicago, even though
disparities between blacks and whites nationally
have remained static.
By Deborah L. Shelton
Chicago Tribune
December 18, 2009
http://www.chicagotribune.com/health/chi-chicago_health_gapdec18,0,628023.story

A widening gulf in the health status of blacks and
whites in Chicago comes even as disparities between the
two races nationally have remained relatively constant,
a new study has found.

The disparity is particularly jarring in five areas:
death from all causes, heart disease mortality, breast
cancer mortality, rates of tuberculosis and the
percentage of women who received no prenatal care during
the first trimester of pregnancy.

Nationally, the racial gap got worse from 1990 to 2005
for six of the 15 health indicators researchers studied.
However, in Chicago, disparities worsened for 11 of the
15 indicators, according to research by the Sinai Urban
Health Institute, published online Thursday in the
American Journal of Public Health.

Poverty, segregation and access to health care all
appear to play a role, researchers said. In Chicago
neighborhoods and medical offices, doctors and patients
see the same factors.

Dr. Charles Barron, medical director at Access Southwest
Family Health Center, said many of his patients struggle
to pay for health care.

"Access is definitely an issue, even at federally
qualified health centers such as Access Community Health
Network, which offers treatment on a sliding-scale
basis," he said.

Tonya Jackson, 39, of North Lawndale, takes seven
medications to treat heart failure. She is a patient at
Mount Sinai Hospital, which is widely known for its
initiatives to treat low-income and poor patients.

"Even with health insurance, a lot of medicines are very
expensive," she said. "When you're a single parent,
you're trying to pay rent, you have your child, and
you're trying to pay bills and buy food, so it's
difficult. A lot of people don't get the care they need
because they have to decide whether they want to eat
that day."

Dr. Niva Lubin-Johnson, an African-American physician,
has witnessed the disparities firsthand in her 20-year
solo practice in Chatham.

"Based on what I see," she said, "we have a greater
disease burden, and part of that comes from lifestyle,
part of it comes from income, part of it comes from
health literacy and people not understanding what they
need to do to live a healthy lifestyle."

An author of the study, institute director Steve
Whitman, previously has compared breast cancer
disparities in Chicago and New York. He said the health
of African-Americans in Chicago fares worse than blacks
elsewhere.

"The underlying issue here is racism and poverty,"
Whitman said. "In Chicago, it's exacerbated by
segregation. Black people in Chicago are forced to live
in neighborhoods where there are no stores to buy fresh
fruits and vegetables, where schools are failing, where
they don't have parks to exercise in and where they tend
to go to segregated health facilities that are poorly
funded and, in different ways, failing."

Dr. Georges Benjamin, executive director of the American
Public Health Association, cautioned about making
geographic comparisons.

"While it is important to measure an urban city like
Chicago against national numbers," Benjamin said, "the
national statistics include lots of places where some of
the challenges of racial disparity don't exist.

"When you average numbers out -- even though researchers
try statistically to correct for some of those things --
you have to be cautious."

But he agreed that racial disparities appear to be
worsening in Chicago.

"Despite Chicago's ... transit system, it still has
pockets of people where people have tremendous problems
accessing care, and that's a huge overlay," Benjamin
said. "Part of it is lack of insurance, and part of it
is access to care."

Ultimately, money might matter most when it comes to
good health, Benjamin said.

"If we were serious about doing something about
eliminating these disparities, we would pay attention to
the social determinants of health that put people in
these situations to begin with," he said. "At the end of
the day, there is very strong correlation between health
and wealth."

Sinai researchers analyzed the 15 measures using data
from city communicable disease records and Illinois
birth and death records.

The study builds on work published in 2004, believed to
be the first to examine the health of blacks and whites
in a major urban center over time and put findings in
the context of national trends.

Researchers reported that the African-American death
rate from breast cancer was 99 percent higher in Chicago
than for white women, a fivefold increase since 1990.

In 1990, blacks in Chicago were 8 percent more likely
than whites to die of heart disease.

In 2005, blacks were 24 percent more likely to die.

In 1990, black women were two times more likely to go
without prenatal care in the first trimester of
pregnancy. By 2005, they were three times more likely to
go without prenatal care.

Most of the measures showed improved health for both
blacks and whites nationally and locally, but whites'
health status improved much more, widening the gap.

If health indicators were equal, 3,200 fewer African-
Americans in Chicago would die every year, or about nine
a day, the study estimates.

Joseph M. Harrington, assistant commissioner for chronic
disease for the Chicago Department of Public Health,
agreed that the problem in Chicago is significant.

"But," he said, "what do we do about it? You can keep
talking about how bad the numbers are, but the real
question is, what do you plan to do?"

The city health department has initiated programs to
address the problem, including a federally funded
project focused on cardiovascular disease among blacks
and Hispanics living in North and South Lawndale,
Harrington said.

"These findings should provoke us to think about what
can be done, that's the call to action," Harrington
said.

"This should provoke us to do something."

_____________________________________________

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