By Deborah L. Shelton
The Chicago Tribune, Dec. 18, 2009
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.”
American Journal of Public Health, 10.2105/AJPH.2009.165407
Dec. 17, 2009, First Look online
“BlackāWhite Health Disparities in the United States and Chicago: A 15-Year Progress Analysis”
By Jennifer M. Orsi, Helen Margellos-Anast, Steven Whitman
http://www.chicagotribune.com/health/chi-chicago_health_gapdec18,0,628023.story