How segregation leads to health disparities

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Shalonda Cooper shows pictures of her mother, Windora, before and after she got sick. She says the poor, segregated neighborhood she grew up in contributed to her mother's bad health. (Jake J. Smith)

Shalonda Cooper shows pictures of her mother, Windora, before and after she got sick. She says the poor, segregated neighborhood she grew up in contributed to her mother's bad health. (Jake J. Smith)

Standing in her home, Shalonda Cooper points to an old picture of her mom, Windora.

“See how she looks here?” Shalonda asks. “She looks healthy! Look at the glow in her face.”

She then points to another picture taken about 20 years later, shortly after Windora had been diagnosed with diabetes and high blood pressure. She was in her thirties.

“Her eyes look sick,” Shalonda says. “They don’t look as bright as they used to look.”

Windora is sitting in a recliner nearby. A stroke a few years ago left her unable to speak, but she smiles as her daughter describes her life.

Windora’s father suffered from diabetes and heart disease. She didn’t maintain a healthy diet. More generally, Windora didn’t know what a healthy lifestyle looked like. “If we knew then what we know now, my mom would be healthier,” Shalonda says.

Hearing about Windora’s life, the health problems may seem expected — the diabetes, the high blood pressure, and even the stroke that eventually resulted from them.

But Windora’s doctor, David Ansell, Senior Vice President for Community Health Equity at Chicago’s Rush University Medical Center, thinks that focusing on these facts tells an overly simple story. He says it misses the underlying driver of Windora’s stroke: the poor, segregated neighborhood where she spent much of her life.

Understanding the death gap

In the early 1900s, sociologists and urban planners believed that safe communities were homogenous communities. “There was a sense that racial violence that occurred in cities like Chicago in 1919, or in other parts of the country in the wake of the Great Migration, seemed to prove that the only way to really make sure that communities could be stable was if, in fact, they were racially segregated,” said Nathan Connolly, a historian at Johns Hopkins University.

This “folk knowledge,” as Connolly calls it, eventually became federal policy.

The federal government drew maps delineating white neighborhoods and developments, and black ones. In the white areas, the feds backed mortgages, revolutionizing financing in the housing sector. They deemed the black areas a bad investment, and didn’t back mortgages there.

As a result, black people had a really hard time buying homes, and ended up living in neighborhoods with no investment, bad infrastructure, and old housing. Meanwhile, white people with financing moved into wealthier parts of town or new subdivisions.

By the time laws promoting segregation started changing — in the 1940s, 1950s, and into the civil rights movement — the thinking behind the debunked policies had been internalized by the housing industry, even when people weren’t seeking federally backed loans.

People internalized it, too. Black families moving into neighborhoods signified plunging property values to white residents.

“Once a neighborhood moves to about 30 percent black, people in that neighborhood who aren’t black perceive that their neighborhood is going downhill,” Connolly said. “They perceive that their property values will be diminished and so they begin the process of trying to rapidly sell off their homes and see if they can leave the community with as much of their initial investment as possible.”

White flight emptied many cities of its white residents; businesses and investment followed.

“These became neighborhoods of not only concentrated segregation, but concentrated poverty,” said Ansell. “And with that, health deteriorated.”

To show what this looks like today, Ansell drives through Chicago’s West Garfield Park, an almost entirely black neighborhood with high crime and unemployment rates.

Life expectancy here is 69 years — the same as Iraq, and nearly a decade below the city average of 78. If he drives five miles northeast, to the wealthy, white River North area, life expectancy skyrockets to 85.

“That’s a 16-year gap,” says Ansell. “That gap is bigger than the gap between Haiti and the United States. And it’s seven El stops away.”

In his book, “The Death Gap,” Ansell looks at the factors that drive this enormous disparity.

For example: River North today is a safe, prosperous area. Most residents have college degrees, health insurance, and easy access to fresh produce.

That was not the case where Windora Cooper spent much of her life, near the Cabrini Green housing projects. When Windora’s family moved there in the early ‘60s, they found themselves living in one of the most famously poor and segregated parts of the city.

As Shalonda recalls, fruits and vegetables were hard to come by, and gun violence was a constant threat. Shalonda remembers seeing a man get shot and die right outside of her window. “That affected my sleep,” she said. “And I’m sure that it affected everybody in the house.”

Windora met Ansell at Cook County Hospital, a public hospital where she was his patient. Cook County treated people from all around Chicago who could not afford private healthcare — but it was perpetually short-staffed and often lacked basic equipment.

“It had a smell to it,” Ansell said. “It was like sweat and desperation and rusted pipes.”

To Ansell, this concoction — limited food options, subpar healthcare, and the stress of living amid poverty and violence — has its roots in discriminatory housing practices, and the exodus of investment that followed. Compared to white people, black people all across Chicago are 30 percent more likely to die of cancer, 70 percent more likely to die of stroke, and 80 percent more likely to die of diabetes, according to Chicago Department of Public Health.

‘The best thing we could have ever did for our family’

Ansell’s solution to this death gap? Invest more in low-income, minority neighborhoods.

But families like Windora’s have found a much more immediate solution: move.

In 1988, Windora and several relatives pooled their money to buy a house in Humboldt Park, a Latino neighborhood on Chicago’s Northwest side.

Windora’s granddaughter Niya says she and her siblings grew up playing in the park nearby — something her older family members had been afraid to do in Cabrini Green. “So we were probably a lot more active than they were, because we went to the park and we did the monkey bars,” said Niya. “We jumped on the swing.”

Her mother, Shalonda, nods in agreement. “When we moved over here, it was the best thing we could have ever did for our family.”

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