(gentle music)
- I'm a primary care physician,
at the University of Chicago on the city South Side.
I'd like to tell you about one of my patients.
Let's call him Mr. Jones for the sake of anonymity.
Mr. Jones was a classic Chicagoan.
Born and raised on the South Side, he loved jazz,
just a great person.
He also had a number of medical problems
that we were working to manage.
Diabetes, high blood pressure, heart disease.
In the beginning of 2020,
right at the beginning of the pandemic,
he started having symptoms of a cold.
And within 48 hours he was too sick to drive himself
to the University of Chicago.
So he called 911 and the ambulance took him
to the closest hospital to his home,
which turned out to be a small community hospital
that was overwhelmed.
And frankly unprepared to deal with the huge influx
of patients that were coming in with this new illness.
I was unable to get him transferred
to the University of Chicago,
and he was ultimately diagnosed with COVID.
And two weeks later, he passed away.
I have many patients that are like Mr. Jones.
Wonderful people, working class African-Americans,
who have chronic medical problems.
The kind of problems that if you get COVID-19
put you at increased risk for worse outcomes, like death.
And while I'll never know for sure if Mr. Jones
would have survived had he been transferred
to the University of Chicago.
What I do know is that hospitals in predominantly
black neighborhoods, are more likely
to be small community hospitals that are under-staffed
and under-resourced, compared to hospitals
in white neighborhoods.
See that is what residential segregation does.
It separates communities by race, and then differentially
allocates not only public funds, but other goods,
resources, and opportunities to those neighborhoods.
But healthcare isn't the only thing
that predicts poor health in residentially
segregated neighborhoods.
Black neighborhoods are less likely to have
all of the things, that are associated
with good mental and physical health,
compared to white neighborhoods.
Clean air that is unpolluted with environmental toxins.
Clean water that does not have lead.
Green spaces and parks, quiet places for meditation,
safe and stable housing, strong educational systems,
opportunities for employment,
pharmacies and grocery stores and other things that we build
in the environment that people need to promote their health.
All the things that we need to have a vibrant,
strong community.
The absence of those things, causes physiological changes
in our bodies.
The presence of chronic discrimination
and racism also causes physiological changes in our bodies.
Those two things together,
are more likely to predict poor health,
than merely the absence of a health clinic or a hospital.
I have a patient and we'll call her Ms. Washington.
She has asthma.
And while she was living in an apartment building
that was full of mold, her asthma was horribly controlled.
She was in and out of the hospital with severe exacerbations
that honestly could have killed her.
Fortunately she was able to find better public housing,
that was free of mold and any other environmental triggers.
And so now her asthma is well controlled.
It immediately got better.
And it's not a threat to her health.
I have another patient, Ms. Smith.
She has diabetes.
And when she was temporarily unhoused, unsheltered,
she was admitted to the hospital with a diabetic emergency
because her insulin was not able to be refrigerated.
And she was out access to her life-saving medication.
I was part of a team of physician scientists
that was led by Dr. Elizabeth Tung
at the University of Chicago,
that interviewed hundreds of people in Chicago
living in hyper segregated neighborhoods.
And what we found is that people who were exposed
to community violence, were more likely to report
that they were socially isolated,
and experiencing loneliness.
Factors that we now know,
are as bad for your health as smoking cigarettes.
And in our study, those people who reported
social isolation and loneliness, were also more likely
to report eating less fruits and vegetables,
being less likely to engage in physical activity,
and being less likely to take the medications
they needed to manage their chronic diseases.
The same people in a different study, when we asked them
about whether or not they had been exposed to community
and police violence, were more likely to report having
a sense of being hypervigilant.
That sense of fight or flight that is stimulated
by an adrenaline rush where your blood pressure
is also elevated.
And in the most extreme cases of people who reported
hypervigilance, their blood pressure had increased
by a magnitude of nine points,
nine millimeters of mercury.
That from other studies we already know increases
your risk of a heart attack or stroke by 50%.
And so when I'm in clinic seeing my patients,
and I'm asking them, "How's your blood pressure doing?
"Let's check and see how that's doing.
"How are you doing with your diet,
"with your physical activity,
"with your ability to take your medications?"
All of the things that we need to do
as primary care physicians to make sure our patients
are doing well, their family, their neighborhood,
their community, all of these factors are always, always
on my mind.
Because we have been living with the effects
of racism for so long,
it feels like it is impossible to overcome them.
But it's not.
Structural racism and residential segregation
are the result of policy choices
that we have made as a country.
And as a result we can make different choices.
We can choose policies that put racial equity
at the front of the table.
We can make choices that are promoting health equity.
Healthcare institutions are already leaning into this work.
And so are many other sectors like housing, transportation,
food, legal services, and many others.
I co-direct our national program called Bridging the Gap:
Reducing Diabetes Disparities in Care,
and we have program grantees all across the country
doing this important work.
One of the sites called Roots Community Health Center,
provides onsite job training
and light manufacturing for returning citizens,
also known as the formerly incarcerated.
Because if you are a black man in this country
with a history of incarceration
it is almost impossible to get a job.
So what Roots is doing is providing holistic
comprehensive care that rebuilds communities.
Not only provides healthcare to individuals.
And this kind of work in conjunction
with progressive comprehensive policies,
is what it's gonna take for us to mitigate
the persistent, intergenerational effects
of structural racism, and residential segregation,
for entire populations of Mr. Jones, Ms. Smith,
and Ms. Washington's.
And not only them but their children, and my children,
and yours as well.
(gentle music)