Black:White Health Disparities in Chicago: Diversity or Racism

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BlackWhite Health Disparities in Chicago
Diversity or Racism?

• Steve Whitman, Ph.D.
• Sinai Urban Health Institute
• 773.257.5661 whist_at_sinai.org
• December 6, 2004

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Co-Authors

• Abigail Silva, MPH
• Helen Margellos-Anast, MPH

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Outline

• Background
• Update of AJPH Disparities Paper
• Comparing Disparities Among Big Cities
• Life Expectancy in Chicago
• Conclusions

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Healthy People Goals

• As part of the Healthy People Initiative we have
  been setting national health goals since 1980
• By 2000, reduce disparities in health
• By 2010, eliminate disparities in health
• overarching among 467 objectives

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The Structure of This Pursuit

• Black and White Infant Mortality in Chicago, 1930
  2002
• Year Black IMR White IMR BW
  Ratio
• 80.0 51.0 1.6
• 39.3 27.0 1.5
• 39.5 23.4 1.7
• 26.9 14.8 1.8
• 15.9 7.1 2.2
• 2002 14.0 5.0 2.8

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Outline

• Background
• Update of AJPH Disparities Paper
• Comparing Disparities Among Big Cities
• Life Expectancy in Chicago
• Conclusions

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AJPH Disparities Paper

• Comparison of Health Status Indicators in
  Chicago Are Black-White Disparities Worsening?
  Margellos, Silva Whitman, AJPH,
  200494116-121.
• Computed NHBNHW rate ratios for 14 Health Status
  Indicators (HSIs) defined by CDC and compared
  them between 1990 and 1998

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Health Status Indicators

• All cause mortality
• Heart disease mort
• Stroke mort
• Lung cancer mort
• Fem br cancer mort
• MVI mort
• Suicide mort
• Homicide mort

• IMR
• LBW
• No PNC, 1st trimester
• Birth rate (15-17 y/o)
• TB
• PS syphilis

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Findings - 1

• For paper, analyzing 1990 and 1998
• US improved on 11 of 14 HSIs (p 0.03)
• Chicago worsened on 11 of 14 HSIs (p 0.03)
• For update, analyzing 1990 and 2000
• US improved on 10 of 14 HSIs (p0.09)
• Chicago worsened on 10 of 14 HSIs (p0.09)

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Findings - 2

• Lesson 1 The US is very slowly reducing BW
  health disparities. Chicago is moving in the
  wrong direction as most BW disparities are
  worsening.
• Lesson 2 The magnitudes of several of the
  observed disparities in Chicago are appalling
• Breast cancer mortality, from 1.20 to 1.41
• Heart disease, from 1.10 to 1.19
• Homicide, from 8.16 to 11.70
• IMR, from 3.05 to 3.18
• LBW, from 2.41 to 2.78

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Examples of Growing Inequities

• IMR Breast Cancer
• NHB NHW Ratio NHB NHW Ratio
• 1980 26.9 14.8 1.80 38.3 35.5
  1.08
• 1990 23.3 7.6 3.05 44.4 37.0
  1.20
• 2000 16.2 5.1 3.18 42.0 29.8
  1.41 data for 1980 are for Blacks and Whites

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Outline

• Background
• Update of AJPH Disparities Paper
• Comparing Disparities Among Big Cities
• Life Expectancy in Chicago
• Conclusions

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Big Cities Analysis - 1

• In the AJPH paper we suggested two hypotheses
  that might explain why Chicago was doing so much
  worse than the US in eliminating BW disparities
• Urban centers are bad at this
• Chicago is uniquely bad at this

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Big Cities Analysis - 2

• To examine these hypotheses we generated a data
  set with the largest cities (those with more than
  100K Black people) and calculated changes in
  NHBNHW disparities (for 1990 2000) for 11 of
  the HSIs. (We have not yet included 15-17 y/o
  birth rate, TB, Syphilis due to logistical
  reasons.)

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Big Cities Analysis - 3

• 24 cities
• 11 HSIs
• 27 of the rate ratios for these HSIs worsened
  for the US
• 54 of the rate ratios for these HSIs for these
  24 cities worsened

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Big Cities Analysis - 4

• Chicago worsened on 7/11 (64) of the HSI rate
  ratios
• 3 cities of the 24 (Atlanta, Milwaukee, and New
  Orleans) did worse than Chicago
• 4 cities did as bad (Columbus, Dallas, Houston,
  and Nashville)
• 16 cities did better, including New York (9), LA
  (55), Philadelphia (36), and Washington, DC
  (50).

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Big Cities Analysis - 5

• Thus, both our hypotheses appear to be supported
  by the data and contribute to explaining
  Chicagos poor performance in reducing
  disparities
• In terms of reducing NHBNHW health disparities
• Urban areas do worse than the US
• Chicago does worse than most other urban areas

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Outline

• Background
• Update of AJPH Disparities Paper
• Comparing Disparities Among Big Cities
• Black Health Comparisons
• Life Expectancy in Chicago
• Conclusions

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Life Expectancy, 2000

• US 77.0 years
• Chicago 74.5
• NH WM 73.7
• NH WF 80.0
• NH BM 65.2
• NH BF 74.3

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• Of Chicagos 77 community areas
• High LE 82.0, Low 64.9 (diff 17.1) (in
  NYC there is a difference of only 8 years)
• The 22 communities with the lowest LE are more
  than 90 Black
• 12 of these 22 have male life expectancies that
  are less than 65 years

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Outline

• Background
• Update of AJPH Disparities Paper
• Comparing Disparities Among Big Cities
• Black Health Comparisons
• Life Expectancy in Chicago
• Conclusions

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Conclusions - 1

• BW health disparities are worsening in Chicago
  though they are improving (slowly) in the US
• Chicago is doing very poorly, even compared with
  other big cities, with respect to reducing BW
  health disparities
• LE, perhaps the most important measure of health,
  is very low for Black people (especially men) in
  Chicago

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Conclusions - 2
The system of individual and institutional racism
defines this countrys founding and its
accumulation of empire. It has generated almost
400 years of poor health among Black people (and
others, of course). This system must be
combated, on the individual and the institutional
level.
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Conclusions - 3

• Together we must find a way to improve the
  health of all people and eventually arrange
  matters so that health and even life and death
  are not driven by the color of ones skin or how
  much money one has.
• Sinai Health Systems Improving Community Health
  Report

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Conclusions - 4
A nation that continues year after year to spend
more money on military defense than on programs
of social uplift is approaching spiritual
death. Dr. Martin Luther King, Jr., excerpted
from an address given at Riverside Church, New
York City, April 4, 1967.