As the Tribune reported in 2019, a New York University School of Medicine study, which builds on similar previous research, found that Chicago residents living in Streeterville could expect live 30 years longer on average than their neighbors in Englewood just 10 miles away. a way. It is the largest urban disparity in the United States
How can people in the same city have such dramatically different health outcomes? It comes down to the social determinants of health, or SDOH. According to the definition of the United States Department of Health and Human Services, SDOH are “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health conditions. health, functioning and quality. life outcomes and risks.
Environmental factors affect so many dimensions of our lives. It’s not surprising. But their relationship to our mental and physical health is underexplored. Health researchers and practitioners are realizing how intertwined all of these elements are and how they combine to create ideal or poor health outcomes.
There are obvious questions related to health: are there clinics and hospitals in your neighborhood? Accessible? But what about the quality of education in your community? Do you have access to fresh and affordable food? Are there paid employment opportunities? Does your neighborhood have clean air? Safe drinking water? Is your apartment heated in winter? Untreated mold? Do you live near a highway or a factory? Is there accessible public transport?
All of these factors explain the community health of a population and, in worst-case scenarios, can cause the life expectancy of our neighbors and ourselves to plummet. The historic red line and systemic racism have shamefully set the stage for Cook County to see some of the worst SDOH disparities in the nation. And there’s still a lot of work to unpack that legacy. And yet, in response to this grim reality, Chicago has also been an incubator for some of the most creative responses to health inequalities.
Chicago’s Cook County Hospital, founded in 1834, was known as “Chicago’s Ellis Island” because of its practice of providing care for immigrants and the poor. It housed the country’s first blood bank in 1937 and one of the first AIDS services in 1983.
Cook County was one of the first municipalities to expand Medicaid to eligible residents through an early expansion initiative called CountyCare in 2012. In the first year, 82,000 adults living in the county with equal or lower incomes at the federal poverty level received low-cost services. , quality health insurance.
Affordable, quality health insurance is one of the most effective ways to make health care accessible – with a focus on affordability. According to the 2021 census, the uninsured rate fell to 8.3%, meaning more than 90% of Americans had health insurance that year.
Yet medical debt remains a crisis for many. Most recently, Cook County became the first local government to launch a program to eliminate medical debt for residents whose incomes reach up to 400% of the federal poverty level through its Debt Relief Initiative. medical. Medical debt is a huge cog in the wheel of social determinants. It prevents people from seeking the care they need and it can create financial instability by deleting credit scores and leading to wage garnishment. An under-explored dimension of this crisis is mental health: people in debt are three times more likely to report suffering from anxiety or depression.
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Medical debt is increasingly being recognized as an SDOH, and once again Cook County is stepping up to show that modern leadership can heal old wounds by being bold and creative.
This, of course, is not a problem unique to Cook County. America as a whole spends more on direct health care costs than other developed countries with poorer health outcomes, and conversely, we spend less on “welfare” – safety net programs that deal with food insecurity and housing, education, etc.
Other municipalities grappling with the generational impacts of inequality, I encourage you to follow Cook County’s lead. Toledo and Lucas County in Ohio have done this before.
By removing systemic barriers to care such as lack of insurance and medical debt, you can ensure your citizens have the best chance of living a healthy life.
Dr. Ram Raju is a physician who has held leadership positions at Northwell Health, NYC Health + Hospitals, and Cook County Health, where he served as CEO from 2011 to 2014. He teaches at the Roosevelt House Public Policy Institute at Hunter College in New York and is a board member of the nonprofit RIP Medical Debt.
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