[Applause]
Sera’s liver was failing and if she
could get on a transplant list she might
go right to the top sarah lived with her
mother and her siblings in Waukegan a
suburb of chicago and while her mother
works the family was uninsured and sarah
was denied an appointment at one of
Chicago’s leading transplant centers her
mother later recalled they told us we
had to raise five hundred thousand
dollars but we couldn’t even raise ten
thousand dollars Sarah died she was 25
we all died but tens of thousands of
Americans died too soon and the killer
is not random this killer strikes
particular people in a particular
American neighborhoods and unlike cancer
and heart disease
this killer cannot be treated with
medications or surgery this is bigger
than the war on cancer this killer is
inequality inequality is responsible for
so many early deaths in America that we
need to treat inequality itself as if it
were a disease and or an epidemic like
cholera or polio and eradicate it it
calls into question who we are as a
nation and a people and it sounds like
it might be abstract or amorphous but
actually the solutions to this problem
are very specific and concrete and I
learned how inequality killed during my
40 years taking care of poor patients
from
some of Chicago’s most neglected
neighborhoods and from the vantage point
of my examination room on the west side
of Chicago I got to see who gets to live
and die in America for almost 30 years I
worked exclusively at hospitals that
only serve the poor african-americans
Latinos immigrants and because of the
poverty of the patients these
institutions were always under financial
stress and treatments and examinations
and therapies and x-rays that were
available at other institutions in the
white neighborhoods in a wealthy
neighborhoods of town were out of reach
for me and my patients once the chief
medical officer of Cook County Hospital
where I spent almost 20 years Chicago’s
public hospital said to me David the
wait list for the eye clinic at County
is so long that you can go blind waiting
and yet at the private hospital across
the street you can see the eye doctor
today if you have the right insurance
card for all those years not one of my
patients who needed a life-saving organ
transplant ever received one even though
their family members were willing to
donate organs and like Sarah
I watched them die and yet many of the
organs that went to nourish the lives of
transplant recipients often middle class
and white people and other institutions
came from the black and brown patients
in Ric use in the city of Chicago and
it’s true across the country 30% of the
organs came from the uninsured our
but it’s more than just the Frank
inequity in healthcare delivery that
caused premature death there was
something about the neighborhood’s
themselves where our patients lived and
the exposure to the toxic stress of
poverty of poor housing of low-wage jobs
of policing and other things that
shortened lifespans in addition to being
a doctor
I’m a social epidemiologist and an
epidemiologist compares disease rates in
one community versus another and there’s
one way to sum up how inequality kills
one number that we can use in that
number is life expectancy this is a map
of the El tracks in Chicago and it’s
going to show you that where you live
dictates when you die and if you live in
Chicago’s loop a neighborhood of
concentrated affluence mostly white
people you live on average to the age of
85 and if the loop were a country
it’d be ranked first in the world and
life expectancy think Japan but go seven
stops down the blue line three stops
from where I practice medicine and you
land in the neighborhood of Garfield
Park and life expectancy plummets to
wonder 69 think Bangladesh in Garfield
Park is a neighborhood of concentrated
disadvantage mostly african-american you
know how could this be you ask yourself
when was the last time in America that
life expectancy was under 69 and you’d
have to go all the way back to nineteen
fifty seven stops seven decades so if
you made me think of well this is just
Chicago this is actually national
problem and it’s getting worse across
the 405 and LA and lose sixteen years of
life is expect
Chansey go from white Fairfax County
Virginia to all white and poor McCullum
County West Virginia and lose 20 years
of life expectancy and its international
go from the South of England to the
north of England you lose eight years go
from the wealthy districts of Shanghai
to the poor districts and he use lose 14
years but it’s particularly growing in
the United States here’s a fact a 16
year old african-american teenager young
man who lives in a neighborhood like
Garfield Park has a little more than a
50% chance of living to the age of 65
why is this I’ve asked this many times
in many audiences and the answer usually
is wells gun violence and certainly gun
violence in Chicago is a problem but
more than half the early deaths in a
neighborhood like Garfield Park are from
heart disease and cancer diseases for
which we have prevention early detection
treatment and even cure so it’s a form
of violence but it’s not interpersonal
violence that’s causing us is something
that’s called structural violence and a
structural violence because the
conditions that cause ill health are
structured and designed into our laws
our policies our procedures and norms
that govern day to day life in
neighborhoods and it’s violent because
people die early as a result I need to
pause here for a second as a white man
and as a doctor who’s practiced in these
neighborhoods for all these years it’s
only recently that I have felt
comfortable naming racism as a key
driver for premature mortality
separate from poverty itself and I want
to explain why there are many poor white
people in Chicago but there’s not one
poor white neighborhood so a young white
girl growing up in a neighborhood has
available to her all the things in that
neighborhood the parks the schools the
grocery stores the health care and has a
potential to get out if you go look
across the United States there are
hundreds 71 cities and not in one city
is there a white neighborhood that’s
more economically disadvantaged than any
black neighborhood in America and this
means premature deaths are berta or
burden on top of the black population in
the United States 200 black people die
every day just because they don’t have
the life and health experience of white
people many years ago my friend Steve
Whitman an epidemiologist in Chicago
added up all the excess white deaths in
Chicago and it became the front page of
the sun-times says 3,200 excess black
deaths in Chicago just because black
people in Chicago did not have the same
health and life outcomes as white people
does that number look familiar to anyone
some major thing in American history
there’s a number of people that died in
9/11 but I just want to say this is not
exclusively about racism poverty itself
no matter where it is kills and over the
past thirty years we’ve seen the 20% of
the highest wage earners in the United
States their life expectancy shoot up
and the lowest 20% of wage earners in
the United States white black and others
their life expectancy has dropped
something we don’t see in other
countries and for the past two years
because of this fact the overall life
expectancy of the in the United States
has dropped and we’re the only developed
country in the world that’s seen a life
so there’s a grim statistics but I’m
here to tell you inequality is not
inevitable and it’s not immutable we can
do something about it in addition to
being a doctor
and a social epidemiologist I’m a human
rights activist and I believe that the
right to health and health care is a
human right there should be available to
everyone regardless of their income or
their situation and all we have to do to
get there is believe that we can be
agents of change so what does change
look like how do we change this so one
we need to change the narrative so we
need to change the narrative of what’s
going on in our neighborhood from
something a factor of personal
responsibility to social responsibility
we have to figure out how do we partner
better with leaders in these
neighborhoods who know what’s going on
in the ground and can help lead the
institutions to solutions but most
importantly we’ve got to measure the
impact of this because the these are
inequities they’re unjust and there’s an
urgency to act so we need that we need
to act so when Sarah died her
congregation carried caskets from their
storefront Church seven miles to the
front doors of Northwestern and held a
funeral and a hunger strike and the
attention that that got changed the
narrative about transplant in Chicago
and the community got together with the
transplant institutions and we were able
to actually get people insurance and
since then a hundred thirty people made
it to transplant lists 70 have gotten
transplants and most of the organs 75%
came from community members and family
members and as a result donations of
organs are way up in the area because
it’s a fair system and when we showed
this map around the city
people said that’s wrong that life
expects is so low what can we do and the
hospitals and the community have gone
together and created a collaborative
called Westside United with the aim to
reduce the life expectancy gap in
Chicago by 50% by 2030 and that’s the
usual map you see of the city this is
the map the community leaders on the
Westside made of their beautiful
community green lots of assets changing
the the map of the city in these
neighborhoods from hopelessness to hope
from risk to opportunity and solving the
problem of inequality is quite concrete
if we focus on health and health care
neighborhood structure jobs that pay
good wages and education these are not
obscure things to do and what we ask the
community leaders to say what would the
headlines look like in the future and
this is one of the headlines that they
came up with when we’re successful
Westside life expectancy is it matches
that of the loop or this one from
violence to victory changing the
Westside story so we are not stuck in
this place there are no limits to what
we can do frankly as a doctor has done
this for many years I’m sick and tired
of watching my patients who are also
sick and tired from dying and getting
sick from poverty and racism we have an
American dream but not everyone gets to
live the American dream life liberty and
the pursuit of happiness we have the
opportunity to make a difference if we
all join in together because we can’t do
this one disease one neighborhood one
city at a time we can’t settle for less
thank you
[Applause] [Music]
Sera’s liver was failing and if she
could get on a transplant list she might
go right to the top sarah lived with her
mother and her siblings in Waukegan a
suburb of chicago and while her mother
works the family was uninsured and sarah
was denied an appointment at one of
Chicago’s leading transplant centers her
mother later recalled they told us we
had to raise five hundred thousand
dollars but we couldn’t even raise ten
thousand dollars Sarah died she was 25
we all died but tens of thousands of
Americans died too soon and the killer
is not random this killer strikes
particular people in a particular
American neighborhoods and unlike cancer
and heart disease
this killer cannot be treated with
medications or surgery this is bigger
than the war on cancer this killer is
inequality inequality is responsible for
so many early deaths in America that we
need to treat inequality itself as if it
were a disease and or an epidemic like
cholera or polio and eradicate it it
calls into question who we are as a
nation and a people and it sounds like
it might be abstract or amorphous but
actually the solutions to this problem
are very specific and concrete and I
learned how inequality killed during my
40 years taking care of poor patients
from
some of Chicago’s most neglected
neighborhoods and from the vantage point
of my examination room on the west side
of Chicago I got to see who gets to live
and die in America for almost 30 years I
worked exclusively at hospitals that
only serve the poor african-americans
Latinos immigrants and because of the
poverty of the patients these
institutions were always under financial
stress and treatments and examinations
and therapies and x-rays that were
available at other institutions in the
white neighborhoods in a wealthy
neighborhoods of town were out of reach
for me and my patients once the chief
medical officer of Cook County Hospital
where I spent almost 20 years Chicago’s
public hospital said to me David the
wait list for the eye clinic at County
is so long that you can go blind waiting
and yet at the private hospital across
the street you can see the eye doctor
today if you have the right insurance
card for all those years not one of my
patients who needed a life-saving organ
transplant ever received one even though
their family members were willing to
donate organs and like Sarah
I watched them die and yet many of the
organs that went to nourish the lives of
transplant recipients often middle class
and white people and other institutions
came from the black and brown patients
in Ric use in the city of Chicago and
it’s true across the country 30% of the
organs came from the uninsured our
but it’s more than just the Frank
inequity in healthcare delivery that
caused premature death there was
something about the neighborhood’s
themselves where our patients lived and
the exposure to the toxic stress of
poverty of poor housing of low-wage jobs
of policing and other things that
shortened lifespans in addition to being
a doctor
I’m a social epidemiologist and an
epidemiologist compares disease rates in
one community versus another and there’s
one way to sum up how inequality kills
one number that we can use in that
number is life expectancy this is a map
of the El tracks in Chicago and it’s
going to show you that where you live
dictates when you die and if you live in
Chicago’s loop a neighborhood of
concentrated affluence mostly white
people you live on average to the age of
85 and if the loop were a country
it’d be ranked first in the world and
life expectancy think Japan but go seven
stops down the blue line three stops
from where I practice medicine and you
land in the neighborhood of Garfield
Park and life expectancy plummets to
wonder 69 think Bangladesh in Garfield
Park is a neighborhood of concentrated
disadvantage mostly african-american you
know how could this be you ask yourself
when was the last time in America that
life expectancy was under 69 and you’d
have to go all the way back to nineteen
fifty seven stops seven decades so if
you made me think of well this is just
Chicago this is actually national
problem and it’s getting worse across
the 405 and LA and lose sixteen years of
life is expect
Chansey go from white Fairfax County
Virginia to all white and poor McCullum
County West Virginia and lose 20 years
of life expectancy and its international
go from the South of England to the
north of England you lose eight years go
from the wealthy districts of Shanghai
to the poor districts and he use lose 14
years but it’s particularly growing in
the United States here’s a fact a 16
year old african-american teenager young
man who lives in a neighborhood like
Garfield Park has a little more than a
50% chance of living to the age of 65
why is this I’ve asked this many times
in many audiences and the answer usually
is wells gun violence and certainly gun
violence in Chicago is a problem but
more than half the early deaths in a
neighborhood like Garfield Park are from
heart disease and cancer diseases for
which we have prevention early detection
treatment and even cure so it’s a form
of violence but it’s not interpersonal
violence that’s causing us is something
that’s called structural violence and a
structural violence because the
conditions that cause ill health are
structured and designed into our laws
our policies our procedures and norms
that govern day to day life in
neighborhoods and it’s violent because
people die early as a result I need to
pause here for a second as a white man
and as a doctor who’s practiced in these
neighborhoods for all these years it’s
only recently that I have felt
comfortable naming racism as a key
driver for premature mortality
separate from poverty itself and I want
to explain why there are many poor white
people in Chicago but there’s not one
poor white neighborhood so a young white
girl growing up in a neighborhood has
available to her all the things in that
neighborhood the parks the schools the
grocery stores the health care and has a
potential to get out if you go look
across the United States there are
hundreds 71 cities and not in one city
is there a white neighborhood that’s
more economically disadvantaged than any
black neighborhood in America and this
means premature deaths are berta or
burden on top of the black population in
the United States 200 black people die
every day just because they don’t have
the life and health experience of white
people many years ago my friend Steve
Whitman an epidemiologist in Chicago
added up all the excess white deaths in
Chicago and it became the front page of
the sun-times says 3,200 excess black
deaths in Chicago just because black
people in Chicago did not have the same
health and life outcomes as white people
does that number look familiar to anyone
some major thing in American history
there’s a number of people that died in
9/11 but I just want to say this is not
exclusively about racism poverty itself
no matter where it is kills and over the
past thirty years we’ve seen the 20% of
the highest wage earners in the United
States their life expectancy shoot up
and the lowest 20% of wage earners in
the United States white black and others
their life expectancy has dropped
something we don’t see in other
countries and for the past two years
because of this fact the overall life
expectancy of the in the United States
has dropped and we’re the only developed
country in the world that’s seen a life
so there’s a grim statistics but I’m
here to tell you inequality is not
inevitable and it’s not immutable we can
do something about it in addition to
being a doctor
and a social epidemiologist I’m a human
rights activist and I believe that the
right to health and health care is a
human right there should be available to
everyone regardless of their income or
their situation and all we have to do to
get there is believe that we can be
agents of change so what does change
look like how do we change this so one
we need to change the narrative so we
need to change the narrative of what’s
going on in our neighborhood from
something a factor of personal
responsibility to social responsibility
we have to figure out how do we partner
better with leaders in these
neighborhoods who know what’s going on
in the ground and can help lead the
institutions to solutions but most
importantly we’ve got to measure the
impact of this because the these are
inequities they’re unjust and there’s an
urgency to act so we need that we need
to act so when Sarah died her
congregation carried caskets from their
storefront Church seven miles to the
front doors of Northwestern and held a
funeral and a hunger strike and the
attention that that got changed the
narrative about transplant in Chicago
and the community got together with the
transplant institutions and we were able
to actually get people insurance and
since then a hundred thirty people made
it to transplant lists 70 have gotten
transplants and most of the organs 75%
came from community members and family
members and as a result donations of
organs are way up in the area because
it’s a fair system and when we showed
this map around the city
people said that’s wrong that life
expects is so low what can we do and the
hospitals and the community have gone
together and created a collaborative
called Westside United with the aim to
reduce the life expectancy gap in
Chicago by 50% by 2030 and that’s the
usual map you see of the city this is
the map the community leaders on the
Westside made of their beautiful
community green lots of assets changing
the the map of the city in these
neighborhoods from hopelessness to hope
from risk to opportunity and solving the
problem of inequality is quite concrete
if we focus on health and health care
neighborhood structure jobs that pay
good wages and education these are not
obscure things to do and what we ask the
community leaders to say what would the
headlines look like in the future and
this is one of the headlines that they
came up with when we’re successful
Westside life expectancy is it matches
that of the loop or this one from
violence to victory changing the
Westside story so we are not stuck in
this place there are no limits to what
we can do frankly as a doctor has done
this for many years I’m sick and tired
of watching my patients who are also
sick and tired from dying and getting
sick from poverty and racism we have an
American dream but not everyone gets to
live the American dream life liberty and
the pursuit of happiness we have the
opportunity to make a difference if we
all join in together because we can’t do
this one disease one neighborhood one
city at a time we can’t settle for less
thank you
[Applause] [Music]
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