Last year, DePaul University and Rush University Medical Center launched the Center for Community Health Equity, a place where scholars can work together—across disciplines and with community partners—to reduce inequities in health caused by racism, structural violence, and poverty. Here, the Center’s co-directors Fernando De Maio, associate professor of sociology, and Dr. Raj C. Shah, associate professor in the Rush department of family medicine and the Rush Alzheimer’s Disease Center, talk about the what and how behind the Center’s mission.How did the Center come about?De Maio:
The first step was a public reading by Dr. David Ansell from his book, “County: Life, Death and Politics at Chicago’s Public Hospital.” At the time, he was the chief medical officer at Rush University Medical Center, and he's done a great deal of work to expose the ways that economic hardships and social inequality affect the health of individuals and communities.
I reached out to him, and after he visited my sociology class and spoke with my students, we started talking about ways that we could collaborate, not just as individuals, but in a more structured way that could bring other faculty and students into the mix. Shah:
Coincidently, our two institutions had started looking for ways to take advantage of the resources at both our campuses. Rush and DePaul share an interest in social justice, so we’re a good fit. And we both want to involve students in research. These two paths—one organic and informal, one organizational and intentional—converged on this idea of a center where scholars, students, and community stakeholders could work together to address issues of health equity and social justice. So, tell us more about the Center’s purpose.De Maio:
Between my office in Lincoln Park and the neighborhood around Rush, life expectancy for residents drops 15 years. At the Center, we’re bringing together all kinds of people—doctors and nurses, community activists, geographers, anthropologists, sociologists, scientists and entrepreneurs—to understand and change that fact. Shah:
What can Rush and DePaul do, specifically? There are other health centers in the city, but their formats tend to be institutional-specific, neighborhood-specific. We decided to play a different role by becoming a platform for generating and sharing information across boundaries of all kinds. The Center can make a big difference by aligning the interests and efforts of faculty, students, the public health department, service organizations, and community members. We can do more, together.De Maio:
So here, people of different disciplines—people who go to different conferences, publish in different journals, and work with different data sets—can share their perspectives. We all need to understand community dynamics, whether one’s particular interest is gentrification, or mortality and disease patterns, or environmental hazards, or economic disadvantage, or crime rates, or any other force that impacts health.What are the Center’s goals?Shah:
First, we’re defining the problem clearly. The issue of health inequity has to be framed in a new way, and the Center is getting us there.
Recently, Rush—like all the not-for-profit health care institutions in the city—performed a community needs assessment. The first one we did, in 2013, had a conventional, medical-centric point of view. This year—for the first time, through the Center—we collaborated with community leaders and service providers, with the public health department, and with other hospital systems, to write a very different kind of assessment. We focused on the root causes of poor health, using a hardship index and a child opportunity index to get quantitative snapshots of communities and using focus groups of residents to gain qualitative insights.
What did we learn? We could clearly see the results of decades of structural racism and economic deprivation in the neighborhoods of Chicago’s West Side. The average life expectancy in Chicago’s poorest neighborhoods is 67 to 72 years; in the wealthiest neighborhoods, it’s 81 to 84 years.
Also apparent were the social and economic gaps between neighborhoods. Median household income in North Lawndale is $23,066; in River Forest, it’s $113,317. The rate of unemployment in West Garfield Park is 27.4 percent; in River Forest, it’s 5.4 percent. In South Lawndale, 34.8 percent of residents lack health insurance; in River Forest, only 3.7 percent are uninsured. De Maio:
With the assessment, everyone could see the gaps. And everyone could agree that the #1 way to improve health is to focus on social determinants. That’s the new frame we’re working in at the Center. That’s the perspective that gets us away from saying that poor health is a personal choice. When you can see a 15-year difference in life expectancy between two neighborhoods that are just five miles apart, it becomes clear that health has everything to do with our communities’ structures and power.
The Center is putting everyone on the same page. As big questions about living conditions and economic opportunities are included in the conversation about health, care programs can become more impactful. Our work at the Center is surfacing ideas for making the city a more humane and just place. How do you go from thinking to doing?De Maio:
It’s not enough just to study the problems; we want to solve them.
Of course, “action” can be an uncomfortable word for academics, who are traditionally trained—and who largely train others—to be non-judgmental observers of the world. The Center, at its best, will push that envelope. With that in mind, we’ve done quite a bit this year.
As we just discussed, the "2016 Community Health Needs Assessment" report was a big achievement. Eleven DePaul faculty and students worked on that project. The Center is also supporting research collaborations among faculty and students from both universities, and the result is a series of working papers, five so far, with more to be published soon; they’re quantitative and qualitative studies, reviews, commentaries, glossaries, and photo essays. All these publications can be found on our website (http://www.healthequitychicago.org/).
Working with DePaul's Master of Public Health program, the Center hosted the 2016 "Health Disparities and Social Justice" conference, which featured more than 40 presentations and 300 participants. In the keynote lecture, Pat O'Campo from Toronto's Centre for Urban Health Solutions explored the tensions between problem-focused and solution-focused research in public health. In the closing panel, we heard from Fr. Jose Landaverde, Rev. Walter Coleman, and Alex Goldenberg—three inspiring community activists who have worked to make Chicago a better place. Videos are posted on our site (http://www.healthequitychicago.org/hdsj-conference-2016).
Right now, we’ve put out call for submissions for our first Student Paper Award. And we’re offering student internships for winter or spring, 2017. Shah:
We’re confident that ideas developed in and through the Center will have an impact, in our own universities’ classrooms and in Chicago itself.
For more information about the Center for Community Health Equity: http://www.healthequitychicago.org/