DO breaks down life expectancy disparities of 20-plus years in the Chicago area

Editor’s note: This is a Letter to the Editor. The views expressed below are the author’s own and do not necessarily represent the views of The DO or the AOA. The author’s thoughts are based on his 14 years spent as a CMO for the fifth-largest nonprofit medical organization as well as presentations that he participated in with area legislators and senior leadership from the South Land Healthy Community Organization.

I have worked in the Chicago Southland area for many years as a practicing physician, medical group leader and hospital administrator, and I am troubled by a significant health care discrepancy that I’ve seen affect its citizens. The issue I’d like to bring attention to is the life expectancy gap between residents of Chicago’s South Side and those in more affluent suburban areas.

As health care professionals, we are well aware that socioeconomic factors, access to medical care, education and community safety all play significant roles in determining health outcomes. However, the extreme difference in life expectancy—often as much as 20 to 30 years—between these neighboring regions is alarming.

In some South Side neighborhoods, life expectancy is 63-65, comparable to that of developing nations, while in some of Chicago’s wealthier neighborhoods and affluent suburbs, residents can expect to live much longer, often well into their 80s. The literature supports a life expectancy gap: Living to 88 years old in the wealthy Loop neighborhood of Chicago is typical, versus 63 years for the underserved Chicago neighborhood of West Garfield Park.

What led to these gaps?

This discrepancy speaks to longstanding systemic inequalities, including:

1. Limited access to quality health care: The Association of American Medical Colleges (AAMC) estimates that the United States will face a physician shortage of up to 86,000 physicians by 2036, due to the growth of the population, physicians reaching retirement age and lack of care available in underserved areas.

2. Higher rates of chronic conditions: According to a presentation from Gwendolyn Oglesby-Odom EdD, MSN, a representative of The Southland Health Network, these conditions can lead to more illness-related deaths in the South Side vs. North Side neighborhoods. These South Side residents who experience hospital stays also typically have two or more chronic conditions such as hypertension, COPD, diabetes, congestive heart failure, mental health struggles, renal failure or substance abuse. As a result, there is a larger rate of adult inpatient utilization on the South Side vs. the North Side, because of fewer physicians and limited access in the area.

3. Food Deserts: South Side residents face a 15.7% food insecurity rate and a 48.3% low food access rate.

4. Impact of environmental and social stressors on overall wellbeing: This can include stressors such as unemployment rates over 15% in some South Side neighborhoods compared to the national rate of 4%.

In my personal experience, I have seen several cases that highlight these issues. One was a 64-year-old male who was self-employed and could not afford health insurance. He presented to the emergency room (ER) with chest pain—luckily, it was not a heart attack. The ER doctor suggested he see a primary care doctor. Since he was approaching Medicare, he agreed. There were no immediate appointments in his area, so he made an appointment for three months down the line. When the primary care doctor did tests and discovered his prostate-specific antigen was 10 times the normal level, he requested further evaluation, which found stage four metastatic prostate cancer. The prognosis would have been much better with early discovery. His issues were cost and availability, which led to a worsened diagnosis.

In another situation, a patient was a 29-year-old pregnant female. She had public aid insurance. She did not seek prenatal care because she could not miss work and physician availability was sparse in her area; plus, she did not have transportation to and from visits when they were available. She came to the emergency department (ED) with hypertension. As the workup began, she had a massive seizure and was found to have eclampsia. An emergency C-section saved the baby, but the mother passed away. The lack of access to health care and transportation contributed to this tragic outcome.

How do we combat these issues?

To find solutions in these neighborhoods and beyond, we need to address the above issues with the following solutions:

1. Increase access to care by recruiting physicians to work in underserved areas. Provide care teams closer to home, work on better management of chronic conditions and provide proactive vs. reactive care.
2. Decrease the cost of care by making community care more available and improving insurance options. This will help patients avoid delaying care due to costs and avoid using the emergency room for primary care situations by making community care more available.
3. Address social determinants of health, which include more healthy food options, access to transportation, investments in wellness education and more mental health community programs.
4. Increase the focus on patient experience: As physicians, it is part of our calling to treat our patients with respect and compassion, be an active listener, follow up on any necessary requests/complaints and build trust.

As osteopathic physicians, we are uniquely positioned to advocate for policies that increase access to preventive care, help improve community health resources and address the social determinants that contribute to this disparity. It is imperative that we continue to push for health care equity and work collaboratively across sectors to close this gap.

Individual solutions

While many of these solutions need to come from those in power, there is still a lot we can do as individuals and professional groups, such as:

1. Draft policy proposals and share them with policymakers, stakeholders and the community.
2. Schedule meetings with local, state and federal legislators to discuss the importance of addressing health care disparities.
3. Use personal stories and experiences to advocate for specific legislative changes.
4. Leverage existing resources: The South Side Healthy Community Organization (SSHCO) is a state-funded organization charged with increasing the number of primary physicians and OB-GYN physicians in the area. They have been given $150 million to achieve this work. Individual members of the medical staff have contributed suggestions. In addition, the hospital president and members of the medical staff regularly meet with area legislators and discuss the physician and nursing shortages with them.

As America embarks upon a new presidency, there are some key recommendations we should make to the administration as well:

• Do not change policies that have been successful. We must not move backwards by disrupting or removing current policies that are already working.
• Collect data that clearly describes the issues and then use this data to create compelling narratives that highlight the urgency of the issues and support political advocacy efforts.
• Identify specific policies that could improve health outcomes, such as increased funding for health care services and education, improving access to healthy food programs and policies to expand mental health resources.

By addressing these inequities head-on, we have the opportunity to not only improve life expectancy in underserved areas but also to uphold the core values of our profession—compassion, holistic care and community health.

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