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Walking Backwards Into the Future on Chicago's West Side

Learning Objectives
1. Explain the impact of historical harms and community disinvestment on health disparities and life expectancy gaps
2. Identify ways in which place-based, people-centered, collective efforts contribute to addressing social and economic inequities
1.25 Credits CME

“Walking Backwards into the Future on Chicago's West Side” spotlights health systems that are creating and implementing an anchor strategy that directly invests into the communities that need it most. West Side United (WSU), is a racial-equity collaborative aligning investments in economic development, education, health care, and the built environment to benefit Chicago's 500,000 West Side residents. Join our conversation to learn more about how WSU's six anchor partner hospitals, in collaboration with the AMA, are working towards creating significant collective impact.

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Video Transcript

We acknowledge that we are all living off the stolen ancestral lands of indigenous peoples, which they have cared for since time immemorial.

We acknowledge the extraction of brilliance, energy, and life for labor forced upon people of African descent for more than 400 years. We celebrate the resilience and strength that all indigenous people and descendants of Africa have shown in this country and worldwide.

We carry our ancestors in us, and we are continually called to be better as we lead this work.

Jocelyn Sargent, PhD, MA: So I just want to go to our panel topic, which is walking backwards towards the future. And that is a Māori, and that's an indigenous community in New Zealand. is a minority statement, model, words that they live by. And the idea there is the past is central to and shapes both present and future. And so we're not trying to forget about our past.

We're trying to bring our ancestors into this and walk with us into the future. And so that is what we were thinking when we were putting together this incredible panel, to hear a little bit about the context in which these folks do their work as well as, you know, everyone here has a personal connection to the work as we do.

It's just that often health equity is not considered in that way. So when we look back at the context of health inequities on Chicago's West Side, what we want to do in this conversation is to understand the drivers of current health outcomes and support for community efforts to transform conditions for optimal quality of life, especially for those most marginalized.

So with that, I will kick off the panel by starting with Linda. So Linda, in your 2018 New York Times article and in the book Under the Skin, you describe the impact of race and place on health. And in your personal account of, and in a personal account of growing up in Chicago in the Englewood neighborhood.

And you're going to have to forgive me if I pronounce that incorrectly. I am trying. Okay, I got Englewood. I get beat up all the time in the Boston area because I didn't say, I can't even remember, like I didn't say, well, I don't say Boston, Worcester. I had the nerve to say Worcester, I think when I first started.

But anyway, so tell me if I get your neighborhood names because I don't want that to happen. But Linda, drawing from your personal experience, how does structural racism impact the health of marginalized people? And what has that meant for you as a Chicagoan?

Linda Villarosa: Well, first, thank you for having me. I'm honored to be on this panel.

And congratulations to the fellows. I'm going to start with a quote from Martin Luther King. And it's often used during Black History Month. He said it in 1966, and it's, "Of all forms of inequality, "inequality in health care is the most shocking "and inhumane." And what's interesting about that quote is it's wrong.

So there was a college professor not long, not too many years ago, who said, "I'm going to just double check that," 'cause it wasn't kind of written down anywhere. So she listened to a recording of that speech in 1966, And what he really said was inequality in health, not health care, is the most shocking and inhuman.

So not inhumane. Inhuman is different and health is different from health care. So I'd like to kick off my part of this conversation by saying that in this country, we spend more on health care than any other country in the world. We are the richest country by far, but money doesn't buy good health in this country.

And we over focus on the health care aspect without looking at what happens to people before they enter the health care system. And for my book, Under the Skin, the basis of it is three things happen in the sort of the health of black Americans. My book is focused on black Americans. One is there's a kind of toxic stress that happens because of racism and discrimination that we experience and we've experienced it for centuries that has created premature aging.

It means from birth to death we live sicker and die quicker. And in the past the argument about our health has either been it's all because of poverty, That's the only reason. Or it's a lack of access to health care only. When I looked at poverty rates in the past, in 1959 when I was born, the black poverty rate was 60%.

After the Civil Rights Movement, it dropped to 40%. And now it's 20%, which is unconscionable. However, the racial health gap has not narrowed in that time, even as poverty has dropped. And then with lack of access to health care, I have a personal anecdote where I was in a fancy medical school giving a lecture not long ago in Boston.

So you can imagine what it was. And there was doctor here, doctor here, and me. And we were talking about the medical system. And I was mentioning, well, the medical system is often hostile to people when they enter it. So maybe they don't want to go in. They said, and they kept saying, no, it's a lack of access to health care.

It's a lack of access. And discrimination hasn't been well proven. We need more evidence. I'm not the kind of person that pops off at the fancy medical college with the two doctors on either side. But I said, we need zero more evidence that people are avoiding the health care system because they are treated poorly or they have heard about someone else treated poorly.

Zero evidence is needed anymore. [audience applauding] So discrimination in health care system itself, driving people out, treating people badly once they get in. Also, this idea of the toxic stress that happens across class lines. The sort of profound research around that is called weathering. And how I heard about it was the statistic that said it was about maternal mortality, which we know is a huge problem in the United States in every state and every city.

That a Black woman, a black birthing person is three to four times more likely to die or almost die or lose her baby than a white woman. But when you look at education, a black woman with a college education, a master's degree, a JD, a PhD, or an MD is more likely to die or almost die than a white woman with an eighth grade education.

So this is not a question of just lack of access to health care and poverty, it is race and racism itself. So the final part is about the social determinants of health. A word, a phrase I don't like because it's jargon And it's just trying to say, like you said, where you live matters. In 2020, I came back to my hometown, Chicago, with my mother.

We were doing a tour of the 1619 Project, and we landed here. We were staying in the fancy hotel in Streeterville. And my mom said, I want to take you to all the places where, when you were a little girl, you came, where when your grandparents came up from Mississippi, where they landed, where I grew up as a little girl.

And the pinnacle of that for her was Betsy Ross Elementary School, where she went to school, elementary school, with Lorraine Hansberry. And she has all the stories of Lorraine Hansberry. So we made a little map, and I had a little rental car. And we were driving through, and she said, we're going to go to where your dad and I were first married.

We're going to go to the church we were married. We're going to go to the elementary school. So I'm looking at the map, and we get to the place. And I said, "Mom, your elementary school is an empty shell. It's boarded windows. It's not really here." We go to the place where she grew up as a little girl and she said, "Oh, I could see the L train out the window."

I was like, "There's no window. The building's gone. It's an empty lot. All there is is the L train." And then most terribly, we went to the place where she and my dad were first married. That had police tape around it and the steps were broken, the windows were boarded. And I said, how did this happen? So I, for my article in 2019, I said, what happened here?

I found out that where we were staying in Streeterville, there was people lived to age 90, and where my mother grew up in Inglewood, people lived to age 60. It's the largest racial life expectancy gap in the country. Then I said, I interviewed some people here, I knew about redlining. Every Chicago black neighborhood was redlined.

So that meant you couldn't get a mortgage if you were a black person and you came up from the South or wherever you were from. So then I said, what happened after that? 'Cause my grandparents owned a building, thank God, and all of our extended family lived there. So then I heard about contract buying.

And that was when people swooped in because they said black people can't get a mortgage, so you could buy a house at an inflated rate, you could never have equity in it 'cause you owned it on a contract, and if you missed a payment, you would lose the house. So I casually said to my mom, how did grandfather and those other relatives buy that building?

And she said, on a contract. And your grandfather was always terrified he would lose that building. That predatory, those predatory guidelines and those rules sapped $3.5 billion out of black Chicago over the years. So then that was when I understood the social determinants of health, that where you live matters.

Because if a community does not have wealth, they cannot have health. If you don't have the structures, if you don't have the institutions, If you don't have healthy air, water, clean housing, some place to be outside safely, you cannot be healthy. That is why I am very excited to be here because I understand from the work that you're doing here on the West Side, it's not about just open a clinic.

It's more than that. It's about building up the community, having community partners, having the church be involved, having activists be involved and having the medical systems be involved. And that is the only way you can make, narrow the gap in life expectancy and also to have people before they die to live better.

Say that.

Sargent: Thank you, Linda. [APPLAUSE]

It's interesting that as we were putting together this panel, we know health equity, that life expectancy gap is one of the things that some folks look at. But as you're saying, the largest racial gap, life expectancy gap is here in Chicago, and that's something that I was planning on turning to David and to Marshall about because we have a slide deck running there and it has some statistics on it.

And one of it speaks to, I think it's a 2018 statistic about life expectancy disparities on the West Side, and it estimates a 16 year. I think there's, we've seen, it's a big gap. It might not be exactly 16 year, I don't know what it is exactly right now, but it's huge where folks in the Chicago loop can expect to live to 85 years old, but in some parts of the West Side community, and I think, Tanya, you even said, for those most marginalized, that it's an even bigger gap that 69 years, which is the average, I think, for neighborhoods as a whole, but we can imagine pockets of neighborhood having even a lower life expectancy rate.

But I just wanted to turn to David and Marshall a bit on this, and just to ask, I'm going to start with you, David, because I was struck by the way that you described this, and you describe it as the death gap. And it's a very important way to phrase what is happening. Can you talk a little bit about why you felt the need to describe it in that way and what you were seeing that motivated you to write the book?

David Ansell, MD, MPH: Yeah, well, thank you for having me. Thanks for your writing. It's really terrific. And getting to actually very understanding causation is so important. So I did a pretty traditional medical career and ended up in Chicago because I knew there was something wrong, and I couldn't quite articulate it. And so Cook County Hospital seemed to me to be the intersection of society and health in America.

And so that's where I went to train. And I wasn't prepared as a white, middle class, young person from upstate New York for the experiences there as a doctor, even to even interpret it.

But I spent 17 years there and then 10 years at Mount Sinai on the west side in Lawndale, North Lawndale, was the neighborhood Ta-Nehisi Coates' article, The Case for Reparations. And for being in the midst of Lawndale, for the first time I could see something. So my patients had diseases that were beyond my ability as a doctor to control, and it was something about the places they lived.

And when you went to Lawndale, Yes, there was redlining and you could see it. But with the other thing I said, what's that tower outside my window? And what's that other tower outside my window? Sears Tower. Well, where did Sears go? What's the other one? Western Electric. So I began to understand that there was acts of, there were a number of acts in the neighborhood.

And one was the act of extraction of capital. It wasn't just that the banks were awful and federal policy was awful. It wasn't just that whites fled and were scared out. It wasn't just that. It was that business left. And they left. And where did the capital go? Well, you can sit in that old Sears Tower and see the Sears Tower downtown.

So you can see, actually, that it was the extraction of capital on top of all of it. And then I got recruited to Rush to be the chief medical officer. And being a chief medical officer of an academic medical center, I was responsible for quality and safety. And Rush is a top-ranked hospital in the world.

Newsweek, it's an honor roll hospital. We were ranked number one in quality. But people were literally dying outside of our doors. And so for me, I was so struck in that people within SideRush didn't really understand what I had seen and experienced. And so the death gap came out of that. And when you think about the death gap, you know, and the -- depending on the size of the geographic area determines the size of that life expectancy gap.

And so when you look at census tracts, which are areas of 4,000, is where you get that 30-year gap. And you get to little bigger areas where there's more diffuse, diverse economics, the gap's a little smaller. But it's as big as 30 or 25 years on the West Side. I made me think of causation. So in medical school you learn about mechanisms of disease.

You know, a heart attack occurs when a plaque ruptures in a coronary artery. Okay, I get that. And you learn about other causes of disease. But nobody taught me, and I never learned, that social pathologies themselves, like racism and economic deprivation, cause disease. And that led me to write about it in The Death Gap. Because if that's the reason why people are getting sick and dying prematurely. So here's a stat, a 50-year-old young man in Englewood or in Garfield Park has about a 50/50 chance of living to the age of 65. And I always ask, so what's the cause, what's the reason? When I ask that reason, people say, well, it's violence. Well gun violence is an important problem, but half the premature mortality is chronic disease, heart disease, cancer, and other things like that. So structural violence, because the policies, the procedures, the norms, the values, and it's violent because people are harmed. And so the solutions, as you mentioned, cannot be medical.

You could put a clinic on every corner, not fix this. We've got to address honestly and openly the root causes. And the capital that's been extracted has to be remanded back in an act of repair to the damage that's not only been done, but continues to be done every day. So that's kind of where that was.

And as a reframing, I quit my job being chief medical officer because we made at Rush the elimination of the death gap, and not the social determinants, the structural underpinnings of that central to our mission as an academic medical center. So that's the transition I went through and our institution went through.

And before I get to Pastor, it was so important for me as a white physician who's been in leadership in a number of institutions to get in front of our board and say, "You see that life expectancy gap? That's caused by racism." And I use economic deprivation, another Martin Luther King word, not poverty, the act of keeping people from making wages and earning money that would allow them to lift themselves up. So that's my, that was my evolution and I'm still evolving.

Sargent: So before you pass that over, I just want to say you also shared that knowledge with an institution very dear to us in this room with AMA. And if you could just talk a little bit about how you approached and challenged AMA.

Ansell: Well I had to do my own root cause analysis on myself. You know, when something goes wrong in a hospital and someone's harmed in the course of providing good care, you do a root cause analysis. You've got to figure out what went wrong.

Let's say a child comes to the hospital and they're harmed. You've got to do a root cause analysis because if you don't figure out what went wrong, you can never prevent it from happening again. Of course, there's not just one thing, it's seven things. I had to do a root cause analysis myself. Why would a doctor who came to Chicago to go to Cook County Hospital, spent 17 years there, 10 years at Mount Sinai, why did it take me so long to get in front of a board and say, "Racism is the cause of this."

Part of it I had to confront for myself and my own soul and my own experience how whiteness and the desire to be near whiteness and not wanting to offend the people in the room and risk, the idea that be risked to tell the truth. So I had to actually get really comfortable with speaking about the root causes and naming them, but also, honestly, it took me a long time to name it and speak honestly about it.

But then, luckily, I met a pastor, Marshall Hatch. And I'm just going to say this, because we presented-- we didn't know what to do when we said we're going to take on this life expectancy gap and these structural determinants of health. So we had a meeting. It was at Malcolm X College. It was just down the street here.

And I'm sitting at the table with Marshall Hatch. And he saw that life expectancy gap. And now I'm going to hand it to him, because we've been following his lead on thinking about solutions.

Sargent: Okay, thank you. -

Reverend Dr Marshall Elijah Hatch, Sr.: I've got a mic, thank you. [laughing] No, thank you Dave and Linda for really the setup and I just wanted to reiterate that what we're talking about is our conditions that public policy created.

You mentioned that Ta-Nehisi Coates' article on Contract Buyers League in Lawndale. And his paper, in which he got famous in Atlantic, was the case for reparations. And often when we hear about reparations, we think we're talking about slavery, something that's past. No, his paper was about the Contract Buyer League right over in Lawndale.

and the way that what we call redlining and structural racism creates these conditions in which we now talk about health. So that you mentioned Lorraine Hansberry. The Hansberry family was a part of a case in 1948 which was the first dent put in restrictive covenants which mean it was legal to not sell to African-Americans in certain communities all the way up until 1948 and of course beyond and the other sort of landmark civil rights cases.

So when we talk about reparations, we're not talking about 1865. We're talking about repairing a damage that is ongoing and in a community like the one in which I passed it, which is an incredibly interesting and meaningful place to do ministry in West Garfield Park, which is one of the communities in the city with the greatest challenge, and which is the work that we're doing with Rush and other partners, of which COVID-19 revealed to us the realities that this disparity in health was exacerbated and also revealed profoundly by COVID-19.

My congregation, April of 2020, we lost four people in one week. I mean, it was a pandemic and everything, including my oldest sister and the best friend that I'd had through high school and college and so on. And so in the same context, I watched in the pandemic, especially young women, CNAs, who never sheltered in place, who were dropping off children early in the morning, going to work in the middle of the pandemic because lo and behold, we found out that truly essential workers couldn't work from home.

And the truly essential workers were the least compensated for their work and lived in communities like this one and West Garfield Park, which is part of this ongoing, You know, the immorality that was revealed in COVID-19 where the most essential workers were underpaid. And then the people with these incredibly impressive titles were working from home.

I mean, I used to preach about how essential can you be if you can work from home. At church, we do like this. Amen. Amen. Amen. Meaning, look at ... How essential could you be if you could work from home in a pandemic? And the people who were literally the most essential were those at the bottom of the economic system and the immorality of that.

And we're in communities like this that have this incredibly immoral legacy of redlining and segregation from opportunity and segregation from resource. All the way up until the largest mass closing of public schools, which are resourced investments in every community, by the way, West Garfield Park.

When Chicago closed 50 schools, five of the 50 were in that one neighborhood. about disinvestment, intentional public policy, intentional creation of conditions in which people have to live and to try to survive.

Thank you all, Linda and David, for the setup because the next time we, as we continue to have discussion about reparation, we're really talking about repairing something that is ongoing. It's like, thank God for non-black people, people who are not of color talking about racism that sound much more impactful when it comes from white lips.

But to talk about structural racism, people often ask, "When are we going to get over race?" And it's like, "I could get over it if it was over." It's ongoing and we are really in the midst of something of which all of us are morally responsible for.

Sargent: So thank you. And you look like you want to talk, Tanya. Oh, you're not ready. Okay, because I am about to turn it over to Tanya and to Ayesha, because one of the things that this community has been so wonderful and gracious in doing is sharing their knowledge with other folks like the AMA. And so I want to thank all of you for coming to the AMA and explaining how important it was for us to be able to have the opportunity to make a social impact investment in the West Side.

And so it's one of the things very outside the norm of what AMA does. And I think it took folks like you, David, like you, Marsha-- Marshall, like you, Ayesha, and Tanya. I'm not sure, but I'm sure you were there in the mix. But I wanted to just turn it over to Ayesha, just to ask the question about, so these things have started to happen around addressing the life expectancy gap, beyond just looking at it clinically, thinking about how people live.

And I was just wondering, what more is happening, or what is happening in your viewpoint, from West Side United's viewpoint, what's happening that you think has some traction and we need to see more of and we need to support. -

Ayesha Jaco: Sure, good afternoon. I'd like to, before I answer, just thank the AMA for joining in this journey.

Going back to 1968 when the riots happened on the West Side, I understand that that was the same year the AMA admitted his first doctor, African American doctor. So when we think about alignment and where we've been in this space, since before we've been in this space, when you talk about the concept of Māori and bringing in ancestors, me coming into this role was because of my ancestors choosing North Lawndale. Me coming into this role was because of my ancestors having an experience in public housing, my ancestors experiencing premature death across all of the conditions that are key drivers in life expectancy. So when we fast forward today and think about Westside United I'd just be remiss not to acknowledge that and to also acknowledge where we sit.

There was the acknowledgement of the indigenous land but there's also the acknowledgement of my childhood neighborhood, where we sit today, where this was an empty lot, where before this green line was restored, we walked across this empty lot with broken glass. This abandoned food and liquor store was our grocery store.

Across the street was the laundromat. So this was our corridor. This was our downtown. And so to be back here, after picking up a copy of "The Death Gap" by Dr Ansel, which for me, after spending time in the nonprofit space, was a game changer. And then through serendipity, and I tell this story all the time, I came across Westside United with the big, hairy, audacious goal, but coming from a background of activism.

So I was skeptical around what this was and if it was going to deliver on what it meant. So if we fast forward to 2023, the table has been set. We have members of our community advisory council in the room, if you all can wave.

So, them alongside Dr Ansell and others are the drivers and the ambassadors. They keep the pulse for community. So, we set the table and we can talk about $170 million invested. We can talk about our workforce goals, but where we are right now is needing to move the needle and go deeper to make the connection around how those investments really impact the median income and the increase of median income of residents in these ZIP codes?

What does it mean in terms of wealth building and the trajectory that people get to embark on when they come from disinvested areas and step into spaces where they can attain family sustainable or sustaining wages? So our work in partnership with the AMA, our community partners, is continuing to develop that measurement model where we can activate and show results and take this to Milwaukee, to Baltimore, to Roxbury, to other places that have the same disparity.

We are a national movement and model here, breathing off the ethers and ambers left by Dr King and Dr Al Raby and all of the others that came before us. are sitting here now in that spirit. So our work is going from those targets and celebration of setting tables, having hospitals be intentional, having them deliver and having the numbers there, but it's the next phase in that work and that's actualizing on the low birth weights, the preterm births, right?

The fact that we need to look at hypertension management. And so we've got everything we need. Now it's around coalescing, aligning, and putting together a structure so that my two-year-old lives to 85, my 11-year-old lives to 85, that I get another 40 years, and that my grandmother who made it to 66, my father who made it to 55, that we continue the work.

So I'm born into this work with that spirit and energy and I am so proud that Dr Ansel was the real deal in that book. I'm so proud that AMA, Deanna came to us and said, "Hey, we're doing this thing. You know, we've got a team. We've got intention. Let's roll up our sleeves. How do we work together?" So I'm excited and I think that the next phase is really delivering on what used to be decreasing the gap by 50%, by 2030, it is now our mission to eradicate the gap, to eliminate the gap.

And that came from communities saying, "What's the mission again? So you want me to tell my child they have a 50% chance of making it, and that's what y'all going to stand behind? We need to do better." And so that is how we move the needle, we keep the pulse, and I'm proud to be doing this work.

Sargent: Thank you.

And so, Tanya, I'm going to ask you to sort of round it all up and just talk about like the young people. You know, I saw an article, I'm not going to ask about it here, recently that David and Marshall wrote about Sancopa Wellness Center and the question of how do we begin to think in terms of how are the children and being able to answer the children are all well.

So you work with the youth. Tell me about what compelled you to take the approach that you did with healthy hood and the life expectancy gap mission that you also have.

Tanya Lozano: Sure. Hello everyone. afternoon. So my journey to this point, similar to Ayesha, I was born into a family of activists. My uncle Rudy Lozano, who I'm wearing his button today, today is actually marks 40 years since his assassination, June 8th, 1983.

He was instrumental in building the Black and Brown coalition that got Mayor Harold Washington elected. And because of the threat of Black and Brown unity to the machine his life was taken. My uncle and my mom picked up that torch after he was assassinated really rooted their work in the immigrant and undocumented communities of Chicago.

They branched out obviously nationally and internationally, but they're rooted here on the Southwest side. And so for me, I was around a predominantly immigrant and undocumented community. I lived with the people as the people. I went to the public elementary school in Pilsen. I went to Benito Juarez High School, you know, grew up in the community.

I was a basketball player and like most athletes, you're a little bit more aware of your physical health than like, you know, a regular person who doesn't play sports. And I played all the way through college. I played elementary school and high school. And it wasn't until college where I learned of what an athletic trainer was.

I played basketball my entire life and never once seen an athletic trainer. I never got my ankles wrapped. I never got my knees iced. I never got stretched out. If I hit my head, my coach was responsible for figuring out whether I had a concussion or not. There was nobody there. And so when I went to college, I was getting wrapped up and iced at practice.

It wasn't even games. And I was like, "What is this? This feels like real care." At first I thought, I was like, "Man, they're treating us like celebrities." And I looked around at my teammates, who were all affluent white, come from affluent white neighborhoods 'cause I was going to college in Naperville, Illinois, 92% white institution.

And it was not out of the norm for them. This is something they had experienced through their entire basketball career. And at one point I was commuting from Pilsen Little Village to Naperville to go to school. And having to see the disparities every single day, just riding the train, was something that I just couldn't live with.

Growing up in an activist family, when you see an injustice, you have a responsibility to meet that injustice. And so when I came back to Chicago, when I was done with school, I didn't finish because that was a really discouraging experience. I said, "You know what? I need to help my community. We're talking about the immigration policy.

We're talking about abolition. We're talking about all of these different things. Meanwhile, we're dying." So we needed to address that. And so it was the death gap, the book, Dr Ansel being my father's doctor, and then eventually my doctor, that really just kind of solidified what I was experiencing, is this idea of this life expectancy gap.

I mean, I don't know if it was said on the panel yet, but the reason why the life expectancy gap is so large in Chicago is because we're historically the most segregated city in all of the country. And that continues, and you can go back to Mayor Daley's plan to gentrify, you can find all the research in the world that will solidify that fact, that we are one of the most segregated cities in all of the country.

And so we started a program specifically with the youth in CPS elementary schools and high schools alternative high schools in underserved communities called 5+1=20. I remember when we had initially brought the idea to Dr Ansel and he was like, "What is this? This sounds genius." And he backed us up before anybody else did, right?

And it was this concept that five screenings for early detection plus one lifestyle change diet and exercise would equal our people 20 years of life that they would get back. And the reason why we did it with the youth was because especially in Latino and black neighborhoods, the youth were already acting as liaisons between the broken health care system and the people who fall between the cracks.

Especially in Latino families, right? You think about the young person, they're the translator, they're liaisons to technology, they're reading documents for their parents, explaining what that means. And so they were already leaders. They were born leaders, honestly. And so we said, "Let's use the youth," right?

And so we started this program in the schools where we would bring volunteer rush medical nursing students to teach a curriculum about the five diseases that cause the life expectancy gap. I'm sure you know what those are, right? But not only would they teach them of the disparities and teach them of the makeup and the treatments for these diseases, they were certified to screen for early detection.

It does not take a rocket scientist to take a blood pressure or a blood sugar. In fact, most of these kids had already known how to take a blood sugar because they had a lot of diabetes in their family. They saw their abuelitas, their tias, their aunts, their uncles taking their blood sugar. And so once we certified in that area, we said, okay, now you have to find 10 people in your family or in your community and you have to perform those screenings.

A lot of times our people don't go to the doctor until they're in the emergency room. And by that time it's so late, right? And so we were hoping that this would at least, you know, be some kind of way to get our people to understand what prevention looked like. Now, the plus one was the prevention. And what we realized is we were asking medical and nursing students to help these students learn how to develop individualized diet and exercise programs for each of their 10 people.

Depending on the person, if you've got a grandma, you're not going to give them the same diet and exercise plan as you're going to give your little cousin, right? And what we realized is we asked the medical students and the nursing students to help with this. But what we realized is they weren't a ton of prevention classes and information themselves in medical school because our health care system doesn't really care too much about prevention 'cause it's a for-profit business.

You need people to get sick to get paid. And so what we realized at that point was this was something we really need to figure out and it wasn't going to happen with our volunteer medical and nursing students. And being that I was an athlete and I had went to college and because it was easy, I became a personal trainer because I had done that kind of work as an athlete in school, I realized in the fitness industry, it was a lot of black and brown fitness professionals serving predominantly Afro and white communities because that's where the infrastructure was to sustain a livelihood.

That infrastructure, it's a privilege to access fitness in that way. It's a privilege to access anything that is preventative in this country. And so at that time, I was working at Equinox, Flirty Girl Fitness, LA Fitness, that's how I was making a living, teaching classes, teaching Zumba. And I was looking at all my friends and I'm like, "Hey y'all, I know y'all feel what I feel.

"I want to serve my own community." I got into this business to serve my community 'cause I know that they need it, right? And they felt the same way, so we started Healthy Hood Chicago really as a fitness studio at first, giving $5 classes to our communities by these incredible fitness instructors of color.

They only had to give a little bit because there was a lot of us to give. And so that's how we started Healthy Hood Chicago. What has come from that really is this idea is that we need to be talking more about, instead of services, about culture and relationships. Our model, right, we went from doing this in the high schools now to what we call the hood method.

And this will be our second summer with this. And thanks to Ayesha and Dr Anselm, Reverend Marshall Hatch and West Side United, we've been able to pilot this program that we really feel is the answer to our issues. And that is that it's modeled after the Cuban health care system. If you don't know anything about that, you should go there.

Because what you learn of Cuba in this country is propaganda and it's false. And when you go there, you'll see for yourself how incredible their medical system actually is. And that's because they have a three-tier medical system. And this is what the Hood Method is trying to replicate, is that there are consultarios that exist on almost every block, like a city block, in that consultario, there's a basic health team.

There's a doctor and a team of nurses. They live there in that house on that block. And when somebody on that block is sick, they come to that person and they take care of that person. They're responsible for all the people on that block and they can take care of 90% of the health issues. So most people don't have to go to a hospital, right?

And because those people live, that basic health team lives on that block, They understand the conditions of those people. They know when somebody's sick or just hung over 'cause they follow them on Facebook, okay? When we think about, yes, poverty has a lot to do with health determinants, right? But in Cuba, there's the least percentage of infant mortality rate than anywhere else in the world, and they are a third world country.

And that's because they have a community-based health care system. They have relationships with their people there. The second tier is policlinicos. Those are specialty clinics. Let's say somebody's diabetic and needs dialysis, they would go to a policlinico. The last thing is a hospital. You would go there to give birth.

You would go there if you needed a surgery, things like that. But all three of those tiers work together. They communicate with each other, and it's a part of a system. And so what we did was we said, now we've done this, we've established these relationships through these young people. Now in the summer times, this summer now, we will be employing 200 interns between the ages of 16 and 24, employing them, meaning they getting paid to serve their own community, not to take them up out of their environment, not to teach them to go get an education to leave the hood, but paying them to serve their own families and their own people.

Every week, 250 families get groceries, fresh groceries delivered to their door via these young people. They get their blood pressure checked, their blood sugar checked. These young people are able to navigate health care system to get every single one of them primary care physicians. But really what's saving our lives is the relationships we're making.

Because now we can see that there's an alternative, right? We can see that there is a way to live a healthier lifestyle with what we have now. Because as an activist, right, as an organizer, it gets really, really tiring to keep hearing we got to wait on a system to change. How could we expect a system to change that profits from the way that it is?

We have to figure it out ourselves. We have to create the demand, as the Black Panther Party says, observation and participation. We have to do more acting than we do writing. We have to show people. We have to show people what it actually looks like to be able to live a healthier lifestyle. And that's why the young people are so important, because they're the culture.

In Cuba, which is where we base a lot of our work, right, or model a lot of our work, is that culture for them is the soul of a nation. Culture is who we are. Culture is what we believe in. Culture is the direction we want to go to, right? And in this country, we think about the artists, especially during the pandemic, they were left out to dry.

They had no jobs, they had no income. A lot of them went homeless. I know because they're my friends. And so what we decided was the artists in Cuba are the intellectuals because you need to be creative because change or because progress requires change. And in order to change, you got to be creative. And so what we've been doing with the artists is that we have people, artists, musicians, visual artists, really talking about shifting the culture of our communities, explaining why being healthy is an act of resistance to a system and a structure that was designed to do what it is doing now.

And the young people are the best for that, why? 'Cause anyways, they're going to be here later, right? But also because they're, again, the leaders of their communities, because that's what age we are in. A lot of our older generation don't know how to work technology. Some of them only know Spanish and things like that.

So these students, these young people, are really where it's at. And that's what we've been focusing on, is really shifting the culture from the inside out, creating the demand. Because if we keep asking, unfortunately it hasn't worked. It hasn't worked. To be able to demand it means that we have to prove that it works and that we can do it ourselves.

We think about the free breakfast in the CPS school system. There was no free breakfast in the CPS school system. The Black Panther Party started a free breakfast for children program. That's why there's breakfast in the schools now because they said, "If the Black Panthers can do it, then what is the city's excuse?"

And that's what it comes down to this health care system. If we can do it ourselves, then what would be the city's excuse? What would be the federal government's excuse? And that's really what we've been trying to do with the hood method. And like I said, we piloted it last summer. We doubled the numbers this summer.

We're serving 250 families. Again, they receive groceries to their door. We have a young person who is assigned to them, who talks to them. And on top of that, we think about, you know, you give somebody a fish for a day, they eat once. But if you teach them how to fish, they eat for a lifetime. It's really explaining and politically educating our people who are receiving these services as to why the system exists the way that it does and what their responsibility now is and being a part of the solution.

Because we can give you food, but that's not going to change nothing. But if we give you food and we teach you why this matters, why this is an act of resistance and give you an opportunity to participate, then we can really shift the culture of our community. -

Sargent: Thank you so much. [audience applauding] I still have more questions here, however, I'm not going to be selfish. I have this incredible panel here. You can give them another hand, right?

Audience Question: [audience applauding] - Thank you, panelists, that was fabulous. A few of the panelists mentioned capital extraction, mentioned reparations, repair, and that really goes to private, not public, not government, in my mind. Because to your point, Reverend Hatch, we're not talking about hundreds of years ago with slavery.

We're talking about individuals, many who might be alive today, or certainly their children are. These individuals were the recipient of that capital extraction, right? The case reparations, the contract lending. So if any of you have thought about how to recover that capital extraction, how to focus perhaps the reparations discussion around private money.

Thank you.

Reverend Hatch: It's an interesting question. The number that I heard, for example, in Chicago, the number 70 billion, would it be, of what is really old in terms of investment in a community. I'm glad to have, for example, Geraldine Blair here, who is one of our parishioners, who is really a legacy resident in East Garfield Park. And their families all over this community that have had multi-generational legacies in this space. I think one of the biggest fears of places like this, of people coming in, spearheading development is that there's very little understanding of how what they do can actually accelerate gentrification.

So much so that if we talk about age disparity gap between West Garfield Park and the Loop five train stops, it will make meaningless any kind of measurables when we talk about the gap has decreased, because the gap is going to decrease if the neighborhood gentrifies. But we haven't done anything for the people who have been harmed except disperse them other places. So it has to be a kind of sophisticated strategy where the goal is not to move people off the land.

I mean, we opened the meeting talking about the aboriginal, the original people, and we have, I think, profoundly, you know, with a sense of responsibility, started naming some of the nations that were moved and then of course stolen land, stolen labor has built the wealth of America and made it the richest nation in the history of the world.

Offer stolen land and stolen labor. I guess I'd be rich too. But the point is that there are legacy residents in communities like these of which we should have the same kind of moral responsibility to make sure that whatever we do, whatever we're envisioning, that we're very intentional, that we don't simply move these people off the land, which is what the market forces are going to do left to themselves.

And so one of the things we've been doing the last three decades is trying to help build an indigenous institution that can build power, organize people, organize resource in West Garfield Park so that the people can't simply be moved off the land, that we have power where whoever comes in has to interface with us.

That level of sophistication I think is what we're going to have to talk about. If we're really talking about doing something that's going to be meaningful, it can't just simply mean the population changes, the life expectancy gap therefore disappears, and we don't know where those people were that were here, and they're all over the place.

It's just a great question you raised. so much of what we owe the land, but what we owe the people who've been on the land, and that they're not just simply moved off the land by some of us that might have good intentions. I'm just going to throw this in here. One of the biggest problems that I have is with faith-based people.

I live in Austin and I'm watching these, I'm sure, well-intentioned Christian groups come in and of course, white people are not going to be anywhere that they're not necessarily running it. That make me want to do this and do that. And so they come in, use the pathologies and the negative statistics to attract resources as they come into the land, and then ultimately, you know, it's Bishop Tutu again.

You know, we had the land, they had the Bible. By the time the process is over, we got the Bible, they got the land. I mean, it simply moved off the land. And that's going to take a lot of doing in East and West Garfield Park. West Garfield Park, I think, might be one of the last of the places that we can actually prioritize the people who are there now and say that the goal is not to move them off, but to build people as we do community development.

Jaco: And what I'll add quickly is that where I grew up is right behind here at Madison and Albany. It is a low-income housing apartment complex that was built maybe in the late '70s. We moved in in 1989 and is now for sale for $13 million. The families that live there, there might be two or three legacy residents in that space.

So when we talk about displacement, I mean, people left, my family left to, you know, be in safer communities, right? But to pass this point, it's important to have Geraldine Blair, who is a member of the Community Advisory Council, so that when we have hospitals at the table, so that when we have the AMA at the table, so that when we look at those that were engaged in the illegal contract buying, those financial institutions that do come back to the table and that want to be here, the decisions that they are making about investment are vetted by people like Geraldine and others.

So we need other anchors and other folks to come around the table with their resources to listen to folks and to reinvest, just as we've seen with our health care partners in the AMA. And it's not that simple because you have to have a moral compass and consciousness and leadership that can call out their privilege, understand where the gaps are and be actionable.

That's why Tanya is so important in this work. Our systems couldn't come up with five plus one. We need that genius paired with resourcing and the engine to actualize that. So in terms of reparations, we've got to have those that played a role come back. And we know the complexities there, but I think in this space where we find ourselves at Westside United and these partnerships, we are on to something on what the possibilities are and what it could look like for this respective industry.

Sargent: Thank you. So we'll just take one more question, Richard. -

Audience Question: Hi everyone, I'm Richard, I'm one of the Medical Justice Fellows. I just want to say all your work is very inspiring and actually touches on a topic we were talking about in the bus a little bit as we were headed over here. So working to try to address the lives of people who have to struggle in these systems, you're caught between these two goals of wanting to destroy a corrupt system and then wanting to help people survive in a corrupt system, which in a way, makes that system stronger.

And so I'm just wondering how, with all the great work you're accomplishing, how do you balance those two impulses? And can you give any advice to us who are starting out in our activist careers of how to balance the desire of overturning a corrupt system versus how people survive in a corrupt system, which may make that system stronger ultimately?

Well, I would say it's not. There's more options than just those two things. One of those options is building, building. As you dismantle, you should be building. We say there are three steps, heal, build, sustain. And those things happen simultaneously. As you're healing people, you're building new systems and structures that support the healing to continue so that you can sustain it.

And sometimes we think about dismantling like we have to burn it all down, right? But the truth is we need to develop new systems that can be a part of the systems that exist right now until those systems are done. So we have all the systems in there. And so that's kind of how we look at it. We can't deny that we live in a capitalist structure.

Like that's, we live in the United States of America, right? As much as some of us don't like capitalism, I know I don't, that's the truth. And like you said, you have to be able to survive that. And so it takes a level of creativity, honestly. And that's why I say building, right? And in order to build something, you have to be creative.

And that's why the young people and the artists and the creatives and the journalists are so important because you need that creative thinking to be able to do that, right? How are you working the system right now, but also building other ones so that you can say, again, creating the demand, right?

Sargent: Thank you.

And actually, as we close off the panel, I'm wondering if every one of the panelists can just go ahead and respond to that last question.

How can you advise them to...

Villarosa: Oh my God. So I think in the last year since my book first came out, I've gone all over the country and heard every single... I feel like so many stories, and some of them are really negative. And so I feel really nourished and refreshed here. I came from Florida where books are being banned, can't say gay, you can't, you know, and then I was in Texas where books are being banned, you can barely say gay, nobody cares about transgender children and, you know, gender affirming care.

They're trying to stop it if they haven't already stopped it. So I would say stick, I mean, you can't give up. And you can't give up. I love build as you dismantle, But I would also say you're going to have to figure out how to shore up against, you know, I love this bubble. I live in Brooklyn, I live in the biggest bubble ever of progressive thinking, but outside of that, there is so many forces that don't want to do what we're doing.

And part of the reason I even wrote my book, and certainly the article about Chicago, was I watched Trump go through here in whatever, 2016, 2017 and said, "How can these people live like this?" And the thing I hate about this whole topic is when people are blamed for their own situation. And that is what happens.

And you have to fight against that. That we have to say, "This is not your fault." We have to lean into the idea and explain, even if it's taking it slow, what structural racism, what historical segregation has done? Education, all the areas, housing, all the areas to say, this is not our fault and you owe us.

We are owed. Somebody was saying, I don't understand reparations, how is that going to get paid? I was like, go to Chicago. It's right there. The history is there, that is owed. The other place where I'm interested in reparations is in forced sterilization. 100 to 150,000 women and other, not just women, but other people were sterilized.

And this was in the last century, in the last 50 years. And only three states have given money back to them. And they are owed. There are, reparations make sense, they make economic sense, they make sense in places, but they also make sense in, you know, in what happened to people medically. So I think this is a super interesting conversation.

And I would say I love what you're talking about on the bus and you keep, just hold that in your mind. As you take it down, you build it up.

Sargent: Thank you. -

Ansell: Well, thanks again for having this panel. I would say three things. Number one, thought in speech is really important and we, in the face of terrible, you know, terrible actions, we remain silent.

And so as leaders, as moving into this space, as doing this fellowship, we've got to be, not only have sort of a clear thoughts that get expressed, but you must speak to them. And naming is so critically important in this. And if you can't think about causation and speak about it, then you're missing that sort of first step in change.

Number two is you've got to take action. Enough, you know, there's no need to more studies. I mean, no studies, no more papers, no more books, you know, because we've got to take action. And if, you know, Marshall, that number of $70 billion, you know, I think for the, and the idea would be, What would it take in the West Side of Chicago, given the gap in median incomes?

Because it is true that if you make above the median income, your chances of life expectancy are better than when you don't adjusted for race. And so that is about $70 billion. That's a lot of money. But so what we've got to take action, and we've got to take action on the right thing. Capital was extracted, human capital is being extracted every day.

People are dying. It's unacceptable. And you've got to keep that front and center. The last thing I will say is we're all friends. We all got to know each other to work on this together. And you've got to, for doctors, for people in this room, you must follow the lead of the community. Because as you said, we can never figure out a 5+1 program.

It's brilliant the idea of getting young people engaged in this. And you've got to be optimistic. You've got to be optimistic that things can be changed. And all you have to do is look back. And maybe they weren't changed perfectly, but you can look back on many things and say, many things have gotten better.

And I like to say this, I paraphrase from someone else, hope itself, you know, hope is not like an idealistic, you know, far-fetched idea. Hope is a muscle that has to be exercised. You know, if you don't exercise hope every day, you're never going, things will never get better. And futility, the idea that is futile, that this is all, to the blame thing that we can't do anything about it is the disease that keeps us from improving.

So hope's a muscle, but it's a practical muscle, and it must be flexed.

Sargent: Thank you.

Jaco: All right. Yes. Okay. So what would I say? You've got to insult yourselves, consult from within, as David talked about, his journey, but also in your respective institutions. You've got to name it, claim it, reframe it. And so stepping into a space like a Westside United, me as a black woman going into the spaces that he went into, it would have not been the same result.

So what is your privilege? Where do you sit? Who can you bring along on the journey to begin that? And then a black woman like myself picking up the book Never Thought, in three million years that I'd be sitting here working with the dude. So having accessibility to the people, you can never write on behalf or research on behalf or build programs on behalf.

So the people have to be with you. They have to be with you in the journey. And I can say, sitting next to a David Ansel, I'm on the journey, the New England Journal journey, the Harvard Business School journey, me, nappy-haired nine-year-old girl from this neighborhood, right? So it's about that, reaching back to the people that you serve and respecting them and their voice and taking them because they bring a community with them.

They bring their ancestors with them. So acknowledging that is so important and carrying that. Taking and continuing to magnify that power, thinking big, the law of attraction. I mean, that one book, working with Pastor Hatch, who I interfaced with his family before we knew each other at a church up the street that his father pastored.

But his vision for his community 30 years ago is now bringing a $50 million development there. [audience applauding] And that is the community that never restored itself after the riots to some degree in '68 and the riots in 2020 due to COVID. So the vision and planting and the insulting that Rush did as an institution to set the table, to bring their peers to the table, to then come with community and to come on this journey has created so much.

So I would say do that. And then as you walk into spaces and think about where you can be impactful, what is your idea to be unpacked? And how will it grow? Is it in maternal and child health? Is it in hypertension management? Like breathing fire into it. And again, bringing along the people who are going to be most impacted.

So I guess I said the same thing. But those have been some of the most impactful things coming from community, coming from the mindset that this is the way it's supposed to be. Having you as a champion, as a partner to help redirect that through partnership is going to be critical. Thank you.

Reverend Hatch.: Thank you, thank you Ayesha.

And just in closing, you always gotta be careful when a Baptist preacher say they're closing. It could be very long after, but not this time. This is a very interesting setting with AMA coming out to this community as part of your national meeting. This dialogue that's incredibly important to actually come out of the ivory towers or the places of privilege and dialogue with people in communities like this, I think is incredibly important and enriching.

I can't help but think, having grown up in this neighborhood, because that was my dad's church pastored 42 years right up the road here, this is holy ground. As a historian, this is the neighborhood Dr King organized in in 1966 that was not randomly chosen. Chicago chosen because it is the most segregated city in America. The West Side chosen because African-Americans on the West Side have a unique history in Chicago's black community and that these are the most recent migrants from the south that came in the 40s and the 50s and even the 60s.

Meaning still sort of connected to the rural land in Mississippi, Arkansas, Tennessee. People tended to go straight up. And so this was chosen because this was a community he could organize in, in the Chicago power structure, because this was a community sufficiently depressed and sufficiently disconnected from Chicago's power base, that he could come in and organize because this was a part of the city that had the least to lose in their connection with Dr King. And I'm a proud West Sider forever, and I always say wherever I go, Dr King was a West Sider, lived and organized in this community, which I think is a great challenge to us. If we can get this right, well, whatever we do is not just about moving these people off the land, but finding a way to develop people as we do community development, which means we have to engage indigenous institutions, legacy residents, and families.

If we can do it right here, I think that it can of course be inspirational and all of the things that we can learn help us literally all over the country. And so again, just reiterating as I close, one more time.

David is a black theologian, by the way. This is holy ground. This is holy ground and we can do something significant here that will give us the kind of leverage and cachet that we can be impactful literally all over the country. Thank you very much.

Sargent: Thank you.

Lozano: I kind of answered it, but I would say your greatest resource is people, relationships.

Ain't no mountain of money in the world that could combat people power. People are your greatest resource. We -- an example, undocumented people can't get health insurance, not even under Obamacare. And that means if somebody needs a kidney transplant, they can't get it. They could be on dialysis for the rest of their life without insurance, but they can't get a transplant.

And we decided that we were going to show up to Rush on Christmas. We let Dr Ansel know ahead of time. And we brought a ton of people over there with children who needed kidney transplants and said, "On Christmas, this is what we want. We want them to be treated fairly." And Dr Ansel welcomed us into the hospital, gave us hot chocolate and conchas, and said, "We're going to figure this out.

We're going to find a way to work the system so that we can do something about this now." And that helps change policy. That helps change policy. People change policy. Not money, people. People do. So, anytime there's an injustice, get your people together. I've seen Dr Ansel in his white coat with a bunch of medical students just lay out on the street in front of City Hall.

I've seen things like that be more impactful than anything else that I've ever seen. So use people as your resource. That's your biggest resource. And if you're a doctor, right, your patients are a part of your power, your people power. Make real relationships with them. Get to know them. Act like a Cuban doctor.

You feel me? Get to know them, follow them on Facebook. Make sure they ain't just hung over, you feel me? People, people is the true resource. Power to the people.

Sargent: Thank you. [applause]

Villarosa: I wanted to add one thing is that as you work and as all of us work here, we have to remember to take care of ourselves. And I think we forget that when we get all energized, as I am right now. And don't forget that you can't take care of others and you can't do your work unless you take care of yourself.

Sargent: Thank you. [APPLAUSE]

Video Information

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Enduring Material activity for a maximum of 1.25  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.25 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.25 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.25 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.25 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.25 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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