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Deadly poverty

Homicide is just one of many killers plaguing Chicago's poor black neighborhoods

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Chicago's homicide rate has drawn headlines this year, locally and nationally, and not without reason. Through July, 308 people had been slain here, 27 percent more than in the first seven months of 2011.

Every life lost to homicide is a tragedy, of course—and a sense that the life was unfairly taken often heightens the pain. Compounding the unfairness, residents of certain neighborhoods are far more likely to suffer that fate.

We illustrated this last month by comparing homicide rates in two sets of Chicago communities—the five poorest and the five least poor. The homicide rate in the poorest neighborhoods was 11 times the rate in the least-poor neighborhoods.

And if that isn't unfair enough, poverty—and especially the concentration of poverty that segregation causes—kills disproportionately in nonviolent ways as well.

Using the same two sets of communities, we extended our analysis beyond homicide—the eighth-leading cause of death in Chicago—to other, more common causes of death.

Our comparison shows that poor African-American neighborhoods should come with a surgeon general's warning. When it comes to the leading causes of death in Chicago (cancer, heart disease, diabetes-related illnesses, stroke, and unintentional injury), the mortality rate in the five poorest neighborhoods—Riverdale, Fuller Park, Englewood, West Garfield Park, and East Garfield Park—was far higher than in the five least-poor neighborhoods— Mount Greenwood, Edison Park, Norwood Park, Beverly, and Clearing. For diabetes-related deaths, it was almost double; for unintentional injury, it was more than double. The infant mortality rate—the rate of death in the first year of life—was two and a half times as high. And the death rate from all causes was 60 percent higher than in the wealthier counterparts, and 43 percent higher than the citywide rate.

We drew the figures from a data set published in July by the Chicago Department of Public Health, based on deaths from 2004 through 2008. In the five poorest neighborhoods, between 40 and 61 percent of the households were in poverty, according to Census Bureau estimates for 2006-2010. These communities are 93 to 98 percent African-American.

The least-poor neighborhoods had poverty rates of 3 to 6 percent. All of these are majority white, and only Beverly has a sizeable proportion of African-Americans (35 percent).

While the disparity in homicide rates among the wealthy and poor is indeed remarkable, homicide claims relatively few lives. From 2004 through 2008, just over 4 percent of deaths in the five poorest neighborhoods were due to homicide. That's a much higher proportion than in the five least-poor neighborhoods, where about one-third of 1 percent of deaths were due to homicide. In the poorest neighborhoods, many more deaths were due to cancer (22 percent) and heart disease (15 percent) than to homicide. So the economic and racial disparities in nonviolent causes of death, especially cancer and heart disease, merit close attention—more attention than they've been receiving.

But there's another way to look at the toll of a high homicide rate on a community. The vast majority of homicide victims are ages 15 to 34, while heart disease and stroke fatalities tend to be much older. Homicide, in other words, robs more years of life than the standard mortality rates indicate.

A measure called Years of Potential Life Lost factors in the prematurity of deaths like homicide—and shows more compellingly the disparate impact of homicide on Chicago's poor black neighborhoods. In Chicago as in most places, a base age of 75 is used in calculating YPLL. A death at age 70 is five years of potential life lost; a death at age 25 is 50 YPLL.

In the five poorest neighborhoods, the YPLL rate for homicide was 2,172. That is, for every 100,000 residents, 2,172 years of potential life were lost each year to homicide. In the five least-poor neighborhoods, the YPLL rate for homicide was just 186.

In the poor neighborhoods, only cancer takes more potential years of life.

YPLL is a mere statistical tool, but it's also a measure of the punishment many Chicagoans have been absorbing for the crime of being poor and black. Annually, the five poorest neighborhoods lost more than two and a half times as many years of potential life as their wealthier counterparts.

The correlation between race and YPLL is pronounced. Here are the ten community areas with the worst YPLL rates, and their percentages of African-American residents:

  1. Englewood—99
  2. Fuller Park—97
  3. Washington Park—99
  4. West Garfield Park—96
  5. Greater Grand Crossing—98
  6. West Englewood—97
  7. East Garfield Park—93
  8. North Lawndale—91
  9. South Shore—95
  10. West Pullman—94

Chicago's other predominantly black neighborhoods all had high YPLL rates as well. The ten communities with the lowest YPLL rates were predominantly white. Lincoln Park, 82 percent white, had the city's best YPLL rate. Englewood's YPLL rate was more than six times Lincoln Park's.

Our analysis of mortality rates parallels earlier findings on health in Chicago neighborhoods. In 2004, researchers from Sinai Urban Health Institute reported on the health of six community areas. Norwood Park, the predominantly white, middle-class community area in the survey, scored "overwhelmingly the best on the health measures," the researchers found, whereas Humboldt Park and North Lawndale, the two poorest community areas surveyed, "almost always scored the worst." The health measures included obesity, asthma, and smoking; North Lawndale had nearly twice the national average of all three.

The health and mortality disparities here mirror the nation's. In the most recent National Vital Statistics report, issued in December by the Centers for Disease Control and Prevention and covering 2009, the death rate for blacks was 1.3 times the rate for whites, and infant mortality was 2.4 times greater.

Disparities in health between blacks and whites aren't solely due to poverty. African-Americans have higher rates of diabetes than whites, for instance, even when their economic status is comparable. But the evidence points to poverty as the fundamental cause of health disparities. And a growing body of research suggests that racial segregation itself worsens health. The threat of violence in segregated, disadvantaged neighborhoods causes residents to spend more time indoors, which means they get less exercise. It may also weaken immune systems, which, combined with time spent in close quarters, may increase the spread of tuberculosis and other infectious diseases.

The stress of living amid violence and unrelenting poverty may also make residents more susceptible to disease. Inferior diets, smoking, alcoholism, and drug addiction all are more common in poor neighborhoods and are linked with higher rates of cancer, heart disease, stroke, and diabetes. Unintentional injury, another leading killer in Chicago and nationally, is also associated with drug abuse: in Chicago, the number one underlying cause of death in this category was accidental drug overdose. (Three times as many people died of accidental overdoses in the five poorest neighborhoods as in their counterparts.)

A research review in the June issue of Health Services Research pointed to studies indicating that such neighborhoods have trouble attracting high-quality health care providers; offer less access to primary care for children; have fewer specialists available; and have longer wait times for kidney transplants. Pharmacies in segregated neighborhoods are less likely to stock sufficient medicines. End-of-life care is also inferior, with "substantial disparities in nursing home quality."

In Chicago, the segregation responsible for these disparities didn't happen by accident. As we wrote last month, it resulted from the enmity of whites toward blacks when they started moving here in larger numbers around 1910. This rancor was abetted by governmental policies that ghettoized blacks—policies that continued through most of the century.

The malignant fruit of that enmity and those policies is still with us. Little attempt is being made to treat it. A hundred years later, in Riverdale, Fuller Park, Englewood, West Garfield Park, East Garfield Park, and the many Chicago neighborhoods like them, residents are still paying the price, day in and day out, in sickness and in premature death.

Sharon Lurye and Alison Marcotte helped research this story.

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