The Elephant in the Room: When your ZIP Code Makes you Sick

The Elephant in the Room is a new series written by LAF attorneys discussing their experience representing individuals in situations impacted by systemic racism. Names have been changed to protect privacy.

Recently the Sinai Urban Health Institute released the findings from its Sinai Community Health Survey 2.0.  The study is the largest face-to-face public health survey ever conducted in Chicago. The Surveyors interviewed residents from nine different Chicago community areas, focusing on sixteen health-related topics, like obesity. The data revealed alarming and stark health inequities that exist between neighborhoods and demographic groups.

 

Researchers found health inequities in all sixteen health indicators, but non-Hispanic Black adults, as well as adults of Puerto Rican or Mexican origin, were most affected, with one in three reporting fair or poor health status. Females of Puerto Rican origin had the most physically unhealthy days in the past month at 8.4 days; adults of Puerto Rican origin reported an average of five or more mentally unhealthy days in the past month.

We often don’t realize that barriers to health are linked to other systemic and structural issues. For example, in North Lawndale, West Englewood, Humboldt Park, Chicago Lawn, and Gage Park, over half of female residents are obese. Those neighborhoods have fewer grocery stores that provide access to fresh, healthful food choices, and fewer parks and green spaces than the North Side neighborhood featured in the study. Residents in those neighborhoods have the highest levels of food insecurity, meaning they don’t have money for more expensive, perishable food choices.

Sinai also surveyed health insurance coverage and usage. Since insurance is the primary way people fund health care needs and expenses, the Affordable Care Act (2010) enabled millions of uninsured individuals to obtain coverage through the expansion of Medicaid and tax credits for marketplace plans. People with insurance are more likely to use health services for preventative care and more likely to have a “health care home”—a regular clinic or provider. This can lead to improved health outcomes and reduced overall health care costs. The study revealed a statistically significant difference in the percentage of adults without health insurance based on race or ethnic group. For example, adults of Mexican origin had an uninsured rate of 36%, compared to a rate of 8% for non-Hispanic White adults. The study also indicated that about one in six adults in Gage Park did not get needed medical care or surgery in the past year due to cost. The percentage by race shows that Non-Hispanic Black adults were most likely not to get medical care due to cost.

This kind of community-level data is valuable to get a snapshot of what is actually happening in the communities LAF serves, because City-wide data often masks the experience of people living in poverty in Chicago. Data like this helps us use our resources effectively and efficiently to address structural issues that keep people in poverty, and unhealthy, in Chicago.

For example, LAF participates in a Medical-Legal Partnership (MLP) with Erie Family Health Centers, which primarily serves Humboldt Park, West Town, and Lawndale, as well as the new Health Forward/Salud Adelante MLP, a collaboration with the Cook County Public Health System, which serves Garfield Park and Back of the Yards (adjacent to the surveyed neighborhoods). Many of our clients from these programs share demographic qualities with the subject of Sinai’s study: they are Puerto Rican or African-American, with physical disabilities and behavioral health challenges. Through these MLPs, where doctors refer clients with legal issues that affect their health, we are able to help treat their issues holistically. We help clients obtain medical insurance so they can get the full range of health care they need, enroll them in SNAP benefits so they can buy food, ensure they have adequate heat, and address hazardous living conditions that cause them and their children to suffer from asthma.

The work LAF is doing with our MLPs is targeting these very disparities and helping people get and stay healthy regardless of where they live.

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