Thanks so much for joining us today. We are happy to present an equity in our Health Care System. Dr. David answer the death gap how inequality kills and dr. Thomas fisher the emergency a year of healing and heartbreak in a chicago e. R. With Katherine Davis with crains dr. Ansell and fishers books be available for sale and signing at the book sales and signing tent marked in in our nancy nancy on your maps david ansell is the Senior Vice President associate provost for Community Health equity at Rush UniversityMedical Center in chicago. He is the author of the death gap how inequality kills and county life death and politics at chicagos public hospital. Thomas l is a Board Certified emergency medicine physician from chicago, and over his career, he has to improve health care as Academic Health insurance, executive health care, company and white house fellow, the first term of the Obama Administration in the emergency. Lets by Penguin Random random house our moderator is kathryn katherine is the health and Life Sciences reporter crains Chicago Business where she writes about hospitals Public Health pharmaceutical companies and biotech startup. She graduated from Columbia College with a bachelors degree in journalism and 2016. I hope youll me with granting them a warm welcome as they come before us today. Thank you so much for that warm introduction. Hello, everyone. Thank you so much for being today. Im katherine, reporter for crains Chicago Business and. Thank you to dr. Ansel and dr. Fisher for being here today. Really excited to get this conversation underway. So lets set the stage for our audience a little bit. You know, dr. Ansel, your was published in 2017. Can you tell us a little bit about, you know, what was happening with your work and with the health care sort market here in chicago at the time that made you want to write this book to begin with. Well, first thanks, everybody, for coming. If i had had been such a big crowd, i would ironed out the back of my shirt. But now i just i was its a little bit about myself, a general internist, primary care doctor. And i were ive worked in now for as a doctor since 1978, first at the public hospital, cook county, then at mount sinai. And i was recruited run an academic Medical Center, actually, you can walk here, too, to rush. But all along, one street on the west side of chicago and patients came with me and i was really struck when i got to rush where was the inaugural chief medical officer for the hospital about the one street two world of living and health care that seemed to be invisible. And so i was motivated to write the death cab to really point out that there are these large gaps of Life Expectancy, literally you can walk from one neighborhood to another and lose 30 years of Life Expectancy. But not only that, the root causes, these were not biological. They were not behaviors, but but related the conditions under which people and yet it was largely invisible all driven by two things in equality in inequity. I do want to point out in the far corner is dr. Kristen palico help write the book. She was premed and really helped me publish a book. We wrote it together perfect. And so dr. Fisher, sort of, you know, the same question for you. Your book published once the pandemic had started, you know, what was sort of going on in your personal work at that time. You were like, now is the time for me to write book about what im seeing, my experience and the inequalities that. Thanks for the question and its wonderful be here home discussing and reflecting on some of the challenges that we all face. Whether we know it or not. Ive been working on the south side of chicago in the same community where i grew up for over 20 years. What i saw in the Emergency Department was overburdened waiting rooms, people with medical problems that they couldnt solve and couldnt find the resources necessary subsequent to their injury to find, repair and. After decades of training and and working on federal policy in local solutions, precious little progress was made. The Emergency Department looked the same and 20 as it did in 2000, when i embarked in my medical career and i was frustrated and challenged by the lack of progress. And so in many ways, this book is a number of things. One, its a reflection on society that pins black folks in place and robs them of their health care and shows them, robs them of their health and shows them no mercy and when they present to the Health Care System the same structures add insult to injury and, i want it not only for me to better understand and create a compendium of the ways in which weve shaped a society towards, one that harms health. But i also wanted to explain to my patients why, is this happening to you . What is it that brings you here and makes it difficult for you to receive the health care you deserve while at the same time you see others taking different pathways, living much longer and, having experiences absent the suffering that you think is normal. The pandemic was really just an accelerant to writing in that not only did it you know, give me plenty of time to write, but also reflected what usually happens over decades in creating Health Inequity occurred in a matter of months. And so youll find stories of and challenges within the book. And so, you know, i know that, you know, you all have been very aware of the Health Inequities in chicago and around the country. You know that have plagued the u. S. For many, many years. You know, but im interested to know what was laid bare for you during that first year of the pandemic. You know, were things surprising they even worse than what you had, you know, already sort of envisioned what was that first year like . Every once to start . So i was on the front lines and, you know, in the Emergency Department, one of the things we prepare for is pandemic. I generally follow the international press, when flus begin in china or hemorrhagic fevers begin in africa, because or later with a global community, they to chicago and walk into our emergency. Id covid coming four months before it did and was quietly preparing until march when all of a sudden the nba closed and then society closed and very quickly there were no airplanes in the sky and and no television to watch. It was then that i sort of began to see the differences in who was in the patients who came to me in, the Emergency Department. You expected people to be transformed by the virus, but they were just our neighbors coughing and wheezing and short of breath, but not all of our neighbors. Some folks were protected they were sitting at home having food delivered to them, working in front of a screen, frustrated by the change, but safe, other folks were forced into to deliver food to stock and warehouses to slaughter in slaughterhouses deemed essential but not so essential. They were protected with masks and plexiglass screens in order to maintain their health. And thats who flooded into the Emergency Department in the first year before, i saw more people die than. In the previous ten years of my clinical practice on the south, those lives deserved to be more than static sticks. And so i tried to tell some of their stories in the book, maybe just want to say doctor for sure. It was a great honor for me to read your book and and the stories of page. I think one thing that we have in common, we have a lot in common, but one thing we have in common and share is is that we see patients. And so so, you know, you hear words like oppression or suffering, things like that. But they really they really come to home. Youre face to face with a patient. You know, it can be different. So i want to just tell you a little bit about sort of my experience. So i being chief medical officer at rush in 2015, my goal when i got to rush from sinai in cook county hospital, the was to be number one in quality. And so i all the work with all my colleagues at who actually move us to be like the pinnacle of quality hospital in the country and im a social epidemiologist and my patients have traveled me and i could see that we could fix quality as much as we want but if we address the conditions people would die unnecessarily. So im saying people are dying outside our doors weve got to think about this differently. And in my own hospital we named racism and economic deprivation as causes of poor health and something we should do something about that was in 16. So when covid was coming we prepared not only the hospital but what our response was going to be. We thinking about it. And so i want you to imagine this covid we were thinking about as being the great equalizer because the whole worlds population lacked immunity. Yet we knew as it was coming, that it was going to disproportionately cause suffering and black and brown neighborhoods, poor neighborhoods, general black and brown neighborhoods in the city. And we began to prepare for that inevitability. It was as if one epidemic was into this preexisting epidemic, which was largely and we did a of preparation for it. But i want to tell you a story of one of my patients. So as the patient so and as the patients are beginning to come in, im in the beginning of the pandemic, i could read the charts of every patient coming into rush. That was impossible. Two weeks later, i see one of my patients sickle cell anemia hospitalized multiple times for sickle cell anemia. But this time it was covid or presumed covid. It turned out to be covid. She at ohare lived in Garfield Park lowest Life Expectancy neighbor. The west side took the bus to the train to ohare, worked at the baggage handler because of her condition, asked her employer to wear a mask. Im going back to what you talked about. The working conditions. I was not allowed to wear a mask caught covid somewhere along the way. Her whole family got covid in and and then we saw the disproportionate impact. And then i will say the first 100 deaths in chicago, 70 were in black people. The mayor said it took my breath away and then called and together a Racial EquityRapid Response that i got to had the honor to sit on to actually address the community conditions, try to address them that were causing the Health Outcomes that dr. Fischer talks about. And so dr. Angela, could you actually expand on that . And us a little bit about what you know came from that task force . Like what were the specific measurable metric x you knew you could go after to improve, you know, if a pandemic gives you an epidemic of any sort, gives you no time, youve got to charge into the problem and so let me just say a couple things that happened. Our medical students got pulled out of homeless shelters, shelters for, and we had a meeting. We said, well, whats going happen in the shelters whom . He met with a shelter . Oh, theyre going to move the beds theyre going to reduce the number of people in shelters by a third and separate the beds. And if you just a logical well, theres a virus thats airborne moving the beds a few feet apart in a room like this is not is going to be not going save lives. The Health Department was very clear from day one that the pandemic is a Health Department was overwhelmed, that they couldnt they they didnt have think through the problem so we actually in and not just us we pulled together a Table Community providers university of illinois the city to really think through what could we do to tampa tamp down the impact of the pandemic and those experience homelessness and we did and we executed on it and it made a giant difference in the city. So when the first hundred deaths occurred, which was early april the of chicago Lori Lightfoot asked her staff what we do about it and they gave her some ideas and she said, thats not good enough. Call side united and west side united was an organization of hospitals and Community Leaders that was formed to address the death gap in chicago by addressing community to terms of health. And that group was asked to cochair the Racial EquityRapid Response team and suddenly the table were not the hospitals and the clinics the city but the community and Community Organizations said. What do we need . They didnt say we need health care. They said we need masks our neighborhood, we need food, we need rental subsidies, we need tests in the community and. So that mobilization to get into communities, that ultimate led to the strategy around vaccination in the city of chicago was launched that early april i dont you know say what didnt make a difference or not you know these things are hard to measure but at the level measure first year after the first year the pandemic chicago third in population, seventh in mortality was a good enough. No, but i do think there were things that were begun to don that brought the community to the table to determine did they need to survive the pandemic. And it wasnt werent icu beds thats not what they were asking for. It was for basic. And so you mentioned the you know, Life Expectancy here in chicago and, you know, as a result of the pandemic, we saw Life Expectancy for all chicagoans, but especially for black brown chicagoans, dropped to very low levels. You know, the Life Expectancy for all chicagoans dropped almost two years on average to 75 years, with even steeper declines for black and latino residents. The life at the end of 2020 for black chicagoans fell below 70 years for the first time to 69 years. And the gap between black and white chicagoans is now ten years. And so my for you, all, you know, is is where do our public and private Health Systems go from here . You know, what are the steps in turning these life expectancies. Around and, you know, even improving them from where they were prepandemic . You know, i think this is a question thats not really about our Health Systems, but really about who we as chicagoans and what we owe to one another, our health is not really constructed by health care. Its created by where we live, learn, work and play. One of the things we saw during the pandemic was not only the disrepair and impact of covid that. Dr. Hansell describes, but it was also created a rash of violence, ways that we hadnt seen in years before. You have to keep in mind our schools were closed, the Community Centers were closed. You couldnt go to church many of the elders that tamp down interpersonal violence were hiding out or killed, and people who were who had the most vulnerability were in the sorts of jobs that didnt provide insurance or time off, who were the ones who are most likely to fall ill and also ones who are least likely to provide for their communities from that led to rashes of violence across the and the spike in not only our death rate but also our ah gun violence rate. When you think back to that time, i took care of somebody who was an elder brought in from home and they were in cardiac arrest. This is not an uncommon situation for us and we took into the room where we do our resuscitation missions. We intubated them, gave them medications, gave them chest compressions, fleetingly, got their heart rate back, but lost it again. And after a course 20 minutes, we accepted the inevitable. And after a moment of silence, one of the things that i do as the attending is and talk to the family when i went into room to talk to the family, the child of this elder was, you know, in his late fifties. And i sat down and theres a process by which i do this, which i honed over 20 years where i, you know, sort of explain the circumstances, ask them their understanding, prepare for what im going to tell them. Tell them that their loved one died. And in that moment, he stopped me and said, you know, dr. Fisher, dont you remember me . And i didnt i didnt remember them all. And i felt, you know, humiliated and embarrassed because here i am in a life death situation and dont remember the interlocutor that im speaking with. He said last year had this same talk when my other parent died. We have these social conditions that are running through our communities in these intergenerational homes and, calling our elders and. Theres by the time they come to me its too late. We as a community have to not only recognize that in those moments. I feel very fortunate to see the depth of their humanity and recognize that, you know, these conversations where we have the opportunity to be vulnerable and clear we see one another as fully human as we see ourselves, which ought to lead to the sort of policy solutions that would raise all of our health. But theres a large voltage drop before we get there and we concentrated our shared tax dollars in the service of those on the north side of the expense of those on the south, in west side, we end up entrenched generation, long poverty as, a result of this segregation. We have an absence of the social services and education that lead to health and and we arent effectively creating jobs that would somebody out of these situations theres been a ton of work done in the city angelou has been a part of a lot of it, the metropolitan planning board, and they urban Institute Just recently published information that described if we got chicagos segregation, that unlinked the services, goods and resources that protect our health from whiteness and