Equity in our Health Care System, dr. David ansell, soul of death gap, and equality, and dr. Thomas fischer, the emergency, the year of stealing and heartbreak in the chicago e. R. With kathryn davis. Dr. Ansell and fishers book will be available for signing at the book sale and signing tent, marked an and, for nasty nasty, on your map. David antel is the Senior Vice President , associate cohost for Community Health equity at University MedicalHealth Center in chicago. Hes the author of the death gap, how inequality kills and county, life, death and politics at chicagos Public Hospital. Thomas all fisher is aboard fide from chicago. Over his career he has worked to improve health care as an academic, Health Insurance executive, company creator and white house fellow in the first term of the obama administration. The emergency was published by Penguin Random house. Catherine is the health care and Life Sciences reporter at cranes chicago business, where she writes about hospitals, public health, pharmaceutical companies, and biotech startups. She graduated from Columbia College with a bachelor in journalism in 2016. I hope you grant them a warm welcome as they come before us today. Thank you so much for [applause] that warm introduction, hello everyone, thank you so much for being here today. I am kathryn, a reporter for chicago business, thank you to doctor ansell, doctor fisher for being here today. Were really excited to get the conversation underway. So, lets set the stage for our audience, you know, dr. Ansell, your book was published in 2017. Can you tell us a little bit about what was happening with your work, and with the health care mark it 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 known it had been such a big crowd i wouldve fired the back of my shirt. No, its just its a little bit about myself. Im a general intern, im a primary care doctor. I have worked in chicago now for as a doctor since 1970, eight first of the Public Hospital cook county, now at mount sinai, that i was recruited to medical center. You can walk here to rush. But all along on, street on the west side of chicago, in my patients came with me. I was really struck when i got to, rush where i was the inaugural treat medical officer for the hospital. When, street two worlds. Of living and health care that seem to be invisible. So i was motivated to write the death gap to point out that there are these large gaps of Life Expectancy, you can literally walk from one neighborhood to another and lose 30 years of Life Expectancy. Not only, that the root causes of these were not biological, they were not behaviors, but violated to the conditions under which people lived. And yet, it was largely invisible, driven by two things, inequality and inequity. I want to point out the far left corner is crystal pilot who helped write the book. She was premed and helped me publish the book, we wrote it together. Publish a book. We wrote it together perfect. And so dr. Fisher, sort of, you know, the same question so, dr. Fischer, your book published once the pandemic had started. What was going on in your personal work at that time where you what i am seeing in my experience and the thanks for the question. And its wonderful to be here, home, discussing and reflect on some of the challenges that we all face, whether we know it or not. I have been working on the south side of chicago in the same Side 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 couldnt solve and couldnt find the resources necessary, subsequent to their injury to repair. And after decades of training and experience and working on federal policy and in local solutions, precious little progress was made. The Emergency Department look the same in 2020 as it did in 2000, when i embarked on 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. Number one, its a reflection on a society that pins black folks in place and rob some of their health care, shows them robs them of their health, and shows them no mercy. And then when they present to the Health Care System, the same structures add insult to injury. And i want to not only for me to better understand and create a compendium of the ways in which we have shaped a society towards won that 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 and living much longer, and having experiences absent the suffering that you think is normal. The pandemic was really just an accelerant to writing and not only did it give me plenty of time to write, but also reflected what his usually happens over decades, in creating health and equity occurred in a matter of months. You will find stories of humanity and challenge within the book. And so, i know that you all have been very aware of the Health Inequities in chicago and around the country, that have plagued the u. S. For many, many years. But im interested to know, what was laid bare for you during that first year of the pandemic. Were things surprising . Had theyve been worse than what you had already sort of envisioned . What was that first year like . Whoever wants to start so, i was on the front lines. And in the Emergency Department, one of the things we prepare for is pandemic. I generally follow international press, for when flus begin in china or hemorrhagic fevers begin in africa because, sooner or later with a global community, they come to chicago and walk into our Emergency Departments. I have seen covid coming for months before it did, and was quietly preparing, until march, when all of a sudden the closed and the society closed and very quickly there were no airplanes in the sky, and no television to watch. It was then that i sort of began to see the differences in who was effective in the patients that came to me in the Emergency Department. You expected people to be transformed by the virus, but they were but not all of our neighbors. Some folks were protected. They were sitting at home, having their food delivered to them, working in front of a screen, frustrated by the change, but safe. Other folks were forced into society, to deliver food, to stop shelves in warehouses, to slaughter meat and slaughterhouses, being essential but not so essential that they were protected with masks and plexus grass plexiglass screens in order to protect their health. And thats who flooded into the Emergency Department. In the first year before vaccine, i saw more people die than in the previous ten years of my clinical practice on the south side. Those lives deserve to be more than statistics. And so i tried to tell some of their stories in the book. I just want to say, dr. Fisher, its a great honor for me to read your book. And the stories of one thing that we have in common and we have a lot in common but one thing we have in common and share is that we see patients. And so, you hear words like oppression and suffering and things like that come home when you are face to face with a patient and it can be different. I wanted to tell you a little bit about my experience. So, i quit being chief medical officer of rush in 2016. My goal when i got to rush from sinai and cook county hospital, the goal was to be number one in quality. And so i did all my work with all my colleagues to actually move us to the pinnacle of quality hospital in the country. And yet, i am a social epidemiologist, and my patients had traveled with me and i could see that we could fix quality as much as we want, but if we didnt address the conditions, people would die unnecessarily, so, im saying, people are dying outside outdoors, weve got to think about this differently. And in my own hospital we named racism and economic deprivation as root causes of poor health, and something we should do something about. That was in 2016. So, when covid was coming, we prepared not only the hospital, but what our Community Response was going to be. We were thinking about it. So, i want you to imagine this. Covid, we were thinking about his being the great equalizer, because the whole World Population immunity, yet we knew, as it was coming, that it was going to disproportionately cause suffering in black and brown neighborhoods, poor neighborhoods in general, and black and brown neighborhoods in the city. And we began to prepare for that inevitability. It was as if one epidemic was crashing into this preexisting epidemic, which was largely invisible. And we did a lot of preparation for it. But i want to tell you a story of one of my patients. So, as the patient as the patients are beginning to come in, i 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 worked at ohare, in Garfield Park, lowest Life Expectancy on the west side took the bus worked as a baggage handler. Because of her condition, after employer to wear a mask. Im going back to what you talked about in the working conditions. It was not allowed to wear a mask, caught covid somewhere along the way, her whole family got covid. And then we saw the disproportionate impact. And then, i will say, the first hundred deaths in chicago, 70 were in a black people. The mayor said it took my breath away. And then called and put together a Racial EquityResponse Team that i had the honor to sit on, and actually address the Community Conditions and try to address them and that dr. Fisher talked about. So, dr. David ansell, could you actually expand on that and tell us about what came from that task force . What were the specific measurable metrics you knew you could go after and improve things . You know, a pandemic gives you an epidemic of any sort. It gives you no time. And youve got to charge into the problem. Let me say a couple of things that happened. Our medical students got pulled out of homeless shelters we had a meeting and say, what is going to happen in the shelters . They are going to move the beds. They are going to reduce the number of people in shelters by a third and separate the beds. And if you just a logical thinking well, a moving the beds a few feet apart in a room like this is not going to they whole department was very clear that the Health Department was overwhelmed, that they couldnt they didnt have problem so we actually came in and actually not just us. We pull together table Community Health providers, university of illinois, the city, to really think through, what could we do, to tamp down the impact of the pandemic and those experiencing homelessness. And we did. And we executed on it and made a giant difference in the city. So, when the first hundred deaths occurred, which was early april, the mayor of chicago, laurie lightfoot, asked her staff, what should we do about it . And they gave her some ideas and she said, that is not good enough. Call westside united. Westside united was an organization of hospitals and Community Leaders that was formed to address the death gap in chicago by addressing community in terms of health. And that group was asked which are the Racial Equity rapid Response Team, and suddenly, at the table, were not only the hospitals and clinics, but the city, and the Community Organizations. And the Community Organization says what do we need . They didnt say we need more health care. They say we need more masks in our neighborhood we need tests in the communities. Ultimately led to those strategies around vaccinations, was launched that early april. And i dont say, is it going to make a difference or . Not these things are hard to measure. But the high level measure, first year after the first year of the pandemic, in chicago, third in population, and seventh and mortality, was a good enough but i do think there were things that that brought the community to the table, to determine what did they need to survive the pandemic. And it wasnt more icu beds. That is not what they were asking for. It was for basics. And so you mentioned the Life Expectancy here in chicago. And as a result of the pandemic, we saw Life Expectancy for all chicagoans, but especially for black and brown chicagoans, drop to a very low level. The Life Expectancy for all chicagoans dropped two years on average to 75 years, with even steeper decline for black and latino residents. The Life Expectancy at the end of 2024 black chicagoans fell below 70 years for the first time, to 69 years. And the gap between black and white chicagoans is now a ten years. And so my question for you all is, where do our public and private Health Systems go from . Here what are the steps in turning these life expectancies around . And even improving them from where they were prepandemic . I think this is a question that is not really about our Health Care System, but really who we are a chicago winds and what we owe to one another. Our health is not really constructed by health care. It is created by where we live, work and play. One of the things we saw during the pandemic was not only the disproportionate impacts of covid that but dr. David ansell described, but it was also created a rash of violence in ways that we hadnt seen in years before. You have to keep in mind that our schools were closed. The Community Centers were closed many of the elders that temps down interpersonal violence were hiding out and people who had the most vulnerability that didnt provide were the ones who are most likely to fall ill. We and that led to ashes of violence across the city and the not only our death rates, but also our 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 them into the room where we do our resuscitations. We intubated them, gave them medications, gave them chest compressions, and fleetingly got their heart rate back, but lost it again. And after a course of 20 minutes, we accepted the inevitable and, after a moment of silence, one of the things that i do as the attending is go and talked to the family. When i went in the room to talk to the family, the child of this elder was in his late 50s and i sat down. And theres a process by which i do this, which i have honed over 20 years where i sort of explain the circumstances, ask them their understanding, prepare them for what i am going to tell them, tell them that their loved one died. And in that moment, he stop me and said, dr. Fisher, dont you remember me . And i didnt. I didnt remember him and i felt humiliated and embarrassed. Because, here i am in a life and death situation, and dont remember the interlocutor that im speaking with. He said, last year we had this same talk when my other parent died. We have these social conditions that are running through our communities and these intergenerational homes and calling our elders, and there is by the time they come to me, it is 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 these conversations, where we have the opportunity to be vulnerable and to clearly see one another as fully human as we see ourselves, which ought to be 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 have concentrated our shared tax dollars in the service of those on the north side of south and the west side. We end up with entrenched generationlong poverty as a result of desegregation. We have an absence of the social services and connection that lead to health and we are effectively creating jobs that would leave somebody out of these situations. There has been a ton of work done in the city. And that dr. David ansell has been a part of it the metropolitan Planning Board in the urban institute recently weve got chicago shag rug asian segregation that the services, goods and resources that protect our health from whiteness and distributed them more equally, not equally, but just as equally as our other segregated cities in the chicagoland in america are 30 . Our income would improve for everybody in the city. The question should be focused on, who do we as a society see ourselves as . And what is our commitment to one another . And are we willing to make the hard choices that are not lurching from emergency to emergency, but deciding to reorganize our society towards mom one that is more just and equitable in resources. And until, then we will continue to lurch from emergency to emergency. That was so really eloquent. And i want to just take the same response and then sort of a different take on it. Number one is, as a white physician, who has been a doctor since 1978, taking care of, largely, my whole career, an underserved patient population, black and brown, tha