AMA policy defines health equity as “optimal health for all,” but in the AMA’s hometown of Chicago, inequities are evident in a 14-year life-expectancy gap between affluent neighborhoods and those on the city’s West Side that have been historically excluded from civic investments.
The conditions that shorten people’s lives are chronic diseases such as heart disease, cancer and diabetes; homicide; infant mortality; HIV, influenza and other infections; and opioid-use disorder. These outcomes stem from daily challenges that include the lack of access to stable and safe housing, healthy food options, childcare and a livable, stable income.
The AMA is committed to eliminating this gap and is working with the organization West Side United to do so in 10 Chicago neighborhoods.
“We're focusing on the lens of the Chicago West Side, examining the roots of these health disparities and our collective approach to solving them,” said Willie Underwood Ill, MD, MSc, MPH, the immediate past chair of the AMA Board of Trustees.
“What's going on in this city is a microcosm of what we see in the large urban centers across our country, including Buffalo where I live and practice,” Dr. Underwood said at the National Association of Black Journalists’ convention in Chicago, where he took part in a panel discussion on the role of microlending in solving the city’s life-expectancy gap.
“I recognize the impact of how we live, how long we live, and the startling 14-year life expectancy gap that exists between the affluent and the historically under-resourced neighborhoods of Chicago and across the United States,” he said.
The AMA is a West Side United anchor mission partner along with Rush University Medical Center, Ann & Robert H. Lurie Children’s Hospital of Chicago, AMITA Health, Cook County Health, Sinai Health System, and University of Illinois Hospital & Health Sciences System.
The AMA’s multiyear, $5 million investment is part of a combined contribution of $177 million that has gone toward local procurement, small business grants and impact investing that has supported hundreds of low-interest loans to support small businesses and community organizations, the preservation of hundreds of homes and housing units, as well as 34,000 square feet of nonprofit and commercial real estate projects, Dr. Underwood said. He added that West Side United has also supported hundreds of construction jobs and hundreds of new and preserved jobs across other industries.
Investments take aim at inequity
“Our work on the West Side is part of the AMA's larger national strategy to advance social justice and equity in medicine through policies, programs, state and federal agencies and investment,” Dr. Underwood explained. “By making targeted upstream investments, we believe that we can improve health outcomes for children and for families over the long haul, and significantly increase the life expectancy for West Side residents.”
These investments are directly addressing social determinants of health by creating more opportunities for West Side residents, Dr. Underwood added.
These investments, for example, helped launch the Fillmore Linen Service, a new 45,000-square-foot operation and anchor tenant for a previously vacant 111-year-old building purchased by the Steans Family Foundation for $3.3 million in 2022. The company will create up to 175 jobs.
In May, Rush signed a contract with Fillmore for its linen services at its three hospitals: Rush University Medical Center, Rush Copley Medical Center and Rush Oak Park Hospital. Combined, the facilities use 6 million pounds of linen a year, according to a Rush news release.
This summer, the Ann & Robert H. Lurie Children’s Hospital of Chicago also signed a contract with Fillmore Linen.
Two other businesses have opened in the building and the Chicago Sun-Times has reported that seven years after renovations are completed, the facility will be placed into a community benefit trust.
There are environmental benefits as well. Rush said it previously sent laundry to facilities in Wisconsin and Indiana, so using the local service will conserve fuel and reduce greenhouse-gas emissions. On its website, Fillmore Linen touts that its washers use up to 70% less water than standard washers and its dryers consume 20% less energy than standard equipment.
“It is extremely important that as we talk about this and that other organizations understand: Let's move out of the charity model and let's move to the investment model,” Dr. Underwood said. “Because if we invest in people, people will invest in themselves and grow a community that we all want others to have.”
Juana Ballesteros, MPH, director of equitable alliances for the AMA Center for Health Equity, also participated in the panel and noted that social impact investment is more than policies and programs; “it’s a philosophy.”
“It's when organizations, foundations, individuals really prioritize their investments with a focus on their social and environmental impact, more so than the traditional purpose of investment—financial return,” Ballesteros said. “Again, really the purpose is for social and environmental benefits.”
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For example, West Side United, Rush and several other local organizations, such as the Pritzker Traubert Foundation, have partnered to build the Sankofa Village Wellness Center in West Garfield Park, a West Side neighborhood where the life expectancy is 69 years.
The center is expected to open next year and serve 17,000 residents, and promises to offer medical, dental and behavioral health services regardless of a person’s ability to pay.
The 2023 West Side United annual report states that its partners have provided $10.5 million in investments, that have supported $16.2 million in loans, including 101 loans in 2023. They have also hired more than 7,000 West Side residents since 2018, including almost 1,100 in 2023.
Beyond economic benefits
Ayesha Jaco, executive director of West Side United, also participated in the panel and she explained how, along with economic benefits, other outcomes being tracked include third-grade reading scores, kindergarten readiness and high-school graduation rates.
“We also think about the impact of access to care, and we think about the impact of neighborhood in the built environment,” she said. “If we go back to the history and track what that has been over time and what the changes and shifts has been, it all points back to that historical disinvestment.”
Dr. Underwood agreed and noted that “it took hundreds of years to get to where we are.”
“The lack of jobs, the lack of opportunities, the lack of transportation, the lack of investment and business growth, the crumbling infrastructure and declining of civic engagement, all decreases the health and the health outcomes of not just the West Side of Chicago, but our community as a whole,” he said.
The work that individual physicians do to care for individual patients should go hand in hand with broader investments to address the root drivers of poor health outcomes and health inequities, he added.
“I joined the AMA because I believed I could make a contribution to our community and I could make it healthier,” Dr. Underwood said. “I became a physician because I believed it was my obligation to make our community and our communities stronger, vibrant, powerful and a place to call home.”
Learn about the AMA’s 2024-2025 strategic plan to advance health equity.
