When I graduated from medical school 50 years ago, I never imagined improving health might mean building a basketball court. But after decades as a Chicago physician I have learned that healing requires hospitals to think — and listen — beyond their walls.
My teachers weren’t professors but rather West Garfield Park residents like Marquis Pitts who told Rush University Medical Center staff in 2017 that what his neighborhood needed was a community center with an indoor basketball court — a safe place for children to gather and play.
He did not ask for another clinic.
Marquis knew from lived experience what public health data shows: Chronic disease kills more residents in his neighborhood than gunfire. And that that while his neighborhood is less than 20 minutes via the CTA’s Green Line ride from Downtown, residents there can expect to live nearly 20 years longer. I call this the death gap: lives shortened by segregation, disinvestment, violence and fractured access to opportunity.
Marquis understood something institutions often miss: For people to live longer, we must listen to communities and change the conditions where they live, work and pray. No hospital can treat or build its way out of these realities.
So we became better at listening and collaborating. Wellness walks brought Rush staff and residents together. A weed-and glass-strewn vacant lot became a free outdoor skating rink. Investments followed in violence prevention, mental health services, schools, businesses and jobs.
Rush also began using its economic power differently, very intentionally focusing the economic benefits of how we purchase, hire and invest to catalyze local economic opportunity. By helping start a local company that cleans hospital gowns and sheets, for example, more than 300 West Side jobs were created.
Community collaboration led to the opening last spring of the Sankofa Wellness Village, where Marquis’ idea became real. The Sankofa Village Wellness Center opened with a regulation-size basketball court at its heart, surrounded by medical and dental care, addiction services, childcare, job support, a credit union and YMCA programs.
Should medical schools teach that basketball is medicine? No, but shared efforts in Chicago are making clear that health is created long before someone enters an examination room. In West Garfield Park, the estimated life expectancy rose in the last decade from a city-worst 66.6 to 70.
Those gains cannot be attributed to one program or institution. COVID-19, homicide and overdose deaths have declined, but driving these longer lives are groups connected by the shared goal of narrowing Chicago’s death gap. West Side United, which Rush helped launch in 2017, aligned hospitals, residents and community groups around investment, employment and health. And the newly created Live Healthy Chicago’s citywide approach, connects hospitals, clinics, community organizations and the health department around heart disease prevention.
Our country faces uncomfortable facts. We spend enormous sums treating disease while underinvesting in the places where disease takes root. Just as hospitals perform a root cause analysis when preventable problems happen, similar tactics can be applied to neighborhoods where residents are dying too soon.
Measure where lives are being lost. Ask residents why. Share power over solutions. Use hiring, purchasing and investment to change the conditions that shape health. Judge success not simply by dollars spent or programs launched but by whether people live longer.
The death gap was created by policy and investment decisions, thus it is not inevitable, nor limited to Chicago. But while cities across the country channel resources to documenting their own death gaps, Chicago is providing a road map to close them.
When I visit the Sankofa Wellness Center and hear the squeaks of basketball shoes, I also hear what I didn’t in medical school: a community telling a hospital what it needs to be healthy.
David Ansell, MD, is senior vice president for community health equity at Rush University System for Health and author of “The Death Gap: How Inequality Kills” and the forthcoming “Crossing the Gap: Healing Epidemics and Inequalities in a Divided City.”