An abandoned graystone in North Lawndale. Credit: Danielle A. Scruggs

Healthy Chicago 2.0, the city’s new four-year public health plan, “aims to ensure that every child raised in Chicago, regardless of neighborhood and background, has the resources and opportunities to live a healthy life,” according to Mayor Rahm Emanuel.

That’s a grand goal—but of course it’s easier to set goals than achieve them.

The Department of Public Health has been rolling out the plan at a series of community meetings, the last of which will be Wednesday evening at Hamilton Park in Englewood. The 86-page report outlining the project, published in late March, is bold in its diagnosis but timid in its prescription. It pulls no punches in detailing the shameful inequities in Chicago: while the children in predominantly white neighborhoods already have the “resources and opportunities to live a healthy life,” the children in many black and brown neighborhoods are growing up with their backs against the wall. 

But although the report offers 30 goals, 82 objectives, and more than 200 “actionable” strategies to diminish Chicago’s health inequities, reducing segregation isn’t one of them.

The public health department’s report illustrates damning health disparities tied to geography.Credit: Houseal Lavigne Associates

Among the damning disparities the report documents: One in two African-American and Hispanic children live in “low child opportunity” areas, compared with one in 50 white children. (“Child opportunity” is a quality-of-life index based on socioeconomic and other community characteristics influencing a child’s health and development.) The “very low” child opportunity areas are all black or Hispanic neighborhoods on the south and west sides. The infant death rate in some black neighborhoods is more than double the citywide rate. Children on the south and west sides have elevated blood lead levels. Their life expectancy is five years lower than life expectancy for children on the north side. Their parents are much less likely to be employed. And, of course, there are far more shootings and other violent crimes in their neighborhoods. 

These disparities are the poisoned fruit of Chicago’s long history of racial segregation—an apartheid that was cultivated by the city’s leaders in the 20th century through a host of policies, among them restrictive covenants, redlining, urban renewal that too often served as “Negro removal,” and high-rise public housing situated in ghettos, which only furthered the isolation of blacks. The restrictive covenants ended long ago and the high-rise projects have been leveled, but the isolation continues: today, most black Chicagoans still live in community areas that are at least 90 percent black. The African-Americans who migrated to Chicago from the south in the early and middle years of the last century were largely poor, and racial segregation concentrated their poverty, creating and intensifying most of the problems that Healthy Chicago 2.0 is, according to the mayor, determined to solve—but without confronting segregation itself.

“We focused on community development,”  Julie Morita, the public health department commissioner, told me when I asked why desegregation was not among the report’s proposed strategies.

That’s what racially segregated cities always focus on: trying to upgrade impoverished minority neighborhoods without attempting to dismantle the segregation that fosters the poverty. Challenging segregation requires too much political courage, because a city’s more affluent residents would prefer that their city’s poor residents stay on the other side of town. Mayor Emanuel, like the mayors before him, understands that desegregation is a loaded subject. Better to make token investments in minority neighborhoods and hope it passes as an earnest effort.

Community development is essential, but can’t by itself heal the deep wounds inflicted by segregation. In 24 of Chicago’s 77 community areas, at least 30 percent of the households are in poverty. Within these impoverished areas are countless census tracts in which more than half of the residents are poor. Most of these neighborhoods have been poor for decades, despite the community development pledges of mayor after mayor. They’re not going to be developed into safe and healthy places without massive, sustained investment—which won’t be forthcoming because of another facet of segregation: the “haves” aren’t affected enough by the problems of the distant poor to accede to the necessary tax increases. 

A racially segregated city isn’t likely to ever be a healthy one for the same reasons that separate will never be equal. 

The public health department also found a gap in life expectancy tied to neighborhood.Credit: Houseal Lavigne Associates

To its credit, Healthy Chicago 2.0 understands that the physical and mental well-being of city residents is intertwined with social and economic conditions, and that most of the city’s inequities are geographically based. That makes it especially disappointing that desegregation isn’t on its agenda. But then, although the city stresses that the plan was created with much community input, it was sponsored and launched by the mayor. 

Is “reducing racial segregation” too demanding a goal for a public health project? Certainly it’ll take a lot more than four years to undo a problem that’s been a century in the making. But the Healthy Chicago 2.0 report is replete with lofty goals, such as “Improve the economic vibrancy, diversity and financial security of communities to reduce economic inequity,” and “Reduce mass incarceration and inequitable police attention in communities of color,” and “Decrease discriminatory treatment in the criminal justice system.”
Many of its more specific goals are unlikely to be met. Healthy Chicago 2.0 wants to reduce the rate of gun-related homicides among African-American males by 20 percent by the year 2020. Its strategies for accomplishing this include identifying youth at-risk for involvement in serious violence and engaging them in prevention efforts, and assessing the likelihood of retaliation after a killing. Smart ideas, but implementing them is challenging, and even if they were implemented, they wouldn’t yield a 20 percent reduction, or anything close, in four years.  

To lower the disproportionate rates of cardiovascular disease and obesity among poor minorities, Healthy Chicago 2.0 seeks to “increase fruit and vegetable consumption among African American adults by 10 percent” and “increase physical activity among adults living in high poverty by 5 percent.” Research has shown, however, that racial disparities in obesity and hypertension “are greater in areas in which there is greater racial segregation” and minimal in racially integrated neighborhoods, Dr. Margaret T. Hicken wrote last year in the American Journal of Epidemiology. Hicken, a researcher for the Institute for Social Research at the University of Michigan, noted that segregation was “an important mechanism by which racial inequalities in health are produced and maintained.”

Segregation also correlates to infant mortality rates, according to the health department.Credit: Houseal Lavigne Associates

How might Healthy Chicago 2.0 address the health disparities caused by segregation? For starters, it could support the parents in segregated neighborhoods who feel that the best way they can help their children “live a healthy life” is by moving to a middle-class neighborhood. That’s not easy in Chicago: the Reader’s story last month on public housing vouchers detailed the rampant discrimination against voucher holders by landlords in middle-class neighborhoods. Voucher holders, the vast majority of whom are African-American, face the most discrimination on the northwest side, where landlords refused to rent to them 58 percent of the time, according to a 2014 study by the Chicago Lawyers’ Committee for Civil Rights Under Law. Such discrimination is illegal, but enforcement is lax: the city agency charged with investigating housing discrimination, the Commission on Human Relations, has had its modest budget of $1.9 million cut nearly in half by Mayor Emanuel. 

Healthy Chicago 2.0 could have called for the mayor to fight housing discrimination by significantly increasing CHR’s funding over the next four years. That’s certainly an “actionable” strategy that could improve the health prospects of some children more quickly than community development.

To combat segregation, Chicago also needs to greatly increase efforts to make affordable housing available in “opportunity” areas—neighborhoods that aren’t poor and segregated—throughout the city. And it should play a leadership role on affordable housing in the metro area, since segregation is a regional problem in need of regional solutions. The Healthy Chicago 2.0 report notes in passing that a lack of affordable housing “can restrict where people live,” and calls for the creation of a “structure to develop a more balanced portfolio of housing that is safe, healthy, accessible and affordable.” That might be on the right track, although a “structure” to develop a “more balanced portfolio” sounds pretty vague. 

Healthy Chicago 2.0 also should focus on school segregation. The report acknowledges that most south-side and west-side children must attend schools “that are not the highest performing,” but it doesn’t make note of the fact that the Chicago Public Schools enrollment, which is 85 percent black and Hispanic, is also 86 percent economically disadvantaged. Poor kids do better in economically diverse schools, much research has shown. One “actionable strategy” to address the racial and economic segregation of CPS’s enrollment would be to establish a network of city-suburban magnet schools with special programs that draw middle-class suburban students into the city, and allow low-income Chicago students to attend school in the suburbs. Such programs exist in Saint Louis, Boston, Milwaukee, Hartford, and Omaha.

The next step for Healthy Chicago 2.0 will be the convening of “implementation teams” comprised of experts and community leaders who will develop  a “comprehensive 18-month work plan.” The public health department will also “engage aldermen and public and private funders” to try to get money for the initiative. 

The Healthy Chicago 2.0 report calls the project an “ambitious public health plan.” And it has some promise. But because it sidesteps the city’s fundamental problem, it’s not ambitious enough. The report quotes Dr. Martin Luther King: “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.”

But King also wrote: “With every ounce of our energy, we must continue to rid this nation of the incubus of segregation.”