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Reflection Questions

  1. Think about your community. Do you think that a people of a different race/ethnicity, socioeconomic status, gender, sexual identity, or religious belief have the same health outcomes as you? If you think you have similar outcomes, what in the community seems to prevent a gap from existing? Or if you think a health inequity exists, what in the community seems to create the gap?
  2. Look up some vital statistics and health outcomes for your community. What are the top causes of death and disability? Describe any differences in outcomes by race/ethnicity, gender, socioeconomic status, and/or any other variable.
  3. Construct your family tree for at least three generations. Look at health conditions and age of death. What factors may have caused differences in health outcomes over generations?

Discussion Questions

  1. Phillips and Lacey are clear in their assessment: “The excess black cancer mortality rates are directly linked to the multiple problems of the socioeconomically disadvantaged, who are unable to purchase or gain access to state-of-art medical services.” This assessment echoes in many, if not all, of the selections in this book. What has changed since their work, which was originally published in 1987? Have programs and policies been developed to address the problems they described?
  2. Phillips and Lacey identified Woodlawn as the Chicago community with the highest cancer mortality rate for black people, followed by Greater Grand Crossing, a community contiguous to Woodlawn, and then Kendood. What has happened to these communities since Phillips and Lacey’s article? Explore the Chicago Health Atlas to find out about the current epidemiological profile of these communities.
  3. David and Collins’ article on birth weight patterns for US-born Blacks, African-Born Blacks, and US-born Whites is often cited as a landmark study, one that changed how people thought about the effects of racism rather than race as a determinant of health. What has it about their methodological design that enabled them to make such an impact on the field?
  4. As we prepared this book, Richard David sat down with us for an interview about his work, and discussed some of the background to his paper, and how he came to understand racism as the root cause of inequities in low birth weight. What lessons does his experience hold for you?
  5. Shah, Whitman, and Silva make the case for local data by examining health conditions in six of Chicago’s community areas. In particular, they noted key differences between North Lawndale and South Lawndale — they are adjacent to one another, “yet they have very different health profiles”. Explore the Chicago Health Atlas to find out about the current epidemiological profile of these communities.
  6. What do Woldemichael et al reveal about racial/ethnic patterns and survival with AIDS? With the roll out of HAART, what happened to racial/ethnic differences in mortality? Consider their findings in relation to the findings on breast cancer mortality in the next chapter and on tuberculosis described by Harris earlier in this book. Is there a generalizable pattern?
  7. Figure 10.1c is arguably one of the most important graphs in the Chicago health equity research literature. What is the message of the graph? How does it related to the graph presented by David and Collins? (see figure 7.1)
  8. Kaiser et al studied Black women’s awareness of breast cancer disparity, and found that over half of the sample was unaware of existing inequities. The respondents who did express knowledge of inequities in cancer mortality “overwhelmingly” placed responsibility for it on individual behaviors and “community culture”. Were the respondents correct?
  9. What do Hicken et al mean by “racism-related vigilance”? Are you satisfied with their measurement of the concept?

Solution Finding

  1. Read the Healthy Chicago 2.0 community needs assessment. Pick one of the objectives where a significant disparity exists by race/ethnicity, gender, sexual identity, or socioeconomic status and discuss how you would approach achieving the reduction in the gap.

Further Readings

Whitman, S., Coonley-Hoganson, R., & Desai, B. T. (1984). Comparative head trauma experiences in two socioeconomically different Chicago-area communities: a population study. Am J Epidemiol, 119(4), 570-580.

Naureckas, E. T., & Thomas, S. (2007). Are we closing the disparities gap? Small-area analysis of asthma in Chicago. Chest, 132(5 Suppl), 858S-865S

Barnes, L. L., de Leon, C. F., Lewis, T. T., Bienias, J. L., Wilson, R. S., & Evans, D. A. (2008). Perceived discrimination and mortality in a population-based study of older adults. Am J Public Health, 98(7), 1241-1247.

Hunt, B. R., Whitman, S., & Hurlbert, M. S. (2014). Increasing Black:White disparities in breast cancer mortality in the 50 largest cities in the United States. Cancer Epidemiol, 38(2), 118-123.

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