A SECOND CITY

Here, in West Garfield Park, a community that has the same life expectancy as Iraq. Residents here live on average to 69, according to the most recent census, a full 16 years less than that of residents in the Loop just six miles to the east.

It’s a neighborhood that has been plundered for years by housing discrimination, segregation, and police violence. It is struggling with poverty, school closings, drug addiction, and shootings. Walk just a few minutes southwest of New Mount Pilgrim and you’ll come to what DNAinfo called the city’s “most dangerous block” in 2016.

In the last two years, only seven of the 48 funerals the church held were for people who lived to the age of 85—the average life expectancy of someone in the Loop. In the same period, it held 16 funerals for people under the age of 50 and a dozen for gun violence victims. In 2016, it held funerals for police shooting victims Quintonio LeGrier and church member Bettie Jones. The final funeral of 2016 was for a 33-year-old man who was killed by police just two blocks away from the church after he had shot his pregnant girlfriend in the stomach.

“Things are getting worse in Garfield Park,” Pastor Marshall Hatch said in an interview a few days earlier. “People are under a lot of stress. There’s a lot of desperation.”

By some accounts, Chicago is undergoing a golden age with higher life expectancies and historic employment highs. Thanks to a job boom in the Loop and its surrounding neighborhoods, private-sector employment grew 16.6 percent in the city in the last seven years. For the first time in half a century, the city is outpacing the suburbs in job growth. Chicago also had a record number of construction cranes last year and hit a five-year high for the number of construction permits issued, both measures of a thriving economy. For the second year in a row, Time Out recently named Chicago as the best city in the world when it comes to “happiness, culture, affordability, city pride, and how people feel about their neighborhood.”

But as the city racks up accolades, neighborhoods like West Garfield Park are being left behind, their residents dying at a far younger age than the national average. What will it take to bridge that gap and save lives?

While life expectancy has improved across the city in recent decades, the gap between poorer neighborhoods like West Garfield Park and richer areas like the Loop has persisted. When looked at by race, non-Hispanic blacks have the lowest life expectancy in the city, followed by non-Hispanic whites and Hispanics.

The expansive South Side dominates the city’s 35 worst communities for life expectancy, but the smaller West Side is home to some of the worst health outcomes in Chicago. West Garfield Park has the lowest life expectancy in Chicago, and four other West Side neighborhoods—East Garfield Park, Humboldt Park, Austin, and North Lawndale—all have life expectancies well below the average in Chicago (78 years), Illinois (79), and the United States as a whole (79).

Life expectancy is used as a kind of shorthand for the health of a population, because it wraps up critical problems into one measurement.

Despite all the talk about genes and biological factors, researchers say they only account for about 20 to 30 percent of a person’s health outcomes.

The rest is determined by a series of social and behavioral factors—which can, theoretically, be changed by individuals and the institutions that serve them. In other words, a person’s ZIP code matters more than their genetic code when it comes to health.

The connection between one's health and factors like income and neighborhood violence can easily be seen at the individual level. People who live in violent places may feel anxious and be reluctant to walk around their neighborhoods. The stress and lack of exercise can exacerbate health issues. In fact, “low-income children face a bewildering array of psychosocial and physical demands that place much pressure on their adaptive capacities and appear to be toxic to the developing brains,” according to a 2011 report published by Stanford University.

But not all social and behavioral factors contribute equally to a community’s health. Community safety and education, for instance, contribute more to the length and quality of a population's health than access to health care.

This means that even if a community has a hospital, people living there could still have a shorter lifespan if the neighborhood is low-income or violent. It is a paradox felt deeply on the West Side, which is home to one of the largest urban medical districts in the country. The Illinois Medical District has a 560-acre footprint and four large hospitals. Sitting in the wealthier Near West Side neighborhood, the IMD is a stone’s throw away from North Lawndale and East Garfield Park.

In an analysis by Sinai Urban Health Institute that will be released next month, North Lawndale was in the top 14 community areas in the city for access to clinical care, but in the bottom six communities for social and economic factors and the bottom 10 for both length of life and overall health outcomes. Similarly, though West Garfield Park ranked 52nd out of 77 for clinical care, it’s dead last in the city for both health outcomes and length of life.

“We can’t just treat our way out of [this problem],” says Julie Morita, the commissioner of the Chicago Department of Public Health. “Where you live makes a big difference in how long you can expect to live. And in order for us to really change that, we really have to focus on the social factors that impact health.”

The social and economic factors that created the death gap on the West Side did not develop overnight. The area was once home to a manufacturing hub that provided jobs to residents and economic stability. But many of these companies left in the wake of the 1968 riots following Martin Luther King Jr.’s assassination.

At the same time, decades of racist federal policies contributed to the area’s decline. The Federal Housing Authority refused to insure mortgages in African-American neighborhoods, preventing a whole population from buying homes and building equity. The federal government also subsidized builders to mass-produce homes in the suburbs on the condition that only whites could live there. The result was devastating poverty and violence.

“If you look at when crime started going up, it’s when factories started leaving,” says Dan Cooper, the executive director of the Center for Equitable Cities at Adler University. “When you have higher poverty and people can't afford to own homes, you have more crime and disorder.”

In a red cinderblock office building on a stretch of Harrison that’s dense with nonprofits and churches, Darnell Shields leafs through a pile of community planning documents on a plastic table painted to look like marble. As the executive director of Austin Coming Together, he is in charge of coordinating the work of 68 local organizations, churches, and businesses to improve education, safety, and economic development in the far West Side neighborhood. Austin is the largest community area in Chicago by geography and sits next to West Garfield Park.

It is the day before Thanksgiving and the office is empty save for Shields and one other employee. Shields is dressed casually in jeans, sneakers, and a grey thermal tee. A lifelong resident of the Austin neighborhood, he is intimately familiar with the challenges that are contributing to the death gap on the West Side.

“I look at Austin as a true victim,” says Shields.

As a child, his father moved his family from south Austin to north Austin to flee a wave of violence that hit the area in the late 1970s as factories closed and drugs came in. But within a decade that wave had made its way north and transformed his neighborhood from a family-friendly area to one challenged by gang strife.

With that change came corruption and the feeling that the city government was abandoning the neighborhood, Shields says. The case of the Austin 7 in the ’90s only reinforced this sentiment, when a group of police officers assigned to investigate drugs and gangs on the West Side were convicted of racketeering and providing protection for narcotics dealers.

“There’s been so much disadvantage in this community. I want people to recognize that, because that’s real. That’s our history,” Shields says. “However, along with that, I want people to recognize how resilient this community is.”

That resilience is apparent in the work Shields has done over the last nine years as a community organizer. At ACT, he is helping residents develop a comprehensive “quality of life” plan to improve the well being of Austin residents by 2025, targeting improvements in elementary education, decreasing the poverty level for families with young children, stabilizing housing values, and decreasing the violent crime rate. ACT has been working with the nonprofit Local Initiatives Support Corporation, or LISC, since 2016 to create the neighborhood’s first such plan and expects to complete it later this year. LISC has helped 18 neighborhoods create similar plans, which have leveraged over $872 million in real estate and program investments.

The ambitious plan is a direct response to people and institutions outside of Austin pitting local leaders against each other in recent years, “forcing them to compete with one another for scarce resources and influence,” according to a quarterly community report published by ACT and Austin Weekly News. This competition has led to “the loss of job opportunities from our family members, the closing of our children’s schools, the theft of properties from our neighbors, and loss of public subsidies to help our most vulnerable community members.” According to the report, the new plan counters this competition by harnessing the “collective power” of the neighborhood and focusing efforts on narrow goals.

Shields says he has seen some positive efforts on the West Side to address issues like job development and low-income housing. Last year, for example, his organization partnered with Chicago Public Schools, Manufacturing Renaissance, and the Jane Addams Resource Corporation to launch an advanced manufacturing training center in an Austin high school. Since training began last February, that program has served 26 trainees and placed seven trainees into employment earning an average wage of $14.62 per hour. But he says that the rising gun violence in recent years has been a major obstacle to change.

“Whether you’re looking to progress education or economic development on the West Side, violent crime is an impediment. No matter what we put our resources in, if we don’t address this feeling of safety, this sense of safety that folks need to have, we’re not going to really be able to maximize what we do,” Shields says. ACT is working to address the problem of violence by coordinating efforts to bring about more spaces where residents can access support services and build more trusting relationships with service providers, he adds.

A mile to the northeast, in her office at the Academy for Scholastic Achievement, Vanessa Ford agrees that the area faces an uphill battle despite its strong nonprofit community. She serves as the director of development at the alternative school that teaches high-risk youth between the ages of 16 and 21.

“There’s a lot of groups on the West Side who’ve been at this a long time and who are making change,” she says. “But they make change in individual lives, like in the kids that we get to actually go on and get a high school diploma and create a life for themselves. That’s a tremendous change, but it’s small.”

ASA graduates 75 percent of its senior class every year and most of its graduates go on to two- or four-year colleges. But the four-decade-old school has seen a drop in enrollment in recent years as violence and the poor economy have driven people out of the West Side. Austin alone shrunk by over 20,000 people between 2000 and 2015, according to a Chicago Tribune analysis, knocking it from its 40-plus-year reign as the city’s most populous neighborhood.

The change has been difficult to watch. Ford’s husband grew up on the West Side and the couple bought an old house in East Garfield Park because “he’s always wanted to stay here and be a part of the change, the redevelopment of it, the regrowth of it.” But it has been a “painfully slow recovery,” she says.

Ford says that she’d like to see redevelopment in the area and for the schools to get better—she didn’t send her children to schools on the West Side because of her concerns about the quality of the education they’d get. But she sees the coordination of financial resources as the biggest obstacle to large-scale changes on the West Side. As a grant writer for the last 15 years, she says that resources that are supposed to help her neighborhood often bypass longstanding local organizations like ASA.

“It seems like all the money goes to the big nonprofits that aren’t necessarily tied in with the grassroots,” she says. This includes money from the nearby hospitals in the medical district, which she says “has a huge footprint over here. They have huge resources that sometimes you feel trickle down to the neighborhood level and sometimes they don’t. You always feel like the big ones can do a better job [than what they’re doing now].”

From his office building at the Rush University Medical Center campus on the Near West Side, Dr. David Ansell can see the nearby Blue Line station. Every few minutes a train slides past on its way from downtown’s vibrant skyscrapers to West Garfield Park, three miles to the east.

“The last time in the United States history when life expectancy was 69 was 1950,” Ansell says. “In seven train stops, you go back seven decades.”

A physician and social epidemiologist by training, Ansell has seen this inequity firsthand during his four-decade-long career on the West Side, working at three hospitals along Ogden Avenue: Cook County, Mount Sinai, and Rush. He now serves as Rush’s senior vice president for health equity. Last year, he came out with his second book on health inequity called The Death Gap: How Inequality Kills.

“I used to think that if people like me just showed up, that would be enough,” Ansell says. “And that’s not enough. We have to somehow link arms together to improve the lives of those who are disadvantaged.”

In July 2016, Ansell presented the problem of the life expectancy gap to Rush’s board. The room went silent.

“Rush had realized that it had been doing all of these community engagement programs for over 25 years, but we weren’t really moving the needle on life expectancy on the West Side,” explains Darlene Hightower, associate vice president of community engagement and practice at Rush. A new approach was needed.

That day, the health system decided to change its mission from being the best in patient care to improving health. In what appears to be a first for a health system in the United States, Rush said that that it must address “the complex social, economic, and structural determinants of health” including “structural racism, economic depravation, substandard housing, violence, and a failing school system.”

Ansell put together a team and they developed a twofold plan. First, Rush would adopt an “anchor mission,” intentionally investing, hiring, purchasing, and volunteering in the most disadvantaged neighborhoods on the West Side. Next, Ansell’s team would bring together West Side residents, community groups, and other health systems to help coordinate strategies to address the root causes of health inequities on the West Side.

The proposed West Side Total Health Collaborative would connect money—from the hospitals, foundations, and the city—to grassroots organizations doing impactful work and create pathways for careers in health care for residents on the West Side.

“Our job as doctors is to heal and prevent suffering,” says Ansell. “In this situation, the healing needs to be aimed at neighborhoods.”

While most anchor institution strategies around the country have focused on one issue, employment or housing for example, the West Side Total Health Collaborative has a wide scope and an impressive goal: To improve life expectancy across region and halve the 16-year life expectancy gap between West Garfield Park and the Loop by 2030.

According to David Zuckerman, a manager for health care engagement at the Democracy Collaborative and organizer of the Healthcare Anchor Network, it is “the most ambitious collective strategy around anchor work” he’s seen to redirect money into a particular region.

In late 2016, Rush sent invitations out to community leaders across the West Side to attend a meeting about the proposed West Side Total Health Collaborative and how hospitals might work together with local organizations to address the life expectancy gap. Close to 50 organizations gathered at Malcolm X College on the Near West Side for that first meeting on January 10, 2017.

It would mark the beginning of a year full of intense research and planning, upending business practices at West Side hospitals, and pushing community leaders to imagine new ways to address the long-term challenges that are driving the life expectancy gap.

On a rainy Monday late last October, a group of hospital administrators piles into a van for a tour of the West Side. These representatives of the West Side Anchor Committee are working with Ansell to redirect their health networks’ resources to the West Side, an area where many of their patients are from but which most on the tour are unfamiliar with.

“We’ve been doing our own thing and nothing’s changed,” explains Mary Kate Daly, the executive director at Lurie Children’s Healthy Communities initiative. “So it’s time to try something different.”

As the van meanders through the West Side, they stop occasionally so that their ad hoc tour guide can explain the importance of the location. The soul food at MacArthur’s. The sparkling gym at the Lawndale Christian Health Center. The busy stretch of 26th street in Little Village, which is the second-highest grossing retail area in the city. The giant parks. The young men standing on corners. The boarded-up houses.

“You’ll have something beautiful like that and then these open lots,” says Rush’s Hightower as they pass a yellow brick Queen Anne. “That gets to something we were talking about at the last meeting: How do you change the neighborhood for the better without the original people being forced out?”

The bus stops at the Garfield Park Conservatory and people gets out to stretch their legs and take in the emerald ferns and tropical flowers. Only a few of the tour participants had been to the century-old greenhouse before and none had come recently, despite being a short 10-minute drive west of the Illinois Medical District.

Back on the bus later, the hospital administrators mull over everything they’d seen so far.

“Taking this tour just reinforces how big the area is we’re talking about,” says Hightower. “These neighborhoods are so different. So the collaborative needs to recognize that and at the same time thread it all together.”

It is a big challenge for the organization, which needs to build bridges between the communities and the hospitals and even between the members of the anchor committee in order to succeed. As competitors, the nine health care institutions—Rush, Rush Oak Park, Mount Sinai, Cook County Health Systems, UI Health, Presence, Loretto, Lurie Children’s, and the Illinois Medical District—are not used to working together toward shared goals.

Now they must collaborate to streamline their hiring processes and coordinate their investing, purchasing, and volunteer efforts on the West Side. If they were one business, the anchor committee would be the biggest corporation in the state, with 47,800 employees, 6,000 new hires a year, and nearly $3 billion in purchasing ability.

Similarly, grassroots organizations working on the West Side for, in some cases, decades are not used to sitting at the same table as hospitals, even if they share a neighborhood. Rush was founded the same year as the city of Chicago and has been on the West Side for 150 years. But few were used to seeing the hospital engage with its neighbors in this way.

“Honestly, I didn’t really associate Rush with the West Side,” says ACT’s Shields. “I hadn’t seen any evidence of programming here on the ground. If it did exist, I didn’t know about it.”

Still, both Shields and Ford were intrigued enough to apply for and be accepted to the group’s planning committee.

“When you look at large institutions who want to leverage their resources and invest and address these issues, there’s usually not enough engagement with residents,” says Shields, who says he wants to voice the concerns of Austin residents with the committee. “[The collaborative has] convened a diverse representation of stakeholders that impact West Side communities in different ways. I think that’s unique.”

Even with the best intentions, building trust has been a challenge in an area used to being treated as the city’s stepchild. And while redlining and other forms of legalized racism are now in the past, the South and West Sides continue to suffer from disinvestment. A 2016 report in the Iowa Law Review found that white wards received “more than twice as many TIF dollars as black and Hispanic wards,” money intended for redevelopment and job creation in poor neighborhoods.

“Our country was built on legalized racism and other historical inequities including policies toward the poor that have persisted de facto into the present,” says Ansell. “The government has contributed [to these life expectancy gaps]. On the other hand, so have the institutions, and that’s why we’re putting skin in the game first.”

Christmas Eve service at New Mount Pilgrim Baptist Church has ended, and the pastor’s son, Marshall Hatch Jr., descends the stairs to the Fellowship Hall below the church’s sanctuary. On one side of the hall, people are packing toys for a trip to the homeless shelter that afternoon. On the other, large photos of young men who recently graduated from the church’s anti-violence residential program that Hatch Jr. runs grace the walls. During the week, the church runs a soup kitchen, has emergency clothing, and runs a gym where young men from the neighborhood come and play basketball.

“You won’t be able to solve these problems in your lifetime, because these problems were created over generations,” says Hatch Jr. “But what you can do is pour into another person. They may be the next mayor of Chicago, the next president of the United States, you never know. But you have to act as if that is the case.”

New Mount Pilgrim Baptist Church is the largest church in West Garfield Park and over half of its parishioners are from the neighborhood, making the church a big, if not the biggest, player in the area. While Pastor Hatch declined to apply for a spot on the planning committee last winter because of time constraints, he says he expected Rush and the collaborative to contact the church again during the planning process. That never happened.

“To not be a part of those conversations I think is a mistake because you’re not hearing voices from the community,” says his son. “Any solution that is not grassroots is myopic and ineffective at best. At worst, it’s buying time for the gentrifiers.”

Hatch Jr. doesn’t deny that resources are important, and he agrees that government and major institutions should do more to help tackle the major public health issues in his community. He runs the church’s Maafa Redemption Project, a residential job training program for young African-American men which is supported by Arne Duncan’s Chicago CRED and which avows to be “transforming West Garfield Park one life at a time.” (Maafa means “the great disaster” in Kiswahili and refers to the transatlantic slave trade.)

But he says that the collaborative’s focus on life expectancy gap doesn’t tell the complete story of the people who live in neighborhoods like his.

“The stats say hopelessness. The stories say resilience,” Hatch Jr. says. “It’s the strength, the willingness to endure, and to not allow your surroundings to have you despair. We’re surrounded by violence, but we’re not violent people.”

He’d like to see a broadening of the conversation about the life expectancy problem to include the legacy of slavery and racist housing policies that underpins the crisis that African-Americans on the West Side face today.

Similarly, Adler’s Cooper believes a true solution will require serious government intervention.

“The amount of resources that are needed to help attract jobs, or to invest in infrastructure and housing, is much beyond the scope of philanthropy,” Cooper explains. Instead, he argues that the best hope for improving health and safety on the West Side is major criminal justice reforms, which would redirect funds from the Illinois Department of Corrections $1.6 billion dollar budget to communities.

A similar argument has been made in recent months by organizers protesting the creation of a $95 million police training facility in West Garfield Park. While the city argues that the training center is necessary and will bring economic development to the neighborhood, critics say that money would be much better spent investing in education and health.

Morita, Chicago’s top public health official, says that the city has taken the challenge of the social determinants of health seriously. But she says, “these are not things that the government alone is responsible for addressing … local investing, local hiring. Those kinds of things will make a difference in those communities and will ultimately improve the health and well being of the people who live in them.”

This week, the collaborative will hold a public meeting to announce the details of their own plan. According to Ansell, these include making new impact investments on the West Side, like new small business grants, and developing new mental health programming and high school-to-career programming in the health care industry. The nine health care institutions that are part of the collaborative will be working with social services agencies to address issues like food scarcity and housing and will also commit to hiring and purchasing more from West Side neighborhoods.

Will it be enough to reduce the life expectancy gap on the West Side?

ASA’s Ford says that the geographical mix of people from large and small-scale organizations involved in the collaborative so far has created a comprehensive view of the problem. Yet, she is not Pollyannaish about the task ahead.

“I’m not naïve enough to think that everything is going to be wonderful and everybody’s gonna be happy,” she says. “But I think we can do a better job. God knows we can do a better job than what’s happening now on the West Side.”

West Side leaders like Shields will be watching the collaborative closely in the coming years as it works toward its bold goals of revitalization. In the meantime, one thing is clear, says Hatch Jr.

“All of us have a moral responsibility, as human beings, as Chicagoans, to invest in these native sons and daughters. These are Chicagoans, too. Not just a third world community.”

This report was supported by a fellowship from the Dart Center for Journalism and Trauma at Columbia Journalism School.