I cringed when my colleague said, "Why don't they just move to a better neighborhood?" Passing the time in the preoperative holding area, we discussed the violent protests and the damage done to Chicago neighborhoods. He was white, male, and privileged. I am Black, male, and also privileged. Yet, we had opposing views on the root causes of the violence.
Note two maps of Chicago: One, from the Chicago Tribune Crime Team, tracks . The red dots represent firearm homicides and are concentrated in majority-Black communities.
The other map, from the Chicago Department of Public Health, shows the COVID-19 deaths among Chicago residents as of May 12. The purple dots dominating the map represent confirmed by laboratory testing. Again, the deaths are concentrated in neighborhoods that are majority-Black.
As a trauma surgeon, I have operated on countless victims of gun violence, most of whom were Black. As an intensive care specialist also treating COVID patients, I see firsthand the deadly convergence of these two public health crises. However, an under-recognized third crisis contributes to both disparities.
These maps seem to indicate that one's zip code, a proxy for race and poverty in many places, affects one's life expectancy in two seemingly unrelated factors -- gun violence and a viral pandemic. Although Black Americans make up 30% of Chicago's population, we constitute 75% of the firearm homicides and 70% of the COVID-19 deaths. The maps make it seem as if Black people are choosing to live in unhealthy, violent neighborhoods. Why would this be so? Simply put, it is not.
Policies intended to restrict Black people in racially segregated communities have proved resilient long after the legacy of enslavement and Jim Crow laws. One ruthlessly effective weapon was the National Housing Act (NHA) of 1934.
The NHA encompassed federal, state, and local laws that mandated racial segregation in housing. After the Great Depression, part of the New Deal was for the federal government to guarantee loans to build and purchase homes. Maps used by mortgage lenders were "redlined" to designate Black communities, with residents unable to get loans to buy homes in "white" neighborhoods.
Consequently, property values in redlined neighborhoods stagnated or fell, disincentivizing realtors to show contractors to invest, and businesses to upgrade. Also, redlined neighborhoods were often intentionally located near industrial areas, landfills, and toxic waste, further encouraging societal divestment, which persists today in education, employment, crime -- and health.
The Fair Housing Act of 1968, prohibiting discrimination in the financing, selling, or leasing of homes, was meant to remedy this long-standing inequity, to questionable success. Today, 75% of formerly redlined neighborhoods remain socioeconomically impoverished and populated by racial minorities, while 91% of the communities identified as "best" have majority white populations.
The narrative that eradicating barriers is the answer to reverse inequality is false. That strategy is necessary but not sufficient. This is especially true when the primary means of intergenerational wealth transfer for lower-middle and middle-class people is homeownership.
And now it has become clear that wealth equals health. Wealthier zip codes have less crime, less unemployment, better schools, and substantially longer life expectancies. Decades of commercial divestment in Black communities has led to intergenerational inequities in employment and income. Disenfranchised and economically deprived, Black people can no more easily move to a better neighborhood in 2020 than in 1934 when housing segregation was legalized or in 1968 when it was outlawed.
We can no longer ignore the systemic inequities born of redlining, now so clearly demonstrated as a threat to public health. As tens of thousands of Americans die and exponentially more are infected, it is not a choice of focusing on the plight of Black Americans at the exclusion of everyone else.
To do so, we must first acknowledge the deadly public health effects of systemic inequality rooted in the legalized racial segregation of Black communities. Second, we must deconstruct de facto barriers intended to exclude Black Americans from mainstream society. Third, we must implement and enforce policies that are designed to include historically marginalized populations.
Racial segregation persists not just by intent but by inaction. Many of the essential workers, upon whom we depend, live in these formerly red-lined neighborhoods and need medical care, have seen family income lost, and can no longer fully participate in the economy.
We are indeed in this together, so let us emerge from this pandemic with a more just society where everyone has the opportunity to be safe and healthy within their communities.
, is an associate professor of trauma and acute care surgery .