Chicago is the medical capital of the United States. We are headquarters for the American Medical Association and the American Hospital Association as well as many allied professional associations. We have more large medical complexes than any other American city. Our great universities are centers of medical research and development. Spread throughout our neighborhoods are more than 70 hospitals.
Chicago is not the health capital of the United States. We have a substantial number of elderly and low-income citizens in poor health. And we have a tragically high infant mortality rate.
It would seem logical to suggest that Chicago has a great opportunity to improve the health of its people by creating a better match between the proliferation of medical resources and the health problems of its less fortunate citizens. Although this effort ought to be pursued, there is a much more effective approach to Chicago`s health–one that links our health to economic development.
Those in poorest health are the poorest people. They experience more disease, injuries, accidents and infant mortality. For several decades, epidemiological research has demonstrated that poverty induces this poor health because, beyond a point, more medical care cannot overcome the effects of poverty. Beyond that point, the only ”cure” for poor health is a bigger income. Much of the poor health in Chicago is beyond the reach of medicine, but it is very treatable by changing the economic condition of poorer Chicagoans.
Here is where the medical and health system can play an important new role in Chicago`s health future. We spend more than $4.5 billion on medicine and health each year; it is our second-largest industry–a huge stream of dollars flowing through the city. Our greatest health opportunity is to make sure we capture as many of those dollars as possible, and that as many of them as possible provide jobs and economic opportunity in our poorest neighborhoods to cure the low income that sickens so many citizens.
There are three important ways to make sure we capture those medical dollars.
First, we need to make sure that jobs generated by health and medical spending are kept in Chicago and are particularly available to lower-income people. Our medical schools, hospitals and burgeoning home health care systems are major employers of people of all skill levels. Many are in or near neighborhoods where people are badly in need of work. We should develop a common agreement among personnel leaders in the health field that an effort will be made to employ neighborhood people first.
Second, we should be sure that health and medical spending is helping create as many new neighborhood businesses as possible, and that existing local businesses have special opportunities to produce these goods and services. Just as we emphasize neighborhood jobs, we should seek a common agreement among purchasing agents that Chicago business and local neighborhood enterprise should be the first source for health-care supplies and services.
To fulfill both these goals, the mayor and governor could appoint a joint task force on ”Capturing Chicago`s Health Dollars.” This group would represent such interests as the medical professions, hospitals, medical suppliers, health insurers, nursing homes, government, civic and neighborhood organizations. The group`s job would be to capture economic benefit from health and medicine expenditures by directing this dollar power to jobs and economic development opportunities for the poor. In achieving their goal, task force members would improve the health of Chicago`s people much more than is possible through providing more medical care.
The third approach to improved health has to do with prevention. We spend more than $900 million in Cook County each year for the medical care of poor people. Yet almot none of this money goes to preventing the community causes of ill health. Therefore, we can`t really improve health because our dollar power is captured by therapy to repair the illnesses of poverty.
An alternative would be to set aside a proportion of Medicaid dollars for community prevention. Only 5 percent would amount to $45 million. This money could then be used to contract with community groups to set up new health enterprises that would employ low-income people and tackle the causes of ill health in the neighborhoods. Examples could include dealing with local traffic hazards, repairing stairways, boarding up abandoned buildings, mounting local anticrime efforts, etc.
As any doctor who has served in inner-city clinics or emergency rooms knows, it is these environmental problems that are the most frequent causes of ill health. What better way to deal with the causes of ill health than by creating neighborhood jobs that provide decent incomes for local people rather than more expenditures for medical growth?
Through these three initiatives, Chicago has the opportunity to increase local economic activity, provide new jobs for poor people and improve their health.
