While breast cancer survival rates have improved across the nation, Chicago is home to a recent and increasing racial disparity in mortality. Black and white breast cancer mortality rates diverged in the early 1990’s, and the gap has grown since.
The connection between place and health is at the core of this issue. Understanding and evaluating what fundamentally drives health disparities requires a lens into how race and ethnicity are tied to wealth and privilege, and how these patterns play out across Chicago’s 77 community areas...
In Chicago, place matters for health in important ways. Neighborhood conditions, such as the quality of public schools, housing conditions, access to medical care and health foods and levels of violence, powerfully predict who is healthy, who is sick, and who lives longer. Due to patterns of residential segregation, the differences across community areas are fundamental determinants of health inequities amongst different racial, ethnic and socioeconomic groups. The map below illustrates how these determinants vary across Chicago. To explore, select one or more disparity filters and the map will then rank communities from most to least disadvantaged.
These overall patterns illustrate how neighborhoods of concentrated poverty, which are predominantly African American and Latino, tend to trap residents in an ongoing cycle of poverty and health. Indeed, the disparity in breast cancer mortality is significantly higher in Chicago than other major American cities. Breast cancer mortality rates were fairly equivalent, these rates diverged in the 1990’s – while breast cancer mortality in black women did not decrease (it even increased slightly), the mortality rate in white women saw a sharp improvement – in this we see that the major advances in breast cancer diagnosis and treatment have not benefited black women in Chicago. This speaks to both patient and provider-side barriers that further drive this disparity.
The segregation seen above amongst Chicago’s communities is mirrored in allocation of health resources. The special distribution of hospitals is uneven across the city, with resources located far from areas of greatest need. Many residents lack access to a primary care provider or health insurance. Uninsurance is a major issue in low-income, low opportunity communities that impacts health seeking behaviors. Community areas with the highest breast cancer mortality rates are concentrated in the south, southwest and far south regions of Chicago. Mammography and cancer treatment resources are sparse in these areas. Instead, services tend to be concentrated in the north and west regions where mortality rates are lower.
In addition to the gap in availability of care, research has demonstrated that differential quality and frequency of mammography screenings are a major problem in Chicago. Black women receive fewer mammograms, receive mammograms of inferior quality, and have inadequate access to quality treatment once a cancer is diagnosed. Black women may be less likely to receive an optimal mammography sequence such as two mammograms in three years or three in five years. If black women are less likely than white women to receive adequately sequential mammograms, disparities might exist even if screening rates are equal.
Chicago’s disparities reflect social barriers that disproportionately affect African American women. Some barriers are related to poverty such as lack of a primary care physician, inadequate health insurance and poor access to health care. These hinder cancer prevention and control efforts, and some studies even argue they modify biological expression of disease. African American women often consider themselves to be at lower risk for developing breast cancer than do white women, a phenomenon that is reinforced by a demonstrated culture of silence surrounding breast cancer. This norm against discussing the disease inhibits dissemination of accurate information, and misinformation of recognizing symptoms, appropriate course of treatment and available resources would only further this trend. Culturally, mistrust of the health care system is common amongst many African Americans. This mistrust is rooted in the history of experimentation and abuse.
Chicago’s “health care deserts” tend to have poorer quality physicians and services, and fewer health resources. Even more, research has substantiated that interactions with the health care system problematize patient retention and care. Studies investigating this link are lacking, but several researchers have suggested that mistrust of a predominantly white health care system may affect interactions with medical providers and general satisfaction with care. Racial prejudice may also lead to differences in mammography referrals. Black patients more so than white are more likely to cite lack of referral as a reason for having undergone breast cancer screening. Studies have also demonstrated that physicians’ perceptions of patients are affected by race and socioeconomic status, which could translate to differential access and satisfaction with care.