In this episode of the Explaining History Podcast, we are joined by Dr David Ansell, Head of Health Equity at Rush University Medical Center in Chicago, to discuss his books *The Death Gap* and *Crossing the Gap* – and the scandal of life expectancies that differ by two decades across a single street.**
David has been a doctor in Chicago for fifty years. He spent seventeen years at Cook County Hospital, the city's public hospital, and another decade at a hospital in the neighbourhood where Martin Luther King came in 1966 to make the case that voting rights and lunch counters would not be the principal issues of the day – that the real friction would be over who gets what kind of jobs, where you get to live, and who gets access to wealth. David could see in his patients' bodies what he could see out of the windows: the correlation between neighbourhood conditions and life expectancy.
The Death Gap was written to point out the problem. Its first chapter is called "One Street, Two Worlds" – the fact that within a mile, you could have two worlds of daily life, and two worlds of health and healthcare. *Crossing the Gap* asks what happens if you try to solve it.
We explore the deep history of these ideas. Frederick Engels in 1848 described the health of the working class as "social murder." Virchow investigated a typhus outbreak in Silesia and concluded it was caused by a lack of democracy. Yet miasma theory dominated thinking into the twentieth century, and eugenics – biological determinism – took hold, partly because it was needed to justify colonialism and slavery. Sir Michael Marmot has been among the great advocates of social and structural causation, but that understanding has been systematically submerged.
The numbers are stark. US life expectancy began to diverge from Europe's in the 1980s, and by 2000 America had fallen off the curve entirely. The US ranks 38th in the world for overall life expectancy, but 60th for premature mortality – dying before 65. There are 948 cities and towns in the United States with at least a twelve-year life expectancy gap within their boundaries. The entire United States, David notes, is now equivalent in life expectancy terms to Blackpool.
We discuss the racialised history of American social policy – the fact that the Nuremberg laws were developed from studying US racial laws, that Social Security excluded Black people, farm workers and Mexicans, and that Franklin Roosevelt's proposed Second Bill of Rights, which would have established social and economic rights, was never passed. We also examine Angus Deaton and Anne Case's concept of "diseases of despair," and the way economic hollowing-out gets under the skin.
Finally, David describes the experiment he left his job as chief medical officer to pursue: what happens if you invest in a neighbourhood that has had capital extracted from it for generations? The answer, it turns out, begins with a basketball court.
Topics covered:
- Life expectancy gaps within single streets and cities
- Engels, Virchow, and the history of social causation
- Miasma theory, eugenics, and biological determinism
- The racialised foundations of American social policy
- FDR's Second Bill of Rights and the absence of economic rights
- Diseases of despair and the hollowing out of economic opportunity
- Medical debt and the morality of debt
- The neighbourhood experiment and the Wellness Village
- Preferential option for the poor, community voice, and accompaniment
---
Dr David Ansell's Crossing the Gap: Healing Epidemics and Inequalities in a Divided City is published by University of Chicago Press and is available now in print and on Audible. Please consider buying from an independent bookshop or directly from the publisher.
*If you enjoy the podcast, please consider supporting us – we are migrating from Patreon to Substack. Details in the show notes.*
","author_name":"Nick Shepley"}