The Death Gap: How Inequality Kills

In the Preface, Ansell states that inequality significantly affects life expectancy in America, with early deaths concentrated in specific neighborhoods. He notes that the book presents inequality as a critical public health issue that must be treated and eradicated like a disease.

Ansell introduces Ogden Avenue in Chicago, which is used as a case study to illustrate the stark health disparities between two neighborhoods located on different sides of the street. Ogden Avenue was a trading road up to the 20th century, when it became a key Midwest connection to Route 66. The road crosses diverse areas, from affluent suburbs to economically-distressed communities. A 20-minute drive along Ogden Avenue reveals a near 20-year gap in life expectancy, which demonstrates how location impacts longevity.

Ansell states that working as a medical doctor for three decades along Ogden Avenue has exposed to him the correlation between neighborhood poverty and health outcomes. He exemplifies this correlation through the existence of Skid Row, a former transient hotel area, which was an epicenter for tuberculosis and AIDS in the 1980s, and The West Side ghetto, characterized by vacant lots, boarded-up businesses, and liquor stores, which also suffers a high mortality rate.

Ansell introduces the three hospitals along Ogden Avenue where he practiced his profession: Rush University Medical Center, John H. Stroger Jr. Hospital of Cook County, and Mount Sinai Hospital. Each institution provided a unique perspective on healthcare disparities. Rush, a well-funded academic hospital, offered top-tier medical services to those with the right insurance. Stroger, a public safety-net hospital, struggled to provide basic care to the uninsured. Sinai, a private safety-net hospital, faced chronic funding shortages, affecting its ability to offer comprehensive care. These hospitals, he argues, highlight the extremes of healthcare in America. While Rush has the resources to deliver world-class care, Stroger and Sinai are often overwhelmed, unable to provide essential services like joint replacements or timely eye care. This disparity is rooted in a healthcare system where resources are unevenly distributed, largely dependent on patients’ socioeconomic status and insurance coverage.

The Preface underscores how health inequality is not random but the result of systemic exploitation by those in power. Historical practices like racially- inflammatory blockbusting, discriminatory tax policies, and mass evictions have entrenched poverty and limited access to quality healthcare. The resulting structural violence has perpetuated multigenerational suffering and premature death in disadvantaged communities. Ansell will develop each of these points throughout the book.

Finally, Ansell states that the methodology of his book is rooted in the works of Friedrich Engels and Rudolf Virchow, who linked social conditions to health outcomes in the 19th century (See: Background). Engels equated poor working conditions with manslaughter, while Virchow argued that political solutions, not just medical interventions, were necessary to address health crises. In this spirit, Ansell’s book aims to provide accessible explanations of health disparities and to propose practical policy and community-building solutions to address them.

The Preface concludes with a call to understand and address the root causes of inequality to create a healthier and more equitable society.