The Death Gap: How Inequality Kills

In The Death Gap, “biological weathering” describes the cumulative physical toll that chronic stress and adverse social conditions take on the bodies of marginalized individuals. Ansell explores how persistent exposure to racism, poverty, and discrimination can lead to accelerated aging and a higher incidence of chronic diseases among these populations.

Cabrini-Green Homes were part of a public housing project instituted during the middle of the 20th century in Chicago. The complex housed up to 15,000 people. By 2011, all these structures were demolished. The complex was known for the poverty of its residents. Ansell discusses how the notorious living conditions and lack of resources in Cabrini-Green contributed to the residents’ poor health outcomes. The demolition of these homes and the displacement of their residents further exacerbated health inequities, underscoring the broader societal neglect and systemic racism that fuel the death gap in urban America.

The city of Flint, Michigan, where a majority of Black residents live, was forced to switch its water supply from the Detroit system to the Flint River in 2014, to save money. The water of the river was improperly treated, contaminated with lead and other toxic chemicals, and led to the poisoning of thousands of residents. Ansell argues that the Flint Water Crisis exemplifies the devastating consequences of environmental racism and governmental neglect on public health. Ansell explores how the decision to switch Flint’s water supply, motivated by cost-cutting, led to widespread lead contamination, disproportionately affecting the city’s predominantly African American population.

In The Death Gap, implicit bias is the unconscious yet pervasive influence that affects medical professionals’ decisions, leading to unequal treatment of patients based on race. Ansell discusses how these biases contribute to significant health disparities, as healthcare providers may unknowingly offer lower-quality care or misdiagnose conditions in marginalized populations.

“Jim Crow” denotes a historical and systemic framework of racial segregation and discrimination that has had lasting impacts on the health and well-being of African Americans. Jim Crow laws were a set of local and state laws that reinforced racial segregation in public places in the Southern states of the US from 1896 until their complete overturn in 1965. Ansell discusses how the policies and social norms established during the Jim Crow era created profound health disparities by limiting access to quality healthcare, education, and economic opportunities for Black communities.

“Precision medicine” aims to tailor treatment according to each person’s individual needs. However, it has been used specifically to treat patients according to genetic profiling—an approach that Ansell critiques as overlooking the broader social determinants of health. Ansell argues that the focus on individualized care can inadvertently exacerbate health disparities by failing to address systemic issues like poverty, access to care, and environmental factors that predominantly affect marginalized communities.