Rush University System for Health is staking millions in a groundbreaking and long-term commitment to improve community living conditions to advance health outcomes. This strategy, to address the social and structural determinants of poor health in addition to the provision of excellent health care, aims to reverse the harmful health impact of structural racism and economic deprivation on life expectancy.
This health equity strategy, still in its early years, helped inform Chicago’s approach to the Covid 19 pandemic and recently prompted Oprah to videotape a ‘thank you’ shout-out and the British National Health Service to ask Rush leaders to advise them on their plans to create an integrated care system in Great Britain.
It’s a strategy that is rooted in partnering with community, sharing decisions about planning and resource distribution in a bidirectional manner and bringing community expertise into Rush’s hospitals and university to guide the training of health professionals in community engagement.
The newly established Rush BMO Institute for Health Equity, reporting into David Ansell, MD, MPH, senior vice president for community health equity, and Susan Freeman, MD, MS, provost, Rush University, senior leaders with decades of experience in population health, will facilitate the implementation of the strategy in partnership with health care, university and community leaders
At the core of the strategy is how an “anchor institution” such as Rush University System for Health leverages its business assets — how it hires, invests, purchases, boosts local entrepreneurs’ work, helps ensure safe housing and high-quality education, and trains neighborhood people for good-paying careers to build individual and community wealth.
It’s rooted in a philosophy of health outcomes: That the diseases and chronic conditions of West Side residents — or those of any distressed community’s members — stem from social, economic and environmental factors — structural racism, concentrated economic disadvantage — rather than genetics or unwise personal choices.
So Rush’s health equity goal is, in the next nine years, to halve the lifespan gap between people who live in Chicago’s predominantly white and highly resourced Loop, with an average life span of 82 years, and those who live in Garfield Park on the West Side, whose lifespan stops at 69. That lifespan gap unfolds in in just seven stops on the CTA’s Blue Line.
Since Rush launched its Anchor Mission in 2017, its accomplishments underscore the commitment to long-term change. It has:
- Loaned $6 million in impact investment loans to financial institutions that then help fund social impact improvement projects on the West Side;
- Hired 1,200 employees from the West Side in jobs with a $30-an-hour average wage;
- Spent $25 million to do business with vendors on the West Side;
Lived Experiences Shape Social Justice Mission
Among the key senior leaders for this anchor initiative is Darlene Hightower, a former civil rights lawyer and native South Sider whose Kenwood Academy summer institute experience changed her life’s trajectory. Hightower is among a team of hundreds of talented staff, students, faculty, administrators and board members across Rush University System for Health — from Chicago to Oak Park and Aurora — who are working to improve community health outcomes.
Hightower, Rush’s vice president for community health equity, grew up in the far Southwest Side Brainerd neighborhood and in Hyde Park on the South Side.
She realized how powerful a high-quality educational program could be when she attended a Kenwood Academy high-school-level class while she was still in middle school.
“I got to be around other really smart kids, and we were encouraged to be at our very best,” Hightower said. “We were encouraged to believe that we’d be amazing. And now we’re judges, lawyers, doctors. One of the alums is COO (chief operating officer) for Beyonce’s entertainment company.”
“I knew deeply that a good educational program could lead to a trajectory in a young person’s life,” she said. “Being around a group of kids, Black and Brown, who came from all over the city – and who were expected to excel. We just grew together.”
In law school at Georgetown University, Hightower worked for the Poverty Law Legal Journal and with the Black Law Students’ Association. She spent a decade working in civil rights law and, all the while, volunteered for causes and interests that she supported. She’s served on the boards of the Chicago Foundation for Women, Girls in the Game, Planned Parenthood and the Art Institute of Chicago’s Evening Board. She also has served on the Commission for U.S. Civil Rights.
Ansell and Hightower met when Hightower applied for a position with the Metropolitan Chicago Breast Cancer Task Force (now Equal Hope), which sits on the Rush campus.
Ansell said he knew that Hightower was the perfect partner in the mortality-gap fight.
“We wanted to do something really big, and it needed a credible leader — someone who had an entirely different lens on the world,” Ansell said.
Mortality-Gap Successes Paved the Way
Rush has a long history of community programs, but only a few initiatives were able to “move the needle” on health outcomes. These initiatives showed that there could be, as detailed in the New England Journal of Medicine paper Health Equity as a System Strategy: The Rush University Medical Center Framework, “a significant impact on racial health inequities by addressing social and structural determinants of health, along with healthcare interventions.”
Ansell played a key role in creating a task force to reduce the mortality gap in breast cancer outcomes between Black and white Chicagoans.
That task force became a not-for-profit organization in 2008 and was renamed Equal Hope in 2019. It offers uninsured women free access to a primary care doctor and to breast and cervical cancer screening tests, as well as to follow-up care when necessary (equalhope.org or 312-942-3368).
In Chicago, the difference in the rate at which Black women die of breast cancer compared with white women decreased to a 32 percent death gap from a 62 percent gap between 2007 and 2018, the latest data available.
Breast cancer mortality rates for Black women decreased more (by 14.2 percent) compared to white women (7.1 percent) in that period, pushing the overall disparity in mortality rates for Chicago women below the U.S. average, according to Equal Hope’s most recent data analysis.
Another example of citywide coordination came with the Ruth M. Rothstein CORE Center, started 23 years ago in a partnership between Cook County Health and Rush University Medical Center. It’s one of the largest HIV/AIDS clinics in the nation, specializing in prevention, care and research of HIV/AIDS and other infectious diseases
“It didn’t focus only on medical needs, but on social conditions and housing, legal, benefits and other issues that could have a big impact on HIV mortality,” Ansell said.
The third influential program was the 2013 to 2019 Building Healthier Urban Communities initiative, funded by a $5 million grant from BMO Financial Group and led by then Rush CEO Larry J. Goodman, MD, and Rush University health care economist Tricia Johnson, PhD. This effort paired Rush with the Medical Home Network, a group that was enrolling the newly insured under Obamacare, and Malcolm X City College, a health science-focused city college that trained young people from Chicago neighborhoods in healthcare fields. This partnership created a pipeline of health professionals from the community to Malcolm X to Rush University and created new healthcare workforce training programs leveraging the strengths of city colleges and Rush University.
These three efforts and the many community-based practices supported by Rush University, gave Rush the insight that achieving big advances in health outcomes would require complex and trusting partnerships beyond the boundaries of the Medical Center campus.
But it was the Rush 2016 Community Health Needs Assessment, required by the Affordable Care Act and led by Rush University faculty and staff, and the Center for Community Health Equity jointly sponsored by Rush and DePaul University, that surfaced the high mortality rates just a few miles from the West Side hospital campus. The life expectancy gaps provided the impetus for the Rush Board of Trustees in June 2016 to endorse a leadership plan for the new community health equity strategy. This plan called for Rush to be a catalyst for measurable improvements in community health outcomes. This led to the launch of the Anchor Mission at Rush and ultimately the creation of West Side United in 2018 and the Rush BMO Institute for Health Equity in 2021.
Rush University System for Health Drives West Side United’s Efforts to Transform Communities and Boost Long-Needed Investments
In two new initiatives, Rush and West Side United were selected to convene the West Side Healthy Chicago Equity Zone — one of six such zones throughout Chicago — and Rush was selected to lead Connect Chicago, Chicago’s Covid 19 testing and health care referral center on the city’s southwest side.
The core anchor mission remains: Help build wealth through impact investing, creating more jobs, advancing healthcare careers and purchasing from West Side vendors. As Rush’s leaders assessed the coverage area that’s been, as Ansell put it, at the center of structural racism and economic deprivation, they focused on 10 West Side neighborhoods with a combined population of 550,000 — larger than cities such as Miami and Cleveland.
“We realized we couldn’t do it alone, so community partnership became key to the strategy,” Ansell said. “That meant empowering residents, local government, other hospitals and community-based organizations to join us and sharing in decision making.”
Conceived and incubated by Rush, West Side United was launched in 2018. It now includes, besides Rush, safety-net providers such as Mount Sinai Hospital, The Loretto Hospital and Humboldt Park Hospital, as well as AMITA Health, Cook County Health, Lurie Children’s Hospital, St. Anthony’s Hospital and UI Health, the latter the University of Illinois-Chicago’s academic healthcare system.
The group conducted two rounds of “listening tours” where 1,500 local residents voiced their concerns.
“We asked people to be leaders with us,” Hightower said. “We formed a planning committee and asked people to nominate themselves. We got 150 applications for eight seats.
“At the end of the second round of the listening tour, we asked people to be on a community advisory council for West Side United, and we got over 100 applications for an 18-seat council,” she said. The council comprises 80 percent West Side residents and 20 percent people who work on the West Side.
“The community wants good paying jobs, support for businesses, safe places to walk, and to create a place where their children weren’t feeling hopeless,” she said. “They want quality schools, safe neighborhoods and good jobs — all foundational principles of healthy communities.”
Rush’s efforts are part of the Healthcare Anchor Network, a growing list of more than 50 hospitals and health systems committed to the anchor philosophy of using their business assets to strengthen local economies and thus the health of the people who live near those hospitals.
David Zuckerman, the network’s executive director, calls Rush “a national leader in the anchor mission movement, helping to build out the field by showing other hospitals that the goals of local inclusive hiring, procurement and place-based investing are achievable.”
“[Rush was] one of the 10 Healthcare Anchor Network founding health systems that recognized the need for this conversation to be happening nationally,” Zuckerman said. “Rush led by example, illustrating that adopting an anchor mission commitment is consistent with the values of organizations whose mission is to heal. Rush literally created an Anchor Mission Playbook, which has been followed by hospitals on their anchor mission journeys.
“While countless healthcare leaders and policy makers have acknowledged that socio-economic factors often directly determine one’s health more than biology or behavior,” Zuckerman said, “Rush focused on the solutions and committed itself to making the long-term investments that heal neighborhoods.”
As noted, these long-term neighborhood healing efforts will be accelerated and coordinated through the new Rush BMO Institute for Health Equity. A $5M donation from BMO Financial Group in 2013 helped Rush catalyze efforts to build healthier communities, and a $10M donation in May 2021 will provide the funding and coordination so Rush’s equity efforts have more impact.
“To truly have an inclusive society with health and economic opportunities for all, we need to remove barriers to health, and that’s exactly what the Rush BMO Institute for Health Equity will do,” said David Casper, U.S. CEO, BMO Financial Group. “At BMO, our purpose is to boldly grow the good in business and life, and we know that by partnering with Rush, we’ll be able to help reduce health care disparities in Chicago, with the potential to create a roadmap for health equity nationwide.”
The Rush BMO Institute for Health Equity will coordinate Rush’s health equity initiatives, across the system’s three hospitals, giving them the funding and resources to thrive. The Institute will further improve health outcomes by focusing on bolstering community programs and community clinical practices, advancing community education and the healthcare pipeline from our neighborhoods to our university to jobs that allow for wealth creation, and supporting community engaged research that aims to reduce health gaps. Central to all of this is Rush’s approach to engage the community in a bidirectional exchange of ideas that will not only promote the best strategies to advance community health but also help train the next generation of Rush health science students in the skills needed to partner with communities to improve health. Rush is building upon years of successful community-based nursing practices, community educational programs and a community-based research network informed by community leaders.
And that’s how Rush and its partners intend to narrow the racial life expectancy gap — an all-in effort.