Testimony from Bonnie Rateree, Cook County PLACE MATTERS, July 23, 2015 at the Public Hearing for the South Suburban Communities

Testimony: Bonnie Rateree, Cook County PLACE MATTERS July 23, 2015 Page 1

Public Hearing for the South Suburban Communities

Gloria Taylor Banquet Hall, 14820 Broadway, Harvey, Illinois

Testimony from Bonnie Rateree

Representing Cook County PLACE MATTERS

July 23, 2015 6:00 p.m. – 8:30 p.m.

1. [Introduction]

Good evening. My name is Bonnie Rateree, I am a life-long resident of Harvey, an

elected school-board member, and a master gardener promoting food and nutrition. This

evening I am giving testimony on health inequities in my role as Steering Committee

Member of Cook County PLACE MATTERS.

The two points of my testimony to you, elected officials in this public hearing tonight, is

that first, the roots of health inequities are to be found in the systemic, structural racism

of our County, State and country, which distributes the social determinants of health

unfairly and inequitably. And second, that we can only fulfil the human right to health—

and achieve health equity----by changing policy.

The popular explanation of health and disease is that each individual person is

responsible for her or his health, and that hospitals and physicians are the source of

health. However, a large and growing body of evidencei shows this explanation of health

is wrongii. While access to medical care is very important, these dominant narratives are

not true. These explanations tend to blame the victim, and shift attention away from the

policies that create societal conditions that produce a disproportionate burden of illness

and premature death among the Black population living in the Southland. In the words of

US health expert Jonathan Fielding “the fundamental challenge is convincing the


American people that their health, individually and collectively, is primarily determined

by the social, physical, and economic environments in which we live.”iii It is not an

accident that the social, physical and economic environment confronting the children and

families of Harvey, where I live and work, is so toxic. The environments that threaten the

lives of African-Americans in the southern suburbs of Cook County did not come about

naturally, they didn’t ‘just happen.’ The daily living conditions that cut Black lives short

are the result of policy. Journalist and author Ta-Nehisi Coates refers to the importance of

policy in his book on growing up in Baltimore: He writes “To be black in the Baltimore

of my youth was to be naked before the elements of the world before all the guns, fists,

knives, crack, rape, and disease. The nakedness is not an error, nor a pathology- the

nakedness is the correct and intended result of policy...”iv

2. [Evidence of racial health inequities]

I will now briefly describe evidence of population health inequities. Life expectancy can

be predicted by where you live in Cook County:

People living in neighborhoods with a median income of over 53,000 per year

lived almost 14 years longer than people living in neighborhoods with a median

income of less than 25,000 dollarsv;

Black babies born to women in the South suburbs of Cook County are three

times-- that is 300%-- more likely to die before their first birthday than are white

babies born to women in the North suburbsvi;

African-Americans in the South Suburbs are more than twice as likely to die from

diabetes when compared to their white counterparts living in the northern suburbs,

according to 2010 data from the Cook County Department of Public Health.vii


Let me emphasize again that these unjust and preventable racial health inequities are

caused by powerful forces that distribute education resources, money, and living

conditions unfairly base on race and geography. Research from the American Journal of

Public Health for example, found that in the year 2000, 245,000 deaths in the US were

attributable to having less than a high school education. That is 50,000 more than the

number of people who died from heart attack that year.viii Research on police violence

from the Harvard School of Public Health found that there is a disproportionate rate of

deaths among US black and white men due to law enforcement action: Between 1960 and

2010, Black men aged 15-34 years died from law enforcement actions at least 2.6 times

(260% more) the rate of their white counterparts.ix

3. [Policy Recommendations]

Let me make four policy recommendations;

First, we need to put an end once and for all to the unfair and broken system of education

financing that relies on local property taxes to fund public education. Education finance

expert and state budget analyst Ralph Martire has referred to this as a “structurally racist

system of finance that selects African Americans and Latinos for very poor education.”x

Second: Raise the minimum wage and eliminate the tipped wage in Illinois so that

working adults will be able to have an income more able to sustain health for themselves

and their children. The US has the least supportive family policies, and the highest child

poverty rate, among 20 wealthy countries in the world.xi Maps of the Chicago area have

been created showing the locations where the opportunity for children to reach their full

potential is low, high and in between. The pattern in our area is similar to that of the

nation as a whole: Black and Hispanic children are concentrated in the lowest opportunity


neighborhoods.xii Thousands of people in Cook County work in the exploding restaurant

industry, in which tipped-wage workers receive less than the minimum wage, and do not

have equal opportunity to work in higher paid positions held disproportionately by white

males.xiii Raising incomes for working adults increases the opportunities for children and

adults to be healthy.

Third: Illinois and the US needs to fully fund child care for adults with children so that

they can work outside the home. Access to quality and affordable child care is an

important part of helping children be healthy and develop fully. In our recent panel and

film screening of The Raising of America, Cook County PLACE MATTERS heard loud

and clear from working parents about the high cost of child care. The audience told our

panel that elected officials need to watch the film to better understand the issue.

Finally, legislators should make it mandatory that health care providers report deaths and

injuries caused by police actions to health agencies in a timely manner. This would make

‘legal intervention’ when injury or death is involved a reportable condition. Policing is a

critical and unrecognized determinant of health inequities, yet the US does not maintain a

complete count of individuals killed by police. And according to research by Justin

Feldman, there is “widespread unwillingness on the part of police departments to share

data with the public. State and local health departments can serve as the independent

monitors of police violence”xiv that we need.

Thank you for this opportunity to provide testimony. My remarks also have Appendices

and References which I hope are helpful to this Hearing.


End Notes

i Solar and Irwin (2010) A conceptual Framework for action on the social determinants of health. Geneva: World Health Organization; Koh, et al. (2011) Healthy People: A 2020 Vision for the social determinants approach. Health Education and Behavior, 38(6), 551-557; National Association of County and City Health Officials. (2014). Expanding the Boundaries: Health equity and public health practice. Washington, DC: NACCHO. ii Raphael, D. (2002) Social justice is good for our hearts: Why societal factors---not lifestyles---are major causes of heart disease in Canada and elsewhere. Toronto: CSJ Foundation for Research and Educaiton. iii Fielding, J. E. Public Health in Big Cities: Looking back, looking forward. Journal of Public Health Management and Practice, 21, Supplment 1, S20-3. Page S22. iv Ta-Nehisi Coates quotation. cited by Muwakil, Salim, July 21, 2015. “Ta-Nehisi Coates’ “Between the World and Me” Forever Changes the Meaning of ‘The American Dream’ In These Times-Views. http://inthesetimes.com/article/18221/salim-muwakkil-reviews-between-the-world-and-me Full quotation: “The

nakedness is not an error, nor a pathology- the nakedness is the correct and intended result of policy, the predictable upshot of people forced for centuries to live under fear.”

v Cook County PLACE MATTERS & Virginia Commonwealth University (2012). Place Matters for Health In Cook County vi Cook County Department of Public Health (2010) Community Health Status Report—Infant Mortality Figure 3, page 2 http://www.cookcountypublichealth.org/files/data-and-reports/chsa/CHSA%20Section%204.pdf Accessed July 22, 2015. vii Cook County Department of Public Health (2010) Community Health Status Report—Diabetes Figure 4, page 3. http://www.cookcountypublichealth.org/files/data-and-reports/chsa/CHSA%20Section%203.pdf Accessed July 22, 2015. viii Galea, S. et al (2011). Estimated deaths attributable to social factors in the United States. American Journal of Public Health, 101(8), 1456-1465. ix Krieger, N., et al. (2015). Trends in US deaths due to legal intervention among black and white men, age 15-34 years, by county income level: 1960-2010. Harvard Public Health Review, 3, 1-5. x Martire, Ralph February 11, 2014. “School Funding Reform, Closing the Opportunity Gap” Presentation, DePaul University, Chicago. Cable Access Network TV accessed on Youtube Feb 20, 2014. xi Marmot, M. (2007) Achieving health equity: From root causes to fair outcomes. Lancet 370(9593), 1153-1163. xii Acevedo-Garcia, D. (2014). The child opportunity index: Improving collaboration between community development and public health. Health Affairs, 33(11), 1948-1957.; See also maps available online at DiversityDataKids.org xiii ROC Chicago xiv Feldman, Justin “Public Health and the Policing of Black Lives” Harvard Review of Public Health No. 6, July 2015. http://harvardpublichealthreview.org/public-health-and-the-policing-of-black-lives/

http://inthesetimes.com/article/18221/salim-muwakkil-reviews-between-the-world-and-me

http://www.cookcountypublichealth.org/files/data-and-reports/chsa/CHSA%20Section%204.pdf

http://www.cookcountypublichealth.org/files/data-and-reports/chsa/CHSA%20Section%203.pdf

Cook County Department of Public Health

Community Health Status Report 2010 Infant Mortality- Page 2

2000-2002 vs. 2005-2007

By Race

The infant mortality rate for the Cook County Department of Public Health’s (CCDPH) jurisdiction decreased slightly from 7.3/1,000 in 2000-2002 to 6.9/1,000 in 2005-2007.

From 2000-2002 to 2005-2007, while the infant mortality rate among Asians increased slightly from 3.4 to 4.3/1,000, the rate was below the Healthy People (HP) 2010 goal of 4.5/1,000. The infant mortality rate among African Americans (AA) in the same time periods remained the same (approximately 14.3/1,000).

Infant mortality rates decreased slightly for Hispanics (from 6.3 to 5.5/1,000) and for Whites (from 5.5 to 5.0/1,000).

Figure 2

2005-2007 By Race/Ethnicity

During 2005-2007, the infant mortality rate for SCC was 15.1 per 1,000, slightly higher than the Illinois and U.S. rates (14.5 and 14.1/1,000 respectively). The infant mortality rate in the South district was 11.3/1,000 which was more than double that of the North district, which was 4.4/1,000. In all regions, the rates of infant mortality for African Americans was approximately double that of Whites and Hispanics. The West district had the highest rate of infant mortality for African Americans (17.8 per 1,000), followed by the South district (14.3 per 1,000).

Figure 3


Community Health Status Report 2010 Diabetes- Page 3

2005-2007 By Race/Ethnicity

The diabetes mortality rate in SCC (62.5/100,000) was lower than Illinois (69.7/100,000) and the U.S. (75.5/100,000). Diabetes mortality rates were highest for AAs compared to other racial/ethnic groups across all regions. In SCC, the AA diabetes mortality rate (135.9/100,000) was higher than the AA rate for Illinois (101.2/100,000). The overall diabetes mortality rates among Asians in SCC, were much higher than the U.S. and Illinois rates, notably in the North district, 113.8/100,000 which was double the U.S. rate (56.3/100,000).

Figure 4

2005-2007

By Gender

Across all regions, diabetes mortality rates for males were higher than females. In SCC, the diabetes mortality rate for males was 81.0/100,000 compared to females at 50.8/100,000. Diabetes mortality rates for males (108.3/100,000) and females (68.0/100,000) were the highest in the South district

Figure 5


Health Equity…the attainment of the highest level of

health for all people (US DHHS 2011)

Source: Virginia Commonwealth U., Cook County PLACE MATTERS (2012)

To inform current national discussions about the deaths of black men due to the police, 1 we present novel data on long-term trends (1960-2010) in deaths due to legal intervention (i.e., deaths due

to law enforcement actions) among US black and white men, by county income level. Among the three health studies investigating trends in this outcome, one focused on the total US population for 1962-1993, 2 one documented a marked excess for young adult black as compared to white men for 1979-1997, 3 and the third reported on systematic underreporting of such deaths, overall and by race/ethnicity and age, for 1976-1998; 4 none included socioeconomic data.

MethodsWe analyzed US national mortality data for 1960-2010, 5 6 using

individual-level mortality records and census denominator data stratified by age, gender, and race/ethnicity, aggregated to the county level, and to which we have appended the corresponding year-specific US county median family income data, categorized into quintiles. 7 We report trends (3-year moving average mortality rates) for the two main groups at risk: US black and white men, age 15-34.

Trends in US deaths due to legal intervention among black and white men, age 15-34 years, by county income level: 1960-2010Nancy Krieger, PhD, Mathew V. Kiang, MPH, Jarvis T. Chen, DSc, and Pamela D. Waterman, MPH

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ResultsBetween 1960 and 2010, 15699 US deaths were classified as due

to legal intervention, of which 63.3% (n=9934) occurred among men age 15-34. Among these men, 5489 were classified as white (55.3%) and 4204 as black (42.3%), a percentage 3 to 4 times that for the US black population (e.g., 1960: 10.5% black, 88.6% white; 2010: 12.6% black, 72.4% white). Only rates for the black men exhibited a sharp rise and fall (1960s-1970s) followed by a post 1980-plateau; rates for the white men exhibited far less variation (Figure 1, Table 1). The rate ratio for black vs. white men for death due to legal intervention always exceeded 2.5 (median: 4.5) and ranged from 2.6 (95% confidence interval [CI] 2.1, 3.1) in 2001 to 10.1 (95% CI 8.7, 11.7) in 1969, with the relative and absolute excess evident in all county income quintiles (Table 1).

DiscussionOur results indicate that the excess black vs. white mortality rate

among men age 15-34 due to legal intervention is both longstanding – and modifiable. Given documented greater underreporting of black vs. white homicides by police officers, the results also likely underestimate the black vs. white excess. Moreover, the lack of sharp difference by county income quintile, post-1980, stands in contrast to well-documented inequities by county income level for both infant mortality and premature mortality (death before age 65), suggesting that societal determinants of deaths due to legal intervention are driven by additional or different aspects of societal inequality. We cannot, based on the limited data available, address debates over whether our findings reflect racially biased use of excessive force. Nevertheless, the data presented provide context for the 2014 emergence of police killings as a highly visible topic. Repeated protests have taken place in most major US cities, about both the deaths themselves and also – in the two very high profile cases involving Michael Brown (Ferguson, Missouri) and Eric Garner (Staten Island, New York) – the decision of grand juries to decline recommending that criminal charges be filed for these deaths. Journalists report that these latest deaths and the responses of the criminal justice system have reignited the concerns and distress triggered by the 2012 acquittal of George Zimmerman, a volunteer neighborhood watchman who killed the teenager Trayvon Martin. In all three of these cases, the victims were unarmed Black American teenage boys or men. The dearth of health research on police killings and their impact on the families, neighborhoods, and communities affected is stark. When it comes to reckoning the toll of racial inequality, accountability requires counting. We offer these descriptive analyses to stimulate further investigation into the patterns, causes, and consequences of social inequalities in deaths due to legal intervention.

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T R E N D S I NU. S. DE AT H S

D U E T O L E G A LI N T E RV E N T I O N

Nancy Krieger, PhD Mathew V. Kiang, MPH

Jarvis T. Chen, DSc Pamela D. Waterman, MPH

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Figure 1. Trends in US mortality rates (3-year moving average), 1960-2010, for black and white

men, ages 15-34, for deaths due to legal intervention, by county income quintile (lowest three

versus top two)

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Table 1US mortality rates (3-year moving average, per 100,000), and rate

ratio and rate difference (and 95% confidence interval (CI)), for black and white men, ages 15-34, for deaths due to legal intervention, overall and by county income quintile: 1965, 1975, 1985, 1995, and 2005

InternationalClassification ofDiseases (ICD):version*

Death due to legal intervention

ICD-7 (1958-1967) (E984) “Injury by intervention of police” (and not including: (E985)“Execution”)

ICD-8 (1968-1978) (E970-E977) “Legal intervention” (and excluding (E978)”Legalexecution”)

ICD-9 (1979-1998) (E970-E977) “Legal intervention (and excluding (E978) “Legalexecution”)

ICD-10 (1999-20120) (Y35.0-Y35.4, Y35.6-Y35.7) “legal intervention” (and excluding(Y35.5) “executions”)

* ICD codes as listed at: http://www.wolfbane.com/icd/ (http://www.wolfbane.com/icd/)

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1975 Total 2.96 0.39 7.56 (6.52,8.77)

2.57 (2.26, 2.87)

Income quintile:

Q1 (low) 2.27 0.45 5.03 (3.63, 6.98) 1.82 (1.31, 2.33)

Q2 3.33 0.38 8.67 (6.29, 11.99) 2.94 (2.26, 3.62)

Q3 3.53 0.44 8.02 (5.68, 11.25) 3.09 (2.19, 3.99)

Q4 3.37 0.38 8.93 (6.50, 12.31) 3.00 (2.30, 3.69)

Q5 (high) 2.46 0.30 8.13 (5.21, 12.53) 2.16 (1.36, 2.95)

1985 Total 1.25 0.28 4.48 (3.71,5.39)

0.97 (0.79, 1.15)

Income quintile:

Q1 (low) 0.91 0.29 3.08 (1.98, 4.75) 0.61 (0.31, 0.91)

Q2 0.86 0.22 3.87 (2.28, 6.43) 0.64 (0.30, 0.98)

Q3 2.03 0.34 6.03 (4.24, 8.58) 1.69 (1.19, 2.19)

Q4 1.37 0.31 4.46 (2.98, 6.62) 1.06 (0.65, 1.47)

Q5 (high) 1.08 0.23 4.61 (2.63, 7.80) 0.84 (0.38, 1.31)

1995 Total 1.21 0.36 3.37 (2.81,4.02)

0.85 (0.68, 1.02)

Income quintile:

Q1 (low) 1.10 0.57 1.94 (1.35, 2.77) 0.53 (0.20, 0.87)

Q2 0.96 0.26 3.73 (2.30, 5.98) 0.71 (0.35, 1.06)

Q3 1.43 0.47 3.04 (2.11, 4.33) 0.96 (0.55, 1.36)

Q4 1.41 0.31 4.56 (3.02, 6.83) 1.10 (0.67, 1.53)

Q5 (high) 1.13 0.21 5.49 (3.19, 9.27) 0.92 (0.48, 1.37)

2005 Total 0.94 0.37 2.57 (2.12,3.09)

0.58 (0.43, 0.72)

Income quintile:

Q1 (low) 0.87 0.37 2.33 (1.54, 3.48) 0.49 (0.21, 0.77)

Q2 0.89 0.41 2.16 (1.42, 3.24) 0.48 (0.17, 0.79)

Q3 1.19 0.41 2.89 (1.93, 4.28) 0.78 (0.40, 1.16)

Q4 0.76 0.34 2.22 (1.35, 3.55) 0.42 (0.11, 0.73)

Q5 (high) 1.09 0.30 3.65 (2.21, 5.89) 0.79 (0.37, 1.21)

Year Group Death due to legal intervention

Rate Rate ratio Rate difference

Black White RR (95% CI) RD (95% CI)

1965 Total 3.33 0.44 7.65 (6.48,9.02)

2.90 (2.51, 3.28)

Income quintile:

Q1 (low) 2.33 0.36 6.45 (4.30, 9.72) 1.97 (1.35, 2.59)

Q2 4.78 0.35 13.60 (9.44, 19.76) 4.43 (3.38, 5.48)

Q3 3.36 0.51 6.57 (4.59, 9.38) 2.85 (2.00, 3.69)

Q4 3.21 0.59 5.47 (3.78, 7.84) 2.62 (1.72, 3.52)

Q5 (high) 3.43 0.36 9.61 (6.15, 14.93) 3.07 (2.01, 4.14)

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1. Walters J. Thousands in New York march over Garner and Brown police deaths. The Guardian. Accessed January 8, 2015.

2. Ikeda RM, Gorwitz R, James SP, Powell KE, Mercy JA. Trends in fatal firearm-related injuries, United States, 1962-1993. Am J Prev Med 1997; 13(5):396-400.

3. Sikora AG, Mulvihill M. Trends in mortality due to legal intervention in the United States, 1979 through 1997. Am J Public Health 2002; 92(5):841-843.

4. Loftin C, Wiersema B, McDowell D, Dobrin A. Underreporting of justifiable homicides committed by police officers in the United States, 1976-1998. Am J Public Health 2003; 93(7):1117-1121.

5. National Center for Health Statistics. Compressed Mortality File: Years 1968-1978 with ICD-8 Codes, 1979-1988 with ICD-9 Codes and 1999-2010 with ICD-10 Codes. Accessed January 8, 2015.

6. National Office of Vital Statistics, Public Health Service, US Department of Health, Education and Welfare. Documentation of the detail mortality tape file (1959-1961, 1962-1967). Washington, DC: US Department of Health, Education, and Welfare, 1969. Accessed January 8, 2015.

7. Krieger N, Chen JT, Coull BA, Beckfield J, Kiang MV, Waterman PD. Jim Crow and premature mortality among the US black and white population, 1960-2009: an age-period-cohort analysis. Epidemiol 2014; 25(4):494-504.

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Health & Medicine

Testimony from Bonnie Rateree, Cook County PLACE MATTERS, July 23, 2015 at the Public Hearing for the South Suburban Communities