Thread by @AlanLHutchison

@UChicagoMed IM Residency @MedChiefs Morning Report is resident-led. I was given the chance to present a case presentation on Homelessness & Chicago History, which I hoped would be educational especially for our interns new to the South Side. Featuring @vdimaggio & Nicole Gier

I am not from the South Side of Chicago, and have never been homeless, and I think it’s important to recognize those limitations going into my presentation.

Chicago has been called a “City of Neighborhoods”, and though we’ve heard the names, I thought it was important to walk through & point out each of the neighborhoods our patient population comes from. @daireclugan crushed this part.

Bronzeville is a neighborhood that encompasses multiple neighborhoods!

We spend a lot of time thinking about differential diagnoses for various signs & symptoms we encounter, so I thought it would be worthwhile to think about this for homelessness (I didn’t reveal the x-axis labels right away).
icjia.state.il.us/assets/article…

I borrowed this slide from Stephen Brown at @UIHealth, I think it provides a useful framework for delving into root causes and solutions.

This is from a 2017 survey by @ChiHomeless, incredible for its focus not just on unsheltered individuals but those “doubled-up” w/ friends/family but w/ no long-term security / guarantee of their housing situation (often without a key to the residence & sleeping on the floor).

“Cost-burdened” refers to households that spend more than 30 percent of their income on housing. “Severely cost-burdened,” which means they spent more than 50 percent.

Cost-burden is a severe issue for Chicago renters on the Far West and South Sides.

There was a question regarding the role of housing cost vs income as contributing to cost-burden. Median income clearly plays a role. But I wanted to delve into the history of the housing…

The Home Owners Loan Corporation (HOLC) was a New Deal government organization to help banks decide which neighborhoods to lend to.

HOLC’s decisions directly correlate with (it not cause) the inequity in cities across the country.

Of note, they were *explicitly racist.*

@UChicago, shamefully, was part of these racist and exclusionary policies and behaviors. They have been working to correct these mistakes, both through raising awareness, scholarship, and neighborhood involvement.

Formal policies went hand-in-hand with white-led mob violence (where police turned a blind eye). This excerpt is from the great work of @eveewing “Ghosts in the Schoolyard” on the 2014 @ChiPubSchools school closures (& more), which disproportionately affected Black communities.

The real-estate community worked actively to inflame white prejudice & exploit black families to make massive profits off of departing white home-owners and Black families eager to live in new neighborhoods. From @natalieymoore great autobiographical history “The South Side”

Disparities continue to the present with the failure of the @cha to properly replace the low-income housing lost when the housing projects were torn down. From @SouthSideWeekly reporting by @jake_bittle @srishtikapur @jazzmyth southsideweekly.com/chicago-unfulf…

Affordable housing struggles continue to this day, including with news breaking DURING MY PRESENTATION.
@HydeParkHerald @aarondgettinger and Christian Belanger on the announcement by @LoriLightfoot

Fantastic work by @nyugrossman cityhealthdashboard.com and Marc N. Gourevitch reported by @CityLab @sarahsholder @dhmontgomery bloomberg.com/news/articles/…

Looks like I hit Twitter's thread limit, so I'll continue this in a reply to this thread! Stay tuned! End of Part 1.

@MedChiefs My morning report on the history of Chicago Housing and Homelessness continues here.

In addition to redlining as a means of segregation, the Dan Ryan Expressway was initially planned to try to separate white communities from Black communities, while of course bulldozing entire Black neighborhoods to construct.

Wonderful reporting by @nytimes, @bradplumer, & @PopovichN on how red-lined neighborhoods are hotter in the summer than non-redlined ones. 6F in Chicago! Likely due to low public investment → fewer green spaces, trees, more concrete. nytimes.com/interactive/20…

Chicago’s demographic geography is due to explicit racist policies & behaviors. Instead of referring to these communities as “socio-economically disadvantaged & under-resourced”, the appropriate description is socio-economically exploited & abused by privileged races & classes.

We return to our patient, who now needs anticoagulation

In April 2020 @JAMACardio @CardioUva and Austin A. Robinson published a RCT comparing warfarin to DOACs, showing that warfarin is superior. jamanetwork.com/journals/jamac…

Since we felt our patient was unlikely to be able to get his INRs regularly checked, we sent him out on a DOAC anyway, since risks of being over- or under- anti-coagulated were too great for this gentleman.

We spent some time talking about racism and cost-burden, but I wanted to pivot more to resources for chronically homelessness, from which this gentleman suffered.

@ChiPublicHealth has Mental Health Clinics, but closed 1/2 in 2012. @GOVERNING @mattiekquinn reported on an audit by Arturo Carrillo of the Collaborative for Community Wellness which found many fewer resources than advertised. governing.com/topics/health-…
collaborativeforcommunitywellness.org/2018-report

Incarceration can lead to homelessness, but in many places the behaviors those suffering from homelessness must do to survive are often themselves criminalized. icjia.state.il.us/assets/article…

@cookcountygov & @ToniPreckwinkle have done great work here, passing a law in 2019 prohibiting most landlords from denying people housing on the basis of a criminal conviction. I also cited a great study by the @ellabakercenter ellabakercenter.org/sites/default/…

The Cook County Jail @CCSOPIO is the institution with the highest number of residents with psychiatric diagnoses, and Sheriff Tom Dart has done good work highlighting this inequity and the need for further resources. chicagotribune.com/opinion/commen… chicagotribune.com/politics/ct-me…

Most of us are too busy learning medicine to reflect on the structure of the multiple governments running Chicago and their interactions, so I thought we would revisit them, though I did it in a quiz fashion.

Note most of the head officials in Chicago are appointed…

… while most of the Cook County head officials are elected.

Nicole Gier-DiMaggio shared with us information about The Boulevard blvd.org/services, another resource we could have utilized

Our patient has several barriers to overcome, but as seen by our difficulty choosing a proper anticoagulation regimen for him, not having stable housing makes everything else very difficult.

There are two general approaches to addressing homelessness, and I think, certainly for our patient, and likely in general, the Housing First approach makes the most sense and is the most humane.

Stephen Brown at @UIHealth shared some slides with me on the work he is leading, which I have summarized here. Most importantly, by housing patients who suffer from homelessness and repeatedly go to the ED, the health system SAVES MONEY by providing them housing.

@UChciagoMed is also beginning to increase their role in this work, led by @lelsmo

@ChicagoStMed is doing great work bringing medical care to populations suffering from homelessness, and @MedChiefs is looking forward to partnering with their outreach the coming year, led by alum and President of the UChicago Chapter Ruth Tangonan

Chicago’s demographic geography was caused by and is maintained by racist policies. It is a result of dedicated collective effort by white people to segregate the Black population

My presentation didn't end there, see my reply for the final leg, in which I discuss all the resources I relied on to learn and present this information! @MedChiefs

The final third of my Morning Report to @MedChiefs at @UChicagoMed on the history of Chicago Housing and Homelessness, in which I discuss the resources I used.

I didn’t have enough time to talk about ALL the history I wanted to:
1919 Red Summer, 1995 Chicago Heat Wave,
Early 2000s dismantling of Chicago Housing Authority Public Housing Projects,
2014 CPS school closings,
2017 @UChicagoMed Trauma Center,
2021 Mercy Hospital Closing

Our @UChicagoMed Internal Medicine Residency @MedChiefs has great people doing great things, and I certainly know I don’t know everything that people are doing, but I want to! @sbhkelly @AlejandroPlana

I’m a white man not from the South Side of Chicago who has never been homeless. I was doing what I could to teach about a history my ancestors did not suffer through, and present inequities I am on the privileged side of. I wanted to share some resources I found helpful.

@eveewing of @UChicagoSSA “Ghosts in the Schoolyard” and @natalieymoore of @WBEZ “The South Side” have written great books on the history of the South Side and its impact on current inequities and policies.

Mary Patillo of @NUsociology wrote “Black Picket Fences” about the Black Middle Class, and @MichelleObama wrote about her experiences seeing the demographics of her South Shore neighborhood change in her autobiography “Becoming”

@DrDavidAAnsell has written extensively about Chicago inequities in medicine in his works “County” and “The Death Gap” and @EricKlinenberg wrote the definitive history of the Chicago Heat Wave’s disproportionate effect on Black neighborhoods in “The Heat Wave”

Chicago is blessed with a litany of great news sources. @WBEZ is my absolute favorite, and @ChicagoTrib and @Suntimes do quality reporting, but I also rely heavily on @hphearland, @SouthSideWeekly, @ChicagoReporter, and @blockclubchicago for more local news on policy & advocacy

I felt like a learned a lot from @DrIbram’s work “How to be an Anti-Racist”, and learned a ton from @haw95 in “Medical Apartheid” on the long history of the medical community exploiting our poor and minority patients

Ta-Nehisi Coates “Between The World and Me” was riveting, & I am saddened reading through @elizabhinton From the War on Poverty to the War on Crime: The Making of Mass Incarceration in America how little has changed in 50 years & how explicitly the carceral state was designed

We have a great library system in Chicago with @chipublib, and apps like @LibbyApp from OverDrive and @hooplaDigital make it easy to listen to these books while doing chores or commuting to and from work.

@UChciagoMed @UChiPritzker is blessed with a number of great clinician-researchers and clinician-advocates investigating health care disparities, including but not limited to @monicavelaw, @DrMonicaPeek, @FutureDocs, @MarshallChinMD, Milda Saunders, @DrRam95, and Valerie Press

@monicavelaw deserves special thanks for founding the “Health Care Disparities” class I took at @UChiPritzker back in 2011, which exposed me to this history and the countless inequities we need to work to correct

@UChicagoMed @UChiPritzker has a monthly Bowman Society Lecture to explore the intersection between race and medicine pritzker.uchicago.edu/resources/bowm…

This was their latest event, on “Race and Renal Function Calculations”, featuring @AmakaEMD @Neil_R_Powe & Leslie Inker, MD with distinguished guest @DorothyERoberts

Here is a list of resources and citations I used, some of which I mentioned above.

The End. Thank you for your attention!