On April 26, Trinity United Church hosted a care package giveaway. A man walks away with  protective masks, hand sanitizer, tissues, soap and more. Photo by Darius Griffin/The TRiiBE

Long-time health disparities affecting Chicago’s most vulnerable populations have been exacerbated by the COVID-19 pandemic. Since March, when uncertainty surrounding the virus heightened fears and sparked an overall economic shutdown, ongoing studies and research further exposed pre-existing failures of institutions and systems meant to keep communities safe and healthy. 

In Black communities on Chicago’s South and West sides, the urgency is palpable. Black Chicagoans, while only 30% of the city’s population, account for the majority of COVID-19 deaths — 43.4% as of July 7. Just as Black Chicago is disproportionately impacted by COVID-19, so is the Latinx community, which accounted for 32.1% of Chicago’s COVID-19 deaths, also as of July 7. More than 2,649 Chicagoans have died from COVID-19 as of July 7.

These health inequities, impacted by lack of substantial investment in social determinants of health, advocates say, can be alleviated with a full 2020 Census count. Beyond access to quality health care, these determining factors include economic stability, education, social and community context, and neighborhood and environment. 

Cook County Board of Commissioners President Toni Preckwinkle said it’s important to acknowledge the systemic racism that underlines the many reasons why Chicago’s communities of color remain at a disadvantage during the pandemic.

“It’s not surprising these communities are most challenged,” Preckwinkle said on a morning call with The TRiiBE back on April 26.

Citing the Cook County’s Social Vulnerability Index — which divides county data by census tract and scores neighborhoods on a scale from 0 (least vulnerable) to 1 (most vulnerable) — Preckwinkle noted patterns of socioeconomic disparities that have long stymied health and opportunity for Black and Brown communities. The index, as defined by the Centers for Disease Control, analyzes the resilience a given community has when confronted by external stresses on human health — or, in this case specifically, the COVID-19 pandemic. 

“Our system has always prided itself on taking whoever comes to our door for over 150 years, African-American and Latinx communities in particular as they’re most likely to be uninsured or underinsured, and face socioeconomic challenges.” Preckwinkle explained in April. “The last time I checked, which was Friday [April 24], we had 232 people in the hospital — 110 are COVID patients. So half of our population is COVID-positive, and we know many of those people are uninsured or underinsured.”

As of January 2020, Cook County Health numbers showed 45% of patients were uninsured at the time of treatment. Those experiencing food apartheid, which is an estimated 380,000 city residents according to a 2011 report from the Illinois Advisory Commission to the U.S. Commission on Civil Rights, as well as those navigating housing insecurity and threats to Medicaid programs, make up large swaths of CountyCare members. 

Illinois, along with Chicago, have put millions of dollars toward outreach to increase participation in the 2020 Census, including a $3 million investment by Cook County, according to Preckwinkle.

Though the state’s response rate was just over 66% — the 8th highest in the nation — and the county’s response rate stood at 61% as of June 23, the participation rates for most of Chicago’s hard-to-reach neighborhoods, including North Lawndale, Woodlawn and Back of the Yards, fall between 30 and 40%, per U.S. Census Bureau’s Self Response Map tallies. Certain census tracts running through neighborhoods such as Little Village and West Englewood have participation as low as 27% and 23%, respectively. 

In contrast, oft-undercounted neighborhoods like Austin have exceeded previous Census response rates — with one tract in the area reporting 41.7% of residents have been counted so far, compared to the 37% rate in 2010.

All the aforementioned neighborhoods have scores near one on Cook County’s SVI, while the county’s overall vulnerability score sits at .57. 

“We get $1,400 per person counted. That’s $14,000 per person over a 10-year period. Clearly, we need those resources for education, for public health and infrastructure,” Preckwinkle added, bringing the conversation back to the 2020 Census. “We have to share that with people: if you’re not counted, we lose resources.”

An older woman receives a care package — including masks, hand sanitizer and more — at a mask giveaway at Trinity United Church on April 26 | Photo by Darius Griffin/The TRiiBE

The board president specified inequalities such as lack of healthy food options, open and safe spaces for children to play, quality schools, public health options, and fair housing — and called for “urgent investment” in each. 

“Formulas for how to distribute billions of dollars are determined based on the Census count. Cook County is currently at 60% which means if Congress were to sit down and assess our piece of the financial resources, we would miss out on 40% of the investments needed to provide for our population,” she explained. “When people fail to complete the Census, they are removing a vital piece of information necessary to complete this formula.”

When the COVID-19 pandemic struck, the U.S. Census Bureau quickly adjusted its initial timeline that required census counts to be completed by July 31 and emphasized the importance — and ease — of getting counted online. As the country has begun reopening, the Bureau announced that field operations would begin in a “phased restart” the week of June 1 in select states including Illinois. The self-response period was again extended, with a new deadline of Oct. 31. 

Chicago’s non-response follow-up, where Census workers go door-to-door to households that have already received an invitation or questionnaire to respond but haven’t done so, will start on Aug. 11, — according to Jeanine Beasley, the Chicago Regional Census Center’s media coordinator. 

Marilyn Sanders, regional director of the Chicago area Census center, said that as non-response follow-up training begins, another postcard mailer will be sent out at the end of the month to remind folks to get counted.

“We’re continuing to reach out to community organizations and trusted voices in those tracts with low response, 20%, 30% — even 40%, to help us convey the message so that it gets to the heart of those communities and the importance of their participation in the census,” Sanders explained. “The national response rate across the country is 60.7%. We would love to be right at the national average or above across our state.” 

In light of pandemic delays, community-focused efforts have picked up, sharing messages on social media, in newsletters and through online forums that resonate on more immediate levels — such as the Census’s effect on health care access and maintaining representation in politics and other areas. 

Chicago Urban League launched its census work in 2018, following up with a May 2019 report detailing the effects that the Census count would have on Black Chicagoans, along with “hard to count” communities. CUL found that “in fiscal year 2016, under the 55 largest federal programs, nearly $35 billion was disbursed to the state of Illinois based on 2010 census data.” 

Per the League’s findings, the top five programs funded by this disbursement represented 70% of total allocations to the state. Programs included Medicaid, Federal Direct student loans, Supplemental Nutrition Assistance Program, Medicare Supplemental Insurance Program (Part B), and highway planning and construction. 

By CUL’s calculations, “Illinois would stand to lose more than $1.34 billion in funding for Medicaid and Federal Medical Assistance Programs alone from 2020 to 2030 (not adjusted for inflation), due to a less-than-1% undercount in 2020.”

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According to South Side Weekly’s live tracker of COVID-19 related deaths, which comprises data from Cook County Medical Examiner records released through the county’s data portal, South Lawndale (Little Village) and Austin are two “hard-to-count” populations most impacted by the coronavirus. As of the tracker’s June 25 update, South Lawndale has lost 114 residents to the virus, while 124 folks have succumbed in Austin.

An April report from CDC showed that overall, about 90% of people in the hospital with COVID-19 had at least one underlying health condition. Half (50%) had high blood pressure, 48% were obese, 35% were compromised by chronic lung disease and 28% had diabetes and cardiovascular disease. 

“Right now, there are only two County-run hospitals available to residents: Stroger and Providence,” Preckwinkle explained. “We need more investment in our healthcare system so we can expand programs and services to address the historical impact of diabetes, respiratory, and health issues Black and Brown people are prone to experiencing.”

In neighborhoods such as North Lawndale, medical experts have seen widespread diabetes and hypertension for decades. 

After moving to North Lawndale while completing his medical residency in 1980, Dr. Art Jones worked alongside community residents and activists to establish the Lawndale Christian Health Center in 1984; serving North and South Lawndale, and East and West Garfield Park. Dr. Jones currently acts as Chief Medical Officer of Medical Home Network, which comprises 10 federally qualified health centers including Lawndale Christian, Mt. Sinai, Rush and LaRabida. 

History, as he’s witnessed, has shown time and again that public health crises have much more dire consequences for communities of color.

Folks waiting in line at the care package giveaway at Trinity United Church on April 26 | Photo by Darius Griffin/The TRiiBE

“[North Lawndale] and under-resourced neighborhoods have had fits and starts over the years in terms of investment but are the first to experience the negative impact of economic downturns and the last to come back,” Dr. Jones wrote via email. 

“Although the focus right now is on the direct impact of COVID-19 infection in terms of morbidity and mortality, we will increasingly see the impact that the pandemic has on deferred management of acute and chronic conditions as well,” he continued. “We should anticipate a rise in violent crimes, children who don’t have computers and the internet falling further behind in education, etc.”

Even as COVID-19 trends change, ensuring that these communities have equitable opportunities for growth moving forward is imperative. Participation in the Census results in real dollars and congressional power that aid in leveling fields that traditionally have additional barriers for Black Americans. 

“We need to make racial equity the lens through which we look at all of our activities. Whether it was grant-making, allocation of resources, what impact programs – who’s burdened, who’s helped and who’s harmed, we have to look at that through a racial lens,” Preckwinkle said.

“If we don’t do that,” she warned, “we’re not addressing the central challenge we face.”