David A. Ansell

Poor health was not just the result of random acts, bad luck, bad behavior or unfortunate genetics. Deliberate public policy decision about housing, education, parks and streets were the key drivers of racial differences in mortality. Crime kept people off the streets and limited their ability to exercise. The lack of grocery stores limited dietary choices. The lack of primary care doctors and specialists in these communities made chronic disease care more difficult. The degradation and loss of hospital services in these communities affected hospital-based outcomes. _ The chronic underfunding of critical health services at Cook County Hospital and other safety-net providers contributed to these poor outcomes as well. The deleterious impact of social structures such as urban poverty and racism on health has been called 'structural violence.