After studying some anthropology in college, I became more aware of my privileges. I felt confident about being safe should there be an emergency. There are nine fire departments within a two-mile radius of my house, and I live only three miles away from the nearest hospital. My proximity to hospitals and private practices has not been a limiting factor for when I seek care. Historically, location is a limiting factor for many individuals. Chicago serves as a model city, by displaying relevant public health scenarios. Urban planners aim to eliminate any disparities in receiving care, by taking into account past social issues. They must work with existing infrastructure to ensure that healthcare is not unattainable to residents of a city, such as Chicago.
Diagnoses are a Privilege
Imagine you live in a rural area of the United States, such as Arizona. Phoenix and surrounding cities have most of Arizona’s hospitals. For Indigenous American Reservations, for example, hospital visits require a 30+ minute drive. According to the New York Times, research shows that as the distance from a hospital increases, the less likely people are to seek health care, even in an emergency. Therefore, proximity to a hospital holds a privilege. Those willing and able to seek health care are more likely to receive a diagnosis, and from there, can pursue proper treatment.
There are a wide variety of factors that influence healthcare availability. Some of these factors, such as urban planning, are out of the control of the patient. Researchers have identified that most cities fall under one of three models of cities. I will discuss the locations of healthcare facilities in each city model. The regions of residential areas concerning hospitals are influential in seeking healthcare.
The Concentric Zone Model and Chicago
Ernest Burgess coined the concentric zone model after he observed Chicago in the early 1920s. I will use Chicago as a model city to explain the features of the concentric zone model.
The map above shows redlining in the 1940s in Chicago, and the rings of Burgess’s model, which assist in the spatial analysis of the city. Following this map, I have included a contemporary map of Chicago, with all locations of hospitals pinned. Imagine that the pinned hospital locations are on the redlined map. There are no hospitals located in the central business district. But, there are hospitals in every zone outside the center.
Regardless of the city fitting the concentric zone model, the GoogleMaps image of Chicago shows large areas between hospitals. As a result of modernization, much of the concentric zone model is obsolete, but again, the model aids in conceptualizing space in Chicago.
The Case of Oak Park, Chicago
Some locations in the city even lie equidistant from multiple hospitals. The Oak Park neighborhood lies between Kindred Hospital Chicago Northlake and Saint Anthony Hospital. Residents have to choose their location of care in an emergency and travel there. They have the choice of traveling to a hospital in a location that has a smaller population (Kindred Hospital). A smaller surrounding population makes it possible that there are fewer people at the hospital, allowing for a shorter wait time. Residents could also head to Saint Anthony Hospital, in an area with a higher population. But, Saint Anthony Hospital is in closer proximity to other hospitals that may offer better treatment for a specific condition.
Transport to a hospital is time-sensitive, especially in an ambulance. Public transportation is an option but requires more time than if an individual were to drive directly to the hospital.
The Sector Model and Chicago
Homer Hoyt proposed the sector model as a more accurate alternative to the concentric zone model for Chicago at the time. I will explain the sector model with its model city, Chicago.
Essentially, the model shows different social classes were less segregated into rings. However, the model does have an impactful flaw. Hoyt based the model on rail systems without considering that cars would gain popularity.
Concerning the sector model of Chicago, most plotted hospitals are in the South Side and North Side regions of Chicago. Please note that this model does not apply to modern-day Chicago, like the concentric zone model. I found more recent demographic data from both the North Side and the South Side, to see if there are any current disparities in accessing healthcare.
Demographic Data of the North Side
The North Side of Chicago is one of the more affluent regions of Chicago. The median household income is $95,173, and only 29,733 people are below the poverty level, according to Point2Homes. Individuals below the poverty line account for only 9.96% of the population of the North Side. Point2Homes also includes commuter information. The top modes of travel to work on the North Side are via car, bus, or walking/biking.
Using the total population of the North Side and the number of commuters for each mode of transportation, I calculated the percentage of the residents using the given methods of commuting. Around 27.2% of the North Side use a car to commute, and roughly 9.00% use public transportation. Combining the number of individuals that walk and bike to work, I found that 4.92% choose this method of commuting to work. The number of commuters using the railroad decreased by 76.2%.
Demographic Data of the South Side
The south side of Chicago is not as affluent as the North Side of Chicago. Point2Homes lists the median household income as $36,491, and 58,399 people below the poverty level. The percent of the population below the poverty level is almost three times that of the North Side, with 26.9%. In addition, transportation methods in the South Side differ from the North Side.
I calculated the percent of the population in the South Side using the given methods of commuting. Around 21.6% of the North Side use a car to commute, and 9.40% use public transportation. Combining the number of individuals that walk and bike to work, I found that 4.37% choose this method of commuting to work. The number of commuters in the railroad decreased by 92.3%, and the number of commuters using the bus increased by 5.1%.
Interpreting the Data
More of the North Side walks/bikes and drives to work compared to the South Side. The reasons for this are not entirely decisive, but I can infer that residents of the North Side are able to afford cars to drive to work. In addition, residents of the North Side might consider their communities more walkable. Their ability to walk to work is likely attributed to closer proximity to work, especially if an individual owns their own business of practice (for law or medicine), for example.
Compared to the North Side, the South Side has slightly more commuters that use public transportation for their commute. Yet, the number of commuters using the railroad decreased drastically, and the number of commuters who use the bus increased by only 5.1%.
Based on their transportation to work, it seems that residents of the North Side and the South Side suffer few disparities in transportation (not including environmental racism). Therefore, hospitals are accessible, whether residents choose to use cars or travel by public transportation. The slightly more frequent use of public transportation in the South Side may delay care, especially if one must depend on the bus or railroad to travel to the hospital.
Why Do the Most and Least Affluent Neighborhoods of Chicago Surround the Central Business District?
Both the residents of the North Side are not exclusively high-class, and the residents of the South Side are not only low-class residents. Residents range in socioeconomic status. But, a majority of the residents on the North Side would account for zone five of both the sector model and the concentric zone model. A majority of the residents on the South Side would account for zone three of both models. Yet, both populations live in zone two of Burgess’s model and zones two and three of Hoyt’s model. Why does this current demographic trend prevent either model from standing the test of time?
Modernization
Modernization is the reason for the invalidity of either model. Neighborhood socioeconomic status shifted through the 1900s and into the 2000s. The social process of gentrification has affected the North Side and the South Side of Chicago (to an extent).
The reason for hospital locations all comes down to their year of construction. Hospital construction occurred when both city models held some relevancy and validity in the late 1800s and early 1900s to accommodate the populations in the area. Time has made the models obsolete, but their lasting impact lies within the infrastructure.
Healthcare Trends in Major US Cities
I mentioned earlier that many cities fit into the concentric zone model and the sector model at some point, and I used Chicago as a model city to explain the models. The circumstances in Chicago are present in other major US cities, such as Philadelphia. Researchers found a direct correlation to access to healthcare and socioeconomic status (SES) of neighborhoods in Philadelphia. A usual source of care (USC) is prominent in localities with a higher SES.
Differences in Usual Source of Care
A usual source of care reduces the adverse effects of social disadvantage and relative deprivation of health (Hussein et al., 2016). Different USCs include regular visits to a primary healthcare provider. Individuals that lack a USC tend to seek healthcare at a hospital or community healthcare clinic when the situation is dire (Hussein et al., 2016). Research has also found that individuals part of the racial/ethnic minority with a low income are less likely to have a USC (Hussein et al., 2016). Burgess’s model puts recent immigrant groups in areas of deteriorated housing and factories. Residents here are likely to have a lower income. Working-class single families were also likely to live in tenements, according to Burgess’s model. Zones two and three of the concentric zone model consist of inhabitants who make up a lower SES and therefore need more convenient access to hospitals and clinics.
Empirical Data
From the research conducted by Hussein et al., empirical data referred to the community as a whole and not individuals. Neighborhoods with a lower SES have a slightly more difficult time accessing primary health care. Their difficulty equates to a 5% increase, compared to areas with a usual source of care. In addition, neighborhoods with a lower SES have a lower probability of 13% of accessing a USC. This circumstance was even observable in cities such as Los Angeles.
This study took place from 2002 to 2012, so the information discovered could not possibly be applied to the building of hospitals in the late 19th century and early 20th century. Urban planners were left to interpret correlations to build hospitals in areas that would most benefit.
Why are Hospitals Concentrated in the North Side and the South Side of Chicago?
We know that Chicago acts as a model city for the concentric zone model and the sector model. The model city has undergone demographic changes resulting from modernization and gentrification, and the observations of Chicago parallel those of other major United States cities. We also know that most of the hospitals in Chicago are in the North and the South Side, and both regions are abstract from one another. There are a few limiting factors in transportation that allow residents of either area of the city to access healthcare. Hospitals surround the central business district for historical reasons and still circle the central business district because of urban planning.
Diseases
Diseases took on urban areas by storm. Crowded living conditions caused there to be an increased rate of infection. Tuberculosis was the only disease that prompted the building of sanatoriums in remote areas. Otherwise, hospitals were near the communities that needed them. At the time, these communities lived in the areas around the central business district. It would be costly to move hospitals out of the North Side and relocate them to communities in need of better access to healthcare.
Urban Planning
The remodeling of a city is not an easy feat. According to cdc.gov, there must be a synergy between urban planning and public health. These synergies manifest in locations promoting physical activity, social integration, and better mental health. Clean water, a reduction in exposure to hazards, and the prevention of infectious disease are also imperative for city-wide health.
Healthier Lifestyles
Physical activity involves the creation of parks, promoting an escape from a sedentary lifestyle. Green spaces lie along the coast and are a common feature of every town. For towns in the outskirts, green spaces encourage a healthier lifestyle, so that way a health situation is less likely to be severe and to warrant a trip to the hospital. Social integration and better mental health are also associated with green spaces (cdc.gov). Parks and playgrounds facilitate social interactions and promote better mental health. Clean water and a reduction in exposure to hazards reduce the need to visit an emergency room for apparent reasons.
Prevention of Infectious Disease
Prevention of infectious disease reduces the risk of having a medical emergency too. On the South Side, Chicago, most of the housing includes apartments. From the COVID-19 pandemic, we know that social distancing mitigates the spread of disease. However, keeping a distance is not always possible in a small housing situation. Thus, the hospitals in the South Side provide some convenience, considering that infections can prompt trips to the hospital. There are some crowded locations outside of the South Side that may not be close to a hospital. But with urgent care facilities and paramedic services, individuals can seek healthcare without bounds that existed 100 years ago.
Urban Planning in Relation to Public Health
Public health trends have historically influenced the locations of healthcare facilities in cities that resembled Chicago in the early 1900s. Cities experience social and demographic changes over time. These changes result in the communities surrounding hospitals differing from the communities that surrounded hospitals in the last century. It may not be the case that these communities necessarily need hospitals in close proximity. As a result, urban planning must compensate communities for citizens to have access to healthcare. Compensations come in the form of transportation, infrastructure to promote better health, and more recently, urgent care and private clinical settings. Empirical data has shown that access to healthcare can be evaluated, and any further alterations to the surrounding environment may be made.
Referenced Materials
Hussein, Mustafa et al. “Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area.” Journal of urban health : bulletin of the New York Academy of Medicine vol. 93,6 (2016): 1027-1045. doi:10.1007/s11524-016-0085-2
https://www.cdc.gov/mmwr/preview/mmwrhtml/su5502a12.htm
Thank you for the article…