61 pages • 2 hours read
David A. AnsellThe Death Gap: How Inequality Kills
Nonfiction | Book | Adult | Published in 2017A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Part 1, Chapters 4-5Chapter Summaries & Analyses
Part 1: “American Roulette”
Part 1, Chapter 4 Summary: “Perception Is Reality”
Ansell discusses how present-day racial and ethnic biases perpetuate poverty and poor health in segregated communities. Despite historical structural violence creating high-poverty neighborhoods, ongoing bias continues to exacerbate the situation. Ansell argues that the conditions in these high-mortality neighborhoods are remediable, but change requires empathy and solidarity from wealthier communities.
Ansell emphasizes the significant “empathy gap” in America, whereby affluent communities have distanced themselves from the poor, both physically and emotionally. The wealthy, who control a disproportionate amount of the national income, have little need for public programs and thus little incentive to support policies that aid the poor. This wealth gap has widened significantly due to tax policies favoring the rich, resulting in significant income inequality. Ansell quotes the data that, in 1955, the richest Americans paid over 51% of their income in federal taxes, but by 2007, this had dropped to just under 17%. The economic policies over recent decades have funneled more wealth to the richest individuals, while slashing safety-net programs for the poor.
Ansell argues that to transform high-mortality neighborhoods like Windora Bradley’s, substantial investments and wealth redistribution are necessary. This requires the wealthy to support higher taxes and policies that channel resources back into impoverished communities. However, these measures would require empathy and an understanding of how the accumulation of wealth by the affluent has contributed to the suffering of the poor.
Ansell recounts a conversation with Niraj, a physician from Hudson, who expressed how his affluent friends dismiss the struggles of the poor, often blaming them for their plight. This perception gap, Ansell argues, is partly due to economic and racial segregation, which limits interactions between different communities and fosters negative stereotypes about the poor.
Furthermore, Ansell discusses the “broken windows theory” (47), which posits that visible signs of disorder in a neighborhood lead to more crime and further decline. Ansell presents evidence from sociologist Robert Sampson, who argues that it is not the actual disorder but the perception of disorder, influenced by racial and economic biases, that drives neighborhood decline. Sampson’s research shows that predominantly Black neighborhoods are perceived as more disorderly than white neighborhoods with the same level of physical disorder, leading to further stigmatization and decline. Racial perceptions and implicit biases thus significantly impact neighborhood reputations, contributing to economic and health disparities. For example, neighborhoods adjoining stigmatized poor Black communities are more likely to be stereotyped and segregated, leading to widespread poverty and segregation. Such stereotypes trap communities in cycles of poverty and poor health.
Ansell exemplifies his argument by discussing how these perceptions impact individuals like Windora Bradley, who live in high-poverty, high-crime neighborhoods. Windora’s struggles with diabetes and other health issues are intensified by her unsafe and resource-poor environment. Despite her constant efforts to improve her neighborhood and lead a healthier life, systemic barriers and a lack of resources continue to impede progress.
The chapter concludes by stressing the need for empathy and structural changes to address the death gaps. Wealthy communities must reinvest in poor neighborhoods and support policies that promote social and economic equity. This requires a redistribution of wealth through taxation to fund living wages, access to higher education, free healthcare, and safe housing. Ansell argues that inequality is a choice, but not for the disadvantaged—rather, it is a choice made by the whole society, especially for those with access to resources. He argues that, with the political and economic will, inequality can be addressed to create a more equitable society.
Part 1, Chapter 5 Summary: “The Three Bs: Beliefs, Behavior, Biology”
Chapter 5 begins with Ansell recounting a dinner party conversation where his explanation of structural violence as a cause of death gaps was met with skepticism on the part of a female interlocutor, a member of a middle-upper class society. Many people, including Ansell’s dinner companion, attribute health disparities to individual choices and behaviors rather than broader systemic issues.
In the conversation, Ansell addressed the common belief that poor health outcomes are a result of individual lifestyle choices, such as diet and exercise, and genetic predispositions. He noted that while it is true that poor people tend to have higher rates of smoking, drinking, drug use, obesity, hypertension, diabetes, and other health issues, this view oversimplifies the problem. He argued that attributing health disparities solely to individual behaviors and biology ignores the significant impact of structural factors like poverty, racism, and lack of access to healthcare. Nevertheless, Ansell’s interlocutor was not open to the argument, maintaining her position and ending the conversation. Ansell admits that he needs to become more diplomatic in conversations, as he aims to be an advocate for the vulnerable communities he works with.
Ansell discusses the fact that historically, scientific and medical establishments have explained health inequalities through racial, ethnic, and biological differences. These ideas date back centuries and have been used to justify enslavement and segregation. He gives several examples of scientific racism, such as the Tuskegee Syphilis Experiment and secret military experiments on minority soldiers during World War II, in which Black men were subjected to chemical experiments without their knowledge and with disastrous effects on their wellbeing. These instances highlight how systemic racism has been perpetuated through pseudoscientific methods and unethical research practices.
Environmental racism is another example of how structural violence affects health outcomes. Ansell points to the high rates of child asthma in Chicago, which have been linked to pollution from coal-burning power plants in predominantly Black and Latino neighborhoods. Similarly, the Flint water crisis, where lead-contaminated water disproportionately affected Black children, exemplifies how systemic neglect and racism contribute to poor health outcomes.
The concept of “precision medicine” (59), which is supposed to treat health issues specific to a race or a community, also reflects scientific racism. Ansell critiques the FDA’s approval of Bi-Dil, a heart failure drug marketed specifically to African Americans, despite a lack of evidence supporting race-based biological differences in drug efficacy. He warns that such practices divert attention from addressing the real societal causes of health disparities.
Ansell introduces the idea of “biological weathering” (69), according to which chronic stress from racism and poverty leads to premature aging and disease. Ansell notes that studies have demonstrated how the effect of discrimination and stress can lead to worse health outcomes, such as low birth weight and higher rates of chronic diseases. This suggests that the social and environmental conditions in which people live have a profound impact on their health.
The chapter also highlights the importance of neighborhood environments on health. Ansell recounts the story of Cora Murphy, the sister of Windora Bradley, who experienced significant improvements in her health after marrying a computer technician and moving from an inner-city neighborhood to a suburban area. This anecdote supports the idea that moving to a lower-stress, lower-poverty environment can have positive health effects. However, Ansell notes that many people living in poverty are unable to move and remain stuck in high-stress environments, perpetuating poor health outcomes.
Finally, Ansell emphasizes that individual responsibility for health is important, but it is not sufficient to close the death gaps in the United States. He argues that addressing systemic issues like poverty, racism, and lack of access to healthcare is crucial for improving health outcomes and reducing inequalities.
Part 1, Chapters 4-5 Analysis
Chapters 4 and 5 continue the book’s exploration of health disparities by discussing the contemporary influences of racial and ethnic biases. Ansell shows how present-day biases perpetuate the cycle of poverty and poor health in segregated communities. These biases manifest in various forms, from overt discriminatory practices to more subtle, systemic inequalities, invoking Environmental and Social Determinants of Health Disparities.
One of the main ideas in these chapters is the significant empathy gap between affluent and impoverished communities. Ansell argues that this gap is a major barrier to addressing health disparities. Wealthier individuals often attribute the struggles of the poor to personal failings, an attitude fostered by economic and racial segregation. In recounting a dinner conversation in Chapter 5, during which his explanation of structural violence was met with skepticism, he highlights a common tendency among affluent individuals to attribute health outcomes to individual choices and behaviors alone.
Ansell argues that this perspective oversimplifies the complex interplay of factors that contribute to health disparities. This perception is worsened by tax policies that favor the rich, widening the wealth gap and diminishing the support for public programs that could alleviate poverty. He asserts that the idea of personal choice, coupled with the misconception that health inequalities are based on racial and ethnic differences, underscores how systemic racism has been perpetuated under the guise of individualism and scientific inquiry, further entrenching health disparities. Instead, Ansell uses the concept of “biological weathering,” where chronic stress from racism and poverty leads to premature aging and disease. This idea challenges the notion that health disparities are solely the result of individual behaviors or genetic predispositions.
Ansell also relates the lack of empathy of the wealthy to the “broken windows theory,” which posits that visible signs of disorder lead to further crime and decline. Ansell refutes this theory, emphasizing perception based on racial and economic biases. He cites sociologist Robert Sampson’s research, which argues that Black neighborhoods, regardless of their actual state, are often perceived as more disorderly, leading to stigmatization and further economic decline. The gaps in empathy create a self-reinforcing cycle, wherein social behaviors and beliefs reinforce systemic violence, deepen economic disparities, and undermine social cohesion.
Although empathy itself cannot directly create a more equitable environment, Ansell presents the emotional experience of empathy as an adhesive that can bring people together and push them towards embracing The Role of Community Activism, which he will continue to explore in later chapters.
