Testimony to the Public Hearing for the South Suburban Communities July 23, 2015, Gloria Taylor Banquet Hall, 14820 Broadway, Harvey, IL Hosted by: Illlinois Commission to End Disparities of American Americans; Co-Chairs: State Representative Monique Davis and State Senator Emil Jones. Community Co sponsors: Illinois African American Family Commission; Harvey Area Chamber of Commerce

1. Testimony: Bonnie Rateree, Cook County PLACE MATTERS July 23, 2015 Page 1
Public Hearing for the South Suburban Communities
Gloria Taylor Banquet Hall, 14820 Broadway, Harvey, Illinois
Testimony from Bonnie Rateree
Representing Cook County PLACE MATTERS
July 23, 2015 6:00 p.m. – 8:30 p.m.
1. [Introduction]
Good evening. My name is Bonnie Rateree, I am a life-long resident of Harvey, an
elected school-board member, and a master gardener promoting food and nutrition. This
evening I am giving testimony on health inequities in my role as Steering Committee
Member of Cook County PLACE MATTERS.
The two points of my testimony to you, elected officials in this public hearing tonight, is
that first, the roots of health inequities are to be found in the systemic, structural racism
of our County, State and country, which distributes the social determinants of health
unfairly and inequitably. And second, that we can only fulfil the human right to health—
and achieve health equity----by changing policy.
The popular explanation of health and disease is that each individual person is
responsible for her or his health, and that hospitals and physicians are the source of
health. However, a large and growing body of evidencei
shows this explanation of health
is wrongii
. While access to medical care is very important, these dominant narratives are
not true. These explanations tend to blame the victim, and shift attention away from the
policies that create societal conditions that produce a disproportionate burden of illness
and premature death among the Black population living in the Southland. In the words of
US health expert Jonathan Fielding “the fundamental challenge is convincing the

2. Testimony: Bonnie Rateree, Cook County PLACE MATTERS July 23, 2015 Page 2
American people that their health, individually and collectively, is primarily determined
by the social, physical, and economic environments in which we live.”iii
It is not an
accident that the social, physical and economic environment confronting the children and
families of Harvey, where I live and work, is so toxic. The environments that threaten the
lives of African-Americans in the southern suburbs of Cook County did not come about
naturally, they didn’t ‘just happen.’ The daily living conditions that cut Black lives short
are the result of policy. Journalist and author Ta-Nehisi Coates refers to the importance of
policy in his book on growing up in Baltimore: He writes “To be black in the Baltimore
of my youth was to be naked before the elements of the world before all the guns, fists,
knives, crack, rape, and disease. The nakedness is not an error, nor a pathology- the
nakedness is the correct and intended result of policy...”iv
2. [Evidence of racial health inequities]
I will now briefly describe evidence of population health inequities. Life expectancy can
be predicted by where you live in Cook County:
 People living in neighborhoods with a median income of over 53,000 per year
lived almost 14 years longer than people living in neighborhoods with a median
income of less than 25,000 dollarsv
;
 Black babies born to women in the South suburbs of Cook County are three
times-- that is 300%-- more likely to die before their first birthday than are white
babies born to women in the North suburbsvi
;
 African-Americans in the South Suburbs are more than twice as likely to die from
diabetes when compared to their white counterparts living in the northern suburbs,
according to 2010 data from the Cook County Department of Public Health.vii

3. Testimony: Bonnie Rateree, Cook County PLACE MATTERS July 23, 2015 Page 3
Let me emphasize again that these unjust and preventable racial health inequities are
caused by powerful forces that distribute education resources, money, and living
conditions unfairly base on race and geography. Research from the American Journal of
Public Health for example, found that in the year 2000, 245,000 deaths in the US were
attributable to having less than a high school education. That is 50,000 more than the
number of people who died from heart attack that year.viii
Research on police violence
from the Harvard School of Public Health found that there is a disproportionate rate of
deaths among US black and white men due to law enforcement action: Between 1960 and
2010, Black men aged 15-34 years died from law enforcement actions at least 2.6 times
(260% more) the rate of their white counterparts.ix
3. [Policy Recommendations]
Let me make four policy recommendations;
First, we need to put an end once and for all to the unfair and broken system of education
financing that relies on local property taxes to fund public education. Education finance
expert and state budget analyst Ralph Martire has referred to this as a “structurally racist
system of finance that selects African Americans and Latinos for very poor education.”x
Second: Raise the minimum wage and eliminate the tipped wage in Illinois so that
working adults will be able to have an income more able to sustain health for themselves
and their children. The US has the least supportive family policies, and the highest child
poverty rate, among 20 wealthy countries in the world.xi
Maps of the Chicago area have
been created showing the locations where the opportunity for children to reach their full
potential is low, high and in between. The pattern in our area is similar to that of the
nation as a whole: Black and Hispanic children are concentrated in the lowest opportunity

4. Testimony: Bonnie Rateree, Cook County PLACE MATTERS July 23, 2015 Page 4
neighborhoods.xii
Thousands of people in Cook County work in the exploding restaurant
industry, in which tipped-wage workers receive less than the minimum wage, and do not
have equal opportunity to work in higher paid positions held disproportionately by white
males.xiii
Raising incomes for working adults increases the opportunities for children and
adults to be healthy.
Third: Illinois and the US needs to fully fund child care for adults with children so that
they can work outside the home. Access to quality and affordable child care is an
important part of helping children be healthy and develop fully. In our recent panel and
film screening of The Raising of America, Cook County PLACE MATTERS heard loud
and clear from working parents about the high cost of child care. The audience told our
panel that elected officials need to watch the film to better understand the issue.
Finally, legislators should make it mandatory that health care providers report deaths and
injuries caused by police actions to health agencies in a timely manner. This would make
‘legal intervention’ when injury or death is involved a reportable condition. Policing is a
critical and unrecognized determinant of health inequities, yet the US does not maintain a
complete count of individuals killed by police. And according to research by Justin
Feldman, there is “widespread unwillingness on the part of police departments to share
data with the public. State and local health departments can serve as the independent
monitors of police violence”xiv
that we need.
Thank you for this opportunity to provide testimony. My remarks also have Appendices
and References which I hope are helpful to this Hearing.

5. Testimony: Bonnie Rateree, Cook County PLACE MATTERS July 23, 2015 Page 5
End Notes
i
Solar and Irwin (2010) A conceptual Framework for action on the social determinants of health. Geneva: World
Health Organization; Koh, et al. (2011) Healthy People: A 2020 Vision for the social determinants approach. Health
Education and Behavior, 38(6), 551-557; National Association of County and City Health Officials. (2014). Expanding
the Boundaries: Health equity and public health practice. Washington, DC: NACCHO.
ii
Raphael, D. (2002) Social justice is good for our hearts: Why societal factors---not lifestyles---are major causes of
heart disease in Canada and elsewhere. Toronto: CSJ Foundation for Research and Educaiton.
iii
Fielding, J. E. Public Health in Big Cities: Looking back, looking forward. Journal of Public Health Management and
Practice, 21, Supplment 1, S20-3. Page S22.
iv
Ta-Nehisi Coates quotation. cited by Muwakil, Salim, July 21, 2015. “Ta-Nehisi Coates’ “Between the World and
Me” Forever Changes the Meaning of ‘The American Dream’ In These Times-Views.
http://inthesetimes.com/article/18221/salim-muwakkil-reviews-between-the-world-and-me Full quotation: “The
nakedness is not an error, nor a pathology- the nakedness is the correct and intended result of policy, the
predictable upshot of people forced for centuries to live under fear.”
v
Cook County PLACE MATTERS & Virginia Commonwealth University (2012). Place Matters for Health In Cook
County
vi
Cook County Department of Public Health (2010) Community Health Status Report—Infant Mortality Figure 3,
page 2 http://www.cookcountypublichealth.org/files/data-and-reports/chsa/CHSA%20Section%204.pdf Accessed
July 22, 2015.
vii
Cook County Department of Public Health (2010) Community Health Status Report—Diabetes Figure 4, page 3.
http://www.cookcountypublichealth.org/files/data-and-reports/chsa/CHSA%20Section%203.pdf Accessed July 22,
2015.
viii
Galea, S. et al (2011). Estimated deaths attributable to social factors in the United States. American Journal of
Public Health, 101(8), 1456-1465.
ix
Krieger, N., et al. (2015). Trends in US deaths due to legal intervention among black and white men, age 15-34
years, by county income level: 1960-2010. Harvard Public Health Review, 3, 1-5.
x
Martire, Ralph February 11, 2014. “School Funding Reform, Closing the Opportunity Gap” Presentation, DePaul
University, Chicago. Cable Access Network TV accessed on Youtube Feb 20, 2014.
xi
Marmot, M. (2007) Achieving health equity: From root causes to fair outcomes. Lancet 370(9593), 1153-1163.
xii
Acevedo-Garcia, D. (2014). The child opportunity index: Improving collaboration between community
development and public health. Health Affairs, 33(11), 1948-1957.; See also maps available online at
DiversityDataKids.org
xiii
ROC Chicago
xiv
Feldman, Justin “Public Health and the Policing of Black Lives” Harvard Review of Public Health No. 6, July 2015.
http://harvardpublichealthreview.org/public-health-and-the-policing-of-black-lives/

6. Cook County Department of Public Health
Community Health Status Report 2010 Infant Mortality- Page 2
2000-2002 vs. 2005-2007
By Race
The infant mortality rate for the
Cook County Department of
Public Health’s (CCDPH)
jurisdiction decreased slightly
from 7.3/1,000 in 2000-2002 to
6.9/1,000 in 2005-2007.
From 2000-2002 to 2005-2007,
while the infant mortality rate
among Asians increased slightly
from 3.4 to 4.3/1,000, the rate was
below the Healthy People (HP)
2010 goal of 4.5/1,000. The infant
mortality rate among African
Americans (AA) in the same time
periods remained the same
(approximately 14.3/1,000).
Infant mortality rates decreased
slightly for Hispanics (from 6.3 to
5.5/1,000) and for Whites (from
5.5 to 5.0/1,000).
Figure 2
2005-2007
By Race/Ethnicity
During 2005-2007, the infant
mortality rate for SCC was 15.1
per 1,000, slightly higher than the
Illinois and U.S. rates (14.5 and
14.1/1,000 respectively).
The infant mortality rate in the
South district was 11.3/1,000
which was more than double that
of the North district, which was
4.4/1,000.
In all regions, the rates of infant
mortality for African Americans
was approximately double that of
Whites and Hispanics. The West
district had the highest rate of
infant mortality for African
Americans (17.8 per 1,000),
followed by the South district
(14.3 per 1,000).
Figure 3

7. Cook County Department of Public Health
Community Health Status Report 2010 Diabetes- Page 3
2005-2007
By Race/Ethnicity
The diabetes mortality rate in
SCC (62.5/100,000) was lower
than Illinois (69.7/100,000) and
the U.S. (75.5/100,000).
Diabetes mortality rates were
highest for AAs compared to
other racial/ethnic groups
across all regions. In SCC, the
AA diabetes mortality rate
(135.9/100,000) was higher than
the AA rate for Illinois
(101.2/100,000).
The overall diabetes mortality
rates among Asians in SCC, were
much higher than the U.S. and
Illinois rates, notably in the
North district, 113.8/100,000
which was double the U.S. rate
(56.3/100,000).
Figure 4
2005-2007
By Gender
Across all regions, diabetes
mortality rates for males were
higher than females. In SCC, the
diabetes mortality rate for males
was 81.0/100,000 compared to
females at 50.8/100,000.
Diabetes mortality rates for
males (108.3/100,000) and
females (68.0/100,000) were the
highest in the South district
Figure 5

8. Cook County Department of Public Health
Health Equity…
the attainment of the highest level of
health for all people (US DHHS 2011)
Source: Virginia
Commonwealth
U., Cook County
PLACE MATTERS
(2012)

9. T
o inform current national discussions about the deaths of black
menduetothepolice,1wepresentnoveldataonlong-termtrends
(1960-2010) in deaths due to legal intervention (i.e., deaths due
to law enforcement actions) among US black and white men, by county
income level. Among the three health studies investigating trends in this
outcome, one focused on the total US population for 1962-1993, 2 one
documented a marked excess for young adult black as compared to white
menfor1979-1997,3andthethirdreportedonsystematicunderreporting
of such deaths, overall and by race/ethnicity and age, for 1976-1998; 4
none included socioeconomic data.
Methods
We analyzed US national mortality data for 1960-2010, 5 6 using
individual-level mortality records and census denominator data
stratified by age, gender, and race/ethnicity, aggregated to the county
level, and to which we have appended the corresponding year-specific
US county median family income data, categorized into quintiles. 7 We
report trends (3-year moving average mortality rates) for the two main
groups at risk: US black and white men, age 15-34.
Trends in US deaths due to
legal intervention among
black and white men, age 15-
34 years, by county income
level: 1960-2010
Nancy Krieger, PhD, Mathew V. Kiang, MPH, Jarvis T. Chen, DSc, and
Pamela D. Waterman, MPH
VOLUME 3, JANUARY 2015
1

10. Results
Between 1960 and 2010, 15699 US deaths were classified as due
to legal intervention, of which 63.3% (n=9934) occurred among men
age 15-34. Among these men, 5489 were classified as white (55.3%) and
4204 as black (42.3%), a percentage 3 to 4 times that for the US black
population (e.g., 1960: 10.5% black, 88.6% white; 2010: 12.6% black,
72.4% white). Only rates for the black men exhibited a sharp rise and fall
(1960s-1970s) followed by a post 1980-plateau; rates for the white men
exhibited far less variation (Figure 1, Table 1). The rate ratio for black
vs. white men for death due to legal intervention always exceeded 2.5
(median: 4.5) and ranged from 2.6 (95% confidence interval [CI] 2.1, 3.1)
in 2001 to 10.1 (95% CI 8.7, 11.7) in 1969, with the relative and absolute
excess evident in all county income quintiles (Table 1).
Discussion
Our results indicate that the excess black vs. white mortality rate
among men age 15-34 due to legal intervention is both longstanding –
and modifiable. Given documented greater underreporting of black vs.
white homicides by police officers, the results also likely underestimate
the black vs. white excess. Moreover, the lack of sharp difference
by county income quintile, post-1980, stands in contrast to well-
documented inequities by county income level for both infant mortality
and premature mortality (death before age 65), suggesting that societal
determinants of deaths due to legal intervention are driven by additional
or different aspects of societal inequality. We cannot, based on the
limited data available, address debates over whether our findings reflect
racially biased use of excessive force. Nevertheless, the data presented
provide context for the 2014 emergence of police killings as a highly
visible topic. Repeated protests have taken place in most major US
cities, about both the deaths themselves and also – in the two very high
profile cases involving Michael Brown (Ferguson, Missouri) and Eric
Garner (Staten Island, New York) – the decision of grand juries to decline
recommendingthatcriminalchargesbefiledforthesedeaths.Journalists
report that these latest deaths and the responses of the criminal justice
system have reignited the concerns and distress triggered by the 2012
acquittal of George Zimmerman, a volunteer neighborhood watchman
who killed the teenager Trayvon Martin. In all three of these cases, the
victims were unarmed Black American teenage boys or men. The dearth
of health research on police killings and their impact on the families,
neighborhoods, and communities affected is stark. When it comes to
reckoning the toll of racial inequality, accountability requires counting.
We offer these descriptive analyses to stimulate further investigation
into the patterns, causes, and consequences of social inequalities in
deaths due to legal intervention.
2
TRENDS IN
U.S. DEATHS
DUE TO LEGAL
INTERVENTION
Nancy Krieger, PhD
Mathew V. Kiang, MPH
Jarvis T. Chen, DSc
PamelaD.Waterman,MPH
VOLUME 3 JANUARY 2015

11. Figure 1. Trends in US mortality rates (3-year moving average), 1960-2010, for black and white
men, ages 15-34, for deaths due to legal intervention, by county income quintile (lowest three
versus top two)
3
VOLUME 3 JANUARY 2015
TRENDS IN
U.S. DEATHS
DUE TO LEGAL
INTERVENTION
Nancy Krieger, PhD
Mathew V. Kiang, MPH
Jarvis T. Chen, DSc
PamelaD.Waterman,MPH
Table 1
US mortality rates (3-year moving average, per 100,000), and rate
ratio and rate difference (and 95% confidence interval (CI)), for black
and white men, ages 15-34, for deaths due to legal intervention, overall
and by county income quintile: 1965, 1975, 1985, 1995, and 2005
International
Classification of
Diseases (ICD):
version*
Death due to legal intervention
ICD-7 (1958-1967) (E984) “Injury by intervention ofpolice” (and not including: (E985)
“Execution”)
ICD-8 (1968-1978) (E970-E977) “Legal intervention” (and excluding (E978)”Legal
execution”)
ICD-9 (1979-1998) (E970-E977) “Legal intervention (and excluding (E978) “Legal
execution”)
ICD-10 (1999-20120) (Y35.0-Y35.4, Y35.6-Y35.7) “legal intervention” (and excluding
(Y35.5) “executions”)
* ICDcodes as listed at: http://www.wolfbane.com/icd/(http://www.wolfbane.com/icd/)

12. 4
TRENDS IN
U.S. DEATHS
DUE TO LEGAL
INTERVENTION
Nancy Krieger, PhD
Mathew V. Kiang, MPH
Jarvis T. Chen, DSc
PamelaD.Waterman,MPH
1975 Total 2.96 0.39 7.56 (6.52,
8.77)
2.57 (2.26, 2.87)
Income quintile:
Q1 (low) 2.27 0.45 5.03 (3.63, 6.98) 1.82 (1.31, 2.33)
Q2 3.33 0.38 8.67 (6.29, 11.99) 2.94 (2.26, 3.62)
Q3 3.53 0.44 8.02 (5.68, 11.25) 3.09 (2.19, 3.99)
Q4 3.37 0.38 8.93 (6.50, 12.31) 3.00 (2.30, 3.69)
Q5 (high) 2.46 0.30 8.13 (5.21, 12.53) 2.16 (1.36, 2.95)
1985 Total 1.25 0.28 4.48 (3.71,
5.39)
0.97 (0.79, 1.15)
Income quintile:
Q1 (low) 0.91 0.29 3.08 (1.98, 4.75) 0.61 (0.31, 0.91)
Q2 0.86 0.22 3.87 (2.28, 6.43) 0.64 (0.30, 0.98)
Q3 2.03 0.34 6.03 (4.24, 8.58) 1.69 (1.19, 2.19)
Q4 1.37 0.31 4.46 (2.98, 6.62) 1.06 (0.65, 1.47)
Q5 (high) 1.08 0.23 4.61 (2.63, 7.80) 0.84 (0.38, 1.31)
1995 Total 1.21 0.36 3.37 (2.81,
4.02)
0.85 (0.68, 1.02)
Income quintile:
Q1 (low) 1.10 0.57 1.94 (1.35, 2.77) 0.53 (0.20, 0.87)
Q2 0.96 0.26 3.73 (2.30, 5.98) 0.71 (0.35, 1.06)
Q3 1.43 0.47 3.04 (2.11, 4.33) 0.96 (0.55, 1.36)
Q4 1.41 0.31 4.56 (3.02, 6.83) 1.10 (0.67, 1.53)
Q5 (high) 1.13 0.21 5.49 (3.19, 9.27) 0.92 (0.48, 1.37)
2005 Total 0.94 0.37 2.57 (2.12,
3.09)
0.58 (0.43, 0.72)
Income quintile:
Q1 (low) 0.87 0.37 2.33 (1.54, 3.48) 0.49 (0.21, 0.77)
Q2 0.89 0.41 2.16 (1.42, 3.24) 0.48 (0.17, 0.79)
Q3 1.19 0.41 2.89 (1.93, 4.28) 0.78 (0.40, 1.16)
Q4 0.76 0.34 2.22 (1.35, 3.55) 0.42 (0.11, 0.73)
Q5 (high) 1.09 0.30 3.65 (2.21, 5.89) 0.79 (0.37, 1.21)
Year Group Death due to legal intervention
Rate Rate ratio Rate difference
Black White RR (95% CI) RD (95% CI)
1965 Total 3.33 0.44 7.65 (6.48,
9.02)
2.90 (2.51, 3.28)
Income quintile:
Q1 (low) 2.33 0.36 6.45 (4.30, 9.72) 1.97 (1.35, 2.59)
Q2 4.78 0.35 13.60 (9.44, 19.76) 4.43 (3.38, 5.48)
Q3 3.36 0.51 6.57 (4.59, 9.38) 2.85 (2.00, 3.69)
Q4 3.21 0.59 5.47 (3.78, 7.84) 2.62 (1.72, 3.52)
Q5 (high) 3.43 0.36 9.61 (6.15, 14.93) 3.07 (2.01, 4.14)
VOLUME 3 JANUARY 2015

13. 5
TRENDS IN
U.S. DEATHS
DUE TO LEGAL
INTERVENTION
Nancy Krieger, PhD
Mathew V. Kiang, MPH
Jarvis T. Chen, DSc
PamelaD.Waterman,MPH
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VOLUME 3 JANUARY 2015