The Morality of Inequality

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In the minutes before Dr. David Ansell’s scheduled talk on January 16 at Northwestern University, he begins chatting comfortably with the crowd, asking what year the students are, if they’re from Chicago, and what interest they have in public health. Brought to campus as a member of the Global Health Speaker Series, Dr. Ansell is a physician and health activist with a striking story. The title of his talk, “County: Life, Death and Politics at Chicago’s Public Hospital,” only introduces a portion of the insight that Ansell brought to Northwestern students and Evanston residents. Instead, Dr. Ansell deftly wove in a broader theme of morality; as he told of his journey as a doctor in one of the nation’s most infamous hospitals and beyond, he kept a running commentary that wasn’t previewed in the talk’s title.  This perception, coupled with a series of unique and powerful experiences, brought his talk to life in the minds of listeners, as well as prompted broader questions beyond a chronological understanding of his time as a Chicago physician.

Ansell’s book chronicles his time at Cook County Hospital, where he headed after graduating medical school in June 1978. County is one of two publicly funded hospitals in Chicago, located just west of Chicago’s Loop. As Ansell introduces the place, he puts special emphasis on who the patients at County really are: anyone who knows up in need. “I wrote the book out of outrage,” Ansell says within the first few minutes of his speech. For those listening, it is just the first of many strongly worded emotions offered by Ansell during his hour-long talk.

Right from the start, it is clear that Ansell is driven by a strong sense of self-understanding. He’s able to explain his intentions with an eloquence that brings listeners right along with his story, declaring that he, “always knew I wanted to be a doctor.” He grew up with stories of his family during the Holocaust, and that translated into a habit of questioning how ordinary people could behave in such a manner. This is the first mention we hear of Ansell’s insight into morality, and a point that is once again referenced later in his talk. It is that family history that served as the driving force that sent Ansell to medical school – but as he explained, it didn’t mean he felt comfortable during his studies.

“I hated medical school,” he says. “Things that were important to me weren’t discussed.” Ansell yearned for discussion of our nation’s healthcare system and conditions. Instead, he said, he wanted to quit in the first year.

With a group of similarly minded friends, Ansell formed an upstate health care forum and began to study the US health care system. “I knew what I wanted to do,” he says. “I had reasons. I wanted to do good things.” Through discussions with this group of friends, Ansell was able to identify his ultimate motivation that has driven his life’s work for years beyond: “Health is a human right.”

Motivations made clear, Ansell continued with medical school, driven by the hope that he could one day contribute to the broader issue of health inequality around the US. This led him to County in 1977. After road tripping from Syracuse to Chicago with his group of friends, they entered the hospital for the first time. “It was like no hospital I’d ever seen,” Ansell remembers, “until I went to Haiti after the 2010 earthquake.”

The place smelled, equipment didn’t seem to function properly, and a sense of chaos reined over the establishment; yet, the group knew it was the right place for them. Sometimes in life there are moments of hindsight where someone’s existence so clearly changes; entering County was that moment for Ansell. To a captivated crowd decades later, he admits that choosing County was, “the single best decision I made in my life.”

In medical school, he felt that professors tried to dissuade his focus from the moral side of medicine, but at County, Ansell found a place where he wasn’t just learning medicine, but had the opportunity to fight for human rights. They called themselves “doctors within borders,” and within days of beginning at County, Ansell and his group of friends found themselves making banners, distributing pamphlets, and picketing to save the hospital from near demise due to lack of public funding.

It felt normal to him, Ansell remembers, to spend time treating patients in the hospital then heading out to the front lines. Listening to him speak, it’s almost as if he’s recounting a fictional story: the young doctors go to work by day in a underfunded hospital and fight for equality by night, simply because they want to. It isn’t just a story, however, made clear by the emotional undercurrent in Ansell’s voice. It isn’t a fairytale, either: in 1979 the hospital ran dry of funding, and Ansell and his colleagues had to push their patients in wheelchairs to Rush University Medical Center.

At this time, BBC happened to be filming a documentary about healthcare in the US and came to County. Asked about the patient transfer process, one doctor told them, “well, I don’t know about you, but I call it murder.” Listening to Ansell recount this in 2013 feels eerie, like a part of history that is unfathomable – yet it happened mere miles away.

Throughout his talk, Ansell skillfully paints a picture of morality and inequality. As he tells of the fallout from Cook County’s closing, he begins to interject comments that offer further insight into his beliefs surrounding public health.

“It’s important to have a belief system,” he says. The system in Chicago shocks listeners around the room; many mouths fell open as Ansell described the strategies of private hospitals to transfer insurance-less patients elsewhere. They told patients there weren’t enough beds, he tells us, when in reality, they knew as well as he did that they were unjustly endangering patients. “They were doctors just like me,” he recalls, “they just didn’t speak up.” Some of these patients died, he says. “It was a system designed to kill people.”

Eventually, Ansell wrote a paper to send to the New England Journal of Medicine about the problem and testified before Congress about the immoral activities of these transfers.

As he continued to talk, Ansell shared his belief that our nation is separated into “Two Americas: Separate and Unequal.” With his research into inequality in mortality rates, specifically that of breast cancer, his work is making an incredible difference in the understanding of how Americans continue to be guided by a growing income gap.

It seems incredible that all this (and much more) could have fit into an hour-long talk, but then again, Dr. Ansell has fit an incredible amount of experience into a career that will only continue in the years ahead. To read more about his experiences and County: Life, Death, and Politics at Chicago’s Public Hospital, visit

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Posted by ELLEN DREWRY on

My grandaughter has has been an excellent writer all through school and her interesting article demonstrates her talent again. International public health is her interest. I feel she will contribute to it.

Posted by David on

You should be proud of your granddaughter. She is an excellent writer.

Posted by Public Health in the News | NPHR Blog on

[…] Global Health Blog tells the story of a recent talk by Dr. David Ansell on the fight for human rights in one of Chicago’s […]

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