Cancer is Not the Problem

UChicago Medicine owes the people of the South Side the mental health care they need, not a $800 million cancer center that no one asked for.

By Dominic Robolino

In February 2022, University of Chicago Medicine (UCM) announced its plans to build the first freestanding cancer center in the city, a $800+ million, 80 bed endeavor. The new facility aims to increase access to care for Southsiders by enhancing research, screening, and treatment capacity across the inpatient and outpatient setting. By creating dedicated beds for cancer, the new facility is expected to free up existing hospital beds for the treatment of patients with other acute care needs. The University has primarily grounded this decision in references to the cancer burden of the South Side and a commitment to health equity.

UCM notes that cancer is the second leading cause of death on the South Side, and that cancer deaths are twice the national average. But—perhaps more importantly— it highlights that UCM’s 2020–2021 Community Health Needs Assessment (CHNA) identified cancer as a new priority for the community. By bolstering cancer care, UCM would be addressing an epidemiological need in a manner that aligns with community interest and input.

It sounds great—or, at the very least, sounds great in theory—but the reality isn’t quite that simple. Cancer is the second leading cause of death across all of Chicago and the entire United States. It’s not a problem unique to the South Side. Cancer death rates in UCM’s service area are twice the national average, but, as UCM points out, patients on the South Side are far more likely to be diagnosed at later stages, when cancers are more advanced and far less treatable. This, along with the fact that most of the deaths are attributable to lung and prostate cancers, implicates insufficient screening and primary care more than a lack of advanced diagnostics and treatment. But the most upsetting part of UCM’s efforts to justify the construction of its cancer center is its blatant misrepresentation of the results of the CHNA.

The CHNA contains pages of epidemiological data and graphs regarding the prevalence, incidence and impact of various diseases. But more importantly, it includes community survey data about the reported health needs of different age groups in UCM’s service area. The top five responses for each age group are listed in the report, summarized as follows: “[m]ental health is the only health issue that appeared across all three age groups, while violent crime, obesity, diabetes, and access to healthy food items were selected by respondents as top needs for two of the three age groups.” Cancer does not crack the top five for any age group. Additionally, in UCM-conducted focus groups, the most commonly identified issues aggregate around four themes: community-wide trauma, mental health, chronic diseases (specifically diabetes and heart disease), and lack of economic opportunity. Still not a single mention of cancer.

Cancer only appears as a priority under the UCMC FY (Fiscal Year) 2023–2025 Community Benefit Priorities report which is “based on the results of the community needs assessment.” It fails to mention what part of the assessment is being referenced. This is all very convenient, given the fact that non-profit hospitals like UCM are required to identify and address community needs in order to maintain their tax exempt status. By self-identifying cancer as a “community benefit priority,” UCM has retroactively prioritized a sector of medical care and research they already planned to enhance. In doing so, the University has effectively gamed the community benefit requirement by disguising its own goals as those of the community. Meanwhile, the South Side’s actual health needs persist unaddressed.

I’m not broadly opposed to the expansion of UCM. The South Side desperately needs more healthcare. As UCM notes, 56 percent of residents leave the area to access healthcare due to a shortage of local facilities and insurance barriers. One resident from the community focus groups specifically attributes the exodus to local “limitations with Medicare or Medicaid.” But in this regard, UCM is part of the problem. To this day, the University’s adult primary care group accepts virtually no Medicaid patients, aside from a handful of exemptions such as Native American ancestry, certain cancer and transplant care, and co-coverage with Medicare or another private insurer. While UCM accepts basic fee-for-service Medicaid, everyone who receives Medicaid in the state of Illinois is required to participate in the HealthChoice program—a Managed Care format. The South Side needs more mental health and primary care that is open to all people regardless of insurance payer. Not only is this what the community asked for in UCM’s needs assessment, but outside data also supports the value of this intervention.

In a 2021 report by UIC’s Institute for Healthcare Delivery Design and School of Public Health for the Illinois Department of Healthcare and Family Services, five areas of the state were identified as facing extreme social vulnerability. In all five of these communities, including South Chicago, three disease groups were identified as the largest contributors to the frequency and intensity of hospitalizations and poor health outcomes: mental illness, particularly bipolar and depressive disorders, substance use disorders, especially alcohol and opioids, and ambulatory care sensitive conditions such as hypertension, diabetes, COPD/asthma, and heart disease. The report identifies increasing access to quality primary and specialty care as the key intervention needed to lower hospitalization rates and improve health outcomes in areas of high social vulnerability such as the South Side.

In 2012, Rahm Emanuel closed half of the city’s 12 mental health clinics, four of which were located on the South Side. This worsened existing disparities in care access in a part of a city already faced with a disproportionately high prevalence of mental illness. Whether addressing the community’s self-reported subjective needs or the academically-identified drivers of healthcare utilization and poor health outcomes, the results are the same. The South Side wants and needs more accessible mental health care and primary care. What they’re getting is a titanic cancer center that skirts their needs. Imagine everything that could be done with $800 million allocated to mental health: inpatient rehab facilities, an addiction research center, outpatient psychiatry and therapy. The possibilities are limitless.

It’s time for the University to lay down the guise of community engagement and honestly address the concerns and needs of its service area. An academic medical center will always be indebted to its patients for the training they provide its students and residents and the data they supply its research adventures. The Affordable Care Act’s Community Benefit requirement was a step in the right direction, but institutional accountability is sorely lacking. As UCM strives for supremacy in cancer care, it should be honest about its motivations—whether they be financial, reputational, or otherwise—instead of halfheartedly manipulating data and misrepresenting community input to falsely legitimize its investments. The University owes the South Side the healthcare it deserves, not just the care UCM wants to provide.

Dominic Robolino is a graduate student at the University of Chicago Pritzker School of Medicine.