Chicago has made national headlines for the more than 780 murders last year and the dozens of homicides committed already this year in the city. The University of Chicago Medicine is now building the only adult Level I trauma center located on the South Side, one of the city’s most violence-plagued communities. Spearheading the effort is Selwyn Rogers Jr., M.D., a Harvard-trained surgeon and public health expert who previously served as chief medical officer with the University of Texas Medical Branch in Galveston. We recently profiled Rogers here. This interview is an extension of that conversation.
What caught your eye about this role?
ROGERS: When you hit 780 homicides, it gets everyone’s attention, especially at a time when murders in New York and Los Angeles were significantly down. Because the University of Chicago has not had a Level I trauma center since 1989, there was a fairly strong community activist push for the university to redevelop or relaunch its adult Level I trauma center to supplement its existing pediatric trauma center and burn center. Initially, I was approached by the chair of surgery at the university, who I knew from my Boston days. But I said, 'No,' and then I gnawed on the idea and prayed on the idea. I thought about what I said I was going to do, which is to focus my life on being happy holistically — not titles, money or worldly possessions, but being happy in my relationships and taking care of myself.
And the second thing was to have impact. Chicago, a world-class city by many measures, had this seemingly intractable problem of intentional violence, especially gun violence, on the South and West sides, disproportionately in certain ZIP codes and certain demographic groups. Mostly people of color are the victims and perpetrators of violence. And it's not just those 780 names or the 130 in the first three months this year. It’s the ripple effect of all the lives that those people touched: their kids, their friends, their loved ones, their community — and the impact that it has, broadly speaking. We have to do something different with a whole bunch of people already doing a fair bit of work. There are a lot of people in these communities trying to do good work with young people, with gangs, with violence interruption. But somehow, the combination of all those things has not materialized in better outcomes and better health for the population.
This is an opportunity to start up a Level I trauma center at University of Chicago Medicine and engage with deep community needs more aggressively as a partner, as a convener, as a facilitator. How can we actually work across many silos to address what I would frame as the underlying social underpinnings of ntentional violence: poverty, homelessness, hopelessness, underemployment, unemployment, lack of education?
Talk about your initial listening tour of the community.
ROGERS: That listening tour is fairly broad. It’s an internal listening tour within the organization as to changing the culture of what it takes to be a Level I trauma center. We’re already a great hospital with regard to cardiac surgery, pediatric trauma, burn surgery, and transplant and cancer care — and all of those things except adult trauma. But trauma adds another level of urgency. If someone is shot in the chest, you have to act pretty quickly. The other element is that there are services that work pretty well in the, quote, unquote, day hospital, from 7 a.m. to 7 p.m. But we're also going to have to function well in the night hospital, from 7 p.m. to 7 a.m.
The other key piece is outward-facing. So, my other role is serving as the executive vice president of community health engagement. And, largely, that role is designed to address population health on the South Side. Beyond trauma, I will look at health care disparities related to cancer, diabetes and peripheral arterial disease. How can we improve the health of the population of the South Side where people of color disproportionately suffer the ill effects of end-stage renal disease or poorly controlled diabetes, poorly controlled hypertension, or lack of access to mental health services? Quoting [visionary American architect and urban planner] Daniel Burnham, “Make no little plans.” We have that audacious goal of our own. I can't think of anything more compelling than this: We will eliminate health care disparities, improve the health of the population and reduce violence on the South Side. … How can we make communities safe and healthy, where people live, breathe, play and pray every day?
After coming here from Texas, has your perception of the city's violence changed?
ROGERS: From the outside looking in, one would say, 'Oh my goodness, look at the outcomes. It's been horrible.' But the reality is that people are doing good work every day to address these issues. I’ve attended listening tours at three churches and a briefing related to the Department of Justice report from the mayor's office. I've attended community advisory council meetings. I’ve gone to LaRabida Children’s Hospital and community events to try to reach folks and listen to their perspectives. What I hear is that the hypersegregation in Chicago, the lack of economic opportunity for people of color in certain communities, the uneven educational system, fractured families and fragmented services all lead to a system for which we’re getting the results that we see. These are complicated issues. But if you don't address poverty, homelessness, hopelessness, educational and employment opportunities, we could be looking at this for decades. This is a crisis right now, but it's not just a crisis in Chicago. It's a crisis in Flint, Mich., in St. Louis, in Baltimore. We need local solutions that are intersectional, that positively affect poverty, disrupted families and medical services across the spectrum. We need multiple interventions to address all these things, and by addressing them in a complex ecosystem, we could have a chance — but not through a siloed approach and certainly not just by adding more police or more federal agents. That doesn't fix poverty, it doesn't fix homelessness, and it certainly doesn't fix hopelessness.
You say you view violence as a disease.
ROGERS: Disease is a tough thing to define because it's like trying to define the color black. Is black darkness or the absence of light? Is disease the absence of health or is health the absence of disease? A disease is anything that alters our normal functioning and our ability to do the things of daily living.
But this is where it gets a little interesting. We thought at one point that osteoporosis was a natural part of aging until we realized that not everyone gets osteoporosis, and that you can actually treat osteoporosis with certain medications. So, osteoporosis became a disease.
Violence as a disease? I'm not saying that people are naturally violent. What I am saying is that there are risk factors for violence. You can identify factors like poverty, homelessness, lack of education and low socioeconomic status that lead to violent episodes in one’s life. And if you are the victim of violence, you're much more likely to be a perpetrator of violence or to be a repeat victim of violence. So, wearing my epidemiological hat, we have risk factors for an occurrence of violence, i.e., it’s not random. We now think that there are opportunities to intervene. Even for folks who grew up in impoverished environments, not everyone becomes a victim of violence. So, what are the resiliency factors? What are the positive deviances, if you will? Why doesn't everyone in certain circumstances become a victim of violence?
We also know that there are some interventions that can work; for example, hospital-based violence intervention programs that help victims access mental health services if they're struggling with post-traumatic stress disorder; or addressing issues like economic underemployment so you can change the course of recidivism, repeat violence.
And the last issue is that of norms. What is normal? When kids are on a playground, do they always strike each other or do they sometimes strike each other? That's behavioral. But what drives it? That is what I was talking about earlier — intersectional ability. There are so many factors that make something normal or abnormal in the context of the human condition, and the norms can drive some of the behaviors.
Are hospitals doing enough?
ROGERS: I think hospitals need to do more, but let me not single out hospitals. I think society needs to do more: governmental organizations, philanthropies, civic organizations, boys and girls clubs. There are many ways that we can intervene to change the current trajectory of so many of our kids, without the need for positive deviance. We should help our young people to do the right thing because it's the right thing to do, but also put them in a context in which it’s likely that they will do the right thing. Hospitals can offer teaching moments in their role as conveners of knowledge across sectors, as advocates for social change. I think there is incredible opportunity.
Any other advice for hospital leaders?
ROGERS: I would encourage hospital executives to ask themselves: Instead of being far removed from the problem in our various offices, how can we understand the issue of urban violence better so that we can have an impact? At times, that's going to be uncomfortable. It's hard to create a solution to a problem if you haven't listened to the victims of the problem. For example, as a surgeon, I would not presuppose that, from my office on the second floor, I can look at two people walking across the street and tell you what their surgical diagnosis is. I’m going to have to get close to them. I’m going to talk with them, engage with them. I’m going to have to translate their words and their language into my language and then translate back for them in a way that they can understand, so we can come to a common diagnosis and then think how we are going to fix it. We’re not currently doing that, not in a systematic way. Every hospital could take its block, its community and engage by listening actively — not assuming that they know the solution — and then be a convener, a broker across multiple lines. There are some settings in which governmental and nongovernmental organizations, or groups like the Urban League, do that very well.
One of the fundamental challenges is how to break down the walls of a traditional hospital to actually embrace the community that we serve and be partners with the community and the vast array of partners that are trying to do good work to help every day.
THE ROGERS FILE
Who has had the biggest influence on your career?
My mother, who taught me that all things are possible when you believe, and Mrs. Olive Walcott, my 11th- and 12th-grade math teacher, who taught me that I have the gift of understanding and could teach.
Do you have any hobbies?
Running with my fiancée Kimberly. She is on her sixth half marathon. I have only finished one, so I have to catch up. I also enjoy cycling and look forward to doing so along Lake Michigan.
What’s your favorite thing about Chicago?
The food and living in [the] Hyde Park/Kenwood [community].
Tell me one thing about you that might surprise people.
I considered being a pastor, because that provides an opportunity to feed the soul of men and women, another form of healing.