In a city with glaring health disparities, where COVID-19 disproportionately took years off the lives of Black and brown Chicagoans, where health care deserts remain on the South Side, and where the pace to replace lead service lines is sluggish, there hasn’t been much talk on the mayoral campaign trail about solutions to many of these issues.

The biggest debate among the nine mayoral candidates so far when it comes to the health of Chicagoans is whether to reopen public mental health clinics that former Mayor Rahm Emanuel closed. Mayor Lori Lightfoot says no, the city needs to take a broader approach and instead is paying other health care providers, including nonprofit clinics, to increase access to services. If reelected, she said she plans to focus on this effort, which her public health chief says reaches far more people than the city clinics could.

But all of Lightfoot’s challengers say they would reopen the city-run clinics.

Kemberly Martin, 55, who lives in the Kenwood neighborhood on the South Side, said it’s time for the city to reopen them and questions if Chicagoans even know they can get help at other clinics.

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“I have private insurance. I have a really good job. And affordability and accessibility is an issue for all,” Martin said. “So if it’s an issue for me … what is it for them who have none of these things?”

Martin, who responded to WBEZ’s People’s Agenda survey that asks what Chicagoans want the mayoral candidates to be talking about, thinks the city — the government — is in a better position than private or nonprofit organizations to help residents who need mental health services.

Among the alarm-raising health inequities that haven’t received as much attention as mental health are two big ones: how to quicken the pace of replacing lead service lines throughout the city, and how to make health care more accessible. There are so-called health care deserts on the South and West sides in particular, where there have long been provider shortages — specialists in particular like obstetricians and psychiatrists — compared to the wealthier North Side. And advocates say this contributes to a divided Chicago, where a person’s health partly depends on their ZIP code.

There are eight challengers vying Feb. 28 to unseat Lightfoot, who hopes to win a second term. Here’s where the candidates stand — or don’t — on three key health equity issues.

The battle over Chicago’s shuttered mental health clinics

When Emanuel closed half a dozen of the city’s public mental health clinics just over a decade ago, Arturo Carrillo witnessed the aftermath. He was a clinical social worker at a hospital on the Southwest Side that already had a waitlist for free mental health services. That waitlist just got longer.

Carrillo is part of a coalition that’s been calling for the clinics to reopen, backed by research that illuminates the persistent need for mental health services that isn’t met. The latest research from the Collaborative for Community Wellness shows the wards with the highest rates of 911 calls for behavioral health come from areas where the city clinics have closed.

“There’s this lasting legacy,” Carrillo said. “This is what disinvestment looks like.”

That’s while the need for mental health care has intensified. In Chicago, the number of adults who reported experiencing serious psychological distress — feeling nervous, hopeless, depressed or worthless — spiked during the pandemic, from at least 134,000 adults in 2018 to nearly 190,000 three years later, according to the Chicago Health Atlas.

Carrillo argues having city-run clinics helps the public hold the government accountable for the level of mental health care provided, and keep a closer eye on how public money is spent.

In responses to questions from WBEZ, all of Lightfoot’s opponents say they would reopen the clinics. In a WBEZ and Chicago Sun-Times candidate questionnaire, Congressman Jesús “Chuy” García did not answer yes or no, but said he would expand existing city clinics and add new ones with the Cook County public health system. In a follow-up email for this story, García’s campaign now says, “We should reopen the clinics.”

Part of García’s plans involves hiring more mental health clinicians. He would be competing with health care organizations across the city and beyond who also are short-staffed.

State Rep. Kam Buckner has one of the most detailed mental health plans. He wants to have 20 city-run mental health clinics, four of which would be open 24 hours a day in each region of the city. He would use data on existing resources to locate clinics in communities with the greatest needs, and make it easier for patients to book appointments through an online portal.

“This crisis that we’re under right now is not Mayor Lightfoot’s doing,” Buckner said during a forum in December. “She didn’t write the original song, but she did perform the remix. And we’re seeing this very clear in our city.”

Activist Ja’Mal Green proposes so-called Healing Houses as well as mobile units that treat residents in their homes. Former Chicago Public Schools CEO Paul Vallas said he would put clinics in each police district, and fund them with reimbursements from public and private insurance plans.

Alexa James, CEO of NAMI Chicago, a mental health advocacy organization that has partnered with the city on responding to 3-1-1 calls, said she thinks focusing solely on reopening clinics is “distracting.” It ignores the progress Lightfoot’s administration has made.

“There’s actually been a huge investment in mental health with this administration,” James said. “We need to double down on that.”

Lightfoot is partnering with nonprofit clinics and community organizations to beef up access to mental health services. In 2019, the city treated about 3,600 Chicagoans at its five mental health clinics and a small number of private providers. No patient was younger than 18, Lightfoot’s public health chief, Dr. Allison Arwady, wrote in a Jan. 6 op-ed in the Chicago Sun-Times.

Compare that to last year, when roughly 60,000 Chicagoans received treatment — including children — after Lightfoot increased mental health funding from around $12 million in 2019 to nearly $90 million in 2022, Arwady wrote. The city steered money to a much bigger network of community clinics and organizations, integrated mental health providers into 911 responses, and also doubled the number of employees at its own clinics.

Reopening the city clinics still wouldn’t expand capacity enough to treat a city with nearly 3 million residents, Arwady wrote in her op-ed. There are other ideas to reach more people, such as putting additional mental health services in libraries.

“That’s a different way of thinking as opposed to let’s open a stand-alone clinic,” Arwady said recently on WBEZ’s Reset talk show. “It’s about meeting people where they are.”

A key question is how the city can sustain its robust network of community mental health providers going forward. More than half the city’s mental health budget comes from federal pandemic dollars that must be spent in the next few years. The city hopes to recoup more public health insurance dollars and supplement with grant funding, said Matt Richards, a deputy commissioner for the Chicago public health department.

Speeding up lead pipe replacement

Chicago has an estimated 390,000 lead service lines — the most of any city in the United States. Health officials warn there is no safe level of lead in blood, and lead service lines pose the risk of lead leaching into residents’ drinking water.

Lightfoot says her administration was the first to tackle the issue by creating a program that helps homeowners replace lead service lines and prioritizing low-income residents. But replacement remains slow, with only a tiny fraction of the lines switched out as of late last year.

For Lily Lowndes, a 21-year-old DePaul University student who responded to WBEZ’s People’s Agenda survey, lead is one of the top public health issues on her mind.

“I would definitely like to see it resolved before, you know, I’m an old woman,” Lowndes said in an interview.

Lightfoot has acknowledged the pace is too slow and her eight rivals have all vowed to accelerate it when asked by WBEZ. Many of the candidates have pointed to the need for additional federal funds to help tackle the issue, but have been light on details on how they will secure them.

García touted his work in Congress working on and advancing federal legislation, like the Bipartisan Infrastructure Law, which allocated $15 billion to replace lead pipes.

Sixth Ward Ald. Roderick Sawyer said he would explore tapping nonprofits to help address the issue. Cook County Commissioner Brandon Johnson said available money needs to be stretched more efficiently, and businessman Willie Wilson said he’s “confident that we can get the money through savings from reducing gun violence and other crime in our city.”

Caroline Pakenham, associate director of water programs at Elevate, a Chicago-based nonprofit that advocates for clean energy and water, said a comprehensive funding plan from all levels can help cover everything from risk assessments and testing to lead abatement and mitigation efforts.

“Every possible funding source really needs to be looked at and secured in order to push the needle on this challenge,” Pakenham said.

Buckner co-sponsored a state law that went into effect last year that will give the city 50 years to replace its lead pipes when a plan is completed by 2027. Both he and Sawyer pointed to prioritizing areas most affected in the city. Replacing lead service lines could also be a major jobs program, Buckner and Wilson said.

Other cities, like Newark, New Jersey, have been more successful at eliminating their lead pipes, and 4th Ward Ald. Sophia King said the city should follow them and enact strategies that will eliminate “any excuse for homeowners to resist lead line replacement.”

But replacing the lines will still likely take decades. Both Buckner and Vallas have also pointed to providing water filters to residents as a more immediate step — which the city already offers to certain eligible residents.

Susan Buchanan, director of the Great Lakes Center for Reproductive and Children’s Environmental Health, said filters are a “reasonable short-term bandaid” while efforts are underway to replace thousands of lead service lines.

But Buchanan said she wants to see candidates address another area where children are more likely to be exposed to lead: deteriorating lead paint in older homes.

“What people forget is, lead levels in the water is not the No. 1 source,” Buchanan said. “Lead in water does not cause elevated lead levels by itself. It is combined with other types of lead exposure, most usually deteriorating lead paint.”

How to tackle the access divide

Segregated Chicago has one of the biggest life expectancy gaps in the U.S., research has shown. On average, a white resident lives nearly nine years longer than a Black resident, according to the Chicago public health department’s Healthy Chicago 2025 report. That gap swells to 17 years depending on where residents live. This inequity is fueled by chronic disease and gun-related homicides, among other factors.

A 2021 study found “alarming access gaps” on the South Side, where there is a dearth of specialists in particular to deliver babies.

Yet the vast disparities in access to health care hasn’t been front and center during the mayoral campaign. While the city doesn’t regulate health care — the state largely does — “the mayor of Chicago has a lot of power,” said Margie Schaps, executive director of Health & Medicine Policy Research Group, a Chicago nonprofit that advocates for equitable policies.

A lot of power symbolically, but also financially. The mayor controls the purse strings through the city budget. For example, Lightfoot earmarked $500,000 to support abortion providers and patients in light of Roe v. Wade overturning. Her 2023 budget includes $3 million for reproductive health services in addition to baseline funding for providers.

Schaps said candidates could be laying out plans on how to better support clinics and so-called safety net hospitals on the South Side that largely treat low-income and uninsured Black and Latino patients, yet are often starved of resources. They could be making more noise about expanding access at the state level to government insurance for immigrants, and making sure hospitals provide discounted care to patients who can’t afford to pay, Schaps said.

“There are a lot of people in our city who don’t have access and wait until they need emergency care,” Schaps said. “It costs a lot of money, and it’s not good for anybody.”

Only five of the nine mayoral candidates responded to questions from WBEZ about how they would increase access to medical care.

Johnson said he would expand guaranteed income programs to help more families afford medical care. He also would bring to the city a county program that aims to erase medical debt for residents.

Wilson would put health clinics in senior buildings. Buckner touted his efforts in Springfield to keep safety net hospitals open and a slew of reforms to tackle health care inequities. That includes requiring training for daycare providers on early childhood trauma and a moratorium on hospital closures during the pandemic.

Lightfoot pointed back to her journey as mayor. During the height of COVID-19, the city opened free testing centers on the South and West sides, and saturated 15 communities hit hardest by the virus with vaccines. And her administration negotiated a deal to help prevent historic Mercy Hospital, a safety net and community anchor, from closing. At the time, Lightfoot’s opponent, King, who spoke out during public hearings to save Mercy, questioned the mayor’s involvement.

Kristen Schorsch covers public health and Cook County at WBEZ. Tessa Weinberg covers Chicago government and politics at WBEZ.

Follow them at @kschorsch and @Tessa_Weinberg.

Read more of WBEZ’s coverage of Chicago Elections 2023.