Content Warning: This section of the guide discusses systemic racism and poverty, patient neglect and abuse, drug use, homelessness, and gun violence.

Written by Dr. David A. Ansell, a Chicago-based physician known for his work combatting healthcare inequity in the United States, the foreword seeks to contextualize Mama Might Be Better Off Dead for those reading 30 years (or more) after the book’s initial publication. Ansell highlights the ways in which the healthcare issue in the United States has both developed and stayed the same since 1993. Two of the fundamental conflicts within the book—widespread healthcare inequity across the United States and concentrated poverty in the neighborhood of North Lawndale—he argues, have remained much the same. Crucially, however, “[w]e now have a better understanding of how the social, structural, and political determinants of health and health care, such as institutional racism and poverty, affect illness burden and life expectancy” (1). These understandings and terminologies are also gradually making their ways into the popular discourse (Ansell quotes President Obama toward the end of the chapter), making way for the problems themselves to be solved.