Poverty makes powerful statement
In Ubaid Harris’ East Baltimore neighborhood, poverty is fatal. Babies born to parents in Clifton-Berea will live shorter lives, on average, than babies born to families anywhere else in Baltimore, a new city analysis suggests. Outsized rates of overdoses, chronic disease and violence have pushed local life expectancy down to 67 years — two decades less than in the city’s more affluent neighborhoods. In Clifton-Berea, nearly one in three families lives below the poverty level.
Harris, 43, an ex-offender who has worked for years at an Edison Highway car wash, believes opportunity is the antidote for the neighborhood’s problems. Dominique Brooks, shown with son Cam-Ron Lee, commenting on Healthy Start’s Belly Buddies group “Poverty is the enemy,” he said during a break at work. “If you eliminate poverty, then you eliminate all of these side issues.”
Health officials, to a great extent, agree. They say some of the factors that lead to an early death — lack of proper medical care, for instance, and poor nutrition — are driven by poverty.
And the violence endemic in Baltimore’s poorest neighborhoods of course plays a role.
A leading contributor to CliftonBerea’s lowest-in-the-city life expectancy is youth homicides. The homicide rate among Clifton-Berea residents under 25 is the equivalent of 107 killings per 100,000 people — higher even than
“They taught me a lot.”
other poor Baltimore neighborhoods, and three times the rate in the city overall.
Clifton-Berea, plagued by a host of problems, “is a sad textbook kind of case,” said Daniel Webster, co-director of the Johns Hopkins Center for the Prevention of Youth Violence and professor of health policy.
“In areas like this one, every bad thing is clustered there.”
The Baltimore Health Department gathers measurements of the problems — everything from infant mortality rates to truancy, lead paint violations and the proliferation of corner stores — and every few years publishes reports on the welbeing of city neighborhoods, collectively called the Neighborhood Health Profiles. The agency’s analysis of that data led to the prediction of the especially low life expectancy for Clifton-Berea residents.
But the data show Clifton-Berea isn’t alone. Life expectancy is just a year longer for people in the adjacent community of Greenmount East and across town in the Upton-Druid Heights area of West Baltimore.
They, too, have higher rates than the city overall of cancer, heart disease and nonfatal shootings, and share other factors tied to poor health outcomes, such as many vacant buildings and significant absenteeism in schools. The health department’s 2011 reports found the lowest life expectancy (63) in Upton-Druid Heights.
City health officials say the profiles are intended, in part, to improve health outcomes by inspiring community discussions.
Each community’s report “creates a dialogue with individual citizens around what the health department is doing and what individual communities can do,” said Sonia Sarkar, the agency’s chief policy and engagement officer.
The data show the average life expectancy for babies born in Baltimore today is about 74 years. The Cross CountryCheswolde area near Mount Washington in Northwest Baltimore has the highest average — about 87 years. It is also one of the city’s more affluent areas with a median income of about $55,000, more than double Clifton-Berea’s.
Clifton-Berea, home to about 8,400 people, lies in a desolate swath of the city northeast of Johns Hopkins Hospital. It is home to the renovated American Brewery building, the new Fort Worthington Elementary/Middle School and the Baltimore Cemetery. Some blocks are vibrant with well-maintained exteriors and small yards that in summer burst with flowers. Many others have rows of boarded-up houses, punctuated by liquor and tobacco stores on the corners.
It is one of the city’s poorest neighborhoods with a median income of about $26,000, $16,000 less than the city’s overall.
Working to change the fortunes of families who live there and in other East Baltimore communities are teams of researchers, medical professionals, nonprofit workers and volunteers. They offer blood pressure screening, substance abuse treatment, prenatal care and violence prevention services.
They’re battling a grim list of challenges, captured in the 38-page report on CliftonBerea: low educational attainment, high unemployment. Frequent requests to exterminate rats. High rates of infant mortality. A lack of fresh food markets and abundance of places to buy liquor and cigarettes.
Leon Purnell is director of the Men and Families Center on Jefferson Street, in the shadow of the Johns Hopkins Hospital campus. The center, a 10-minute walk from Clifton-Berea, helps people with issues such as quitting smoking and managing diabetes. But before staff can start those conversations, he says, they must help clients with more immediate challenges.
“They’ll never think about their health,” Purnell said. “They’re worried about being evicted or their gas and electric being off.”
The center — which operates from a pair of century-old rowhouses that have experienced flooding and been struck by lightning — serves hundreds of people who pass through its old gray metal door each year. A dozen flyers taped to the door alert passersby to center services: an annual block party and health fair, workshops on how to have criminal records expunged, job fairs and health clinics. People who step inside can get help signing up for insurance, getting medications, obtaining identification cards or learning how to eat healthier.
Purnell also sends a couple of dozen “neighborhood navigators” onto the streets to stop people and knock on doors. The navigators ask whether they’ve been to the hospital recently and what immediate needs they have that are preventing them from thinking about their health.
Clarence Howard, 63, has worked as a navigator for four years.
The encounters, he said, start simply: “How’ve you been? How are you feeling? You all right? You know we’re right around the corner?”
The navigators live in the communities in which they work, which Howard said means people are more inclined to know and trust them. He tells people a little about his story, and gradually builds confidence.
“We start from the basics,” he said. “‘Does you got an ID? That will help you get a job.’ Then we help you get a job. Then, after that: ‘Let’s tackle some of those bills you got.’ After that: ‘What about your health?’
“If my bills and life and all that ain’t right, I ain’t even thinking about no health. That’s the last thing on my mind.”
The center is part of an initiative, called Baltimore Connect, started by the Johns Hopkins Bloomberg School of Public Health several years ago to bring together programs working on health issues.
Another program, B’More for Healthy Babies, offers outreach and education in communities that have high percentages of risky births. It is credited with reducing infant mortality rates in Baltimore by about 40 percent since its launch in 2009.
In Clifton-Berea, the mortality rate among babies from birth to their first birthday is about 15 per 1,000, the seventhhighest rate in the city. The citywide rate is about 10 infant deaths per 1,000 births.
B’More for Healthy Babies works with Baltimore Healthy Start, a nonprofit that tries to establish relationships with expectant mothers as early as possible, and maintains contact through the baby’s second birthday.
The mothers are offered home visits, nutrition counseling, screening for depression and domestic violence, pregnancy testings and breast feeding classes, transportation and GED classes, said Lashelle Stewart, interim director of Healthy Start. She said the program teaches mothers the developmental milestones to watch for and safe sleeping conditions for their babies.
New mom Dominique Brooks, 18, joined Healthy Start’s Belly Buddies group while she was pregnant with son Cam-Ron Lee. The group — which focuses on stress relief, prenatal care and camaraderie — taught her how to make bean burgers in place of greasy fast food, imparted the benefits of breast milk and offered frequent reminders about safe sleeping for babies — Alone, on their Backs and in their Cribs.
“They tell me about ‘ABC’ every time they come out – no pillows, blankets or stuffed animals in the crib,” Brooks said. “They taught me a lot.”
Brooks has returned to high school; she wants to become a veterinarian.
Dr. Charles W. Callahan, vice president of population health for the University of Maryland Medical Center in Baltimore, said the people of Clifton-Berea — and much of Baltimore — need a unified response to address health and social needs.
Callahan says the research is clear: Individual well being depends more on environmental conditions, support networks and education than the quality of the local health care system.
Take, for example, one of the best predictors of health in middle age: a high school diploma. That makes the opening this year of Fort Worthington Elementary/ Middle School — and the services that come with it, such as a meeting space for the community and recreational programming — an investment that could pay dividends.
“I am encouraged,” Callahan said. “So many individuals and families are coming together and addressing these conditions, these challenges, head on.
“A couple of dozen babies are born in Baltimore every day. We need to be thinking broadly.”