Bal­ti­more un­veils plan to ad­dress life ex­pectancy, other health gaps

Race ac­counts for many dif­fer­ences, re­port says

Baltimore Sun - - FRONT PAGE - By Mered­ith Cohn

Cit­ing race as the dif­fer­ence maker for many of the city’s health prob­lems, the Bal­ti­more City Health De­part­ment has de­vel­oped a plan to as­sess and ad­dress those dis­par­i­ties.

In a re­port re­leased Tues­day, the de­part­ment out­lined plans to cut health dis­par­i­ties in half in the next decade by fo­cus­ing on four ar­eas: be­hav­ioral health such as drug over­doses; vi­o­lence; chronic dis­ease; and “life course,” which in­cludes the of­ten-cited 20-year gap in life ex­pectancy be­tween Bal­ti­more’s rich­est, white neigh­bor­hoods and poor­est, black ones. Of­fi­cials dubbed the re­port Healthy Bal­ti­more 2020 be­cause they plan to as­sess progress in­cre­men­tally and not wait 10 years to say if they’ve reached their goal. Dr. Leana Wen

The re­port speaks to much that has gone wrong in the city with res­i­dents’ health be­cause of his­toric racial in­equal­ity and eco­nomic and geo­graphic dis­par­ity, said Dr. Leana S. Wen, the city’s health com­mis­sioner. It looks be­yond tra­di­tional in­di­ca­tors of good health such as ed­u­ca­tion, pub­lic safety and the econ­omy.

“It’s taken 18 months to get this process to where it is now be­cause we wanted to make sure we had a co­he­sive frame­work to look at health is­sues in the city,” Wen said. “You can name all the health is­sues in the city, but that would just be a list of

prob­lems and not a strat­egy. We needed some­thing to tackle and to com­mu­ni­cate our pri­or­i­ties to our res­i­dents.”

Many cities have such blue­prints for ad­dress­ing vex­ing so­cio-eco­nomic prob­lems as a means to ad­dress health. The U.S. Cen­ters for Dis­ease Con­trol and Preven­tion’s last ac­count­ing of the na­tion’s over­all health in 2015 looked at such racial dis­par­i­ties.

Bal­ti­more’s health de­part­ment out­lined what was billed as the city’s first com­pre­hen­sive plan to ad­dress in­tractable health prob­lems in 2011. It tar­geted the top 10 se­ri­ous ail­ments, in­clud­ing HIV in­fec­tion and heart dis­ease, adopt­ing a model de­vel­oped in New York City in 2004 called Take Care New York.

Other cities have used dif­fer­ent out­lines. Wash­ing­ton, for ex­am­ple, has a plan called DC Healthy Peo­ple 2020 Frame­work that mon­i­tors 150 ob­jec­tives and rec­om­mends 85 strate­gies for im­prov­ing health in 29 ar­eas, in­clud­ing sub­stance abuse, oral and men­tal health, and food safety.

Bal­ti­more’s fo­cus on dis­par­i­ties “makes good sense,” said Dr. Peter Beilen­son, a for­mer Bal­ti­more health com­mis­sioner who is now CEO of the health in­sur­ance co-op Ever­green Health.

“The over­ar­ch­ing goal is hugely im­por­tant,” he said. “Race and class dis­par­i­ties in this city are dra­matic, prob­a­bly more so than in other ur­ban ju­ris­dic­tions.”

Jan Des­per Peters, CEO of the Black Men­tal Health Al­liance, said that com­mu­nity in­put will be cru­cial in mak­ing any plan work.

She said the re­port’s ap­proach to re­duc­ing dis­par­i­ties by tack­ling so­cial de­ter­mi­nants of health is in sync with the al­liance’s mis­sion. But she still wants to en­sure that those out­side govern­ment have a say go­ing for­ward.

“Any­one at­tempt­ing a plan to at­tack dis­par­i­ties has to be con­cerned with the whole per­son,” Des­per Peters said. “And the com­mu­nity needs to play a sig­nif­i­cant role in what that plan looks like, not the health de­part­ment telling the com­mu­nity what’s best for them.”

Raimee Eck, pres­i­dent-elect of the Mary­land Pub­lic Health As­so­ci­a­tion, an or­ga­ni­za­tion of pub­lic health pro­fes­sion­als, said the city ap­pears to have got­ten off to a good start by con­sid­er­ing his­toric bar­ri­ers to health across neigh­bor­hoods.

“Dr. Wen’s team has pro­moted a plan to ad­dress the en­vi­ron­men­tal fac­tors, or so­cial de­ter­mi­nants of health, in a way that will hope­fully re­shape our com­mu­ni­ties and not just try to ‘treat’ them,” she said. “Struc­tural racism is cer­tainly an im­por­tant fac­tor in how our city has been shaped over time, and not for the bet­ter; un­der­stand­ing that his­tory and ap­proach­ing health-re­lated is­sues with this con­cept in mind is a ne­ces­sity, not an op­tion.”

The re­port out­lines up to five ob­jec­tives un­der each fo­cus area and lists how progress will be tracked, though there are spe­cific goals for in­di­vid­ual dis­par­i­ties.

Ex­am­ples of ob­jec­tives in­clude re­duc­ing dis­par­i­ties in over­dose deaths, youth homi­cides and school ab­sen­teeism, in the num­ber of chil­dren with un­met med­i­cal needs and who are obese, and in the in­fant mor­tal­ity rate and fa­tal falls among se­niors.

Wen said such dis­par­i­ties have long been ev­i­dent in health out­comes, but they gained a par­tic­u­lar ur­gency af­ter the ri­ots that fol­lowed the death last year of Fred­die Gray, a 25-year-old black man who suf­fered a spinal in­jury in po­lice cus­tody. Res­i­dents in the poor com­mu­nity where Gray lived, in ad­di­tion to many oth­ers, ex­pressed frus­tra­tion about the lack of jobs and op­por­tu­ni­ties, which Wen said con­trib­uted to poor health con­di­tions.

Res­i­dents who are black or live in cer­tain ZIP codes were more likely than peo­ple in bet­ter-off ar­eas of the city or the state to be ad­dicted to drugs or al­co­hol, die vi­o­lently, be obese, have asthma, or be born un­der­weight, for ex­am­ple.

Bal­ti­more now has one of the five high­est rates of drug over­doses in the coun­try, with 393 fa­tal­i­ties last year, more than the num­ber of homi­cides. African-Amer­i­cans make up about 63 per­cent of the city’s pop­u­la­tion, but more than 90 per­cent of homi­cide vic­tims are black.

One city child in four drinks a soda daily, and fewer than one in five eats the rec­om­mended serv­ings of fruits and vegeta­bles.

“We see how health ties into ev­ery­thing,” Wen said.

Wen cited pro­grams that are work­ing and can be bol­stered go­ing for­ward. They in­clude Safe Streets, a pro­gram which of­fi­cials said me­di­ated 692 con­flicts to avoid vi­o­lence in the last year. They also in­clude other pro­grams that have trained 1,200 res­i­dents to use the opi­oid over­dose an­ti­dote nalox­one, con­trib­uted to a 36 per­cent de­crease in teen births, and sup­ported 298,870 trips to school health providers.

Beilen­son said the health de­part­ment should seek com­mu­nity in­put in pick­ing three or four pri­or­i­ties, per­haps one un­der each of the four fo­cus ar­eas, to ad­dress, so re­sources aren’t spread too thin.

City of­fi­cials said pro­grams will be im­proved or de­vel­oped in con­sul­ta­tion with com­mu­nity mem­bers. Neigh­bor­hood meet­ings are planned, in­clud­ing one at the Y in Druid Hill in West Bal­ti­more on Tues­day.

“Grow­ing a health­ier Bal­ti­more is foun­da­tional to our sus­tained suc­cess as a city,” Mayor Stephanie Rawl­ings-Blake said in a state­ment. “My ad­min­is­tra­tion — along with sup­port from nu­mer­ous city and state agen­cies — has main­tained a com­mit­ment to im­prov­ing health and eq­uity within our com­mu­ni­ties. We must recom­mit our­selves to the chal­lenges we con­tinue to face.”

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