The ‘uncertain path ahead’
Recently, I treated a patient in clinic, a woman in her early 40s. Just two years prior, she was experiencing homelessness and frequented emergency rooms every few weeks. Through the Affordable Care Act, she was able to get health insurance, which in turn helped her get her blood pressure managed and diabetes treated. It also enabled her to obtain treatment for depression and alcoholism.
As a result, she now had a job and a home. She regained custody of her children. Thanks to health insurance, which she called “her rock,” she had her life back.
But when I saw her, she was distraught and worried that her insurance could now be in jeopardy — that she could lose everything. For many of us, the national uncertainty we face is deeply personal. In 2010, 81,000 adults in Baltimore City were without health insurance. Today, that number has been cut in half. Will their coverage now be at risk?
Baltimore City has long relied on critical funding from the federal government to support initiatives ranging from HIV prevention and disaster preparedness to reproductive health access and efforts to reduce trauma. Are these programs in jeopardy, and is the progress made through them also at risk of reversal?
As the city’s doctor, I worry about the uncertain path ahead.
However, there is no choice but to move forward. In Baltimore, public health has never been on the back burner, and we will not put it there now. If anything, it’s time to turn up the heat. Here’s how:
First, we commit to a focus on our “North Star.” Our mission has always been to improve health, reduce disparities and combat injustice. We will use our strategic blueprint, Healthy Baltimore 2020, to guide us as we aim to cut health disparities over the next 10 years.
Through B’More for Healthy Babies, we have dramatically reduced our city’s infant mortality rate, hitting a record low in 2015. And Safe Streets, our violence interruption initiative, continues to prevent hundreds of shootings every year.
Wemust galvanize new relationships and strengthen existing ones in support of a clear and unwavering mission toward better health.
Second, we commit to addressing systemic challenges that endanger lives.
We cannot stop violence without addressing the trauma in our communities and treating, not incarcerating, individuals with diseases of addiction or mental illness. We cannot improve health in homes and in communities without supporting affordable housing and accessible transportation. We cannot enable a productive workforce without ensuring that children have the best chance to succeed — whether by preventing lead poisoning or getting glasses to see.
All of these solutions will not occur overnight, but we must have the courage to take the long view.
Third, we commit to the fundamental principles of public health.
At its core, public health is about preventing small issues from becoming big problems, interrupting the next health crisis before it happens.
It has been said that “public health saved your life today; you just don’t know it.”
Our restaurant inspections prevent foodborne illnesses, but it is difficult to consider the individual who could have gotten food poisoning, but didn’t. Similarly, naloxone saves lives from opioid overdose in our city nearly every day, but as we consider staggering numbers of overdose deaths, we must also consider the more than 530 lives saved with this medication in Baltimore. Through our needle exchange program that has operated for over 20 years, we have reduced the HIV rate from intravenous drug use from 63 percent in 1994 to 7 percent in 2014.
We must prioritize funding such programs that are clearly proven to be successful and that save lives.
Since our Health Department’s founding in 1793, Baltimore has made tremendous progress in improving health and wellness of our residents.
We refuse to roll back the gains we have made. It is imperative, now more than ever, to “double down” on public health.
I want to let my patient know, and all of Baltimore’s residents to know, that we are all in on moving forward to uphold our fundamental principles of compassion, inclusion, equity and justice.