The ‘uncertain path ahead’

Baltimore Sun - - COMMENTARY - By Leana S. Wen Dr. Leana S. Wen is the Bal­ti­more City health com­mis­sioner. Her email is health.com­mis­sioner@bal­ti­morecity.gov; Twit­ter: @DrLeanaWen and @BMore_Healthy.

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.

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