Dr. Leana S. Wen: Tackling the Roots of Inequality in Baltimore

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One year ago, following the tragic death of 25 year-old Freddie Gray and the period of civil unrest that followed, many were telling a “tale of two Baltimores:” the story of a city that epitomized urban inequality, where residents saw a 20-year gap in life expectancy between neighborhoods just a few miles apart. But there is another story too often left untold—one of intervention, prevention, and early investment—that is changing outcomes for young people and redefining Baltimore as a city of recovery and resilience.

In the immediate aftermath last April, we at the Baltimore City Health Department, like many, spurred to immediate action. We set up a prescription medication and food delivery program to assist vulnerable individuals impacted by 13 burned, looted and closed pharmacies. We canvassed senior buildings and provided outreach at more than 150 churches for social services. We provided transportation to chemotherapy and dialysis appointments, and coordinated emergency mental health services to those most impacted by the unrest. But these emergency response services, while critical, only mobilized during this time of greatest need. Similarly, in the following weeks, partners from across the city offered additional direct services, ranging from summer jobs and afterschool programs to laptops and new playground equipment, all providing immediate opportunity to our young people. However, these too, were reactive actions. What about the countless moments before a tipping point?

A true public health approach requires us to look further upstream, at how the inequalities could have been prevented in the first place.

In Sandtown-Winchester—and communities like it across Baltimore—traumatic experiences of abuse, violence, and neglect affect countless youth. To tackle violence upstream, we have launched a citywide trauma strategy and are working to train every single city employee—teachers, police officers, public works employees, nurses, and more—in how to recognize and treat the effects of trauma. The strategy also includes starting healing circles and mindfulness programs among youth, offering mental health services in 120 schools, and introducing a crisis intervention team that responds to families and communities facing violence.

Addiction, like trauma, is a root cause of violence that has been ignored for decades yet powerfully determines the trajectory of young people’s lives. Over the past year, Baltimore has ramped up our effort to address the opioid epidemic head-on, launching the most aggressive naloxone distribution program in the country. Not only did we put the opioid overdose reversal drug in the hands of over 10,000 people last year, but we are going to where people are, conducting trainings on how everyone in our city can save a life. This work, which has garnered national recognition from President Obama and the U.S. Surgeon General, is empowering residents to save lives, while creating opportunities for further intervention and better futures.

Public health does not stop at the immediate inputs of violence. We must also make the case for the earliest inventions that can set children on better trajectories sooner. Freddie Gray was lead-poisoned as a child, as are thousands of children across America every year. These youth often experience worse educational outcomes and are at a disadvantage right out of the gate. Public health interventions, such as housing remediation and universal lead testing for children, have already resulted in an 86% reduction in the number of children poisoned by lead within 10 years. Expanding such work will lead to better health while leveling the playing field of inequality in the first inning, rather than the bottom of the ninth.

To improve infant health outcomes, Baltimore’s B’More for Health Babies program offers nurse home-visiting and extensive support services to mothers. The results have been extraordinary: within five years, infant mortality has decreased by 28% to its lowest in Baltimore’s history, the teen birth rate has decreased by 36%, and the disparity between black and white infant deaths decreased by almost 40%. Even more incredibly, nurse home visiting programs across the country have been shown to improve school graduation rates and to reduce violent activities.

Since its earliest days, public health has been about tracing the roots of an epidemic back to their source. Today in Baltimore, the task is no different. Every day we continue to connect the dots, identify underlying causes of disparity, and offer interventions that will change the outcomes for all citizens, especially our most vulnerable.

The unrest expressed the collective pain and trauma that have accumulated through decades of inequality in Baltimore’s urban communities. One year later, Baltimore is starting to tell the tale of a new Baltimore: one that not only provides immediate recovery, but is focused on realigning priorities toward prevention and early investment.

There is so much more work to be done, but the compass is pointed in the right direction, towards health and justice, with compassion and action.

Dr. Leana Wen is the Commissioner of Health in Baltimore City. Follow @DrLeanaWen and @BMore_Healthy.

 

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