Resilience

Integration of Public Health Into the Whole Community

by Kathleen E. Goodwin & Leana S. Wen

The Baltimore City Health Department (BCHD) is the oldest, continuously operating health department in the country – founded in 1793 to respond to a local yellow fever outbreak. BCHD is committed to theea that health is critical to a community’s ability to thrive and thus deserves to be incorporated in decision making in almost every sector.

Public health has never taken a back seat in Baltimore, Maryland. BCHD strives to engage with partners throughout the city, state, and nation to encourage prioritization of health and well-being. The aim is to focus on upstream prevention rather than reactionary responses.

Childhood Illnesses

BCHD functions as the citywide convener to set an agenda focused on collective health priorities by aligning goals and using evidence-based strategies. In 2009, Baltimore had one of the worst infant mortality rates in the United States. BCHD led a coalition of 150 public and private partners, including hospitals, clinics, foundations, sororities, and churches, to found a program called B’More for Healthy Babies. Within six years, Baltimore’s infant mortality rate fell by 28 percent. The number of infants dying in their sleep was reduced by half. The disparity between black and white infant deaths dropped by 40 percent.

The guiding principle at BCHD is to go to where people are. Until April 2016, children were only getting eye screenings in their schools in pre-kindergarten, first, and eighth grades. Less than 20 percent of kids who screened positive were actually getting glasses, resulting in thousands of children struggling to reach their full potential because of being unable to see the boards in their rooms. The straightforward intervention of glasses could mitigate a host of downstream problems. Together with partners at Johns Hopkins University and the support of local foundations, BCHD launched Vision for Baltimore, which provides eye screenings and glasses free of charge in schools – for every child in every grade, from kindergarten through eighth grade – so they do not have to miss and their caregivers do not have to miss work.

Drug Addiction

BCHD has also been successful at changing legislation to save lives. Opioid addiction is an epidemic in Baltimore, as in the rest of the United States. Over 20,000 people in Baltimore use heroin. In 2015, more people died from overdoses than died from homicide, so the Health Commissioner declared overdose to be a public health crisis. BCHD worked to pass legislation so that, as of 1 October 2015, the Health Commissioner issued a blanket prescription for the opioid antidote, naloxone, to all 620,000 residents of Baltimore.

BCHD is committed to the belief that every resident has the ability to save a life, so has trained over 11,000 people on how to save a life and developed the first-of-its-kind online naloxone-training platform, DontDie.org. BCHD continues to partner with other city agencies, businesses, community groups, and faith leaders to provide trainings in markets, churches, senior housing, jails, bars and restaurants, even the Maryland Zoo. There are early signs of success. For example, in the first quarter of 2016, overdose deaths decreased by 8 percent in Baltimore, even as they continue to rise at unprecedented rates throughout the country.

Crime & Violence

BCHD’s mandate is to protect the most vulnerable members of the community. In the unrest following Freddie Gray’s death in April 2015, over a dozen pharmacies were burned, looted, or closed. Many seniors and other at-risk individuals did not have access to life-saving medications, so BCHD set up a 311 service request for assistance with prescription medication access and arranged for the delivery of urgently needed medications to residents’ homes. BCHD also organized food distribution and set up a shuttle for seniors to get groceries. Efforts have continued, with virtual supermarkets to keep on delivering healthy food to people who do not have access to it, and a 24/7 phone hotline for individuals seeking addiction and mental health help.

Public Policy

All of BCHD’s programs strive to incorporate health in all policies across the city and view any issue that decreases the safety and well-being of citizens to be a health issue. For example, BCHD continues to advocate for violence prevention to be a core tenet of public health. BCHD’s Safe Streets program partners with community-based organizations to hire recently released citizens, many of whom are former gang members and drug dealers. In 2015, Safe Streets workers mediated nearly 700 conflicts, and the majority of these interactions were deemed to be likely, or very likely, to have reduced gun violence.

Baltimore is a unique city, but the problems the Baltimore City Health Department addresses on a daily basis – infant mortality, child health, the opioid epidemic, food and medication access, and violence – are issues that touch every city. This is the necessary role of local public health: to go to where people are, to unite communities, and to respond to needs with continuous innovation and unending dedication to serve.

Kathleen E. Goodwin is special assistant to the commissioner at the Baltimore City Health Department and a Baltimore Corps fellow. She graduated from Harvard University in 2013 with a B.A. in social studies, focusing on communal violence in South Asia. Following two years as a financial analyst at Credit Suisse, she enrolled in the Goucher College Post-Baccalaureate Premedical program and fulfilled the requirements to apply to medical school.

Leana S. Wen (pictured above), M.D. M.Sc. FAAEM, is the commissioner of health, Baltimore City. She leads the oldest, continuously operating health department in the United States, with over 1,000 employees. Her transformative approach to public health involves engaging hospitals and returning citizens in violence prevention and launching an ambitious opioid overdose prevention program that is training every resident to save lives. Following the civil unrest in April 2015, she directed Baltimore’s medical access and trauma recovery efforts.

Significant contribution to this article was provided by: Jennifer L. Martin, J.D. M.A., who is the director in the Office of Public Health Preparedness and Response (OPHPR) at the Baltimore City Health Department.  As the director, she oversees and facilitates the emergency preparedness and response program within the agency, including biosurveillance and bioterrorism program activities, continuity of operations planning, and health and medical response planning. Additionally, the city’s extreme heat and extreme cold planning efforts are led by BCHD under her direction. She also serves as BCHD’s representative for issues and planning related to climate change at the state and local levels.