Baltimore City Health Commissioner Oxiris Barbot unveiled an ambitious initiative this week aimed at improving the overall health of Baltimore citizens by 2015. It sets practical goals for reducing the most serious health risks and acknowledges that achieving them will take the combined efforts of the city's hospitals, schools, social services agencies, foundations and private businesses. If it works, it will be a major achievement for Dr. Barbot, who arrived in Baltimore a year ago. But the plan is maddeningly short on details about how such a complex collaboration would actually work and who would direct the effort.
There's no question Baltimore needs a comprehensive plan to improve the health of its residents. The city ranked 24th of the state's 24 jurisdictions in the most recent Robert Wood Johnson Foundation County Health Rankings Report for Maryland. Moreover, the disparity between the city and its neighbors is growing. One indication of the seriousness of the problem is Dr. Barbot's estimate that tens of thousands of years of potential life were lost because of premature deaths among Baltimore City residents last year.
Her initiative, called Healthy Baltimore 2015, targets the top 10 causes of premature deaths in the city for a combination of preventive, intervention and treatment strategies which, if implemented, would result in a significantly healthier population over the next four years.
The plan sets specific goals for reducing deaths from serious illnesses such as heart disease, cancer, HIV/AIDS and diabetes by a quarter. But it also addresses behavioral and nutritional issues, such as smoking, alcohol abuse, drug addiction and obesity, and environmental factors such as the density of vacant buildings and liquor stores in a community.
Dr. Barbot says all these factors have to be taken into account because, for better or worse, they all hold the potential for affecting residents' physical and mental well-being. What she envisions is a global approach in which state and local government agencies partner with public and private institutions across the city to come up with the policies and programs to achieve the reductions in health risks outlined in her plan.
The problem is that the initiative issued this week contains few details about how we're supposed to get from here to there. Dr. Barbot seems to put great faith in institutional partnerships, but exactly what such partnerships would do under her initiative that they aren't already doing is a little vague.
Similarly, she apparently believes there's tremendous untapped energy in neighborhood and community groups that could be harnessed for such causes as promoting healthier eating habits or environmental cleanup. But the initiative promises no new funding to jump start such efforts, nor is it clear whether the groups would work directly with the health department, on their own, or as junior partners to some larger institution. Who is going to put all this together?
These are the kinds of details Dr. Barbot says are still being worked out and that will be exhaustively discussed among the institutions and agencies she hopes to involve; the initiative itself is just a way of getting everybody on the same page. But as things now stand that page is more a call to action than an operational blueprint. It may bring the major stakeholders to the table, but they'll still have to figure out what to do once they get there.
In taking a comprehensive view of both the problem as well as the potential resources available to address it, Ms. Barbot may have gone further than her predecessors to establish a broad definition of Baltimore's health crisis. That is in itself an achievement, but the real work is yet to come.
In the meantime, what the city needs is for Dr. Barbot to become the recognizable public face of the Healthy Baltimore effort she is championing. In effect, she must play a role similar to that of First Lady Michelle Obama in her campaign against childhood obesity, or of city schools CEO Andrés Alonso as the personification of school reform. Some individuals are more temperamentally suited to such roles than others, but Dr. Barbot owes it to her signature initiative to give it a try.
In doing so she should aim to inspire, educate and empower at the grass-roots level as well as in the institutional and agency boardrooms. Big societal problems such as poverty and the lack of health care or access to nutritious food in inner-city neighborhoods certainly contribute to Baltimore's health problems, but so do the individual decisions people make on a daily basis about smoking, exercise and diet. All the programs in the world won't do much good if people aren't motivated to participate. But first you've got to get their attention, not just issue another report.