By Oxiris Barbot
1:10 PM EDT, October 21, 2013
Tomorrow's planned release of the Healthy Baltimore 2015 Interim Status Report says a lot about the health of our city.
The banner headline is that the health status of Baltimore City residents looks brighter than it did just a few years ago. The follow up, and perhaps more newsworthy message, is that we are closing the gap in racial and ethnic disparities for many of the leading health indicators.
When the Healthy Baltimore 2015 plan was released in May of 2011, we were clear that improving health outcomes required each of us, whether individually or through our organizations, to commit to addressing the underlying issues that drove poor health outcomes and that no single sector of our civil society could do this alone nor claim sole credit or bare sole blame. As a city we are guided by the fact that where we live, work, learn and play affect community health outcomes more than direct clinical services do. We are driven by the vision that every resident in Baltimore City has the right to realize their full health potential.
Baltimore's average life expectancy has increased by more than a year and a half to 73.5 years. Though the disparity between life expectancy of blacks as compared to whites hasn't improved, the encouraging news is that both have gained at least a year in life expectancy. Life expectancy for African Americans is now 70.8 years, and for whites it is 75.3 years. While that gain in years may not sound like a lot, it's cause for pause and acknowledgment that citywide efforts at improving health outcomes are taking hold.
The major contributors to improved life expectancy include the significant decline in youth homicides, fewer people contracting and dying from HIV and fewer people dying prematurely from heart disease. We are also saving more babies through collaborative initiatives such as B'More for Healthy Babies and in fact set a record low for infant mortality in Baltimore City last year.
In roughly two thirds of the leading indicators for which racial data is available, we have closed the racial divide by 5 percent (asthma hospitalizations) to 87 percent (alcohol and drug-related hospitalizations).
All the news is not good however.
The Healthy Baltimore 2015 interim update reports a drastic increase in emergency department visits for asthma, diabetes, hypertension and substance abuse in spite of decreases in hospitalizations for all of these conditions. In these same leading indicators, the racial disparities have gotten worse, by between 34 percent and 67 percent. I'll be convening the heads of emergency departments at all of our hospitals to better understand what they are seeing on the ground and how we can work together to ensure that our residents utilize emergency departments for true emergencies and visit their local doctors or clinics for everything else.
Beyond that, we are losing ground on the rates of syphilis, which are skyrocketing predominantly in the MSM (men who have sex with men) community. And while we are responding by making sure that every test we conduct for HIV includes a test for syphilis and providing free treatment for those who are infected and their partners, we need the support of individuals and other treatment providers to ensure that we get these infections under control.
While I celebrate passage of the Affordable Care Act, we can't assume that having an insurance card in everyone's hand is the magic elixir that will cure all ills and erase all disparities. The percentage of Baltimore City residents with no health insurance coverage in the last twelve months has decreased by 19 percent; however, the racial disparity of those who remain without insurance has increased by 39 percent.
We should all be troubled by these trends. Addressing underlying drivers of health inequities demands a multi-sector approach that goes beyond public health. It requires us to be proactive in considering the health consequences of commercial development, housing policy, transportation decisions and a host of other policy arenas that may not seem even remotely related to health outcomes of a community.
This interim report (the full text of which is available at baltimorehealth.org is intended to be a reality check — a reminder that we can't assume that someone else is looking out for the health of our communities.
The health challenges we face as a city didn't happen overnight nor can they be fixed overnight, but we can do better. We are only as healthy as our most challenged community. In a city with an abundance of health riches and a talent pool like no other, there is no reason why all of our health indicators can't be going in the right direction for everyone.
Dr. Oxiris Barbot is Baltimore City health commissioner. Her email is email@example.com.
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