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The 'uncertain path ahead'

Leana Wen: As [Baltimore] city's doctor, I worry about the uncertain path ahead.

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. Crying on the examining table, she told me how worried she was that her insurance could now be in jeopardy — that she could lose everything she worked so hard to achieve.

For my patient, like so many of our residents, the national uncertainty we face is deeply personal. In 2010, 81,000 adults in Baltimore City were without health insurance. That number has been cut in half — meaning that more than 40,000 now have access to life-saving care. Will their coverage now be at risk? Will our neighbors and family members be priced out of the basic right to health?

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 a doctor, I am anxious for my patients. 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. Safe Streets, our violence interruption initiative, continues to save hundreds of lives — and prevent hundreds of shootings — every year.

These efforts are proof that collective impact works. We must 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.

In times of crisis, it is human nature to tackle immediate concerns with quick fixes. Although some might work, others may simply be covering up greater problems. We must refuse that temptation and instead confront difficult challenges head-on.

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. It is about investing as early as possible, as far upstream, to intervene and interrupt 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 food-borne 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.

Thanks to the growth made under Baltimore Mayor Stephanie Rawlings-Blake, and with the determined leadership of Mayor-elect Catherine Pugh, our incoming City Council, dedicated state and federal officials, and incredible community partners, we can continue to strive for a future in which the neighborhoods where our children live do not determine whether they live.

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.

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

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