This month Baltimore says farewell to its health commissioner, Dr. Oxiris Barbot. Her able leadership since arriving in 2010 has guided our city with a simple vision — making Baltimore a city where all residents realize their full health potential.
While acknowledging the importance of access to care, Dr. Barbot acted on the understanding that social determinants beyond health care were essential in achieving health for all. After bringing to light a 20-year gap in life expectancy between neighborhoods in the city, she sought and forged partnerships and collaborations to put health in all policies. She studied how to get other sectors excited about health and helped make the mayor's Cross Agency Health Task Force an effective force for progress.
The job of a health commissioner has never been more important, never less appreciated and never more difficult. The importance is obvious in a city like Baltimore where one neighborhood has a life expectancy of 83 years and another has a life expectancy of 63 years. The reason that health departments exist is because places can make you sick or healthy. Realtors know this, but few others still do. Many Americans have bought the dogma that health is created exclusively by the choices of individuals and their doctors. Forming communities to address our common health problems was going out of style, until the wake-up call from the City Health Department found a way to rally us.
Dr. Barbot became the city's public health champion. She got the science right, and she got things done by leading the staff of the health department to communicate its objectives in The Healthy Baltimore Initiative. Here was a data-driven blueprint for progress for the city in 10 key areas of public health. The agenda was ambitious, and it was clear from the outset that no health department could do it alone. We are now one year away from the 2015 deadline toward achieving the objectives of Healthy Baltimore, and miracles are occurring. The progress occurred because the health department reached out to other players. Other departments in the city and other community groups took center stage to do their part to make Healthy Baltimore a common cause.
There are many examples:
•The health department partnered with the Family League of Baltimore to establish the Teen Pregnancy Prevention Initiative with a key feature being a youth advisory council that involves teens themselves to help steer outreach and to develop future leaders.
•The Baltimore City Housing Department led the city's Vacants to Value program to reduce vacant building density in the city.
•A Virtual Supermarket Program is collaborating with Baltimore's Department of Planning and Housing to improve access to healthy food in food desert neighborhoods.
•Key legislation passed in Annapolis on needle exchange and liquor sales will lead to better health in Baltimore.
In bygone days, countering teen pregnancy, vacant buildings and a lack of healthy food would have been problems tackled alone by a beleaguered health department. The current success comes from mobilizing the substantial resources in the city and community. Baltimore is blessed with two schools of public health, two medical schools and eight nursing schools. Some of the faculty and students of these schools already work extensively with the health department, and many more would like to help if they could find an effective role.
Many of the city's health indicators are moving in the right direction. Gonorrhea is down by 40 percent. HIV is down by 25.4 percent. Death from cardiovascular disease is down by 9.9 percent. Teen pregnancies have fallen by nearly 25 percent. Vacant building density has fallen by 8 percent. Even more critical, the infant mortality rate for black infants has fallen from 18.6 to 12.6 per 1,000 — an astonishing achievement that most think reflects sustained efforts by a variety of initiatives, not the least of which is BCHD's B'more for Healthy Babies.
We must recognize that good fortune is compatible with continued striving. The existence of a 20-year gap in life expectancy remains a tremendous chasm and marks just how much more work there is for all of us to do under the next leader. There are emerging threats from violence and opioid deaths that we can do better in responding to. The challenge for Baltimore will be to find a new health champion who stays focused on science but mobilizes even more of the untapped resources in Baltimore and stays connected to the community. A city like Baltimore sees many arrivals and departures every year, saying farewell to our outgoing health commissioner will be a hard goodbye.
Dr. David Bishai is a professor in the Johns Hopkins Bloomberg School of Public Health and director of the Interdepartmental Program in Health Economics. His editorial is made in a personal capacity and is independent of his affiliation with Johns Hopkins University. His email is firstname.lastname@example.org.
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