Though still burdened with chronic public health problems, Baltimore has made quiet progress over the past several years. Fewer teen-agers are getting pregnant. More babies are surviving. And more children are getting immunized.

The numbers, released yesterday by the Baltimore City Health Department, show an upswing in dealing with key health issues.

"This is not just a one-time occurrence. Routinely, year after year, we're seeing improvements," said Dr. Peter Beilenson, the city health commissioner. "There are reasons to be optimistic about the health of Baltimore City."

The gains have been attributed to public and private initiatives, as well as social trends and medical discoveries.

In many of the categories, the changes are impressive. Between 1992 and 1996, the last year for which statistics are available, the city's teen birth rate dropped by 20 percent. Between 1993 and 1998, infant mortality dropped by 16 percent. Though those rates are relatively high, Baltimore's rate is no longer one of the worst nationwide.

Thanks to a push for more money for drug treatment, slots for uninsured addicts doubled between 1996 and 1999.

"This is what happens when you focus your money and your efforts," said Dr. Georges Benjamin, deputy director for public health services at the state Department of Health and Mental Hygiene.

In 1995, for example, 62 percent of Baltimore school students were immunized. The Health Department and city schools teamed to provide free shot clinics, send certified letters to parents, and require schools to refuse admittance to students who aren't immunized. Now, the immunization rate is 99.8 percent.

Drug treatment for the city's estimated 59,000 drug addicts has been another major problem. Those who wanted treatment often ended up on long waiting lists. In the past few years, Beilenson and Mayor Kurt L. Schmoke have raised money to increase the treatment slots for addicts. This year, an estimated 22,000 people should receive treatment -- double the number three years ago.

Other improvements in Baltimore's health, such as the drop in the number of AIDS cases, stem from scientific advances such as the development of new drugs. Officials attribute the reduction in the teen pregnancy rate to a variety of factors, including increased availability of condoms for teen-agers and peer-taught abstinence programs.

Still, Baltimore's health picture is troubled. A study released late last year by the U.S. Centers for Disease Control and Prevention showed that Baltimore's syphilis rate was more than 30 times the national average, with a gonorrhea rate nine times higher than average. The CDC said a drop in the number of city health department staffers at clinics for sexually transmitted diseases was responsible for the high rates.

The latest Baltimore figures showed syphilis cases have dropped by 31 percent from 1997 to 1998, but the number of gonorrhea cases has remained steady in the last few years, at about 6,900 cases a year -- many of them teen-agers. Beilenson said he was able to restore the six staffers lost to federal budget cuts, so the STD clinics are back up to their full complement.

Another problem is the large increase in cases of hepatitis A, a viral infection often spread through poor hygiene in restaurants. According to the report, 41 cases were reported in 1996, compared with 116 last year.

Experts say some other statistics highlight how difficult it is to improve a city's health. About 21 percent of Baltimore's 661,504 residents live at or below the poverty level, according to the report. A quarter of residents are on Medicaid, the federal-state health program for the poor and disabled. About 8 percent of the population is unemployed.

"It's just a very tough environment in which to work, knowing that fiscal resources tend to be focused elsewhere, particularly in law enforcement vs. drug treatment," said Michael Preston, executive director of MedChi, the state medical society.

One factor not included in the report is homelessness, and in Baltimore those numbers appear to be rising, said Jeff Singer, president and chief executive officer of Health Care for the Homeless, a downtown clinic. He said clinic workers are seeing more patients, as are the soup kitchens and food pantry. The homeless population is estimated at 2,000 people a night.

Singer pointed to the movement for a single-payer system as the best hope for the homeless and others who don't get regular health care. Under this system, everyone is guaranteed care, and all the costs are paid by one entity, such as the government. Canada has this setup, and there have been unsuccessful campaigns for single-payer systems in California and other states. A group including Beilenson will be advocating a similar plan for Maryland.

Pub Date: 3/10/99