Lives in jeopardy

The Baltimore Sun

If you hope to experience a long, healthy life, you may not want to be in Baltimore. A recent study puts life expectancy in the city at 68.6 years, the lowest in the state and among the worst in the country. By contrast, residents of Montgomery County can expect to live 81.3 years, the highest longevity rate in the state and among the highest in the country. The situation cries out for changes in access to health care for the most vulnerable city residents.

Health researchers at Harvard University found that only six areas averaged lower life expectancy rates than Baltimore and those were counties in South Dakota that house a number of Native American reservations. Persistent geographic disparities existed even when researchers removed the effects of high rates of homicide and HIV/AIDS in urban areas.

What shortens the lives of urban residents, particularly those ages 15 to 59, is the prevalence of chronic health problems, including diabetes, hypertension, heart and lung disease, injuries and the effects of smoking and alcohol. And although these problems may be well-known and preventable, they need to be managed better over time instead of being treated, at much greater expense, in hospital emergency rooms once a patient's condition becomes acute.

That argues for changes in the delivery of health care services, through community health centers, expanded access to primary care physicians and other methods. Some additional federal and state resources are helping the shift from emergency rooms to primary care. Community health advocates estimate that Maryland has received about $5.7 million in extra funds - including about $2.4 million for Baltimore - as President Bush has tried to honor his pledge to serve more people in community health centers. And Gov. Robert L. Ehrlich Jr. promises to spend an additional $3 million in the 2007 fiscal year to cover visits to primary care doctors, prescription drugs and other medical services for about 30,000 low-income patients throughout the state.

City health officials are wisely working with state hospital regulators to find ways - that could be applied statewide - to redirect financial incentives from emergency room treatment to community centers, where the care of chronic diseases is more effective and less expensive. In addition, more aggressive outreach programs are needed, not only to push patients to have regular check-ups but also to educate them more about the dangers of smoking, drinking and overeating. A combination of better behavior and improved primary care could push Baltimore up the life-expectancy ladder.

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