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Whether you're looking at chronic conditions, sexually transmitted diseases or other maladies, Baltimore has some of the worse health outcomes in the state and the nation.

City data shows 19 percent of Baltimore residents have asthma, while statewide it's 14 percent; 30 percent of children are obese, compared with 15 percent statewide; 30 percent of city kids have had at least two traumatic childhood experiences, versus 19 percent statewide.

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About 12 percent of city babies have low birth weight, compared with the national average of 6 percent. A quarter of Baltimore residents smoke, while 17 percent of U.S. residents do.

Health officials consider race a driver of many of the disparities in Baltimore, which is 62 percent African-American, compared with 30 percent in Maryland and about 13 percent nationally.

The U.S. Centers for Disease Control and Prevention found that this is the case in many urban areas. A recent survey found more barriers to health care and greater risk of disease for residents who live in predominantly minority neighborhoods when compared to the rest of their counties or states. Poverty is a big factor, but middle-class African-Americans also suffer higher rates of disease.

A comparison of disease rates of Baltimore's black population and the nation as a whole by Johns Hopkins researchers in 2010 found stark disparities: Black infants in Baltimore died at more than twice the national rate, and so did black diabetics. Black Baltimore residents were diagnosed with HIV at a rate 71/2 times the national rate.

Baltimore City statistics also show that blacks are far more likely than white residents to be hospitalized for several chronic diseases and drug or alcohol use, have higher rates of sexually transmitted diseases and report that their mental health is not good.

Data collected by the Big Cities Health Coalition from more than a dozen large metropolitan areas shows Baltimore in the bottom three for many health outcomes by race.

The themes in all the cities are the same, however, said Dr. LaMar Hasbrouck, executive director of the National Association of County and City Health Officials, which developed the Big Cities forum. All need more attention and resources paid to rooting out the causes.

"Every large city has pockets where there are going to be marked disparities by race and ethnicity," Hasbrouck said. "They will also be marked disparities by income. We understand this isn't happenstance. The drivers are historical things, the way we've structured systems and policies that perpetuated or created the disparities."

Neighborhoods are unsafe to exercise outdoors, devoid of employment opportunities and without stable housing and transportation, Hasbrouck said. This increases stress and reduces health.

All city agencies need to promote change, he said, and indeed that is what the Baltimore City Health Department calls for in a new blueprint to reduce disparities by half in the next decade.

"This is ambitious but doable," said Dr. Leana Wen, the Baltimore City Health Commissioner. "We'll improve overall health by cutting disparities."

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