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A better future for Baltimore after Freddie Gray

At this particularly vulnerable moment in the history of Baltimore, we have a choice. Either we wait for things to return to "normal" — which is not an acceptable state for many residents of our city — or we can seize this moment, when the light shines on the many inequities present in our society, to truly address the multitude of issues that keep too many of our citizens from a decent chance to succeed.

The reasons for this inequality are varied and long-standing; some date back to contemptible racial policies of the 1700s, some to economic policies of the past few decades and some come from biased criminal justice strategies in the recent past. Institutionalized racism clearly plays a role, as well, in contributing to the chasm between the two Baltimores.

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So, what is needed to begin the change that must come to our city? In the classes I teach to undergraduates at Johns Hopkins, we talk about the social determinants of health — i.e. what are the factors in a person's environment that impact their health and their community's health? The conclusion we have reached is that for a neighborhood, a community, or a city to be truly healthy, a "four-legged stool" must be in place. As with an actual stool, providing just one, two or even three of the legs will not keep the stool from falling down — all four legs must be present and sturdy.

The four components necessary for a truly health community are the following:

1.) Affordable, lead-free housing in a safe neighborhood. Despite the fact that lead paint has been banned in Baltimore since the 1950s, a large percentage of homes still contain lead paint, the dust from which is a potent poison that causes life-long learning and behavioral problems. Just as important, growing up in dangerous neighborhoods, beset by violence, leads to tragically high rates of depression and PTSD among residents. This is a major contributor to the overwhelming sense of hopelessness that is all too common among young people in these neighborhoods.

2.) Access to health care and healthy foods. For far too long, those of lower socioeconomic status have not had access to preventive and primary care, leading to higher rates of suffering and death from potentially preventable or treatable conditions. And, the lack of access to healthy food in the many "food deserts" of the city lead to the epidemic of obesity, diabetes and other chronic diseases disproportionately affecting this population.

3.) A decent public school system that prepares students for today's economy. Far too many of Baltimore's public schools do not provide the skills necessary for the future success of its students. Amazingly, even with recent improvements, over a third of city students don't even graduate from high school, drastically limiting their earning power for the rest of their lives.

4.) Livable wage jobs — not minimum wage jobs — available for and accessible to adults in the community. Perhaps the largest contributor to the disparities between communities in Baltimore is the pervasive lack of availability of livable wage jobs in impoverished communities of color. If it is true that a well-paying job is the best social program, than we must do more to bring employers and their companies to these areas of the city, so that these jobs are accessible to residents of these communities

Ensuring that these four components are present in all of Baltimore's neighborhoods won't necessarily cost a tremendous amount of money, but to embark on this course does require a tremendous amount of political pressure from the residents of Baltimore — of all colors, creeds, and economic statuses — to be exerted on the city's elected leaders to follow this path. If we don't exert the power of a nearly unified 620,000 Baltimoreans and supporters in the surrounding counties, we are doomed to repeat the injustices of the past. Disparities between the rich and poor will continue to grow, as will the level of hopelessness in the communities without the four legs of the stool that they need to become healthier and more successful. Heading in this direction will not end well for anyone, because the fates of the two Baltimores are intimately intertwined.

How much better it would be, then, for us all to use this very painful moment to commit to comprehensively address the underlying causes of the disparities that have existed for far too long in order to ensure a better future for Baltimore.

Dr. Peter Beilenson is the president and CEO of Evergreen Health; he served as Howard County's health officer from 2007 to 2012 and as Baltimore City's health commissioner from 1992 to 2005. His email is plb@evergreenmd.org.

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