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Baltimore launches effort to improve worst health problems

Faced with an array of intractable health problems that are prematurely killing Baltimore's residents, city leaders plan to unveil Tuesday an ambitious plan targeting HIV infection, heart disease and other serious ailments in the top 10.

Health officials will for the first time map out specific and comprehensive goals, such as reducing smoking rates by 20 percent and the number of obese adults by 15 percent — all by 2015. The effort goes beyond the Health Department to engage just about every community in Baltimore, including hospitals, neighborhood associations, businesses and faith organizations.

The city's health commissioner, Dr. Oxiris Barbot, acknowledges that the sour economy and events out of her control could hamper efforts to improve on the specific measures included in Healthy Baltimore 2015. But she said that including every group that wants a role will improve the odds of success.

"Where we live, work and play has as much to do with keeping us healthy as making us sick," she said. "Healthy Baltimore is not about what the city Health Department is doing, it's more about what community groups and institutions can do along with the city."

Although there are no new funds being dedicated to the campaign, Barbot said Mayor Stephanie Rawlings-Blake has directed all city agencies to approach their actions based on what is healthy. For example, new lights from public works may make it safer to walk around the city, or a community garden approved by planning officials could provide better-quality food. Health officials will also identify grants and other resources that may be available to groups, which could choose specific projects based on the most pressing needs.

Those projects, combined with existing public and private programs in the city to reduce high rates of disease, infections and addictions, will contribute to the goals, Barbot said.

Park Heights, for example, grapples with high rates of obesity, hypertension and HIV, and residents and other stakeholders have formed a task force to address some of them. The members will help determine new areas of focus under the city plan, said Julius Colon, president and chief executive of Park Heights Renaissance Inc., a coalition formed to promote revitalization.
The city will provide community profiles in the next couple of weeks to neighborhoods, including specific data about their problems. Colon said that data will show residents how great the disparities are in Park Heights compared with more affluent neighborhoods, and where they may want to focus.

"We have quite a few issues in Park Heights, and if we had to pick one it would be difficult," he said. "Some of the issues overlap, like obesity and cardiovascular health, so we will see how we can focus attention strategically. ... The community has been neglected for some time, but we have hope."

Baltimore's program was modeled on one created in New York City in 2004 called Take Care New York that also identified 10 areas to improve.

Goals were reached or surpassed in four categories by 2007 and in nine by 2009. For example, the number of New Yorkers without a regular doctor dropped from 25 percent to 20 percent; the percentage of smokers decreased from 21.5 percent to about 17 percent; and the number who died from drugs dropped from 905 to 832. Still, there were challenges identified by city officials, including infant mortality.

Dr. Thomas Farley, New York City health commissioner, said missing some goals meant the plan was ambitious but still achievable. The first four years of the program focused on what medical providers could do, but he said officials realized that involving the community could make a bigger dent. In the past 2 years, 500 partners have signed on and advanced 250 specific projects.

"We in public health will always have a task in front of us to communicate to the general public and elected leaders that there are things we can do as a society to keep people healthy and keep people from getting sick in the first place," he said. "An agenda like this is a very good way of selling information that gets past the false assumption that all health comes out of a doctor's office."

That's why Barbot, who came to Baltimore from the New York health department about nine months ago, decided to include outside groups from the start.

To that end, the city Health Department will act mostly as a coordinator. Barbot will use existing department funds to create a new office of policy and planning and name a director. The director will help oversee the goals — which include 36 specific measures within the 10 categories — and will be responsible for documenting results every 5 years.

The data from 2009 and 2010 used to form the first set of goals were shocking in many cases, Barbot said, especially when race, income and education were considered.

•36 percent of low-income residents smoke compared with 15 percent of highest-income residents.

•137 of every 100,000 black residents have hypertension compared with 15 of every 100,000 white residents.

•There also are 717 vacant buildings and 12.5 liquor stores per 10,000 households in Baltimore.

The city aims to cut all of these statistics — and more — by 10 percent to 25 percent by 2015. To that end, Barbot said officials have been in touch with other groups, including hospitals, area businesses and nonprofit groups on top of community associations.

On the issue of liquor stores, Barbot has tapped C. Debra Furr-Holden, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, to participate. She is also director of the Drug Investigations, Violence, and Environmental Studies Laboratory that researches violence, alcohol, tobacco and drug exposure.

She said some liquor stores also cash checks and provide other vital services in neighborhoods, but many others are nuisances and violate city zoning by operating too close to schools and churches. She will work with communities to identify which are desirable and which are contributing to problems. She'll also help identify public policy changes that could help clean up existing stores or prevent new ones.

She said the number of liquor stores and their proximity to residential communities can have a profound impact on public health.

"But if you just deal with zoning or one city agency, you'll have limited results," she said. "You can't have everyone in their silos using up a limited pool of resources. You need all the stakeholders at the table. It's lofty, but it's the approach we need to be taking."

Source: By Meredith Cohn, The Baltimore Sun

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