Vital Signs Blog

Blog: Baltimore unrest draws attention to health disparities

Along with everything else, the city of Baltimore's public health infrastructure took a hit during the demonstrations and rioting following the death of Freddie Gray, a 25-year-old black man who died April 19 from injuries suffered while in police custody.

Two of the city's most prominent physicians wrote a commentary posted on the JAMA website addressing the past and current roles public health efforts have played in mitigating Baltimore's social inequities and healthcare disparities. The authors called on the city's healthcare professionals to use their economic and human resources to address the underlying causes of social unrest.

The essay was co-written by Dr. Joshua Sharfstein, associate dean for public health practice and training at the Johns Hopkins Bloomberg School of Public Health, and Baltimore City Health Commissioner Dr. Leana Wen. The two authors stated their case for the public health profession to “embrace the mission” of seeking solutions to health inequities.

“The problems reflect a long-standing dysfunctional relationship between law enforcement and citizens, structural poverty, and the legacy of discrimination in housing and finance policy,” Sharfstein and Wen wrote. “The problems also deeply engage public health—in addressing immediate needs, in understanding the basis of unrest, and in shaping long-term solutions.”

Sharfstein and Wen described how the city Health Department set up a hotline to help those who lost their access to prescription drugs when 13 pharmacies closed during the violence. The department also conducted door-to-door outreach to get needed medications to senior citizens in public housing.

There has been debate in recent years over whether Baltimore was becoming the “the new Brooklyn” in terms of developing a younger population with money to spend on restaurants, art and music. But the two public health physicians instead focused on a “two Baltimores” theme addressing the divide between the city's more affluent and poorer residents.

Between 2008 and 2011, Sharfstein and Wen recalled that the city's Health Department teamed with Johns Hopkins students and faculty to create health profiles for Baltimore's 55 neighborhoods, reporting that life expectancy varied by as much as 20 years between communities.

“There's the Baltimore that was featured prominently in the news with … boarded-up houses,” Wen told the American Public Health Association's Public Health Newswire. “Then there's the Inner Harbor with the lights and ritzy hotels. And they coexist right next to each other. The 20-year difference in life expectancy shows us that the inequities are so pervasive, to the point that how long a person lives doesn't so much depend on their genetic codes as their ZIP codes.”

Sharfstein and Wen wrote in JAMA about promising public health initiatives to eradicate lead poisoning, reduce the homicide rate and lower rates of infant mortality and teen pregnancy among African Americans. Despite the progress, they lamented that recent events have shown that a much greater effort is needed.

“As recent events have made plain, however, this progress is not nearly enough,” they wrote. “This is not a moment for public health to question its effectiveness, but rather to strengthen its resolve.”


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