The death last April of Freddie Gray Jr., the 25-year-old Baltimore man fatally injured while in policy custody, sparked violent protests in that city's poor and minority communities. The civil unrest, which included looting and angry clashes with police, ultimately led to the governor declaring a state of emergency.
It was Dr. Leana Wen's third month on the job as commissioner of the Baltimore City Health Department. Based on her experience as an emergency department physician, she initially focused on keeping the city's hospitals safe and accessible for staff and patients.
But as the protests persisted, Wen faced a new set of issues. The department had to set up transportation services for elderly individuals so they could get their medications. Thirteen area pharmacies had closed because of looting.
The department established a crisis line to provide 24-hour mental health trauma counseling. It deployed teams of mental health professionals to affected neighborhoods.
Those measures represented an extension of activities that many urban public health departments have taken on in recent years to tackle social conditions that can lead to unrest. Baltimore and the rest of the nation have made major advances in reducing childhood lead exposure over the past decade (the fiasco in Flint, Mich., being a notable outlier).
As was widely reported after his death, Gray grew up in a west Baltimore row house filled with lead paint chips. He did poorly in school because of his inability to focus and had frequent run-ins with the law. A 2008 family lawsuit against the landlord resulted in an undisclosed settlement.
But like most public health agencies, Baltimore's hadn't moved much beyond dealing with its lead problem when it came to tackling the conditions of poverty that can lead to ill health.
It focused most of its limited resources on boosting vaccination rates, preventing the spread of infectious disease, and ensuring the city's restaurants were clean and safe.
That attitude is changing rapidly, though. “We're the ones who really should be at the head of the table for everything—health is tied to everything,” Wen said.
It's a view that's shared by a growing number of public health departments around the country. They are looking to broaden their role to include improving the overall population's health.
Experts say such efforts represent an evolution of the core mission of public health departments. Health-determining behaviors such as poor nutrition, smoking and drug abuse are more prevalent in poor communities. The resulting diseases and chronic conditions are America's greatest public health challenges today.