JAMA: What Baltimore hospitals can do to reduce disparities

'Public health provided a critical window into understanding' the city's unrest

Protests in Baltimore following the death of a 25-year-old African American man while in police custody shed light on economic and health issues plaguing the city's low-income residents—and how they could be remedied with closer attention to public health needs, experts write in JAMA

According to Leana Wen of the Baltimore City Health Department (BCHD) and Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health, the city's health department during and after the riots:

  • Helped coordinate the response of hospitals and other health care facilities to ensure they were taking the proper safety precautions;
  • Prepared and delivered situational updates for hospital emergency planners;
  • Created a citywide security plan for hospitals;
  • Manned a hotline for city residents whose access to necessary medications was cut off by the closing of more than 12 city pharmacies in the aftermath of the riots;
  • Began a door-to-door campaign in public housing for elderly residents and helped transfer prescriptions to alternate pharmacies and dispense medications;
  • Arranged trauma counseling services at school, churches, and community centers, and created a free 24/7 mental health crisis line; and 
  • Provided and updated regularly an online resource guide with any changes in hospital and clinic hours.

As the department expanded its efforts to meet residents' immediate health care needs during the crisis, "public health provided a critical window into understanding the underlying causes of unrest in Baltimore," and it became clear that the city's hospitals could and should do more to address disparities, Wen and Sharfstein writes.

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According to the researchers, the public health sector in Baltimore should work more closely with schools to keep children healthy in and out of the classroom. Specifically, they write, officials could:

  • Work with housing agencies to map preventable illness and vulnerable teen parents before and after childbirth;
  • Implement efforts to provide treatment and support for mental health and substance misuse issues;
  • Develop programs to prevent violence among young people; and
  • Give youth insight into the relationship between law enforcement officials and the areas they serve.

The researchers say it is critical to include the health care system when addressing potential solutions to societal problems. "Public health officials, while engaging with leaders in other fields, can ask difficult questions about whether certain types of social policies are working based on evidence and, if not, what alternative approaches can be tried," the researchers write. They add, "This is not a moment for public health to question its effectiveness, but rather to strengthen its resolve" (Wen/Sharfstein, JAMA, 5/7).

The takeaway: Public health experts from the city's health department and Johns Hopkins' Bloomberg School of Public Health explain what public health improvements could do to decrease disparities in the Baltimore.

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