Wednesday, December 7, 2011

Baltimore Declares First Code Blue of the Season

Because anticipated drop in temperatures and expected snowfall are a potential danger to health, I declared the first Code Blue cold weather alert of the winter season for tonight. The City’s Code Blue is a multi-agency effort to reduce hypothermia deaths this winter by protecting homeless individuals, seniors and other vulnerable populations from extreme cold weather.

In response to the City’s expected freezing temperatures overnight as well as potential snow accumulation, tonight’s code blue declaration will trigger several responses aimed at providing for those must susceptible to extreme cold weather:

  • The Mayor’s Office of Homeless Services operates a 24-hour Housing & Resource Center for men and women at 620 Fallsway.
  • Private homeless shelters will be encouraged to extend their hours and keep people indoors.
  • Homeless Services will provide 60 additional beds for residents seeking meals and sleeping quarters accessible thru the Housing & Resource Center at 620 Fallsway.
  • Additional cold weather education and outreach efforts, as needed.

Last winter, there were 8 days when the high temperature did not surpass 32 degrees Fahrenheit.
The state Medical Examiner’s office recorded 11 hypothermia-related deaths in Baltimore.
Our city’s most at risk of hypothermia death include the elderly, individuals with pre-existing heart conditions, those who abuse alcohol, drug users and the homeless.

As always, it is important to minimize your risk of hypothermia by staying indoors in safely heated areas. If you must go outside, be sure to dress warmly and stay dry.  Also remember that drinking alcohol – even in small quantities – can increase your risk of cold-related injuries, so imbibe with caution. And of course, if you have elderly or chronically ill neighbors, check in on them to make sure they are staying warm. 

On this first Cold Blue night of the season, it’s also important to remind residents lacking heat of the dangers of carbon monoxide poisoning from using generators in enclosed spaces, or burns caused by alternate heating sources. Energy assistance is available to residents in need at the Office of Home Energy, 410-396-5555.

If you or someone you know needs shelter tonight, please find the list of city and private shelters on our website.  For other cold-related inquiries and service requests, or to find a nearby homeless shelter, residents can call 311 (410-396-3100 after hours).

Bundle up, and take care, B’more.
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As always, it is important to minimize your risk of hypothermia by staying indoors in safely heated areas. If you must go outside, be sure to dress warmly and stay dry.  Also remember that drinking alcohol – even in small quantities – can increase your risk of cold-related injuries, so imbibe with caution. And of course, if you have elderly or chronically ill neighbors, check in on them to make sure they are staying warm. 

On this first Cold Blue night of the season, it’s also important to remind residents lacking heat of the dangers of carbon monoxide poisoning from using generators in enclosed spaces, or burns caused by alternate heating sources. Energy assistance is available to residents in need at the Office of Home Energy, 410-396-5555.

If you or someone you know needs shelter tonight, please find the list of city and private shelters on our website.  For other cold-related inquiries and service requests, or to find a nearby homeless shelter, residents can call 311 (410-396-3100 after hours).

Bundle up, and take care, B’more. 

Tuesday, December 6, 2011

Honor National Flu Vaccination Week By Getting Immunized

Winter is here, and that means a host of wonderful traditions – ice skating, hot chocolate, building snowmen, and the Hampden holiday light show. It also means we are in the midst of flu season. This week is National Flu Vaccination Week (December 4 – 10). If you haven’t already received your annual flu vaccine, I encourage you to get one before it’s too late. 

According to CDC, it takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection. Therefore, CDC recommends early vaccination to ensure that as many people as possible are protected during the current flu season. That is why it is so important for people to get vaccinated early in the season.

It is also important to take preventive measures at this time of year: wash your hands frequently, cover your mouth when coughing and sneezing, and stay home when you’re sick. These steps will keep you from spreading or catching the flu this year.

Typical flu symptoms include fever, dry cough, sore throat, runny or stuffy nose, headache and muscle aches, and extreme fatigue. While most people recover quickly and fully from the flu, others are at risk for more serious complications.This includes children under five, adults over 65, pregnant women, and those with certain health problems. Residents in these high risk categories are encouraged to contact their physician as soon as they experience any flu symptoms, especially fever and cough, to find out if they may benefit from anti-viral medications. If taken early in the course of the flu, these medications can help decrease the length of illness. Also, persons over 65 years of age should check with their healthcare provider to make sure they are vaccinated for pneumococcal disease.

If you haven’t gotten your flu shot yet, I encourage you to visit one of the Health Department’s TIKE clinics. Shots are free and there is no appointment necessary. Other tips on avoiding flu are available on the DHMH website at, and from the CDC website's flu information web pages at

Monday, December 5, 2011

A Major League Win for Tobacco Cessation: MLB Bans Smokeless Tobacco in Games

Over the summer, I shared with you the initiative among health commissioners from 15 major US cities – including Baltimore – to urge Major League Baseball to curb tobacco use among its players. When MLB announced the terms of the players’ new contract recently, we received extraordinarily good news: the new bargaining agreement includes historic limitations on the use of smokeless tobacco by players, managers and coaches.  

The new agreement prohibits players, managers and coaches from using smokeless tobacco during televised interviews, at team events, autograph signings and other appearances made on behalf of their teams. Any time when fans are in the ballpark, they will be prohibited from carrying tobacco products in their uniforms or on their body, and violators are subject to discipline.

Major League Baseball and the players’ union are jointly launching a nationwide public service campaign against smokeless tobacco, with youth – and in particular, young baseball players – as the target audiences. The Major League Baseball Players Association is establishing its own Tobacco Cessation Center, to be launched in the 2012 season. In addition, players will be screened for oral cancer during their annual physicals, probably at spring training.

This is extraordinary news, because the simple fact of the matter is that tobacco use is the number one cause of preventable death in the United States. As cigarette smoking has declined, the tobacco industry has increased its marketing of smokeless products and is spending record sums to promote them. But smokeless tobacco use is itself very dangerous, causing serious diseases of the mouth, including oral cancer. In addition, there is reason to worry that smokeless tobacco use by young persons may serve as a gateway to cigarette smoking, this nation’s leading preventable cause of premature death and disease. The new contract means that players, coaches, and managers will be offered the resources to quit and the screenings they need.

To show they are tobacco-free, many players turn their pockets inside out. That trend was pioneered by former Baltimore Oriole Tony Batista. Come Opening Day next year, I hope to see a whole lot more inside-out pockets on display.

While these provisions do not include an outright prohibition on smokeless tobacco use during games, they represent the first steps baseball ever has taken to begin breaking the game’s addiction to tobacco.  The new agreement will make a difference in how smokeless tobacco is perceived by young people, and hopefully represents a major step toward its ultimate elimination from the game.

To show your appreciation to MLB for taking this major step toward eliminating tobacco use from America’s greatest pastime, visit Tobacco Free Baseball and sign their online thank you letter. If you are anyone you know wants to quit tobacco, we urge you to call 1-800-QUIT NOW for information on how to stop.

Take care, B’more.

Wednesday, November 30, 2011

How Baltimore Is "Moving Forward" on HIV/AIDS

Today we mark a monumental achievement in our ongoing fight against the scourge of HIV/AIDS. For three decades now, HIV has been a long-standing and significant health problem in Baltimore, with terrible consequences. Countless people from all walks of life have died from HIV/AIDS. More than 13,000 people—two percent of the City’s population—are living with HIV.

In addition to the physical and emotional tolls the virus takes on its victims, the costs to our society are staggering. Everyone reading this, I’m sure, has been touched by this epidemic in some form or fashion. Through various programs and initiatives—the City has made tremendous progress in getting more people tested for HIV, getting more HIV positive people into care, and helping those with HIV live longer, healthier lives.

Now, on the eve of World AIDS Day, I’m pleased to report Baltimore has a new, aggressive plan to dramatically reduce new HIV infections, expand treatment, better coordinate services and make a significant improvement to the status of the HIV/AIDS crisis in Baltimore. On Tuesday, Mayor Stephanie Rawlings-Blake unveiled our new strategic report on HIV, “Moving Forward”. The strategy will help us better engage non-profit and community partners in our efforts educate residents and improve the lives of those who are HIV-positive.

The report was prepared by the Baltimore City Commission on HIV/AIDS.  It adopts specific, measurable goals in four key areas and outlines a variety of strategic initiatives to achieve those goals in an accelerated timeframe.

1.      Reduce new HIV infections by 25% in Baltimore City by 2015
2.      Increase access and improve health outcomes by facilitating earlier, more continuous, and more comprehensive care
3.      Reduce HIV-related health disparities by focusing resources and coordinated services on the most at-risk populations
4.      Achieve a more collaborative City response by creating effective linkages between services providers, advocacy organizations, and community-based models

The measurable goals and specific strategic initiatives outlined for each of the key goals are designed to drive aggressive and fundamental changes, yet are calibrated to be realistically achievable by 2015. I’m especially pleased that our vision aligns with the new National HIV/AIDS Strategy, as well as the ambitious goals we’ve set for improving the health of Baltimore residents through our Healthy Baltimore 2015 agenda.

Reducing HIV disparities is of particular concern in Baltimore. Eighty-seven percent of new HIV infections are among African-Americans, who only represent 64% of Baltimore’s population. This is one of the City’s most glaring health disparities. As referenced in the Strategy, 44 percent of the city population from 10 zip codes represented 60% of new HIV cases. These same zip codes have high rates of STDs, poverty and crime, along with higher rates of other poverty-related health problems, like cardiovascular disease and diabetes.

The Health Department, working in concert with our partners at the state and in the community, is working hard to address these needs. We provided more than 45,000 HIV tests in calendar year 2010. Through these efforts we identified 283 people who were previously unaware of their positive HIV status. Additionally, we operate two STD clinics that provide in excess of 30,000 patient visits per year, and offer HIV testing to all patients who register. Lastly, we are preparing a social marketing campaign in collaboration with Maryland Institute College of Art aimed at increasing awareness and testing among African-American MSM, the group that is currently experiencing the highest rate of HIV transmission.

Our focus is to ensure that patients who test positive make it all the way from receiving their results, through notification of their sex and needle-sharing partners, to being linked to HIV primary care.  As leaders of these efforts, we have a responsibility to hold ourselves and each other accountable to achieving measurable results

It is important to realize that the report provides critical guidelines for dramatically reducing HIV/AIDS in Baltimore, but reaching the target goals that have been established cannot be achieved unless communities and individuals also make effective prevention and treatment of HIV/AIDS a priority.

This strategy is our path forward. I’m counting on all of you to help us put this strategy into action. Let’s show the world that Baltimore is aware, that Baltimore cares, and that Baltimore is committed to stopping the spread of HIV.

Tuesday, November 22, 2011

Maryland Highlights New Family Planning Works Act

Like many other bills passed this spring by the General Assembly, the Family Planning Works Act received little fanfare at the time. But come Jan. 1, this important piece of legislation will provide free family planning services for 35,000 additional low-income women in Maryland.

Passage of the Family Planning Works Act is an important step in Baltimore’s ongoing efforts to improve birth outcomes by reducing a stubbornly high teen pregnancy rate and the number of unintended and unplanned pregnancies. Approximately 1 in 6 of all births in Baltimore occurs to teen mothers. Our teen pregnancy rate of 64/1,000 is twice that of the state and almost twice that of the United States. Far too many of these teen births are unintended. Our teenagers need better access to pregnancy prevention information, resources and support networks.

Maryland ranks near the bottom nationally in its rates of infant mortality and other birth outcomes measures, and Baltimore City, Prince George’s County, and the Eastern Shore have the most critical women and infant health needs in the state. This expansion will improve birth outcomes by reversing infant mortality and low birth weight rates, improving the health of mothers and babies, and reducing the number of abortions. Additionally, the reduction in unintended pregnancies and births is expected to produce $20 million to $40 million in savings for the state.

This move has public support. According to a survey by The National Women's Law Center and Planned Parenthood Federation of America, 76% of voters strongly support efforts to reduce the number of unintended pregnancies in America through common-sense measures such as comprehensive sex education and access to contraception.
The Family Planning Works Act will help women of all ages—especially many teens living in Baltimore City—with the access they need to obtain the safest and most effective forms of birth control…for free.

Women can sign up immediately, and free family planning services – including breast and reproductive cancer screenings, pelvic exams, sexually transmitted disease testing, pregnancy counseling, and contraception – will be available beginning on January 1st. The Act allows all women up to 200% of the Federal Poverty Level – about $22,000 per year for a single woman – to receive free family planning services.

I urge women to sign up now so they can start receiving services on January 1st when the new law takes effect. If you are a working woman who could not qualify for coverage before, I encourage you to call 311 to get connected to one of our clinics today. If you are a teen thinking about engaging in sexual activity, or if you are having unprotected sex—call 311 and get connected to learn about birth control counseling options.
This service is free. It and will improve your health, and the health of your family.

This expansion is very positive news for Baltimore. By helping more of our teens and young women better plan for their future and the future of their families, we can positively impact health outcomes citywide.

Tuesday, November 8, 2011

Social Determinants of Health Indicators Make It To Healthy People 2020

Last week, I attended a lecture from a national leader in public health who, when asked about the most powerful strategy to address the root causes of poor population health, suggested investment in early childhood education.  This expert’s advice speaks to what the evidence tells us about the impact of education on longer life expectancy, improved health, greater quality of life, and more health-promoting behaviors.  But this thinking confirms what community members have long known, that where we live, work, learn, and play dramatically impacts our health. 

Our city-wide policy agenda, Healthy Baltimore 2015 incorporates the “social determinants of health” with other leading indicators prioritized based on where we can have the greatest impact on morbidity and mortality, and improve the quality of life for city residents.  But, of course, our community health improvement efforts exist within a larger state and federal context. For that reason, I was thrilled to see that our thinking in Baltimore is consistent with the 12 national priority indicators of health, announced yesterday by the Department of Health and Human Services.    

Like Healthy Baltimore 2015’s 10 priority areas, the 12 national priorities include a focus on the root causes of poor health in addition to traditional public health and health care access indicators.  Both sets of priorities include an intention focus on identifying and reducing health inequities.  Also similar, the national priority areas incorporate what we know about critical points across the life cycle where interventions are likely to have the greatest impact on health outcomes.   One major difference between the national and local priority areas is that in Baltimore, we emphasize the importance of place.  For example, priority area 10 focuses on the need to “create health promoting neighborhoods” with a specific focus on liquor outlet density and vacant housing which are both significant concerns for many of our neighborhoods.

It is an exciting time to work in public health, with alignment between the national Healthy People 2020 initiative, Maryland’s State Health Improvement Plan, and Healthy Baltimore 2015.  I believe we have an unprecedented opportunity to improve health in our city as a whole and reduce long standing health inequities. I encourage you to check out the 10 national priority areas as well as the Healthy Baltimore 2015 priority areas and to join with us in this city wide effort to improve population health.  

Friday, November 4, 2011

How will you Script Your Future?

Earlier this week, I had the privilege of welcoming U.S. Surgeon General Dr. Regina Benjamin to Baltimore City’s Inner Harbor. The occasion was a press conference to announce Baltimore is one of several cities selected to participate in the multi-year national Script Your Future campaign.

While most Americans recognize the importance of taking prescribed medication as directed, people who skip or forget doses are less likely to understand the health consequences of medication non-adherence. Poor medication adherence has serious health consequences can impact patients’ quality of life and longevity, especially those who suffer from chronic conditions such as asthma, high blood pressure and diabetes. Script Your Future aims to educate consumers and health care professionals about this danger.

Dr. Barbot poses US Surgeon General Dr. Regina Benjamin.

It starts with a better understanding and awareness of the problem. There are many barriers and predictors of non-adherence. Nearly three out of four Americans admit that they do not always take their medication as directed, a problem that causes more than one-third of medicine-related hospitalizations, nearly  125,000 deaths in the United States each year, and adds $290 billion in avoidable costs to the health care system annually.

One thing is clear – if we want more patients to take their medicine as directed, we need to get health care professionals and patients to talk to one another. Research shows that many patients with chronic conditions often have a poor understanding of their condition, how their prescribed medication works and the consequences of not taking it. And doctors and pharmacists often aren’t aware if their patients are taking their medicine or not.

When patients understand their condition and how medication helps them manage it, they are more likely to commit to taking their medicine. But that commitment needs to be a two-way street. Right now, conversations between patients and health care professionals aren’t happening nearly as often as they should. It’s often hard to find the time to have these conversations and, sadly, physicians are rarely taught how to best motivate patients to take their medicine as directed. But we have to take the time.

It really does start with a conversation.

I’m excited to be a part of the Script Your Future campaign in Baltimore because it provides tools and resources to help health care professionals and patients talk to each other, and it aids us in our mission for Healthy Baltimore 2015. One of our goals is to increase by 10 percent the number of adults with high blood pressure taking medications. Currently, only three out of four adult men diagnosed with high blood pressure report they are taking medicine for high blood pressure. Script Your Future contains many useful tools that can help our physicians, nurse practitioners and pharmacists be more effective in communicating with their patients and help their patients avoid the serious health consequences of not taking medication as directed.

To see a video of the press conference from WMAR Ch. 2 news, click here.

What have been some of the barriers you’ve had to overcome to take your medicines as prescribed? Do you use a pillbox? Do you keep a list of medicines with you at all times? I’m curious to hear your thoughts on the campaign and subject.

Take Care, B’more!

Monday, October 31, 2011

The scary truth about Halloween candy, calories and kids

This Halloween, the vampires, ghosts, and Disney princesses that stop by your door clamoring for treats will be gathering a scary amount of candy – with public health specialists estimating that kids will bring home up to 7,000 calories worth of loot after trick or treating this year. To put that into perspective, you could eat 29 pounds of green grapes and consume the same amount of calories. This is truly frightening news when you consider the growing obesity epidemic facing our kids, as well as the heart health and diabetes risks associated with high-fat, HFC-laden Halloween treats.

The funny thing is that while Halloween candy is shrinking, we seem to be eating more of it, one individually-wrapped bite at a time. Studies show that when products are put into smaller packages and there are many of those small packages available, people eat significantly more than if they were presented with multiple full-sized candies.  So that bag of fun-sized Snickers on your desk is probably worse for you than a case of full-sized candy bars.

If you’re still in doubt about what candy might be the safest bet if you’re watching your sodium or sugar intake, the Huffington Post lets you test your knowledge of Halloween nutrition (or lack thereof). You can also check out FitSugar’s 100-calorie gallery to help you pick a healthy portion when you do decide to indulge.
In light of some of these terrifying nutritional facts, consider handing out something a little healthier to the tricksters this year. Apples are a classic choice for the health-conscious neighbor; pretzels, baked potato chips, and raisins are other healthy treats. You could encourage the little goblins’ creative side by handing out small tubs of Play-Do or other craft supplies. In fact, there are tons of non-food options to hand out – temporary tattoos, bubbles, crayons, bouncy balls, and stickers . . . the list goes on.

Another tip for parents I like: set a limit for how many pieces of candy children can eat each day _ and stick to it. 

The good news? No matter what you’re handing out, trick or treating door-to-door means a lot of walking, which can help burn off some of that candy corn.

If you’re concerned about the safety of the candy your children bring home, be sure to check out our Halloween candy safety tips on our Website homepage.

Trick or treat with care, B’more!

Is our healthcare system to big to fail? Thoughts from the APHA annual meeting

Yesterday the annual meeting of the American Public Health Association (APHA) in Washington, D.C., began in earnest. This is the time of the year that public health practitioners from all over the country gather to learn about what’s been accomplished over the previous year as well as what’s hot.

In reviewing the program, it’s clear that across the country much has been accomplished. What's also apparent is that public health has never been more important.

The United States spends more money on healthcare than any other country and our health outcomes are amongst the worst of the world’s developed countries. If the U.S. healthcare system was a stand-alone business, we would have been outsourced to Europe or Costa Rica.  The truth is that our healthcare system is too big to fail for many reasons, but mostly because the health of our nation is central to our ongoing competitiveness in the world market.

The role of public health has never been more important. Chronic diseases are what are killing us. The medical system has not been able to make significant inroads into turning this tide because our healthcare system was not built to promote health; it was built to treat illness. As such, it doesn’t have the capacity to meaningfully identify, let alone address, the social determinants of health _ examples are unhealthy housing or inadequate public transportation systems _ that perpetuate poor health outcomes.

Health reform and the Affordable Healthcare Act offer an opportunity to truly transform how this country promotes health. It’s up to us in public health to seize the opportunity to improve the health of our communities.

To learn more about the conference and what’s hot, follow along on APHA’s Annual Meeting Blog.

I am excited to be here and learn from my colleagues from around the country about what’s worked and what hasn't in their communities to improve health outcomes. I look forward to returning to Baltimore invigorated and armed with many new ideas for promoting better health for all.

Take Care, B’more.

Thursday, October 27, 2011

Don't gamble with your health - get a flu shot soon

If you were playing poker, calculated the odds and knew you had a 60 percent chance of winning the pot, would you make the call or fold?

Americans face a similar decision each autumn: whether or not to get vaccinated for the flu, or fold and hope not to get sick. Unlike the common cold, influenza is a serious viral illness. This week, we learned a little more about the odds that a flu shot or flu mist will protect those who receive it from the influenza viruses currently circulating.

Based on a review of selected, previously published studies, authors of the recent The Lancet Infectious Diseases article reported the flu shot was 59 percent effective against flu in healthy adults. This finding may be a surprise to some. But effectiveness ranges widely from season to season and can also vary depending on the health and age of the person being vaccinated. 

This is why public health leaders, the federal government and industry are investing and supporting the development of new and improved influenza vaccines. Maximizing our protection against influenza also requires diligent attention to frequent hand washing and covering our mouths when we cough or sneeze. It’s all of these things to together that increase our odds of not getting influenza.

But the fact remains: vaccination is still the safest, most effective means for preventing transmission of the influenza virus and staying healthy. This is especially important for the very young, elderly and people with high-risk chronic health conditions. Scientific observational studies have demonstrated the value of influenza vaccines in this population time and again. And as this Time magazine piece notes, "59% is better than zero."

This flu season, don’t gamble with your health. Make the call and get protected from influenza by getting the flu shot or flu mist at your doctor’s office, local pharmacy, or dial 311 to find the nearest Health Department free clinic

Take Care, Baltimore