Tuesday, May 31, 2011

Health Department Observes World No Tobacco Day

In 2009, the percentage of adult smokers in Baltimore City (28.3%) was higher than Kentucky and West Virginia – the two states tied for the highest percentage of smokers (25.6%) in the country. Although Maryland has one of the lowest smoking rates in the country, significant disparities exist among Baltimore smokers with high and low income and educational attainment levels. The smoking rates for city residents with an income of less than $15,000 is 36 percent (compared to 15.1 percent for the highest income group). Likewise, the rate for college graduates is 14.8 percent, compared to 33.9 percent for those with a high school education or less, according to the 2009 Baltimore City Community Health Survey.
These are troubling numbers, especially because tobacco use remains one of the most preventable causes of death and disease.

Today, I am calling on all city residents to join us in commemorating World No Tobacco Day. This day is an excellent opportunity to raise awareness about the harmful effects of tobacco use on the health and well-being of Baltimore City residents.

The negative health effects of tobacco use are well known. It contributes to early heart attacks, strokes, chronic lung diseases and cancers. There is also compelling evidence of the harmful impact of secondhand smoke to nonsmokers and children who suffer from respiratory infections. Smoking is associated with preterm births, stillbirths and low birth weight, all of which can cause infant mortality. Eighty percent of all fire deaths occur in the home; careless smoking is often to blame.

This year, more than 5 million people worldwide will die from a tobacco-related heart attack, stroke, cancer, lung ailment or other disease. Having killed 100 million people during the 20th century, tobacco use could kill 1 billion during the 21st century, according to the World Health Organization.

If you or a loved one is ready to take the step of quitting tobacco, we want to help. Every day, the Health Department and our partners provide the following educational outreach and treatment support for tobacco users:

  • Residents may call 410-361-9765 for a referral to a cessation program.
  • The Health Department’s SmokeFree Baltimore Tour Bus will provide tobacco use and quitting information from 10:00 a.m. to 2:00 p.m. at Baltimore Medical System at Orleans Square health center at 2323 Orleans St.
  • The department’s Tobacco Use Prevention and Cessation Program provides pharmacotherapies to Federally Qualified Health Centers (FQHC) for uninsured clients in their cessation programs. Free patches are distributed to clients – either through one-on-one counseling by a health care provider or during cessation classes. To find the FQHC nearest you, call 311, the city’s service line. 
  • The national Quit Line – 1-800-QUITNOW – provides counseling to callers who want to quit. Qualifying callers are provided with a month’s supply of patches and gum.

Being tobacco free is a high priority area for this department. Earlier this month, we unveiled Healthy Baltimore 2015, our five-year health policy agenda for improving health outcomes and reducing health disparities in Baltimore. In it, we set ambitious goals for realizing our goal of a tobacco free Baltimore. I hope you’ll take a few minutes to review this important document and sign up to partner with us on these and other important efforts to improve public health in Baltimore City.

Friday, May 27, 2011

University of Medicine and Dentistry of New Jersey Commencement Speech

This past Monday, I had the honor of delivering the keynote address at commencement ceremonies for my alma mater, the University of Medicine and Dentistry of New Jersey – New Jersey Medical School. What do you think are the biggest challenges facing the next generation of young physicians and dentists? How can we better bridge primary care and public health?

Dean Johnson, esteemed colleagues, parents and family, and class of 2011.

It is an honor to be your commencement speaker. 

It’s astounding to think it was just 20 years ago when I was in your seat.  My medical school graduation was one of the most momentous days of my professional career.  Personally, I was humbled by the honor of having my grandfather travel from a rural town in Puerto Rico to see his granddaughter become a doctor.  As for many of you, this accomplishment was not just my own, it was - and still is - my family’s accomplishment as well.  Professionally, I saw it as the beginning of a journey I had always dreamt about.  It was real and I had the paper to prove it!
One of my internal motivations has always been hearing my mom’s voice in my head saying “don’t forget where you came from and make sure you give back to the community”.  I’m certain that many of you may have that same tape running in your head because we all come from somewhere and we all get to where we are with the support of others.  And even if we don’t share similar upbringings, we share the fact that we had the privilege and honor of being from New Jersey Medical School.

Newark, New Jersey and its people have become a part of you - same as you have become a part of the lives you have touched in this city.  The patients and families I cared for and learned from here helped to shape my views when I went to Washington, DC to work in a community health center.  They also helped to inform my decisions when I went into public health in NYC and now in Baltimore City as health commissioner.

And so MY first point to you is to “remember where you came from and make sure you give back to the community” wherever that community may be.

In preparing for this speech, I searched the internet for just the right quote to impart words of wisdom and I pretty much gave up until I came across a quote that reminded me of what my mom said. It’s a quote from the 18th century German philosopher, Immanuel Kant:

“Always recognize that human individuals are ends, and do not use them as means to your end.”

By remembering that individuals are ends, we then come to the second point: Each of our patients has something to teach us.  All too often this point in medical school has been made within the context of learning about the body and natural course of disease.  As you progress in your careers, my hope is that this point will take much greater dimension to learning and integrating how social determinants of health – things that impact where we live, work and play - affect the patients you see and the way you practice medicine.

As physicians we have the privilege of being let into our patients’ lives.  Some times by choice and other times in spite of their objections.  This privilege should never be taken for granted.  With this privilege comes the responsibility of bearing witness to the social conditions that affect individual health outcomes, as well as community health outcomes. 

One of the most important things we can do is not ignore the power of the white coat.  I encourage each of you to be more than just physicians.  I challenge each of you to be physician advocates.  To be outraged by the health inequities that are driven by social determinants of health such as education, housing, access to healthy foods and transportation.  There are opportunities that will be afforded to you by virtue of the power of the white coat.  Use this to the advantage of your patients.

According to the Institute on Medicine as a Profession

Physician advocacy extends beyond the provision of good clinical care and advocacy on behalf of individual patients to include collaborations with people and organizations that combat interpersonal, structural, and systematic inequities and abuses in our society. Advocacy is the bridge that links patient care with efforts to address social determinants of health, institutionalized prejudices, and structural dislocations that patients and communities face. Physicians are especially qualified to advocate upon behalf of social change. The prestige and credibility that they command may serve as valuable resources in advocacy efforts. 

When I was just out of training I worked in a community health center in inner city Washington DC.  Day in and day out I saw children that were being lead poisoned by their housing environment.  It was frustrating to be treating outcomes that were so easily avoidable.  I was at a loss of what to do until I did what we as scientists have been trained to do – document what we see. 

I created a very simple database that tracked the addresses of children with elevated lead levels.  This simple tool demonstrated that there were identifiable units that were serially poisoning the children of our community. Just as I finished the first phase of the database, I was connected to a young lawyer in the Department of Justice who came to our clinic working on another project, but who was also interested in housing justice. 

To make a long story short, he was able to use the database to make his case against delinquent landlords even stronger and levy heavier fines against those landlords.  In the end, then-Secretary of Housing Andrew Cuomo came to our clinic to highlight the work that had been done.

The power of the white coat lies in the ability to apply your diagnostic skills to identifying trends in a community.  It lies in your ability to translate medical data into everyday language that illustrates that acuity with which things such as housing policy, educational policy and even land use policy affect communities such as the one we have served here in Newark. 

As John F. Kennedy said, “the goal of education is the advancement of knowledge and the dissemination of truth”.

Births and deaths and the dignity with which they occur remind us of why it is we do the work we do and that there is urgency to creating a healthcare delivery system that makes healthy choices the default choices.

You will be among the first group of doctors finishing their residency training when the majority of the provisions within the Affordable Care Act go into effect in 2014.  None of us know exactly what this beast will end up looking like, but one thing is certain:  It won’t be what it is now.

The question is “Will it be what we want it and need it to be?”

Not one of us should have the delusion that an insurance card will be a game changer when it comes to addressing health disparities and health inequities. But we should all have the courage to advocate for a healthcare system that values preventative care, makes it easier for doctors to do the right thing with the use of electronic health records and provides a quality feedback loop at the systems level so that we can know when what we’re doing isn’t giving us the outcomes that we anticipate. 

As I end, I am reminded of a visit I made to South Africa shortly after apartheid had fallen.  I had the privilege of visiting Kwazulu-Natal, the birthplace of Community Oriented Primary Care.  COPC is a way of practicing primary care that incorporates the social determinants of health.  It was started in the 40’s by Sidney and Emily Kark, first in Israel and then in South Africa.  It gave rise to the community health center movement here in the 1970’s. 

During that trip I also had the privilege of spending time with young doctors who were studying at the newly formed school of public health.  To this day, I have never forgotten what one young doctor said to me about her class - “We are excited to heal our country”.  I hope that you too are excited about healing your country and your community. 

We come to medicine out of love – love for science and the purity of reason; love of our fellow man and the wellness of communities.  Be the best you can be at whatever specialty you choose because your patients deserve it.  Be advocates - whether you are an interventional radiologist or a general pediatrician – because your patients and their communities need you.  Understand social determinants of health and how they affect your daily practice and the outcomes you can attain with your patients.  Also be mindful of the fact that where we live, work and play oftentimes play as big a role in making us sick as they do in keeping us healthy.  But most of all strive for health equity.

Thank you and Godspeed.

Baltimore City Health Department Joins With Maryland Hepatitis Coalition to Commemorate Hepatitis Awareness Month

The Baltimore City Health Department joined today with members of the Maryland Hepatitis Coalition (MHC) and state and local officials to recognize National Hepatitis Awareness Month.  Throughout the year, the Health Department is actively involved with the prevention of viral hepatitis through its Immunization Program, Needle Exchange Program, and Perinatal Hepatitis B Prevention Project.  Today we are happy to join with our partners to honor Hepatitis Heroes and to bring this issue to the forefront in an effort to fight this silent killer.

An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected. About 80,000 new infections occur each year, according to the Centers for Disease Control and Prevention.

The Maryland Hepatitis Coalition is an excellent example of the positive power of government and community collaboration. By honoring these Hepatitis Heroes, the Coalition is bringing more positive attention to the great work that is already being done to prevent the transmission of viral hepatitis, to care for and treat those infected with viral hepatitis, and to educate clients and the general public about viral hepatitis.

Healthcare for the Homeless clients are medically and socially complex, and often uninsured. As a local gastroenterologist, Dr. Jonathan B. Schreiber, HCH/Mercy Medical Center, has opened his practice, committing time and resources, to welcome HCH clients. Dr. Schreiber has never declined a request to care for HCH clients and has ensured HCH clients receive the highest quality care.
Please join me in applauding the MHC’s 2011 Hepatitis Heroes Honorees:
  • Appolo Bama, LPN of Total Health Care, Men’s Health Center for significantly increasing the number of patients vaccinated and protected against hepatitis B.
  • Frank Parish, RN, CIC of the Baltimore City Detention Center for implementing hepatitis B vaccination for individuals at high risk in the Detention Center.
  • Kathleen L. Becker, DNP, CRNP of Healthcare for the Homeless and Johns Hopkins University School of Nursing for her longstanding commitment to providing high quality care to patients at Health Care for the Homeless.
  • Jonathan B. Schreiber, MD of Mercy Medical Center for caring for patients with chronic viral hepatitis referred from Health Care for the Homeless.

In addition to these four individuals, we also wish to recognize Maryland Delegate Shirley Nathan-Pulliam. Del. Nathan-Pulliam has been a strong supporter of viral hepatitis prevention and care for many years. She has championed increasing funding for testing, vaccination and health services for individuals impacted by these diseases because she recognizes that a large number of people are impacted but they are not aware and they are not receiving the lifesaving services and support they need to prevent sickness and death.

For more information on hepatitis prevention activities in Baltimore City, visit the Health Department’s website. The CDC’s website also has additional information on viral hepatitis. 

Should Maryland ban the sale of crib bumper pads?

As reported this week in the Baltimore Sun, Maryland Department of Health and Mental Hygiene Secretary Dr. Joshua Sharfstein is considering an expert panel’s recommendation that Maryland become the first state to ban the sale of bumper pads for baby cribs. Bumper pads, used to line the inside of a crib, can be health risk and have been involved in at least 2 dozen infant deaths across the nation.

An interesting finding from the panel was that research does not show any safety benefits of crib bumpers (that is to say they do not prevent serious head injuries as marketed) and that they can in fact be hazardous. Infants can get caught in the bumpers ties and can suffocate.

I commend the Secretary for addressing this issue and encourage him to accept the panel’s recommendation banning the sale of bumper pads in Maryland. Even one death due to an unsafe sleep environment is one too many, and in Baltimore City last year, 16 babies died in unsafe sleeping environments. Most of these deaths involved babies who were not in a crib (they were in an adult bed, with or without parents or siblings) and were not sleeping on their backs.

It is important for our citizens to understand how to put a baby to sleep safely. Babies need to be Alone, on their Back, in a safe Crib free of bumpers and other items. No Exceptions. More information on this important topic can be found on our B’more for Healthy Babies Website.

Wednesday, May 18, 2011

National Bike Month

Bike riding is good for people and communities.  It improves health and fitness, and it reduces our carbon footprint as well as traffic. However, there are significant health and safety risks associated with bicycle riding. Each year, more than 500,000 people in the U.S. are treated in emergency departments, and more than 700 people die as a result of bicycle-related injuries. 

Just recently we had a scare at the health department when one of our senior staff members had a tire blow out while going downhill.  As you can imagine she flew over her handle bars and suffered a number of injuries sending her to the ICU.  Thankfully she was ok.  Her helmet was destroyed, but her skull wasn’t.  The importance of helmets is that simple.

Bicycle helmets are the single most effective safety device available to reduce head injury and death from a bicycle crash, so it’s important to wear a helmet every time you ride. To maximize protection, be sure the helmet fits properly. A helmet should sit on top of the head in a level position and should not rock forward, backward or side to side. The Johns Hopkins Children’s Safety Center, run by the Johns Hopkins Center for Injury Research and Policy, offers free bike helmet fittings and also supplies reduced-cost helmets. For more information about their program, or call 410-614-5587 for more information.

Even with a well-fitting helmet, bicyclists need to exercise caution and good judgment to insure that every ride is a safe one. The League of American Bicyclists has some great safety tips for bicyclists including:
  • Follow the Rules of the Road
  • Be Visible
  • Be Predicable
  • Anticipate Conflicts
  • Wear a Helmet
Bike safety is not just a concern for cyclists, but for motorists as well. You can check out AAA for a longer list of tips, but the bottom line is:

  • Stay alert
  • Yield to bicyclists when turning.
  • Slow down and give at least 3 feet of clearance when passing.
  • Always check for bicyclists before opening your car door.
I was glad to see when I moved to Baltimore that work is being done to increase the number of bike lanes we have.  While I haven’t yet gotten into the routine of riding to work, I have ventured out on my bike.  If you see me around on my hybrid, make sure to wave!

In recognition of National Bike Month, the Baltimore City Health Department will promote the safe use of bicycles throughout May by participating in BikeBaltimore, the Department of Transportation’s bike program. BikeBaltimore organizes a variety of events around Baltimore City to encourage safe bicycle riding, from bicycle maintenance to group rides.

How are you planning to celebrate Bike Month? Do you use biking as a way to stay fit? Can you offer any other safety tips for cyclists? Let me know in the comments.

Tuesday, May 10, 2011

Healthy Baltimore 2015

Last month, the Robert Wood Johnson Foundation issued the second annual County Health Rankings. As it did last year, Baltimore City ranked last in the state. 

One statistic in particular stuck out: 14,887. That’s the number of years of potential life lost before the age of 75.  Put simply, far too many Baltimore City residents are dying before their time.

Statistics like these give great urgency to the work we do to improve the health of our city, our neighborhoods and our residents.  It also makes clear that traditional medical or public health approaches aren’t working and it’s time to try something different.

That conversation starts today with the release of Healthy Baltimore 2015.

This comprehensive health policy agenda highlights 10 priority areas that account for the greatest morbidity and mortality in Baltimore.  These areas were chosen because there are evidence-based interventions proven to make a difference.  The plan looks at the relevance of where we live, work and play on health outcomes, as oftentimes they play as significant a role in making us sick as they do in keeping us healthy.

The city has set ambitious, yet reachable, improvement goals for the following priority areas:

1. Promote access to quality health care for all. 

2. Be tobacco free. 

3. Redesign Communities to Prevent Obesity.

4. Promote Heart Health.

5. Stop the spread of HIV and other STIs. 

6. Recognize and Treat Mental Health Disorders. 

7. Reduce Drug Use and Alcohol Abuse.

8. Encourage early detection of cancer.

9. Promote Healthy Children and Adolescents.   

10. Create Health Promoting Neighborhoods. 

For more information on the specific indicators we will use to measure progress in these areas, please view the full Healthy Baltimore 2015 report.

As you can see, there is much work to be done. Healthy Baltimore 2015 makes clear that we all play a role in improving the health of our city.

Over the course of the next several weeks to months, we will work with partners throughout the city to flesh out a 3-pronged approach to moving the needle for each of the leading indicators, including policy development; prevention, quality, and access; and community engagement.  Later this spring, senior leaders within the department will visit communities around the city to share this plan and the updated neighborhood health profiles.  We hope communities will put this information to use in designing new strategies and interventions for tackling the top priorities they identify for creating health promoting environments.

Let me be clear: the health department alone cannot successfully execute Healthy Baltimore 2015.  We welcome all motivated neighborhood leaders, individual citizens, aca­demic institutions, community-based organizations, business owners and the media to join us in this effort as partners in health. 

Partners can contribute to the success of Healthy Baltimore 2015 in many ways. These varying levels of engagement include, but are not limited to:

  • Communication – displaying or distributing health information materials within each of the ten priority areas.
  • Facilitation – actively participating in interventions such as incorporating wellness at work programs into the business day.
  • Integration – actively considering the potential health impacts of pending business or policy decisions.
To become a partner, please email me at health.commissioner@baltimorecity.gov. Together, we can reshape the landscape to make Baltimore City a place where all residents realize their full health potential.