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!