Great Job “Kicking The Habit”, CVS

I applaud CVS’ leadership in promoting health and wellness in announcing that effective this October, their stores will no longer carry cigarettes, cigars and chewing tobacco. 

As a retail pharmacy with a national footprint, CVS stands poised to rise head and shoulders above its competitors with regards to “putting its money where its mouth is.”  There is no place for tobacco within establishments such as pharmacies that have come to be identified with health and wellness.  I encourage other pharmacies to follow suit and truly be beacons of health and wellness in their communities.

The life-changing impacts of tobacco use on health is clear – it is the number one preventable cause of heart disease, babies exposed to tobacco smoke are five times more likely to die from Sudden Infant Death Syndrome, and those who smoke and have chronic illnesses are more likely to have poorer health outcomes than those who do not smoke.

Nearly a quarter of Baltimore City residents surveyed in 2011 reported that they were a current smoker. The city's Healthy Baltimore 2015 goal is to decrease the percentage of adults who currently smoke by 20%, and this decision by CVS, which has many Baltimore stores, will surely be a help as we strive to reach that goal.

Healthy Baltimore 2015 outlines 10 priority areas that account for the greatest preventable disease, disability and death and where we have identified goals to make Baltimore a healthier city in which to live, work and play. Among the areas that stand to benefit from this announcement include: 

• Be Tobacco Free
• Promote Heart Health 
• Create Health Promoting Neighborhoods

We look forward to working with CVS and any other pharmacy willing to take a stand in promoting wellness in their communities by eliminating the sale of tobacco in their establishments. 

Take care, B’more.

Keep The Little Ones Warm AND Safe During The Cold Winter Months

It’s cold out there and we’re all bundling up with lots of layers.  These are times when parents and caregivers are especially concerned with keeping babies extra warm.    The reality is that more layers and more blankets are not necessarily the best way to keep babies safely warm.

Sadly, infant sleep-related deaths sometimes rise during the winter as parents think they are doing the right thing by “bundling up” their babies when putting them to sleep.  A desire to keep babies warm may inadvertently lead instead to tragedy.

Several risk factors in winter months can contribute to sleep-related infant deaths.  Babies can be overheated with too many layers on or can suffocate under blankets. Additionally, this risk can be compounded by greater exposure to tobacco smoke inside the home when windows are closed, or from congestion due to having colds.

Every parent and caregiver should observe the A-B-C’s of safe sleep.  All babies less than one-year-old need to sleep alone, on their back, in a crib - every time, no exceptions.

In the winter months, remember these tips:

·                     Babies can be dressed in a wearable blanket or one-piece pajama. For an extra layer of warmth, a onesie or undershirt can be put on the baby underneath either of these options.

·                     Avoid covering babies with blankets and comforters which can suffocate a baby.

·                     Hats should not be worn because they can slide down accidentally and cover the baby’s face.

·                     The room that a baby is sleeping in should be at a temperature comfortable for a lightly-clothed adult, such as 72 degrees.

·                     Babies should be sleeping alone, on their back, in a crib (ABC’s of safe sleep).

BCHD works with the Family League of Baltimore City to manage the B’more for Healthy Babies coalition, bringing together communities, organizations, and resources so that every baby might have the best start possible.  For more Safe Sleep tips, check out www.healthybabiesbaltimore.com

For families who cannot afford to provide a safe sleeping environment for their infants, the Baltimore City Health Department will provide and set up a portable crib free of charge. For help in getting a crib, contact HealthCare Access Maryland at 410-649-0526. Also, resources on safe cribs is here: http://www.cpsc.gov/en/safety-education/safety-education-centers/cribs/

Remember, everyone taking care of babies needs to keep them warm and safe as the temperatures get colder. Far too many babies in Baltimore City die before their first birthday, and many of these deaths are preventable.

Take Care B’More.

In Action To Combat HIV

Yesterday I had the honor of being invited to the White House for the 3 year anniversary celebration of the Obama administration’s National HIV AIDS Strategy (NHAS).  As part of this celebration, Secretary of Health and Human Services Kathleen Sebelius announced a new initiative, The HIV Care Continuum Initiative, focused on increasing the number of individuals who get tested for HIV, linked into care if and when they are diagnosed with HIV, started on treatment early and retained in care.  This strategy emphasizes that treatment is prevention.  (Details of the HIV Care Continuum Initiative can be found here.)

With Grant Colfax, M.D.,Director of the Office of

National AIDS Policy, at yesterday’s announcement.

Treatment as prevention means that if an individual with HIV gets diagnosed early and started on medication early, then the likelihood of having very low levels of the HIV virus in their body increases.  It’s imperative that people with HIV maintain low to negligible levels of the virus because that increases their chances of remaining healthy.  Beyond that, maintaining undetectable levels of virus (and practicing safe sex) makes it highly unlikely that they will transmit the virus to their sexual partners.  That’s how we get to “Treatment is Prevention.”

In Baltimore City we incorporated NHAS into Healthy Baltimore 2015, our city’s health policy agenda.  Our stated goal is to reduce the number of new HIV infections by 25%, but the reality is that our work is focused on helping to create an HIV/AIDS-free generation.  Nationally, roughly 20% of the people with HIV don’t know they are infected and only 2/3 of the ones who know get into care; another significant percentage drop off when it comes to starting medication.  By the time we get to the viral suppression bucket, we are left with only 25% of those we began with - 1 in 4 individuals.  The other 3 are destined to develop illnesses resulting from the virus and, for many of them, infecting sexual partners. 

It sounds difficult, but collectively we can achieve an AIDS-free generation.  Much of the work we do in collaboration with our clinical and community partners specifically targets increasing the number of individuals that travel through the continuum of care outlined above and live full lives free of debilitating illnesses. 

The new initiative announced today will provide much needed dollars for local health departments to partner with federally qualified health clinics. 

One of the ways in which we are focused on combating HIV / AIDS is through the city’s HIV/AIDS Commission.  The Baltimore City Health Department (BCHD) is accepting applications for appointments to the commission, whose mission will be to coordinate and enhance HIV prevention and care services and serve as the official HIV prevention planning body for the City.  If you are interested in being considered for appointment to serve in this Commission, please fill out the application.  

BCHD offers free HIV testing 6 days and 5 nights a week in our mobile van.  In addition, we will be at Artscape this weekend offering free confidential HIV testing, Friday and Saturday between 11 a.m. & 9 p.m. and on Sunday from 11 a.m. – 8 p.m.

Information on additional HIV / AIDS resources for Baltimore City is available on the Baltimore City Health Department website here.

We all have a role to play in ridding our city of HIV.  The first step is to get tested.

Take Care, B’More.

Consider Equity In Targeting Obesity

There is no doubt that reducing empty calorie consumption is a necessary component for eradicating the obesity epidemic.  In recent years, several approaches have been promoted as means of targeting large numbers of the American people who are either currently obese or at risk of becoming obese.  Some of these measures include restricting advertisement of junk foods to children, requiring calorie labeling on menus and restricting the size of sugar-sweetened beverages that are sold.  While there is not universal agreement on the appropriateness of these approaches, we can safely say that measures targeted towards promoting health and preventing obesity can and should be equally applied to all Americans regardless of their economic status. 

That is not the case with promoting the restriction of purchasing sugar-sweetened beverages with food stamps.  In order to qualify for SNAP benefits, individuals must have income that falls below 130% of the Federal Poverty Line; however, the income can go as high as 200% of the Federal Poverty Line for families receiving non-cash TANF services.  

As the argument goes, obesity is an epidemic that costs the healthcare system millions of dollars and a significant amount of federal dollars are being diverted from other important programs to underwrite treating this epidemic.  Therefore, the government should have greater discretion as to what it does and doesn’t subsidize within its food programs as a way to impact the obesity epidemic and bend the health care cost curve.   

It is not clear that restricting food purchase choices in a way that targets poor people will result in changed behaviors related to food choices and healthy eating.  However, if we accept the premise that targeting groups of individuals who receive federal dollars to purchase food is an effective way to decrease obesity, why stop at SNAP benefits?  There are more than 2 million federal employees and a growing number of elderly who use federal dollars to buy food for themselves and their families every day.  Both of these groups of individuals would benefit from decreased consumption of sugar-sweetened beverages and the potential savings accrued from their improved health would contribute additional health care savings.  These examples underscore the point that our perceptions of acceptable and reasonable restrictions on groups of individuals, especially if they are poor, are subjective.

One approach we at the Baltimore City Health Department have chosen to take to promote healthy food purchase and eating is evidenced through our Virtual Supermarket Program in which healthier food choices are incentivized at point of purchase.  The VSP is a program that is designed to improve food access for SNAP recipients who live in food deserts. Individuals get $10 health bucks every fourth order they make with the Virtual Supermarket to purchase fruits, vegetables, whole grains, and low-fat dairy products.

Ultimately, our approach respects an individual’s agency around health and wellness decisions and provides greater opportunities for sustainable behavioral change that can help turn the tide on obesity.

I'm curious to hear your take on the situation, Baltimore.  How are you impacted by this issue? Please share your comments below.

Take care, B’more.

Seniors and Hoarding

It was my pleasure to speak this morning to seniors, social workers, nurses and caregivers who attended our 3^rd installment of Waxter Wisdom, a series of discussions covering some of the most challenging financial, medical and emotional issues facing aging adults and people with disabilities.

Since the program launched in December, we've already held frank conversations on end of life planning and healthy sex. Today’s discussion was on a topic that we once assumed was a rarity, but actually plagues as much as five percent of Baltimoreans: hoarding.

Thanks to the popularity of the A&E reality television show, hoarding has become quite a hot topic. By now, many of us have seen how cleaning crews are called in because the shame and sheer weight of accumulated papers, books, clothes and even trash has overwhelmed the person living inside and they need to literally dig their way out.

Physical challenges, dementia or Alzheimer’s, and difficulty managing years of accumulated memories all place seniors at much greater risk for hoarding. As we become less mobile or able to manage daily household chores, stacks of papers, books or treasures can quickly form  a dangerous obstacle course around the home, creating fire hazards and limiting the family’s movements – as well as hindering emergency workers’ ability to get inside in a crisis.

But we cannot ignore one additional, very important risk factor that compounds each of these challenges: social isolation.

As we age and physical or mental challenges arise, it’s quite easy to become depressed and isolated, losing interest in leaving home or inviting friends and family into our lives. And research shows that people who live alone – who are either widowed or never married – are overrepresented amongst those who suffer from hoarding.

It’s easier for seniors who are isolated to hide the confusion and feeling overwhelmed by a growing hoard – it’s also much tougher for them to get help.

And so, today, I urge us all to check on an elderly neighbor or relative. If someone in your life needs help sorting through collections, organizing memories, or just managing daily tasks, the following resources might be useful:

• Children of Hoarders: www.chidrenofhoarders.com
• Obsessive-Compulsive Foundation: www.ocfoundation.org/hoarding  
• National Study Group on Chronic Disorganization: www.nsgcd.org
• Clutterers Anonymous: www.clutterersanonymous.com

Also, our new directory of health and wellness resources for older adults, caregivers and the disabled in Baltimore City and County includes information on local mental health professionals and other support.

Some of us might know someone – or even be someone – who struggles with clutter and has trouble throwing things away.

But through forums like Waxter, we can learn about important resources and support to help our friends and loved ones before cherished memories become a hazard.

Take Care, B’More.

Transforming Baltimore

 Nothing is more transformative to a City than engaged, informed citizens.

Last night, I had the pleasure of witnessing the potential for change in our city as I testified at the Planning Commission’s first public hearing as part of TransForm Baltimore.  It’s our City’s effort to update and modernize our zoning code in a way that encourages growth and new development while protecting the assets and features that make Baltimore unique. 

You may wonder why a Health Commissioner is so concerned about zoning. 

Zoning codes are one of the most effective tools for promoting and protecting the public’s health.  The World Health Organization, the US Surgeon General and the Center for Disease Control have all recommended use of zoning codes as a method of reducing harm in communities.  This is especially important for things such as high alcohol outlet density.

Several good public health research studies recently conducted in urban centers throughout the country have demonstrated that alcohol outlets that sell for off-premise consumption (so-called “packaged goods stores) are strongly and consistently associated with increased violent crime.  Additionally, through our own Neighborhood Health Profiles, we know that Baltimore neighborhoods with higher alcohol outlet density are generally associated with poorer health outcomes, including shorter life expectancy, higher homicide rates, and greater poverty.  Lastly, through our Neighborhood Health Initiative, we heard loud and clear from communities throughout the city that this is a major public health concern; in fact residents in over half of the council districts prioritized liquor outlet density as one of their top ten health concerns.

Violence as a public health issue is something that I feel passionate about.  Addressing this pressing health concern must include every tool that is available to us.  That’s why I am particularly in favor of the amendments which I believe will right size the distribution of alcohol outlets:

Phasing out nonconforming Class A Liquor Outlets. These stores have been “non-conforming” in residential neighborhoods for 40 years. More often than not, these are the stores where you can buy cheap liquor across a plexiglass barrier.

Clarifying the definition of BD-7 licenses, commonly known as taverns. Often, BD-7s function as modern-day “speakeasies” – you can buy liquor in the front for off-site consumption, but to get into the actual bar you have to be buzzed in. In the new code, at least 50% of the outlet’s sales and floor area must be dedicated to on-site consumption. 

Enforcing a 300-foot limitation on new liquor stores. In the proposed zoning code, new liquor stores will not be permitted within 300 feet of existing stores with the exception of downtown.  

One of the priorities within Healthy Baltimore 2015 is “Creating Health Promoting Neighborhoods.” Current liquor board regulations say that Baltimore City should have one liquor license for every 1,000 residents. Instead, Baltimore currently has more than twice what it should, based on its population.

As I said in my testimony, in order to get a comparable ratio for health promoting outlets, we would need 30 times as many grocery stores and 4 times as many parks or open spaces as we currently have.  It shouldn't be easier to walk to your nearest package goods store than it is to walk to your nearest supermarket or park.

Last night, we heard residents speak about the shorter life expectancy, higher homicide rates, and greater poverty that they’ve seen in neighborhoods with too many liquor stores and ask for an opportunity to be part of the process that attempts to right-size the number of liquor licenses in our City.

You can stay informed during this process by visiting the Planning Commission's Zoning Rewrite website at http://www.rewritebaltimore.org.

You can also attend one of the upcoming Planning Commission hearings on Transform Baltimore:

December 13, 2012, 6pm, BCCC-Liberty Campus

January 5, 2013, 11am, Poly/Western High School

January 24, 2013, 5pm, Southeast Regional Library

February 21, 2013, 6pm, Morgan State University

Finally, we hope you'll share photos or short testimonials that show how alcohol outlets affect your neighborhood.  We are particularly interested in hearing youth opinions.  You can send your photos and stories to elizabeth.tung@baltimorecity.gov or to the Health Department at 1001 E Fayette Street, Baltimore MD, 21202, attn. Elizabeth Tung.

Take Care, B’More

It’s a noteworthy fact that teen births in Baltimore City have dropped by 30% over the last three years. And while that’s certainly great news and something to get excited about, we can, and we must, do better.

Baltimore still has one of the highest teen birth rates of any major city in the United States. Approximately 1 in 6 births in Baltimore occurs to teen mothers—less than 20% of which are planned.

We can, and we must, do better.

Teen pregnancy, like many of our city’s pressing health challenges, is complicated by factors involving where we live, work, learn and play – the social determinants of health. Teen pregnancy rates remain highest in communities and neighborhoods with higher rates of poverty, unemployment and crime. And we know that historically, teen pregnancy disproportionally impacts minority communities, particularly African American and Latinos.

This is important because teen moms are less likely to graduate high school, and education is strongly associated with financial stability and security. So improving the health of our neighborhoods will be is critical to our success in reducing teen births.

We must sustain our recent gains if we are to meet our Healthy Baltimore 2015 goal of reducing the teen birth rate by 20%. That’s why this morning I had the privilege of joining Mayor Stephanie Rawlings-Blake in announcing a new campaign to prevent teen and unintended births.

Know What U Want removes several barriers teens face with getting accurate information about abstinence and birth control as options to avoid pregnancy. With this campaign, we are encouraging teens to consider the importance of family planning when making important life choices. The Mayor noted, “Know What U Want will help teens accomplish their personal goals and improve our birth outcomes by keeping our teens in school and on paths to being highly productive city residents.”

Know What U Want is founded upon the belief that teens and young adults are best equipped to make decisions when they have access to health information that is real, relevant, and resourceful.

We extremely thankful for the financial support we received from The Abell Foundation, The Straus Foundation, The David and Barbara B. Hirschhorn Foundation, and the Henry and Ruth Blaustine Rosenberg Foundation.

It’s our hope that www.KnowWhatUWant.org will become a one-stop-shop where Baltimore teens and young adults can anonymously learn about abstinence, family planning, and available clinical services from a trustworthy source.

The Website also lists upcoming events. The fun starts in earnest next Saturday when city teens will spread “Know What You Want” through messages on Facebook, YouTube, and “tagging” public sidewalks with our U choose logo.

The chalk spray eventually will wash away with the rain. But we hope the message it imparts will last a lifetime. And that message is: Know what you want, and choose what’s right for you.