Editor’s note: This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more.
The 2015 Aspen Ideas Festival began with the second annual Spotlight Health on “Smart Solutions to the World’s Toughest Challenges.” From disaster relief in Nepal to the Ebola pandemic in West Africa, the health sector has faced a number of difficult problems in the year since Spotlight Health first launched. There were physicians, politicians, and public health officials from dozens of countries in attendance to discuss just such issues.
We arrived at the Aspen Ideas Festival after a challenging year at the Baltimore City Health Department. In a city already burdened with poverty, violence, and substance use disorders, Baltimore experienced a 23 percent increase in drug and alcohol-related overdose deaths in 2014, with 303 deaths.
In the first quarter of 2015, Baltimore experienced a 178 percent increase in fentanyl-related overdose deaths when compared to the same period in 2014. Homicides in the month of May made it the city’s deadliest month in nearly 40 years. Just two months before our arrival at Aspen, the city experienced major civil unrest following the death of Freddie Gray, a 25-year-old African American man, while in police custody. Though the riots and demonstrations brought Baltimore to national attention, our city’s poverty, violence, and deep disparities are far from unique.
After months of emergency response and public health rebuilding efforts following the unrest, we arrived at Aspen in a Baltimore state of mind. We had just finished our food and medication access program to assist seniors and vulnerable residents whose pharmacies had closed during the unrest. The Health Department was in the midst of our mental health and trauma recovery plan launch for impacted residents. But sitting in the Greenwald Pavilion and listening to five former Secretaries of the U.S. Department of Health and Human Services (HHS) discuss the 50th anniversary of Medicare and Medicaid was a reminder of our national context. Their conversation brought several universal themes to mind.
Silos Weaken Public Health Efforts
Foremost among these was that health silos prevent critical pieces of our work from being efficient and effective. Dr. Karen DeSalvo, the Acting Assistant Secretary for Health at HHS and former Commissioner of Health in post-Katrina New Orleans, spoke of the mutual reinforcement of public health silos and health disparities. She described the increasing marginalization of public health through underfunding and its complicated relationship with medicine and academic health centers. In an allusion to the mythical Greek “Siren Sisters,” Panacea (medicine) and Hygeia (public health), DeSalvo described public health today as the neglected, “less sexy sister.” Also notable is that public health receives a mere 3 percent of health spending despite determining vastly greater proportions of health outcomes.
These silos don’t just exist in New Orleans. Recently, we had a meeting at the Baltimore City Health Department where we brought together members of the community and prominent members of a local academic medical center to discuss and strategize how to bring trauma-informed care to Baltimore. As the meeting began, we noticed that a senior member of our team was absent. After a brief search, we found her in a conference room that was just steps away. She was convening other members of the community and other leaders of that same academic medical center to discuss and strategize bringing trauma-informed care to Baltimore. Neither group had any idea the other was hosting a meeting on the very same topic.
Though regularly hosting major events like Aspen’s Spotlight Health is beyond the capacity of city health departments, the lack of a coherent strategy at the local level has an impact on our communities and requires a solution. In a city facing high burdens of disease, increasing rates of violence, and histories of institutional distrust, health silos serve to augment the impact of already destructive health disparities. In an environment of severely limited funding, poor allocation of personnel, funding, and social capital further weakens the potential impact of public health interventions. In Baltimore, the historical depth and complexity of public health issues like substance use disorders require multi-disciplinary and multi-agency approaches.
Aligning Resources To Improve Health
We returned from Aspen re-energized to align our resources and efforts. On July 13, we released the recommendations from the Baltimore Mayor’s Heroin Treatment and Prevention Task Force, a major effort from a diverse set of city agencies, treatment providers, and community partners.
Every recommendation had a public health focus but also enlisted partners from other sectors. For example, our citywide overdose prevention plan involves police officers and people in recovery as key partners to deliver the life-saving antidote, naloxone, and provide peer-to-peer counseling. Our public education campaign aimed at reducing stigma is not just a public health effort, but is also a partnership with communication firms, the community of individuals with substance use disorders, and their support networks. So far in 2015, we have trained more than 2,000 people in naloxone administration, a 400 percent increase over the number trained in all of 2014. We have also just launched billboards across the city and a new website, dontdie.org.
From our work reducing infant mortality, we know that tackling policy and service-based silos can make measurable improvements in health disparities. In 2009, Baltimore had the fourth worst infant mortality in the country. Our city launched a collaborative effort, B’More for Healthy Babies that involved over 100 partner agencies across the corporate, nonprofit, academic, donor, and government sectors. In just five years, Baltimore City has seen a 28 percent decrease in infant mortality to its lowest ever rate in 2012. In 2014, we experienced the lowest number of sleep-related infant deaths in our history. There is far more work to be done, but these statistics are testament to what can be accomplished by our partners working together towards a shared vision and goal.
In all of this work, we hope to align our public health and health care priorities to strive towards a healthier, safer Baltimore. In our city, we are proactively investing in prevention today for a healthier tomorrow, even while continuing to face routine challenges. In centralizing our citywide strategy and breaking free of silos, we maximize the impact of our interventions. Reflection on recent events from a national frame of mind can help Baltimore with our own ‘toughest challenges.’
Author’s Note
The authors wish to acknowledge Gabriel Auteri and Shirli Tay for their contributions to this article.
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