Health expert voices challenges in Baltimore City

The biggest public health care challenge in Baltimore City is lining up the needs against the resources, according to Dr. Joshua Sharfstein, Baltimore City Commissioner of Health.

The challenges with drug addiction, HIV prevention, life expectancy, violence, and environmental health are amplified by limited access to public health care, Sharfstein told GBC members at a Health Care Committee meeting on June 12. Public health strategy starts with evidence and data, and focuses on prevention.

Understanding “where we are” is the challenge since the cycles of assessment and response continually change, he said. HIV is a good example of knowing where we are and focusing on prevention. We know that approximately 20 percent of newly diagnosed HIV patients in Baltimore are between the ages of 20 and 29. “That’s why the prevention message is so critical for teenagers,” said Sharfstein.

Mayor Sheila Dixon joined city and state health department officials and community leaders to announce a new citywide campaign to prevent HIV invention among youth, said Sharfstein. “Based around the slogan, ‘Spread the word, not the disease – AIDS is no joke,’ the campaign has included television and radio public service announcements, bus shelter advertisements, t-shirts, a Web site, wristbands and print ads,” he said.

Another example of prevention is a community-based intervention program called “Operation Safe Streets (OSS),” Sharfstein said. OSS is a Baltimore City program that focuses on reducing shootings and homicides. Community organizations in areas with high rates of violent crime are eligible to apply.

OSS is based on the highly successful CeaseFire model developed at the University of Illinois School of Public Health in Chicago. CeaseFire has been operating in 15 of Chicago’s high-crime neighborhoods and has experienced reductions in shootings up to 68 percent in the first year of implementation, he said.

“Operation Safe Streets represents a significant opportunity for Baltimore communities to impact the violence that they experience using behavior change, a part of the public health approach,” said Sharfstein.

Sharfstein and Mayor Dixon joined local physicians and members of health advocacy groups to launch another prevention campaign “B’More Healthy.” The campaign encourages city residents to take 10 steps to improve their health, prevent illness, and preserve well-being, as well as provide services that can help residents accomplish these goals, he said. The advertising efforts include delivering thousands of cards around the city and paid ads in bus shelters.

Meanwhile an aggressive smoking cessation program is underway, he said. The Baltimore City Health Department provided residents who want to quit smoking with free nicotine patches, gum and telephone counseling sessions. The quit line “1-800-QUIT-NOW” is funded by the state of Maryland and run by Free and Clear.

A citywide outreach effort targeting unvaccinated youth appears to be working. The Health Department coordinated contacting the parents or guardians of children who are not up to date with new immunization requirements. The campaign reduced the number of children who are out of compliance from more than 24,000 to about 2,000, said Sharfstein. It’s a way to wipe out disparities before other things can happen.

Some examples of engaging the city’s resources include programs such as “Reach Out and Read,” providing fluoride varnish to prevent future dental issues, and the use of buprenorphine and methadone to treat heroin addiction, Sharfstein said.

The Baltimore City Health Department and Baltimore Substance Abuse Systems, Inc. released two new studies supporting the expanded use of buprenorphine and methadone to treat addiction to heroin and other opiates, he said. The studies showed the high cost of opiate use for the health care system and the potential to reduce health care costs by expanding drug treatment. The studies were conducted by the Center for Health Program Development and Management at the University of Maryland Baltimore County and financed by a grant from the Annie E. Casey Foundation, said Sharfstein.

Collaboration and partnerships are essential to prevention, preparedness, and employee awareness programs, he said. There are also larger challenges to consider like evacuation, pandemic flu, and anthrax vaccine shots. These issues are not just faced by the city, but the region and beyond.

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