The State of Black Health in Baltimore
The March 2017 Baltimore City Health Department “White Paper: State of Health in Baltimore” is a good start for addressing urgent health needs and inequity in our city, but we need our health department to do more even though we understand it is financially challenged by budgetary restraints and the grant chase hustle.
If indeed “health is in all policy,” then we need a health impact and racial equity assessment for all policy or at least all MAJOR policy. What is the health impact of the mayor vetoing the minimum wage? What will be the health impact of the Port Covington development? A group like Equity Matters suggested this approach a few years ago, but it has yet to be implemented.
We need to define trauma and explicitly say that police brutality and race-based trauma are affecting the lives of Baltimore’s majority Black population. The U.S. DOJ Investigative Report of the Baltimore Police Department catalogued a long litany of health impacts as they found a racist pattern and practice of policing by the police force. The DOJ essentially laid the ground for the future examination and alleviation of this specific form of trauma. Relatedly, the health department should be play a major role in the DOJ consent decree of the Baltimore Police Department. The health department should count and track vital statistics on police brutality, police-involved shootings, police-inflicted killings, and the delay in medical treatment of detainees or suspects.
Further, how can we understand how historical trauma has played a role in producing negative health outcomes for residents and neighborhoods via segregation, forced displacement, physical/psychological violence, economic destruction, cultural dispossession, and medical apartheid as depicted by Michelle Sotero? This question forms the core of a robust racial equity analysis. It should also drive service delivery as we should foreground and amplify the work of groups like the Community Healing Network Inc. and Black Mental Health Alliance.
Additionally, how can the Baltimore City Health Department assess its own role in participating in and inflicting historical trauma on Black residents and Black neighborhoods by operating a segregated public health system and practicing public health from the top-down (with Johns Hopkins as a major partner) as opposed to the practicing public health from the grassroots (with HBCUs and Black institutions)?
Mass Lead Poisoning: We Need a State of Emergency NOW
The data on Baltimore’s lead poisoning is devastating and cause for profound alarm. This is not captured in the white paper. In fact, the problem is so dire that Baltimore City Health Department should declare a state of emergency over the issue.
A look at maps of lead poisoning in the city reveal the scope of the problem. An investigation by Reuters reporters revealed that thousands of census tracts in America have higher lead poisoning rates than those found in Flint, Michigan.
When we review Baltimore maps, we find that childhood lead poisoning rates and lead paint violations are clustered in Baltimore’s Black neighborhoods. In fact, the greatest concentration of lead poison are found in the same areas that were red- and yellow-lined in the 1937 Residential Security map used to help determine which neighborhoods would receive mortgage lending and capital vs. those which would not.
Healthy Baltimore 2020 Plan
So what are the issue the Baltimore City Health Department focused on? They have released a visually appealing plan called Healthy Baltimore 2020. It is a good plan that includes addressing four core areas: 1) Behavioral Health, 2) Violence, 3) Chronic Disease, and 4) Life Course & Core Services.
Again, Healthy Baltimore 2020 constitutes an excellent plan given the funding challenges of the health department. Certainly, the opiod epidemic must be addressed and may be the #1 most urgent issue affecting public health in Baltimore. Health Commissioner Leana Wen has worked unceasingly to address this devastating crisis.
As the chart to the left shows, the opiod epidemic is escalating rapidly. In fact, while much attention was given to the number of murders in 2015 (totaling 344), the number of deaths due to opiod overdose was even higher (totaling 396).
However, several of the health issues affecting Black Baltimoreans and Black neighborhoods are not given the attention they deserve. Everything from historical trauma as a root cause of Baltimore’s health inequities to race-based trauma due to racist and brutal policing is not named. Therefore there’s no plan to address it to make Black lives matter and make Black neighborhoods matter. There’s no plan for restorative justice to be rendered and Black healing to be fostered.
Another tremendous absence is the ringing of the alarm regarding mass lead poisoning as itself a fundamental root cause and driver of the four issues that are being addressed by the health department. By eliminating lead poison, we can drive down its attendant impacts on behavioral and mental health, reduce violence, decrease chronic disease, and boost the quality of life throughout the life course. A push to eliminate lead poisoning as a threat in Baltimore City by 2020 would increase the educational outcomes for Black youth and positively affect the life trajectory of over their lives.
The violence reduction work of the health department’s Safe Streets program should also be given more financial support and greatly expanded so that it can operate in more than the 4 or 5 neighborhoods it is currently operating in. Although the number of murders have been extraordinarily high over the past two years, much of that can be attributed to the way in which the David Kennedy model of Ceasefire (another violence prevention intervention) was underfunded and Safe Streets has been underutilized. We must do much more to prevent violence in Black neighborhoods. The Baltimore Ceasefire which started over the summer of 2017 has provided a promising approach, especially with the inclusion of groups like Out for Justice and The Living Well.
Another important point of emphasis is the need to continue to work to decrease Black Baltimore’s infant mortality rate. Infant mortality is the pulse of the health of the community. Although the rate has been decreased by the work of programs like DRUM Healthy Families and the health department initiative B’More for Healthy Babies, we must do better to protect the health of our most vulnerable and precious children.
Black Neighborhoods Matter!
It is also a common thing to only look at public health in terms of individuals and populations. But human beings are ecosocial. We exist in our environments and our health outcomes are in large part driven by the ecosystems in which we live. Hence, Black neighborhoods matter with respect to Black lives and Black health.
Therefore, Black health is stymied by the continued redlining that takes place in Black neighborhoods. Baltimore remains a deeply hypersegregated city where private lending and public spending are funneled towards the White L, while neighborhoods in the city’s Black Butterfly are structurally disadvantaged. This means that resources are missing in Black neighborhoods that help foster health (i.e. quality transit, access to fresh fruits and vegetables, well resourced public schools, and access to jobs and solidarity economic arrangements).
To boost Black health, Baltimore City must allocate resources in Black neighborhoods without displacing existing residents. This requires a fundamental shift in thinking, policies, and practices from our elected officials. Currently, public spending (TIFs, PILOTs, and tax breaks) and private lending (bank lending for mortgages and small businesses) can be found in the White L. The Charm City Circulator, Zipcar, MTA light rail, and Bike Share can be found in the White L. Mayor Catherine Pugh’s preliminary budget for FY2018 spends more on policing than it does on health, housing, arts, parks, and job development COMBINED. This all spells apartheid for Black Butterfly neighborhoods and we must always remember: apartheid budgets and policies breed social pathologies.
All of Baltimore must demand that Black Health Matters. We must address the legacy of historical and race-based trauma. We must ensure health is in ALL policy…from tax policy to transportation policy. We must demand health impact analyses of corporate development project such as what will be taking place in Port Covington over the next 30+ years. We must raise the alarm about the mass lead poisoning crisis we are in and push until a state of emergency is declared and the threat of lead poisoning for our babies is wiped out. We must declare that Black neighborhoods matter and pass policies to back it up. We must put an end to public health from the top-down and uplift a new public health from the grassroots!
