Healthy Baltimore 2015: A Guideline for Improving and Sustaining Health

There was a sense of excitement in Baltimore last month as our mayor, Stephanie Rawlings-Blake, and Commissioner of Health Oxiris Barbot, MD, announced targets for Healthy Baltimore 2015, the city’s new health policy initiative that sets priority areas for improving health. While this seems so far into the future, 4 years will surely pass quickly, and without a careful plan for how best to achieve each of the target goals, the potential for failure is an ever-present threat. We must all embrace these goals if they are to be successful, although many are beyond our ability to influence beyond word of mouth and political and emotional support. While several of the “targets” are focused on our youth, this is the optimal time to begin making a change if we are to have a healthier older population in the years to come.

Just as our nation as a whole has its vision for how best to improve the health and quality of life of its citizens, every city and state must also examine its own “unique” issues and look for ways not only to solve problems as they arise, but also to anticipate problems in order to deal with them preventively. I use the word unique because we are a nation of 50 different states, each with a particular population mix and unique socioeconomic factors, geography, and even mindset. And these differences are even further stratified when one considers the regional differences within each state.

The following are 10 “targets,” or priority areas, that Baltimore has set are listed below. I hope that you will consider your own location and contrast the issues we face here in Baltimore with those that are most important to where you live. While there are clearly regional differences, there are also many similarities that we all need to face on a daily basis if we are to achieve our goals of a more healthy population.

Healthy Baltimore 2015 Priority Areas:

1. Promote Access to Quality Health Care for All
2. Be Tobacco Free
3. Redesign Communities to Prevent Obesity
4. Promote Heart Health
5. Stop the Spread of HIV and Other Sexually Transmitted Infections
6. Recognize and Treat Mental Health Needs
7. Reduce Drug Use and Alcohol Abuse
8. Encourage Early Detection of Cancer
9. Promote Healthy Children and Adolescents
10. Create Health Promoting Neighborhoods

Below are summaries of the specific improvement goals for each of the 10 targets listed above:

1. Reduce the rates of emergency department visits for asthma, hypertension, and diabetes by 10% and hospitalization for asthma, hypertension, and diabetes by 15%, and reduce the percentage of uninsured persons who report having unmet medical needs during the last 12 months by 20%.
2. Decrease the percentage of adults and teens who currently smoke by 20%, and decrease the rate of births to women who smoke during pregnancy by 15%.
3. Decrease the percentage of adults who are obese and inequities in supermarket access by 15%, and increase the percentage of adults who get the recommended levels of physical activity by 20%.
4. Decrease the rate of premature deaths from cardiovascular disease and increase the percentage of adults with high blood pressure on medication by 10%.
5. Decrease the numbers of new HIV infections and syphilis cases by 25%, and decrease the rates of gonorrhea and Chlamydia in adolescents by 25%.
6. Decrease the percentage of adults with unmet mental healthcare needs by 25%, and decrease the percentage of adolescents with feelings of hopelessness or sadness by 20%.
7. Decrease the rates of alcohol and drug-related emergency department visits by 15% and alcohol and drug-related hospital admissions by 10%, and decrease the percentage of high school students reporting alcohol or drug use in the last 30 days by 20%.
8. Increase the percentages of adults age 50 years and older who have had colon cancer screening in the past decade by 15% and of women who receive breast cancer screening based on the latest guidelines by 10%.
9. Decrease the rates of teen birth by 20%, infant mortality by 10%, and juvenile homicide and nonfatal shooting victims by 30%, and increase the rate of school readiness by 15%.
10. Decrease the density of vacant buildings by 20% and liquor outlets by 15%.

While some of these goals can be easily achieved through political mandate and improved education, some will find it hard to believe that in 4 short years we can be successful in preventing “premature deaths” from cardiovascular disease, one of the above-stated goals. It is important to note, however, that this is not necessarily predicated on preventing coronary artery disease—a life-long challenge—as some might think from reading the list, but rather a need locally to better identify individuals with untreated coronary artery disease and untreated risk factors for the progression of coronary artery disease, such as hypertension and hypercholesterolemia. If unchecked, these will lead to premature morbidity and death. The goal is to initiate treatment for those in need as early as possible, something individuals in other parts of the country and in more affluent areas often take for granted. We continue to have a large uninsured population that seeks medical care only when a crisis develops and has no primary healthcare provider—good preventive care earlier in life can go a long way toward reducing the ills of the older adult and the cost of healthcare for our nation as a whole.

I applaud Mayor Rawlings-Blake and Commissioner of Health Barbot for accepting the challenge that lies ahead and bringing yet another critical issue to the population as a whole for comment and assistance. Proper healthcare is not just a personal matter, but also a public one that affects everyone around us and reflects the health of our nation and economy. I hope that you will identify your own “top ten list” and become an advocate for change!

For additional information on Healthy Baltimore 2015, go to http//baltimorehealth.org/reports-publications/healthy-baltimore-2015

Dr. Gambert is Professor of Medicine and Associate Chair for Clinical Program Development, Co-Director, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Director, Geriatric Medicine, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, and Professor Medicine, Division of Gerontology and Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Send your comments and questions for Dr. Gambert to: medwards@hmpcommunications.com