Making Public Health Visible

By Narintohn Luangrath, Special Assistant to the  Baltimore City Health Commissioner and
Dr. Leana S. Wen, 
MD, MSc, FAAEM, Baltimore City Health Commissioner

At a commencement ceremony several years ago, Dr. Linda Rae Murray, then-president of the American Public Health Association, recounted a famous saying: “When public health works, we’re invisible.” She followed that by urging the graduates to “refuse to be invisible, because […] we need to lend our strength and our science to broad social movements whose goal is to make things better.”

When public health is invisible, we only end up talking about it when things go wrong; people tend to think about public health agencies as entities that respond to infectious disease outbreaks or shut down a restaurant due to health code violations. We frequently think about health as healthcare, but what determines how long and how well we live is less about what happens in the doctor’s office and more about where we live, the air we breathe, and the availability of other resources in our communities. At the Baltimore City Health Department (BCHD), we believe that all issues – education, housing, employment, public safety, and beyond – can and should be tied back to health. We are committed to making the progress earned through public health visible, and to make the case for incorporating health-in-all policies across the City.

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Our opioid overdose prevention and treatment work makes the connection between addiction and issues like housing, criminal justice, and employment. BCHD’s federal-level advocacy efforts include emphasizing the importance of Medication-Assisted Treatment (MAT) – the “gold standard” of opioid addiction treatment – combined with wraparound services and psychosocial support. We will soon be opening a Stabilization Center – the beginning of a 24/7 “ER” for addiction – where patients will be connected to critical social supports and behavioral health services. In our efforts to fight the criminalization of addiction, we partner with public safety agencies to treat addiction as the disease that it is; our Law Enforcement Assisted Diversion (LEAD) Program refers individuals caught with small amounts of drugs to treatment, rather than incarceration.

Recognizing that access to fresh produce is connected to our residents’ health outcomes, BCHD developed the Virtual Supermarket program, which provides easy access to fresh fruits and vegetables for those living in food deserts across the City. Since we launched the Virtual Supermarket program in 2010, nearly $600,000 worth of groceries have been purchased, with 43 percent of customers buying more fruits and vegetables. We recently announced the launch of our 14th Virtual Supermarket site at Ruscombe Gardens, a residential center for seniors. BCHD is proud to run a program that helps Baltimoreans make the healthy choice the easy choice.

While lack of access to fresh produce can lead to chronic health problems like heart disease and diabetes, BCHD also views other social concerns as connected to health. For example, violence follows the same pattern as infectious diseases, spreading from person to person. Recognizing the need to intervene and prevent the spread of violence, BCHD started Safe Streets, an evidence-based program based on the national Cure Violence Model that hires individuals from the communities they serve as conflict mediators. These outreach workers de-escalated more than 1,000 conflicts last year, four out of five of which were deemed likely or very likely to result in gun violence. Three out of the program’s four sites have gone at least one year without a fatal shooting.

To truly break the cycle of violence, however, we must focus further upstream. Understanding the importance of health to education, BCHD convened nonprofit, academic, and private sector partners to start Vision for Baltimore, which aims to conduct vision screenings and assist all public school students, in every grade K-8, who need them with free glasses. Before the program started, about 25 percent of schoolchildren needed glasses, but were not getting them – that’s upwards of 20,000 students whose learning was interrupted because of their vision problems. Since the program started in 2016, more than 2,000 students have received glasses.

Further upstream, we’ve set our sights on improving outcomes for our most vulnerable babies and young children. Our B’More for Healthy Babies (BHB) initiative provides home visits by nurses, social workers, and community health aides. Staff teach parents the “ABCs” of Safe Sleep (Alone, on the Back, in a Crib), help new mothers with breastfeeding, provide resources to quit smoking, and refer mothers to services like housing assistance. Since BHB started in 2009, Baltimore has cut infant mortality by nearly 40 percent, and reduced the disparity between African-American and white mortality by half. Moreover, BHB’s engagement with every Baltimore hospital, as well as dozens of community groups and churches, has resulted in a 70 percent reduction in sleep-related infant deaths in just seven years.

Former Assistant Secretary of Health, Dr. Karen DeSalvo, likes to say that “public health saved your life today, you just didn’t know it.” But maybe it’s time for people to know. Maybe it’s time for those of us working in public health to tell the stories of the communities we serve, and to make the case for public health every day. At BCHD, just like in local health departments around the country, we are doing a lot with very little. Our team works tirelessly every day to eliminate disparities and work towards a more well and equitable city. During this Public Health Week, we must continue to champion health as a basic human right, and to speak up and make public health visible to all.

Narintohn Luangrath is the Special Assistant to the Commissioner of Health and a Baltimore Corps Fellow at the Baltimore City Health Department. Dr. Leana S. Wen is the Commissioner of Health for Baltimore City.