Nearly five months into her new job, Baltimore City Health Commissioner Leana Wen, M.D. has a tough road ahead of her.
After the death of Freddie Gray while in police custody, clashes between residents and police officers caused more than a dozen pharmacies across Charm City to shutter. Wen’s office moved quickly to open up an emergency hotline, and she has also canvassed the streets in search of seniors and those with limited mobility without their prescription medication.
Even with these targeted efforts, Wen admits that Baltimoreans deserve more — and acknowledges that the outcries in the streets from the city’s youngest residents represent a growing frustration with the status quo that leaves them disadvantaged and hopeless of a prosperous future.
Freddie Gray may have been the straw that broke the camel’s back. Since his April 19th death, law enforcement officials have been silent about how the young man died, even suggesting that he may have severed his own neck while in back of a police van. For many Baltimoreans, Gray’s story bore a striking similarity to that of their family and friends. Police misconduct counts among an endless list of qualms residents have with their government, mainly composed of black Democrats.
While some observers criticized the activity in April, others pointed out that the upheaval served as the community’s last resort in making known the problems that have plagued the city for decades, even as neighboring cities undergo urban renaissances of their own. Lack of access to health care, food insecurity, high prevalence of chronic disease, and exposure to poisonous substances make for a dismal life outcome for many Baltimoreans. The health consequences have been severe. For example, a study conducted by Johns Hopkins School of Public Health — located less than five miles from the epicenter of the recent pandemonium — showed that children living in the poorest sections of Baltimore have poorer health and negative outlooks on life than their counterparts in the urban centers of Nigeria, India, and China.
Now, as Baltimore’s top health official, Wen hopes to help improve the life circumstances of Baltimore’s youngest residents. “We want to provide equal opportunity so that our children have an equitable future. We know that people who are born in certain zip codes have 20 years less of life expectancy,” Wen told ThinkProgress.
Among Wen’s top priorities as health commissioner are ensuring youth wellness, combating substance abuse among Baltimoreans, addressing residents’ mental health needs, sheltering the homeless, and expanding preventive healthcare. She said that focusing on these issue areas — with the help of other government agencies and community partners — can help close gaps in health care.
“Our public policy should enable people to make healthy choices. These problems have festered for decades so solutions will not come overnight,” Wen added. “It’s our duty as public officials to start somewhere and make that happen.”
Since the late 1960s, manufacturing jobs in Baltimore have declined by 90 percent and been replaced by jobs located too far away or with requirements far beyond what residents had. The eroding economy and rise of the underground drug trade has played a part in the violence that has plagued the city. In 2013, Baltimore saw its murder rate swell to more than 37 per 100,000 people. Today, Charm City has the fifth highest murder rate in the country.
If guns and knives aren’t killing residents, then a poor diet, deadly habits, and exposure to lethal levels of lead in the home could also serve as their undoing. In parts of Charm City — particularly those where majority of residents of black — chronic illnesses like heart disease, stroke, HIV/AIDS, diabetes, and cancer kill low-income residents at a significantly higher rate than their counterparts who live in Baltimore’s majority white enclaves. In 2007, nearly 20 percent of residents had no health insurance. And for many residents, making it to the first year of life is a miracle in itself: Until 2012, the infant mortality rate in Charm City hovered over 10 percent. Even with the recent decline, Baltimore still counts among one of the worst cities for infants in the United States with mortality rates that eclipse that of some third-world countries.
As a an emergency medical physician working in a Washington, D.C. emergency room, Wen saw these scenarios play out firsthand. In the ER, she often diagnosed diseases, tended to children with asthma, treated victims of gun violence, and resuscitated patients who had heart attacks. Those experiences, along with questions about the circumstances that led to these health outcomes, compelled her to pursue a career in public health.
Since then, Wen has served as an activist and academic, discussing public health issues with officials in Washington D.C. and Geneva and teaching at the Milken Institute School of Public Health Policy at The George Washington University. At this point in her career, she has an opportunity to usher change instead of advocating for it. But the question remains of where Wen would start in repairing Baltimore’s health care infrastructure and connecting people to much needed services.
In the public health field, a debate often rages on about to how much of the onus should be placed on residents of low-income enclaves to control their health when their environment doesn’t give them much help. Wen says that while both parties have a responsibility in creating a healthy environment for the community, the government shares a greater part of the responsibility in listening to residents.
“We have to address problems in preventative measures. That’s the case for everything,” Wen told ThinkProgress. “Every jurisdiction is facing this problem. People tend to react instead of looking at what caused the situation in the first place. Government officials have to set policies that allow people to make those decisions. How can we expect people to eat fresh food and vegetables if none exist? If our corner stores are selling alcohol and tobacco to underage kids, how do we expect them to take on healthy habits later in life?”
At this point, connecting the public and private sectors as well as the community may be a huge undertaking. As government officials try to restore quickly eroding trust in the public, a heavy National Guard presence on the streets questions about planes hovering over the city raises suspicion. On the ground, community members unite to fill in the gaps in care anyway they can, with organizations uniting affect grassroots change.
Wen says that getting the government involved would require her team doing the same thing, a practice she said she started shortly after Baltimoreans took to the streets. Even then, signs of resistance and skepticism arose among residents.
“The first question I got was what office am I running for and what I wanted from people. Residents think that we’re doing outreach for our benefit,” Wen said. “The first step in improving Baltimore is making sure that everything we do benefits the community. Our priorities aren’t set by the health department, but people in the community. We need genuine engagement and not assume that what we want is what they want.”