Baltimore, Maryland

Located on the Chesapeake Bay, Baltimore is Maryland’s largest city and formerly home to a robust manufacturing and shipping industry.

During and after World War II, the city experienced strong growth, powered by its manufacturing sector. By 1950, more than 950,000 people lived in Baltimore, and approximately one-third of employed residents worked in manufacturing. As Baltimore’s manufacturing sector declined, the city experienced “white flight” that re-shaped its racial composition, with the white population decreasing as the Black population increased. The city’s economy has shifted over time; today, many of Baltimore’s largest employers are academic institutions and health systems. As these sectors have expanded, so has the number of available professional and service-sector jobs. However, this economic transition has not equally benefited all residents, nearly one-quarter of whom live in poverty.

Many of Baltimore’s Black residents experience significant disparities in health, income, and educational attainment. Some of the disparities have been linked to historical racial segregation that has led to many Black residents living in unsafe neighborhoods with limited economic opportunities. Government agencies, community organizations, and local residents are engaged in a number of cross-sector collaborations to address these challenges and improve the health and well-being of all who call Baltimore home.

Overview

Population and Demographics

Population: 622,000

SOURCES:
U.S. Census Bureau; photography courtesy Flickr user dpbirds, CC BY-NC-ND 2.0.

Context and Actions

Community Context and Challenges

Discriminatory housing practices, concerns about police brutality, and a history of substandard health care have contributed to a fraught relationship between the Black community and local institutions.
Black children are much more likely to live in poverty (41%) than white children (13%).
Trash, vacant properties, lead paint, and aging infrastructure in low-income neighborhoods create health and safety issues for residents; for example, vacant properties are associated with increases in violent crimes.
Economic and social disadvantages faced by Black residents have serious consequences on their health and well-being, including higher rates of chronic illness, substance abuse, homicide, and infant mortality than white residents.
Substance abuse, especially heroin use, is a longstanding issue; out of 303 overdose deaths in 2014, 192 were related to heroin.

SOURCES:
Baltimore City Health Department. (2014). Baltimore City Health Disparities Report Card, 2013.

Taking Action

To address Baltimore’s significant health inequities, agencies and organizations are partnering on cross-sector initiatives that target top public health priorities.

Efforts focus on many issues, including child and adolescent well-being, opioid overdose prevention, and neighborhood health and safety. These local efforts operate in the context of a state government that has consistently focused on reforming health care; Maryland adopted the Affordable Care Act’s (ACA’s) Medicaid expansion while also undertaking an ambitious statewide initiative to constrain hospital spending growth, increase health care quality, and improve population health.

NOTE:
These baseline reports, created in 2016, track community programs and initiatives in their early stages and measure initial progress only. Future reports will provide more in-depth insights and analysis into this community's efforts to build a Culture of Health.

Gaining Community Trust

Leaders of local health systems recognize the need to regain the Black community’s trust, particularly given their history of providing substandard care to Black patients and regarding them primarily as research subjects.

Green and Healthy Homes Initiative

Green and Healthy Homes Initiative (GHHI), founded in 2008 as a program of the Coalition to End Childhood Lead Poisoning, provides free services for low-income households such as lead removal, weatherization, and mitigating other safety hazards. GHHI also provides legal services, education on home safety issues, and home inspections to identify hazards. GHHI partners include Baltimore government agencies, federal government agencies, private foundations, universities and other groups.

Vacants to Value

The Vacants to Value Program, implemented in 2010, is a mayoral initiative to rehabilitate vacant properties in low-income neighborhoods. As part of this program, the Baltimore Mayor’s Office partners with real-estate developers to make the vacant properties livable and provides financial incentives to potential homeowners. A recent evaluation suggests that Vacants to Value is “making a difference in select city neighborhoods,” but notes that the city has “overstated” the program’s impact.

B’More for Healthy Babies

A broad citywide effort launched in 2009, B’More for Healthy Babies seeks to improve infant health outcomes through interventions such as evidence-based home visiting, providing education on parenting and safe sleep practices for infants, reducing substance-exposed pregnancies, and reducing teen pregnancy. Partners include the Baltimore City Health Department, Family League of Baltimore, health care providers, home-visiting organizations, local and state government agencies, community organizations, and churches. Funding comes from public sources, private foundations and a health insurance company.

Going Forward

Questions for Consideration

A number of agencies and organizations in Baltimore are partnering on cross-sector initiatives to address the city’s significant inequities in health and well-being. Additional surveillance, information gathering, analysis, and reporting will identify changes in health equity over time in Baltimore, examine the impact of the city’s many cross-sector initiatives on overall population health and health equity, and describe how public health priorities and initiatives evolve.

The following questions could provide insights into the degree to which meaningful change is taking place and can be sustained:

How have key indicators of health equity in Baltimore changed over time? Which key indicators have changed most significantly, and which ones have not?
Have barriers and facilitators been identified that increased health equity in Baltimore? Which ones contribute most significantly?
Which new cross-sector partnerships have emerged that show improvements in the health and well-being of Baltimore’s residents? Which cross-sector partnerships are led by universities, and what is the health and well-being impact of these university-led initiatives?
Baltimore elected a new mayor in fall 2016. To what extent have public health priorities shifted under a new mayoral administration, and how have current health and well-being initiatives been sustained or changed?
What are the interrelationships among various initiatives to improve public health and well-being in Baltimore? Is there coordination across initiatives?