Community Context

Baltimore, the largest city in Maryland, is located on the Mid-Atlantic Coast at the mouth of the Patapsco River. Baltimore’s port has long been a key economic driver in the local economy, but more recently there has been
a shift from manufacturing and blue-collar industry to large education and health systems, foundations, and a private sector comprising large insurance and financial institutions. Despite recent efforts at reparations, some local anchor institutions have troubled histories involving mistreatment and exploitation of Black community members. 

Baltimore has had a high degree of mayoral turnover over the past 10 years (four mayors between 2010 – 2021). Mayor Brandon Scott was elected in 2020 and is seeking to “bring generational change to the city.” City leaders have historically been Democrats, and Maryland’s current governor is a moderate Republican. 

Baltimore is one of the first cities to have implemented redlining in the 1930s, resulting in persistent housing segregation that has led to disparities in housing quality, access to transportation, and access to economic opportunities, as well as health disparities that still affect Black Baltimoreans today. 

Coupled with high levels of poverty, Black residents experience disproportionately high rates of lead exposure, HIV infection, drug use, violence, and other outcomes that have created significant trauma and mental health concerns. COVID-19 further exacerbated these issues as those members of the Black community who were already suffering due to underlying health conditions and significant socioeconomic barriers were hard hit by the pandemic. 

Baltimore’s Journey to Promote Health, Well-Being, and Equity

Baltimore continues to benefit from significant support provided by its large anchor institutions and is further bolstered by a network of community-based organizations that aim to improve the health and well-being of city residents.

The community is home to several longstanding, large-scale initiatives to tackle deeply entrenched health and social issues, particularly for communities of color. Baltimore’s history of confronting various social determinants of health and health inequities has shaped community members’ broad definition of health, which incorporates education, violence and trauma, the built environment, and housing, in addition to physical and mental health. Baltimore’s commitment to health equity ties directly with its efforts to address racial equity. Though local government and nonprofit stakeholders were already taking action to address equity, the city’s high-profile issues around police violence following the death of Freddie Gray, followed by the events of 2020, further ignited efforts to make lasting structural change.


Baseline research started in 2016 to track community programs and initiatives. The most recent report, from 2022, provides more in-depth insights and analysis into the community's efforts to build a Culture of Health.

Lessons Learned: Where is Baltimore Five Years Later?

Baltimore’s journey to promote health, well-being, and equity is one that illustrates that a shared understanding of what drives health equity is not enough to make progress in the absence of strong leadership, established goals, and systems changes. 

There is currently momentum around improved health and health equity, yet Baltimore has a long way to go to help residents out of deep poverty as well as overcome logistical barriers, such as high turnover among leadership and the lack of a shared vision and framework for action for the city. 

Other communities can learn from Baltimore’s approaches to finding common ground, as well as the challenges it encountered, to inform their own journeys. And as COVID-19 recovery continues, with historic funding flowing to local communities, future research could consider the ways in which momentum around health, equity, and well-being influences community health narratives and decisions moving forward. 

With significant capacity to address health and equity topics, Baltimore continues to refine how it engages its anchor institutions, nonprofits, local government agencies, and community residents. Yet many of the difficulties the city faces are undergirded by a lack of trust in institutions and an inability to establish effective and sustained collaborative structures. 

 

Facilitators:

  • Foundations as a backbone for investments in large-scale initiatives 

  • Capacity for data collection and utilization

  • Stakeholders incorporating community input

Barriers:

  • High turnover among municipal leaders 

  • Lack of trust between community members and medical and educational institutions 

  • Lack of trust between community members and the police