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 like 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.

Community Actions: A First Look

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.

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.

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 are the health and well-being impacts 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 are current health and well-being initiatives be sustained or changed?

  • What are the interrelationships among various initiatives to improve public health and well-being in Baltimore? Is there coordination across initiatives?