Health in the City that Believes

The U.S. Census of 2010 will tell you this of Baltimore: the city has total population of just over 620,000. Close to 64 percent of the city’s population is of African American, which is nearly five times higher than the nation’s average of just under 13 percent. About 30 percent of Baltimore’s inhabitants are white. The city’s Hispanic population grows the fastest, but amounts only to about 4 percent of the total population. The other groups are Asian (close to 3 percent) and American Indian (1 percent).

Baltimore provides two different narratives concerning health – one narrative comes with several globally recognized success stories; the other offers a tale of daunting challenges and immeasurable suffering.

Let’s look at the local success first. It concerns the city’s medical institutions. The largest employer in Baltimore is Johns Hopkins Hospital or, rather, a constellation of twenty-nine top-ranking hospitals and outpatient clinics. A call to the hospital’s public relations office confirms that Johns Hopkins Medicine employs currently over 30,000 people. In other words, Johns Hopkins Medicine covers nearly 10 percent of the city’s just over 350,000 jobs. Johns Hopkins is the grandest of the city’s medical institutions, but it is not alone. University of Maryland’s Medical Center is a high-ranking magnet hospital. Other massive foundations, such as Union Memorial Hospital, Mercy Medical Center, Sinai Hospital, and Greater Baltimore Medical Center, add to the equation that makes Baltimore a nationally significant medical hub. Baltimore also hosts the world’s largest school of public health, The Johns Hopkins School of Public Health. The number of medical institutions in the city means that health-care professionals in Baltimore are all over – they walk their kids to school, shop at the local grocery stores, and their children play little league baseball with yours. The commencement speaker at my younger son’s elementary school graduation was a fifth grader’s parent, Carol Greider. She also happens to be the city’s most recent recipient of Nobel Prize for medicine. The city buzzes with medical innovations and homes top-notch professionals who are committed to their surrounding community through numerous outreach programs. You might think that a city like this is a beacon of health. You are quickly proven wrong – the overall health of the people in Baltimore City amounts to one of the country’s worst urban statistics with regard to wellness.

It must not be fun to work at Baltimore City’s Health Department when the Health Status Report is due or when the city publishes its Health Disparities Report or other similar studies, such as Community Health Survey. The elected officials will surely want to identify some signs of progress, but the scope of challenges leaves little room for applause. The most recent Health Status Report of Baltimore was published in 2008. It shows you that the city trails behind the rest of Maryland and the nation practically in every possible health indicator, including teen births, low birth weight, infant mortality, tuberculosis, obesity or other chronic disease risk factors, diabetes, and cancer incidences. Some numbers are particularly devastating – intoxication and substance overdose deaths in Baltimore are twenty times higher than the nation’s average in 2006 (Baltimore’s 235 per 100,000 to the nation’s average of 11.5 per 100,000) and the city’s incidence of new HIV/AIDS cases over five times higher than around the country (Baltimore’s 162 cases per 100,000 to the country’s 23.2 per 100,000). Perhaps the saddest fact of all is that in Baltimore the majority of children’s injury deaths relate to homicide (59 percent), and homicide is the fifth leading cause of death in the city. Gosh, offenders, listen to Baltimore’s Safe Streets campaign: ”Stop shooting, start living.” Maybe some did, for The Baltimore Sun was just recently happy to spread the good news coming from the FBI’s Uniform Crime Report of 2010 that Maryland had followed the rest of the nation in the decline of violent crime.

One way to understand health is to look at the way in which struggle with illness is distributed across social classes, ages, and gender. Maryland as a state is doing somewhat decently in regard to its children. Annie E. Casey Foundation’s Kids Count Data Book 2011 summed that Maryland is in the middle of the pack when compared to children’s well-being in the other states around the U.S.A. The trouble begins when we focus on health disparaties in Baltimore City.  The Baltimore City’s Health Disparities Report of 2010 contains an itemized grade scale from A to F. While health (or illness) equality in a few cases earned an A – white and black women were equally likely to have diabetes or white and black men suffer a stroke, for instance. Still, D’s and F’s come across as the alarmingly common grades. For instance, Baltimore earned a F for the following social determinants of health: mortality ratio of men to women; mortality ratio of High School education or less to college education; HIV/AIDS ratio of black to white; homicide ratio of city inhabitants to the rest of Maryland. In short, especially black men in Baltimore city face health challenges that are daunting if not catastrophic.

You have to believe in Baltimore – otherwise you will join the exodus of mostly middle-class people who have left the city and now embellish the rather decent health statistics of the rest of the State of Maryland. (The population of the city has shrunk by a third since the 1950s.)I am among those who believe in the city and wish it success with its most recent health initiative launched in spring 2011 – Healthy Baltimore 2015. Let it be true that by 2015 the city will have reached its ten targets that include decreasing the premature death from cardiovascular diseases by 10 percent, infant mortality rate by 10 percent, and density of vacant buildings by 20 percent. And, may I add, let it also be true that Baltimore finds ways of smoothing the sharply drawn differences between its 2011 neigborhood health statistics.

Meanwhile, I will visit and write about the institutions that significantly contribute to the Baltimoreans’ perceptions of health – religions. It appears to me that Baltimore’s engagement with health and healing cannot be fully grasped without its centers of faith, be these the praise-filled houses of Pentecostals or the stately brick-buildings of Roman Catholics, pop-up communities of perpetual seekers or outreach centers of those who believe that faith lives in actions. Duke Center for Spirituality, Theology, and Health is among the research centers that have recently drawn attention to the joint study of religions and health around the United States and, for that matter, the world. But how about the particular narratives of Baltimore as a city that is the home of conflicting health narratives and vibrant, multicultural, spiritual centers? As a registered nurse and a college professor teaching theology I have many questions in mind; the story is for the people to tell.