Warning that "we're in for a marathon, not a sprint," President William R. Brody has charged an unusual multidivisional council of health and human services specialists with devising new ways in which Johns Hopkins can partner with civic, government and business groups to tackle an enduring health crisis in East Baltimore.
The group, known as the President's Council on Urban Health, or PCUH, is to submit its recommendations to Brody by the end of the academic year.
"You only need to take two steps outside the doors of The Johns Hopkins Hospital to understand that the communities surrounding the hospital are suffering," Brody said. "In many areas the health indices of local residents are closer to those of people in developing nations than to their fellow Americans. We have an obligation to the community to try to help."
The president appointed Colene Daniel, vice president for corporate services and community health and services of The Johns Hopkins Health System and The Johns Hopkins Hospital, and Martha Hill, professor of nursing and director of the Center for Nursing Research, co-chairs of PCUH.
The council will consider a variety of needs and issues during the next seven months. Its 76 members are drawn from every Baltimore-based division of the university, as well as important community and government organizations that deal routinely with health and safety issues in East Baltimore. Police Commissioner Thomas Frazier, Commissioner of Health Peter Beilenson and Congressman Elijah Cummings are among those who have agreed to serve on the council.
Major health status indicators for the East Baltimore community surrounding The Johns Hopkins Hospital are among the worst in the city and the entire state. City health department statistics show those neighborhoods have Baltimore's highest age- and sex-adjusted rates of morbidity and mortality from cardiovascular and cerebrovascular disease. Its residents suffer unduly high incidence of diabetes and cancer, as well as from some pulmonary diseases, violence, HIV-related illnesses and substance abuse.
The rate of sexually transmitted diseases in East Baltimore is the highest in the country, and, in the case of syphilis, the highest of any city in the developed world. As many as 18 percent of babies born in some East Baltimore neighborhoods are likely to experience complications arising from low birth weight. Twelve percent of first-graders present symptoms of asthma.
"There is tremendous need to focus on both ends of the health care spectrum," said Colene Daniel, who has considerable experience working with health issues in the communities surrounding The Johns Hopkins Hospital. "Issues of prevention and early treatment and effective primary care are critical, as are the acute care emergencies that have tended to define how the hospital and the community interacted in the past."
Many observers have found irony in the fact that the hospital frequently considered the world's best is surrounded by populations manifesting some of the nation's worst health indices. But in some ways the situation is not dissimilar to what is happening in many parts of the world where emerging nations' wealth and poverty are both highly concentrated within their urban areas.
"What we're seeing in developing nations is that as infectious diseases become less significant through immunization or other forms of control, then you begin to experience an emerging epidemic of chronic diseases," said Martha Hill, who is nationally known for her research into hypertension among African American urban men. "People move to the city, get a TV and a couch and sit down, and there you go; you're on your way to hypertension and heart disease."
It is these diseases of urban life--along with substance abuse, violence and sexually transmitted diseases--that tend to cut wide swaths through poor urban populations in America. A secondary though no less important goal of the president's council is to develop a national and possibly international model for using the resources of an academic health center to combat these illnesses and improve urban health.
"These are not the kinds of problems we can expect to solve in one year or even five," Brody said of the daunting task of addressing issues such as drug addiction and community violence. "The reason I've brought this council together is for it to make specific recommendations on how to proceed from here. The council members can look at structural changes in the way we do things in East Baltimore, or at specific programs targeted to local problems or, more probably, some combination of both."
The president's council has initially divided itself into two kinds of subgroups to more effectively assess the current situation. First are the specific disease-oriented groups, looking at cardiovascular diseases, pulmonary diseases, sexually transmitted and infectious diseases including HIV/AIDS, substance abuse and violence.
The second category of groups is focusing on identifying community action tasks needed to build the foundation of a healthier city. Those groups are looking at issues of the environment; internal and external communications; data and information systems to integrate health care delivery; revitalization efforts including public safety and economic development; and health education and promotion focusing on family, maternal and child health, and social services.
Despite the enormity of the problems at hand, council members have begun their efforts with a guardedly optimistic outlook and even a bit of a sense of humor. Disease-oriented group members quickly earned the nickname "dogs," while those on the community action task forces became "cats." Several officials involved with the effort spoke hopefully of a unique confluence of events and opportunities that may permit real progress in efforts aimed against some of East Baltimore's most tenacious health problems.
"There's already a lot that's been started in the past few years, such as the Historic East Baltimore Community Action Coalition, and the city's declaration of the area as an Empowerment Zone," Hill said. "It's not a matter of going in and starting from scratch after a long drought. There's enormous strength in these communities that we think can be leveraged to confront some of these problems."
Perhaps the greatest asset the group possesses is the increased comfort and growing level of trust that have slowly evolved between Hopkins and its community neighbors. "I think today the relationship with the local community is much stronger than at any time in the past 107 years," Daniel said. "There is more of a sense of partnership--that we can sit down and discuss things and sometimes disagree, and even disagree vocally and get our voices up, but at the end of the day we can work out our differences and come to agreement. There's more sense of mutual respect, something that wasn't here before."
Part of it may be a realization from the very top that the health issues confronting East Baltimore can only be addressed through effective partnerships. "We'll need to build bridges to various groups, including many of those we've never worked with in the past," Brody said. "There's already a lot going on, but not all of it has been visible. It's important to start by recognizing what is already being done, and to try to build from there with community guidance."
Input from the people who live and work in the communities surrounding The Johns Hopkins Hospital will prove especially important in the months ahead. "What Dr. Brody has asked us to do is to think through the problems and the possibilities and come up with recommendations of how we should organize ourselves to most effectively confront these problems," Hill said. "Right now I think we're in a discovery period and a consensus-building period. We're spending time talking with the community. What we have to remember is if we talk only to ourselves we'll no doubt miss the fundamental issues."
A complete list of members of the President's Council on Urban Health can be found on the Web with this story at http://www.jhu.edu/~gazette/octdec98/nov0298/members.html.