The Urban Health Council has taken a significant step in its effort to address the serious health needs of East Baltimore residents by recommending the creation of the Johns Hopkins Urban Health Institute.
In response, President William R. Brody; Edward Miller, dean of the medical faculty and CEO of Johns Hopkins Medicine; Ronald Peterson, president of The Johns Hopkins Hospital; and the Hopkins deans and directors have established a core budget for the institute and are now launching a national search for its director.
Funds totalling $4.5 million over five years have been allocated by the university to establish the institute, and additional federal and foundation support will be sought.
Envisioned as a national model for utilizing the resources of an academic health center to improve the health of the community of which it is a part, the multidisciplinary institute will have jointly appointed faculty, a full-time core staff and connections to relevant community, government and health agencies, as well as to other academic institutions.
The institute's director will report directly to the provost.
The new center's threefold mission is to promote and support research, clinical service and education as they pertain to urban health. By summer's end, designs are to develop a strategic plan, hire core staff and identify a location to house the institute.
Thomas O'Toole, assistant professor in the Department of Internal Medicine at the School of Medicine, has been named the institute's interim director. The search for a permanent director is expected to conclude by the summer of 2001.
"Hopkins already provides a tremendous amount of care through many departments and clinics in East Baltimore," said Provost Steven Knapp, who has represented President Brody in leading the urban health initiative. "The challenge is to coordinate those activities in a way that will make them truly effective and responsive to the community, and that's the role of the new institute."
The Urban Health Council, a Hopkins-led consortium of faculty and staff, community residents, local leaders and city officials, was convened by President Brody in 1998 to address the needs of East Baltimore and suggest ways to marshal efforts to effectively combat the community's unyielding health crisis. The group was originally known as the President's Council on Urban Health and was chaired by Colene Daniel and Martha Hill.
"Tom O'Toole has exactly the right background that will enable him to place the institute on a firm footing and prepare the way for the appointment of its first permanent director," Knapp said. "He is already actively working in and with the community, and he has a deep understanding of the complex issues affecting the health of urban populations. He brings an extraordinary level of energy and dedication to this important job." Before coming to Hopkins, O'Toole spent eight years at the University of Pittsburgh Health Center, where from 1995 to 1999 he served as director of the school's Program for Health Care to Underserved Populations, and for two years also was medical director of the Salvation Army Public Inebriate Program Detoxification Center Clinic in Pittsburgh. In the mid-'80s, O'Toole was on the legislative staff of U.S. Sen. Joe Biden, D-Del., working on domestic social issues and health care policy, and he has served on government task forces in Pennsylvania and Baltimore.
"I am thrilled to be involved in the process of launching such a community health endeavor associated with the prestigious Johns Hopkins, seen as a leader in national and international health care," said O'Toole, who will co-chair the Urban Health Council with Colene Daniel. "The potential for this to have a significant and substantially positive impact on our neighborhood is very exciting."
O'Toole foresees a multifaceted strategy that reaches into areas of economic development, housing improvement, violence prevention and school retention, among others. General functions of the UHI will be to:
Leverage faculty resources, across all academic divisions, in the development of proposals for grant funding to support research on urban health through joint appointments and shared research funding.
Help residents access existing community health care services.
Translate new knowledge into ad-vances in health care and the promotion of healthy lifestyles.
Foster communication among faculty interested in urban health and connect them with community leaders and government officials.
Raise the level of community health knowledge through outreach programs, including school-based initiatives, and equip the community to advocate for health promotion and disease prevention through leadership training.
Through a Council on Urban Health, provide the mechanism to regularly bring together people throughout the community concerned about urban health.
Prepare workers to meet community health needs through the development of a training program, perhaps in concert with a community college.
Enhance the education of students across the university system in subjects related to urban health through the development of curricula, specific courses and internship experiences.
Identify through systematic research and evaluation "what works" in raising health indices in measurable ways, and bench mark progress through an annual East Baltimore health care access survey.
O'Toole said input from community members will greatly influence the institute's focus.
"The fact that we have people dying from preventable illnesses in the shadow of one of the world's most pre-eminent health institutions speaks to the need for improved relations between Hopkins and our surrounding neighbors," O'Toole said. "To affect the health status of these communities requires efforts that transcend the traditional roles of an academic health institution. The Urban Health Institute will be a very powerful vehicle for addressing the disparate health care, health access and health outcomes for community residents."
O'Toole said his intent as interim director is to make sure the institute moves ahead in a "deliberate and focused manner to yield real results in the community and for Hopkins."
"This institute will not be the end-all for East Baltimore," O'Toole said. "But it will be a significant partner with the community and a facilitator for action."
Within the next six to 12 months, intentions are to identify and engage core faculty through joint appointments; design a specific plan for a focused and aggressive attack on substance abuse in a defined population; secure grant funding to support research and outreach related to substance abuses; conduct an East Baltimore Healthcare Access Survey to establish baseline data; and work with city, state, business and community leaders to establish a partnership for a healthy East Baltimore.
Health status indicators for the area surrounding the Johns Hopkins Medical Institutions are among the worst in the city and the entire state. The City Health Department's 1998 statistics show that these neighborhoods have Baltimore's highest age- and sex-adjusted rates of morbidity and mortality from cardiovascular and cerebrovascular disease. The rate of sexually transmitted diseases in East Baltimore is the highest in the country and, in the case of syphilis, among the highest of any city in the developed world. Residents suffer unduly high incidence of diabetes and cancer as well as from some pulmonary diseases, violence, HIV-related illnesses and an epidemic level of substance abuse--a significant contributor to the array of health, environmental and social problems that face this particular community.
In January, the community residents insisted that the Urban Health Council give first priority to substance abuse health issues.
According to UHC chair Colene Daniel, the "fabric of the family" in East Baltimore is prone to the ravages of this condition, and the council agreed that the best way to demonstrate Hopkins' commitment to improving the status of the community would be to adopt substance abuse as its primary concern. One of its primary targets will be substance abuse as it pertains to women with children between the ages of 0 and 6.
Ed Rutkowski, director of the Patterson Park Community Development Corporation and a member of the Urban Health Council, said, "I believe if the institute comes up with and executes a solid plan for reducing substance abuse, the most immediate benefits would be a decrease in crime and an increase in employment. [Reducing substance abuse] would also mean better housing conditions and subsequently better health overall for residents.
"It will be a very difficult task," he said, "but that is part of the challenge this institute faces. And Johns Hopkins is accustomed to meeting such challenges."