Baltimore's infant mortality rate rivals Third World countries. Too many of the city's children aren't vaccinated on time. Vision and hearing problems diagnosed in schools routinely go uncorrected. Lead-paint poisoning is common. Regular medical care is not.
"Baltimore's children are not healthy," concludes a two-year study released yesterday by Advocates for Children and Youth Inc., a statewide non-profit organization that does research and lobbying on behalf of children.
To improve the health of thousands of Baltimore youngsters, government must redesign its health system so that it spends more to prevent disease and pays less to tend sick children, according to the report titled, "Baltimore's Unhealthy Children: Is There a Doctor in the House?"
"Give us the money up front, to spend on prenatal care" and other preventive programs, said Susan Leviton, president of Advocates for Children and Youth. "We have often been involved with children when it was too late," after they've been abused or hospitalized.
"We spend our money on expensive treatment," she added. "We don't spend money on prevention. Pay now, or pay later."
The study repeats findings of other reports over the years: Prenatal care, food programs for new mothers and babies and regular medical treatment all reduce illness and save money.
The report makes dozens of recommendations for change, ranging from the broad ("Public awareness of child health issues must be increased") to the specific ("Expand Medicaid coverage for family planning services to women with incomes up to 185 percent of the federal poverty level").
Among dozens of recommendations for change, the report suggests:
* Government should provide universal health insurance.
* The state should create a $500,000 contingency fund for the federal Women Infants and Children nutrition program, to give the program enough financial flexibility to enroll more people.
* Government should reduce unintended teen pregnancies through more educational programs, and promotion of the use and distribution of contraceptives by health clinics in high schools.
* Medical services should be distributed through the communities that need them the most and should be easily accessible by public transportation. The state should subsidize transportation costs.
* The state should require that all day-care centers be tested for lead paint, harmful to children when ingested, and that homes be tested before being sold or rented.
But the bottom line is money. To change the grim statistics, the report concludes, Baltimore's children need more state money.
The report says children need more lobbyists who are dedicated to talking with legislators, testifying at budget hearings and pressing for changes in health care. "We know what the solutions are, but we've been unwilling to fund them," Ms. Leviton said. "Now we have to go to the legislature. Last year, in our budget, we cut 1,000 health-care workers. We added 200 correctional officers. You want to keep doing that?"
The report cites some successes. For instance, the Baltimore Project, in Sandtown-Winchester, trains neighborhood women to find prenatal care for pregnant women in their community.
The pilot program, paid for through private grants, aims to improve the health of mothers and allow them to give birth to healthier babies. The program is far cheaper than neonatal intensive care units, for which hospitals charge several thousand dollars a day, Ms. Leviton said.
But the study found stark contrasts between health care in Baltimore, where most of the state's poor live, and other areas of the state. In the city, 18.9 of every 1,000 babies born from 1984 through 1986 died in their first year of life. For black infants, the rate was even higher: 21.1 deaths per 1,000 births in 1987. Both figures are more than double the national average of 9 deaths per 1,000 births.
In the city, the schools provide one school nurse for every 3,131 elementary school pupils. In Baltimore County, the ratio is one nurse to 389 pupils.
In the city, 10.5 percent of all babies born in 1987 were classified as having low birthweight, a leading factor in medical problems for infants. The state average was 6 percent of newborns were low-birthweight babies.
Maryland, the nation's fifth wealthiest state, ranks 41st in infant mortality, 42nd in percentage of low-birthweight infants and 49th in the percentage of babies born to unmarried women, the report found.
Ms. Leviton said, "Poor mothers are giving birth to very sick kids."