New Realities of Public Health

September 07, 1993

Two hundred years after the city appointed its first public health officers, Baltimore faces a health threat more complex than raw sewage in the streets and periodic outbreaks of cholera, typhoid or yellow fever. The biggest challenges for public health now lie in the political arena, as illustrated in such issues as the city's proposed needle exchange program for intravenous drug abusers.

Last session in Annapolis, a bill granting the city permission to establish a pilot program failed in committee. Suburban legislators didn't want to have to explain to their constituents why they voted to allow the government to undertake a program that acknowledged and might even seem to condone an illegal activity. Gov. William Donald Schaefer was also among those opposing the idea.

Last week, however, the governor brought welcome news when he addressed the city health department's 200th anniversary celebration. In exchange for the city's agreement not to pursue other ways of undertaking a needle-exchange, Mr. Schaefer promises to support emergency legislation early in the 1994 legislative session. Once passed and signed, the law could take effect immediately -- an important consideration in a city where four to five new addicts are infected with the AIDS virus each day. At that rate, a full year's delay could cost another couple of thousand lives.

Needle exchange is the kind of political issue that shapes the new public health agenda. It seems radical, even unsavory, until one takes a look at the underlying reality.

The statistics are grim -- one-quarter or more of the city's 40,000 intravenous drug abuses are already infected with the virus that causes AIDS. Baltimore exceeds the national average in the percentage of AIDS cases traced directly to needle-sharing among infected users. Not all of these cases are the users themselves; virtually all of Maryland's 100 or so young children with AIDS are the offspring of IV drug users. Infected users also put their spouses or other sexual partners at risk.

Mayor Schmoke and the city health commissioner, Dr. Peter Beilenson, eagerly welcomed the governor's support. We, too, are glad to see more officials grasping the new realities of public health.

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