A cure is badly needed for urban health care ills

January 25, 1994|By WILEY A. HALL

Liberty Medical Center sits in the middle of West Baltimore -- one of the sickest communities in one of the sickest cities in one of the sickest nations in the industrialized world.

Poor, uneducated and black, the residents of West Baltimore have the highest rates of cancer, heart disease and substance abuse in the state. They are twice as likely as the average Marylander to die in infancy, three times more likely to die of AIDS and seven times more likely to be murdered.

It is as though they lived in the Third World.

"We have to ask ourselves what we have been doing wrong," says Everard O. Rutledge, chief executive officer of Liberty Medical Center.

"By 'we,' of course, I mean the entire medical community," continues Mr. Rutledge. "West Baltimore has access to the latest and the greatest in medical technology. We are in a city served by two of the finest teaching institutions in the world -- at Johns Hopkins and the University of Maryland. And the medical practitioners on the front lines, the doctors and the nurses and the paramedicals, give it everything they've got, every day, heart and soul. Yet still we have mortality and morbidity rates approaching that of Third World nations.

"Clearly, what we are doing is not working," Mr. Rutledge continues. "All of our technology and all of our care and efforts are not touching people in this community."

Baltimore, of course, is not unique, though this city ranks at or near the top nationally in a number of death rates: from cancer, infant mortality and homicide. The United States, in turn, ranks at or near the top in those categories among industrialized nations.

But the illnesses that ravage this city afflict urban communities across the country. And the questions about the delivery of medical services that Mr. Rutledge raises here probably should be raised across the board.

"The tragedy is that many of these problems are preventable," he says. "But we are still seeing pathology at the end stage. There are a lot of uncontrolled cases of diabetes, heart disease and cancer ravaging our community."

Mr. Rutledge says that poor people, many of whom struggle every day to survive, often put preventive health care near the bottom of their list of priorities.

"Then there is a shortage of physicians serving these communities. There are barriers such as fear of crime and lack of transportation -- there is a whole complex of factors working together to undercut the efforts of the medical practitioner."

President Clinton is expected to address health care reform during his State of the Union address tonight. But the problems facing urban communities go beyond a need for insurance, and my hopes are fading fast that the president and Congress are prepared to devote either the emotional energy or the necessary resources to urban health problems this year.

For one thing, the improving economy eases the pressure for universal coverage, because middle-class Americans are less afraid of losing their jobs than a year ago. And the president seems to be drifting toward a punitive approach to social problems: longer prison terms and mandatory sentences are part of his anti-crime package; a mandatory cutoff of services is at the heart of his plans for welfare reform. Mr. Clinton may decide universal health coverage is too soft to fit his emerging, Reaganesque politics.

Mr. Rutledge has decided not to wait for the president. Last week, Liberty Medical Center announced the formation of the Urban Medical Institute, funded through public and private grants. He hopes the institute will provide a model for other urban areas on how to deliver effective health care services to impoverished communities.

The new institute will focus on community outreach -- on training the hospital's doctors, nurses and support staff to treat people where they live. It will help victims and their families form support groups, and it will help create job opportunities.

"What we are looking for is a new paradigm," says Mr. Rutledge. "We need to take medicine to the patients instead of waiting for the patients to come to the medicine."

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