Baltimore's health disparities revealed in report

Inequalities fall along education, income lines, study finds

May 25, 2010|By Meredith Cohn, The Baltimore Sun

Those with little education and low incomes are much more likely to become sick or die in Baltimore from a variety of health maladies than those with more education and money, according to Baltimore's first Health Disparities Report Card, to be released Tuesday.

While disparities have been known of for some time, especially among the races, this is the first effort to comprehensively quantify the scope of the problem. And health officials say the results will supply a host of public and private policy makers with data to tweak existing programs and create new ones to close the gaps.

"We wanted not just to point out disparities that everyone knows are there, but to understand why the disparities are there," said Ryan Petteway, a city Health Department epidemiologist who helped produce the report. "We see the largest disparities are driven by education and income. A lot of people may be surprised."

Baltimore is not the first city to examine disparities in its communities. Officials in Baltimore point to Louisville, Ky., which became the first city in the nation to establish a center for health equity in 2006. Other health departments tackling the gaps include Milwaukee, Boston, Oakland, Calif., Seattle and Portland, Ore.

Further, there are efforts on the national level to reduce social determinations to health, many that revolve around access to healthy foods, such as first lady Michelle Obama's plan to address childhood obesity. And while mortality rates in general are improving in the city and the state, following a national trend, in Baltimore the report found disparity rates were still striking.

For every 100,000 people, about 1,000 died of all causes in 2008. That compares with a rate of about 744 in Maryland, which does not include city figures.

In all, more blacks died than whites (about 1,100 per 100,000, compared with 850) and more men died than women (almost 1,300 per 100,000, compared with 784). But the biggest disparity came for those with a high school education or less verses those with a bachelor's degree or higher (1,950 compared with more than 735).

When breaking down the illness and mortality numbers further, the ratios were similar for those with heart disease, several types of cancer, strokes, diabetes and HIV/AIDS, as well as the rate of infant mortality and homicide.

When it came to education, a survey of residents showed the picture was similar for general health, as well as obesity, high blood pressure, asthma, diabetes and smoking, access to health insurance, neighborhood violence, prevalence of rats and roaches and food and energy insecurity.

Higher percentages of blacks than whites and more men than women suffered, but the biggest disparities were between those who made less than $15,000 and those who earned more than $75,000.

Health officials said they will need to engage all departments in the city, including zoning, planning, parks and housing in solutions, particularly for neighborhoods that lack places to shop for good food or recreate and have high crime rates. The officials also will need to share the data with local and national institutions such as hospitals and non-profits that develop programs aimed at improving health outcomes.

"This is definitely intended as a guide," said Richard Matens, the city's assistant commissioner for chronic diseases. "The report really drives home that disparities are massive, and no one agency can do it alone."

He and Interim Health Commissioner Olivia Farrow pointed to several programs and policy changes in Baltimore already under way. The city, and the state, have banned smoking in most indoor places and launched efforts to curb salt intake. Officials have started health screening programs in churches and barbershops and recently announced the findings of a task force on ways to improve access to healthy foods in neighborhoods that lack grocery stores.

"We're looking at a lot of different things," said Farrow. "This will help us do some finer targeting."

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