Transforming Baltimore: Public Health as a Social Justice Engine

A Q&A with Dr. Leana Wen, Baltimore City Health Commissioner

Dr  Wen 011215 Official1 (1)During her first year as Baltimore city’s health commissioner, Dr. Leana Wen has taken on the tough, chronic issues that plague the city—poverty, violence, and drug abuse. We spoke with Dr. Wen about her efforts to turn Baltimore into a trauma-informed community and a national model for overdose prevention and drug treatment. She talks about the critical steps needed to tackle these deeply entrenched and intertwined challenges.

Baltimore is still recovering from Freddie Gray’s death and the protests and riots that ensued seven months ago. What is the approach you’ve taken to helping the city recover?

Though the period of severe unrest may be behind us, the underlying problems that caused them have not gone away. Violence, poverty, and health disparities have many inputs. In Baltimore and in many other places across the country, these are closely tied to substance use and mental health problems, and to historical policies of mass arrest and incarceration. By focusing on the root causes of violence, poverty, and health disparities, we can turn this challenging moment into an opportunity to transform our city into a national model by demonstrating how public health can be a powerful tool for social justice.

How are you addressing violence prevention in Baltimore?

Violence prevention is a key function of public health. In many ways, violence is no different from an infectious disease. Just like measles or the flu, it is contagious and spreads from person to person. It creates fear and wreaks havoc. It results in illness, trauma, and death.

But this also means that there is hope, because, like any disease, violence can be prevented, and it can be treated. We can implement interventions to interrupt the violence, and we can prevent violence from happening in the first place.

Last year, our Safe Streets program—in which “violence interrupters”, many of whom are recently returned citizens, walk the streets and intervene in potentially violent situations—mediated 880 conflicts, 80 percent of which were deemed “likely” or “very likely” to end in gun violence.

Meanwhile, we are teaching middle school students to recognize the signs of relationship violence and empowering them to change the norms around dating. And we are working with health care providers, who have a valuable opportunity to intervene and help address the underlying issues of violence when a patient comes in with an injury.

We know that preventing violence is far from simple and requires a combination of approaches. Ultimately, violence has its roots in poverty, substance addiction, unmet mental health needs, and rampant disparities. All of these underlying issues must also be addressed for us to have a just and safe city. So we must continue to target our efforts on evidence-based, public health strategies that serve our neighborhoods and save the lives of our residents.

How are you working to change mindsets around violence, crime and trauma?

We are training all of Baltimore’s front-line city employees—including teachers, social workers, police officers, and other outreach workers—on understanding and treating the effects of trauma. When someone is arrested, we can’t just look at that individual as a perpetrator of violence. We need to understand and treat the effects of the trauma they’ve experienced.

Social issues, like poverty, homelessness, mental health, and substance abuse addiction, often underlie deep trauma. We want to make sure all of our front-line city workers have this mentality when we are approaching our residents.

You’re also working to make Baltimore a national model for overdose prevention and drug treatment. Why did you decide to prioritize these issues?

In my city, more people die from drug and alcohol overdoses than from homicide. Nationally, drugs account for more deaths than car crashes, shootings, or alcohol, according to data from the Centers for Disease Control and Prevention. The CDC estimates that 120 Americans die from drug overdoses every day.

The majority of overdose deaths are from opioids, which include heroin and prescription painkillers such as oxycodone. People who overdose on opioids stop breathing, and within minutes can suffer brain damage and death.

What is most tragic about these deaths from opioid overdose is that there is an antidote that is safe, effective, and literally lifesaving: naloxone, also called Narcan. It’s easy for almost anyone to administer.

In Baltimore, we have been training people with heroin addiction to use naloxone since 2004, including targeted training in hot spots, such as shooting alleys, recovery housing, and prisons. In fact, we’ve trained over 6,000 Baltimoreans this year alone, including community members, legislators, and even police officers.

We advocated for a change in state law that enables us to train anyone who wants to learn to administer Narcan and allows me to prescribe Naloxone to any of our 600,000 residents.

To be sure, treating overdose isn’t the only solution. Addiction treatment requires long-term medications and psychosocial support. We also have to focus on prevention, stop drug trafficking, and teach doctors more careful prescribing.

But if it’s one lesson that I’ve learned from the ER, it’s that if we can’t save a life today, there’s no chance for a better tomorrow.

Baltimore has long been known as the heroin capital of the country. I want Baltimore to be known as a model for recovery and resilience.

You’re tackling some of the most persistent problems facing American cities. What are some of the key steps to accomplishing this work?

Baltimore has a long history of innovation in public health. We are the oldest public health department in the country, and we have a long history of taking on different issues. It is our job to make the case that public health is tied to everything—that we cannot talk about poverty without also addressing the heroin epidemic and what it’s done in terms of crime and unemployment for citizens. We cannot talk about better health care and better jobs if we’re not addressing the core problems that people have when it comes to shelter and employment that also tie closely into health.

We also know the most credible messenger is not necessarily a medical professional, but people who are from the communities they serve. We all have a role to play. We need to work closely with those stakeholders—young people, neighbors, community doctors, nurses—as well as our partners in local government, law enforcement, and hospitals to move the needle and see progress as we take on these challenges.

Collaboration is key. B’more for Healthy Babies for example, is a partnership of more than 100 city agencies, health care providers, insurers, and nonprofits, all of which have signed on to a citywide strategy for reducing infant mortality. Through this collective impact model we have worked together to drop Baltimore’s infant mortality rate by over 20 percent, hitting its lowest point ever recorded in 2012. And as a result of the success of programs like this, we are expanding B’more for Healthy Babies into the B’more for Healthy Youth and B’more for Healthy Teens programs as part of a comprehensive youth health and wellness campaign.

What lessons would you like to share with others working in public health?

Public health is a powerful social justice tool through which we can develop a framework to level the playing field of inequality. We have to change the mindset to acknowledge, for example, that racism is also a pressing public health issue.

By changing the conversation around how we view public health, by directly engaging people in their communities, and by recruiting the most credible messengers, we can find innovative ways to move the needle over the short term, while catalyzing social change that will improve outcomes for generations of Americans.