The university should take a national lead in the effort to improve the health of poor, inner-city residents, according to the report of the President's Council on Urban Health. The report goes on to recommend the creation of an independent urban health institute within the university, a possibility now under active consideration.
The council, or PCUH as it is widely known, is a consortium of community residents, local leaders, city officials and Hopkins faculty and staff convened by President William R. Brody in September of last year. It was charged with assessing the needs of the East Baltimore community and suggesting ways in which Hopkins can more efficiently and effectively organize itself to tackle an unrelenting health crisis. The council's final report was presented to the university's board of trustees at its annual meeting in May. Soon after, President Brody asked the council's co-chairs, Martha Hill, a professor in the School of Nursing, and Colene Daniel, a Hopkins Health System vice president, to formulate a concrete proposal to address the key issue identified by the council: the creation of an institute for urban health.
Considering the scope of the community's health problems, that effort promises to be no easy task. "The major challenge will be meeting people's expectations raised by this whole process," Hill says.
Enthusiasm within Hopkins and its surrounding communities is running high for additional new efforts to combat some of the worst health indices in the state. "I get about a proposal a week," Hill says. "People come expecting me to fund something or even write a grant for them." The requests are premature, says Hill, explaining that she and Daniel were asked only to identify the scope of the health crisis facing East Baltimore and to suggest possible solutions.
Health status indicators for the community surrounding The Johns Hopkins Hospital are among the worst in the city and the entire state. City Health Department statistics show those neighborhoods have Baltimore's highest age- and sex-adjusted rates of morbidity and mortality from cardiovascular and cerebrovascular disease. Its residents suffer unduly high incidence of diabetes and cancer, as well as from some pulmonary diseases, violence, HIV-related illnesses and an epidemic level of substance abuse. The rate of sexually transmitted diseases in East Baltimore is the highest in the country and, in the case of syphilis, the highest of any city in the developed world.
More than 150 volunteers sat on the president's council and participated in its 12 working groups. During the past nine months they met and worked regularly at the committee level and participated in several daylong retreats held in the East Baltimore community. Their efforts culminated in a 35-page report, which is now available to all interested members of the Hopkins community.
"The many recommendations and strategies proposed in this report reflect creative, often bold thinking about how to enhance the health of our community," President Brody says. "It is an exciting and inspiring guide for moving forward with dispatch and resolve."
The report identifies three primary priorities for action: creating and funding an urban health institute within the university and health system, situated at the highest levels of decision-making; establishing an initiative for substance abuse prevention and treatment in the community; and encouraging and facilitating the economic growth of East Baltimore.
Delivery of the report to the board of trustees marked the completion--actually more than a week ahead of schedule--of PCUH's initial charge.
There are some who have expressed disappointment that new efforts are not already under way. But the successful completion of the report represents a considerable achievement and was the necessary first step, according to Provost Steven Knapp, who has been asked by Brody to oversee the planning of the urban health institute process.
"This is an extremely complex issue that has involved every part of the university, as well as many representatives of the community," Knapp says. "None of this was obvious when we started, and, in fact, even well-informed people were not aware of all the dimensions of the problem; for instance, the magnitude of the syphilis epidemic surprised many of the health professionals. The council started with a very strict time line last September and has stuck to it remarkably well, delivering the report to the university trustees exactly when it was originally promised. We've reached a consensus about what needs to be done; now we need to work out a plan on how to do it."
That job has been delegated to a task force drawn from PCUH volunteers. Their work, designated as phase II, will focus on creating a concrete proposal, time line and budget for an urban health institute, which will be presented to a special meeting of the deans of the university's eight academic divisions on Sept. 1. If created, the institute will have a full-time staff to focus on addressing the community health challenges raised in the report.
PCUH RecommendationsCreating and funding an urban health institute within the university and health system, situated at the highest levels of decision-making
Establishing an initiative for substance abuse prevention and treatment in the community
Encouraging and facilitating the economic growth of East Baltimore
"I'm excited about the possibilities," says Donna Jones Stanley, executive director of Associated Black Charities of Baltimore. Stanley co-chaired the Family, Maternity and Child Health working group with pediatrics professor and department chair George Dover from the School of Medicine. "Phase I was a good process, an intense process--boy, was it intense--that was very successful in energizing the community," she says. "This community has been pushing and prodding for a long time to get Hopkins to let them take the lead, and I think a real partnership has developed out of this."
"I'm satisfied with what we've done so far but just want to keep going," agrees community member Lucille Gorham, who served on the Cardiovascular working group. "Over the years there have been promises made and projects started that didn't finish. But it sounds like this is a little more permanent this time."
Like many in the community, Gorham thinks the time to act is now. "There should be some urgency about this," she says. "There are so many sick people in this neighborhood who can benefit from an urban health approach. Most people don't have an idea what it's like living in these communities."
One immediate benefit of the council process has been to put university researchers, community activists and city officials in close working contact, in some instances for the first time. Gorham, who serves as director of the Middle East Community Organization, one of the prominent neighborhood community groups, has turned her work with the Cardiovascular committee into action. "Eating habits and stress levels are two of the issues we need to address ourselves," she says. "One way we want to look at nutrition is through community gardens, and so we've decided to sponsor them to help teach people the importance of eating right. A lot of people in the community believe they can't eat right because they don't have the money, but that's not the case."
"Without a doubt the full collaboration between all these groups--Hopkins, city government, the community and businesses--has been the great success of phase I," says PCUH co-chair Colene Daniel. "That process of collaboration is very powerful, and to my knowledge this is the first time it's occurred at such a level. Every day brings another positive surprise. We're seeing partnerships evolve and groups identify programs and develop solutions. It's remarkable."
Daniel cites the integration of two projects from the Safe and Sound program that has been proposed by Violence Prevention working group co-chairs Jackie Campbell, associate dean at the School of Nursing, and Col. Margaret Patten of the Baltimore City Police Department. Another project focusing on children's health is being discussed by the Department of Pediatrics and the Associated Black Charities.
Despite the hurdles ahead, Daniel is optimistic about the future. "Undoubtedly the greatest challenge will be raising the money," she says. "That goes without saying. But I would describe this next phase as due diligence. We're going to get down to work to actualize the dream by developing an operational and business plan. We have to. I think this is one of the most important activities to assure the future of East Baltimore."
Copies of Report on an Urban Health Initiative, the final report of the President's Council on Urban Health, may be obtained from the Office of Corporate Services, Community Health and Services at 410-955-8806. It can be found online at www.jhu.edu/news_info/reports/urbanhealth.