Backing Into a Solution for Improved Public Health

In the most recent issue of Health Affairs, there is an article, "Civil Unrest, Police Use of Force, And The Public's Health" by Jessica Bylander.  I read the article with great interest from several perspectives--a health system CEO working to champion value-based care delivery in my community and beyond, the son of a former police detective, and a holder of two degrees in Criminal Justice.  The article was well written and directed toward the considerable challenges facing the African American community.

Based on my upbringing and didactical training, I continue to take issue with the demonization of law enforcement.  It has become extremely popular to do so, but too many fail to take into account what police officers are subjected to as they try to enforce the laws and protect the citizenry.  I was taught to respect the police and comply with what they asked.  Have I been disrespected by the police?  Sure, but I have had to swallow my pride and do what I was told to do.   It appears that once a young man or young woman in the African American community feels disrespected by the police, they have to challenge that authority and there are times that such challenges end badly.  

Unfortunately, the breakdown of the traditional family has led to many of the problems in poorer communities, both black and white, with rarely anyone there to teach, guide, shape or mentor.  The article talks about an eight-year-old receiving health education in school who says that he didn't need to hear about heart disease or STDs.  Both of his brothers had died before their 16th birthdays and he didn't see himself most likely living much longer.  That to me is heartbreaking.  What a failure of family, community and government.  The political leadership in Baltimore and other cities in the US should be embarrassed as to what has become of their inner cities.  

So, what can health care do about it?  There is a very thought provoking statement in the article related to health care. Joseph Betancourt, associate professor of medicine at Harvard, said, "The mistrust that people have for the police force in these communities mirrors the mistrust that the same people feel for the health care system."  

Until now, I have looked at health care as we are all here to help you no matter what your race or socioeconomic status and you should work with us and be grateful.  The mistrust concept is disconcerting but should serve as a starting point for those of us in health care who are trying to restore public health options to the inner cities as well as the poorer communities that we all serve.  

In Maryland, and certainly Baltimore, the recipients of our services should benefit from our industry's transition to value-based care delivery.  With the goals to care for people in the most appropriate setting and work with them to keep them out of the hospital, health systems are bringing care to the community in record numbers.  Primary care, chronic care, dental care, ancillary testing and health education are now being extended to housing complexes, barber shops, churches, schools, neighborhood centers, outreach clinics and the list goes on.  We are engaging community health workers with diverse backgrounds.  We are trying to best serve residents who are the sickest of the sick, the high utilizers of services, the non-compliant patients, and even the next generation of the sickest.  

There is a lot of work to be done related to these many challenges, but Maryland health care is off to a great start.  We are addressing some of the past inequalities through a conscious effort to improve the health status of the communities that we serve.