Because we are in the business of preventing bad things from happening, it has been argued that public health succeeds when it is invisible.
As a result, there is no such thing as a public health face. We see the face of the individual who got food poisoning, but we don’t see the faces of the millions of people who benefit from health inspectors’ efforts to ensure food safety.
We see the faces of individuals who overdosed, were shot or had a heart attack, but we don’t see the faces of others who were spared these grave consequences because of public health measures.
Nobody will make the case for our work if public health is invisible. When it comes to deciding on a budget, it will be the first thing to be cut.
This was my continual fight in Baltimore, as well as my colleagues’ struggles across the country.
Making the case for initiatives that had been proven to be effective was one of the most challenging aspects of our employment.
When government financing was limited in Baltimore, foundations and philanthropists often stepped in to help, but private sources cannot compensate for the government’s obligation.
The private sector can contribute, but it won’t be able to fill all of the gaps left by the government.
Take, for example, the Zika virus. A mosquito-borne virus was linked to serious birth abnormalities in women who were exposed during pregnancy in late 2015.
Microcephaly, or an abnormally small head, is a condition in which babies are born with brain damage and may never walk or communicate.
In South and Central America, the virus began to spread. At its peak, the Zika virus infected 1.5 million people in Brazil, resulting in over 3,500 cases of baby microcephaly in less than a year.
The Zika-carrying Aedes mosquito can be found throughout the continental United States, including Maryland and as far north as Massachusetts.
Public health professionals warned that we needed to start Zika prevention efforts right away to avoid the disease’s negative consequences.
We needed to do mosquito surveillance to look for Zika, spray for it and eradicate breeding sites, as well as educate health professionals and patients about travel advisories and other precautions.
The health ramifications, as well as the economic consequences, would be disastrous if we didn’t. According to the CDC, the cost of caring for and educating one kid born with severe Zika-related abnormalities may be as high as $10 million throughout their lifetime.
Even though the Centers for Disease Control and Prevention and the World Health Organization labeled Zika a global public health emergency, Congress took ten months to approve President Obama’s $1.9 billion budget to combat the epidemic.
I spoke with members of Congress alongside other local and state health authorities about the critical need for action.
We stated that the delay was illogical. If 35 hundred kids were born in the United States with serious deformities, the cost to the country would be $35 billion.
Not to mention the indignity of knowing that a lifetime of misery may have been avoided if we’d acted sooner.
In practice, the CDC was compelled to divert funds from other parts of local public health to cover the cost of Zika preparedness due to a lack of fast action.
Funding work for Zika in Baltimore would have reduced our emergency response staff by a third if we hadn’t acquired more money.
These were the same people who were on the front lines of responding to social disturbance and preparing the city for hurricanes and bioterrorism.
What sense would it have made to lower their numbers, to reduce the number of people working on one emergency to respond to another?
This was a matter of public safety and national security, in addition to health and economic concerns.
If individuals do not recognize the importance of public health, it will fail. Only a few years after the struggle over Zika money and action, we discovered this at a severe cost.
With the appearance of COVID-19, the fight took on a considerably more cataclysmic magnitude.
It is up to those who work in public health to make the case for it. It’s up to us to make the unseen apparent.
The team gathered at the end of my first year as health commissioner to assess our success and set new targets.
We reinforced our commitment to the three primary areas that I identified on my first listening tour: addiction and mental health, adolescent health and wellbeing, and care for the most vulnerable.
We also took on the overarching task of making public health visible, which would aid us in achieving our objectives.
We used five tactics over the next few years to deliver on the promise of improving health and reducing inequities while putting a human face on public health.
To begin with, we used every crisis as an opportunity to emphasize and resolve an existing public health issue.
We held major immunization drives and educated residents about vaccines, emphasizing their safety and effectiveness when we received reports of suspected cases of measles in Baltimore.
The immunization rate among Baltimore public school pupils quickly rose to above 99 percent, making it one of the highest in the country.
When deaths from synthetic marijuana were discovered, we started a public awareness campaign and convinced the city council to approve legislation prohibiting the sale of these substances from corner stores.
We leveraged public indignation when animal control officers rescued dozens of starving puppies bred for dogfighting to raise awareness of animal abuse and enact a city rule prohibiting dog fighting paraphernalia.
All of these issues were vital to public health, but none of them were enough to pique public interest.
There were requests for immunization every year. The need for vaccines and the hazards of synthetic medications were emphasized on our website, and other pieces discussed the link between animal cruelty and human aggression.
Even still, inciting events were required to gain media attention—and thereby public attention.
We took advantage of the situation and used a three-pronged approach of service delivery, public education, and policy change to make something meaningful out of the crisis.
Second, we establish long-term objectives while displaying short-term accomplishments. The history of public health is extensive.
Life expectancy and rates of diseases that take years to manifest and quantify are common health outcome measures.
As scientists, we must employ these criteria, but we must also devise more immediate gauges of success that will bolster community confidence and support for our activities.
These long-term metrics (and associated measures of disparities) were established as part of the Healthy Baltimore 2020 goals; we also laid out short-term actions to demonstrate that we were making good progress toward our desired outcome.
While our primary goal was to reduce cardiovascular disease, we also worked toward a more immediate goal of increasing the number of healthy food options available to Baltimore’s most vulnerable inhabitants.
We worked with corner businesses to assist them to promote healthy options, and we expanded our grocery delivery collaboration with ShopRite.
Every time a new corner store signed on or a new senior center or library became a food delivery site, we had neighborhood celebrations and invited local media.
These “Baltimarket” shows were extremely popular. The city’s people had demanded that we address food deserts, and it meant a lot to them that we listened and followed through on our commitments.
Our food access projects gained international notice, with World Bank health officials and delegations traveling from as far as Saudi Arabia to learn how to replicate them in their own countries.
Third, we talked about our work in a style that was data-driven yet told through storytelling.
“Data validate, but they don’t motivate,” Senator Mikulski stated. Data provides context and legitimacy, but stories are what motivate people to take action.
Every time we discussed a program, we told a story and put a face to someone who had taken part in it.
One of our programs was created to help the elderly avoid falling. Every year, one out of every four persons over the age of 65 will die.
resulting in approximately three million injuries reported in emergency rooms across the country,
Eight hundred thousand people were admitted to hospitals, and almost 27,000 people died.
I’ve seen elders with shattered hips, cracked ribs, and brain hemorrhages as a result of falls.
After one slip and fall, I’ve witnessed how someone working and caring for their grandchildren can lose mobility and freedom.
Falls are a leading cause of social isolation, sadness, and cognitive deterioration among the elderly.
The program began by looking at hospital data to see where elderly people were falling.
We began exploring for commonalities when we discovered clusters. A corridor lighting had gone dark directly over a shaggy rug in one housing complex.
In the same hallway, several others tripped and were injured. In other cases, we discovered issues in the home, such as light switches that were out of reach or an overabundance of debris.
We also discovered drug combinations that resulted in frequent falls. The data alone helped funders appreciate the impact of our work on health and the economy.
Human attention was piqued by the stories and faces of the individuals. When a local television station broadcasted a senior exercise class,
Many people contacted us, expressing an interest in improving their agility and participating in Tai Chi and dance aerobics.
When two elders spoke about how house renovations lowered their risk of falling, dozens more asked for services in their own homes.
The work was founded on data, but it was brought to life through tales.
Fourth, because people don’t typically think of public health, it’s our job to make the connection between what we do and what they value.
Although there is a degree of separation between our work and that of others, we must be the ones to make the argument.
If the topic is education, we must demonstrate how medical disorders such as asthma are linked to persistent absenteeism and low academic performance.
Thus, a school-based asthma treatment program will avoid the child from missing school to go to the doctor, as well as the parent or caregiver from missing work.
As a result, investing in school health is also an investment in education.
The same may be said for public safety, jobs, housing, climate change, and infrastructure requirements.
Everything is influenced by public health, and everything is influenced by the public’s health.
There is no such thing as a sector that is not related to health. Those of us who work in public health must continually seek out.
to people who are unaware of the impact of our work and illustrate how we add value to them
Along the journey, we will face doubt, criticism, and outright hatred, but we must not be hesitant to step outside our comfort zone.
We will never make progress or promote our priorities if we only talk to those who believe like us.
In the same manner, we need to be present at strategic debates about our communities’ futures.
We must set our table and invite everyone else if other officials fail to invite us.
No one informed me or my employees that a fentanyl task force was required by the health department.
Law enforcement was the convening entity in other jurisdictions. We could have waited for someone else to invite us, but we didn’t want to.
But that would have taken the time and cost lives (and we might not have been invited if we had waited).
Furthermore, having law enforcement as the convener would have undermined my goal of treating addiction as a health issue rather than a criminal justice one.
No one informed me or my colleagues that the health department required the collaboration of tech and engineering firms.
We spotted a need in the market and founded TECHealth. Not only did we obtain vital technical knowledge, but we also made new friends.
We also worked with local start-ups, who got even more invested in the city as a result of our efforts.
No one anticipated the health department to bring businesses together to discuss health issues, but when I did, with Don Fry’s aid, all of the major corporations stepped up.
They would eventually become important contributors to our Healthy Baltimore 2020 goals.
Among his accomplishments are directing attempts for a citywide workplace health designation and managing a fitness challenge known as “Billion Steps.”
Those of us in the public health field will face skepticism, criticism, and outright hatred, but we must not be hesitant to step outside of our comfort zones.
Partnerships can also bring together people that don’t always agree on everything.
At the same time that I was identified as a defendant in a lawsuit initiated by the Catholic Church over a reproductive rights problem on behalf of the health department and the city,
I also collaborated on initiatives with Catholic Charities and Catholic Church representatives on issues that were important to us all.
Together, we were successful in getting state legislation on paid family leaves passed.
We partnered on offering mental health and trauma treatment services and advocated for higher financing for children’s health and violence prevention.
In some instances, we overcame ideological disagreements to advance the greater good.
The health department was able to innovate, lead, and demonstrate that public health should be at the table—and frequently at the head of the table—by building and cultivating these partnerships.
When an organization decides to be at the forefront of important issues, there is one disadvantage.
People began to want us to be accountable for things other than our work as our work grew more well-known.
Residents wrote me letters claiming that potholes were a public health hazard.
We didn’t go a day without receiving calls from constituents asking what we were going to do about rat infestations.
Other agencies were in charge of these tasks—the transportation department patched potholes, for example.
The rat-eradication effort was run by the public works department. We politely declined and delegated the task to our colleagues.
Some concerns didn’t cleanly come within the purview of any single agency, which the health department could have addressed but for which we just lacked the resources.
Another commissioner might have opted to concentrate their efforts on environmental policy, homelessness, and the prevention of chronic diseases.
However, as Mayor Stephanie Rawlings-Blake has repeatedly stated, if everything is a priority, nothing is a priority.
As a result, we chose to focus on the community’s most pressing needs, where we could have the most impact, and what would make the unseen visible.
We recognized that what appeared to be small steps made a significant and enduring influence on the people we served.
Our attention was drawn to the big picture, but we couldn’t get there until we first tackled what we could do right now.
And we never lost sight of the fact that it wasn’t about what we were fighting for, but about who we were fighting for.