Health disparities across the U.S. are related to factors like race, income, and education level. From the poverty rate to premature births and average life expectancy, these inequalities perpetuate health problems faced by citizens across the country, including Maryland. This problem is especially pronounced in Baltimore, a diverse city where about 63% of the residents are Black, according to 2019 U.S. Census data. In particular, COVID-19 has deeply hurt Baltimore residents, with more than 465 deaths in the city as of early September. Being such a diverse city, Baltimore residents of color are deeply impacted by this virus, and often lack access to care, testing or other support. An MSTEHP fellow could do further research on why these disparities exist and how they can be minimized throughout the state.
Baltimore’s high poverty rate has increased by about 5% since 1990. Currently, about 19% of its residents live in poverty, which is around 10% higher than Maryland’s average poverty rate. Black Marylanders in Baltimore are acutely affected with 28% living at or under the poverty line, the highest of all other minority groups in the city and across the state.
While national life expectancy has increased over time, there is a continual gap between Baltimore and the rest of the state. For instance, in 1980 life expectancy in Howard County, the highest life expectancy county in Maryland, was 75, while Baltimore County’s life expectancy was 68, a difference of seven years. A decade later, in 1990, the difference in life expectancy between the two counties grew to 10 years, and by 2014, it was 11 years. Additionally, there are differences in life expectancy among racial groups in Baltimore. For example, there is a ~15-year difference in life expectancy between Blacks and Asians, a 12-year difference between Blacks and Hispanics and a 5-year difference between Blacks and whites. These differences are more pronounced in Maryland compared to the national average, where Blacks again have the lowest life expectancy at 75 years, compared to that of Asians (86 years), Hispanics (82 years) and whites (78 years).
There is also a big inequity in maternal health quality. In the U.S., Black women are more likely to die from pregnancy or childbirth than women in any other racial group, and are three or four more times to die from childbirth than white women, according to a 2018 report. This problem is also seen in Maryland, where Black mothers die due to pregnancy 2.7 times more than white mothers.
Drug addiction, a serious health issue across the country, is also related to health and economic disparities. According to the National Survey on Drug Use and Health, 19.7 million American adults battled a substance abuse disorder in 2017. According to the Baltimore City Health Department, Baltimore had 761 drug and alcohol-related intoxication deaths, 692 of which were opioid-related, in 2017. That is more than double the number of people who died of a homicide. In addition, the city has the highest overdose fatality rate of any city in the United States. The evidence is substantial that substance-related abuse disproportionately affects communities of color. According to the 2018 National Survey on Drug Use and Health, 6.9% of Black people 12 or older in the U.S. have a substance use disorder (SUD). Although overall drug abuse problems for Blacks in Baltimore are declining, 88.7% of those diagnosed with a SUD did not seek out or receive addiction treatment. With so many people not seeking treatment for their drug problems, it can lead to detrimental effects in the community.
What is being done to address the issue?
Maryland already has programs and organizations in place to help combat these health issues, as well as efforts to help Black residents. For instance, the University of Maryland Medical Center launched an initiative for the city of Baltimore called the Maryland Healthy Men Project to help Black men get their blood pressure under control and live an overall healthier life. About 40% of Black men have high blood pressure, so this program offers free blood pressure screenings and other health tips for men in the city. Additionally, the Black Mental Health Alliance provides programming for youth on tobacco prevention in partnership with the City Health Department. They host community events like a “No Smoking” Skate Party, and a “Safe Summer” Festival to discourage tobacco use, especially among young people of color. The Baltimore City Health Department is also working to solve the opioid epidemic in their city. First, they are focusing on saving lives with naloxone to help prevent overdoses. Secondly, they are increasing access to a variety of evidence-based treatment options. Lastly, they are increasing education on addiction to fight the negative associations many people have on this issue.
To help address the birthing inequities for Black mothers, researchers from the University of Maryland School of Public Health put together a study on geographic, socioeconomic and maternal health factors that contribute to unbalanced outcomes in many births. They published their study in the American Journal of Preventive Medicine which found that a large contributor of the disparity is differences in maternal education, marital status and paternity acknowledgement, source of payment for delivery, and hypertension in pregnancy. They also submitted this report to the governor’s office in Maryland with further recommendations on how to increase positive birthing outcomes.
How might MSTEHP help provide expertise in solving Maryland’s health disparities?
A MSTEHP fellow could partner with existing organizations to expand upon the work already being done to address these disparities in Baltimore. As a parallel example, the Missouri state science policy fellowship, called the Missouri Science and Technology (MOST) Policy Fellowship, has done similar research on Black Missourian Health disparities across the state, and the long-term effects on Black residents. They used this research to learn more about the health issues facing their own state.
What is the bottom line?
This is a complex problem, with much opportunity for further research and education. A fellow could study which mechanisms persist in contributing to these disparities in Baltimore, as well as conduct further research to help support Black residents through programming or other initiatives. For instance, drug and alcohol addiction has such a negative stigma, but it must be treated as the disease it is to truly make a difference and to ignite further assistance and policy change.