A call to action on health disparities

June 8, 2010 Baltimore Sun

By Brian D. Smedley, Ph.D

Most parents would be dismayed to see their child come home with a "D" on their report card. They would want to know how they and the school can work together to improve the child's scholastic performance.

With the announcement that the Baltimore City Health Department has given the very same grade to the city's efforts to reduce health inequities, will residents demand accountability, involvement and improvement?

In a remarkable report, the agency reviewed trends regarding a number of health indicators of residents of the city and the state and found that Baltimore's inhabitants fared worse than the state on 13 of 14 indicators.

The largest of these health inequities are between residents of different income and education levels, a finding replicated in almost every other major study investigating why some groups enjoy better health than others. The Health Department's study found that people with lower levels of education and income had poorer health than more advantaged groups in the form of higher infant mortality, higher rates of disease and disability, and premature mortality - and this was true across all age groups. Indeed, income and education disparities received "F"s on most of the report's indicators.

Racial and ethnic disparities are also persistent, with African-Americans faring worse than whites on about two out of three indicators. Indeed, on some measures, these disparities are getting worse: Since 2000, white mortality has declined at a pace that is 5 percent faster than that for African-Americans.

Why do these health gaps persist? Most might assume that a lack of access to quality health care or poor health habits are the prime culprits. These factors are clearly important. But a growing body of public health research demonstrates that neighborhood conditions - such as the quality of housing, food, transportation and the environment - play a major role in shaping the health of the community. They directly influence health through the kinds of risks that people are exposed to on a daily basis, such as pollution, violence and overcrowding, and indirectly influence health by shaping health behaviors, such as the kinds of food people eat and their level of physical activity.

These health inequities, as the report points out, are unjust and avoidable - that is, with good policy and planning, we can help everyone enjoy equal opportunities for good health.

But too many Baltimore neighborhoods are toxic to their residents' health. They lack stores selling fresh fruits and vegetables but are overrun with liquor and tobacco vendors. They are littered with crumbling, dilapidated homes. They share space with polluting industrial sites. And their streets are not safe for play or exercise.

These problems are less the fault of the people who live in these communities than of those who have the power to increase investments in neighborhoods and make them healthier and safer for all.