Healthcare Advocacy Plan for Baltimore County, Maryland

The following healthcare advocacy plan targets Washington County, Maryland. Baltimore is Maryland’s most populous and poorest county, with an annual median income of $37,395 (US 2010 Census). Approximately 22.4% of Baltimore residents live below poverty level, compared to 9% statewide. Based on the 2010 US census, Baltimore County has a population of 616,802 people, majority of whom (66.5%)are between 18 and 64 years. 21.6% of Baltimore residents are below 18 years.   Data from the County health department indicates that Baltimore is a majority black city where African Americans constitute 63.3% of the population.  Non-Hispanic whites constitute 29.7% of the population.

According to CDC (2015), the leading cause of deaths in Baltimore includes diseases of the heart (causes 25.8% of all deaths), cancers (23.1%), stroke (5.2%), HIV/AIDS (3.9%) and chronic lower respiratory disease. However, the main causes of death for people fewer than 75 years include homicide, HIV/AIDS and drug-induced deaths (Baltimore City Health Department, 2015).  The infant mortality rate is 6.5% with blacks and Hispanics having the highest mortality rates of 10.6 and 4.4%, respectively (Maryland-2015 State Health Profile). According to Maryland 2020 objectives, the state seeks to improve the health status of the children and their well-being by addressing the burden of non-communicable diseases.

Although insurance coverage in the county is relatively high in Maryland compared to other states there are gaping inter-county disparities, with Baltimore County having one of the lowest insurance coverage. Disparity is observed in that Black community and Hispanics have the lowest insurance coverage with 57% and 62% coverage respectively (Maryland-2015 State Health Profile). The health disparities are aggravated by the high obesity rates among children and school students, high rates of heroin use, and relatively high HIV/AIDS infection rates.  Focusing on preventable diseases, there are prominent health disparities in the prevalence of diabetes, asthma and hypertension.  Given these disparities, it is fundamental for stakeholders to advocate for improved access to healthcare services among the majority African-American community in the county.  Therefore, there is great need to address the high rate of heroine, and substance abuse, increase nutrition education among school going children and increase health safety-net to cover for the large number of uninsured African Americans.

The high rates of uninsured African-Americans correlate with high unemployment among African Americans, and lack of or inadequate information among the group on the importance of health insurance. While low income families have reduced probability of having employer-based health insurance coverage, African American are less likely to have job-based insurance coverage at all income levels compared to whites (Noonan, Hector & Wagner, 2016). Therefore, targeted safety-net that address the complexity of accessing health insurance should be given priority.

Heroin continues to be the primary drug of abuse in Baltimore City.  In 2009, 64% of 10,156 patients admitted to treatment reported heroin as their main (56%), secondary (6%) or tertiary (2%) drug of abuse.  Majority of patients admitted for treatment report multiple abuses of substances such as heroin in combination with cocaine, marijuana and alcohol.  Heroin and other drug addictions are closely associated with severe health problems, including HIV/AIDs, violence, and crime

In Baltimore, there is substantial unmet need for heroin treatment.  Until recently, individuals seeking treatment were frequently turned away because of a lack of available treatment slots or other services.  In treatment centers received 7,756 calls for substance abuse services with callers requesting only information (Genberg et al., 2015). A large percentage (64%) of those who call the centers receive treatment appointment while the rest are placed on the waiting list. The average waiting time after contacting the services is 8 days (Genberg et al., 2015). The existing funding priorities for Baltimore City’s substance abuse treatment system include reducing heroin addiction, increasing the supply of effective drug abuse treatment, needle exchange, social services and other referral sources.  These priorities have to be expanded and directed to the high-priority population. Particularly, the need exchange program has to target individuals at the risk of HIV/AIDs and other infectious diseases.

Incorporating physical activity programs in schools, support schools to promote health education and to provide the necessary resources to promote physical activities in schools help increase the level of physical activities and improve their eating habits. The worth of building a physical activity culture among elementary students by integrating health education in curriculum is emphasized by many scholars (Erwin, Beets, Centeio & Morrow, 2014). Increasing the time 4th, 5th and 6th-grade children engaging in moderate to vigorous physical activities promises a great opportunity to improve the activity level of children and reduce their risk of being obesity and consequently contracting non-communicable diseases. The mandatory health screenings of 4th, 5th, and 6th-grade children to measure their Body Mass Index (BMI) scores once at the beginning and end of the program will help the community identify at-risk children and implement the necessary interventions on time.

Access to timely, effective and high quality health to all Baltimore county and minimizing disparities in health outcomes based on race, socioeconomic status and residence is critical. Ensuring access to the available health care delivery is critical in improving the quality of life and life expectancy. This requires improving health insurance coverage and overcoming the social and cultural barriers to access to healthcare.  Therefore, the advocacy initiatives seek to achieve high-quality, longer lives that are free from preventable diseases and premature death among African Americans in Baltimore County.  Additionally, it involves promoting initiative s that will help the account achieve health equity, reduce or eliminate disparities, and improve the health of all groups. In line with Health People Objective, Maryland, Baltimore County has already established strong leadership to facilitate the improvement of healthcare access which will facilitate the proposed strategies to combat health disparities, reduce HIV/AID infections and reduce obesity among school-going children.

References

CDC. Community Health Indicators. Retrieved from https://wwwn.cdc.gov/communityhealth on 4/17/2017

City of Baltimore Community Health Assessment (2010-2015). Retrieved from http://www.naccho.org/uploads/downloadable-resources/Programs/Public-Health-Infrastructure/BCHD-CHA-overview.pdf on 4/17/2017

Erwin, H., Beets, M. W., Centeio, E., & Morrow, J. R. (2014). Best Practices and Recommendations for Increasing Physical Activity in Youth. JOPERD: The Journal Of Physical Education, Recreation & Dance, 85(7), 27-34.

Genberg, B. L., Astemborski, J., Vlahov, D., Kirk, G. D., & Mehta, S. H. (2015). Incarceration and injection drug use in Baltimore, Maryland. Addiction, 110(7), 1152-1159.

Noonan A., Hector E V & Wagner F (2016). Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Reviews.

Rawlings-Blake S (2015). Health Baltimore 2015. Retrieved from http://health.baltimorecity.gov/sites/default/files/HB2015InterimUpdateOct2015Optimized_2.pdf on 4/17/2017.