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Institute for Integrative Health
Feb. 4, 2019
Institute for Integrative Health
Sen. Mikulski, I will never tire of telling you how fortunate Maryland and the nation were to have you in Congress—a social worker and, of course, one of UMB’s own—fighting for the vulnerable. It’s such an honor to be here with Dr. Sandro Galea, and to hear his powerful call to action.
Of course, as you know, I’m not an epidemiologist. I’m not a public health expert. But I am a pediatrician, and I still practice each week on the Westside of Baltimore, where three-quarters of my patients are covered by Medicaid or CHIP.
I’m also a university president in this city, which is one of the most diverse—and yet one of the most racially segregated—in the nation. And you don’t have to look far to see the health effects of poverty and isolation. I see them every day.
When I give talks on the University’s engagement in West Baltimore—why we do what we do—I usually show maps, just like many of you. And the maps of this city are stark. In the West Baltimore neighborhood of Poppleton, adjacent to our campus, we have a Community Engagement Center, and I’ll talk about the center in just a minute. In this neighborhood of Poppleton, the median household income is under $20,000 a year. Nearly half the population lives below the poverty line.
Then you have Roland Park, one of Baltimore’s most affluent neighborhoods. If you’re not from here, it’s on the north end of the city, about five miles from Poppleton. Median household income in Roland Park is $108,000 a year. And the share of households living in poverty is 3.6 percent. Life expectancy in these two neighborhoods differs by 16 years—68 years old in Poppleton; about 84 in Roland Park.
I’m sure everyone in this room can tell me exactly why this is. But I know why too. Because I see the obstacles to good health that my patients and my neighbors have to confront every single day. I see the toll it takes on them. And then I try to explain to people what we mean when we say “social determinants of health.”
That’s why Dr. Galea’s call to arms, that we start doing something—collectively, purposefully, politically—about the upstream factors that have consigned generations of people to sickness, I say YES. And I say NOW.
At UMB, we have started doing something right here in the city. I mentioned our Community Center in Southwest Baltimore. It’s become the cornerstone of our engagement efforts. It’s where we collaborate with neighbors to cultivate community health and wealth, to enrich learning, and strengthen neighborhood development.
We offer afterschool programs, job training and placement, free legal advice, fresh food markets, fitness classes, computer labs and workspace. But it’s anything but a one-way transaction. Our neighbors helped us build the center. They brought the community to us. They tell us what programming they need. They identify the projects we should undertake together. They advise us on our direction and plans. And they give our students at UMB an education they won’t get anywhere else.
Community engagement is essential to a university like UMB, where we’re training the next generation of physicians, pharmacists, nurses, lawyers, dentists, social workers, and biomedical scientists. When I think about the difference our engagement efforts are making, I think this education of our own students trumps everything else. Because now we’re building competencies we ignored just a generation ago: cultural competency, competency in engagement, collaboration, interprofessionalism.
We’re putting our students into the community so they know what the conditions of poverty look like. So they understand the barriers faced by their patients and clients. So they focus themselves, their colleagues, and their professions on those upstream factors—and the downstream costs. So they can influence policy and practice. And so they can shape professional education going forward. And this is key, because we can’t sustain any momentum without getting our front-line providers into this fight.
And I’d venture that we can’t sustain momentum without getting the communities we care for into this fight as well. There are a lot of ways of doing this, of course. I want to talk quickly about one way we’re helping to build advocacy capacity in our communities.
Three-and-a-half years ago we launched the UMB CURE Scholars Program, a mentoring program for West Baltimore middle schoolers starting in 6th grade. It’s designed to excite students about science, and start them thinking about careers in health care or research. Twice a week, the scholars come to campus for science experiments and projects, homework help, field trips. They take tours of our labs and operating rooms. They interact with our faculty and students. On Saturdays, they’re on campus most of the day for intensive tutoring.
We’ve now got more than 100 amazing scholars—6th to 9th grade—making a long-term commitment to this program. We’ve got 250 mentors who give up a lot of time to these kids. It’s been an amazing journey for all of us.
We launched this program because we believe that making change in the health space begins with making change in the education space. I know not every one of these scholars will go into health care or research. And I don’t care. This program is about developing talent and curiosity and dedication, so that success is achievable no matter what they pursue. And so that their success lifts up their families and their communities.
But if they do go into health care? There’s a snowballing benefit. Because patients of color are more likely to take the advice of providers of color. Maybe you saw the study last year showing that Black men are more likely to accept preventive treatment when it’s recommended by a Black physician. And when the treatment recommended is for chronic conditions—cholesterol screening, diabetes screening—they’re more likely still to follow the advice.
The researchers said this pairing of patients and providers could cut the Black/White gap in cardiovascular mortality by 19 percent. It could shrink the life expectancy gap between Black and White men by 8 percent.
And there’s still one more reason why I think pipeline programs like these are indispensable—especially when we talk about making real and sustainable change to policy and practice. Because these students are already conscious of taking up the cause. They want to invest in the communities they came from, and serve the underserved. But they also want a platform from which they can influence and advocate.
Our scholars are hardly ignorant of the fact that politics and economics are often at the root of health inequities that put their parents and neighbors in their graves younger than anyone else.
We need to grow this community of health professionals, researchers, epidemiologists, population health scientists who have skin in the game—and a vested interest in making change.
You know, we’re not alone in our impatience to do what’s right. I’ve got a campus of 7,000 students who push me every day to do more. And I’ve got thousands of neighbors in West Baltimore who suffer until we do. And so I thank you—Dr. Galea, Sen. Mikulski, Dr. Berman, and all of you—for planting this flag for health equity.