The selection of a Baltimore City Health Commissioner is an opportunity to prioritize public health to meet the urgent needs of Baltimore residents in collaboration with residents. Disparities in health outcomes, life expectancies and access to necessary services exist in Baltimore despite being home to major medical institutions. Priorities and programs that have been initiated in the city to address health concerns are often determined without participation by residents or those who are being served. We describe key areas of concern and solutions to address them below.

During the process of choosing a new health commissioner, we request the mayor to hold town halls with candidates in different parts of the city to hear from residents about their healthcare needs. Candidates for commissioner should explain how they would improve public health and time should be provided for candidates to respond to questions from the audience.

Key areas of concern:

1. Barriers to care - Despite the large numbers of medical facilities in Baltimore, residents continue to face barriers to care. Some of the barriers are lack of health insurance, discrimination experienced in health facilities and the elimination of essential services. Not for-profit institutions have positive revenue in the tens if not hundreds of millions of dollars each year. Given the tremendous amount of medical resources in Baltimore, nobody should go without health care. We propose eliminating barriers to care by:

• Placing publicly financed community health centers in every neighborhood of the city.

• Training and employing paid community health liaisons in every neighborhood who can assess health concerns raised by residents of those neighborhoods and connect them with necessary services.

• Training and employing paid health navigators who can accompany residents on request to assist them directly when they interact with the healthcare system and advocate with them to guarantee they secure all necessary treatments and follow up care.

• Creating an office that receives and investigates complaints of discrimination experienced in the healthcare system and reports those complaints publicly in a way that respects the privacy of the complainant. For cases in which there are ethical or legal violations, these should be addressed by the appropriate bodies.

• Requiring that all community hospitals in Baltimore provide essential services to include but not restricted to emergency care, obstetrics and gynecology, pediatrics, medical and surgical wards and intensive care.

1. Unhealthy living conditions - Baltimore has poor air quality, contaminated water and homes, food deserts and food insecurity, unsafe pedestrian and biking paths, inadequate recreational facilities for children and adolescents, violence, stress and wealth inequality. We propose improving living conditions by:

• Reducing air pollutants through industrial regulation and improving public, pedestrian and bicycle transit to reduce the use of combustion vehicles. THis should include making public transit affordable and programs to increase bicycle ownership in poor communities.

• Rebuilding our water infrastructure through a public works program to remove lead and other contaminants.

• Training and employing workers to clean up contaminated homes.

• Ending food deserts by bringing grocery stores and markets into all neighborhoods, supporting community gardens, farmers markets and CSAs and providing education about healthy eating and cooking.

• End food insecurity by providing free meals in community, recreation and senior centers.

• Building and improving walkways, street crossings and bicycle paths.

• Building community and recreation centers in every neighborhood to provide after school care, athletics, academic mentoring, adult education and stress reduction services.

• Training and employing community mediators to provide conflict resolution to reduce violence and police involvement.

• Providing grants to neighborhoods to develop programs to reduce violence and increase safety.

1. Substance abuse and overdose deaths - Baltimore residents suffer from generations of heroin addiction, alcohol abuse and overdose deaths from opioids. We propose treating addiction and preventing deaths by:

• Treating substance abuse as a public health problem rather than a criminal problem.

• Providing treatment on demand for residents who request it.

• Employing harm reduction techniques such as low threshold methadone maintenance, provision of clean needles, provision of medically-supervised facilities for heroin injection and training and access to naloxone to prevent overdose deaths.

• Providing grants to neighborhoods to reduce alcoholism.

• Providing a pathway for residents employed in the illegal drug market to transition to legal employment.

The above programs will require increased revenue. This will require the Department of Health to actively pursue such revenue streams.

One area of revenue is to take it from the budget for Baltimore City Police. The Police Department receives three times as much funding as does the Department of Health. It is our belief that this reflects an inversion of priorities. We need a greater investment in health, which should cause a decreased need for police as our communities become more secure, healthier and safer. Decriminalizing drug use and reducing the need for police through conflict resolution will save money that would otherwise be spent in the legal system and prisons.

Another revenue stream comes from the medical institutions in the City of Baltimore,including Carefirst Blue Cross. Improving the health of Baltimoreans and establishing a network of community health liaisons and navigators should reduce the utilization of Emergency Rooms and admissions to the hospital. This will reduce stress on our medical institutions. These institutions should be required, because they are part of the Baltimore Community, to contribute to the above programs. There should also be a requirement that grants secured through programs to serve Baltimore residents include impacted communities in the grant process and provide benefits to those impacted residents.

Likewise, new development in Baltimore should contribute to the health and well-being of Baltimore residents in the recognition that a healthier and more secure city will attract new residents.

Finally, such an innovative and comprehensive plan for improving the health of Baltimore residents ought to attract new grant monies to the city.