In the emergency room at George Washington University (GW) Hospital, in D.C., Dr. Leana S. Wen administered anti-inflammatory meds to kids choking with asthma, rescued middle-aged dads from heart attacks and sewed up shooting victims. Unlike a primary care doctor, she knew almost nothing about the strangers wheeled into the frenzied space: their medical history, financial situation and neighborhood all mysteries.
The usual anonymity made it all the more surprising when she recognized a 24-year-old mother of two. Homeless and addicted to opioids, the woman would show up nearly every week, begging for treatment. Without fail, Wen delivered the disappointing news that the next available appointment was three weeks away. Inevitably, the young mom relapsed during that window. The last time Wen saw the young woman, she wasn’t breathing. Her family had discovered her unresponsive, killed by an overdose.
“I always think back to my patient now: she had come to us requesting help, not once, not twice, but over and over again, dozens of times,” says Wen. “Because we do not have the treatment capacity, the people looking to us for help fall through the cracks, overdose and die. Why has our system failed her, just as it is failing so many others who wish to get help for their addictions?”
Last January, at age 32, Wen took a new job as the city’s health commissioner. As the leader of the country’s oldest public health department (established in 1793), Wen devotes much of her attention to an urgent problem: addiction to opioids (a class of drugs that includes heroin, morphine and oxycodone) and prescription painkillers. In the seaside port city of 622,000 residents, two-thirds of them black, heroin addiction grips 20,000 people. Many more pop prescription drugs before turning to heroin, a drug that’s cheaper than ever and more socially acceptable since it can be snorted and not just injected.
Baltimore’s drug addiction is lethal: Last year, 393 residents died of overdoses, a staggering number that surpassed the city’s 344 murders in a year of record gun violence. Long past a criminal “war on drugs,” Wen is implementing a public health response to this medical crisis. Her three-part plan involves preventing overdoses, treating addiction and ending stigma against drug users. By treating addiction as a sickness, not a scourge, she’s now saving lives on a broader scale than any emergency room physician.
“It ties into every aspect of the city. I’ve spoken to kids who question why they have to go to school every morning when everyone in their family is addicted to drugs and doesn’t get up. If we have employees that are addicted or have criminal histories because of their addiction, then what does that mean for a healthy workforce?” asks Wen, a fast talker who regularly works 14-hour days. “This is absolutely something we need to address as a critical public health emergency.”
Tenacious even in childhood, Wen spent the first eight years of her life in post-Mao China, until the 1989 Tiananmen Square massacre forced her politically dissident parents to flee the country. They moved to Los Angeles’s gang-infested neighborhoods like Compton and East Los Angeles, scraping money together from jobs as a dishwasher and hotel maid. With money tight, Wen remembers her aunts choosing between prescription medications, food or bus passes. Never one to wait, Wen enrolled in classes at California State University, Los Angeles, when she was just 13 years old. By age 18, she finished her degree, graduating with the highest honors, and went on to earn her M.D. from Washington University School of Medicine in St. Louis.
Working as a public health professor at GW, Wen spearheaded campaigns to cut healthcare costs, remove lead from homes and design walkable neighborhoods with access to reasonably priced, nutritious food, which caught the attention of Baltimore Mayor Stephanie Rawlings-Blake and landed her a new job.
A key to Wen’s plan for fighting opioid addiction is the distribution of an antidote to reverse a life-threatening opioid overdose. Inhaled through a nasal spray or injected into the upper arm or thigh like an EpiPen, Naloxone instantly revives a person from an overdose with few, if any, serious side effects. During a heroin high, chemicals block pain and induce euphoria — dulling the body to such an extent that the lungs forget to breathe while sleeping or the heart fails to pump adequately. Essentially shaking the brain out of its high, Naloxone creates a 30 to 90 minute window in which medical treatment can be sought. “It truly is a miracle drug,” Baltimore County Fire Chief John Hohman tells the Baltimore Sun. “It takes someone from near-death to consciousness in a matter of seconds.”
There’s only one catch: “You can’t give yourself this medication,” Wen explains. A person in the midst of an overdose often doesn’t have the wherewithal to inject the antidote. “That’s why we need every single person in our city to have access to it,” she adds, explaining that friends, family and community members have the ability to save a life.
In a controversial move, Wen issued a blanket prescription to the entire city last October — meaning anyone can buy the drug from a pharmacist. (For recipients of Medicaid, the price was reduced to $1 at a time when the drug’s price spiked drastically.) Wen sent training videos to jails and hospitals. Health department staffers visited areas notorious for open-air drug markets. Last year, the agency distributed 10,000 units of Naloxone and trained 12,500 residents how to administer it. That’s a big number for a program’s first year, but it’s still only half the number of active heroin users in Baltimore.
Outside of the roughly 30 recorded uses of Naloxone by police officers, there’s little hard evidence whether the drug has saved lives inside the city’s crack houses, parks and underpasses. Using data from Poison Control and other sources, Baltimore estimates Naloxone saved hundreds since 2015. “This remains a vastly underreported statistic,” says Sean Naron, a city spokesperson.
Critics claim that Naloxone encourages risky behavior and perpetuates the cycle of addiction because it removes the risk of death. “Naloxone does not truly save lives; it merely extends them until the next overdose,” Maine’s Gov. Paul LePage, wrote in April when he vetoed a bill that would have expanded access to Naloxone without a prescription. Suggestions like that make Wen balk. She calls them “specious,” “inhumane” and “ill-informed.” “That argument is based on stigma and not on science,” she responds. “You would never say to someone who is dying from a peanut allergy that you’re withholding their EpiPen to make them not eat peanuts.” Similarly for drug addiction, Wen believes there’s no use in talking about recovery tomorrow, if we don’t have the ability to stop a fatal overdose today.
Most in the medical community agree on the dire need for Naloxone. Experts caution, however, that it can’t be the sole response to this health crisis. Like most other cities, Baltimore is still trying to figure out how to effectively direct users whose lives were saved by Naloxone into long-term treatment programs, says Dr. Marc Fishman, medical director at Maryland Treatment Centers, a regional clinic. After reversing an overdose, an addict may “get dusted off and given a piece of paper with some phone numbers. They’re told to call this number today, tomorrow, next week. Maybe somebody will answer. Maybe they’ll take your insurance. Maybe they’ll see you next week or next month,” explains Fishman, who is also an addiction psychiatrist and faculty member at the Johns Hopkins School of Medicine.
Instead, Fishman suggests the medical system needs a “full continuum” from Naloxone administration to addiction treatment. It’s not unprecedented: just look to patients with heart issues, he says. They, too, receive lifesaving drugs to stabilize their ticker, but rather than being discharged immediately, a cardiac clinic assigns a care plan and prescribes maintenance medicines to patients.
Wen fully embraces the idea: she wants to see medication-assisted treatment that fools the brain into thinking it’s getting opioids without getting high or blocks an opioid high after shooting up, alongside housing and supportive social services. In the meantime, she’s set up a 24-hour hotline for users to get treatment option referrals. (Since October, it’s received 1,000 calls every month.) By next year, Wen wants to open a stabilization center where a person can drop in for several days to get sober.
It’s far from the perfect solution, Wen acknowledges. But at the moment, she’s constantly iterating new approaches. Last year, at a meeting of the Mayor’s Task Force on Heroin, Wen asked her colleagues to think of what they could do immediately that wouldn’t need further funding or manpower. That type of thinking fits with the approach she learned from life-or-death decisions in the emergency room: it’s better to act quickly now with what’s available than to wait for an instrument that might never come.
“Everybody is working hard and trying stuff. Some things are succeeding, and some are failing,” Fishman says. “I get a sense of dynamic enthusiasm. People are rolling up their shirtsleeves. I’m sorry that white kids from the suburbs had to start dying before anybody started paying attention, but it’s better late than never.”
Despite Wen’s tireless efforts, overdoses continue to rise in Baltimore. Last year, 260 heroin users overdosed, tripling the 76 intoxication deaths in 2011. Why are people still dying? Wen returns to the idea that a heroin user, on the brink of an overdose, can’t save himself; the rest of the city needs to be on the lookout, which isn’t always the case.
Baltimore’s response to this crisis has the ability to end an epidemic and to unite an ailing community. Wen, who says she’s an optimist by nature, might just find a way to cure a hurting American city after all.
Homepage photo by Spencer Platt/Getty Images
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Tag: maryland
Inside the Rebirth of Baltimore’s Upton/Druid Heights Community
The West Baltimore neighborhood of Upton/Druid Heights was once the nation’s premier African-American community — a Harlem before the renaissance. It was the place where you’d see Thurgood Marshall in a trim suit walking to the train station, on his way to the courtrooms in Washington, D.C. Then came desegregation and the assassination of Dr. Martin Luther King, Jr., which sparked riots that burned the central shopping district. Vacant lots became “shooting galleries” for heroin and crack addicts, and urban renewal policies replaced neighborhoods of stately row houses with towering projects and freeways.
Today, Upton/Druid Heights is best known as the backdrop for HBO’s crime drama “The Wire.” Residents aren’t expected to live past 63 years of age, a full two decades less than someone who lives in an upscale part of town, like Roland Park. The median household income is a paltry $13,388, and unemployment hovers around 17.5 percent, pushing half of all citizens below the poverty line. For the kids, the situation is just as bleak. Only about half are considered “school ready” by the time they’re in kindergarten; by eighth grade, only 40.6 percent test proficient in reading, and one in three young adults has been arrested.
“It’s almost like a community that everyone’s forgotten and overlooked,” says Bronwyn Mayden, a West Baltimore native who’s heading up Promise Heights, a comprehensive anti-poverty initiative in one of the city’s neediest neighborhoods. Mayden, a former civil rights advocate whose mother was a lifelong public school teacher, grew up in Upton/Druid Heights. Ask her to describe her surroundings, and she’ll tell you about the community’s assets rather than its drawbacks. Dreary statistics don’t faze her, and her sense of ownership for her hometown is peppered throughout her speech. Rarely does she refer to buildings by their formal names; instead, she calls them my schools, my churches.
Spearheaded by Mayden, a faculty member at the University of Maryland-Baltimore’s (UMB) School of Social Work, Promise Heights is founded on the belief that children raised in this neighborhood need comprehensive support to have a shot at success. The initiative rallies local organizations and coordinates their services around four public schools and several Head Start programs in Upton/Druid Heights. Centralizing aid has not only made parents aware of programs they’d never heard of, but it also enables teachers to focus on their primary job — educating kids — rather than having to spend all their time trying to contain the damage caused by family issues, medical conditions and trauma.
“There’s no way that high-poverty schools can do this alone,” says Mayden. “You’re spending zillions of dollars, but we’re not dealing with families. You’re not doing it in a holistic way.”
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With dozens of services — including parenting classes, prenatal care and counseling for violent trauma — extending out from one central hub, social workers from UMB are stationed in schools, meeting kids and identifying their needs. If a teacher notices that a student is nodding off in class, for instance, he can refer her to a social worker. Once the root of the problem is discovered — like an untreated medical problem, perhaps — the student can be referred to the appropriate aid organization.
“If we don’t ensure that those homes, families and communities are as healthy, productive and stable as possible, then we know that students will not only fail, but will also create chaos for those around them,” says Henriette Taylor, a social worker at one of the elementary schools. Adds Mayden, “We invite partners into this community which has been so disinvested, so that we don’t have to become the expert in everything.”
The Breathmobile, a mobile clinic that provides treatment for asthma, is just one of the 40 partnerships that constitute Promise Heights. The respiratory disease the number one reason why Baltimore students miss school: Parents worry that school will exacerbate their child’s inability to breathe, or worse, when asthma isn’t treated, a kid ends up in the emergency room. But since these families live in an underserved area, they often don’t have access to quality specialized medical care. “Just physically getting there, they don’t drive or have the money to get the transportation,” says Lisa Bell, nurse practitioner and program coordinator of the Breathmobile program. Its goal, she continues, “is to eliminate any of those barriers that exist.”
The University of Maryland Children’s Hospital’s Breathmobile, which screened and treated 49 students in Upton/Druid Heights last school year, parks right outside neighborhood schools during the day, so students only need to walk outside for preventative care. Parents receive home treatment, educational resources and an individual plan.
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Information that Bell jots down inside the remodeled RV might make its way back to the central office of social workers, who can follow-up to see if a child is allergic to a parent’s secondhand smoke or if there’s rats or cockroaches (whose droppings are a common allergen) in the family’s home. From there, UMB’s social workers and nurses can make home visits, set up tenants with legal services or just check in on the treatment.
So far, the model has had enormous success. The neighborhood is reversing perceptions from “The Wire” with small improvements: One school has a new library with 4,000 books, and 300 volunteers came together to build a playground. In school, students are performing better. Almost 92 percent of toddlers are now considered “school ready,” and the chronic absenteeism rate has been cut in half, down to 10.7 percent last school year.
Promise Heights was funded through a planning grant from the U.S. Department of Education’s Promise Neighborhoods, “an all-encompassing, all-hands-on-deck anti-poverty effort” that President Barack Obama first vowed during a campaign speech in 2007. Meant to take the wraparound model pioneered by Harlem Children’s Zone — what’s known as “cradle-to-college-to-career” — across the nation, the Dept. of Education has distributed $213 million to 48 communities. Funding, however, hasn’t been renewed in Congress, and the grant backing a significant portion of Promise Heights’ $1.5 million budget recently ran dry.
Despite the fact that Mayden must now devote almost all her time to writing grant proposals and fundraising in a city of limited resources, she continues to work towards urban renewal from within. “If you ask me my end game, I’m trying to help every child in this neighborhood of extreme poverty to graduate from high school and to help as many as possible get to college and to graduate from college,” she says. “I think we have a lot of assets that we can build upon.”
WATCH: See inside the historic Samuel Coleridge-Taylor Elementary School.
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Wondering If You’ve Had Too Many Beers? There’s an App for That
As we ring in the holidays with a host of festive fetes, roads become increasingly dangerous for alcohol-related crashes. But Maryland is hoping the new app, ENDUI, will help its residents avoid getting behind the wheel when they’ve had too much to drink.
The state recently unveiled the app that helps drivers determine if they’ve had too much to drink by entering gender, weight, the type of alcohol consumed and the timeframe in which those drinks were imbibed. ENDUI, developed by the Maryland Highway Safety Office, then estimates a blood-alcohol content and assists users with calling designated friends or cab companies.
ENDUI also features two interactive games that assess cognitive response and reactions to help determine whether a driver is impaired, and it also lets users report other drivers suspected to be under the influence, the Baltimore Sun reports.
“The game is meant to be a hook and pull you in,” says Tom Gianni, chief of the Maryland Highway Safety Office. “Then it’s meant to give you a lesson of, ‘See what can happen. Imagine if you were behind the wheel.'”
Last year, 152 people were killed in an alcohol-related crash in Maryland, which is one-third of all traffic fatalities in the state, according to organizers with Maryland Remembers, a yearly victims memorial.
Funded with federal money from the National Highway Traffic Safety Administration reserved for drunk-driving education, the app is one of many across the country hoping to engage Americans. New York, New Mexico, California and Colorado have similar ones.
“I think states are starting to go that route because they’re trying to reach consumers where they are and where they spend time, and everyone spends time on their phone,” says Kara Macek, a spokeswoman at the Governors Highway Safety Association. “I think we’re going to see more of that as we go forward.”
The app is currently available for free on Google Play and iTunes.
MORE: A Technological Solution to Texting While Driving
Children Can’t Learn When There Are Problems At Home. That’s Where Community Schools Come In
Walking down a hallway of Chicago’s South Loop Elementary School, Melissa Mitchell heard a first grader unleash a string of profanities inside a classroom.
“I hear this little voice screaming every curse word I’ve ever heard,” Mitchell says. She looked inside and saw “teeny, teeny” Brianne, standing on top of a desk.
“I’m not going to do this — every word you can think of — spelling test!” the little girl screamed, Mitchell recalls.
At most schools, Brianne would’ve ended up in the principal’s office for discipline. But South Loop is a community school that includes a variety of social services for kids and parents — from medical care and counseling to food pantries and adult GED classes. These facilities, which are gaining in popularity, are based on the idea that no matter how great a teacher is or how many high-tech gadgets a classroom has, kids can’t learn if they’re struggling with challenges at home (think: unemployed parents, a lack of food, the threat of eviction).
Instead of being sent to the principal, Brianne ended up in Mitchell’s office. At the time, Mitchell served as the school’s resource coordinator and was in charge of determining what social supports the South Loop community needs and finding ways to meet them.
Mitchell learned that Brianne wasn’t simply being a brat. The little girl’s parents were going through an acrimonious separation, creating an unstable environment at home. At six years of age, Brianne didn’t understand everything that was happening; nevertheless, it was upsetting her and spilling over into the school day.
After identifying the source of the behavior problem, Mitchell worked with Brianne’s family to address some of the trouble at home. She helped the mother find stable housing and childcare subsidies and connected Brianne and her family to a counselor.
While the community school model that helped Brianne and her family has been around for years — maybe over a century — it’s recently been gathering steam as more and more educators and elected officials see the value of a holistic approach to education reform.
Advocates currently estimate that as many as 5,000 community schools exist in the U.S., with more on the way.
Last year, Michigan’s Republican Gov. Rick Snyder expanded a program placing social workers in schools — a step toward community schools. In June, Democratic Mayor Bill De Blasio announced plans to spend $52 million to open 40 community schools in New York City. And in July, Maryland U.S. Rep. Steny Hoyer and Illinois U.S. Rep. Aaron Schock introduced a bipartisan bill that would establish a grant program to create more community schools nationwide.
A strategy, not a program
Each of the community schools created by these efforts will look different. That’s because their underlying philosophy holds that each one should grow and develop in response to the needs of the community it’s in, not according to some pre-ordained plan.
“It’s a strategy, not a program,” says Jane Quinn, Director of the National Center for Community Schools, part of the Children’s Aid Society.
Community schools each do a comprehensive needs assessment to determine what supports are most needed and often end up with school-based health clinics to address student’s physical, mental and dental health needs, including vision-correction to make sure kids that can see the lessons on the chalkboard.
There’s a lot of evidence that wealthy kids succeed partly because they can take advantage of “out of school enrichment,” Quinn says. Community schools can level the playing field with an extended school day and more academic and extra-curricular offerings outside of the traditional school day.
At Earle STEM Academy in Chicago’s impoverished Englewood neighborhood, program supervisor Quintella Rodgers says that after-school activities include a job club that teaches financial literacy, a power group that focuses on social and emotional health and individual academic help, plus photography, karate, Pilates, volleyball, basketball and DJing classes.
For the whole family
In community schools, “the primary allegiance is to the kids in the schools,” said Sarah Zeller-Berkman, who works for Youth Development Institute, which runs Beacon Community Schools in New York City. “But they still need and want to serve the broader community.” One way they accomplish this is by offering programs for parents and finding ways to integrate them into the school.
Community schools offer extra programming by creating partnerships with existing organizations, like colleges offering classes or not-for-profits running mentoring programs. The social services offered in community schools don’t usually duplicate ongoing efforts, but seek to bring them together under one roof.
At Salomé Ureña de Henríquez, a Children’s Aid Society community school in New York’s Washington Heights neighborhood, for example, the additional services offered include a variety of classes and programs for parents.
On a recent tour of the building, Director Migdalia Cortes-Torres pointed out photographs depicting some recent grads, resplendent in caps and gowns, on a bulletin board outside the school’s health clinic. But they weren’t pictures of students who had finished high school or junior high; they were pictures of students’ parents who had received their GEDs through a program at the school.
In addition to the GED program, Cortes-Torres said the school, which serves a largely Dominican population, offers classes for parents in nutrition and cooking, child development, English language and computer skills. They can learn art history, go on poetry retreats and even travel internationally with other parents.
Lidia Aguasanta, the school’s parent coordinator, says that she’s been helping parents to not only get their high-school diplomas, but to go for college degrees as well. “I do trips with them” to local universities because, she says, “they’re scared to leave the community” and are intimated by the complicated process of enrolling in college since many don’t speak English.
In community schools, support for parents help students achieve success, too. Aguasanta recalls a struggling mom that she convinced to enroll at Boricua College in New York City. The woman is now thriving and the simple fact that she’s now pursuing higher ed makes it more likely that her daughter, a 7th grader at the school, will too, Aguasanta says.
Studies indicate success
Beyond anecdotes like this one, research studies are pointing to hard evidence that community schools can reduce absenteeism and dropout levels and improve grades and test scores.
Not everybody is sold on community schools, however. Jason Bedrick, a policy analyst at the Cato Institute’s Center for Educational Freedom, tells the Wall Street Journal that the model needs more study before people invest in it on a large scale. And the New York Times reported last year that while the creation of community schools in Cincinnati has led to some improvements, many of the schools “are still in dire academic straits.”
Nevertheless, staunch opposition to the model is rare. “Community schools have no natural enemies,” says Quinn, quoting Martin Blank, head of the Coalition for Community Schools. Instructors, including those that belong to the American Federation of Teachers, like community schools because they can focus on teaching, not on whether their students are hungry or in trouble at home.
There are, however, “rival hypotheses” about where school resources should go, Quinn says. Some people believe, for instance, that the key to improving education is high-quality teaching and that anything else is just a distraction.
Wendy Kopp, the founder of Teach For America, has dedicated decades to putting new young teachers in schools, based partly on the idea that better teaching is central to better education. But, she also voices support for the principals of community schools.
“All the successful schools … are taking a community approach,” she said at a recent NationSwell event. It’s important that schools are responsive to people on the ground, not to theorists with big fix-all theories. “You need to empower people at the local level.”
At South Loop Elementary, where locals can address education holistically, Melissa Mitchell’s response to Brianne’s profanity-laced tantrum worked.
“It wasn’t a perfect rainbows and butterflies outcome,” says Mitchell, who’s now the head of Illinois’ Federation For Community Schools. But Brianne did settle down and “the father and mother came to a reasonable custody agreement.”
Leaving Brianne with a little less on her mind and giving her the ability to focus on what she was really in school for: Learning.
Meet the Sanitation Worker Who Founded a Nonprofit That Helps the Homeless
Garbage collectors take care of a lot of stuff many of us prefer not to think about. And for the past seven years, one especially thoughtful sanitation driver in Silver Spring, Md., not only collects his community’s trash, he also keeps an eye out for people who need help.
In 2007, Harvey was driving his route for Waste Management when he noticed a lot of people sleeping out on the streets — despite the fact that there were shelters nearby. “Sometimes I guess when the shelters get full they have no other place to go,” Harvey tells Good Morning America. “So they’ve got to turn to the streets even if it’s for a night or two they’re out there.”
Harvey couldn’t get the homeless people out of his mind. He and his wife Theresa began to make sandwiches and collect blankets, which he then distributed. But Harvey wanted to help even more. According to People Magazine, his brother helped him make a video of the homeless people along his route, which he showed his manager and then asked, “Is there anything we can do as a company?”
Harvey began to collect donations at work, and he and his wife soon founded God’s Connection Transition, a nonprofit that helps 5,000 homeless and low-income people a month. The Harveys convinced companies including Safeway, Pepperidge Farm and Costco to donate food, which they stock in a rented Gaithersburg warehouse. Hundreds of needy families stop in once a week to shop for what they need.
“As long as I know there’s somebody out here … It’s hard to go home sit at a table eat a meal,” Harvey, who still delivers care packages to homeless people in the early morning hours, tells Good Morning America.
MORE: Meet the Man Who’s Putting Dry Socks on the Feet of the Homeless
Which States Are Tops in the Open Data Movement?
As more local municipalities join the open data movement, the Center for Data Innovation, a think tank, has assessed which state governments are actually measuring up with the best policies.
A new report ranks states based on progress with open data policies and digital accessibility to data portals. Hawaii, Illinois, Maryland, New York, Oklahoma and Utah are the top six states, respectively, in making strides with the open data movement.
The report also finds that 10 states currently maintain open data policies, and all but one offer an open-data portal. (New Hampshire being the exception as the only state with an open-data policy that doesn’t offer complete datasets.) Over the last two years, five states have created new policies while four have amended existing ones. Overall, 24 states offer some form of an open data portal, including some without policies in place.
The rankings were determined based on four categories including the presence of an open-data policy, the quality of the policy, the presence of a open-data portal and the quality of that portal, according to Government Executive.
The report also explores common elements among those states with the most successful open data campaigns, including data being open by default — which includes public, expenditure and legislative records — as well as being released in a non-proprietary format or a machine readable format. A universal format is important in order for nonprofits, businesses and other users to process and translate the datasets. For example, if a state releases data in a PDF or DOC, it may not be considered effective because the format is not machine-readable.
While some states have polices on government transparency, the report points out that often that translates to publishing data on only a few topics, which is a good starting point, but not comprehensive enough.
“While a general transparency portal is a good start, open data portals can help increase transparency and accountability by opening up all government data, non just certain types of records,” the report says.
MORE: To Increase Government Transparency, San Diego Joins the Open Data Movement
Maryland’s Public Experiment to Combat Poverty and End Obesity
In parts of Maryland, when poverty rates rise, so do healthcare costs — a correlation that’s not uncommon across the country.
In response, the Affordable Care Act carved out a portion of its budget to support communities promoting nutrition and exercise, while reducing obesity and tobacco use. Called the Prevention and Public Health Fund, it aims at not only getting Americans healthier, but also quelling healthcare and hospital costs through preventative measures.
It’s estimated that up to 40 percent of deaths each year from the five leading causes — heart disease, cancer, chronic lower respiratory diseases, stroke and unintentional injuries — are preventable, according to the Centers for Disease Control and Prevention.
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In Maryland, preventative care exploration has been underway since the 1970s, but thanks to the new funding from Obamacare, state officials have revitalized a plan to get its residents healthy.
The western Maryland city of Cumberland has one of the greatest needs for preventative care. The area, with a population of about 20,000, has notched an obesity rate of nearly 29 percent. The surrounding area of Allegany County carries a poverty rate of 16 percent, leading to poor nutrition practices, food insecurity, and often, costly hospital visits.
But Western Maryland Health Systems (WMHS) is tapping into federal funds to transition medical practices out of a traditional fee-for-service model that reimburses doctors and hospitals for each test, treatment, and medication. As critics of fee-for-service have noted, this model can lead to unnecessary treatments or substandard care which prompts further treatment. Instead, WMHS will help doctors cap and stabilize reimbursements through Medicare and Medicaid, encouraging hospitals to use more preventative care methods to keep their patients healthy, according to the American Prospect.
Perhaps the more interesting part of the state’s initiative is the community outreach teams that will visit the homes of patients with conditions like asthma or diabetes to ensure they’re taking medicine and heeding a doctor’s advice.
“If you begin to work on controlling the healthcare spending in an area, you have to be able to confront and understand some of those social determinants of health,” said John M. Colmers, chairman of the state’s Health Services Cost Review Commission and a vice president at Johns Hopkins Medicine.
A variety of organizations across the state are pitching in to help low-income families find better sources of nutrition and increase exercise. The University of Maryland’s extension office for Allegany County has implemented educational programs for families while passing out healthy recipes and helping out at local food banks. Two of its staff, Katheryn Kinsman and Eileen Morgan, have been working with local families for 26 years.
Their biggest challenge, according to Morgan, is getting inside the home.
“There is an extreme amount of pride here, and just forming any kind of rapport here is hard,” Morgan told American Prospect. “Just getting in the door is hard.”
Apart from pride, the poverty rate has directly contributed to the area’s poor health — common afflictions include obesity, asthma, and untreated mental illness. To combat obesity, Morgan and Kinsman use simple methods like teaching how to prepare nutritious meals, learning to chop and stir, and finding sources of fresh fruit and vegetables. The two recalled buying clients a pot and wooden spoon before teaching a class.
“If you’re a mom with very little resources and several kids, and you go into the market and you can get a box of 12 cupcakes for a dollar, while apples are a dollar apiece, which are you going to buy?” Kinsman said.
Even finding an area to exercise poses a problem for Cumberland, which is why the local extension office offers an exercise class at the community center.
But with renewed attention and funds to promote healthy living, state officials are hopeful to turn the tide in Cumberland and Allegany County.
This Program Shares Its Wisdom About Producing Minority Ph.D. Science Students
It goes without saying that the folks at the University of Maryland, Baltimore County (UMBC) know a thing or two about supporting and encouraging minority and low-income undergraduate students in continuing their studies and earning science Ph.D.s.
Impressively, over the past two decades, the Meyerhoff Scholars Program at UMBC has produced 900 graduates who have gone on to rack up 423 advanced science degrees and 107 medical degrees.
Compare that to Penn State, which was recently named one of the top 40 schools for educating black students who eventually earned advanced science degrees. Despite the recognition, the public university earned that status by producing just four (!) degrees earned by black science students out of about 3,000 STEM students total.
“The data is shocking,” Penn State Chemistry professor Mary Beth Williams told Jeffrey Mervis of Science Insider. “Clearly we have to do a better job.”
So the people behind UMBC’s successful Meyerhoff Scholars Program will mentor faculty and staff at Penn State and the University of North Carolina in an attempt to increase the number of minority students enrolled in science Ph.D. programs. Over five years, the Howard Hughes Medical Institute will dedicate $7.75 million to the effort.
Clearly, UMBC has figured out a formula that keeps minority and low-income students on track to become scientists: Close monitoring of academic progress, a summer program for incoming freshmen, scholarships, research opportunities, and a close cohort of talented students who foster a sense of teamwork with each other. Its current four-year class of Meyerhoff Scholars includes 300 students, 60 percent of which are underrepresented minorities.
Williams said she plans to study these lessons carefully in the program’s implementation at Penn State. “My goal is to clone it as much as possible. It’s been successful for 25 years, so why mess with it? The more you change, the more you’re inviting failure.”
The president of UMBC, Freeman Hrabowski, is proud of how the scholars program has grown from its initial class of 19 African-American male science students in 1989. “What Meyerhoff has done is get us to think about our responsibility to students who say they want a STEM degree,” he told Mervis. “And what helps underrepresented minorities will also help the rest of our students.”
MORE: When People Said Minorities Weren’t Interested in Science, This Guy Proved Them Wrong
Correction: June 5, 2014
A previous version of this post misstated the funding for this program. It is funded by the Howard Hughes Medical Institute, not the UMBC.
How Maryland Decreased Its Infant Mortality Rate in Record Time
People knock local governments for bureaucracy and red tape, but Maryland deserves an equal amount of fanfare for its data-driven — scratch that, successful data-driven — push to lower the statewide infant mortality rate.
With his state’s numbers well above the national average, Governor Martin O’Malley managed to lower it two separate times, both ahead of schedule. In 2007, he set five-year deadline to reduce Maryland’s infant mortality rate by 10 percent. When that goal was achieved a mere two years later, with 8 fatalities per 1,000 live births down to 7.2, O’Malley honed in on the main area of concern: The continued-high numbers of African Americans dying in infancy. Again, he aimed for a 10 percent reduction, this time by 2017. Finding success again, he reached that milestone five years early.
The fruits of O’Malley’s efforts are easy to see. According to Governing, between 2011 and 2012, the state’s infant-mortality rate among African-Americans declined by 14 percent, to 10.3 per 1,000 live births. Also in 2012, Maryland’s infant mortality hit a record low of 6.3, down by 21 percent since 2008 and about the same as the national rate for 2012.
How did O’Malley manage do this so hyper-effectively? It all comes down to data. O’Malley tasked the state’s health serves to identify and funnel resources into areas with the highest infant-mortality rates. Two areas, Prince George’s County (which lies just east of Washington, D.C.) and Baltimore, demanded the most attention.
Baltimore, the state’s largest city, had some of the most grave infant-mortality issues. To address these problems, the state worked with local organizations like B’more for Healthy Babies, which is led by the city’s health department. For instance, B’more’s Sleep Safe initiative uses the media, community outreach and provider education to reduce sleep-related deaths. With the second leading cause of death among city infants being preventable sleep-related complications, this was proof of targeted problem-solving.
In-home education and social services for pregnant women and new mothers also were cornerstones of the Baltimore initiative. The city’s infant-mortality rate has dropped every year since B’more for Healthy Babies began in 2009, falling by 28 percent from 2009 to 2012, Governing reports. In 2012, Baltimore’s infant mortality for the first time fell below 10 per 1,000 live births. Notably, the disparity between African-American and white infant-mortality rates declined by 40 percent during that time.
Prince George’s County saw the creation of a similar “Healthy Women, Health Lives” program that took a comprehensive approach to the overall health of women of childbearing age.
Governing makes a point of noting how a lower infant-mortality rate is good for more than just immediate families.
Infant mortality is far more common among premature, low-birth-weight (LBW) and very-low-birth-weight (VLBW) babies. Including the costs of delivery-related hospital stays, transfers and readmissions, the expenses for a normal-birth-weight Maryland baby totaled $8,703 in 2009, compared to $45,543 for an LBW baby and $239,945 for a VLBW baby. As the number of LBW and VLBW babies declines, the health-care savings help pay for the resources used to reduce infant mortality overall.
The B’more for Healthy Babies and Healthy Women, Healthy Lives programs focus on both education and health resources. As the state’s Department of Health and Mental Hygiene realized that many uninsured women were delivering babies without any prenatal care, they charged local health departments with implementing a program called “Quick Start.” This allows uninsured women to get timely prenatal care appointments while awaiting Medicaid eligibility determinations.
With better prenatal care comes better-informed mothers and healthier babies. Call it a win-win.
One Unique Center Has Students Teaching Students. Here’s How It’s Paying Off
For some students, school can be nerve-wracking. But an ingenious school in Towson, Maryland, makes pupils feel at ease by having college students teach all the classes.
At Goucher College in Towson, M.D., immigrants come to the Futuro Latino Learning Center to learn English and computer skills. Most of the college students teaching at the center are Spanish-speaking or are Spanish majors; they are supported with work-study grants. These educators serve mostly Spanish-speaking immigrants, but the center also has some attendees from Iran, Brazil, and Syria (many of whom are parents).
Director Frances Ramos-Fontan, who was born in Puerto Rico, teaches Spanish at Goucher and runs the center. She told Carrie Wells of the Baltimore Sun, “You have participants who have never sat in front of a computer. We had one woman from Guatemala, her hands were frozen she was so afraid. It’s like learning another language from scratch, learning a computer.”
It’s not just the students at Futuro Latino Learning Center that receive an education–the college students benefit too. Fernando Parra, a freshman Spanish and international relations major at Goucher who teaches computer classes at the center, said, “It’s really great having the opportunity to teach them something that we take for granted.”
MORE: This Non-Profit Is Teaching Immigrants Much More Than Just Language