A Health Commissioner Who Knows What He's Talking About?

Cross posted at Daily Kos.

I know, it seems shocking. Look at the health statistics in the city of Baltimore - fifth highest overall mortality rate, second highest homicide rate, fourth highest infant mortality rate, third in low birth weight rankings... and the clincher: second highest AIDS and HIV rates, at a whopping 40.4% and 50.5%, respectively. Oh, and years of neglect and corruption in the City Health Department. How could the Baltimore City Health Commissioner be improving the situation?

Well, he is. Josh Sharfstein, M.D. is currently the Health Commissioner of Baltimore, and he has a pretty impossible job. He is tasked with improving the public health of a city that has such serious epidemics - the spread of HIV, heroin addiction, asthma among children, infant mortality...the list goes on. And he has to deal with Mayor Sheila Dixon and the Baltimore City Council - no easy feat.

But Sharfstein has proposed some interesting strategies for combating these problems. For tackling the spread of HIV and heroin addiction among Baltimoreans, he supports buprenorphine. Buprenorphine is an alternative to methadone, the controversial heroin substitute. Health professionals are divided on the benefits on buprenorphine. Some say it is over-prescribed and an inadequate substitute to counseling services. Others say it provides the benefits of methadone without being as highly addictive.

But the best part of bupenorphine is that regular doctors can describe it (after a number of hours of training). Methadone has to be distributed at special methadone clinics. No one wants methadone clinics in their communities, so it becomes more difficult to build them. Bupenorphine could help produce the safer consumption of heroin substitutes in Baltimore, and ultimately lead to a drop in the HIV rates among users.

Sharfstein has also committed to targeting other urban policy issues that affect public health. For example, high school dropout rates can turn into a public health nightmare - they can lead to increased rates of teen pregnancy and drug use, among other things. However, studies have shown that providing families with books will increase the likelihood that their kids will stay in school. So, the Commissioner came up with a plan for Baltimore City to give books to pediatricians, who would in turn give them to their patients so they would have something to read - simple, but effective.

Baltimore has also begun its "Safe Streets" program - a copy of Chicago's Ceasefire Program to lower gun violence in the city. There is no greater risk to public health than the murder rate, and it is not only the police commissioner who needs to get involved in such programs, the health commissioner must as well.

However, the greatest achievement Sharfstein has made is establishing a shift to community based health provision in Baltimore. For too long, the city has suffered a health budget that was too small to get anything done (thanks in large part to inadequate federal funding). However, community organizations can do more with less - they have more devoted staff, a knowledge of the local needs of their target area, and a relationship with the people that need access to services. All of these things allow community based organizations to provide primary care better than the City can. Thus, instead of wasting money on inadequate health services, the Health Commissioner has invested in community based primary care initiatives. However, the City still needs to do its part, and has maintained clinics and health centers that still fulfill a need.

Republicans constantly talk about the need to increase efficiency in our health care system - but they only know how to do that by cutting services. The services are still needed, we just need to change how we provide them. Supporting health care can take many forms, but two things is clear: government still needs to maintain a role in health care provision through funding local services, and we need more health commissioners like Josh Sharfstein in the country.