JUDY WOODRUFF: The neighborhoods where people live and work often reflect how healthy they are.
Nowhere is that more true than in West Baltimore, where violence, food deserts, and homes filled with mold, lead paint and toxic levels of stress translate to drastically lower life expectancies than almost anywhere else in the state of Maryland.
That history has also led to a frayed trust with the medical establishment there, one that hospitals are working to restore.
Special correspondent Sarah Varney has our report from Baltimore. It was produced in collaboration with our partner Kaiser Health News.
SARAH VARNEY, Kaiser Health News: The street protests that erupted in West Baltimore after 25-year-old Freddie Gray died while in police custody brought attention to the staggering poverty and violence in the city’s impoverished neighborhoods.
In Sandtown-Winchester, where Gray lived, the dismal health and low life expectancy rivals some of the world’s poorest countries. That’s especially striking in a city world-renowned for its prestigious medical schools and public health research.
Men and women in Sandtown live, on average, just 69 years, a decade below the rest of the country. Health officials say infants here die at almost twice the national average. And adults are felled by heart disease, prostate cancer and AIDS with shocking frequency.
Pastor Derrick DeWitt of First Mount Calvary Baptist Church in Sandtown prays for an end to his neighborhood’s ill health, but preaches self-reliance.
REV. DERRICK DEWITT, First Mount Calvary Baptist Church: You have to make sure that you are getting the health care that you need. Things are not equal, and they probably will never be equal.
SARAH VARNEY: Pastor DeWitt, like many residents here, is deeply distrustful of Baltimore’s hospitals. He learned to be wary of nearby Bon Secours Hospital early on from his grandmother, who was a member of the church he now leads.
REV. DERRICK DEWITT: All of our family who went to Bon Secours never came out of Bon Secours. So, she kind of instilled in us, “Never take me there. If I ever have to go to the hospital, never take me there.” And that attitude still exists today.
SARAH VARNEY: But in an emergency, Bon Secours is one of the closest hospitals to Sandtown-Winchester.
REV. DERRICK DEWITT: My directive is, if you have to put me in the car, take me to a hospital other than Bon Secours, because the nickname for Bon Secours, do you know what that is?
SARAH VARNEY: Tell me.
REV. DERRICK DEWITT: “Bon se-killer.”
SARAH VARNEY: Bon Secours is working mightily to change that reputation, but the distrust goes beyond just one hospital. Stories dating back to the 1800s that so-called night doctors kidnapped black children for medical experiments are vividly remembered.
Experimentation was, in fact, happening to black Americans nationwide. At Johns Hopkins, researchers famously took tissue cells from Henrietta Lacks, a black cancer patient, without permission in 1951.
EDDIE REAVES, West Baltimore resident: To me, they have always been like that. Never did like Johns Hopkins.
SARAH VARNEY: Eddie Reaves, age 64, is a member of Pastor DeWitt’s church. His partner died two years ago after doctors at Johns Hopkins operated on her heart.
EDDIE REAVES: From day one, before she even went in, I never liked them, because that’s all they do is experiment, to me, on people.
SARAH VARNEY: Reaves is equally skeptical of other Baltimore hospitals. He spent much of his life addicted to drugs, and when his diabetes and asthma spiraled out of control, he would end up in the E.R.
But even after he got off drugs and signed up for health insurance, Reaves found the medical system was a maze of doctors who charged too much and didn’t listen to him.
EDDIE REAVES: When the doctor give me something that give me side effect, I don’t take my medication. He said, why are you not taking it? I said, because it give me side effects. And, sometimes, they think it’s a big joke, but I don’t take nothing that give me side effects.
SARAH VARNEY: Dr. Samuel Ross, the CEO of Bon Secours, is well aware of his hospital’s reputation in the neighborhood, and what it’s going to take to earn people’s trust.
DR. SAMUEL ROSS, Bon Secours Baltimore Health System: You often find out that a lot is urban myth. But we also have to sit down and say, well, tell me why you feel that way? And then, let me show you some things that may cause you to feel a different way.
SARAH VARNEY: Nearby, at the University of Maryland, Baltimore, president Dr. Jay Perman says repairing the relationship with black Baltimoreans will take a long time.
DR. JAY PERMAN, University of Maryland, Baltimore: I think there’s still too much of a perception that we experiment. Now, that is not the case. Care is rigorously delivered with consent from the patient always. But it takes a long time, I think, for people to understand that the days of hidden experimentation are over.
SARAH VARNEY: Making that case is not only a moral imperative, but now a financial one.
While Freddie Gray’s death and the street protests have called attention to the health problems in Baltimore’s poorest neighborhoods, sweeping changes to the health care system have forced hospitals to go after their root cause. Because of the Affordable Care Act and a change to the way Maryland pays for medical care, health professionals are being pushed to look more closely at the details of their patients’ lives.
Public health researchers say it’s when patients are in their neighborhoods, in crowded homes or decaying public schools, with no grocery stores or reliable buses that health problems fester.
DR. JAY PERMAN: In the past, we have always thought about making correct diagnoses, and preparing the right prescription or therapeutic plan, and then sending the patient out.
And I think it’s the fact that we didn’t focus — we in general in the American health care system didn’t focus on what happens to the patient when they’re not directly in our care and in front of us.
SARAH VARNEY: So, hospitals are aiming to fix the everyday problems that are making their patients sick. And there’s renewed urgency. Hospitals can now face financial consequences from the federal government and the state of Maryland for failing to prevent their patients from returning to the E.R. for avoidable problems.
The Maryland legislature has pressed for changes too. A 2012 law established five health enterprise zones which offer tax credits and grants to bring health care resources to poor communities.
Driving that effort are groups like the Coordinating Center, which are paid by the health enterprise zones to visit high-risk patients, like Toni Settles, just after they leave Bon Secours, the University of Maryland and other Baltimore hospitals. Advocates go into patients’ homes to figure out how to keep their recovery on track.
JENN SULIN-STAIR: Will you need help with planning finances to afford those things?
SARAH VARNEY: Jenn Sulin-Stair is part coach, part confidant, part fixer who first had to earn Settles’ trust.
TONI SETTLES, West Baltimore resident: It wasn’t a whole lot of talk. She put action to it, you know, and set up appointments for me and then set up dates. And that’s the difference. I never had nobody one on one, no indeed. They will say one thing, do another.
SARAH VARNEY: The health enterprise zones pay for this kind of help for two months.
Senior vice president Carol Marsiglia says, without an intervention, half of high-risk patients return to the hospital within 12 days. Although mental illness and substance abuse can play a big role, Marsiglia says the grinding realities of poverty often derail recovery, a broken wheelchair or no money to fill a prescription or get a needed oxygen tank.
CAROL MARSIGLIA, The Coordinating Center: So, we do work to try to find some financial resources, get that co-pay paid, so that the person can get the oxygen they need. Otherwise, they may likely be back in the hospital early the next week.
SARAH VARNEY: But for many, the obstacles just keep on coming. David Kelly Jr., an outreach worker from LIGHT Health and Wellness, a West Baltimore community center, has been counseling Anthony Chase for years. The two drive to a mall parking lot to have a private and frank conversation about keeping Chase’s HIV and bipolar disorder under control.
MAN: I’m working on myself right now. I’m working on all of me.
DAVID KELLY JR.: Well, a big part of that is going to be definitely maintaining your treatment adherence, I think. If you use that as a foundation and build from that, you know, everything else sort of…
MAN: Yes, falls in place.
SARAH VARNEY: The hospitals, too, have renewed their focus on West Baltimore. A well-respected homeless clinic recently opened up inside Bon Secours, and the hospital is converting a church near Sandtown into a clinic that will offer primary care, mental health counseling and social services.
WOMAN: First step, pour the milk into a bag, and then you measure the vanilla.
SARAH VARNEY: And the University of Maryland, Baltimore, is partnering with public schools to inspire young African-Americans to become health care professionals, and training current medical students to delve more deeply into the social conditions that perpetuate poor health.
At Pastor DeWitt’s church, Johns Hopkins recently held focus groups to ask residents why they used the emergency room instead of going to a doctor’s office. But it’s not clear if these intensive efforts will be sustained. Funding for the health enterprise zones expires next year.
And many here are asking how far hospitals can go, even when threatened with financial penalties to fix toxic neighborhoods.
For his part, Reaves remains unconvinced that all the attention the protests brought to his neighborhood over this last year will do much good.
EDDIE REAVES: Things will get worser and worser to me, but you got to keep on living, though, do what you got to do.
SARAH VARNEY: It’s a fatalism hard-earned.
For the PBS NewsHour and Kaiser Health News, I’m Sarah Varney in Baltimore.
JUDY WOODRUFF: And a postscript to our report: Johns Hopkins officials say they are committed to the Baltimore community and improving the relationship.
That includes a series of community events on issues about the Henrietta Lacks story, including a program and scholarship for high school students and a symposium that attracts over 1,000 people from the community. The events are planned in cooperation with the Lacks family and they address the ethical issues related to biomedical research.