Why are Baltimore teens in poorer health than those in urban Nigeria?

In the Baltimore neighborhood of Sandtown, the infant mortality rate is more than than six times the national average, and life expectancy is more than a decade lower than in the rest of the country. And the health outlook is especially poor among teens. Dr. Robert Blum, Johns Hopkins Urban Health Institute Director, joins Hari Sreenivasan to discuss the area's health care.

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    Something different tonight.

    We're going to use most of our remaining time to offer you a detailed look at life in one of the poorest sections of Baltimore.

    Our focus is Sandtown-Winchester — the impoverished neighborhood where there was rioting this past week following the death of Freddie Gray. He grew up and was arrested there.

    So let's begin "Sandtown by the Numbers." It's a community of 14,000 people on Baltimore's west side that like so many others was hard hit by the loss of manufacturing jobs after big companies like Bethlehem Steel left town.

    The latest available numbers put the unemployment rate in Sandtown at more than 21 percent that's about four times the national average.

    Almost a third of the residents there live in poverty — that's twice the national average.

    We begin by looking at health care in Sandtown.

    For more about this, we are joined by Dr. Robert Blum, the director of Johns Hopkins Urban Health Institute.

    The institute is less than five miles away from Sandtown.

    So, there's this phrase about this genetic lottery.

    We don't choose who we're born to, right? But the infant mortality rate in Sandtown is more than three and a half times the national average, 21 per 1,000 births compared to six per 1,000 births.

    So, from the very outset of life we already see a huge disparity in health for a person born there versus the average American. Unpack that for us a bit.


    Well, first of all, just to put that in perspective, if Baltimore were a country, we would be 75th in the world for infant mortality, below every industrialize country and many low and middle-income countries.

    We have persistent problems due to lack of access to resources, due to persistent poverty, due to lack of education, due to lack of opportunities, and all of these interact to create an environment where neither children nor adults thrive.


    So, there's another number we came across that struck us.

    That is life expectancy in Sandtown. It's just over 65 years, 13 years below the national average. That puts people there on par with folks in Pakistan and Rwanda. What should we make of that?


    So, what we have is a whole set of conditions.

    We know today that one's environment, one's context drive their life expectancy, drive their health status, and to live in an environment of persistent poverty, we're not just talking about access to medical care.

    We're talking about access to food, and healthy food. We're talking about access to exercise and recreational places. We're talking about sanitation.

    Our environments — and Sandtown-Winchester is one example, but there are many communities like that in Baltimore, where the entire environment, both the physical and social environment, is toxic.


    And you wrote in The Washington Post recently, quoting now, "Teenagers in Baltimore face poorer health and more negative outlooks than those in urban centers of Nigeria, India and China."

    So, how does this affect the perception that they have of the world?


    The perception they have because of lack of opportunity, because of being left out of any American dream is that there isn't any institution they trust.

    The focus this past week has been on the police and lack of trust for the police.

    But there's lack of trust for education, for government, for social services.

    They don't trust any adult because in fact many of them report that they live in persistent fear in home, in school, in their neighborhoods. Their lives are consistent fear.


    So, focusing in on health care, what kind of access challenges are there in this neighborhood?

    I mean, just when I was there in the last couple of days, I met several of these folks who don't have transportation. So, for them, even the burned down CVS was a serious problem of where they were going to get their prescriptions filled.


    Absolutely. So, lack of transportation is a big issue.

    Lack of healthy food is a huge issue. Many of the people in these communities have to travel miles without any transportation to get to a grocery store, a green grocer. For many, lack of access to health care services.

    These are compounded by persistent trauma that people in our neighborhoods have. For example, children have, on average, two — experience two adverse childhood experiences.

    This is extreme violence. And approximately 18 percent say they have witnessed a relative or a friend or someone they knew having been shot or killed.

    So kids grow up in these kinds of environments, and that kind of toxic stress takes a huge toll on physical health as well as mental health.

    Mental health issues are a tremendous set of concerns for people. And it becomes intergenerational.

    It's passed from mother to child or father to child, not genetically or biological, but socially.

    And that's the context.


    All right. Dr. Robert Blum, director of Johns Hopkins Urban Health Institute — thanks so much for joining us.


    Thank you very much for having me.

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