… that’s the only way to describe the urban health landscape in the United States, the richest country in the world and the self-proclaimed leader of the “free” world. I’ve been in Baltimore for the International Conference on Urban Health and on Thursday afternoon was invited to visit parts of the inner city. I visited Paul’s Place, a soup kitchen for homeless and low-income people; and Homeless Health Care. I drove along streets where homeless people wander, and where poor families live in grossly substandard housing, and where thousands of homes are abandoned as the middle and upper-income people have fled to the suburbs.
Perhaps the most terrifying visit was to the University of Maryland’s Shock Trauma Centre, which treats about 7,000 gunshot and other victims of violence. This is a state-of-the-art facility with literally millions of dollars in equipment and staff devoted to one goal: Patching up the thousands of poor people who stream through its doors as victims of urban violence. There is a separate emergency room for other patients.
Virtually all the patients to Shock Trauma are poor and have no health insurance. Most of them are black, and almost all are either victims of gang violence, or members of gangs who have been shot or stabbed. Dr. Carnell Cooper and his surgeons have an amazing success rate: 97% of the people who are alive when they enter the facility are patched up and sent on their way.
Dr. Cooper and his team despaired of the revolving door at Shock Trauma: Many patients would come back time and again, since they were discharged back into the terrible urban neighbourhoods where they were assaulted in the first place. The toxic mix of poverty, racism, gang violence, drugs, housing insecurity and a deliberate policy of neglect by almost all levels of government contributes to the steady flow of patients at Shock Trauma.
In recent years, there is a tiny ray of hope. Dr. Cooper has engaged victims of the violence and others in a multi-disciplinary team to tackle some of the devastating social and health conditions that breed the epidemic of violence. They’ve had remarkable success among the several hundred young people (men and women) that they have worked with. Recidivism is way down – which means less costs to the system, and less damage to the neighbourhoods. He doesn’t have the resources to address the most fundamental issues (lack of affordable housing, lack of jobs, shortfalls in education, and so on), but he is making a real difference by simply engaging the victims.
You’d think that politicians and policy-makers would embrace Dr. Cooper and his team, if only because they are saving taxpayers’ money, but the pattern of official neglect continues.
In 1918, at the end of the First World War, Dr. Charles Hastings, Toronto’s first medical officer of Health, delivered his inaugural address to the American Public Health Association. He directly linked health and democracy:
“Every nation that permits people to remain under the fetters of preventable disease, and permits social conditions to exist that make it impossible for them to be properly fed, clothed and housed, so as to maintain a high degree of resistance and physical fitness, and that endorses a wage that does not afford sufficient revenue for the home, a revenue that will make possible the development of a sound mind and body, is trampling a primary principle of democracy under its feet.”
“Health is a prerequisite to the enjoyment of life. We do not only want life, but we want it more abundantly. As Farrand has expressed it: “To make a country really safe for democracy, we must first make it healthy.” We have heard much about making the world safe for democracy, but have we a democracy that is safe for the world? This must be assured.”
“Will any of the democracies of today stand the test?”
By Dr. Hastings’ standard, the Government of the United States of America stands condemned of failing in this most basic test of civilization.
On the final day of the Baltimore conference, we heard from Congressman Elijah Cummings, who put a more contemporary focus on the issue. He noted that the Bush administration is stalling on a bill that would provide basic health care to children (the United States doesn’t have a comprehensive health care plan and as many as 50 million Americans are denied access to even the most basic primary care). He spoke of a young boy in Baltimore who died of an infection caused by tooth decay because he was denied access to basic health services.
Congressman Cummings ended with this statement:
“If President Bush can spend $196 billion on Iraq and Afghanistan, then we can afford universal health care.”