The first time I attended a community meeting with Mayor Sheila Dixon, I was intimidated by the set-up: Mayor in front, those of us in her cabinet sitting across on a stage behind her.
Like sitting ducks.
When the meeting started, my anxiety rose further. An elderly woman came forward to ask a question. The Mayor answered with a smile – and then turned to us on the stage to provide additional details.
With all of the pressing health issues in Baltimore – from drug addiction to HIV to cardiovascular disease and premature death — I was convinced that virtually all questions all night long would be directed at the Health Department, and I would be on the spot.
But that first question went to the Department of Transportation. Phew.
Then the second did too. As the minutes and then hours went by, I sat like a stone. No questions for Health.
Citizens asked about why there were lights missing on their streets (Transportation), how they could apply for traffic bumps (Transportation), and what could be done to lower property taxes (Finance). They asked about safety at their local elementary (Schools), trash pick up (Public Works), boarded up homes (Housing), recent criminal activity (Police), and plans for the park around the corner (Recreation and Parks).
Six months later, after about 10 hours of community meetings across the city, I have probably fielded just a handful of questions – virtually all of them about rat eradication on specific blocks.
It’s an interesting paradox. We are all concerned about the health of Baltimore, and our health indices are some of the most troubling in the nation. But health is a relatively minor factor in community politics.
I admit, that may be a good thing for my blood pressure. But it’s not a good thing for Baltimore. The less local passion about an issue, the less likely it is that the issue will be addressed.
Three hours into one sweltering community meeting this summer, there were no questions for Health. My mind started to wander. I began to fantasize about an angry citizen demanding to know why rates of life-saving colon cancer screening were so low in the neighborhood. When I came back to earth, his question was about traffic bumps.
I believe the problem is not lack of interest – it’s lack of local data. Communities respond to the pile of trash in front of them because it’s their pile of trash.
The solution is to have compelling health data available on as local a level as possible.
It’s not entirely a new idea. Traditionally, agencies, including the Health Department, have searched for community specific data to make available. The Baltimore Neighborhood Indicators Alliance has posted a range of community-level data online through 2004 (see http://www.ubalt.edu/bnia/mapping/index.html). This approach is important, and should be continued and expanded.
But current efforts are defined by what data is available at the community level – not necessarily what data the communities would like to know, or the Health Department would like to have available. Many key topics – such as the percentage of people who get the health care they need – are not covered.
The Health Department would like to ask a broad range of health-related questions in a citywide health survey. But it would be prohibitively time consuming and expensive to conduct that survey to produce reliable estimates for each of Baltimore’s many neighborhoods.
So here’s the audacious idea: What if communities could collect their own information?
What if, based on a citywide survey, the Health Department designed a “how-to” guide and supported community groups in conducting their own local assessment? We could combine the newly collected data with the information that is already available and produce a specific health report for the community.
There are lots of practical questions about this idea, relating to logistics, ethics, and reliability. But I would bet we could get help from some of the city’s premier research institutions, perhaps with teams of students coordinating with local improvement associations. And I also bet that the communities that participate in gathering health information will care a lot about what they find.
Residents might even speak up during community meetings with the mayor.
“Why are half of our neighbors waiting more than two months for a medical appointment?”
“Why do only 10% of our neighbors who smoke know they can get free counseling and patches by calling 1-800-QUIT-NOW?”
“Why has not a single person been screened for colon cancer on my block like they should be?”