July 7, 2014

System Health

Academic medical schools play a critical role in sustaining and improving the health and well-being of all people. That is especially true for the communities surrounding these institutions. Most medical schools around the world are located within urban environments, and many have affiliations with city hospitals or hospital systems.

In a 2010 article published by the Association of Academic Health Centers (AAHC), AAHC president and CEO Steven A. Wartman stressed the need for academic medical centers to rally their resources not to “simply coexist” but to develop a “viable partnership” with the surrounding communities, thereby fulfilling their “true mission” of improving human health and well-being.1

We in the academic medical community have incredible opportunities to dramatically impact the lives of people in major metropolitan areas and beyond. Barriers to the success of these health programs, especially in urban areas and regardless of country of origin, often include overcoming health disparities and inequalities; training a culturally sensitive workforce; implementing biomedical research findings in the local population; and promoting clinical care that is focused on quality and patient outcomes.2

Needs of All Citizens

The question, then, is how can academic medical centers appropriately address the health needs of all citizens? In Maryland, and particularly the city of Baltimore, we grapple with this issue every day.

Although Maryland is home to the National Institutes of Health, one of the top national and international supporters of biomedical and health-care research, the state ranks twenty-fourth in terms of overall health,3 and Baltimore is America’s eighth most unhealthy city.4 Although there is no shortage of primary-care physicians in the metropolitan area (one for every 527 residents), and both the University of Maryland Medicine (School of Medicine and Hospital System) and Johns Hopkins Medicine (School of Medicine and Hospital System) operate within the city limits, Baltimore has the fourth highest number of adults with type 2 diabetes, and city residents have an average life expectancy of 68 years (the national average is 79 years).5

Against this backdrop, and the challenges we face in terms of educating and implementing preventive health measures in our surrounding communities, the University of Maryland School of Medicine has remained relentless in its pursuit of improving the health and well-being of citizens throughout the nation.

Most recently an incentive-based series of initiatives was enacted across Maryland to reduce health disparities and inequalities.6 Defined urban renewal zones targeted for economic improvement called Health Enterprise Zones (HEZs) are designed to transform health care for underserved populations. Through state-funded resources, primary-care providers and community-based health organizations within each of five HEZs (one of which is located in Baltimore) will receive incentives to open or maintain practices in these areas.7 Launched in early 2013, we anticipate that the HEZs will have a measurable and powerful impact on Marylanders’ well-being.

Adapting to the Culture

Delivering needed community care requires us to adapt to the local culture, understand our citizens’ perspectives, and relate accordingly to our patients. We have found successful approaches through partnering with community leaders, meeting people “on their terms,” and identifying the best inroads to open up a dialogue about health. Improving well-being cannot be accomplished merely by research; we must apply that knowledge to real-life settings. The University of Maryland School of Medicine stands as an example of how academic medical centers can create an ever-widening sphere of influence on better living; radically changing how we interact with our citizens; and making a commitment to health and well-being for all.

  1. Steven A. Wartman, “The Compelling Value Proposition of Academic Health Centers,” Association of Academic Health Centers Issue Brief (2010); www.aahcdc.org/PolicyReports/IssueBriefs/View/tabid/79/ArticleId/14/The-Compelling-Value-Proposition-of-Academic-Health-Centers.aspx.
  2. Edward Hillhouse and Steven Wartman, “Improving Health Care in the Middle East and North Africa,” Lancet 383 (Jan. 11, 2014): 126.
  3. America’s Health Rankings 2013 Report; www.americashealthrankings.org/MD.
  4. Jaclyn Colletti and Maria Masters, “America’s 10 Fattest (and Leanest) Cities,” Men’s Health (2010); www.menshealth.com/mhlists/metrogrades-fattest-cities/printer.php.
  5. U.S. Department of Health and Human Services, “Community Health Status Report” (Baltimore City, Maryland, 2009); www.cdc.gov/CommunityHealth/ReportPdf.aspx?GeogCD=24510&PeerStrat=3&state=Maryland&county=Baltimore%20City.
  6. E. Albert Reece, Anthony G. Brown, and Joshua M. Sharfstein, “New Incentive-based Programs: Maryland’s Health Disparities Initiatives,” JAMA 310 (July 17, 2013): 259, 260.
  7. Carlessia A. Hussein et al., “Working With Communitites to Achieve Health Equity in Maryland’s Five Health Enterprise Zones,” Journal of Health Care for the Poor and Underserved 25, supp. l (Feb. 25, 2014): 4-10.