- The Enterprise
- The Recorder
A few dozen local health and nonprofit officials gathered for a public forum last week at the Jaycees center in Waldorf, where the data spoke loudest about the need to reduce health disparities in the state.
A new state law passed during the 2012 legislative session budgets $4 million in the current fiscal year to create and support two to four “health enterprise zones” in areas with existing health disparities among minority groups.
Through proposed incentives like income tax credits, student loan assistance and grant funding, the four-year pilot program aims to reduce disparities by attracting physicians to underserved areas.
The goal is to both increase access to health care and reduce costs by getting people to visit a personal care provider rather than hospital emergency rooms, Maryland Department of Health and Mental Hygiene Deputy Secretary Frances B. Phillips said at the forum.
Phillips and Mark Luckner, executive director of the Maryland Community Health Resources Commission, spent most of the forum explaining the program, but figures presented by Dr. David A. Mann, an epidemiologist with the department’s Office of Minority Health and Health Disparities, made the case for why such a program was needed.
The data showed African-Americans in Maryland are twice as likely as whites not to have health insurance, suffer from rates of infant mortality, late prenatal care and end-stage kidney disease at three times the rate of whites and contract HIV nearly 12 times as often as whites.
Other data showed little disparity in the mortality rates of whites and blacks suffering from heart disease and cancer in the three Southern Maryland counties, but great variances in the number of emergency room visits related to diabetes, hypertension and asthma.
The rate of diabetes-related ER visits for blacks was five times higher than for whites in St. Mary's County and four times higher in Calvert County.
In Charles County, blacks went to the ER for diabetes, high blood pressure and asthma at double the rate of whites.
“Something’s going on with the black patients that’s not going on with the white patients,” Phillips said.
But the Charles County data also show a slightly higher percentage of black adults were of a healthy weight and that the rate of smoking was lower among blacks.
In combating these disparities, Phillips said solutions would be found locally.
“In terms of helping communities become healthier, that doesn’t happen in Baltimore,” she said. “It absolutely happens in counties, in coalitions like this and through the kinds of groups that you all represent. This is where the real work gets done. This is where the real partnerships are.”
Modeled after programs such as the Harlem Children’s Zone and Promise Neighborhoods, the health enterprise zones were the chief recommendation for reducing health disparities made by a workgroup established by Lt. Gov. Anthony G. Brown (D) and chaired by University of Maryland School of Medicine dean Dr. E. Albert Reece.
The workgroup issued a report in January which cited higher rates of certain diseases — particularly asthma, diabetes and high blood pressure — among minority groups.
“Every Marylander, of every race, ethnicity and nationality, in every part of our state, should have the chance to live a healthy, productive life,” Brown said in a statement after legislation authorizing the program passed in April. “With our Health Enterprise Zone program, we will be able to saturate underserved communities with primary care and other health services to help reduce rates of chronic and often preventable illnesses, such as hypertension, asthma, diabetes and other controllable medical conditions.”
Each zone must be made up of a contiguous cluster of ZIP codes with at least 5,000 residents and have documented evidence of health disparities, economic disadvantage — as evidenced by high rates of Medicaid enrollment or participation in the federal Special Supplemental Nutrition Program for Women, Infants and Children program — and poor health outcomes like lower life expectancy or higher rates of low-birth-weight infants.
“These two to four HEZs, that’s just the start, and we really are looking at this as an incubator to attract investment to really all kinds of supplemental programs from other sources beyond state funding,” Phillips said.
Phillips mentioned Sen. Thomas “Mac” Middleton (D-Charles), who co-sponsored the legislation, as one of those critical to getting the bill passed. “There is no finer champion of rural health,” she said of the senator.
Middleton, who did not attend the forum, said the greatest incentive that can be offered to physicians is student loan forgiveness, noting that medical students often graduate with more than $150,000 of debt at ages where they are looking to settle down, get married and buy new cars and homes.
“Loan forgiveness becomes a very critical piece of getting doctors to come to these underserved areas,” he said.
Middleton also said that he was assured by Gov. Martin O'Malley’s (D) administration that rural regions like Nanjemoy would be able to get some assistance even if they are not specifically included in a health enterprise zone.
To be selected for an HEZ, applications need to outline the community’s health needs, identify specific diseases where disparity exists, propose measurable goals and strategies to meet them, exhibit balance between community-based and primary care solutions and showcase a local coalition of providers and organizations, according to material Luckner presented at the forum.
The department and commission are accepting public comments on the program’s eligibility requirements, application review principles and provided benefits.
Comments may be submitted until July 31.
The HEZs will be selected in the fall and winter, with implementation scheduled to being in December.