Medicine for the Greater Good: one hospital’s community outreach
The violent police attacks on Jacob Blake, George Floyd, and far too many others, along…
The violent police attacks on Jacob Blake, George Floyd, and far too many others, along with the high rates of Covid-19 among minority communities, have illuminated an ugly fact: being a person of color in America is bad for your health.
Across the board, people of color have worse health outcomes than their white counterparts. Black Americans have lower life expectancies than white Americans, and the infant mortality rate for Black infants is more than twice that of white babies. Black Americans are 60% more likely to have diabetes than are white Americans, and they have higher rates or heart disease, cancer and other diseases.
The main drivers of this are structural racism and poverty. As a society, we have an urgent responsibility to address these problems. But many of the solutions require major social reforms. And even if we can enact these changes — no easy task in our polarized country — it will take generations to undo the impact of these forces.
In the meantime, millions of people are suffering. Hospitals and other health care institutions need to do something now to improve the situation.
We and our colleagues have been wrestling with this issue for more than a decade. We began with the realization that Johns Hopkins Medicine, the institution where we work, wasn’t as connected to the communities of color surrounding it as it could be, and wasn’t helping them as much as it could.
In 2013, we and others started Medicine for the Greater Good (MGG). It aims to collaborate with Black and brown communities in Baltimore to help them improve their health.
With support from Johns Hopkins Medicine, the organization now works with almost 100 community and faith groups in and around Baltimore. Over the past seven years, we’ve helped more than 5,000 people throughout the city learn about how they can do more to maintain and improve their health.
These communities and groups face daunting health problems. Health disparities in Baltimore are particularly shocking. For instance, there’s a 20-year difference in life expectancy between some predominantly Black neighborhoods and some largely white areas.
To help address this unconscionable difference, we start by listening to community groups to find out what they need. One thing we‘ve learned is that fostering good health requires much more than matching a medicine to an illness. Many people have nonmedical issues that keep them from getting the care they need. People tell us they must go without medication in order to pay for groceries. Others have to take three buses simply to get to a pharmacy to fill a prescription.
Both of us grew up in city neighborhoods in Baltimore, and we’ve seen the gap between large health care institutions such as Johns Hopkins and the lower-income communities that surround it. Most doctors at Hopkins don’t live in these communities, and didn’t grow up in them, so it’s harder for them to understand what it’s like to live there.
On top of that, communities are often reluctant to trust Medicine for the Greater Good. This is understandable: They’ve heard promises of help before, promises that haven’t always been kept. They are also keenly aware of the history of white scientists and doctors exploiting people of color in the name of progress, such as the federal government’s Tuskegee syphilis experiments, which ran from the 1930s to the 1970s, or Johns Hopkins researchers taking Henrietta Lacks’ cells for study in 1951 without her knowledge, to give just two examples. Only by acknowledging this past can we hope to move beyond it.
Overcoming this mistrust requires patience, and it can be uncomfortable. We don’t shy away from that; it’s part of the process. A few years ago, one of us (P.G.) visited the same church for three straight Sundays. On the first two, the pastor ignored my presence. On the third Sunday, he came over after the service had ended to say hello. We now have a solid relationship with the pastor and his church, and work with them to help keep the congregation healthy. Medicine for the Greater Good recently donated 1,000 masks to the church, along with several gallons of hand sanitizer.
Since March, of course, we’ve focused on Covid-19. We regularly hold meetings, mostly virtual, with Baltimore church groups, schools, and community groups, sharing the latest information about how to reduce the risk of infection and how to get tested. We run about two sessions a week, sometimes more, and have connected with more than 10,000 people. Our partners tell us these sessions are a lifeline, that they have no other credible source of information about how to deal with the pandemic.
Here too, we let our partners tell us what they need. For instance, we’ve been asked how to reduce risks when passing the collection plate, and how to perform a safe adult baptism.
In one way, the approach of Medicine for the Greater Good is simple: More than anything, it requires a willingness to reach out. But simple is not the same as easy. Connecting with people from different communities requires sustained hard work over months and years. It’s possible that is one reason our approach has not been widely copied. From what we can tell, few if any health care institutions are reaching out in this way. We’d love to see that change.
Millions of Black Americans and other people of color are struggling with severe health inequities, including Covid-19, and the tools we have right now to alleviate these problems are limited. As we strive to counteract the toxic effects of deep-rooted racism and poverty, we need to use every tool we’ve got. Collaboration, listening, and honesty are good places to start.
Panagis Galiatsatos is a pulmonary and critical care medicine physician and an assistant professor of medicine at the Johns Hopkins University School of Medicine, where Erica Johnson is an infectious disease physician and an assistant professor of medicine. They are co-directors of Medicine for the Greater Good.