The CEO of Hopkins Medicine and Dean of the Medical Faculty, Dr. Paul Rothman, explored the social determinants of health and the Hospital’s efforts to overcome disparities in medical care at a speaker event hosted by the Osler Medical Symposium this Tuesday in Gilman.
Rothman, who has been at the Hospital for six years, oversees 45,000 employees at six major facilities in Maryland and Florida, with around 25,000 employees working and living in the Baltimore area. In his talk, he discussed the University’s founding by Johns Hopkins.
“[Johns Hopkins] asked us to be of and serve the community of Baltimore,” he said. “This sense of responsibility goes back to what Mr. Hopkins asked us to do in the hospital and has been true ever since.”
In 2015, Freddie Gray, a 25-year-old black man and Baltimore native, died from injuries sustained while in police custody. His death sparked protests both peaceful and violent.
Rothman saw this series of events as a call to reevaluate the Hospital’s mission and role in the Baltimore community.
“After Freddie Gray’s death in 2015, I think it was an impetus for us to do even more in the City,” he said. “We really took it upon ourselves to think about what our role is in the community.”
He cited the striking differences among Baltimore neighborhoods as a barrier to health in Baltimore.
“The lack of health care equality in the city was striking,” he said. “Life expectancy in Roland Park is 83 years of age... What would it be in Upton, Druid Hill? 63.”
Later he discussed specific race-related disparities in participation and treatment at Hopkins Medicine and noted that the Hospital lacks data about the race of its patients.
“If you look across a whole range of healthcare outcomes, say premature heart disease, it’s 50 percent [higher] in African Americans than it is in whites,” Rothman said. “Martin Luther King said, ‘Of all the inequalities, injustice in healthcare is the most shocking and inhuman.”
Rothman said he began implementing policies over the past year to ensure that the hospital system is incorporating patients’ race and outcomes as a measure of quality of care.
Rothman cited four specific roots of poverty in Baltimore that perpetuate poverty and poor health outcomes: mental health crisis, opioid addiction, unemployment and incarceration, and education.
For each issue, he explained what Hopkins Medicine has been doing to promote recovery in these areas. He first addressed the issue of mental illness.
“One in five Baltimore residents experience a mental health illness a year. One in 20 has a serious condition, like schizophrenia,” he said. “A lot of these people end up in jail or end up on illegal substances to self-medicate.”
He further elaborated that Hopkins has begun to allow patients to stay in their homes while they receive outpatient care for their mental illness.
“What we’re trying to do is get mental health [treatment] out of the hospital setting and into the community,” Rothman said.
Discussing opioid addiction, Rothman explored how Baltimore has never switched illegal substance preference but has remained a ‘heroin city’ since the 1960s. He says that it is one of the greatest threats to health in the City and that better preventative measures may be the answer.
“In Baltimore, there are two fatal overdoses every day,” he said. “We’re teaching our medical students about treatment and prevention of opioid addiction.”
Rothman cited the loss of manufacturing jobs as a major culprit of unemployment and poverty in the City. He said that Hopkins works on being a job provider, especially for workers with a criminal background, women and those from severely underserved neighborhoods.
“Not only do we want to employ people, but we want to be able to help businesses that can hire in Baltimore so that others can hire more people,” he said.
This initiative moves the Hospital to source more materials from local business so that they experience greater revenue and thus can expand and employ more residents. In addition, Rothman said that Hopkins hires the greatest number of non-violent ex-criminals in Baltimore.
He also talked about Hopkins implementing early education and high school programs to increase employment and higher education admissions.
Rothman answered a question about whether the University looks to other communities for inspiration on how to solve Baltimore’s health care issues.
“We look at how other health systems do it. Look: We don’t have all the answers. The problems are large and daunting. Any help we can get to implement the best practices here is great. We try to innovate in the space ourselves, because we have so many great minds, but this is something where everyone is a winner if it works,” he said.
Bloomberg School of Public Health student Mayriam Robles-Garcia, who is from the Dominican Republic, attended the event and was able to ask Rothman about his experiences.
“I was interested in [Rothman’s] transition from being a physician to healthcare administration, because my background is clinical,” she said. “I can only aspire to be as successful as he is, working with underserved communities. I’m from a developing country, so I was really motivated to come here for this talk.”