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Think Big… Move fast

As Baltimore’s long-tenured health commissioner, Peter Beilenson daily confronts some of the nation’s most entrenched big-city health problems. He does it with political savvy, a flair for statistics, and one foot on the accelerator.

By Dale Keiger
Photos by David Colwell and Howard Korn

On a Tuesday morning in Baltimore in late June, Peter Beilenson is digging into some numbers. Baltimore has just had a bad weekend, with eight homicides. But none involved juveniles, to the relief of the dozen people assembled with Beilenson around a conference table. According to a bar graph projected on an overhead screen, since the first of the year 10 Baltimore kids have died by homicide. That’s 10 too many, but it’s a 33 percent reduction compared to this point last year, which is the kind of number this group is after.

They meet weekly as part of a city health department data review called KidStat. Beilenson, MPH ’90, is the Baltimore City health commissioner. He’s held the job for the past 11 years, a long tenure for a big-city health commissioner. And the job gets more challenging all the time. Commissioners like Beilenson must deal with all the old problems—restaurant sanitation, vermin control, epidemics of sexually transmitted diseases, drug addiction—and new urban nightmares like bioterrorism, SARS, and “dirty bombs.” For more than a decade, Baltimore’s health problems have been Beilenson’s headache, and he’s responded by thinking big and moving fast.

“I would not want an extra day in this job unless I felt like we were really pushing things.”—Peter Beilenson

During Beilenson’s time on the job, Baltimore has not been the healthiest city in which to live. It has had high rates of violent crime, sexually transmitted diseases, and substance abuse, especially heroin. National television viewers of Homicide, The Corner, and The Wire know it mostly as that place where you’re either an overworked cop, a junkie, or a murder victim. Newspaper readers may recall it as the city that a few years ago managed what Beilenson, 43, ruefully calls “the trifecta”: the highest incidence of syphilis, gonorrhea, and Chlamydia among American cities. Baltimore ranks second in per capita violent crime, behind Detroit, with an appalling murder rate of five or six per week.

But

Beilenson checks in on the city’s mobile needle-exchange program.

to Beilenson, the city is becoming healthier by the day. He has a formidable memory, and he’s practiced at listing for reporters, legislators, and the public one sign of progress after another. Baltimore has had, for three years running, the biggest drop in violent crime of any major U.S. city—a 26 percent reduction since 1999—and the largest two-year drop in drug-related emergency-room visits. In what Beilenson has described as one of the most

Beilenson talks to reporters.

important accomplishments of his tenure, the city recently recorded the lowest infant-mortality rate in its history (10.4 deaths per 1,000 births, down from 11.9 deaths in 2001) and, for the first time last year, it saw infant mortality among blacks drop below the national average for blacks. Beilenson has set a goal to eradicate syphilis and tuberculosis in the city by 2008; he claims to be ahead of schedule on both. And in a time of straitened public finances, “we’ve increased drug treatment more per capita than any city in the United States, by far,” he says. “In fiscal ’97, we had 4,000 drug-treatment slots that treated 11,000 individuals that year. This year, we have approximately 9,000 treatment slots treating about 26,000 individuals.”

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