Baltimore City Health Department

History

The Baltimore City Health Department was founded in 1793 and is considered the oldest continuously operating health department in the United States. It was established in response to the first recorded yellow fever outbreak in Baltimore at Fell's Point. On September 12, 1793, Governor Thomas Lee issued a proclamation appointing Baltimore’s first health officers, Drs. John Worthington and John Ross .

Prior to 1793, Baltimore lacked a public health system but faced various health problems. For the majority of the 18th century, public health activity was centered on the reporting of “nuisances” and the government of Baltimore was managed by the town and special commissioners. In 1745, the town issued a prohibition against geese and swine running at large and in 1750, it enforced the removal of “stinking fish and dead creates or carrion” left out on streets. At the meetings of the Continental Congress in 1776 and 1777, delegates of the Continental Congress complained about the uncleanliness of Baltimore. Oliver Wolcott of Connecticut called Baltimore “the most dirty place I was ever in.” In November 1785, citizens of Baltimore petitioned Governor William Paca to establish a health office that could manage prevalent diseases and other health concerns. Their efforts were unsuccessful and the urgent need for a health department became apparent only after citywide outbreaks of yellow fever and smallpox later in the century.

The first health officers were called “quarantine physicians” and were tasked with the prevention of the spread of yellow fever further into Baltimore. During the same year, many French fleeing the Haitian Revolution were seeking refuge in Baltimore. Dr. John Ross was delegated the role of maritime quarantine and was responsible for stopping yellow fever from reaching beyond the port. Dr. John Worthington managed land quarantine and patrolled traffic on the roads between Baltimore and Philadelphia, a port city that was experiencing a massive yellow fever outbreak.

In 1794, a Committee of Health was established along with a quarantine hospital at Hawkins Point. On January 1, 1797, Baltimore officially became incorporated as a city and the public health department was placed in the control of nine health commissioners. The Board of Health (which in 1900 was named the “Department of Health”) was established as a branch of the city government and the Committee of Health came to be known as the “Commissioners of Health.”

The administration of the Health Department was founded on Ordinance No. 11 (April 7, 1797) and Ordinance No. 15 (April 11, 1797), which served as bases for all subsequent sanitary legislation. By the end of this year, the primary responsibilities of the health department were to keep contagious diseases out and to maintain cleanliness of the city and inspect meat and fish brought into Baltimore. Quarantines against yellow fever continued for many years and debate ensued over whether yellow fever was actually contagious. In 1797, Dr. John Davidge of Baltimore published for the first time a report claiming that it was not contagious, and his theory was reaffirmed by Dr. David Reese after the 1819 yellow fever epidemic. Quarantines against yellow fever were eventually dropped in the nineteenth century.

Records show that Baltimore City experienced major yellow fever outbreaks in 1794, 1797, 1798, 1799, 1800, 1808, and 1819. After the 1819 yellow fever epidemic, the Health Department issued the Ordinance of 1821, which required that the Board of Health fence in affected areas, guard the fenced district with sentinels, and display a yellow flag on homes of infected people in future cases of yellow fever outbreak.

Baltimore also faced numerous outbreaks of smallpox in the 18th and 19th centuries. Vaccination became mandatory in smallpox districts during the 1827 epidemic and physicians were required to report cases of smallpox in 1834.

In the 1800s, the internal organization of the Health Department underwent major changes. The number of health commissioners was reduced to five in 1801, four in 1803, and two in 1808; the title of quarantine physician was abolished during the same year. In 1820, a consulting physician was appointed as an advisor to the mayor about city health issues. By 1900, the Board of Health was abolished and there was only one commissioner of health who held sole responsibility for the health department.

The 20th century saw the expansion of the Health Department's internal organization and the establishment of public health administration as a branch of medical practice in Baltimore. Previously, public health had been administered through volunteer service of private physicians. In the early part of the century, the BCHD took aggressive measures against cases of communicable diseases including pulmonary tuberculosis and typhoid. In 1909, the Sydenham Hospital, located on the grounds of the Bay View Asylum, was inaugurated for patients with scarlet fever and diphtheria. The installation of water chlorination in 1911, a sewer system in 1915, and water filtration in 1915 through the Bureau of Sanitation eradicated typhoid from Baltimore City.

In 1908 and 1917, the BCHD published two milk ordinances that required the pasteurization of milk. In 1919, the Baltimore Bureau of Child Welfare was established, followed by the Bureau of Maternity Hygiene fifteen years later. The Bureau of Child Welfare developed educational programs for expectant mothers, foundling and orphan asylums, and advances in infant hygiene that led to reductions in infant mortality.

From 1853 to the 1930s, Health Department activities were largely conducted by a group of “health wardens”, qualified physicians assigned to one of the 24 political wards in the city. Throughout the 20th century, the Health Department collaborated heavily with the medical community to develop solutions to diseases and basic health needs of its citizens.

The beginning of the 20th century also saw the establishment of a Bureau of Health Education. The BCHD distributed public health literature, organized exhibits, started the Baltimore Health News in 1918, and inaugurated a radio program called Keeping Well in 1932.

During this century, Baltimore came to be divided into health districts, each with a staff of health officers and public health nurses. The Eastern Health District was established in 1932 and the boundaries of other districts, including the Druid and Northern districts, continued to evolve in subsequent decades.

During the epidemic of HIV/AIDS in the United States, Baltimore City Health Department official Robert Mehl persuaded the city's mayor to form a committee to address food problems; the Baltimore-based charity Moveable Feast grew out of this initiative in 1990. By 2010, the organization's region of service had expanded from merely Baltimore to include all of the Eastern Shore of Maryland.

Role in 2015 Baltimore protests

In April 2015, protests occurred in Baltimore, following the death of Freddie Gray. The civil unrest resulted in the mobilization of thousands of police and Maryland National Guard troops and the declaration of a state of emergency in Baltimore.

During the protests, the Baltimore City Health Department (BCHD) coordinated a response with hospitals, health care facilities, and community members. During the riots, BCHD provided updates for hospital emergency planners and led to the establishment of a citywide security plan for hospitals and healthcare facilities. Immediately following the violence, the Health Department mobilized an emergency shuttle, food pantry, and medical supply pantry at the Sandtown-Winchester Senior Center in the community where Freddie Gray lived. Staff members led twice-daily shuttle trips from West Baltimore to Walmart and Giant for residents whose local grocery stores and pharmacies were affected by looting.

After 13 pharmacies in the city closed due to looting and fire damage, BCHD partnered with the 3-1-1 hotline to provide residents with access to life-saving medications. Health Department staff provided prescription deliveries, transportation assistance, prescription transfers, door-to-door outreach, and disseminated information about open pharmacies in nearby areas. BCHD also developed the Baltimore Healthcare Access List and Pharmacies Operations List, which provided up-to-date information about closures and hours of health care providers and pharmacies.

During the unrest, BCHD announced its commitment to address the mental health needs of Baltimore’s residents. The implementation of the Baltimore Mental Health/Trauma Recovery Plan led to the creation of a 24/7 crisis response line, free group counseling, and healing circles led by licensed mental health professionals.

Today, the Health Department continues to work to provide trauma-informed care training to front-line city employees in order to improve the relationship between at-risk citizens and prevent traumatizing and re-traumatizing. Mayor Stephanie Rawlings-Blake and Health Commissioner Leana Wen have stated their commitment to training every front-line city worker to becoming fully trauma-informed. BCHD has also brought on board a team of Baltimore Corps Fellows whose priority is to engage the community, particularly the youth, to better address their health concerns. Additionally, BCHD hosts weekly B’More Health Talks, virtual town hall meetings led by Commissioner Dr. Leana Wen that unite community leaders in discussions about relevant public health issues. In late 2015, BCHD launched an ambitious overdose prevention program that involves standing orders for every resident in the city. This program was featured by President Barack Obama in a panel discussion with Commissioner Wen.

Programs

The Baltimore City Health Department administers many programs under each of its nine divisions and bureaus. Some programs are:

Organization

The Baltimore City Health Department is led by the Commissioner of Health, appointed by the Baltimore City Mayor. The Commissioner is assisted in managing the Department by the Chief of Staff, Deputy Chief of Staff, and deputy commissioners.

Under the Baltimore City Charter, 1996, the Health Department is the city's legally designated public health authority. Responsibilities include:

Internal structure

Health commissioners

Prior to 1845, the Health Department was under the leadership of more than one health commissioner at a given time. In 1845, the Health Department was reorganized with one sole commissioner of health. In 1900, the Board of Health was abolished and the health commissioner was granted full responsibility for the Health Department.

Bureaus and offices

The Baltimore City Health Department consists of nine operating divisions and bureaus. These include:

Social media

BCHD uses Facebook, Twitter, and Instagram to provide public health information and updates about ongoing programs and activities. It also publishes a blog featuring news about recent events and relevant issues within the Health Department.