June 4, 2024

 A note from UHC co-director, Dr. Usama Bilal

 
Over the last couple years, the UHC-housed Big Cities Health Inventory has been publishing data on how health outcomes compare between big US cities. In one of their briefs, they used simple descriptive statistics to show how Baltimore was an outlier among big cities in the rate of drug overdose deaths. While urban health has a wide toolkit of methods, both qualitative and quantitative, sometimes the most basic description can carry the most power in driving conversations.

This monitoring of the status of population health is actually the first of the 10 essential public health functions, and one we sometimes dismiss as it does not carry with it the allure of “fancy methods” or even “fancy data.” Now the Baltimore Banner, in collaboration with the New York Times, has produced a long piece on the root causes of this pattern. They point to disjointed efforts, include lack of resources in the local health department, which include resources for even monitoring the situation and being able to display trends for the public, along with declines in people receiving addiction treatment. They also mention the prohibition of supervised injection sites in Maryland.

UHC researchers have been conducting research on this topic for a number of years. Dr. Pricila Mullachery, former postdoctoral fellow and senior research scientist at the UHC, published a few descriptions of how drug overdose deaths and opioid pill sales scale with city size, and how disparities in overdose deaths changed with the pandemic. UHC affiliates Drs. Alexis Roth, Ayden Scheim, and Steven Lankenau have also published many articles outlining promising strategies for the prevention of drug-related deaths including, among others, the presence and acceptability of supervised injection sites, availability of medication-assisted treatment, and training in reversal of overdoses.

Supervised injection sites specifically have been in the spotlight in Philadelphia, as city council decided last year to ban them from most of the city, the city has decided to not use funds to promote safe drug use (with comments by Ayden Scheim), and new rehab facilities are being blocked (with comments by Alexis Roth).

This is not an exclusive US phenomenon at all. As you all know, the UHC also conducts research in Latin American cities, as part of the SALURBAL project. This last month, former UHC alumni and GATHER fellow Dr. Rosie Mae Henson published a paper in the American Journal of Public Health with the first description of how trends in drug overdoses changed in Mexican cities before and during the COVID-19 pandemic. She found a very large increase in drug overdose deaths over time, most intensely in 2020-2021. This increase was especially high in urban areas, especially in those urban areas that lay on the US-Mexico Border. Mexico has seen a number of discussions around the role of fentanyl in driving drug morbidity and mortality, and this article can help contribute evidence on where these changes may be especially salient.

In summary, "a basic tenet of epidemiology [and urban health] is that much can be learned from precise description of how health is distributed by person, place, and time." The examples from UHC work above show how a mere understanding of the distribution of health outcomes can drive conversations about solutions to address ill health.