To tackle these gaps, health officials say, the county and state need to ramp up the money invested in needy households amid more affluent communities and tailor health programs to target the most affected minority groups.
Montgomery, Maryland’s most populous jurisdiction, recently released its first report on health inequities, tracking disparities in health indicators among racial groups from 2008 to 2017. Some gaps, such as the rate of deaths by diabetes for black and white residents, have narrowed. But other key indicators — including infant mortality, heart diseases and several infectious diseases — increasingly affect poor and minority residents more than their affluent neighbors.
Black infants in the county were more than twice as likely to die as white infants from 2016 to 2017, the most recent data available, according to the report. Their mortality rate — about 8 deaths per 1,000 live births — was better than the national rate among black infants, but worse than overall national, state and county averages.
“When your overall numbers are strong, you mask and hide pockets of need,” said county health officer Travis Gayles, who has championed equity initiatives since moving to Montgomery from the District two years ago. “The gap between black infants and everyone else — it’s significant, and it’s growing.”
Like other metropolitan suburbs, Montgomery has changed in the past few decades, from a predominantly white jurisdiction into a diverse, majority-minority community of 1 million residents — about one-third of whom are foreign born.
Some disparities, such as the uptick in incidence of tuberculosis and HIV in blacks and Latinos, could be explained by the arrival of residents from countries where these infectious diseases are more rampant, said Raymond Crowel, director of the county’s Department of Health and Human Services.
But, Gayles said, Montgomery’s strong overall numbers have disqualified the county from various state and federal grants and have disguised the need to address problems in specific neighborhoods and communities. “We’re not seen as high-risk, high-need . . . [but] we’re trying to use the data to tell a different story.”
Rebecca Smith, who in 2018 became the county’s first full-time maternal and infant health coordinator, said Montgomery is “a different county than we were 25 years ago,” in part because the number of people living below the poverty line has surged from about 45,000 to 73,000.
“We’re way more diverse, and we have a much, much larger low-income population,” Smith said.
In 2009, Maryland introduced the statewide Babies Born Healthy program to assist jurisdictions “with the highest numbers and highest rates of infant deaths.” In its early years, the $200,000 annual grant went to Baltimore City and Baltimore, Charles, Prince George’s and Wicomico counties.
Montgomery has 200,000 black residents — significantly more than Charles and Wicomico counties — but was initially deemed ineligible because of its low overall rate of infant mortality.
In 2018, however, Montgomery health officials broke down the overall numbers by race and geographic distribution, identifying seven Zip codes in which predominantly black and Latino communities showed rates of infant mortality above the state average of 6.5 per 1,000 births, Gayles said.
The Maryland Department of Health, which has restructured this grant to focus on health equity, awarded Montgomery funding. It has been channeled into a home-visiting program targeting black mothers in northern Silver Spring, said Smith, who oversees the program. For more than a year, a full-time nurse and several volunteers have gone door to door, trying to ensure that mothers have access to basic necessities, such as cribs, and knowledge of prenatal care.
The funding also allows the department to provide special programming to about 60 clients. This has included sessions with lactation consultants, a therapist-mediated discussion on postpartum depression and a “Breastfeeding Night” with the global nonprofit La Leche League.
“Within our population, we do feel we’re having a positive effect,” Smith said.
But there is greater need that has not been met, she added.
The Babies Born Healthy program operates in only three of the seven Zip codes identified by the county as high need. It is supplemented by an older, county-funded program called SMILE that is housed under the African American Health Program and has seen boosts in annual funding from $240,000 to $330,000 over the last three years.
Gayles said he hopes to see greater increases, especially in light of Montgomery’s sweeping legislation that mandates equity considerations in policymaking.
In an interview Wednesday, County Executive Marc Elrich (D) said he plans to significantly expand funding for minority health initiatives in the budget that he will propose this spring.
“That’s the whole point of doing this kind of [equity] research,” Elrich said. “You get to see exactly where the problems are.”
Gayles is also lobbying state and U.S. agencies to reconsider Montgomery’s eligibility for programs targeting infant mortality, such as the federal Maternal, Infant, and Early Childhood Home Visiting Program, which awards $400 million per year.
Smith and Gayles hope to convince state officials to include Montgomery among the counties receiving funds in 2021.
“Most rich counties have just rich people, but here in Montgomery County, we’ve got it all,” Smith said. “Our pockets of need — they’re deep.”