Maryland’s Health Enterprise Zones: A Policy Model?

The California Endowment notes on their website that a person’s zip code determines their life expectancy. In Baltimore, studies show a 20-year gap in life expectancy between upper-income, predominantly white neighborhoods and poorer, predominantly minority neighborhoods. In thinking about ways in which to confront these pernicious facts, the General Assembly of Maryland in April of this year, passed a piece of legislation that flew under the radar next to Doomsday budgets, tax increases, marriage equality and casinos. This piece of legislation, known as Health Enterprise Zones (HEZ), aim to improve healthcare in minority communities and reduce health disparities in the state of Maryland. Essentially, the pilot program would offer tax breaks and other incentives to local health departments in the state, as well as, to community groups for their program operation in underserved and neglected areas labeled as HEZs. The General Assembly has set aside $4 million for physicians and community health providers dedicated to improving access and affordability to health services in these HEZs.

The genesis of these zones is the result of a work group chaired by University of Maryland School of Medicine Dean Dr. E. Albert Reece. Lt. Governor Anthony Brown and other state officials were looking for ways to address the disparities in the state that cost Medicare an extra $26 million annually, according to a 2006 report. This report notes that black residents in Maryland are nearly twice as likely to be hospitalized for asthma, hypertension, and heart failure. The infant mortality rate amongst African American babies is practically three times more than for white babies in Maryland.

While Maryland boasts some of the best teaching hospitals and the nation’s highest median household income, it ranks 33rd in geographic health disparities and receives equally poor marks for infant mortality, infectious diseases and health outcomes, according to data from the Maryland Health Quality and Cost Council.

A long-lasting solution to those problems will have to not only bring more health services to the under-served communities, but set up a framework to entice the providers of those services to stick around. HEZs are designed for just this purpose in that the Department of Health and Mental Hygiene in Maryland will set the boundaries of enterprise zones — areas where residents lack access to health care either because of proximity, cost or both — and accept applications from private physicians, community health organizations and local health departments that promise to dedicate their resources to serving the area.

Lt. Gov. Brown reflects on the legislation by saying, “Every Marylander, of every race, ethnicity, and nationality, in every part of our state, should have the chance to live a healthy, productive life. With our Health Enterprise Zone program, we will be able to saturate underserved communities with primary care and other health services to help reduce rates of chronic and often preventable illnesses, such as hypertension, asthma, diabetes and other controllable medical conditions.”

In thinking about the potential impact of HEZs, Maryland’s efforts are laudable in attempting to wrestle with and activate health policy interventions in a placed-based way. Research, including that of the Center for the Study of Social Policy, finds that families do better when they live in strong and supportive communities. In short, place matters, and that is especially true when it comes to individual, family, and community health and well-being. HEZ’s is a placed-based intervention that attempts to get at the crux of eliminating health disparities in Maryland, and thus, should be considered in other states and municipalities where health disparities are pervasive. Further, HEZ’s may ameliorate a number of child health issues addressed through the PolicyforResults Initiative, including combating childhood obesity and improving children’s social, emotional, and behavioral health outcomes.