Neighborhood Nursing is a new program in Baltimore that meets people where they are and offers free health checks. Its teams of nurses and community health workers are making weekly visits to the lobbies of three apartment buildings in Johnston Square, a predominantly Black neighborhood disadvantaged by decades of discriminatory housing policies. 

By next year, the team aims to visit more than 4,000 people in the Baltimore metropolitan area at least once a year, meeting them in their homes, seniors centers, libraries or even laundromats. The project is a collaboration with the Coppin State, Morgan State and University of Maryland nursing schools. 

“We’re trying to turn primary care on its head and deliver it in a completely different way,” says project leader Sarah Szanton, dean of the Johns Hopkins School of Nursing. It is for everybody — sick or healthy, rich or poor, young or old, and no matter if they have private insurance, Medicare, Medicaid, or no insurance at all. While 94% of residents in Baltimore are insured there are still startling health disparities, the project says. 

The project is still in its pilot phase, building trust and gathering feedback from the community. By 2025, staff members hope to expand their services to four neighborhoods — two within Baltimore, one suburban and one more rural.

So far, evidence is only anecdotal, but the team is already seeing a difference in the level of trust from community members. “The first couple weeks we showed up, it was like, ‘Who are they?’” said community health worker Terry Lindsay. “Now people are opening up the doors to their homes, saying, ‘Come on in and sit down.’”

The goal is to improve the health of individuals, says Szanton, and empower communities to create happier, healthier places to live.

“I think of what we’re building as like pipes in a water system,” Szanton said, “Where there’s a resource that’s flowing to every household and that connects them to each other.”

It is modeled after a program first tried in Costa Rica about 30 years ago, when that country was grappling with the same core problem that the US is experiencing today: Patients struggle to access preventive primary care, especially in poor and rural areas. Hospitals are overflowing and basic needs from hunger to high blood pressure are spiraling into bigger, costlier problems.

America only puts about 5 cents out of every dollar spent on health care toward primary care — and spends less than peer nations on social supports like food and housing.

Costa Rica’s approach is very different, says Asaf Bitton, a primary care doctor who has studied its model and directs Ariadne Labs, a health innovation center at Harvard School of Public Health. It pioneered a nationwide version of Neighborhood Nursing, while spending less than 10% of what the US spends per person on care. 

Teams of health workers visit residents’ homes at least once a year, whether the patients live in cities, on banana farms or in remote villages reachable only by boat. Deaths from communicable diseases like tuberculosis and hepatitis have fallen by 94%. Disparities in access to health care have improved too — as have outcomes for chronic conditions like diabetes and heart disease. 

Costa Rica’s per-capita income is a sixth that of the US—and per-capita health-care costs a fraction of the US—but life expectancy there is approaching 81 years. In the US, life expectancy peaked at just under seventy-nine years, in 2014, and has declined since.

Costa Rica has reduced premature mortality at all income levels, but the largest declines have been at the lower end, says Atul Gawande in the New Yorker article. In fact, by 2012 Costa Rica had largely eliminated disparities in infant mortality based on how much money families have or where they live. (In the U.S., babies born in high-poverty counties are almost twice as likely to die in their first year of life as those born in low-poverty counties—and it’s a similar story for those born in rural instead of suburban areas.)

Sources:

Neighborhood Nursing. John Hopkins School of Nursing

A New Kind of Primary Care Comes to America. Tradeoffs, June 6 2024

Costa Ricans live longer than we do. What’s the secret? New Yorker, Aug 30 2021

Cover image; Ariadne Labs