Meet Philadelphia's unsung activist top doc

Posted: February 09, 2011

A few months ago, after hearing unrelated presentations about youth smoking (level: high) and safe sex among teenagers (low), the Philadelphia commissioner of public health had an idea: Perhaps condom machines should be placed at retailers where youths buy cigarettes.

It hasn't happened (yet); the focus now is on reducing illegal tobacco sales. But the remark at a Board of Health meeting in November reflects an approach - driven by science, connected to the community, and focused relentlessly on the nuts and bolts of big issues - that observers say makes Donald F. Schwarz the city's most effective top doc in memory.

Even his highest-profile loss, last year's ill-fated soda tax, lives on in other ways. Do you know what your kids are drinking? asks a television ad that is now part of a wide-ranging campaign on smoking and obesity.

"With something as controversial and new as the soda tax, you never win the first round," said Kelly D. Brownell, director of Yale University's Rudd Center for Food Policy and Obesity, who calls Schwarz a "public health hero" - and notes that cigarette taxes, widely credited for reducing smoking rates nationwide, were just as contentious decades ago.

Talk to medical people around town, and each will point to something else, often beyond the power of the city Health Department, that Schwarz has had a hand in.

Hospitals are "adopting" primary-care city health clinics to make it easier for patients to get specialized services. City recreation centers are serving dinner to children who may not get fed at home. Special vouchers for poor women - redeemable only at farmer's markets, and only for fruits and vegetables - were created last summer and bought $1.3 million of fresh produce.

"He has focused on areas that impact the largest number of Philadelphians," said Marla Gold, dean of Drexel University's School of Public Health and a longtime member of the city Board of Health, by working "to make healthy options the default behavior."

In other words, create an environment, such as the introduction of treated drinking water in the last century, that invisibly encourages people to make healthy decisions.

A more-recent example: City Council's approval of a Schwarz-backed bill to raise fines for selling tobacco to minors, making it less likely teens will be exposed. Gold said that is a more effective way to reduce teen smoking than cessation programs.

"If there was one negative," Gold said, it would be that Schwarz makes little effort to make himself known.

Indeed, he has not publicized an American Medical Association award for outstanding public service that he will receive Wednesday night at a gala in Washington.

As deputy mayor for health and opportunity, Schwarz, 54, oversees behavioral health, child welfare, and transitional housing, besides the Health Department, responsible for $2.7 billion in mostly predetermined funding.

Shortly after he arrived from Children's Hospital of Philadelphia in 2008, a grand-jury report described a failed child-welfare system that let 14-year-old Danieal Kelly starve to death in her bed. In both its grisly detail and Schwarz's peripheral involvement, the case is reminiscent of last month's criminal charges against abortion doctor Kermit Gosnell.

Schwarz said his staff was working on several changes to ensure that cases like Gosnell's, which fall mainly under the state's jurisdiction, are spotted and pursued by the city.

In the 2008 case, Schwarz said he asked Department of Human Services officials how many other children had died on their watch - and, when they could not answer, spent weeks at his desk comparing lists of DHS names against lists from the Medical Examiner's Office.

That led to greater centralization of death reviews - and, among other things, the surprising discovery that 19 homeless people had died in January 2009. Based on patterns in those cases, the city changed its outreach and cut the number of homeless deaths to 11 in January 2010; Schwarz hopes that last month's tally, still incomplete, will be lower.

This is what people mean when they say Schwarz is driven by science, or "data."

Dentistry, for example.

"The infection in your mouth affects the likelihood you are going to have a premature baby," Schwarz said. Dental health relates to childhood health, which affects intellectual development, literacy - the whole package.

So he's working to ensure that every youth entering the child welfare system gets a dental screening.

Gary D. Foster, director of Temple University's Center for Obesity Research, called Schwarz's work in his field "unheard of and unprecedented."

"And then I heard about stuff he is doing with homelessness, and I had no idea."


Contact staff writer Don Sapatkin at 215-854-2617 or dsapatkin@phillynews.com.

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