The results from the County’s latest Community Health Needs Assessment, which will be officially released in full detail by the Bexar County Health Collaborative Tuesday morning, show a jarring trend that’s pervasive across the country – health outcomes continue to be worse for those in low-income communities, especially Hispanics and other minorities.

For Bexar County, where the Hispanic population is nearing 60% and is expected to continue growing, this reality hits especially hard.

Among the most troubling and prevalent issues detailed in the report regarding these groups are high diabetes and obesity rates that are likely to continue growing if not addressed, Health Collaborative Board Chair Dr. Robert Ferrer told the Rivard Report Monday. Similarly, there has been no progress in terms of fruit and vegetable consumption and physical activity.

The report also shows key comparisons of life expectancy rates between low-income communities and more affluent ones by zip code – those in more at-risk areas have a much lower life expectancy, sometimes by nearly 20 years, than those on the opposite end of the spectrum, Ferrer said.

To view or download the report’s executive summary, click here.

“There’s a big difference in life expectancy and it cuts across a lot of different (factors), it’s not one or two things accounting for the differences,” he said, adding that there are more than 10 causes of death accounting for those disparities, including heart disease, diabetes, homicides, suicides, and vehicle accidents.

“They’re just all much more common with less affluent people,” he said.

Additionally, the report notes that income inequality and segregation in the county are getting worse, and that poverty and limited access to quality education remain constant, all of which contribute to poor health outcomes in Hispanic communities more than restricted access to medical care. Adverse childhood experiences and a child’s exposure to the juvenile justice system are two other main influencers.

“…The greater share of disparities in health and life expectancy for different populations can be traced not so much to differences in access to and use of medical care, but to stark differences in the social, economic, and environmental conditions in which people are born, grow up and grow old, work and play,” the report’s executive summary states.

Social Inequalities & Health framework from the 2016 Community Health Needs Assessment.

Analyzing social and economic situations throughout the county is an integral part of the Community Health Needs Assessment, which is conducted every three years in order to give health professionals and Bexar County residents a glimpse into the overall health status of the community and the various factors that affect it. It’s part of a two-pronged effort and acts as the foundation for the Community Health Improvement Plan, where the collaborative works with various stakeholder groups to develop goals and strategies to address the priority areas identified in the assessment.

This year’s five focus areas are:

Healthy Eating and Active Living

Healthy Child and Family Development

Safe Communities

Behavioral and Mental Well-Being

Sexual Health

This time around, the Health Collaborative – which is made up of citizens, community organizations, and businesses – has identified developing ways to fund more preventative measures for diseases, such as diabetes or heart disease, and other health conditions throughout the county as a key priority for the Community Health Improvement Plan

That work will include looking at the main drivers of those high rates of disease, Ferrer said, which involves a variety of factors.

For many people, “their built environment seems to be a problem,” Ferrer said, including “(limited to no) access to healthy modes of transportation, access to safe places to walk in or to have some easy, accessible physical activity.” Improving these realities for a large portion of the population will take community-wide efforts.

The assessment also shows areas where the county has moved the health needle in a positive way. The report shows a steady decline in certain sexually transmitted diseases, such as syphilis, chlamydia, and gonorrhea, for example, which Ferrer attributes to strong initiatives from local health communities. There also was a decline in whooping cough, though the rate of incidence remains higher than in 2010.

“(Metropolitan Health District) took (syphilis) on as a priority to make sure we’re treating it better and make sure we were doing everything that we could to treat congenital syphilis,” Ferrer said. “Metro Health has worked very hard to identify and make sure everyone is tested and has access to treatment.”

Additionally, researchers noted that the overall teen birthrate continues to drop. Birthrates among Hispanic and black or African-American girls were identified as the main contributors to the decline. Ferrer said that the increased availability of implantable contraceptives has helped steer that trend in a more favorable direction. Once implanted, the contraceptive protects a woman for a long period of time, serving as an easier and more reliable source of birth control versus taking a pill everyday, Ferrer added.

Vaccines. Photo by Carlos Reusser Monsalvez via Flickr.

The pre-term birth rate and rate of low birth weight babies has also gone down in recent years.

Moving forward, the Health Collaborative identified issues with technical fixes, such as policy or straight-forward practices, including vaccination against communicable disease, trauma-informed care, and policy to create healthy food environments.

They’ve also pinpointed issues that require more complex, long-term solutions, including mental illness and substance abuse, physical inactivity, unhealthy eating and food insecurity, interpersonal violence, senior well-being, and premature death among low-income people and people of color.

Each time the Health Collaborative conducts the Community Health Needs Assessment, “we try to make connections by looking at where disease comes from … we try to make a logical pathway from people’s social conditions, like poverty and education, to their behaviors” like eating healthy and being more physically active, Ferrer said.

“The diseases don’t happen in a vacuum. There are these big disparities, so we have to think about what the social factors generating these results (are).”

Along with the full health assessment, the Bexar County Health Collaborative will unveil an online portal this fall with the results, graphs, and other useful tools for all county residents to view.

Top image: A group enjoys assorted foods in front of a fried food stand. Photo by Scott Ball.

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