Commentaries at the San Antonio Report provide space for our community to share perspectives and offer solutions to pressing local issues. The views expressed in this commentary belong to the author alone.
In San Antonio and South Texas, health equity and economic equity are closely linked. Healthy individuals are better positioned to maintain consistent work schedules, accrue experience and achieve upward mobility on the income scale. It also allows them to contribute to Social Security, Medicare and retirement accounts. Moreover, access to employer-sponsored health insurance is a critical aspect of our labor force productivity. In its absence workers and their families are compelled to find other sources or go without funded access to health care.
According to data from the Census Bureau 2023 estimates, South Bexar County is home to over 48,000 employed residents between the ages of 19-64 who remain uninsured in spite of their employment status. Additionally, another 24,500 uninsured South Bexar residents in this age range are unemployed or not in the workforce. While some uninsured residents are enrolled in University Health CareLink or federally qualified clinics like CentroMed and CommuniCare, many others lack access to health care funding, often due to unawareness of their eligibility for Affordable Care Act (ACA) enrollment.
This lack of access leads many to forgo necessary care, hoping that their ailments will resolve on their own. Unfortunately, such decisions frequently lead to serious health complications, including advanced diseases that require hospitalization or, in severe diabetic cases, limb amputation. The consequences can be dire, sometimes resulting in premature death.
An experienced health insurance navigator can be invaluable for uninsured individuals and families. Evidence shows that regular access to health care helps prevent severe complications, ultimately lowering costs for both patients and the community. Consider the case of Diana, a 67-year-old resident who, at age 60, developed foot ulcers requiring vascular intervention. Without insurance, she was unaware of her options until a licensed navigator helped her enroll in an appropriate ACA plan. This timely intervention allowed her to receive the necessary care, preventing a potential amputation. Today, Diana walks pain-free and continues to access preventive care for her chronic condition. Her story highlights the urgency of addressing health care access, particularly for the uninsured.
However, the challenge extends beyond insurance. The lack of health care facilities in underserved Southside areas perpetuates a vicious cycle, where limited access to early care leads to more advanced diseases, costly interventions and poorer health outcomes. Essential services like ambulatory surgery centers, wound care, and diagnostic testing remain largely inaccessible, preventing patients from fully recovering from surgeries or managing chronic conditions.
South Side needs more primary and specialty care providers
Primary care serves as the foundation of the health care ecosystem. When specialized care is needed, individuals rely on primary care providers for referrals. Unfortunately, the availability of primary and specialty care on the South Side is limited. This scarcity forces families into difficult choices.
For instance, a single working mom may lose a full day’s work to take her asthmatic child to a specialist on the North Side, balancing the needs of her other child and the difficulties in transferring from one bus to another. Geographic distribution maps in the South Bexar Report illustrate Southside health provider scarcity.
Mental health services sorely lacking on South Side
The lack of mental health services on the South Side compounds these issues. The community faces a significant deficit in mental health resources, with no dedicated facilities available. Mental health crises often manifest in behaviors linked to domestic violence, substance abuse and other issues, further stressing families already coping with economic hardships. Schools are stepping in to provide mental health counseling. Still, the lack of comprehensive services means many individuals, their families and the community endure preventable crises that professional intervention could mitigate. It seems that every evening TV news reports tragedies that stem from mental health illness.
According to The Center for Health Care Services, the local mental health authority, behavioral health problems are persistent and widespread in Bexar County, especially in lower-income communities. CHCS observed adult and child units were operating well above capacity prior to the COVID-19 pandemic. Since the spring of 2020, the adult mental health units have been operating at up to 120% of capacity, and the impacts of COVID-19 have not been equally distributed within Bexar County.
Citizens in the southeast and southwest quadrants have been challenged by minimal access to resources and had the highest uptick in requests for behavioral health appointments. More specifically, there was a notable 55% increase among Southwest Side residents and a 79% increase among Southeast Side residents for behavioral health services during the COVID-19 pandemic. Geographic distribution maps in the South Bexar Report depict the scarcity of psychiatrists and clinical psychologists on the South Side.
When a person in crisis cannot work, productivity declines and the consequences ripple through the community, resulting in both emotional and financial costs. Thus, expanding mental health services must be integral to any health equity strategy.
Despite these challenges, the potential for positive change is evident. Recent economic growth on the South Side presents an opportunity to address the documented health inequities faced by the community. A resounding community commitment is essential to narrowing the 20-year life expectancy gap experienced by Southside residents. This commitment is reflected in partnerships among major health care and educational institutions, as well as city council support for initiatives like the Center for Health Equity in South Texas (CHEST).
The interconnected issues of health and economic disparities necessitate a multifaceted approach. Addressing the lack of access to care, enhancing mental health resources and ensuring comprehensive support services are vital steps toward a healthier and more equitable future for all residents of San Antonio and South Texas. The commitment from community leaders and organizations to actively support and collaborate via the newly formed CHEST provides a promising foundation for meaningful progress in bridging these gaps.
