Before it was an economic crisis, or a housing crisis, or an education crisis, the pandemic was and remains a health crisis, one that served to highlight San Antonio’s deep-rooted economic and health inequities.
This Thursday, my City Council colleagues and I are poised to vote on the City’s $380 million Community Recovery & Resiliency Plan. Primarily funded by the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act, the plan is the product of tireless work from City Manager Erik Walsh and his team. In its current state, the plan does well to put San Antonio on a path not only to recover but also to transform itself.
Yet there remains a noticeable absence in the plan: direct investment in health improvements.
The proposal directs $54.5 million to short-term health and emergency efforts directly related to COVID-19, such as testing and tracing; $20.7 million to the City’s personal protective supplies and equipment; $50 million for housing security; $33 million to micro business support; and $80 million and $27 million to workforce development and digital inclusion, respectively.
Half a million dollars are slated for door-to-door outreach in some of the City’s most underserved neighborhoods. While not explicitly stated in the document, staff intends to connect residents to health insurance and other wraparound services. This is a good start.
But for the thousands of residents that do not qualify for Medicaid or a federal insurance subsidy (“premium tax credits”) on the Affordable Care Act’s insurance marketplace, there is little to celebrate. According to SA2020’s 2019 Impact Report, 15 percent of Hispanic community members under the age of 65 in Bexar County do not have health insurance, while the black community fares worse, with more than 20 percent uninsured.
Why is this important? As of Monday in Bexar County, African Americans have the highest fatality rate from COVID-19: 7 percent compared to 2.8 percent among whites. It’s a disparity with an explanation far more complex than the generic “underlying health conditions.”
Five years ago, I received my master’s degree in public health in a program called Exposure, Epidemiology, and Risk. One of the first things I learned was that health depends on far more than one’s doctor or clinic. Social determinants of health – such as transportation, access to healthy food, job opportunities, and education – act together to play a much larger role in determining one’s health condition and life expectancy.
Unfortunately, many of these determinants align with geography and race. Recent reports by the Bexar County Health Collaborative and the University of Texas indicate that residents in Bexar County’s poorest zip codes live decades less than residents in its wealthiest zip codes.
Longstanding racial and geographic inequities in areas like job access, community investment, and education, caused by historical injustices such as generational disinvestment and redlining, set the groundwork for the underlying health conditions we see today.
These longstanding inequities do not have to be our collective destiny. The City’s Recovery and Resiliency Plan’s investments in workforce development, child care, and small-business support have the potential to chip away at generational inequities in social determinants of health.
But we will need additional ambitious initiatives to improve public health, such as better access to physical and mental health care, access to healthy foods, and safe jobs.
Fortunately, part of this road map is already laid out. In its April report, the COVID-19 Health Transition Team, convened by Mayor Ron Nirenberg and Judge Nelson Wolff, recommended long-term measures for improving our local public health system and improving pandemic preparedness. These included funding improved health data collection and disease data systems, ensuring that the public health system is engaged daily in eliminating health disparities, and full documentation of successes and lessons learned from the current pandemic. It also recommended actions for an equitable recovery. It was the first, and perhaps only, transition report to call on local government to center racial and economic equity in its recovery.
And in a recent joint meeting of the City Council and County Commissioners Court, Wolff recognized the public health challenge we face and expressed a willingness to address it. I look forward to having the City and County chart a long-term path to further improve the health of Bexar County residents.
Some may see an investment in health as a challenge to our economic interests, but make no mistake: a healthy economy demands a healthy community. As noted by the National Association of Chronic Disease Directors, a community’s collective health bears both an economic and human cost. Poor community health escalates health care costs, decreases employment rates, and hurts productivity. By supporting improvements in public health, we support our local economy.
In fewer than six months, COVID-19 has brought the world to its knees. While it has magnified our weaknesses, it has also given us an opportunity. An opportunity to reprioritize our values and invest in programs that will yield long-term public health benefits and ensure that everyone, regardless of race or location, has the same chance to thrive and succeed. We may not have another chance like this in our lifetime, so let’s write the first chapter of our recovery story with an arc towards health equity.