Local health leaders came together for the first in a four-part series of meetings with the Bexar County Health Collaborative, a nonprofit working with the San Antonio Metropolitan Health District, to create the 2017 Community Health Improvement Plan (CHIP).

CHIP is the Health Collaborative’s community-wide action plan focusing on improving the health and well-being of Bexar County residents in five areas: healthy eating and active living, healthy child and family development, safe communities, behavioral and mental well-being, and sexual health.

Much of the discussion at Wednesday’s initial meeting focused on health disparities between north and south San Antonio residents. Bexar County residents south of Hildebrand Avenue on a City Council district map have a 15-20% lower life expectancy than those who lives north of that line. Changing that statistic is what the Health Collaborative is exploring.

“For wellness, you should not only look at [medical] treatment, which is only [contributing to] 20%, but the entire picture,” said Dr. Anil Mangla, director of public health and research at the University of the Incarnate Word School of Osteopathic Medicine.

Director of Health Collaborative Dr. Anil Mangla.
Director of Health Collaborative Dr. Anil Mangla. Credit: Scott Ball / San Antonio Report

That larger picture includes health behaviors, socioeconomic status, environment, and education level. Mangla cited statistics indicating which City Council districts are disproportionately experiencing health issues.

The meeting took place at the new school, located at Brooks City Base and a fitting illustration of efforts to improve health outcomes in South San Antonio. The university will be receiving its first students in July, and will function as a community-based medical school, Mangla said.

Mangla pointed out that the medical school is located in City Council District 3, which currently has the city’s most high-risk population for health complications. Mangla explained that the school would work to address the challenges some patients experience maintaining their health because of barriers to accessing health care.

Students will be assigned families to work with for two years, Mangla said, calling the arrangement a “very different” educational model that will help the medical students better understand how social determinants of health affect entire communities.

These social determinants of health are what Dr. Robert Ferrer, chairman of the board of directors for the Health Collaborative, elaborated on as he explained how the conditions of a person’s everyday life shape affect health.

“We construct our own environments, and they lead to either more or less opportunities to be healthy,” Ferrer said.

Dr. Robert Ferrer?
Chairman of the Board of Health Collaborative Dr. Robert Ferrer. Credit: Scott Ball / San Antonio Report

Ferrer said almost every disease is 100% genetic and 100% environment, and that “if we work to have greater control over the built environment, we gain more control over how genetics may negatively impact an individual.”

Speaking to the importance of eliminating man-made barriers to health and wellness, he presented a real estate map of San Antonio in 1935; the red zones indicated those locations where agents were unwilling to offer financial assistance, believing that a home loan was less likely to be paid back based on the demographic makeup of a specific district. Pulling up a map of 2016 San Antonio, and overlapping them, Ferrer showed that the districts with the most health disparity are along those same red lines drawn four generations ago.

City planners, politicians, social workers, doctors, dieticians, counselors, teachers, business owners, real estate agents – all are integral in the conversations about community health – and these were all voices present at this first collaborative meeting.

In an interview with the Rivard Report, Elizabeth Lutz, executive director of the Health Collaborative, explained that the biggest asset of the collaborative workgroup meetings is the ability to get agencies together to share ideas and contribute to problem-solving from their area of expertise.

She pointed to the barriers that residents in some parts of the city have to overcome. For example, if a person is written a prescription, that person needs a healthcare provider, transportation, money, and somewhere to store the medication. In Lutz’s words, “You may not be the person who can come in and make a [walkable] sidewalk, but you can look around in this room and find someone who may be able to help you do it.”

For now, the 2017 CHIP is a working document. At the collaborative meetings stakeholders are divided into groups based on priority areas and their area of expertise. They will work together to create a results-based plan to promote and improve community health and wellness within their focus area.

Participating organizations include Region 20, the Witte Museum, the San Antonio Housing Authority, the Mayor’s Fitness Council, independent family physicians, dieticians, the American Diabetes Association, and the YMCA of Greater San Antonio.

Individuals wanting to join the meetings can sign up on the Health Collaborative’s website to receive information about participation. There are three sessions remaining, taking place April 19, May 24, and June 28, with the final plan set to be released this summer.

Roseanna Garza reports on health and bioscience for the San Antonio Report.