Colleen Bridger, the City’s new Metro Health director, wants to make the healthy choice the easy choice for San Antonio residents, many of whom face common health issues but don’t have easy access to health care.
The City of San Antonio hired Bridger, 49, as its Metropolitan Health District director late last year, filling a position that has been covered in interim by Dr. Vincent Nathan, who served as assistant director since 2012.
Assuming her role as director in March, Bridger relocated to Texas from North Carolina, where she was head of the Orange County Health Department for five years. In 2014, the North Carolina Association of Health Directors named her health director of the year. She also ran health departments in the North Carolina counties of Stokes and Gaston.
North Carolina’s Orange County has a population of 135,000 and a public health budget of $7 million, a dramatic difference from San Antonio’s 1.4 million population, $44 million overall budget, and health department staff of 400. Seventy-four percent of Orange County’s population is white, while San Antonio has a far more diverse population, with 63% of its residents being of Hispanic descent.
In an interview with the Rivard Report, Bridger explained that “some of the similarities [between the populations] are obesity, diabetes, [and] chronic diseases, which were always at the forefront of the work [being done] at the health department.”
Bridger is Metro Health’s first permanent director since the dismissal of Dr. Thomas Schlenker, who was fired in late 2015 for what City Manager Sheryl Sculley described as “unprofessional treatment of women up and down the chain of command.” In a statement released by Sculley, she also cited “his lack of leadership, continued disregard for direction, and repeated instances of unprofessional conduct.”
Schlenker, on the other hand, said that it was his strong stance on sugar-sweetened beverages that led to his termination. He maintained his position against the influence of soft drink companies on public health policies, and believes that his attempt to organize an anti-sugary drink campaign in 2014 failed due to the City’s insistence that the soda industry be included at the campaign’s drawing board.
Bridger is the first director of Metro Health in recent memory who is not a medical doctor. In a 2015 city election, a City Charter amendment omitted the requirement that the health department director be a licensed physician, specifying only that the director be trained in public health administration.
Bridger believes the change in policy can have a positive impact on community public health, which has seen a gradual shift in focus away from direct medicine and more toward analyzing sociological factors that impact individuals and communities.
“We need somebody who is able to communicate that the vast majority of what keeps people healthy does not happen in the clinical setting,” Bridger said. “Someone who can really advocate on behalf of looking at the social determinants of health [is] going to have a bigger impact on social determinants of health than a physician who has been trained to look at the patient one patient at a time.”
Schlenker, who was Metro Health director for four years before his removal, told the Rivard Report that while “it’s not necessary to have a physician direct the health department, [it] changes the role of the director. Hopefully, the new department will have enough physician leadership there that things go well.”
Schlenker agrees that focusing on social determinants of health will benefit the city.
“San Antonio is one of the least healthy and most unequal cities here in the United States, and the way to address that disparity is by focusing on some of the more upstream determinants of health like dropout rates and teen birth rates,” he said.
Social determinants of health have been outlined as the main points of focus for the 2017-2019 Metro Health strategic plan. They include whether residents live in an area that is safely walkable, have access to fresh and healthy food choices, and are aware of health resources within their community.
Bridger wants to bring together people within the community in a way that makes them feel as though they are “part of a team working toward combating a specific issue.” This will help guide health advocacy organizations in filling gaps in services and best utilizing public and private resources.
San Antonio works formally toward this understanding through the Community Health Improvement Plan, which convenes individuals and organizations to discuss current efforts toward improving the well-being of San Antonio residents, with the intention of improving services.
“I think [we are] doing a good job of identifying what the priority areas are,” Bridger said. “And then I think different entities need to own each of those priority areas and then figure out what the implementation plan looks like.”
The science behind health is plentiful: Drinking sugar-sweetened beverages and not exercising have been widely proven as having detrimental impacts on overall health. A focus on social determinants of health may help educate people about adopting healthier habits.
Currently, vending machines in municipal buildings in San Antonio do not sell sugar-sweetened drinks, an example of how the city helps its employees make healthier choices.
In North Carolina, a state with deep ties to the cultivation and production of tobacco, Bridger helped pass an ordinance that banned smoking in public areas, including on public sidewalks. She credits the ordinance with reducing the number of emergency room visits due to cardiovascular illness and disease.
“I came here with a strong tobacco regulation background,” Bridger said. “Today I just walked from my office to the Marriott, and I don’t think I took a step where I was not breathing someone else’s cigarette smoke. That’s one thing where I believe that regulation could play a broader role.”
Bridger told the Rivard Report that the Orange County smoking ban prompted more investigation of issues related to why people smoke, including substance abuse and homelessness.
In settling into her new job, Bridger sees her role as ensuring that the health experts on her staff have access to the resources they need to do their jobs effectively.
“I consider myself to be a generalist who’s overseeing the work of specialists – some of them physicians – to make sure that people are getting what they need and that they have the resources they need to do that,” Bridger said.
Deputy City Manager Erik Walsh told the Rivard Report that “[Bridger’s] high-energy management style and collaborative attitude stood out to us” when making the decision to hire her. “We were looking for someone to lead and energize the community’s public health initiatives, and [Bridger] was a perfect fit,” he said.
Walsh noted Bridger’s past successes in partnering with health service providers to achieve community goals, as well as local and national awards as integral to the decision. “She is trilingual in English, Spanish, and French, and is a nationally recognized speaker, trainer, and innovations expert.”
Bridger was moved toward a career in public health after she studied abroad in France and stayed with a physician who worked for Doctors Without Borders in Africa – which she recalls as her first exposure to public health.
From there, Bridger began looking into public health as a career. “That’s when I started solidifying a kind of academic thinking about public health. My thesis for undergraduate degree was ‘The Economic Effect of AIDS in Uganda,’” she said.
Bridger’s very first job out of college was working at a migrant farmworker health clinic in Mexico, providing case management services to pregnant women. There she improved her Spanish and “saw a lot of what happens when you don’t have access to public health services.”
Raised by a single mother, Bridger spent her childhood on a farm and paid her own way through college, a background she said afforded her a considerable understanding of the challenges many people face in their daily lives.
“I think that I bring this really wide-reaching understanding and empathy for people and where they are coming from,” she said, “and can meet them where they are, and then figure out how to get together where we need to be – and that is healthier.”