I am no longer the City’s Director of Metro Health and all indications are I might be the last trained physician to hold that post, but the focus shouldn’t be on me or what others are saying about me. The focus should be on San Antonio’s unacceptable public health profile and the urgent need to address it on all fronts.
We made so much progress in my short time at Metro Health – for which I credit my committed and competent team of public health care professionals. Yet San Antonio has a long, long way to go. We need to help change local dietary habits, physical activity levels and the social and environmental conditions that make San Antonio one of the least healthy cities in the US.
And, yes, that includes educating our population about the danger of heavy consumption of sugar-packed drinks. No amount of advertising or marketing or “philanthropy” by the sugary drink manufacturers can change that.
Four years ago in July 2011, while moving into the well-worn, but new to me, offices of the San Antonio Metropolitan Health District at 332 W. Commerce, my eye turned to a panoramic photograph of Pope John Paul II’s visit here in 1987. Now, having left that office, my thoughts I turn to Pope Francis I and his statement in the recent papal encyclical, Laudato Si.
“Economic and technological development, that does not leave the world a better place and with integrated superior quality of life, cannot be considered progress,” the document states. Let’s ask ourselves, as the local economy expands and the physical environment in which we live is transformed, will that be true progress?
Metro Health serves 1.8 million people who live in San Antonio and Bexar County, yet it focuses special attention on the inequities of health: teenage births, congenital syphilis, and the high rates of obesity and diabetes concentrated among people of color and the poor. This is the necessary role of local public health because these inequities are unjust, preventable and worse here than in most other U.S. cities. Necessary also because the persistence of these public health scourges undermines the health of everyone.
Truth be told, however, some of us benefit, in the short term, from the those who build our houses, keep our gardens and tend to us in hotels and restaurants for low wages plus meager or no benefits, and who ruin their health in the process. The long-term consequences are severe for the teen mom, high school dropout destined for a life of poverty, the baby born with congenital syphilis doomed to fail in school, and even the robust manual laborer working two jobs and bringing in enough money to support a family. That is the worker who most often loses a foot to diabetes by age 45 and dies of diabetic complications by age 50.
It’s not hard to see that the consequences are also severe for those of us more fortunate. We all share the social and economic costs that comes with 2,500 babies born to teenage moms in our city each year, 10-20 congenital syphilis babies, 200,000 adult diabetics, 400,000 pre-diabetics, and a diabetic amputation rate three times the national average.
Is this going to be the San Antonio in the future? Does it really need to be this way? Answer: Not if we care enough as a community to embrace real change. In fact, the solutions are all around us.
I have the pleasure of spending an hour every week with eight-year-olds at Hawthorne Elementary School, located in the shadow of that exploding center of urban renewal called the Pearl. Little Devean and Gabriela stick out in my mind. Two bright and eager second graders struggling to read, both of whom improved over the course of a year. Is it enough? Don’t they deserve more than one hour a week with an amateur teacher like myself? Pre-K 4 SA is a beautiful thing started by former Mayor Julián Castro that needs to be sustained and deepened to ensure that the next generation of Deveans and Gabrielas learn to read by third grade, so they can read-to-learn for every grade thereafter.
Early childhood education is one of the most important public health interventions available. It’s one that increases the likelihood of success to and through high school. The most common reason for girls to drop out of high school is pregnancy. The recommended public health approach is science-based sex education offered to all, plus access to safe and effective contraception for those that are sexually active. Metro Health has led the local effort to bring down teen births and abortions and has been remarkably successful of late. San Antonio is the first community in the country to use funding from Medicaid, which pays for most teenage births, for prevention of those births by offering, at no charge, long-acting-reversal-contraception (LARK) to teens at risk. LARKs are the safest and most effective type of contraception for teens because they require no extra attention after insertion and last for 3-5 years. And Medicaid, a $400 billion per year enterprise, ends up saving money.
When I moved to San Antonio from Wisconsin, where there is less than one congenital syphilis case annually in the entire state, I was shocked to see 10 or more infected babies born in this city every year. It’s been difficult, but by gaining the trust and support of the local medical community, moving and upgrading in every way the Metro Health STD clinic, creating innovative programs that reach out into the community to those most at risk, and by passing statewide legislation requiring third trimester syphilis testing for all pregnant women, we have begun to reverse the trend. I credit a wonderfully talented and dedicated Metro Health staff.
And finally, let’s talk about San Antonio’s most widespread and serious public health problem. I call it “diabesity” and compare it to a giant iceberg that is crushing us. It fills our hospital beds, decimates our work force, and destroys individuals and the families that care for the afflicted as they slowly decline into blindness, kidney failure and amputations of toes, feet and legs. Although care of diabetics needs much improvement, the only way this enormous weight on our collective shoulders will ever be lightened is through prevention.
Metro Health is taking two approaches that together have a real chance of bending the curve. The first is a neighborhood health strategy that embeds health organizers at the grass-roots level to catalyze residents to organize themselves for health and safety. You can see evidence of their work in early morning walkers circling San Pedro Park, community gardens sprouting in Denver Heights, Zumba classes in front of the Alamo, junior chefs being trained on Guadalupe Street and Metro Health violence interrupters out and about evenings and weekends on the streets of San Antonio’s most dangerous neighborhoods. And I have a special love for the bicycling clubs that pedal the city, especially the fine folks at Earn-A-Bike and Dante’s Role Models.
The second strategy to combat “diabesity” is just a few months old. It is called the Diabetes Collaborative and acknowledges the fact that the reason we have such a problem is not for lack of resources. San Antonio has an abundance of fine medical systems and many excellent programs directly targeting diabetes that are winning many daily battles. But while we are winning battles, we are losing the war.
We know this because diabetes rates have approximately doubled since 1980 and each year they continue to increase. Currently, 18% of adults living in Bexar County have diabetes. The solution, we believe, is that we all need to work together for years into the future to achieve “collective impact” on a single goal. Common measures will keep us on the right path and a solid backbone organization will ensure the effort is sustained. Metro Health has been the backbone organization to this point and it must continue to play that important role.
I am no longer at its helm, but for the sake of true progress, as understood by Pope Francis and many others, Metro Health and the Diabetes Collaborative must continue.
For myself and my wife Carolina, a physician of the UT Department of Family and Community Medicine, who runs a ground breaking community health program of promotores that she has hired, trained and supervises on a daily basis, we hope to remain in San Antonio. I hope to continue working on public health issues that are essential to true progress for our community. I am buoyed by many accumulated colleagues and friends, and the spirit of San Antonio de Bexar that has survived and reinvented itself, over and over again, for 300 years.
*Featured/top image: The Metropolitan Health District in the historic Continental Hotel at 322 W. Commerce St. Photo by Scott Ball.