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.
Did you know that where we live, how we move around, our education, the air we breathe and the food we can access play a large part in our health? These factors are often called the nonmedical social determinants of health, or the community foundations of health.
The U.S. Department of Health and Human Services defines the social determinants of health as the “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” They encapsulate the conditions in our communities that are often overlooked yet are essential for people to thrive — and impact substantially the health and well-being and lives of our families and neighbors for generations.
It is sometimes too late to overcome adverse nonmedical life difficulties, even with available health care resources. A low-income, multigenerational working family in a flood-prone neighborhood with poor streets, no sidewalks and few trees in a poorly insulated house with circulating fans in summer and space heaters in winter is likely to experience frequent nagging illnesses and compromised immune systems. This very scenario allowed the COVID-19 pandemic to impact Southside families disproportionately.
Life in a community with little access to health-enhancing vital resources requires more than traditional health care services. We need to broaden how we define “health care,” but it requires a shift in thinking and action. Reimagining health begins with deconstructing what health care should look like. It is not only about direct medical care but also about addressing the upstream causes of health and well-being.
Consequently, for example, Methodist Healthcare Ministries (MHM) embraces a commitment to health equity and a focus on social determinants of health and wellness for today and future generations so that everyone can reach their full potential for health and life. Similarly, the new collaborative UT School of Public Health, San Antonio centers people and communities in its education, research and service missions, reflected in its mission to be the People’s School. The new UT School of Public Health, San Antonio is recruiting and enrolling students locally, educating them with local data and providing experiential learning in the local communities, leveraging its vital strategic alliances with MetroHealth and the County Health Department.
We must recognize the multiple ways we can support health and well-being and revitalize our local communities, especially through collaboration across industries and sectors. Our collective work in the health care sector in San Antonio has been focused primarily on accessibility and affordability. We now recognize that we do not just want people to “stabilize” or “survive;” we want them to thrive. We can deepen our local impact by collaborating with diverse partners and addressing the multisectoral determinants of health through direct care, policy efforts and grassroots community-driven initiatives.
A collaborative partnership model leverages constructive interaction among local institutions across multiple sectors to address what cannot be addressed by any one sector working alone. It will prioritize early detection and preventive care, thereby mitigating long-term costs associated with advanced illness. It will also focus on longer-term community priorities through community partnerships, collaborations with community-based organizations and community-led interventions that address social determinants across San Antonio, such as food security, education and economic opportunities, digital connectivity, neighborhood safety, clean environment and resilient affordable housing.
For example, 1 in 6 people in San Antonio and the surrounding communities are food insecure. Children, military families and communities of color make up 25% of the population experiencing food insecurity. Food-insecure populations experience higher rates of mental health challenges and several chronic diseases. According to RTI Health Solutions, food-insecure families spend $2,500 more a year on health care costs. The lack of access to affordable, healthy food can make it that much harder for an entire community to improve their health.
Zip code 78211 exemplifies how these challenges are magnified on the South Side of San Antonio. According to Feeding America, 19.8% of individuals who live in this zip code experience food insecurity. According to U.S. Census five-year estimates, 26.34% of the population in 78211 lives in poverty. Reinforcing these challenges is the 38.5% of Southside families who earn enough to be above the poverty level but cannot afford basic living costs and are ineligible for the Supplemental Nutrition Assistance Program (SNAP).
Housing and health are also deeply intertwined. Housing insecurity has been linked to higher rates of mental health issues, poor birth outcomes, exacerbated chronic diseases and an increased risk of death and disability. The Strategic Housing and Implementation Plan (SHIP) adopted by the city underscores this issue: 95,000 of our neighbors are cost-burdened, spending more than 30% of their income on housing.
This cost burden can often force families into tough decisions, like choosing between health care and paying for housing or essential utilities. According to a Federal Reserve survey, nearly 40% of Americans would need to borrow money or sell assets to cover a $400 unexpected healthcare expense. As a result, many sacrifice health care services, such as preventive care check-ups, treatment for chronic conditions, accessing emergency health care or filling prescriptions. Such sacrifices further worsen health outcomes and deepen disparities, particularly in marginalized populations.
To combat this, we must prioritize policies that address the social determinants of health, not just for individual well-being but for the health of our city as a whole. Investment in under-resourced communities to revitalize them is essential to reversing these trends. If we fail to act, disparities will continue to widen health inequities and destabilize families and entire communities. A city is only as healthy as its most marginalized residents, and without addressing these challenges, long-term prosperity will remain out of reach for too many.
It is why MHM and the UT Health School of Public Health, San Antonio along with the City’s Metro Health Department, the County Health Department, and University Health’s Public Health Institute, are looking beyond traditional community health markers to track conditions and provide education and services for improving nonmedical social determinants of health.
We invite you to join us on this journey and think about how we can work together to leverage our strengths through the Center for Health Equity in South Texas (CHEST) in building a thriving future not just for the South Side but for all of San Antonio and the surrounding communities.
