John Burman

San Antonio doesn’t get an annual State of the City’s Health report card, but improving the health, wellness and activity levels of people living here is a key SA2020 goal, so in late February I sat down with Dr. Thomas Schlenker, the director of San Antonio Metropolitan Health District, to learn more about his ideas and goals for a more healthy and active city.

Dr. Schlenker came to San Antonio in 2011, replacing Dr. Fernando Guerra, the longtime director of the San Antonio Metro Health District. A native of Wisconsin, Schlenker attended Antioch College where he received a BA in political science. He then enrolled in medical school at Northwestern University outside Chicago, and afterwards, earned his Masters of Public Health at Harvard.

Formerly the public health director for Madison and Dane County, Wisconsin from 2006-2011, he has also led health departments in four states, served as Chief Medical Officer for the Children’s Hospital of Wisconsin-Kenosha, and was a Senior Fulbright Fellow at the National Institute of Public Health in Cuernavaca, Mexico.

Although my conversation with Dr. Schlenker went in many directions over the course of our hour together, his responses showcased his drive to elevate the overall health of our city.

John Burnam: I know you’ve spent time in preventative care and public health in Utah, Wisconsin, and now Texas. These states have widely divergent demographics and I am sure each has fairly unique challenges. Have you enjoyed these different experiences?

Dr. Thomas Schlenker
Dr. Thomas Schlenker

Dr. Schlenker: They do, and that’s a big part of the fun-learning the ins-and-outs of a new community. I grew up in Wisconsin so the state was really familiar to me. Moving to Utah and now San Antonio has been almost like working in different worlds but I have enjoyed it a lot.

JB: When you decided to leave Madison County, was there anything in particular that drew you to San Antonio?

TS: San Antonio is very close to Mexico — where part of my family is — and the strong Latino culture drew me here. I was also impressed that it was a dynamic and developing metro area with a ton of potential but also a lot of inadequacies that needed to be met. Things are rapidly changing here, which I enjoy.

JB: I’m sure you had a pretty strong idea of what you were getting into before you got here but have there been any deficiencies that weren’t expected but have been difficult to handle?

TS: Some of the things that surprised me included high rates of poor birth outcomes and teenage pregnancy among Hispanics. In other parts of our country, Hispanics do well in these areas so I was especially surprised that these problems affected San Antonio. I’m sure that the history of marginalization and discrimination has a lot do with it. Also, there are a lot of difference between the Latino culture here and the rest of the country [which is] new to me. The biggest surprise to me, though, was the levels of syphilis in the city.

The numbers of Syphilis cases have been progressively decreasing for a while now throughout the rest of the country but in San Antonio, we’ve seen increases each year over the past decade. I wouldn’t be surprised if we were number one in the country and that is nothing to brag about.

Primary, Secondary and Congenital Syphilis, Bexar County, Texas and the United States, 2000–2012

JB: It is interesting that you bring up syphilis because I know that reducing the number of cases is one of the major goals you’ve set for 2015. How are you progressing with some of your other goals?

TS: I’ve been surprised with our progress in physical fitness. Certainly, we haven’t achieved the goals we set because in general, the population is not healthy — two-thirds of the city is overweight or obese — but we’ve quickly progressed.  It has been a great joy to have a very engaged mayor and partners in the community like the YMCA and the San Antonio Sports Foundation. We have rapidly developed a perspective of the built environment and the positive impact it has on physical, mental, and spiritual wellbeing and it has been great to see progressive local businesses like Rackspace also jump in to help.

JB: I know that one of those progressive moves has been the introduction of Síclovía. Have you been impressed with the response to this event?

TS: Absolutely. The turnout has gone from 15,000 to 45,000. Each one has gotten bigger, better, and more fun. There has been tremendous enthusiasm and people are starting to realize that alternative transportation could be the solution to many of our problems.

Courtesy of Metro Health.
Courtesy of Metro Health.

JB: Do you think events like Síclovía along with the fact that San Antonio now has the second largest public bike program in the country are helping increase awareness about the need for safer roads and policies to support alternative transportation?

South Alamo B cycle station
Zach Gonzales and Gem Abrahamsen unlock bikes at the S. Alamo B-cycle station in front of Hemisfair Park. Photo by Iris Dimmick.

TS: Absolutely. The more bikers and joggers we get on our streets, the more drivers will be forced to respect them. The B cycle program has especially been a success and it is great to see the number of stations and locations expand. Ultimately, though, everyone should have their own bicycle.

President Roosevelt or one of his predecessors promised that if he was elected there would be a chicken in every pot . I’d love to change that promise to a bike for everyone. I really think we can do it and we’ve helped set up programs like Ride to Own that help even those who can’t afford them, get a bike.

JB: So, another one of your goals for this year was to develop upon the idea of the built environment. Could you share a little about these developments and how they are also working to increase physical activity in the city?

TS: One of the ways we’ve implemented the idea of the built environment is through the construction of the Mission branch library on Roosevelt. It is a beautiful building and it has a walking track and outdoor reading and community gardens. The idea was to integrate the indoors with the outdoors and connect the health qualities of reading with the enjoyment of being outdoors. Even though the revenue stream that supplied the building is now gone, I would predict that other new libraries and public buildings will employ and improve upon the model.

JB: I know that Metro health wants to see the built environment as part of the solution to reduce physical inactivity in the city over the next 3 years by 10%. Could you share a little about what physical inactivity means and how you plan to track and measure the reduction?

TS: Good question. First, the measure of physical inactivity which we use comes from a national standard set by the CDC. To be considered inactive, you must have no physical activity outside of work, within the last month. This is a big problem in San Antonio because 25% of our city is considered inactive by the national standards.

One of the ways we are going to capture this data is through the new updated Witte tree house program. The Witte sees 150,000 school aged children a year so it provides us with a large population from which to collect data. Kids will go through the new exhibits with an electronic card they will register at each station.

The H-E-B Science Treehouse's outdoor water exhibits at the Witte Museum. Photo by Iris Dimmick.
The H-E-B Science Treehouse’s outdoor water exhibits at the Witte Museum. Photo by Iris Dimmick.

These stations will be games that measure things like height, weight, age, gender, ethnicity and level of physical activity. From this data we divide everything by demographics and determine things like BMI and whether kids are eating vegetables or exercising. The hope is that we can then use that data to track our progress.

JB: Changing gears, over the past couple years, a lot of focus in San Antonio has been tied to the new urban renaissance. I know Metro Health operates out of a different sphere than SA2020 and the Mayors Fitness Council but I was wondering what you felt Metro Health’s role was in the urbanization process. Are there any major needs you think need to be addressed?

Fitness station at a local park. Photo courtesy of Metro Health.
Fitness station at a local park. Photo courtesy of Metro Health.

TS: We are big proponents of San Antonio’s high density urban living because we see the suburban sprawl as bad for the overall health of our city.

JB: Could you share some of the reasons urban living is better for public health than suburban?

TS: One is physical activity. Data shows that there is a much higher likelihood of someone living in a high density area using alternative modes of transportation.  Even taking the bus to work is more exercise than driving to work. Second, there are major environmental benefits to urban living because of the increased likelihood of walking, riding a bike, or taking the bus. Another big part of it is just the idea of living in closer proximity to your community. The people you live with and around have a huge impact on health. Living in a walled compound way out in the suburbs restricts interaction between neighbors in a way that living closer together does not. All of it is antithetical to public health and it is a huge drain on resources so we definitely support the growth of downtown. However, like many people, we have our concerns too. We need a grocery store in the downtown area because living downtown isn’t going to be good for your health if you are eating out every night.

JB: Given that there has been this influx of people to downtown, what are the things people living in these areas can do to help Metro Health achieve its goals? What are some ways we can get involved?

TS: One big way would be for them to just get involved with their neighbors. Isolation is bad for public health. Try to get to know those around you and get involved in block clubs and neighborhood associations. Even if you live in condos or lofts you could find ways to participate.

Another way is to just help demand that the city make alternative transportation more accessible. People in your age range are mostly physically active so you need to continue to be the demand for more options and safer streets from the city. You could say ‘we kind of like San Antonio but it could be better. There could be more and better connected bike paths and better food options’.  Also, speaking of biking, there is a real bike culture here and a lot of businesses are bike friendly. Ride your bike to the restaurant or bar or join a cycling group. These groups are great both for individual health but also the health of a neighborhood. It just makes a community feel safer and more connected when they see people out and about.  Thank goodness for all of the young people moving down here!

JB: Well, thank you for your time Dr. Schlenker, I just had one more question. Are there city health organizations that you guys in San Antonio look to as sort of the gold standard?  Are there any cities with similar demographics that you look at and say “we need to do what they are doing?”

TS: Well New York City is a wonderful example of what could be done. I’ve never been but I am eager to go on the highline where they made a linear park on the old train tracks. It’s a great idea and it makes a huge contribution to public health.

John Burnam is an independent nonprofit consultant currently working with San Antonio Christian Dental and The Louise Batz Foundation for Bedside Advocacy. He works in patient safety, community health and well-being, and nonprofit development. He graduated from Trinity University with a Bachelors in Art History and Classic and then from Vanderbilt University  with a master’s degree in theological studies.  Prospective employers can check him out on LinkedIn.

Related Stories on the Rivard Report:

The Essence of Patient Safety and Bedside Advocacy

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The Palmaz Award: Celebrating Biomedical Innovation in the Alamo City

The Feed: Five Minutes With The Mayor’s Fitness Council

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John Burnam

John Burnam is the co-founder and principal of Burnam | Gray, a nonprofit consulting firm that seeks to help agencies ignite and scale best practices.