Volunteers empty cans of pears into individual crates.
Community Housing Resource Partners conducts a food fair for residents of its housing communities in June. Credit: Bonnie Arbittier / San Antonio Report

For the second year in a row, Bexar County finds itself near the lower half of the state’s counties in an annual ranking of health outcomes, a ranking attributed to the number of children living in poverty and high rates of obesity.

Coming in at 121 out of 244 Texas counties, Bexar County is down four spots from its position last year; in previous years, however, it had been ranked in the mid-60s to mid-80s. The County Health Rankings and Roadmaps is released annually by the Robert Wood Johnson Foundation and the University of Wisconsin Public Health Institute.

“What I think you’re seeing is another indicator of the deep disparity that exists in San Antonio and that fact that the gap between the rich and poor is widening,” said Colleen Bridger, the assistant city manager who until recently was the director of the San Antonio Metropolitan Health District. “We are making huge strides in this community, and there are a lot of positive things going on. But until we address more of the upstream issues related to people’s well-being, we will continue to see challenges.”

The report divides rankings into two categories: health outcomes, based on quality and length of life, and health factors, which includes everything from adult smoking rates to preventable hospital stays to unemployment.

For Bexar County, health outcomes are heavily impacted by social and economic factors, including severe housing problems and the number of children living in poverty, said Justin Rivas, an associate researcher on the report. “What is uncommon about Bexar County is that despite its health outcomes score, the health factors that influence the health of a county are right up there in the top fifth of the state.

“It’s the health factors that we like to focus more on because it gives an idea of how tomorrow’s health [will be], while health outcomes are just looking at length and quality of life today.”

The report utilizes more than 20 data sources to compare counties within each state on more than 30 health-influencing factors such as access to quality health care, education, and jobs, aiming to provide insight into how health is influenced by location. And for the first time, the report examined how a lack of opportunity for safe, secure, and affordable housing is tied to poor health outcomes, Rivas said.

According to the report, Bexar County has better access to exercise opportunities and healthy foods, more mental health providers, dentists, and physicians, and a lower unemployment rate than the state average. But the number of children living in poverty (22 percent) and the severe housing cost burden for families (with 18 percent of families experiencing severe housing problems) are key drivers in physical and mental health, Rivas said.

“Almost a quarter of the kids living in Bexar County live in poverty, and when you break it down by race, 10 percent are white, 27 percent Hispanic, and 30 are black,” he said. “These kids live in challenging home environments. They don’t have disposable income, and maybe the families just don’t have time to do things that are healthy, or they don’t have access to things that contribute to physical and mental health.”

The report echoes what has recently become a major point of focus for Metro Health: addressing how children are impacted by adverse childhood experiences throughout their lifetime, which might include violence in the home, emotional and physical neglect, poverty, or incarceration of a parent or guardian.

New Metro Health Director Jennifer Herriott said the department included in its 2020-22 Strategic Plan a focus on educating the community to be “trauma-informed” when dealing with children who are experiencing a variety of difficult circumstances.

“If we can start to fix the systems that interact with these kids, healing them from the trauma they are experiencing, they will be less likely to go into the juvenile justice system, [Child Protective Services], or foster care,” she said. “If we can get them started on the right foot, healing from their trauma, they will do better in school, [earn higher wages], and have better improvements in health.”

Bridger said addressing adverse childhood experiences systemically is not the only forward-thinking move the department has made to address concerns outlined in the new county report. The adult smoking rate, which sits at 14 percent – on par with both state and national averages – is being addressed through recent Tobacco 21 legislation.

“We expect to see the youth smoking rate start to decline in about a year and continue to decline year after year,” Bridger said, noting that several years will need to pass before there is “enough critical mass to affect the adult smoking statistic.”

Rivas, who worked closely with Metro Health when it received the Robert Wood Johnson Culture of Health Prize in September for its “innovative and collaborative vision of community health,” said the City “has a lot of great work being done that might not show up in the data just yet.”

“San Antonio has done some really awesome policy stuff, and there are great things going on programmatically that will dictate positive health outcomes data in the future. But there is a lot of social and economic disparity that exists and will need to be addressed through specific strategies.”

Roseanna Garza

Roseanna Garza

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