Bexar County is ill.

The county ranks 121 out of 244 Texas counties for health outcomes and 217 for physical environment, and certain populations fare worse, according to its annual check-up via the County Health Rankings.

Every year since 2010, the Robert Wood Johnson Foundation has released its County Health Rankings so each state can see how its counties compare on more than 30 factors that impact health, income, education, transportation, jobs, and more.

In Bexar County, health ills stem from differences in housing and transportation opportunities.

Housing and Health

Owning a home can help build savings for future family wealth, education or other opportunities important to health and wellbeing. However, housing is not affordable for low-income families in Bexar County.

In Bexar County, 14 percent of households are severely burdened by housing costs. The rate is even higher in some census tracts.

High housing costs leave little left over for transportation, education, healthy food, medical care and other essentials to stay healthy and thrive.

“Low-income children have an increased risk of injuries from accidents and physical abuse and are susceptible to more frequent and severe chronic conditions and their complications such as asthma, obesity, diabetes, ADHD, behavior disorders, and anxiety than children living in high income households,” according to County Health Rankings.

Lack of Transportation Options

In addition to higher housing cost burden, we also know that more segregated counties have more health disparities and fewer transportation options.

Among 100 metro areas ranked, San Antonio is the 21st worst for pedestrians, according to the 2019 Dangerous by Design report by Smart Growth America. The San Antonio metro area’s Pedestrian Danger Index increased from 96.9 in 2014 to 131.2 in 2019, far worse than the national average of 55.3.

Over one-third of workers driving alone in Bexar County are commuting more than 30 minutes. Long commute times rob Latino and other families of time to invest in education, health, and other opportunities to build future wealth.

Transit service is underfunded, thus unable to provide frequent service in our sprawling region, and roadways prioritize the movement of vehicles, thus are unsafe for people to walk and bike.

Since 2010, our walkability score has gotten worse, more people are being killed or seriously injured in traffic crashes, fewer people are using transit, vehicle miles traveled have increased, and the average commute time has gotten longer, according to SA2020.

It is important to point out that transit use has increased on a dozen recently improved routes thanks to additional funding from the city.

Although residents may not connect the dots between transportation and public health, they feel the burden because it negative impacts livability. Lack of reliable transportation options can make it impossible to keep a job, get out of poverty, and care for aging family members.

Transportation Needs 

Residents responding to the 2016 Bexar County Community Health Needs Assessment reported that public transportation in the region is limited, making it difficult to get to work, access healthy food, make health appointments, and attend school events

“Although bus transportation exists, this was reported to be challenging for residents because travel takes a long time and schedules are not always convenient,” according to the report.

Residents responding to the 2018 Comprehensive Community Needs Assessment report transportation as one of the single barriers standing in their way.

Percent Using Public Transportation from the American Community Survey, 2017 estimates.
Percent of residents using public transportation from the American Community Survey (2017 estimates) Credit: Courtesy / Lily Casura

Local delegate agencies and nonprofits serving residents report transportation as one of the most requested client services. 

“Stress brought on by limited transportation options for aging family members, and the need for employees and students to leave work or school to bring aging family members to medical appointments was a frequently expressed need,” according to the report.

Roadway Design Also Matters

Through the appropriate use of design standards and guidance, more can be done to provide safe infrastructure for people walking, biking, and taking transit.

However, street design is not evolving enough to equitably improve pedestrian safety, particularly in Texas, which is one of the top ten most dangerous states for people walking, according to the latest Dangerous by Design report.

For example, 33 percent of severe pedestrian injury crashes occurred on just 1 percent of San Antonio roadways, according to the Severe Pedestrian Injury Areas Report.

You can identify the most dangerous streets near you using an interactive map courtesy of the National Complete Streets Coalition.

It’s particularly important to consider the transportation needs of seniors as this population is disproportionately burdened by pedestrian fatalities and injuries. Additionally, more and more grandparents are suddenly finding themselves parenting small children and teens.

“It can be daunting for families who need services from different agencies to go from one place to another to find assistance and services for specific problem elements,” according to the Community Needs Assessment.

Moreover, increasing access to safe transportation options can reduce vehicle miles traveled and improve air quality.

“Since we already built entire cities for drivers, then we need to build pedestrian-oriented, walkable urban places for health, safety, sustainability, and welfare purposes,” said urban planner John Osten.

Moving Toward Community Action

With the former Director of Metro Health, Dr. Colleen Bridger, now serving as Interim Assistant City Manager over the Department of Human Services—and three other departments—the leap from health to transportation just got a whole lot smaller.

To improve health equity – and get a better County Health Ranking in the future –investment in transportation should focus on bundling services with affordable housing, employment and job training opportunities, childcare, programs for seniors, healthy food, health care, and other community services in areas with highest social vulnerability and growing senior populations.

We need better alignment among professionals working in transportation, housing, sustainability, community development, air quality, and health to improve health and livability.

Will you help Bexar County get healthier in time for its next annual check-up?

Amanda Merck is a content curator/research area specialist for Salud America! at the Institute for Health Promotion Research at the UT Health Science Center at San Antonio. She also is a VIA board member.