Alazan Courts, the oldest still-occupied public housing complex in San Antonio, is located in 78207, one of the poorest zip codes in the county.
Alazan Courts, the oldest still-occupied public housing complex in San Antonio, is located in 78207, one of the poorest zip codes in the county. Credit: Bonnie Arbittier / San Antonio Report

The first triennial health study on Bexar County residents since the pandemic began revealed “some glimpses of improvement” from previous reports, but overall, social, racial and geographic inequities continue to drive local health disparities, the study found.

The nonprofit Health Collaborative released its 2022 Community Health Needs Assessment last week, which once again found that social determinants such as race and ethnicity, poverty, lack of education and housing insecurity strongly correlate to poor health outcomes.

The report uses data from the Center for Disease Control and Prevention’s public health database and the U.S. Census along with data collected by Community Information Now, a local nonprofit. The Health Collaborative also conducted “community voice” data gathering for the report.

Much of the data is from 2019 and 2020, and so includes some insight into how the pandemic affected — in many cases worsened — the social and structural inequities that lead to disparate health outcomes.

The overarching message, said Elizabeth Lutz, executive director of the Health Collaborative: “We continue to see a huge divide in the sectors of our community in regards to access.” 

Cristina Martinez, a research coordinator with Community Information Now offered a broad overview.

“Racial ethnic disparities are a top issue, under living conditions, we see low-income, poverty, unemployment, affordable housing, poor air quality, rapidly growing population, low educational attainment, food insecurity and lack of health insurance,” she said. “For risk behaviors, some top issues were substance abuse and poor nutrition, and for disease and injury, the top issues were low birth rate, mental illness and abuse and neglect.”

Martinez said population growth is a challenge as Bexar County works to improve health-related systems and infrastructure. Food insecurity and food access affect healthy eating and nutrition. Education and stable housing are also drivers of many health issues, she said.

The report highlighted longtime disparities between wealthier Northside residents and those living in other parts of Bexar County. Those residents have a longer life expectancy than those who live on the near South, East and West sides of town, a geographic disparity that likely grew during the pandemic, the report found.

Newly appointed director of Bexar County’s new Preventative Health and Environmental Services Department Andrea Guerrero-Guajardo, who has previously served on the Health Collaborative’s board of directors, said the report will help the new department understand the biggest structural and social issues facing residents.

“It’s meant to address all the health disparities this room is well aware of, especially in the unincorporated areas of Bexar County,” Guerrero-Guajardo said.

“This document holds the key and holds the data to create and to understand what is going on in those unincorporated areas,” she said. “The data tells us the story, but the information really comes from… priorities and experiences of [the community].”

Lutz said a lack of housing affordability, a major issue uncovered in the report, is “really devastating” to families.

The report also noted that infant mortality rates among the county’s Black population was double that among other groups, even as infant mortality overall is down 11% since 2015.

“There are some glimpses of improvement,” Lutz said, but deep challenges remain.

The outlying west, north, and east areas of Bexar County have the lowest concentration of families below poverty, with the highest concentrations being in zip codes 78207, 78208 and 78226.
The outlying west, north, and east areas of Bexar County have the lowest concentration of families below poverty, with the highest concentrations in zip codes 78207, 78208 and 78226. Credit: Courtesy / Health Collaborative

Affordable housing and homelessness

Median household income in Bexar County rose nearly 13% to $52,286 between 2015 and 2019, but because this data predates the COVID-19 pandemic, the rise may not have continued, researchers wrote.

Still, nearly half of renter-occupied households and one in five owner-occupied households were considered housing cost-burdened in 2019, meaning they spent more than 30% of their income on housing costs.  

A common barrier to safe housing is income, researchers found. It can be difficult to gather all the money required to rent a place to live, which often includes first and last month’s rent as well as a security deposit. The report also found it can be difficult for some immigrants in Bexar County to wade through the bureaucratic steps it takes to obtain housing assistance.

Food insecurity

Food insecurity rose in 2018 and in 2019, the study revealed.

In the study, Randy Escamilla, director of public relations for Southside ISD, told researchers the community needs access to food. 

“Our community, anytime they see a slab of concrete being poured, they’re hoping and crossing their fingers that that’s going to be an H-E-B.” Escamilla told researchers. “That’s all this community wants is an H-E-B, that’s all.”

Escamilla added that in his neighborhood, Alamo Heights, there are eight grocery stores within a two-mile radius. 

Causes of death

The number one cause of death among children and teenagers in 2020 was homicide with a weapon, the report found. Accidents were the second-leading cause of death. 

For adults 18 to 64, the leading cause of death in 2020 was diseases of the heart, cancer, COVID-19, accidents or unintentional injury, and chronic liver disease and cirrhosis.

Causes of death among seniors 65 or older were the same, with the addition of Alzheimer’s disease and cerebrovascular diseases.

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Raquel Torres

Raquel Torres is the San Antonio Report's breaking news reporter. She previously worked at the Tyler Morning Telegraph and is a 2020 graduate of Stephen F. Austin State University.