Commentary in the San Antonio Report provides a space for our community to share perspectives and offer solutions to pressing local issues. The views expressed in this commentary belong solely to the author.
Did you know that where we live, the way we move, our education, the air we breathe and the food we have access to play a huge role in our health? These factors are often referred to as nonmedical social determinants of health or 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 in which people are born, live, learn, work, play, worship, and age that affect a broad range of health, functioning, and quality “Life Outcomes and Risks.” They summarize the conditions in our communities that are often overlooked but are essential for people to thrive – and have a significant impact on the health, well-being and lives of our families and for generations affect neighbors.
Sometimes it is too late to overcome adverse non-medical life difficulties, even with available healthcare resources. A low-income, multigenerational working-class family in a flood-prone neighborhood with poor roads, no sidewalks, and few trees in a poorly insulated home with circulating fans in the summer and space heaters in the winter is likely to suffer from frequent nagging illnesses and a weakened immune system. This exact scenario caused the COVID-19 pandemic to disproportionately affect Southside families.
Living in a community with little access to health-promoting vital resources requires more than traditional health services. We need to expand our definition of “health care,” but doing so requires a shift in thinking and action. Reimagining health begins with deconstructing what health care should look like. This is not just about direct medical care, but also about addressing the upstream causes of health and well-being.
As a result, Methodist Healthcare Ministries (MHM), for example, is committed to health equity and focuses on the social determinants of health and well-being for current and future generations so that everyone can achieve their full potential for health and life. Similarly, the new collaborative UT School of Public Health in San Antonio centers people and communities in its educational, research and service missions, reflected in its mission to be the people’s school. The new UT School of Public Health in San Antonio recruits and enrolls students locally, teaches them using local data, and provides experiential learning in local communities. It leverages its key strategic alliances with MetroHealth and the County Health Department.
We need to recognize the diverse ways we can support health and wellbeing and revitalize our local communities, particularly through collaboration across industries and sectors. Our collaborative work in the healthcare sector in San Antonio has focused primarily on accessibility and affordability. We now realize that we don’t just want people to “stabilize” or “survive.” We want them to thrive. We can increase our local impact by working with diverse partners and addressing the multisectoral determinants of health through direct care, policy efforts and community-led grassroots initiatives.
A collaborative partnership model leverages constructive interaction between local institutions across multiple sectors to address issues that cannot be addressed by any single sector alone. It will prioritize early detection and prevention, reducing the long-term costs associated with advanced disease. The focus 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 opportunity, digital connectivity, neighborhood safety, environmental cleanliness, and resilient affordable housing.
For example, one in six people in San Antonio and surrounding communities experience food insecurity. Children, military families and communities of color make up 25% of the population experiencing food insecurity. Populations experiencing food insecurity are more likely to suffer from mental health issues and multiple chronic illnesses. According to RTI Health Solutions, families experiencing food insecurity spend $2,500 more annually on healthcare costs. Lack of access to affordable, healthy food can make it significantly more difficult for an entire community to improve their health.
The 78211 zip code illustrates how these challenges are even greater on the south side of San Antonio. According to Feeding America, 19.8% of people living in this zip code experience food insecurity. According to five-year U.S. Census estimates, 26.34% of the population in 78211 lives in poverty. Compounding these challenges is the fact that 38.5% of Southside families earn enough to live above the poverty line but cannot afford basic living expenses and are ineligible for the Supplemental Nutrition Assistance Program (SNAP).
Housing and health are also closely linked. Housing insecurity is associated with higher rates of mental health problems, poor birth outcomes, exacerbation of chronic diseases, and increased risk of death and disability. The Strategic Housing and Implementation Plan (SHIP) adopted by the city highlights this problem: 95,000 of our neighbors are cost-burdened, spending more than 30% of their income on housing.
This cost burden can often force families to make difficult decisions, such as: B. the choice between healthcare and financing housing or essential services. According to a Federal Reserve survey, nearly 40% of Americans would need to borrow money or sell assets to cover a $400 unexpected health care expense. As a result, many forego health services such as preventive care, chronic disease management, access to emergency medical care, or filling prescriptions. Such sacrifices further worsen health outcomes and exacerbate inequalities, particularly among marginalized populations.
To address this, we must prioritize actions that address the social determinants of health, not just for the well-being of individuals, but for the health of our city as a whole. To reverse these trends, investing in underserved communities to revitalize these communities is essential. Unless we act, the disparities will continue to widen health disparities 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.
That’s 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 education and provide services to improve nonmedical social determinants of health.
We invite you to join us on this journey and consider how we can work together to leverage our strengths through the Center for Health Equity in South Texas (CHEST) and create a prosperous future not just for the South Side, but for… to build all of San Antonio and the surrounding communities.
