Ron Nirenberg April 2017
Despite affecting everyone in this community, "community health and wellness" has not been a big priority at City Hall. "Community health and wellness" had one third of the ranking that "streets" received in community input via SpeakUPSanAntonio. Yet it impacts our well being, workforce, economic development and the prosperity of San Antonio.
As a city we must address the social determinants of health, particularly in those areas of San Antonio with the greatest health disparities.
An individual’s health and wellness is directly linked to the quality of their environment. Safe communities mean safe streets that lead to healthier communities.
Sidewalks, well-lit streets, no stray dogs, and slower residential traffic all lead to people walk more in their neighborhoods, and regular walking can improve myriad health outcomes. But since 2010, the neighborhood walkability score decreased from 44 to 34 for the city overall. We must improved street and sidewalk infrastructure in these neighborhoods, while we also focus on neighborhood crime prevention.
What health-related areas do you think deserve increased attention, priority, and local resources, and, if elected, how would you elevate the discussion of these health issues at City Hall and lead effective action to improve health and healthcare in our community?
As a city we need to focus on healthy families and safe communities. Improved infrastructure such as sidewalks, parks, well-lit streets, streets without stray and dangerous dogs mean families can walk and play. They can participate in community activities and engage with neighbors. Such physical activities lead to safer and healthier communities.
In San Antonio, obesity and diabetes continue to be significant problems. While 14.2 percent of the Bexar County population diagnosed with diabetes, the burden is much higher in the near east, south, and near west sides.
Long-running programs like the Mayor’s Fitness Council have called attention to the importance of a healthier lifestyle. However, city leaders must become more active in public health groups such as the Bexar County Health Collaborative (BCHC) and other non-profits targeting specific diseases in the city.
We must coordinate with SAMHD to develop task forces to focus on specific public
health concerns, such as the opioid epidemic, which has impacted all socioeconomic groups. We will also work with community partners to develop a Public Health Advisory Committee to advise and make policy recommendations.
Finally, we should encourage local non-profit public health organizations through financial support and collaboration with city agencies to address specific health issues. This includes areas where needs are acute but also places where prevention will be needed as the city grows. And we will make community health data more accessible on the city’s website so that citizens can take ownership and track our progress as a community.
Bexar County is the primary source of funding for indigent health care in our area through the Bexar County Hospital District and University Health System. How would you, if elected, promote cooperative efforts to increase services and access to care for the citizens of San Antonio?
The City of San Antonio will work closely with Bexar County to evaluate current systems. We will work with VIA to improve transportation to clinics through frequent bus service in high need areas at the most needed times.
We will also work with SAMHD and the county to establish a system of community health workers (CHWs) in areas of greatest health disparity. This system is very common in the border regions of Texas and in San Antonio, the organizations serving the AIDS community utilize CHWs, and we will prove up the community cost effectiveness of this preventative approach versus dealing with the negative outcomes only when it is too late.
School based clinics in high need areas - such as those located in Harris and Hidalgo counties - provide basic health services to students and their families. In Harris County, the Baylor College of Medicine is part of the partnership. In San Antonio, we have indigent health clinics staffed by UTHSCSA medical students at Haven for Hope. The new medical school at UIW/Brooks City Base is establishing an “Adopt a Family” Program.
Some San Antonio school districts have school based clinics - though budget cuts have closed many - so the City should work with these institutions to enhance health care, cost effectively.
The disparity of health care between our poorest and wealthiest zip codes/districts is quite striking (Bexar County Health Collaborative 2016 report). How would you, if elected, reduce health disparities and improve health outcomes for our lower income communities/citizens?
First, we must recognize the social determinants of health, particularly in those areas of San Antonio with the greatest health disparities. For the city’s part, this means equity
for all parts of our city - particularly those most challenged - when we invest in infrastructure of service. An individual’s health and wellness is directly linked to the quality of their environment. Safe communities mean safe streets that lead to healthier communities.
Utilization of care is also a significant challenge. Clinics exist, but getting to them is difficult for many reasons. Community Health Workers (CHWs) and school based clinics can help residents understand their needs and direct them to the right resources.
By improving communities through safer streets and access to healthier foods, we improve overall quality of life, and this should also be a call-to-arms for partners in the public and private sector.. For example, HEB partnered with the FQHCs to provide nutrition education and information to promote healthier eating for pregnant women. The goal was to reduce the rate of gestational diabetes through a change in lifestyle. The City should convene interested businesses and organizations that can take on active roles in providing education and resources for these purposes.
San Antonio has a high incidence of obesity and diabetes mellitus and has been ranked as high as second in the nation for obesity in recent years. Past city efforts attempting to improve these rates, such as trying to reduce the prevalence of sugary drinks in our community, have been met with controversy. What ideas do you have to reduce the incidence of these chronic health issues?
We must ensure that health data and experts are driving the community health conversation, not politics. We will collaborate with Bexar County and with school district SHACs (School Health Advisory Councils) to include plans that limit sugary foods and drinks at school and educate residents about overconsumption of sugar. And by improving communities through better parks, safer streets, and increased walkability, we will encourage more physical activity among the general population. This promotes healthy living and decreases the risks of obesity and diabetes.
Nutrition education must also be incorporated into the area science curricula. For example, SAMHD and the BCHC can work directly with school districts to incorporate curriculum that shows how healthy food and drink choices - as opposed to increased sugars in processed foods and drink - have a positive impact on the body.
As a city, we can promote gardening, sustainability programs in the schools. COSA should partner, including through land use policy, with non-profits like Green Spaces Alliance, to provide long-term programs in the schools with greatest need. For example, Bonham Academy, a land-locked school, managed to find space to create garden beds, setting them up in a tiny space between the portable classroom buildings.
According to the CDC, child abuse and neglect are serious problems that can have
lasting harmful effects on its victims. The goal in preventing child abuse and neglect is clear — to stop this violence from happening in the first place. What local policies, resources and efforts will you support to promote safe, stable, nurturing relationships and environments for all children and families?
First, we must ensure that Community Safety Net programs, such as those that provide services to victims of child abuse and neglect and family violence, are not stripped of needed funding during the city budget process. In addition, we should continue to enhance the delegate agency funding process to recognize the continuum of care that will comprehensively deal with perennial challenges like homelessness. For example, data shows that the vast majority of our homeless population are victims of domestic abuse, struggle with addiction, or have untreated mental health issues. So when set goals for addressing homelessness and allocate funding accordingly, we should also consider and support organizations that deal with these associated challenges.
In addition, the City must work with local and state leaders and agencies to track data and effectiveness of our strategies. Our local legislative agenda should seek to partner with area delegations that improve transparency and access to information needed by health practitioners and and city and county officials.
Finally, city policy and investments should reflect a focus on children and the impact to the next generation. We should fully support and join in with the Bexar County Children’s Agenda recently launched by ReadyKidSA, a coalition of organizations devoted to ensuring that area children grow up healthy and educated for the future.
This means ensuring equity of services and infrastructure on all sides of town so that no matter where families are raised in San Antonio, they can thrive in a safe, affordable and high quality community.