Community health assessments have become an integral part of community health. The Bexar County Community Health Assessment (CHA), issued every three years by The Health Collaborative (THC), has become a tool for helping Bexar County think about community health in a different way.
THC joined city and county leadership in releasing the 2013 CHA in October. This comprehensive report of local health guides the development of the Community Health Improvement Plan (CHIP). But what does the data mean to doctors?
Anil T. Mangla, PhD, MPH, FRIPH, Assistant Director for the San Antonio Metropolitan Health District, and Robert Ferrer, MD, MPH, of the Department of Family and Community Medicine, UT Health Science Center at San Antonio, are board members of THC.
Both serve on the data committee that produced the assessment and they also will be working on the CHIP. In the sections that follow, they share their views with MD News readers on what the Bexar County CHA brings to physicians.
Anil T. Mangla, PhD, MPH, FRIPH, Assistant Director for the San Antonio Metropolitan Health District and THC Board Member
Health care in San Antonio needs to be data-driven, and the Bexar County Community Health Assessment is an important tool in supporting this effort.
Data can help us make sure we are implementing the correct programs to impact the disease burden in Bexar County.
When I look at the assessment, I break it into six areas: screening, scoping, assessment, recommendations, reporting and monitoring/evaluation. Screening establishes where we are in the community and what we want to do. It gives us the global view of community health. Scoping helps us identify the populations affected by disease and determine where we have the greatest health need. Assessment is the baseline of where we are. Recommendation is determining what we can do to affect the population. Reporting is the interpretation of the data so that our leadership understands the disease burden at the local level. Monitoring and evaluation brings us back full circle to tell us if we implemented the right programs and whether they are working.
Physicians as providers are at the front line of public health. What they see is real, so it’s important that they understand the disease burden and current trends. Consider the current syphilis crisis. We have experienced an increase in syphilis cases over the last five years. Many in the medical community consider syphilis a disease of the past. However, it has not gone away. A physician who knows that we have a syphilis crisis is better able to identify the disease when patients come in for diagnosis. Too often patients with the disease are misdiagnosed.
Another trend we are seeing is the skyrocketing number of diabetes-related amputations. Many patients don’t know that they have diabetes, so by the time they come in for treatment, it’s too late. The result is often an amputation. If a physician is aware of the increase in diabetes-related amputations, patients with diabetes may be more accurately diagnosed and treated earlier, lessening the need for amputations.
Currently we are experiencing a substantial increase in pertussis, also known as whooping cough, in children. Children aren’t completing the series of vaccinations required. In 2011 the DTaP coverage was 90 percent and only 77 percent for the fourth dose, a decrease of 13 percent. If physicians know this, they can impress on families the importance of this final dose.
In these and other instances, the CHA gives upfront knowledge that physicians need to consider in treating their patients. It can provide physicians with a context that means better treatment for the patient and an improvement in health status for the community.
Robert Ferrer, MD, MPH, of the Department of Family and Community Medicine for UT Health Science Center at San Antonio and THC Board Member
The Bexar County CHA highlights for physicians the most common problems in our community, some of which get a lot of public attention (like diabetes) and some of which don’t (high rates of late or no prenatal care).
One the major insights for all physicians is the high rate of mental health problems. A finding that jumped out for me was the fact that 9 percent of adolescents have attempted suicide. Another was that the leading cause for hospitalizations is mental health disorders. Because mental health affects the care of every condition, it’s a reminder for all physicians to be considering mental health as they care for patients so they can appropriately connect those who are suffering to resources. Of course, the low availability of mental health resources is a larger policy and delivery issue.
Some of the indicators I see as most important for physicians aren’t traditional health metrics at all. One is the low educational attainment in many sectors of the county. For example, in four of the eight county sectors cited in the CHA report, fewer than half the residents have any education beyond high school. And in those same sectors, more than a quarter of all families with children live below the poverty line. That sets up generational cycles in which poverty and low education perpetuate themselves to diminish the prospects for future health and well-being. To break those cycles, we should do everything we can to lift educational attainment across all areas of Bexar County.
Another insight comes from the profound disparities in morbidity and mortality across so many conditions. Those disparities point to the common struggles that patients face regardless of their specific disease or condition: gaining access to care, having adequate opportunities for healthy living patterns and becoming educated about how to manage their illnesses. So, seeing the persistent disparities reminds me to always think about patients in the context of their daily lives. What extra help does this person need? What resources can I help him access?
In the Department of Family and Community Medicine at UT Health Science Center at San Antonio, we’ll use the CHA data to understand the social determinants and major health problems in the areas where our patients live.
For example, I was struck by the very low rates of healthy eating patterns and will be addressing that in my department though our community outreach We’re working now on plans to promote healthy diets in the context of shared family meals — something to nourish the spirit as well as the body.
Physicians are an important component of the CHA and CHIP processes. Each CHA collects public comments through community meetings where physicians have an opportunity to share their observations about the communities in which they live or work. As development of the next CHIP begins this fall, physicians also can become involved in any of the priority area workgroups. Investing time in the CHA and CHIP is a valuable contribution in the health of our community.
The Bexar County CHA is a signature project of THC, a convening organization bringing together the area’s healthcare systems, community organizations and businesses to solve the region’s critical community health needs. The 2013 assessment is the fifth in a series issued by THC since 1998. The assessment is available at http://healthcollaborative.net.
THC members include Appddiction Studio, Baptist Health System, Bexar County Department of Community Resources, CHRISTUS Santa Rosa Health System, Community First Health Plans, Methodist Healthcare Ministries of South Texas, Methodist Healthcare System, Our Lady of the Lake University, San Antonio Metro Health District, University Health System, University of Texas Health Science Center at San Antonio Department of Family and Community Medicine, WellMed Medical Management, Inc. and the YMCA of Greater San Antonio.