Building Place and Equity into Health Planning in San Antonio

Author: Leah Hendey
Date Posted: January 2, 2019

Children don't get to choose where they are born. But in Bexar County, Texas, where San Antonio is located, current death data shows that children born in neighborhoods immediately to the east and west of downtown can expect to live as many as 20 fewer years than children in the far northwest corner of the county. 

This fact is one of many Community Information Now (CI:Now), the NNIP Partner in San Antonio, pulled together for The Health Collaborative's 2016 Bexar County Community Health Needs Assessment Report. Community Health Needs Assessments or CHNAs are a federal requirement of nonprofit hospitals that need to be completed at least once every three years. In addition to requiring hospitals to engage with community members and local public health agencies - they must be data-driven. The CNHA is subsequently used to inform the Community Health Improvement Plan and other policies, strategies, and resource allocation by hospitals, local governments, nonprofits, and philanthropy.
As The Health Collaborative's data partner for the CHNA, CI:Now introduced the Bay Area Regional Health Inequities framework to the Collaborative's CHNA Steering Committee, who adopted it as lens for the report. This framework recognizes that only a small part of a person's health is due to the medical care that they receive and ties social inequities based on race, class, gender, etc. to the physical conditions of the neighborhoods people live in and social determinants of health such as income and employment to disparities in health outcomes - like life expectancy. Unlike the traditional model that focuses overwhelmingly on personal behaviors and medical care as determinants of health outcomes, this framework helps focus interventions on "upstream" factors, including the social, economic, environmental, and structural factors that lead to poor health outcomes. 
Previous CHNAs in this community had broken data down primarily by demographic factors like race/ethnicity. But because San Antonio's large Hispanic population spans the income distribution and is well-represented across the county, a breakdown by race/ethnicity masks much of the disparity in many health outcomes. Having worked to improve upon the CHNA with every three-year assessment cycle, the Health Collaborative saw clearly the value of mapping data, such as life expectancy, by place to reveal the true severity of those disparities. The 2019 CHNA in development now will cover both Bexar and Atascosa Counties and map many additional indicators. The Robert Wood Johnson Foundation awarded their annual Culture of Health Prize to San Antonio for its efforts to address health inequities, and acknowledged CI:Now’s contributions to data-driven decisionmaking. 

This story was written by Leah Hendey at the Urban Institute, drawn from documents and interviews with the Health Collaborative. CI:Now is the San Antonio partner in the National Neighborhood Indicators Partnership, a learning network in 30 cities coordinated by the Urban Institute. All partners ensure communities have access to data and the skills to use information to advance equity and well-being across neighborhoods.

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