Shared from the 10/14/2019 Houston Chronicle eEdition

Survey finds little health improvement in poor communities

Despite stronger safety net, disadvantaged residents still suffer high rates of illnesses

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Steve Gonzales / Staff photographer

Sister Mama Sonya, of Houston’s Third Ward, has a positive outlook despite diabetes and mysterious abdominal pain.

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Steve Gonzales /Staff photographer

Sister Mama Sonya visits Houston Health Department’s DAWN Center, which provides free diabetes self-management education and other services.

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One in five Harris County residents rate their health as poor or fair, double the U.S. average and no better than nearly a decade ago, according to a University of Texas survey.

The survey, which provides a snapshot of health disparities across 38 county communities, found the worst health assessments in Aldine, Settegast, Edgebrook, Gulfton and South Acres, all economically depressed areas. The percentage of respondents rating their health as poor or fair ranged from 28 in South Acres to 45 in Aldine.

“We can’t seem to improve a base of people’s health, even though we’ve strengthened the area’s safety-net health clinics in the last decade,” said Stephen Linder, the survey’s principal investigator and director of the Institute for Health Policy at the UTHealth School of Public Health. “If we hadn’t strengthened the safety net, it would be even worse.”

Obesity, high blood pressure and diabetes were the most chronic health problems affecting county residents. Thirty-two percent meet the definition for obesity, 29 percent suffer from hypertension and 13 percent have diabetes, numbers that mask even higher rates in the disadvantaged areas. Gulfton’s rate of diabetes was 21 percent, for instance, up from 15 percent in 2010.

Nineteen percent of respondents said they “sometimes” had trouble just getting food in the last 12 months. More than 10 percent of black residents encountered such difficultly “regularly” and a quarter of both blacks and Hispanics encountered it “sometimes.”

Ken Janda, a former Houston insurance company CEO who is now a consulting firm principal, said the report “highlights something that should be obvious — health outcomes are strongly correlated with income. In order to improve the overall health of Texas and Houston in particular we have to improve access to healthy environments, activities and care for low-income populations.”

Linder began presenting survey findings to local health officials and community groups last month. A report on the survey, based on 2017 and 2018 telephone interviews in English and Spanish with 5,694 Harris County households, can be accessed online at www.healthofhouston.org.

Dr. Umair Shah, executive director of Harris County Public Health, praised the report for “highlighting where things are happening” and said it will allow the sprawling county to “pinpoint interventions in areas most in need.” He said the report “really paints a picture that we have to do more to address problems at the community level.”

The survey builds on a similar one Linder conducted in the Houston area in 2010, which pioneered the concept of gathering and analyzing data at the subcounty level, now increasingly being employed around the state and nation. Previously, the only subnational and sub-state data was collected at the county level, which Shah emphasized isn’t “always that helpful in one with 4.7 million people and the size of Rhode Island.”

‘Hard part is not knowing’

Among those in the county battling health issues is Sister Mama Sonya, whose doctors are struggling to determine the cause of abdominal pain that wasn’t relieved by the removal earlier this year of abenign tumor near her pancreas. She has fibroids, but doctors don’t think that’s the issue.

“The hard part is not knowing what the condition is,” says Sonya, 63, who lives in the Third Ward, where nearly 1 in 4 people rate their health as poor or fair. “I just want to know what it is, how to treat it.”

Sonya, who used to consume lots of sugar and fast food but no longer does, also battles diabetes and the accompanying nerve pain in the extremities, which exacerbates the clinical depression she was diagnosed with years ago. She founded Sisters Controlling Diabetes, a support group for women of color with the condition, and wrote a book, “Sweet Sensations for the Spirit,” a collection of conversations with diabetes patients.

She lost her insurance recently when she was laid off, but receives treatment through the Harris Health System, the county’s safety-net hospital system.

In fact, thanks to the Affordable Care Act, fewer Harris County residents are uninsured now — 27 percent of adults, down from to 31 percent in 2010; and 11 percent of children, down from 13 percent. Forty percent have no dental insurance, compared to 49 percent in 2010.

But closer analysis revealed continued cracks.

Fifty-six percent of Hispanics were uninsured, four times the rate of whites and roughly three times that of blacks and Asians. Linder said the primary reason for that is Hispanics disproportionately work in service industries, construction trades and small firms that provide no insurance to their employees. Hispanics living here illegally accounted for about 6 percent of the total.

Geographically, rates varied from 7 percent to 56 percent, with the highest amounts in Pasadena, Galena Park, Gulfton, Aldine and a southwest Houston area that includes part ofBellaire. The latter two had the highest percentage of residents both uninsured and unable to get needed care.

Lacking insurance, Diana Lopez of Gulfton, would try to push through teeth pain, headaches and high blood pressure.

“I’d faint sometimes, never sure why,” says Lopez, who has matters under control now thanks to a local clinic that provides low-cost care, including sliding-scale rates. “And I’d bear any pain, try to blow it off, take over-the-counter medication. I just didn’t have the money for insurance.”

Even the big-picture insurance improvement was underwhelming to Dr. David Persse, Houston Health Department’s health authority. Noting the “thousands of hours of effort” by the health department to facilitate people signing up for coverage, he said “the all-too-small improvement” was his biggest disappointment from the survey.

“This hurts everyone,” said Persse. “Caring for persons without insurance still spends health care dollars, but in the most inefficient and ineffective ways. In addition, these inefficiencies serve to slow down the system as well as increase costs for all persons seeking health care regardless of their insurance status.”

Persse added that the lack of insurance has contributed to nights this summer when the majority of emergency centers across Houston have requested ambulance traffic be diverted elsewhere, “unusual for this time of year.” That’s only likely to worsen during the coming flu season, he noted.

Some positive numbers

There were some improvements since 2010: the percentage of mothers who’ve ever breastfed rose from 82 to 89; the percentage of adults who met the Centers for Disease Control and Prevention guidelines for physical activity rose from 47 to 59; the percentage of pregnant women receiving prenatal care in the first trimester rose from 84 to 92; and cancer screening rates improved — from 72 percent to 80 percent for breast cancer.

The county’s HPV vaccination rate was also a positive. Forty-one percent of Harris County adolescents — 47 percent of girls and 35 percent of boys — had received the full complement of shots. That’s higher than the state — 38 percent overall, including 42 percent of girls and 34 percent of boys. The issue was not on the 2010 survey. todd.ackerman@chron.com twitter.com/chronmed

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