Final Report—Executive Summary

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The 2006 Bexar County Community Health Assessment is a major initiative of The Health Collaborative. The mission of the organization is to improve the health status of the community through collaborative means. Partners include Baptist Health System, CHRISTUS Santa Rosa Health Care, Methodist Healthcare System, University Health System, the YMCA of Greater San Antonio, Community First Health Plans, Methodist Healthcare Ministries, San Antonio Metropolitan Health District and Steve Blanchard PhD.

The Bexar County Community Health Assessment is guided by the determinants of health model.¹ The model defines health broadly, as the consequence of several domains, social and physical environments, genetics and individual behavior choices. It provides a framework for interpreting the outcome data collected by the assessment that encourages the reader to ask such questions as “To what extent is the relatively high rate of infant mortality in this sector of the city the consequence of the social context of the neighborhood?” Furthermore, the model suggests that individual level behavior choices are themselves, in large part, the consequence of social environments.

Healthy Lifestyles

Across Texas fewer people reported having a healthy body weight in the period 2004–05 than in 2002. Only 32 percent of Texans report having a healthy body weight, compared to the 35 percent reported in 2002. In Bexar County, following the same pattern as Texas, the proportion of the population reporting having healthy body weight dropped from 35 percent in 2002 to 29 percent in 2004–05. In the northern sectors of the county, there was little change in the proportion of the population reporting a healthy body weight (39 percent in 2002 compared to 36 percent in 2004–05). However, in the southern sectors of the county the percentage with healthy body weight declined from 28 percent in 2002 to 18 percent in 2004–05. This indicates that 10 percent fewer people report having a healthy body weight in the short span of 2 to 3 years. Another way of looking at this community health concern is that in 2004–05, 69 percent of the population of Bexar County reported being overweight. In the northern part of the county 62 percent of respondents indicated they were overweight, and in the southern part of the county 80 percent of the population reports being over overweight. Overweight people have more health problems than people with healthy body weights. In Bexar County, body weight is a serious health concern that needs attention.

Leisure time physical activity increased in the period between 2002 and 2004–05. Seventy-three percent of Texans were physically active in 2004–05, which is up from 71 percent in 2002. In Bexar County, 76 percent of residents reported they exercised in the last 30 days in 2004–05, which is up from 69 percent in 2002. Eighty-two percent of residents in the northern sectors report engaging in leisure time activity compared to 66 percent of residents in the southern sectors. It is possible that messages about the need for more active lifestyles are reaching the community. Given the high numbers of people who are overweight, it is important that increased and continued efforts are made to promote increased physical activity and healthy lifestyles.

Safety and Injury

Leading causes of death in Bexar County were measured in two ways: the age adjusted rate based on the number of people who died, and the number of years of potential life lost as a result of death. The number of years of potential life lost (YPLL) is a measure of premature death. A premature death is one that occurs earlier than 65 years of age.* Premature death has dramatic impact on the family and the community. YPLL was chosen as a measure of mortality for this assessment because it reflects the burden that the loss places on the community to fill the gap left by the loss of a productive member of the community.

The leading cause of premature death in Bexar County is unintentional injury. Nineteen percent of years of life lost to premature death are the result of vehicle crashes and injury in the home and in other locations. Unintentional injury mortality claims 831 years of life per 100,000 population. This is up from 813 years of potential life lost per 100,000 population in 2000. The people who die due to unintentional injuries tend to be young. On average, an individual who dies of an unintentional injury loses 29 years of life.

Vehicle crashes alone account for over one-half of years of life lost to premature unintentional injury deaths in Bexar County. Vehicle crashes claim 438 years of potential life per 100,000 population, which is down from 451 years of life lost per 100,000 in 2000. People who die from vehicle crashes lose an average of 34 years of life. When compared to the average of 12 years for those who die prematurely from cancer and 11 years for victims of heart disease, it is obvious that Bexar County would benefit substantially from efforts to reduce unintentional injuries, especially vehicle crash deaths.

Seatbelt use is high across Bexar County. The Healthy People 2010 goal is for at least 92 percent of adults to wear seatbelts. In Bexar County, 89 percent of adults reported using seatbelts. Ninety-three percent of children are in child safety seats when they ride in automobiles. This is less than the 100 percent suggested by HP 2010. Continuous efforts to maintain and improve the use of automobile safety restraints have resulted in gains over time and need to be supported and sustained. Additional prevention measures are needed to reduce motor vehicle crashes in order to reduce the injury and deaths that result from them.

Domestic violence and child abuse are high in Bexar County. In 2002, 11 percent of adults reported being victims of domestic violence within the last five years. This is almost three times the HP 2010 target of no more than 3.3 percent. The domestic violence assault rate was 749 per 100,000 population in 2004, which is an increase from 591 per 100,000 in 2000. It is possible that part of the increase may be attributed to increased awareness of domestic violence due to the work of Bexar County Family Justice Center, the P.E.A.C.E. Initiative, and the Family Violence Prevention Service and other similar community efforts and that more cases are being reported and/or identified.