Final Report—Executive Summary
Diabetes Health, Heart Health and Cancer
The causes of death that claim the largest number of lives are heart disease and malignant neoplasms (cancer). These two conditions claim the lives of 48 percent of all residents of Bexar County. By the time people have developed heart disease or cancer, the community can do little for them other than help ensure access to the healthcare system. However, the scientific literature indicates that there is much that can be done to help prevent these conditions and help maintain the quality of life for those who have heart disease or cancer, especially in the early stages of the disease. Unhealthy behaviors such as smoking and making uninformed eating choices that lead to obesity are major factors that contribute to these chronic conditions. Community prevention strategies and interventions that support exercise and healthy eating choices can help to reduce the risk for heart disease and cancer.
In 2004 heart disease mortality claimed 448 years of potential life per 100,000 population, which is an average of 11 years of life lost for every death. This is down from 474 years of potential life lost per 100,000 population in 2000.
Cancer mortality claimed an average of 12 years of life lost for every death. Cancer deaths resulted in 639 years of potential life per 100,000 population in 2004. This is down from 702 years of potential life lost per 100,000 population in 2000.
Stroke mortality claimed an average of 12 years of life lost for every death. Stroke deaths resulted in 119 years of potential life per 100,000 population in 2004. This is down from 116 years of potential life lost per 100,000 population in 2000.
Diabetes mortality claimed an average of 10 years of life lost for every death. Diabetes deaths resulted in 90 years of potential life per 100,000 population in 2004. This is down from 96 years of potential life lost per 100,000 population in 2000.
Many of the risk factors for cardiovascular disease and diabetes are the same. Health promotion for cardiovascular health is for the most part health promotion for diabetes health. Having diabetes is a risk factor for cardiovascular disease. In Bexar County, 11 percent of the population report having diabetes. Residents of the south side of Bexar County report that 16 percent have diabetes.
Healthy eating is instrumental to prevention of cardiovascular disease, cancer and diabetes. HP 2010 recommends that adults consume a diet rich in fruits and vegetables and avoid high-fat diets. The goal is that 50 percent of adults consume at least three servings of vegetables and 75 percent eat two servings of fruits each day. In Bexar County 16 percent of residents report eating fruits two times a day, which is down from 20 percent in 2002. Twenty-seven percent report consuming vegetables three times a day. There was little change in vegetable consumption between 2002 and 2004.
Obesity puts unnecessary strain on the heart. A heart-healthy person will avoid diets that are high in fat. In 2002, 14 percent of Bexar County residents indicated they regularly consumed diets that were high in fats. Thirty-five percent of Bexar County residents report in 2004-05 that they have body mass indexes (BMI) of over 30 and are considered obese. Forty-six percent of individuals living in the southern part of the county are obese.
Some of the health behaviors that promote health for diabetes and heart disease are also good for cancer health. These include regular physical exercise, healthy nutritional habits, and avoiding the use of tobacco products. It is also important that people receive routine medical check-ups.
Healthy People 2010 recommends that sexually active women receive an annual pap test to screen for cervical cancer. In Bexar County 81 percent of women over 18 reported receiving a pap test within the past three years. This is a decrease from 88 percent in 2002.
The HP 2010 goal is that 50 percent of people over 50 will receive a colorectal cancer screen within the preceding two years. Only 26 percent of Bexar County residents over 50 report having received a fecal occult test in the preceding two years.
Phase III of the 2006 Bexar County Community Health Assessment presents findings from five projects that engaged Bexar County residents in discussions about community health. Two of these, the Hearing Community Voices meeting held on June 28, 2006, and the nine neighbor meetings had a similar focus. These meetings were designed to learn what areas of community health residents of Bexar County identify as important areas worthy of personal and public interest. It was not surprising to find that there was a high degree of overlap in the community health issues that were discussed at the large Hearing Community Voices meeting held at a central location in downtown San Antonio and the nine smaller meetings held throughout Bexar County. In many ways, these concerns reflect the findings of the health behaviors and health outcomes described in Phases I & II of this assessment report.
Participants at the “Hearing Community Voices” meeting and the nine neighbor meetings expressed interest in infrastructure and physical environment, community programs, education, crime and safety, and access to healthcare facilities. They expressed an interest in improving physical environment by making it more suitable to the needs of people living in communities. Participants indicated that good streets, sidewalks, streetlights, and parks help them feel safe and good about the communities in which they live. They want community centers and libraries. Interest in community programs was connected to the concerns about the infrastructure and environment. Closely coupled with suggestions for community centers and parks is the desire for programs that support communities. Many of the suggestions connect improving infrastructure to enhancing the social environment in the community. These included ideas such as after-school programs, parenting classes, child care, and adult daycare. Many of the suggestions are aimed at increasing access to recreational facilities.
Participants’ ideas about education were linked to concerns about infrastructure and community programs. Many participants supported having community centers that offer educational programs. There was significant support for libraries that, in addition to housing educational materials, often have programs and classes that help local residents increase their knowledge.
Crime and safety are always concerns in communities. What is interesting is that in these community meetings, suggestions about making their communities healthier, safer, and better places to live placed more emphasis on infrastructure, community resources, and education than were given for crime and safety. An increased enforcement of speed limits and greater police presence were major suggestions in this classification, but there were also many ideas that involved the community, such as neighborhood watch.
Interest in access to healthcare was often mentioned as a way to make neighborhoods healthier, safer, better places to live. At “Hearing Community Voices,” participants ranked universal healthcare coverage as the highest priority among solutions to improve the social environment. It is not surprising that concerns about healthcare ranked first for the “over 65” population. Participants wanted improved access to health services, more access to health specialties, pharmacies open in off hours, and wellness centers.
The findings of the health literacy survey indicate that residents have better comprehension of health-related materials than expected. Yet the study emphasizes that there are areas of concern, especially for the residents who need materials communicated in Spanish. The results corroborate concerns expressed at the “Hearing Community Voices” meeting and the neighborhood meetings about the need for education programs to help residents of our community. The San Antonio Health Literacy Initiative recommends that “Web sites and educational pamphlets that contain health information should be written at a 5th- or 6th-grade level to facilitate comprehension.” They also emphasize that “Health care providers should also use more common terminology when talking to patients.”
The information collected by the promotoras at the Edgewood Family Network confirms the need among residents of the West Side for education about healthy eating and cooking. Residents indicated a willingness to learn more about obesity and ask for places where they can exercise and groups with which they can exercise. In many ways these same concerns were repeated in the responses given in the neighborhood meetings around the county. The health behaviors and health outcomes findings of this assessment demonstrate a need for residents to address both exercise and eating behaviors if the high rates of obesity and chronic diseases are to be reversed.
Many of the concerns voiced by the residents in the area around the Mision Luterana project are similar to the responses provided in other meetings. These residents have a strong desire to improve the quality of life for the youth who live in the area. They want programs to engage the youth in order to improve their minds and job opportunities. They want recreation programs that will both increase the level of physical activity and will engage their youth in more constructive endeavors. Throughout the community meetings, residents voiced a need for after-school programs and improved access to affordable child care near their homes or places of work. Nowhere was this need expressed more strongly than in the Mision Luterana area.