Bexar County Community Health Assessment

Jump to another page... Introduction Community Health Behaviors Assessment Community Health Outcomes Assessment The Determinants of Health Organization of the 2006 Bexar County Community Health Assessment

The Determinants of Health

The Bexar County Community Health Assessment is guided by the determinants of health model¹. 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. For example, social contexts of stress can lead to individual choices that increase the risk of poor health outcomes, e.g., smoking, alcohol, substance abuse². Each health topic section of the assessment reports will link outcomes of that section to domains of the model.

Health can be described as “a state of well being and the capacity to function in the face of changing circumstances.”³ The model emphasizes the interaction between individuals and the social and environmental circumstances in which we live that influence health. In this way the model functions to emphasize that the health of individual is interconnected with the “health” of the community. Social factors such as how much education a person has, their income, occupational status, and the strength of their connection to the community will have an impact on their health. The physical environment also plays a role in health; aspects such as the quality of the air we breathe and the water we drink, contribute to health in the community. Other features of the community such as access to places to make a living wage, places to exercise (sidewalks, parks, and recreation facilities), places to learn (schools, colleges and universities, libraries) and relax (theatres, and cultural events) create the social environment in which we live and contribute to a healthy community.⁴

The interactive aspect of the model emphasizes that individual behavior choices are made in the context of the social and physical environment. The stresses that are created by the inequities found in the environment often result in individual behaviors that lead to poor health, behaviors such as smoking, excessive alcohol consumption, and obesity.

Community health is also influenced by social policy. Policies about funding for education, how environmental contaminants are managed; whether employers provide health insurance and a living wage contribute to a healthy community. Interventions that influence the quality of life in the community include training programs to enhance or learn new job skills, public funding for services and healthcare for children and the elderly Access to quality health care also contributes to health status. Access to healthcare facilities and providers with knowledge and skill to address mental and physical dysfunctions influences our ability to maintain health. However, the health system affects a small portion of overall health of the individual.

To know whether we are making progress in improving community health, it is necessary to go beyond measures of individual health. Individual health issues are usually monitored by the medical care system. Community influence on care provided by the healthcare system is minimal. To have a good understanding on the community’s impact on health, it is important to include measures of the vitality of the community. Community interest demonstrated through interaction in the community and participation in community projects can help increase the vitality of the community. This assessment is based on the premise that statistical indicators provide information about the magnitude and severity of community health problems.

Yet statistical indicators are only a metric to monitor status. To improve the health of the community it is necessary that we establish clear goals of what we want to achieve and objectives to set a course to reach those goals. In setting goals and objectives for community health, it is crucial that community members participate in the process of community assessment to create more of a complete understanding of community health concerns. The knowledge and values of the community should lead the establishment of goals and objectives for creating a healthier community. Participation will give ownership of the process and can help build a sense of trust and social cohesion. It is through this process that we can attach the root causes of poor health in Bexar County. A root cause is a cause that is at a root of an effect. An effect can have more than one root. Thus a given effect can have, and usually does have, more than one root cause. For example, people die as a result of complications of diabetes. However, scientific research indicates that obesity is a risk factor for diabetes and lack of exercise is a risk factor for obesity. Factors that influence obesity may be lack of education about appropriate eating choices and/or lack of resources to buy healthy foods. Living in a community that does not provide access to locations to exercise may limit ones ability or willingness to exercise.