Executive Summary. Healthy Lifestyles

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1 Executive Summary The 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 the major health systems in San Antonio, the YMCA of Greater San Antonio, Community First Health Plans, Methodist Healthcare Ministries, San Antonio Metropolitan Health District, and community representatives. Major health systems represented are Baptist Health System, CHRISTUS Santa Rosa Health Care, Methodist Healthcare, and University Health System. The Bexar 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. The model 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 than in Only thirty-two percent of Texans report having a healthy body weight, compared to the 35 percent reported in 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 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 ). However, in the southern sectors of the county the percentage with healthy body weight declined from 28 percent in 2002 to 18 percent in 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 , 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 Seventy-three percent of Texans were physically active in , which is up from 71 percent in In Bexar County, 76 percent of residents reported they exercised in the last 30 days in , which is up from 69 percent in 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 Executive Summary 1

2 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 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 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 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 It is possible that part of the increase may be attributed to increased awareness of what domestic violence, is 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. Sixty-five is because this is the usual age of retirement and it is the age when everyone is eligible for universal healthcare benefits through the Medicare system. Executive Summary 2

3 Infant and Child Health Though Bexar County birth characteristics look good when compared to Texas and Harris County, teenage pregnancy remains a concern. It is important that mothers receive early prenatal care to reduce risks to the baby and the mother. Teenage mothers have somewhat worse pregnancy outcomes than older mothers. It is difficult for young parents to provide the financial and emotional support needed to care for a baby while completing their education. Support and encouragement should be given to mothers younger than 18 to complete their high school education. Births to single mothers are also a concern. Thirty-nine percent of births in Bexar County occur to single mothers. Pregnancy outcomes for these mothers are worse than for married mothers. Single mothers tend to have less financial, emotional and physical support to help care for their child. These situations can contribute to poor health and lower educational performance for their children. The community would benefit from finding better ways to strengthen and support these families. The Bexar County fertility rate in 2004 was 73 births per 1,000 women of childbearing age, a decrease from 75 births per 1,000 women of childbearing age in Teenage fertility (12 to 17 years old) rate was 21 births per 1,000 females in 2004, down from 25 births per 1,000 females in The low birth weight births were 8.8 percent of total births in This is a noticeable increase from 7.5 percent low birth weight births in In 2004, 86 percent of mothers began prenatal care in the first trimester of pregnancy. This is the same rate as in The infant mortality rate, 6.2 deaths per 1,000 live births, is elevated for Bexar County and a number of the Sectors over the rate in 2000, 4.9 deaths per 1,000 live births as published in the 2002 Community Health Assessment. Infant mortality is also elevated for Harris County (6.5 in 2004 and 4.9 in 2000) and for Texas as a whole (6.3 in 2004 and 5.7 in 2000). This elevation may be a consequence of random variation where, thankfully, the number of infant deaths each year is relatively small. Nonetheless, the fact that infant mortality is elevated in so many of the Sectors, as well as Bexar County, Harris County, and Texas suggests that something may be occurring that warrants close monitoring of this vital indicator of public health for an enduring increase. Oral Health Oral health is frequently overlooked as a community health concern. The scientific literature indicates that dental caries in children is five times more common in the community than asthma. In Bexar County only 59 percent of adults and 77 percent of children had a dental visit in the last six months. Mental Health The 2000 Surgeon General s report on mental illness indicates that mental illness is the second leading cause of disability. People who live on incomes lower than the federal poverty guidelines are 50 percent more likely to be depressed. The number of people dying from suicide is substantially smaller than heart disease or cancer, but is the twelfth Executive Summary 3

4 leading cause of death in Bexar County. A person who dies prematurely as a result of suicide loses an average of 26 years of life. The leading cause of suicide is depression. A suicide death is a signal to the community that residents are in distress and need help. In 2004 suicide mortality claimed 221 years of potential life per 100,000 population; this is down from 281 years of potential life lost per 100,000 population in In Bexar County 24 percent of adults reported that they have experienced chronic depression (feeling depressed for two years or longer). The National Institute of Mental Health reports depression ranks second in terms of disease burden. Depression is associated with physical symptoms and may be a precursor to other physical diseases. Physical activity has been shown to improve mental health. Supporting physical activity is good for both the physical and mental health of our community. In Bexar County residents reported an increase in the number of poor mental health days they experience a month. The average number of poor mental health days increased from 3.4 days to 4.0 days per month. Though this is a small increase numerically, this increase results in many hours of production lost each month. 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, 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 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 This is down from 702 years of potential life lost per 100,000 population in 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 This is down from 116 years of potential life lost per 100,000 population in 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 This is down from 96 years of potential life lost per 100,000 population in 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 Executive Summary 4

5 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 serving of fruits each day. In Bexar County 16 percent of residents report eating fruits two times a day, down from 20 percent in Twenty-seven percent report consuming vegetables three times a day. There was little change in vegetable consumption between 2002 and 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 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 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. Executive Summary 5

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