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MEDICAL STUDENT

PERSPECTIVES

SAN ANTONIO’S DISPARITIES:
A NEW SOLUTION TO AN OLD PROBLEM

By Raul F. Membreno
MD/MPH Candidate, UT Health San Antonio

A house divided cannot stand. San Antonio is one of the nation’s fastest growing cities.
Growth often brings new economic opportunities, better schools and jobs, and greater access
to parks and health services. However, not all growth leads to economic and social growth.
Studies show that the rich are getting richer and the poor are getting poorer in the Alamo City.
According to a study cited in the San Antonio Express News, ‘in 1980, 26% of lower-income
households resided in majority lower-income tracts, but by 2010 that figure had risen to 38%.’ The polarization of the city has led to
devastating consequences for low income communities including widespread hunger, low incomes and striking health disparities.
Hunger is still a problem today. CBS featured San Antonio in the documentary Hunger in America in 1968, which revealed that more
than 400,000 Mexican Americans were living in hunger. Government programs and the SA food bank have aided in the fight against
hunger but experts concur that hunger rates have not definitively decreased in the past 50 years. One theory for the lack of progress in
reducing hunger rates is as follows: zip codes with higher income levels have greater access to reasonably priced, healthy food due to
increased access to various supermarkets that must compete with each other; whereas areas with higher poverty rates may have to pay
double for the same healthy food product due to lack of competition in these areas.
The San Antonio income disparity is among the nation’s worst. The Pew Research center labelled the Alamo City as the city with the
greatest gap in income levels among zip codes in 2012. The average salary of San Antonio residents in the zip code 78207 is $21,903,
whereas residents of 78258 earn on average $93,710. To elaborate on the reality of the poorest zip code in San Antonio, almost 50%
of adults lack a high school diploma in zip code 78207. The unemployment rate is a devastating 60%, and 40% of people live in poverty.
On the other hand, the zip code of 78258 has approximately the same number of households and a 98% rate of high school graduates
among adults, an unemployment rate less than 33%, and a mere 4% poverty rate.
Geography is the greatest determinant of health. Perhaps the most striking reason to address San Antonio’s notorious disparity in
zip codes is the effect on life expectancy. The Texas Public Radio conducted a Community Health Needs Assessment in 2016 that
identified a 20-year difference in life expectancy between different zip codes in the city. The affluent northwest and southeast residential
communities had an average life expectancy of 90-94 years, whereas the west and east had an average life expectancy of 70-74 years.
If every human being deserves a long, healthy life regardless of the economic climate of his or her place of birth, then the need for
initiatives to address this two decade gap is palpable.
An old problem requires a new solution. Proposed solutions to address the disparity between the north and south side of the city in-
clude adult education programs to increase the 17% literacy rate in Bexar County, improving the qualities of schools in decrepit areas,
and investment in the economies of financially stagnant communities. All of these proposals require political and legislative action.
Unfortunately, this solution has been recommended in the past with limited change. Perhaps the way to breach the barrier between the
affluent and the needy is to take a small step forward rather than a gallop to the finish line. The key issue that readers of the Bexar
County Medical Society can directly affect is the enormous health disparity present in the Alamo City. San Antonio needs physicians
committed to serving communities that cannot afford or access healthcare. Encouraging physicians to participate in community service
via free health clinics and other public health efforts in low income areas is one step in the right direction to snap the trend of record-
setting health disparities in San Antonio.

Raul F. Membreno is a San Antonio native and an MS2 in the MD/MPH program at UT Health San Antonio.

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