Page 21 - Layout 1

SOCIAL DETERMINANTS SOCIAL DETERMINANTS
OF HEALTH OF HEALTH
continued from page 19

of specific importance in improving the
health of the San Antonio community,
where crime rates tend to surpass the state
average. The 2017 Bexar County Commu-
nity Health Improvement Plan reported
that violent crimes were 1.4 times the 2016
Texas rate, with both family crimes and child
abuse/neglect crimes 14% higher than the
2016 Texas rate, all with expected increases
in coming years. In light of this data, one
may assume that increasing crime rates may
contribute to a further reduction in neigh-
borhood physical activity, yielding pre-
dictably poorer health outcomes for San
Antonio residents.
Traffic fatality rates are indeed a reflection
of neighborhood safety, and they also impact of Northside and Near Northside residents, respectively), have con- nants-in-promoting-health-and-health-equity/
the walkability of an area. In a highly car-de- firmed child abuse cases (20 to 70 per 1000 on the Near Westside ver- 3. Weitzman M, Baten A, Rosenthal DG, Hoshino R, Tohn E, Jacobs
pendent city such as San Antonio, where sus 0 to 15 per 1000 in Northside and Near Northside), and have a DE. Housing and child health. Curr Probl Pediatr Adolesc Health
traffic fatalities have been shown to be higher diagnosis of diabetes (17% for residents on Near Westside versus 7.7% Care. 2013 Sep;43(8):187-224. doi:
4
than the state rate, prioritizing safe, well- on the Far Northside). With further investigation, similar health out- 10.1016/j.cppeds.2013.06.001. PMID: 23953987.
maintained walking areas is essential to com- comes may be associated with housing conditions, transportation, 4. The Health Collaborative. (2016). 2016 Bexar County Commu-
8
munity health. This is especially true for the safety, walkability and public transportation of areas outside of the nity Health Needs Assessment Report. San Antonio, TX: The
areas outside of Loop 410, where there are north-central region. Health Collaborative.
fewer walkable areas and generally poorer Addressing the innumerable associations between physical environ- 5. Bhatnagar A. (2017). Environmental Determinants of Cardiovas-
7
health outcomes. ment and health outcomes remains a seemingly insurmountable chal- cular Disease. Circulation research, 121(2), 162–180.
It may be less intuitive that limited public lenge for our public health officials, city council members and law https://doi.org/10.1161/CIRCRESAHA.117.306458
transportation can compromise numerous enforcement. Government initiatives seek to dissemble factors up- 6. Madzia, J., Ryan, P., Yolton, K., Percy, Z., Newman, N., LeMasters,
aspects of community health. Interestingly, stream of poor health outcomes such as poverty, infrastructure, G., & Brokamp, C. (2019). Residential Greenspace Association
access to public transportation is linked with trauma, while also pursuing a more direct approach by connecting and with Childhood Behavioral Outcomes. The Journal of pedi-
a stronger sense of community, better mental empowering community members. With time and further study, un- atrics, 207, 233–240. https://doi.org/10.1016/
health and increased physical activity, which derstanding the effects of physical environment on health will yield a j.jpeds.2018.10.061
10
enhances cardiovascular outcomes. San An- stronger, healthier San Antonio, and transform San Antonio into a 7. 2019 Impact Report. (2019). SA2020. San Antonio, TX: SA2020.
tonio’s Metropolitan Transit (VIA) is the home that is suitable for all. 8. 2017 Healthy Bexar Plan. (2017). Community Health Improve-
only city-wide public transportation system ment Plan. San Antonio, TX: Metropolitan Health District; San
in a city that is otherwise deemed “highly car- Teresa Samson is an OMS-III at University of the Incarnate Antonio, TX: Health Collaborative.
dependent, with low walkability,” and many Word and is a member of the Bexar County Medical Society 9. Han, B., Cohen, D. A., Derose, K. P., Li, J., & Williamson, S.
would suggest the transit system is inade- Publications Committee. (2018). Violent Crime and Park Use in Low-Income Urban Neigh-
1
quate to support movement across one of the nation’s largest-by-area residents within particular ZIP codes. Proper application of these borhoods. American journal of preventive medicine, 54(3), 352–
cities. In fact, data from the 2019 Bexar County & Atascosa County findings may improve approaches to healthcare by enabling providers References 358. https://doi.org/10.1016/j.amepre.2017.10.025
4
Community Health Needs Assessment Report suggests that public to better understand variables in patient health, and prompt governing 1. Nagasako, E., Waterman, B., Reidhead, M., Lian, M., & Gehlert, 10.Bird EL, Ige JO, Pilkington P, Pinto A, Petrokofsky C, Burgess-
transportation use may routinely double commuting times for resi- bodies to address the underlying causes for poor health outcomes. This S. (2018). Measuring Subcounty Differences in Population Health Allen J. Built and natural environment planning principles for pro-
4
dents. These findings will hopefully prompt San Antonio to improve data application is of high importance in San Antonio, a city where Using Hospital and Census-Derived Data Sets: The Missouri ZIP moting health: an umbrella review. BMC Public Health. 2018 Jul
its connectivity through enhanced public transportation and commu- residents on the north side have a life expectancy 20 years longer than Health Rankings Project. Journal of public health management 28;18(1):930. doi: 10.1186/s12889-018-5870-2. PMID:
nity efforts, and thereby curb related health outcomes. residents living in the south side, which is primarily home to minority and practice : JPHMP, 24(4), 340–349. 30055594; PMCID: PMC6064105.
8
Possibly the most important health indication of the physical envi- and low-income families. This finding is consistent with the distribu- https://doi.org/10.1097/PHH.0000000000000578 11.Arthur, K.N., Spencer-Hwang, R., Knutsen, S.F. et al. Are percep-
ronment is ZIP code. Studies have supported the predictive capacity tion of other health outcomes in the San Antonio area. Compared to 2. Artiga, S. (2018). Beyond Healthcare: The Role of Social Deter- tions of community safety associated with respiratory illness
of ZIP code on population health. One study performed in Missouri north-central areas, residents of the south, west, and east sides of town minants in Promoting Health and Health Equity. Kaiser Family among a low-income, minority adult population?. BMC Public
analyzed both hospital and census data to identify strong associations are more likely to describe themselves as “fair or poor health versus Foundation. https://www.kff.org/racial-equity-and-health-pol- Health 18, 1089 (2018). https://doi.org/ 10.1186/s12889-018-
between Community Health Rankings and the health outcomes of better health” (29.1% of Southwest residents versus 12.9% and 17.5% icy/issue-brief/beyond-health-care-the-role-of-social-determi- 5933-4.

20 SAN ANTONIO MEDICINE • January 2021 Visit us at www.bcms.org 21