CityFest: Turning redlining into ‘greenlining’ with health equity

CityFest: Turning redlining into ‘greenlining’ with health equity

This story was originally published by San Antonio Report and can be found here

Take a 1930s map of San Antonio’s redlined communities – used to avoid “hazardous” loans in Black and Hispanic neighborhoods – and compare it with a map of families currently living below the poverty level and coronavirus cases. A disturbing pattern emerges: structural racism in action.

Across the country, communities of color have been disproportionally impacted by the coronavirus pandemic in terms of economic and health outcomes, said Dr. Somava Saha, executive lead of Well Being in the Nation Network. “If you look at those places, what you’ll see is that they lack the underlying conditions of [a successful] place,” such as a clean environment, healthy food, and access to health care.

Depending on how communities handle the pandemic, Saha said, “this is either a moment where we are going to erase those red lines or … we’re creating the future redlining maps. … That’s the charge for all of us in this moment in history, is to think about how we use this moment to ‘greenline’ the areas that have been redlined.”

The City of San Antonio’s response and recovery plan is aimed at erasing those lines, said Colleen Bridger, assistant city manager and interim director of Metropolitan Health District. “Literally everything we’re doing is steeped in a focus on equity. … I love calling it greenlining.”

Saha and Bridger spoke during a panel discussion on Friday as part of the San Antonio Report’s five-day urban ideas festival CityFest. They were joined by Erika Gonzalez, president and CEO of South Texas Allergy & Asthma Medical Professionals, and Jaime Wesolowski, president and CEO of Methodist Healthcare Ministries of South Texas, to discuss Saha’s keynote address on health equity and possible paths forward.

Saha, who is a primary care doctor and public health practitioner, likened public health to a fire.

“We [could be] the best-organized bucket brigade trying to put out a fire, [but] there is a tanker full of gasoline going into the fire at the same time,” Saha said.

Similarly, doctors typically address the patient in front of them but not the underlying cause of the illness, she added. “What would it take for us to strategically shift those underlying things in the environment that are driving poor outcomes?”

These maps show (from left) racial segregation via redlining policies, poverty, and coronavirus cases in San Antonio.
These maps show (from left) racial segregation via redlining policies, poverty, and coronavirus cases in San Antonio. Credit: Courtesy / Dr. Somava Saha

Doctors treat children with asthma with medication – that’s an example of a “downstream” need, she said. But if someone digs further and finds out that their home has dust and mold that is causing the asthma, moving the child to a different home is a “mid-stream” solution.

“If we both remediate [substandard housing] and also create policies that make it possible for those places to [sustain] high-quality housing – and often mixed-income housing – then we begin to change the underlying legacies of disinvestment that got us here,” Saha said. That’s one of the so-called “upstream” solutions.

Saha is working with Methodist Healthcare Ministries to formulate an equity plan for the hospital system to address internal equity and start looking outside its traditional role of treating patients. The hospital system and nonprofit that serves 74 counties in South Texas is looking to broaden its scope to include upstream solutions.

“We need to evaluate not just health outcomes but those upstream social determinants of health … food, housing, education, the list goes on and on,” Wesolowski said. The nonprofit will undergo an internal equity, diversity, and inclusion audit starting next week.

This graphic shows how downstream, midstream, and upstream health interventions are connected.
This graphic shows how downstream, midstream, and upstream health interventions are connected. Credit: Courtesy / Dr. Somava Saha

This equity work will involve partnerships with local governments, businesses, nonprofits, and – most importantly – the underserved community, he said.

Door-to-door outreach to low-income communities of color is a priority in the City’s recovery plan, Bridger said, but one of the main barriers is trust.

“Redining happened in the ’30s and here we are today and we’re still seeing those same communities suffering from those same problems,” she said. “They don’t believe us when we say, ‘Oh yes, this time we’re going to help you.’ … The only way to build trust is by saying what you’re doing to do and then doing what you said you were going to do. We’re just now in that transition from the saying to the doing part.”

A key element to building that trust is forming relationships with neighborhood leaders and doctors who are established in those communities, Gonzalez said. Building those networks will help the city roll out its plans to stem the spread of coronavirus and help underserved populations take advantage of workforce development programs and other assistance that is available.

“We’ve often used the Promotoras with our health workers in the community who speak the language, who understand the culture, who look like the people they are trying to help,” she said.

That trust should work both ways, Saha said.

Successful programs that see 50 to 75 percent improvement in health outcomes “are often the ones that are led by or have substantial leadership by those people with lived experience of inequity.”

Health leaders need to trust that the community knows what it needs, she said.

Wesolowski, of Methodist Healthcare Ministries, has learned that an important piece of equity work is listening. “We can’t come in there and tell them what they really need.”

Iris Dimmick

IRIS DIMMICK

Senior reporter Iris Dimmick covers City Hall, politics, development, and more. Contact her at iris@sareport.org 

CityFest 2020: A weeklong festival of ideas focused on San Antonio’s resiliency

CityFest 2020: A weeklong festival of ideas focused on San Antonio’s resiliency

This story was originally published by San Antonio Report and can be found here

The turning of the calendar brought a turn in leadership to the San Antonio Report’s board of directors. A.J. Rodriguez ascended to board chairman late last month, after John “Chico” Newman Jr. stepped down from that position and the board after more than five years.

The changes went into effect at the board’s Jan. 25 meeting.

Rodriguez joined the board in 2020, after briefly serving on the San Antonio Report’s Board of Community Advisors. Founding Vice Chair Newman, who served as chairman for a year, decided to retire from the board because he believes the organization needs a fresh set of eyes. Newman served on the board since its inception, when the San Antonio Report, founded in 2012, reorganized as a nonprofit in 2016.

The change in board leadership comes three months after the board named Angie Mock publisher and CEO of the nonprofit news organization, replacing co-founder Robert Rivard, who continues to serve as editor and lead columnist. Mock previously served as CEO of the Boys & Girls Club of San Antonio and had been a member of the San Antonio Report’s board since 2018.

“We are deeply grateful for Chico’s vision, dedication, and passion that led us from a blog to a thriving nonprofit news organization,” Mock said. “Equally, I’m excited about what the future holds with A.J.’s leadership. A.J. brings a wealth of nonprofit success and strategic vision to the San Antonio Report.”

Rodriguez joined the nonprofit Texas 2036 in September 2020 as the executive vice president. Texas 2036 is a nonpartisan organization that provides research-based solutions to make Texas a better place for all residents by the state’s bicentennial. Before that, he served as vice president of external affairs and on the executive leadership team of Zachry Group, a privately held construction and engineering business. Rodriguez also served as the deputy city manager for the City of San Antonio from 2008 to 2011.

This experience makes Rodriguez the best fit to lead the board of directors as the San Antonio Report continues to evolve, Newman said.

“He is the right person at the right time,” Newman said. “You really can’t be any better than the leadership of an organization. With the combination of Angie and A.J., the San Antonio Report has outstanding leadership.”

A longtime fan of the San Antonio Report, Rodriguez said he joined the Board of Community Advisors and then the board of directors because he truly believes in the organization’s mission.

“I’ve felt compelled to participate in any way I could to support the mission of the organization,” he said.

Retired SBC Southwestern Bell President Wayne Alexander is the vice chair and treasurer of the board, while San Antonio Report founder and Editor Rivard serves as secretary. Other board directors include Teach for America Chief People Officer Laura Saldivar Luna, attorney Brian Steward, former Rackspace Community Affairs Director Cara Nichols, and Dr. Erika Gonzalez, CEO, president, and co-founder of South Texas Allergy and Asthma Professionals. Kate Rogers, a longtime H-E-B executive and the former vice president of community outreach and engagement for the Charles Butt Foundation, rounds out the eight-member board.

As the new board chairman, Rodriguez said he wants to serve as a resource for the organization, to help grow and develop the San Antonio Report at “an increasingly rapid rate,” and to maintain the high standards of journalism it upholds. He also said he is excited to work with Mock as she carries the organization forward under her leadership.

“There’s nowhere to go but up,” Rodriguez said.

Looking back over the past five years, Newman said he could not agree more. If someone had told him five years ago that the San Antonio Report would be where it is today, he would have said that was “aspirational.”

“For a small group, we punch way above our weight,” he said.

Newman has watched the organization evolve from just a handful of people to a staff of 20, from a small startup to a professional organization. He said the shifts in leadership are part of the same evolution for the San Antonio Report and will help further its mission to build a more informed community.

“We should constantly be learning, evolving, and getting better – and we have,” he said. “The organization has come a long way in five and a half years.”

San Antonio Report Staff

SAN ANTONIO REPORT STAFF

This article was assembled by various members of the San Antonio Report staff. 

In San Antonio, Asthma Hits Kids in Low-Income Zip Codes Harder

In San Antonio, Asthma Hits Kids in Low-Income Zip Codes Harder

This story was originally published by San Antonio Report and can be found here

After she found out her children had been denied free state health insurance, Jessica Gutierrez started crunching the numbers.

With a 6-year-old daughter and 4-year-old son in need of regular medication to treat the asthma they’ve both had since they were babies, Gutierrez was faced with a tough choice: buy health coverage through the federal exchange or go with her employer’s plan, even though it would eat up most of her recent raise. Plus, the rent on her Westside house near Woodlawn Lake just went up.

Editor’s Note

Disconnected is a series about economic segregation in San Antonio.

The series debuts a new story every Monday and looks at economic segregation through the lens of the major beats the Rivard Report covers. The goal was to create a human-centric look at one of the city’s biggest problems.

For more information on why we chose this project or to catch up on any missed stories, visit the Disconnected home page.

“That just means it’s going to put me back to where I’m not bringing home as much as I originally thought I would,” Gutierrez said. “I feel like I take five steps forward and then I have to take three steps back. … But their health is very important for me, and we have these medications every month, and I have to have insurance for them.”

Gutierrez and her kids are among the thousands of San Antonio families dealing with asthma, a complex disease that robs people of breath as their airways constrict and fill with mucus.

Health experts also have said asthmatics are at high risk of serious illness if they contract COVID-19, the disease that has infected nearly 170,000 people around the world, including three San Antonio residents, and caused the death of nearly 7,000 people worldwide. San Antonio officials have not yet confirmed that the virus is spreading from person to person in the community, though many health experts believe that’s only because of a lack of available testing.

State health records show that San Antonio consistently has the highest asthma rates of any major city in Texas. However, a closer examination makes it clear that asthma does not affect all parts of the city equally.

Zip codes in low-income neighborhoods on the East, West, and Southwest sides had some of the highest rates of people going to the hospital for asthma in San Antonio, according to public health data shared by San Antonio’s Metropolitan Health District.

“We see that areas that have higher poverty levels that are the ones that tend to have the most problems, and a lot of this has to do with access to care,” said Erika Gonzalez, an asthma and allergy doctor who also chairs the San Antonio Hispanic Chamber of Commerce.

From 2015 to 2017, the zip codes with the highest rates of asthma hospital visits were the near Eastside zip codes of 78203 and 78208, where hospitalizations added up to 14 to 15 per 10,000 residents on average over those three years.

That’s around five times higher than the hospitalization rate 2 miles away in 78209, which covers the wealthy enclave of Alamo Heights and the adjacent Broadway neighborhood of Mahncke Park. There, the rate is just over 3 per 10,000 people.

Gutierrez, 33, has spent most of her life in a neighborhood within the 78228 zip code, one of three Westside zip codes where rates averaged around 11 per 10,000.

Asthma has a strong relationship to allergies, and its triggers vary widely. Pollen, air fresheners, smoke, cleaning products, mold spores, smog, pet dander, dust mites, cockroaches, and rodents all can bring on attacks, under certain circumstances.

Aside from the human costs of poor health and premature deaths, asthma also can drag down a region’s economy when it leads to days of missed work and school. Researchers with the American Thoracic Institute and New York University have estimated that San Antonio’s ozone pollution alone is responsible for nearly 107,000 instances in 2019 when a person had to miss work or school because of a lung condition

“There is a financial burden of asthma on the government and on residents,” said Haley Feazel-Orr, an epidemiologist at the San Antonio Metropolitan Health District. “It takes up taxpayer dollars and insurance money, and [it affects] hospitals when someone can’t pay for their hospital bills because they had to go the emergency room because they were having an acute attack.”

Jessica Gutierrez walks with her children Zara and Josiah Walker down the waterfront at Woodlawn Lake Park. Credit: Stephanie Marquez for the San Antonio Report

Finding Asthma Triggers

Health researchers have noted that asthma tends to run in families, though its genetic influences are complicated. Gutierrez and her brother both developed asthma as children. As an adult, she still experiences the coughing, wheezing, and shortness of breath that characterizes the disease.

Doctors diagnosed both of her kids by the time they were a year old, Gutierrez said. She recalls when she used to lug around the machine used to administer albuterol, the bronchodilator medication that helped open their tiny airways when they suffered attacks.

It took a visit to an allergist around a year and a half ago to find out what triggered their attacks, she said. They each got an allergy test, conducted with a series of pinpricks to see if their skin reacted to certain allergic triggers. Gutierrez found out that she’s mostly allergic to mountain cedar. For her son, it’s mold spores. Her daughter suffers from grass allergies.

Once Gutierrez knew this, she could plan ahead for allergy seasons. Plus, she found a doctor who would answer her phone calls, offering advice that could keep the family out of urgent care clinics.

“We’ve been under control for about a year and a half already,” she said. “It’s been a while since we’ve had to go in [to urgent care].”

Lately, however, there’s been the question of insurance.

That became an issue only after her recent raise, when she took a new job as an administrative coordinator at the nonprofit SA2020. It boosted her income to a level at which her kids no longer qualified for the Texas Children’s Health Plan, she said. She thinks she’ll go with her employer’s insurance plan, even though the extra money she’ll pay in premiums will eat up all of the extra money she’s bringing in.

Overall, asthma is still a factor in Gutierrez’s life, but not a barrier. After earning her associate degree in business administration, she expects to get her bachelor’s degree in the same field in the next couple of years. She’s also spoken to a mortgage lender who says she can get on the right track to eventually borrow enough to buy her own house. All of this has been easier with their asthma under control, she said.

“Right now, we’re in a really good spot compared to where we were three years ago,” she said.

Oak Pollen and Air Fresheners

San Antonio is home to several programs focused on helping people like Gutierrez learn how to manage asthma on a daily basis.

For example, the City’s SA Kids BREATHE program sends community health workers, also known as promotoras, into residents’ homes, teaching people how to find their asthma triggers and use medication properly. From May through November, the program had more than 80 participants.

“We’ve had positive outcomes, for sure,” said Paul Kloppe, a respiratory therapist who oversees and mentors the team of health workers who visit participants’ homes three to five times over a six-month period.

However, there’s been much less local interest in tackling one of the broader issues associated with asthma: poor air quality.

Federal regulators consider San Antonio’s air quality to be officially unhealthy because of ozone, a pollutant tied to vehicle exhausts, industrial sites, and chemical use, among other sources. In Bexar County, nearly 60 percent of emissions of the nitrogen oxides that help form ozone come from mobile sources, such as vehicles and construction equipment, according to the Texas Commission on Environmental Quality (TCEQ).

(From left) Danny and Lisa Olivares, with neighbor Marie Smith, look at the Monarch Silica sand mine from the Olivares’ property on the South Side. Credit: Bonnie Arbittier / San Antonio Report

Despite this, the TCEQ this year produced a study focusing on the relatively small amount of ozone wafting in from foreign countries as part of an argument to federal authorities to avoid more stringent air quality regulations in San Antonio.

At a February TCEQ hearing, Alamo Area Council of Governments (AACOG) Executive Director Diane Rath, San Antonio Chamber of Commerce CEO Richard Perez, and Bexar County Commissioner Kevin Wolff (Pct. 3) all praised the study. Each emphasized the negative effect that more stringent air quality rules could have on the local economy.

During the hearing, which lasted less than an hour, Terry Burns, a retired doctor who chairs the Alamo Group of the Sierra Club, was the only speaker to mention public health.

“As a physician, I think that should be remembered that … the purpose of this activity we’re all engaged in [is] to protect people’s health,” Burns said. “I call upon San Antonio and the AACOG to actually get busy and take action to reduce our local ozone production.”

Some asthma triggers are beyond anyone’s ability to control. Some of the worst times for asthmatics are during the dreaded Ashe juniper season, December through February. Oak pollen and mold spores also spike at different times of the year.

Others factors are up to individual choices, such keeping a clean home, not smoking, and avoiding fragrant products. These factors are often the focus of Diane Rhodes, an asthma educator with North East Independent School District who in early March taught a free class for parents.

Diane Rhodes, asthma educator for North East Independent School District, sits behind her desk with visual aids she uses to teach children about that triggers asthma attacks.
Diane Rhodes, asthma educator for North East Independent School District, sits with the visual aids she uses to teach children what triggers attacks. Credit: Brendan Gibbons / San Antonio Report

“Asthma doesn’t happen overnight,” Rhodes explained to her lone attendee, a mother of five children. “It happens over a period of days.”

Rhodes explained how allergic and other triggers stack up until a person reaches a “symptom threshold” and suffers an asthma attack. An asthmatic might be OK during a smoggy day in the middle of oak pollen season until they enter a room with too many air fresheners. Identifying triggers is the way to get to a normal life with as little medication as possible, she said.

That’s how the fight against asthma in San Antonio continues – family by family and home by home.

“We have the time to meet families, to get to know families,” said Tracy Compean, a community health worker with SA Kids BREATHE.

‘Just Keep Moving Forward’

Recently, Compean and Kloppe have been visiting Monica Casillas at the mobile home park in south Bexar County where she lives with her husband, Miguel, and their 8-year-old son, also named Miguel.

A former elementary school teacher, Monica Casillas met her husband in 2007 at a family barbecue. They fell in love, and she ended up leaving teaching to raise their son. Now, young Miguel has severe health problems, including asthma and diabetes. An asthma attack landed her son in the hospital in November, she said.

“He turns red and can’t stop coughing,” she said.

For a long time, her husband made a living doing landscaping and construction work, despite having high blood pressure and diabetes, she said.

But starting last April, he suffered a series of four strokes and has not been able to work since. The family could end up waiting until next year to hear whether her husband qualifies for health insurance through Medicare, which is available for certain people under 65 with disabilities. For now, the family is uninsured, and their medical bills are stacking up, Casillas said.

Free programs are helping fill some of the gaps. Casillas found out about SA Kids BREATHE through a City social worker who also helped her son get enrolled in a homeschool curriculum through his district. Compean has been able to find them free food and clothing through local charities and government programs.

“San Antonio has a lot of resources,” Compean said during an interview last week at the Casillas home. “I have a lot of connections I can call upon.”

However, those resources can be intermittent, with funding and other support sometimes running out, Compean said. Coordinating her family’s care is also a full-time job for Casillas, who said she spends hours on the phone talking to health providers, social workers, and others who might help. That’s in addition to her efforts to make sure her son and husband get the daily monitoring and medication they need.

Still, Casillas said the asthma issues have been better since getting her son on the right medications. Sometimes, however, the challenges can seem overwhelming.

“Just keep moving forward, and have patience,” Casillas said. “That’s all you can do.”

Brendan Gibbons

BRENDAN GIBBONS

Brendan Gibbons is the San Antonio Report’s environment and energy reporter.