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Public health director: 'We're not providing an environment for people to be healthy'
 Brooke Crum  / 

Waco-McLennan County Public Health Director Brenda Gray is not deterred by the results of the 2019 Community Health Needs Assessment, which found that residents of Waco and McLennan County have faced the same barriers to better health for at least half a decade.

Gray, new to her role as public health director in Waco, has some ideas on how to improve her community’s health.

The 2019 health needs assessment, which is conducted every three years, found three broad needs in the community: access to health care, lifestyle and health behaviors, and women’s health.

The Center for Community Research and Development at Baylor University conducted the survey in conjunction with the Baylor Scott & White Hillcrest Medical Center, the Ascension Providence Healthcare Network, the Family Health Center, Prosper Waco and the Waco-McLennan County Public Health District.

The 2013 and 2016 surveys found the same three needs to represent significant barriers to better health, said Ingrid Taylor, Ascension Texas’ director of community benefit.

“Within McLennan County, there’s great consistency,” Taylor said.

PDF: Waco-McLennan County Community Health Needs Assessment 2018-19

Tara Stafford, director of community benefits at Baylor Scott & White of Central Texas, said it is not for a “lack of trying” that these three needs have consistently been identified for at least the past six years.

“They’re big issues. It’s hard to move that needle, and it’s also hard to see an immediate shift in those issues,” Stafford said. “Big change takes time, so we wouldn’t expect to see drastic improvement on these for many, many years.”

But Gray sees that as a challenge worth tackling. She envisions the public health district having a greater role in providing health care access to McLennan County residents and even altering the physical environment of the region to create a healthier community.

“We’re not providing an environment for people to be healthy, and then to blame the individual, to me, seems a little bit unfair,” she said. “We’re creating and supporting those policies and system and environmental changes as a health district with our partners to improve the health of McLennan County and the city of Waco.”

Health district spokeswoman Kelly Craine echoed her colleague: “Place matters. You can predict your health outcome from your ZIP code.”

For Gray and her community health care partners, it is time to make all McLennan County ZIP codes healthier.

Access to care

Nearly 8% of respondents to this year’s survey said they had difficulty accessing a health care professional in the past 12 months, the report states. Residents between the ages of 25 and 44 in the east and central portions of the county were more likely to have difficulty accessing care.

About 7% of respondents reported having no health insurance coverage at the time of the survey. County data also showed high rates of uninsured residents and a dependence on emergency rooms for health care, according to the report.

“One of the things the health district does well is provide services to individuals who find they don’t have the appropriate insurance or coverage or the resources to get care in a private setting, so they come to the health district for that,” Gray said. “We are one of the links in the chain or safety net for people who don’t have access to private care or private insurance to cover their health care. We are a very important link in increasing access to health care.”

Roughly 11% of respondents reported inconsistent access to health insurance or interruptions in coverage in the past 12 months, and they were five times more likely to have difficulty accessing a health care professional. Those respondents clustered in socioeconomically disadvantaged areas of Waco and McLennan County, particularly in the cities of Axtell, McGregor and Moody, according to the report.

Gray said she plans to “broaden our footprint to ensure the entire county” knows they can receive immunizations at the health district, as well as private HIV and AIDS testing and diagnosis, treatment and counseling for anyone with a disease spread through sex. Families may also access the Women, Infants and Children program at the health district.

Lifestyle, healthy behaviors

More than 20% of respondents performed no physical activity during a typical week, according to the report. Meanwhile, 54% said they consume less than the federally recommended minimum 1 to 2 cups of fruit per day, and 73% said they consume less than the recommended minimum 2 to 3 cups of vegetables per day.

“The literature is replete with placing the responsibility on individuals for their health, and there is a level of responsibility that every person is, at some point in their lives, responsible for making those right choices. But I think it’s incumbent not only on the leaders of the city of Waco, but Texas and the United States, to make health a default in every community,” Gray said. “There are communities that are healthier because they have the green spaces, the parks, the sidewalks and the grocery stores, but when you have communities that are under-resourced and have food deserts and don’t have safe spaces for children to play and sidewalks, then the first choice is not for health or exercise or eating the right types of things. I believe the health district can have a significant impact in advocating for policy and system changes that increase the ability for those under-resourced communities.”

She said it is a matter of perspective, looking at health as a community issue, not just an individual responsibility. Ensuring that people live in communities that provide healthy opportunities allows them to make health a “default choice.” Part of that involves making sure residents feel safe in their communities and have access to healthy foods.

“I grew up in a neighborhood where there was virtually nowhere I could go in my neighborhood and feel safe,” Gray said, “and I think today that’s a challenge for a lot of parents and young people.”

Women’s health

Among the survey respondents, those with consistent health insurance coverage were more than twice as likely as the uninsured respondents to have received a well woman exam in the past 12 months, the report states. Those with a college degree or higher also were twice as likely as those with less than a high school degree to have received a well woman exam in the past year.

Local health statistics confirm women’s health as a significant need, with high rates of teen births that are even higher among minorities, according to the report.

Gray said women’s health is a passion for her and that she is determined to work toward greater health equity for women and children in the county. One of her goals is to expand the WIC program office to include resources for entire families that go beyond just nutrition, creating a maternal and child health division.

“That is my long-term vision to have a department that is more comprehensive and focuses on women, children and adolescents, and families being healthy,” she said. “Fundamentally, if moms are healthy and children are healthy, that’s the central building block for creating healthy adults.”

Data collection

The survey data was collected from Sept. 1, 2018, to Nov. 23, 2018, using various methods.

Vaidehi Shah, senior epidemiologist at the health district, said the data collection process changed this year from a phone survey to include an online survey and advertisements online and through postcards sent through the mail. Facebook advertisements led to 25 respondents, and Instagram led to 2 respondents.

“We had to change with changing times,” Shah said. “We’re just trying to figure out the best way to do this and get maximum responses.”

She and other partners helped develop questions for the survey, as well as its methodology, or how the data was collected.

“We first came up with a list of questions, and this time what we were concentrating on is the needs that we identified in 2016,” she said.

The survey consisted of 78 questions. Researchers mailed out 15,000 postcards to random addresses. The postcards asked people to complete the survey online or by phone. That was followed up by phone interviews for all addresses that did not complete the online survey and another wave of postcards.

Interviewers paired with at least one research analyst also visited 884 homes to collect data. They focused on “under-represented ZIP codes within the greater Waco area and McLennan County,” according to the report.

Next steps

The Affordable Care Act of 2010 requires nonprofit hospitals to conduct a community health needs assessment at least once every three years and develop an implementation plan to address the needs found in the survey, according to the IRS website.

“These needs are required to be considered as hospitals complete the next phase of this community benefit requirement, which is that in November hospitals have to publish their implementation plans,” Taylor with Ascension Texas said. “There’s ongoing efforts to address these needs. From our perspective, what we’ll be doing is developing these implementation strategies, and the collaboration will continue.”

Baylor Scott & White Hillcrest Medical Center will develop its own implementation plan, as well. The survey is indispensable to creating that plan, Stafford with Baylor Scott & White said.

“It’s something that we feel is very valuable to take a regular pulse from the community’s perspective on what they see are the biggest challenges that they face on their health journey, accessing health care and, of course, improving their health,” she said.

11th Street bridge demolition, I-35 lane closures to continue this week
 Rhiannon Saegert  / 

Partial closures along Interstate 35 will continue throughout the week as the $340 million widening project marches along.

Crews will be removing beams from the 11th and 12th street bridge throughout the week, starting Monday night.

“That’s one of those that we anticipated Monday night through Thursday night, maybe,” said Ken Roberts, a Texas Department of Transportation spokesperson. “It’s kind of hard to say, and it’s a fast-moving operation.”

It appears contractors are tackling work as their progress and conditions dictate, favoring an adaptable efficiency over strict adherence to advanced scheduling.

“Timelines are kind of estimated based on how the work progresses and field conditions, those kinds of things,” Roberts said. “Generally, the traveling public should expect lane closures between 7 p.m. and 6 a.m.”

All lanes of the I-35 frontage road are expected to be closed nightly from South Fifth Street to South 12th Street on Monday and Tuesday. Starting Wednesday, the northbound frontage road is expected to be closed from Park Avenue to north of 12th Street.

“What they’re doing is preparing for some detours as we work on the main lanes,” Roberts said.

Roberts said traffic will slow, and local traffic is urged to avoid the area or take alternate routes. He said through traffic is the largest contributor to the traffic.

The interstate will not close fully at any point, he said.

“There’s going to be a lane open, there’s going to be detours, they’re going to (divert) main lanes onto the frontage road, perhaps bring frontage roads onto the main lanes, but there’s always going to be traffic moving through,” Roberts said.

When driving in the project area, it is important to remain aware of changing routes and detours, he said.

“One of the things that we want folks to keep in mind is to watch the traffic control and follow our signage,” Roberts said. “There’s always going to be a means of getting through, and generally traffic is lighter at night.”

Documents detail probe of man charged with aiding migrants

TUCSON, Ariz. — Federal authorities for months suspected a humanitarian group of harboring immigrants, eventually resulting in felony charges against a volunteer who says he was simply being a good Samaritan, according to recently released court documents.

A jury in June was unable to reach a verdict against Scott Warren on charges of conspiracy and harboring and transporting immigrants. Federal prosecutors plan to retry Warren, of Ajo, Arizona, on two counts of harboring in November.

Warren says he was fulfilling his humanitarian duty by helping two injured migrant men at a facility known as “The Barn,” where members of the humanitarian group No More Deaths are based. Prosecutors say he was helping them evade authorities.

Documents unsealed in the case show the timeline for the investigation that led to Warren’s arrest while also revealing how locals and officials from the U.S. Fish and Wildlife Service worked closely with Border Patrol agents.

In April 2017, an anonymous Ajo resident contacted Border Patrol saying she suspected No More Deaths members were harboring immigrants in “The Barn.”

The relationship between No More Deaths members and federal officials, who view them as a nuisance for leaving water jugs on federal land and who had increasingly taken action against them, was already strained.

The group said it did not have any members available to comment, though it has repeatedly noted its mission is to help migrants who might otherwise die in the desert.

The U.S. attorney’s office also declined to comment on the documents.

In July 2017, Border Patrol agents along with sheriff’s deputies and Fish and Wildlife personnel detained members of No More Deaths for allegedly vandalizing a camera at Cabeza Prieta National Wildlife Refuge, where the group regularly left water jugs. Fish and Wildlife officials had banned them from getting permits to enter the wildlife refuge. Warren was among those who had a lifetime ban, according to text messages between a Fish and Wildlife employee and a Border Patrol agent.

Then in November, agents interviewed residents who said they’d noticed more traffic and littering outside No More Deaths site.

Agents eventually encountered a migrant man who said he had traveled across the desert with two other men who were picked up by a van. Suspecting they might be at the No More Deaths building, agents began watching “The Barn” on Jan. 17, 2018, arresting Warren and the two migrant men, both from Central America, that same day.

The men were deported after providing video testimony.

Earlier this month, a federal judge ordered several court documents to be unsealed at the request of the news organization The Intercept and others, including The Associated Press.

Prosecutors argued that the unsealed documents should never have been filed in court, and contended they should be kept under seal because they weren’t relevant to the outcome of the case.

Aide says Trump's critics should focus on problems back home

WASHINGTON — A top White House aide said Sunday that President Donald Trump, frustrated by the Democrats’ unrelenting investigations and talk of impeachment, swung hard at an influential black Democratic congressman and his Baltimore district because he believes such Capitol Hill critics are neglecting serious problems back home in their zeal to undermine his presidency.

Acting chief of staff Mick Mulvaney insisted in two national television interviews that that Trump was not making racist comments when he tweeted that the majority-black district of Rep. Elijah Cummings was a “disgusting, rat and rodent infested mess.” Mulvaney, a former congressman himself, said he understood why some people could perceive Trump’s words as racist.

Trump’s repeated weekend attacks on Cummings, the powerful chairman of the House Oversight and Reform Committee, marked the latest rhetorical shot against a prominent lawmaker. Two weeks ago, Trump caused a nationwide uproar with racist tweets directed at four Democratic congresswomen of color as he looked to stoke racial divisions for political gain heading into the 2020 election.

Mulvaney said Trump’s words were exaggerated for effect — “Does the president speak hyperbolically? Absolutely” — and meant to draw attention to Democratic-backed investigations of the Republican president and his team in Washington.

“Instead of helping people back home, they’re focusing on scandal in Washington D.C., which is the exact opposite of what they said they would do when they ran for election in 2018,” Mulvaney said, pointing at Democrats who now control the House.

He asserted that Trump’s barbs were a reaction to what the president considered to be inaccurate statements by Cummings about conditions in which children are being held in detention at the U.S.-Mexico border.

At a hearing last week, Cummings accused a top administration official of wrongly calling reports of filthy, overcrowded border facilities “unsubstantiated.”

“When the president hears lies like that, he’s going to fight back,” Mulvaney said.

Trump’s tweets Saturday charged that Cummings’ district, which includes Johns Hopkins Hospital, the Social Security Administration and the national headquarters of the NAACP, is “considered the worst run and most dangerous anywhere in the United States.”

Condemnation followed from Democrats over the weekend, including some of the party’s presidential candidates. Statements from a spokesman for Maryland’s Republican governor and from the lieutenant governor defended Cummings’ district and its people.

Trump, unbowed, resumed the verbal volleying Sunday: “There is nothing racist in stating plainly what most people already know, that Elijah Cummings has done a terrible job for the people of his district, and of Baltimore itself. Dems always play the race card when they are unable to win with facts. Shame!”

The president has tried to put racial polarization at the center of his appeal to his base of voters, tapping into anxieties about demographic and cultural changes in the nation in the belief that the divided country he leads will simply choose sides over issues such as race.

Mulvaney argued that Trump would criticize any lawmaker, no matter the person’s race, in a similar way if Trump felt that individual spoke unfairly about the president’s policies. He volunteered that if Rep. Adam Schiff, the California Democrat who leads the House Intelligence Committee, had made the same remarks as Cummings, Trump would have pushed back.

“It has zero to do with the fact that Adam is Jewish and everything to do with Adam would just be wrong if he were saying that,” Mulvaney said. “This is what the president does. He fights and he’s not wrong to do so.”

To Mulvaney, Trump was “right to raise” the challenges faced in Cummings’ district at the same time that Cummings and other Democrats are “chasing down” the Russia investigation undertaken by Robert Mueller and pursuing “this bizarre impeachment crusade.”

Diplomats recommit to saving Iran deal, oppose US sanctions

VIENNA — Diplomats from Iran and five world powers recommitted Sunday to salvaging a major nuclear deal amid mounting tensions between the West and Tehran since the U.S. withdrew from the accord and reimposed sanctions.

Representatives of Iran, Germany, France, Britain, China, Russia and the European Union met in Vienna to discuss the 2015 agreement that restricts the Iranian nuclear program.

“The atmosphere was constructive, and the discussions were good,” Iranian Deputy Foreign Minister Seyed Abbas Araghchi told reporters after the meeting ended.

“I cannot say that we resolved everything” but all the parties are still “determined to save this deal,” he added.

Fu Cong, the head of Chinese delegation, said that while there were “some tense moments” during the meeting, “on the whole the atmosphere was very good. Friendly. And it was very professional.”

Both diplomats said there was a general agreement to organize a higher-level meeting of foreign ministers soon, but also that preparations for such a summit needed to be done well. A date has not been set.

Iran is pressuring the remaining parties to the deal to offset the sanctions U.S. President Donald Trump reinstated after pulling out. The country recently surpassed the uranium stockpile and enrichment limits set out in the agreement, saying the action could be reversed if the other parties came up with economic incentives.

Experts warn that higher enrichment level and a growing uranium stockpile narrow the one-year window that Iran would need to have enough material to make an atomic bomb, something Iran denies it wants but that the deal prevented.

So far, neither Iran’s announcement that it exceeded the amount of low-enriched uranium allowed under the deal nor its revelation it had begun enriching uranium past the 3.67% purity allowed, to 4.5%, are seen as violations likely to prompt the European parties to invoke a dispute resolution mechanism.

Both of Iran’s actions were verified by the U.N.’s nuclear watchdog, the International Atomic Energy Agency.

At the Sunday meeting, Fu said, the Europeans urged Iran to come back to full compliance and Iran urged the European Union, France, Britain and Germany to implement their part of the deal.