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.
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.”
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.”
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.
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.