Nestled next to Brays Bayou in downtown Houston is MD Anderson, one of the top cancer treatment centers in the world. Less than fifteen miles away bordering the same bayou system is the Harrisburg/ Manchester neighborhood, one of the city’s most infamous hotspots for pollution from refineries, chemical plants and other hazardous industries, which has left a minority-majority neighborhood with elevated risks of cancer.
It’s just one example of how healthcare providers in Texas can be well-funded, well-equipped, and still be unable to deal with some of the root causes of illness that bring people to their doors.
“Medical care is not usually the answer,” said Elena Marks, CEO of the Episcopal Health Foundation, in an interview. Her nonprofit organization researches and provides grants for healthcare solutions that, ironic as it may sound, actually happen outside the hospital.
Twenty percent of what determines health outcomes in a community is the health care a person receives. The other 80%, said Marks, can be traced back to something healthcare researchers call the social determinants of health— the conditions in which people are born into, grow up and live in. Such social factors include poverty, education, racism, housing, transportation, and access to healthy foods.
“We’re spending $3.5 trillion a year in this country on ‘health,’ 97 percent of that is going to healthcare, and so we’re spending 97 percent of our health budget on a 20 percent factor,” Marks said.
One of the best ways to understand how these social determinants impact Texans is an interactive map recently released by the foundation showing how life expectancy varies county by county, and neighborhood by neighborhood.
Economic situation, racism and housing can affect things like blood pressure, asthma and diabetes are hard to tackle with any single solution. To equalize and improve the health outcomes of all Americans, it would take sweeping laws, and above all, a fundamental change in how Americans view health and healthcare. “If you could fix one thing, you would fix poverty,” Marks said.
“It’s a cultural thing”
Much of the Episcopal Health Foundation’s work deals with social determinants too. In the 57 Texas counties the foundation operates in, it has funded and partnered with dozens of nonprofits that directly address the root causes of illnesses that communities or certain industries face.
For example, one of those nonprofits, the HOPE Clinic in Houston, noticed that many of its patients who were nail salon workers suffered from coughs, neck pain, and fungal infections. The HOPE Clinic surveyed nail salon workers and hired them as researchers, and then went as far as going to nail salon schools and businesses to educate them about the need for gloves, protective masks, better seating for posture and less-hazardous chemicals for their work. Another Episcopal Health Foundation-funded nonprofit, Houston’s Northwest Assistance Ministries children’s clinic, used its lawyers to get an apartment owner to fix the mold that was hurting a Houston teenager with asthma problems:
Marks said initiatives like that help move healthcare dollars upstream so that they actually improve health and not just deliver more healthcare. She said the idea of making people understand that most health-related issues happens outside the hospital is going to be lengthy battle of ideas. “It’s a cultural thing. We as Americans have decided doctors, technology and pills are Gods– that there’s gotta be something technological to fix everything. Because of our cultural bias, we have built this incredibly expensive infrastructure. You’ve got trillions of dollars invested in the status quo. You have all these hospitals who still make money by filling beds– and you only fill beds when people are sick.”
“That’s what is at stake here, we’re trying to change the entire system,” Marks said.
The policy environment
It’s an understatement to say it’s not easy to change an entrenched system in a state that hasn’t made health care— much less preventing illness in the first place or tackling Marks’ focus on social factors— a priority.
Texas has the largest number of and highest percentage of uninsured residents, according to an Urban Institute analysis. The state has significant challenges with obesity, maternal mortality, and mental health. Almost 30,000 smokers in Texas die annually.
Despite these challenges, the Republican majority in Texas— in control of government during the same time the numbers above have ticked up— has done little to improve either health or healthcare in the state. Last legislative session the focus was on public school financing and property taxes. The session before that it was a “bathroom bill”— regulating who can use which public restroom.
As Marks said, improving the health of Texans is a “cultural thing,” but it’s also political. The conservative leadership’s desire to stop the bleeding, much less sow up the wound, is severely lacking. Until there is a change of heart or a change of leadership, the Episcopal Health Foundation, HOPE Clinic and hundreds of other non-profits around the state will have to step in and up to tackle Texas’s toughest tempest that is health and health care.
Photo: Carl Court/Getty Images