September 10, 2003

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September 10, 2003
Congress on Children 2003Voices for Children San
Antonio
Fernando A. Guerra, M.D., M.P.H., F.A.A.P.
Director of Health San Antonio Metropolitan
Health District
http//www.sanantonio.gov/health/
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Every Day in our Community we must deal with a
number of Challenges
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Key Health Issues for our Community

• Health, social and economic disparities
• Increasing infant mortality rates
• Unmet womens health needs
• Impact of State Medicaid, CHIP and Title V cuts
  on local access to health care
• Teenage/unplanned/unwanted pregnancies
• Obesity and poor nutrition
• Lack of exercise
• Abuse of tobacco, alcohol and illicit drugs
• Conditions associated with aging

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Key Health Issues for our Community(Continued)

• Bioterrorism and threats from weapons of mass
  destruction
• Undiagnosed/untreated mental illness
• Threats from infectious diseases (e.g. STDs,
  HIV/AIDS, hepatitis C, TB, etc.)
• New and emerging infectious diseases (e.g. SARS,
  West Nile Virus)
• Environmental contamination from industrial waste
  generators
• Etc.

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Or think about these challenges in terms that
affect people every day...

• The stark contrast of academic achievement across
  school districts.
• Lack of employment opportunities to assure living
  wages and financial security.
• Increasing number of single mothers with
  competing priorities.
• Declining resources for quality mental health
  services.
• Lack of affordable basic dental care for
  children.
• Limited food and nutrition supplement programs.
• Limited support and availability of family
  planning services
• Significant number of utility disconnects and
  their health and social consequences.

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Bexar County Age Distribution (Hispanic, NH White
Black)
NH White
Black
Hispanic
Female
Male
Male
Female
Male
Female
Age
Percent
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Source 2000 Census
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Percentage of Births by Race/Ethnicity for Bexar
County
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Projected Population of Bexar County by Race and
Ethnicity, 2000-2040
Population
Year
8

Source U.S. Census and Texas State Data Center
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Bexar County Household Income Distribution Census
2000
Income
Cum.
of HH
Below Living Wage
Less than 10,000
62119
10.8
10,000 to 14,999
39268
17.7
15,000 to 19,999
42796
25.2
20,000 to 24,999
43536
32.8
25,000 to 29,999
42046
40.1
Living Wage
30,000 to 34,999
42723
47.6
35,000 to 39,999
35533
53.8
40,000 to 44,999
33785
59.7
45,000 to 49,999
29992
64.9
50,000 to 59,999
50048
EnablingOpportunities
60,000 to 74,999
52900
75,000 to 99,999
46777
100,000 to 124,9
23398
Source Living Wage Est. for 2 Adults 2
Children Harvard.edu (24,273)
125,000 to 149,9
10013
150,000 to 199,9
8695
200,000 or more
9012
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Bexar County Educational Attainment by Race and
Ethnicity- Census 2000
(Population 25 years and over)

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SAT Mean Total Score by School District 2002
Percent Economically Disadvantaged Children by
School District 2002
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Source Texas Education Agency
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2002 Single Mother Births Occurring within SAISD
Elementary Attendance Area
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Maternal Health Indicators Bexar County
1992
2002
/ rate
/ rate
22,058
24,772
Total Births
1,506
6.1
Births to Mothers lt 18
1,497
6.8
Births to Single Mothers
4,091
18.5
36.5
9,043
Births to Mothers
Receiving Late or No
11.4
Prenatal Care
22.5
2,813
4,972
Low Birth Weight Infants
8.1
2,007
(lt2500 grams)
7.1
1,562
Infant Deaths
161
7.3
7.3
182

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Births to Hispanics in Bexar County US Citizens
Vs. Foreign Born Mothers
Births to Hispanic Mothers Born in Mexico 97-
2001
Births to Hispanic Mothers Born in US 97- 2001
Total Births
64,346
15,692
Births to Mothers lt 18
6,584
10.2
508
3.2
25,599
39.8
3,065
19.5
Births to Single Mothers
Births to Mothers Receiving Late
or no Prenatal Care
2,312
14.7
10,392
16.2
Education gt 12 years
15,745
24.4
2,832
18.0
Low Birth Weight Infants
1,116
7.1
5,413
8.4
Pretermlt37 weeks
6,976
10.8
1,583
10
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2002 Births to Mothers Ages 12-17
150 to 156
100 to 149
50 to 99
1 to 49
none
San Antonio Council District
Healthy People 2010 Goal No More Than 5 of All
Births.
Births ()
Council District
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Births to Mothers lt22 Yrs. by Birth Order and
Age, Bexar County 2002
Birth Order
6,683
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27 of Total Births
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2002 Infant Mortality
9 to 10
6 to 8
3 to 5
1 to 2
none
Infant Mortality Rate per 1,000 Births
San Antonio Council District
Rate
Healthy People 2010 Goal lt4.5 Infant Deaths per
1000 Births.
Council District
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San Antonio Maternal Health Indicators by Race
and Ethnicity (2002)
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Average Age at Death for Leading Causes of Death
in 2002 by Race and Ethnicity
Age
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Causes listed above accounted for 74 of the
9,842 deaths in Bexar during 2002.
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2002 Diabetes Deaths by Age by Race/Ethnicity for
Bexar County
Deaths
Age
20
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Homicide Deaths by Age by Race/Ethnicity for
Bexar County, 2002
Deaths
Age
21
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Suicide Deaths by Age by Race/Ethnicity for Bexar
County, 2002
Deaths
Age
22
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2002 Reported Sexually Transmitted Diseases For
Ages 12 to 21
Total Syphilis
Gonorrhea
Chlamydia
AIDS
HIV
Total
Age
12
10
10
13
11
28
39
14
22
130
152
15
53
275
328
16
5
85
386
1
477
17
5
138
509
1
653
18
3
145
561
1
3
713
19
2
159
582
1
2
746
20
5
155
542
7
709
21
11
157
490
4
662
Sum
31
925
3513
2
18
4489
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Bexar County Juveniles on Probation by CY 2002
300
plus
200
to
299
100
to
199
1
to
99
none
5,435 Total
72 Hispanic
Probation by Gender by Age at Referral
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Bexar County Juvenile Probation by Type of
Offense- 2002
Need for Supervision (CINS) Behavior
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High Lead Levels
Children Ages 0-6 with Elevated Blood-Lead Levels
(gt10 µg/dL) in Bexar County, Texas from 1/1997
to 12/2002
Age of Single Family Dwellings
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How can we use data to inform public policy?
Are there areas in San Antonio where residents
have a disproportionate number of health,
environmental, legal, educational, economic,
housing and social challenges?
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Births Age lt18 STDs ltAge 22 Selected Zip Codes
with 50 of Indicators
Teenage Births
Sexually Transmitted Disease
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Juvenile Probation Age 10 to 16 High School
Dropouts Selected Zip Codes with 50 of
Indicators
Juvenile Probation
High School Dropouts
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WIC Children at or Above 95 BMI and Asthma
Inpatients Age lt18 Selected Zip Codes with 50
of Indicators
Asthma Inpatients
Overweight Children on WIC
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Adults with Less than High School Education
Single Mother BirthsSelected Zip Codes with 50
of Indicators
Less Than HS Education
Single Mother Births
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Domestic Violence Cases EMS Runs for 10/02
Selected Zip Codes with 50 of Indicators
Domestic Violence
EMS Runs
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Stray Animal Calls Substandard / Abandoned
Housing 1991 to 2000 Selected Zip Codes with 50
of Indicators
Stray Animals
Substandard / Abandoned Housing
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Only Nine Zip Codes with 27 of total population,
account for 35 to 50 of the need for municipal
services
Zip Codes 78201, 78207, 78210, 78211, 78223,
78227, 78228, 78237, 78242
Area of
Interest 9
of
zip codes
County
Bexar County
Total Population
1,392,931


378,001


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Population Age lt18
396,473


111,505


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Median Household Income
45,034

26,824


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Area of Interest (Nine Zip Codes)
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Impact of 9 Selected Zip Codes on Key Health,
Social Other Indicators
9 zip codes
of County
Bexar County




2002 Births Age lt 18
1,505


746


50
2002 STDs lt21
3,383


1,477


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2002 Juvenile Probation
5,637


2,290


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High School Dropouts
10,032


4,626


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2002 Single Mother Births
9,038


3,625


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2002 Medicaid Births
11,146


4,627


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2002 WIC Overweight
4,691


2,211


47
Asthma Age lt18
1,395


525


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Lead Age lt6
4,201


1,628


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2002 Family Planning Visits
24,591


12,378


50
Infant Death
182


65


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EMS calls Oct. 02
8,633


3,153


37
2001 Domestic Violence
8,800


3,721


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2002 Stray Animal Calls
46,551


18,980


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1991 to 2000 Abandoned Housing
14,433


6,860


48




30,591
16,341
53
Renter Occ. SF Housing lt45.000
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Infant Mortality Rate 8.9 /1,000
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For the past 12 years, 50 of the Teen Births
(age lt18) Occurred in only Nine Zip Codes
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What data are missing?

• Data on mental illness
• Arrests (by Age and Offense)
• Data on Child Abuse cases
• Unemployment rates at sub-County level
• Prevalence of homelessness, especially for women
  with young children
• Families without adequate food or food security
• Medical and social status of our elderly
  population
• Availability of affordable child care
• Sub-county data on families without health
  insurance
• Data on Unlicensed day homes

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Think about the following

• Why is our infant mortality rate going up?
• Why is it that the health outcomes of foreign
  born mothers are slowly getting worse over time
  they in San Antonio?
• Given the population demographics, especially
  among young Hispanics, what can we do to reduce
  the incidence of teen births?
• How do we empower communities so that children
  receive the education and other opportunities to
  assure their health and well-being in the future?
• How will this community offset the cuts to CHIP
  and Medicaid that we have recently experienced?

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How can we Connect the dots? where do we go from
here? We need an approach that involves
improving women's health, children's education,
housing, higher wages, social justice,
transportation, and a safe environment. Perhaps
our data and its analysis will serve to engage
community groups for action. Such is our hope for
Voices for Children of San Antonio.
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