Health care is financially out of reach for some.
A majority of poor children in Texas live in families where more than half of the household income goes to housing, straining budgets and creating a ripple effect that ultimately damages their health, a new national study found.
This often unseen poverty has far-reaching and interconnected consequences as families become unable to buy nutritious food, seek medical care, fill prescriptions or secure reliable transportation. It also can determine where and how often children go to school, which can jeopardize future achievement, researchers and public health experts said.
“Where we live matters to our health,” said Joe Hinton, a researcher with the 2019 County Health Rankings & Roadmaps, an annual project that looks at health and demographic indicators at the county level across the United States. “All people don’t have the same opportunities for a long and healthy life.”
In Harris County, for instance, 23 percent of the county’s children live in poverty — more than triple the rate of Denton County, which has one of the best overall health rankings in the state, the study shows. The overall child poverty rate in Texas is 21 percent.
The study also found that one in five households in Harris County face “severe housing problems,” which could include high costs, overcrowding or even a lack of working plumbing or functional kitchen.
Compare that to nearby Fort Bend County, which reported that 14 percent of households experienced such housing issues.
There is a deep divide across Texas when it comes to race and housing. Overall, 20 percent of black households face severe housing problems, twice the rate of white households in the state.
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While troubling, the findings do not surprise Elena Marks, chief executive of Houston’s Episcopal Health Foundation, who has long seen a connection between living conditions and health. It is a mistake, she said, to think of a community’s health solely in terms of traditional medical care. In fact, emerging evidence shows that social factors, including housing, are often better determinants.
“Medical care is only about 20 percent of overall health,” she said. Yet it carries an outsize 95 percent share of the nation’s $3.5 trillion spent annually on health resources.
Marks and other public health experts would like to see some redeployment of those funds to address a system they see as is set up to pay doctors and hospitals for care but not address root causes.
She pointed to a case where a young boy in Houston was repeatedly landing in the emergency room for severe asthma, only to return home to the very place that was triggering his condition. “There is nothing the healthcare system can do if the home is the issue,” she said.
In that situation, Episcopal Health Foundation funded a project that ripped out the aging carpet, replaced the mattress, and removed mold in air vents and bathroom. The boy’s health dramatically improved — all for less the price of a single emergency room visit.
Similarly, Memorial Hermann Health System now asks patients in its emergency rooms, clinics and in-patient care if they ran out of food the previous month, or feared they might.
Like housing, food insecurity can be a critical determinant of overall health.
“If I’m not sure where I’m going to sleep tonight, or whether I’m going to eat, I’m not going to worry about my diabetes. We have to bring all of those things together,” said Carol Paret, chief community health officer for Memorial Hermann. “You’re never going to cure this with just a prescription pad.”
The national study, released Tuesday, was the result of a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin-Madison. It examined a wide range of health indicators across the country at the county level, including life expectancy, birth weight, number of days with poor physical or mental health, level of education, sleep deprivation, access to healthy food, firearm fatalities and even length of commute. It also looked at the rate of uninsured. Texas leads the nation in the number and rate of uninsured.
According to the study’s ranking, the healthiest county in Texas is Hartley, followed by Denton, Williamson, Collin, and Fort Bend counties. The least healthy county, although not all counties reported, is San Augustine followed by Duval, Morris, Hall and Marion counties.
Harris County is ranked 53rd among the 254 Texas counties. Montgomery is 11th; Bexar 121st.
Sheri Johnson, acting director of County Health Rankings & Roadmaps, said in a statement that it was time for the nation to tackle the disparities. “It is time to do the difficult work of coming together to undo policies and practices that create barriers to opportunity,” she said.
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