I. EXECUTIVE SUMMARY

Executive Summary

Preliminary Recommendations

The purpose of this assessment is to explore the health of the community by comparing local data to the national Healthy People 2000 objectives in the areas of physical and mental health as well as substance abuse. The findings of the assessment will be used for future planning, policy recommendations, issue solutions, resource allocations, and, most importantly, achieving our vision of a healthier community. The assessment utilizes several research methods including data collection for multiple health indicators at the local, state, and national level, as well as the use of focus groups and a forum on "Mind and Body Health" to gather information from the community.

This begins the transition from focusing on diseases and mortality data to focusing on the causes and determinants of disease and ill health.

This is a consensus report developed by a working group of planners and marketing staff from several health organizations. Input was received from multiple community, provider, advocacy, and consumer groups. This report marks the beginning of a transition from focusing on diseases and mortality data to focusing on the causes and determinants of disease and ill health. The transition also focuses on the importance of the effectiveness and efficiency of healthy behaviors and promoting wellness.

The report examines the health status of Travis County and includes some data on the Austin Metropolitan Statistical Area (MSA). The metropolitan area is characterized by great growth over the past ten years and has largely become a young, culturally diverse population. The area also faces the challenges of addressing a significant income gap between the rich and poor as well as a high cost of living, especially in the areas of housing and health care.

The health of most Austin and Travis County residents is good.

The health of most Austin and Travis County residents is good; however this good health is not shared equally by all citizens. An examination of the physical health status of Travis County, the MSA, and the State of Texas found that the leading causes of death are heart disease, cancers, stroke, and unintentional injury. However, the leading causes of death vary among age groups and by race/ethnicity.

In fact, significant disparities exist between racial/ethnic populations, with minorities having higher rates of disease incidence for many physical health problems in comparison to Whites. For example, the Travis County ten year average (1989-1998) age-adjusted mortality rates for stroke in Blacks (44.3 per 100,000 population) is 65.3 percent higher that that of White Non-Hispanic (26.8 per 100,000) and that of Hispanics (32 per 100,000) is 19.4 percent higher than that of Whites.

Four of the top ten disabilities are mental illness-related conditions. Mental illness has been seriously underestimated and is expected to continue to increase.

In addition to physical health, mental health is an important aspect of overall health. Four of the top ten leading disabilities are mental illness-related conditions. Mental illness has been seriously underestimated and is expected to continue to increase, especially within the growing population of Travis County. Stigma and cultural barriers prevent many populations from seeking services.

Untreated mental illness negatively impacts the individual, their families, and the community. These negative impacts are manifested in suicides, loss of workplace productivity, hopelessness, unemployment, increased criminal justice system involvement, physical health concerns, substance abuse, and increased health care costs.

Based on the data collected and the information provided by the community focus groups and forum, four health initiatives were developed which have the greatest potential to improve individual and community quality of life, productivity, and the efficient use of resources in central Texas. They are:

1. Understanding and reducing the significant disparities in mental health, physical health, and substance abuse that exist;
2. Focusing sufficient resources for creative, effective efforts in preventing illness and injury and maintaining a healthy lifestyle (utilization of wellness and prevention strategies);
3. Improving access to health care and services, especially for the indigent and working poor, to ensure detection and treatment of illness and injury at the earliest possible time; and
4. Reducing substance abuse and its impact on the community.

Based on feedback from a series of community focus groups composed of providers, advocates, and consumers, numerous barriers to meeting the aforementioned initiatives were identified. One such barrier is a mistrust of the health care system by some populations. Additionally, consumers feel that culturally competent services are not available to them and that the system is intimidating and not user friendly. Another barrier identified by the focus groups is the competition for resources, even though there are examples of collaborations such as the Austin Dental Collaboration. Lastly, some neighborhoods are under-served and have few opportunities or incentives for improving healthy behaviors.

The same focus groups thought the best opportunities for improving the health status of individuals and the community should come from grassroots initiatives and programs. They cited faith-based services and neighborhood center programs as being the most acceptable programs. Important characteristics of these types of programs are that they be developed from within the community with support from leadership and resources from the broader area and that they be committed to listening and understanding the issues and concerns of the neighborhood.

Given the rising costs of health care and the limited resources available, it is time to rethink our current strategies and look for the most cost-effective solutions. We must gain an improved understanding of the determinants of health and well being as well as how individual behaviors and environmental factors relate to ill health and use this knowledge to our advantage.

We must use enhanced knowledge and understanding of individual behaviors and environmental factors to improve health and wellness.

Travis County continues to grow, be mentally and physically healthy, and be a great place to live, work, and play. Issues, however, still remain-access to health care, disparities in health, an insufficient focus on prevention, and a continuing substance abuse problem.

Preliminary Recommendations

• Engage in a community exploration of the determinants of health disparities
  • Conduct community forums to discuss the causes of health disparities, their impact, and resolutions
  • Educate and empower citizens to develop health behaviors
  • Develop data systems to collect more and different specific information relating to the causes of health disparities
• Develop a wellness and prevention consortium/partnership
  • Encourage collaborations between consortium members;
  • Advocate for wellness and prevention programs and resources;
  • Plan strategies for wellness and prevention activities;
  • Developing standardized wellness and prevention messages; and
  • Coordinate wellness and prevention assessments within targeted neighborhoods.
  • Priorities for the Consortium would be to promote and coordinate specific strategies identified as sound practices, such as:
    • Wellness programs in businesses and schools;
    • Physical activity programs;
    • Smoking cessation programs
    • Healthy nutrition programs.
    • Conduct health and wellness surveys to supplement the BRFSS surveys conducted at the State and national level.
• Implement community-based education and screening services
  • Target neighborhoods where health disparities are prevalent
  • Provide wellness and prevention services without eligibility requirements
  • Provide comprehensive services to include but not limited to:
    • Chronic and communicable disease prevention
    • Immunizations
    • WIC Services
    • Violence and injury prevention
    • Women's health
    • Men's health
    • Environmental services
• Implement community-based outreach initiative
  • Employ the use of a mobile health van
  • Provide similar services as described in the community-based education and screening service initiative
• Lead efforts to maximize efficiency of regional service delivery network
  • Establish the ICC-CENTEX.NET information system
  • Enhance coordination of care providers in information sharing
  • Develop additional financial resources to support the ICC
• Strengthen existing successful programs and pilot the impact of increased delivery efficiency
  • Enroll individuals up to 250 percent FPL into new health plan
  • Provide behavioral health care
• Develop strategies for long-term sustainable health care financing
  • Explore new insurance options that combines large and small business
  • Expand the specialty care provider network
  • Explore the viability of a health care taxing distract
• Utilize the Substance Abuse Planning Partnership (SAPP) to formulate policy initiatives that will overcome barriers to establishing a more effective delivery system.
  • Develop a proposal for establishing a mechanism to allow funding decisions to be made on a local level rather than regional or state levels.
  • Reduce gaps for prevention services.
  • Increase after school activities.
• Increase capacity for substance abuse services
  • Fully fund 24 detoxification beds (5-7 days)
  • Fully fund 150 residential treatment beds (14-90 days)
  • Fully fund outpatient services for 300 (90-120 days)
• Establish a process to provide substance abuse crisis stabilization, assessment and referral services.
  • Reduce substance abuse treatment waiting times for special populations (dually diagnosed, elderly, HIV+, offenders, pregnant and parenting women, and youth.)
• Conduct inventory of current efforts and develop a plan for coordination of community-wide prevention/intervention and treatment activities resulting in agreement about common outcome measures to increase accountability, efficiency and effectiveness.
  • Develop a coordinated community prevention plan, including relating plan items to root causes of substance abuse.
  • Establish local coordinator of prevention services position.
• Increase outreach activities to parents, teachers, and physicians and target to populations likely to be uninsured, at risk of substance experimentation use and abuse.
  • Streamline processes to ensure client qualification for multiple services is completed at one time.
  • Develop a common intake, eligibility and referral data set.
• Implement best practices as well as a system of accountability.
  • Identify, for this community, the costs of prevention and treatment best practices.
  • Develop community-based strategies for disseminating information on best practices.
  • Establish a substance abuse web site to include best practice information.
  • Host a best practice conference to address local needs and current efforts.
• Develop a focused public education campaign using multiple venues to communicate that substance abuse disorders are conditions to be treated rather than punished and that economic wisdom supports treatment.

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