Some of the results are not surprising, but others contradict our assumptions:
- Houston’s rate of mental illness is twice the national average (twice that of Los Angeles County)
- Almost half of Houstonians reported difficulty purchasing enough food or paying their mortgages
- 34% of adults under 65 are uninsured
- 56% of Hispanic residents are uninsured compared to 14% of whites
- When undocumented residents are excluded, 46% of Hispanics are uninsured
- Half of adults have no dental insurance (explains why family doctors see so many dental complaints)
- 32% of adults are obese
- 3% were frightened for their safety
A Q&A with Dr. Stephen Linder
Written by: Anissa Anderson Orr | Updated: August 28, 2012
As a professor of public health, Dr. Stephen Linder helps inform Houstonians about ways to prevent disease and stay healthy. But diagnosing each community’s health care needs poses a challenge. Studies on the health of Houston-area residents—a diverse population of nearly 6 million people—don’t always show the whole picture.
“Doing a population-based survey was the missing piece in the mosaic of data that Houston needs,” explains Linder, associate director of the Institute for Health Policy at The University of Texas School of Public Health. “We needed a better sense of what the total need for health services is on a community-wide basis, rather than keeping a tally of those who actually get services.”
To fill in the blanks, Linder and his colleagues developed the 2010 Health of Houston Survey, released to the public, and on their website, in November of 2011. With information from more than 5,000 households, and covering 28 areas within Harris County, the population study is the first of its kind to report the health of Houstonians by neighborhood (click here to see where your neighborhood stands).
So how healthy is Houston really? We definitely have some room to improve, Linder says. An estimated 20 percent of Houstonians reported they are in poor or fair health—twice the national average. Lack of health insurance, health care access and increased risk for psychological distress were big problems in some neighborhoods. HealthLeader recently sat down with Linder and asked him what the study results say about Houston.
HealthLeader: Houston has always had a reputation, fair or not, for being unhealthy. But did you expect so many of your study respondents to say they were in fair or poor health?
Dr. Stephen Linder: It was a surprise. Our sense was that the interesting feature of the study would be the geographic disparities—some neighborhoods having more problems than others—and not the deviation from national averages. We thought our local rates would be close to the national average, or at least within 10 percent. Not twice the national rate for certain adverse health conditions.
HL:What else was surprising?
SL: We found that Houston had twice the national rate for risk of psychiatric illness. Not only that, the rate for women was twice as high as for men. We compared it to Los Angeles County, which has similar demographics as Houston. L.A. County had lower than the national rate for the risk of psychiatric illness, and thus less than half of the average in Houston, and it reversed the gender disparity. Men were doing a little better than women were in L.A. County, but we have no idea why. When we repeat the survey in 2013, we are going to ask a more extensive battery of questions about mental health to see if we can sort out the source of that gender disparity.
HL:Were you surprised by the disparities you found in insurance coverage among Houstonians?
SL: We knew the percentage of people who were uninsured was high in Houston, so we expected a high uninsured rate. But, we found that the overall rate of people who were uninsured was 34 percent in Harris County. That’s not only dramatically higher than the national rate; it is also higher than the L.A. County rate, which is 10 points lower than ours. The real surprise, however, was the disparities across population groups. The largest difference in insurance coverage was between whites and Hispanics. About 14 percent of whites were uninsured, but 56 percent of Hispanics were uninsured. If we exclude those who were undocumented, the number dropped to 46 percent. Asians, African-Americans and whites all had better than the area average in insurance coverage.
HL:What did survey respondents think was the biggest problem facing their neighborhood?
SL: Crime wasn’t at the top of the list. Instead, they named stray dogs and cats as their biggest concern. That wasn’t what we expected. It was worst on the east side of Houston. Strays can be a big problem for neighborhoods, because they increase the risk of animal bites and rabies if you have a lot of animals that have not been inoculated. Usually children are at the highest risk for being bitten.
HL:Does Houston rank the best in anything?
SL: We have done well in reducing smoking rates. Our current smoking rate is lower than the national average. Unfortunately, it is not as low as L.A. County. About 17 percent of the Houston population smokes. Nationally, the average is a little over 21 percent, and L.A. County was 13 percent. So they are doing something right in L.A., but it is worth noting that we are doing better than most places. Another area we did well in was breastfeeding. We have already exceeded the U.S. Department of Health and Human Services’ Healthy People 2020 targets for initiation of breastfeeding. For sustaining breastfeeding up to six months, which is what the Centers for Disease Control recommends, we are below the 2020 targets, but we are doing better than the state is, and better than the national average.
HL:What will the 2013 study look like?
SL: We want to include more questions on mental and dental health and investigate some of the anomalies in the results, such as why the rate of uninsured is so high among Hispanics, and why women are at such higher risk for mental illness. We will start collecting data in 2013, and plan to release the study in the fall of 2014.
HL:What should Houston focus on to improve our citizens’ health?
SL: We need to attend to geographic disparities in health, and to do so in more of an integrated fashion. We should concentrate on those hot spots of need in a way that responds to the full spectrum of needs, as opposed to singling out a disease or condition, like heart disease or diabetes.
There also are inequalities in the burden of illness and access that make some populations more vulnerable to disease. Now we have a way to measure these disparities with the indicators in our survey. Given the scale of the survey and the variety of indicators we have we can understand the problem of health disparities more fully and work toward solutions.
For more information on the Health of Houston survey, visit the UTHealth newsroom.