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>> CASTILLO: GOOD AFTERNOON EVERYONE. THE TIME IS NOW 2:00.
2:00 P.M. ON THURSDAY, OCTOBER 26, 2023. THE COMMUNITY HEALTH COMMITTEE MEETING IS NOW CALLED TO ORDER. MADAM CLERK, CAN YOU PLEASE CALL THE ROLL.
[Approval of Minutes ]
QUORUM. >> CASTILLO: THANK YOU SO MUCH.
ITEM 1 IS APPROVAL OF THE MINUTES FROM THE COMMUNITY HEALTH MEETING OF SEPTEMBER 28, 2023. CAN I GET A MOTION AND SECOND?
>> SECOND. >> CASTILLO: WE HAVE A MOTION AND A SECOND.
IS THERE -- SOUNDS GOOD. DO WE NEED A VOICE VOTE? ALL THOSE IN FAVOR? WE CAN NOW MOVE ON TO ITEM -- IS THERE ANY PUBLIC COMMENT?
>> THERE IS NO PUBLIC COMMENT. >> CASTILLO: THANK YOU.
[Briefing and Possible Action on ]
ITEM 2 IS BRIEFING ON THE METRO HEALTH 2.0 STRATEGIC PLAN AND IT WILL BEPRESENTED BY CLAUDE JACOB. >> JACOB: GOOD AFTERNOON AND BIDDING YOU GREETINGS FROM THE FANTASTIC TEAM AT METRO HEALTH. IT'S AN HONOR AND PLEASURE TO PROVIDE THIS UPDATE THIS AFTERNOON ON BEHALF OF OUR TEAM.
I'M JOINED BY MEMBERS OF MY SENIOR STAFF AS WELL AS A SPECIAL GUEST, DR. BENJAMIN, EXECUTIVE DIRECTOR AT THE AMERICAN PUBLIC HEALTH ASSOCIATION, HAS BEEN WITH US THIS WEEK. I DID WANT TO AT LEAST ACKNOWLEDGE DR. BENJAMIN.
AND BEFORE I DIVE INTO MY FORMAL PRESENTATION, I DID WANT TO AT LEAST HIGHLIGHT HIS BACKGROUND AND WHY HE'S ACTUALLY VISITING WITH US. FAIR ENOUGH? DR. BENJAMIN IS ONE OF THE NATION'S MOST INFLUENTIAL LEADERS BECAUSE HE SPEAKS PASSIONATELY ABOUT THE HEALTH ISSUES HAVING AN IMPACT ON OUR NATION TODAY.
HAVING TRANDATE THE BROOKS ARMY MEDICAL CENTER BACK IN THE '80S.
1978. HE HAS BEEN THE EXECUTIVE DIRECTOR AT THE AMERICAN PUBLIC HEALTH ASSOCIATION SINCE 2002, AND JUST WANTED TO AT LEAST SHARE WITH THIS BODY THE EXCITING NEWS FOR US IS THE FACT FOR THE FIRST TIME IN 40 YEARS THE ANNUAL MEETING OF THE AMERICAN PUBLIC HEALTH ASSOCIATION WILL BE TAKING PLACE HERE IN SAN ANTONIO, BUT IN 2026. AND SO WE DID WANT TO AT LEAST ACKNOWLEDGE THAT MILESTONE AND AS I TALK ABOUT THE CONTEXT OF METRO HEALTH 2.0 AND OUR FUTURE DATE, I DID WANT TO INVITE DR. BENJAMIN TO PROVIDE SOME REMARKS AND THEN I'LL DIVE
INTO MY PRESENTATION. >> GOOD AFTERNOON, EVERYONE. MADAM CHAIRPERSON AND MEMBERS OF THE COMMITTEE, THANK YOU FOR ALLOWING ME TO SPEND A COUPLE MOMENTS WITH YOU. I CAME DOWN MOSTLY TO TALK WITH CLAUDE AND TALK WITH MEMBERS OF HIS DEPARTMENT. I HAD AN OPPORTUNITY YESTERDAY TO MEET WITH YOUR CITY MANAGER TO TALK ABOUT THE ANNUAL MEETING. WE'RE REALLY EXCITED ABOUT COMING HERE. WHEN WE COME TO A CITY, WE BRING ABOUT 20 MILLION BUCKS DURING THE WEEK OR SO THAT WE'RE HERE. I LOVE THIS TOWN.
I SPENT THREE YEARS HERE AS A MEDICAL RESIDENT AT BROOKE AND, YOU KNOW, PUBLIC HEALTH HAS BECOME MY LIFE. I'M AN EMERGENCY PHYSICIAN, BUT I DRIFTED INTO PUBLIC HEALTH AND, YOU KNOW, WE ARE NOW IN THE PROCESS OF MODERNIZING OUR PUBLIC HEALTH SYSTEM AT THE NATIONAL LEVEL. SO IN MANY WAYS METRO HEALTH IS -- I'VE LOOKED AT YOUR STRATEGIC PLAN AND YOU ARE WELL ON YOUR WAY TO DOING THAT. AS THE NATION'S ASSOCIATION SUPPORTING PUBLIC HEALTH WORKERS AND THE FIELD, WE'RE REALLY HERE TO SUPPORT YOU. MY PURPOSE IN BEING HERE TODAY IS PROVIDE SUPPORT FOR BOTH THE DEPARTMENT AS WELL AS ANY MEMBERS OF THE COUNCIL AND YOUR COMMITTEE AND ANY WAY WE CAN BE HELPFUL OVER THE MANY YEARS THAT WE'VE BEEN AROUND. WE'VE BEEN AROUND SINCE 18712 SO WE HAVE A LITTLE --
1872 SO THANK YOU. THANK YOU. >> JACOB: THANK YOU, DR. BENJAMIN. I'VE BEEN A DID YOU SAY PAYING MEMBER OF THE AMERICAN HEALTH ASSOCIATION FOR NEARLY 30 YEARS AND I CURRENTLY SERVE AS A MEMBER OF DR. BENJAMIN'S EXECUTIVE BOARD. WITH THAT, THIS AFTERNOON THE PRESENTATION I WILL PROVIDE AN OVERVIEW OF OUR LATEST PLAN THAT'S BEEN
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CODIFIED BY OUR DEPARTMENT AS WE POSITION OURSELVES TO BE RECOGNIZED AS A 21ST CENTURY HEALTH DEPARTMENT. WITH THAT, MEDICAL EXAMINER 2.0.IT IS OUR DEPARTMENT'S NEW FIVE-YEAR STRATEGIC PLAN FOR OPERATIONALIZING INVESTMENTS IN PUBLIC HEALTH INFRASTRUCTURE AND MODERNIZATION.
THE PLAN SERVES AS OUR FRAMEWORK FOR BUILDING OUR INTERNAL CAPACITY TO RESPOND TO FUTURE PUBLIC HEALTH THREATS AND WORK WITH COMMUNITY PARTNERS TO ACHIEVE OUR VISION OF HEALTHY PEOPLE THRIVING IN A HEALTHY COMMUNITY.
THE PLAN ITSELF IS ORGANIZED IN THE SIX FOCUS AREAS AND I'LL HIGHLIGHT THEM THIS AFTERNOON. OUR WORK AROUND COMMUNITY ENGAGEMENT, DATA AND INFORMATION TECHNOLOGY, FINANCING, PARTNERSHIPS, PUBLIC HEALTH LAWS AND GOVERNANCE, AND WORKFORCE. JUST KNOW THE SUBTEXT HE IS APPLYING LESSONS LEARNED FROM THE COVID-19 PANDEMIC AND I CAN'T SAY ENOUGH ABOUT OUR FANTASTIC TEAM TO HELPING PIVOT WITHIN A PIVOT DURING OUR RESPONSE EFFORTS ON THE GROUND WITH COVID-19.
THE ALIGNMENT OF OUR WORK, THERE ARE NATIONAL PUBLIC HEALTH FRAMEWORKS.
METRO HEALTH 2.0 IS INFORMED BY COLLECTION OF THESE STRATEGIES AND FRAMEWORK.
THE SIX FOCUS AREAS IN THE PLAN COME FROM THE NATIONAL CALL TO ACTION THAT WAS CODIFIED BY THE U.S. BIPARTISAN POLICY CENTERS PUBLIC HEALTH FORWARD FRAMEWORK TO MODERNIZE THE SYSTEM AND GUIDE STRATEGIC INVESTMENTS FOR POLICYMAKERS. I SHOULD NOTE THAT MAYOR NIRENBERG SERVED ON THE 14-MEMBER TASK FORCE AND I HAD THE HONOR OF SERVING ON THE NATIONAL ADVISORY, SO 25 SUBJECT MATTER EXPERTS WERE BUTT TOGETHER IN 2021 TO AT LEAST HELP CODIFY THIS PLAN.
SO WE HAVE ROLLED OUT THE NATIONAL BLUEPRINT. IT'S BEEN LESS THAN TWO YEARS. WITH THAT, THIS IS AN OPPORTUNITY TO DEMONSTRATE HOW OUR WORK AT METRO HEALTH ALIGNS WITH THESE NATIONAL PLANS AND FRAMEWORKS.
ON THIS SLIDE YOU WILL ALSO SEE THE LOGO FOR THE PUBLIC HEALTH ACCREDITATION BOARD.
THIS IS A NATIONAL NON-PROFIT THAT WAS ESTABLISHED BACK IN 20007.
THERE ARE EIGHT LOCAL HEALTH DEPARTMENTS PHAB ACCREDITED AND WE HAD THE HONOR OF MEETING THESE STANDARDS IN 2019 SO WE'RE ON OUR JOURNEY TO REACCREDITATION AND NATIONWIDE ONE IN FIVE LOCAL HEALTH DEPARTMENTS HAS MET THESE STANDARDS OVER THE LAST DECADE. THIS PLAN I'M PRESENTING THIS AFTERNOON IS A REQUIREMENT FOR CONTINUED ACCREDITATION WHICH WE EXPECT TO COMPLETE ALL OUR PAPERWORK BY THE END OF NEXT YEAR. BY EARLY 2025, WE EXPECT TO BE PHAB REACCREDITED. LASTLY IN THE BOTTOM RIGHT CORNER, OVER THE COURSE OF THE PANDEMIC WE'VE HAD A NUMBER OF FRAMEWORKS REFRESHED.
THIS IS THE TEN ESSENTIAL HEALTH SERVICES, I JUST WANTED YOU TO KNOW WE ALIGNED THIS PUBLIC HEALTH 2.0 FRAMEWORK TO NATIONAL BLUEPRINTS AND IT GIVES A BETTER STANDARD TO MAKE SURE WE'RE USING THESE FRAMEWORKS AS WE TALK TO COLLEAGUES AND NETWORKS AND JURISDICTIONS FROM COAST TO COAST. SO THIS NEWS, YOU PROBABLY RECALL ABOUT A YEAR AGO LAST FALL, NOVEMBER 2022, WE RECEIVED A FEDERAL GRANT.
THE CDC PUBLIC HEALTH INFRASTRUCTURE GRANT. THIS GRANT WAS AWARDED AS A FIVE-YEAR GRANT. WE RECEIVED $25.5 MILLION OVER A FIVE-YEAR PERIOD.
THIS -- OUR METRO HEALTH # .0 PLAN IS ALIGNED WITH CDC'S GRANT GOALS TO BETTER SUPPORT THE DEPARTMENT'S EFFORTS. THIS PLAN AS I'M PRESENTING TO YOU HELPS TO ACCELERATE THE IMPLEMENTATION OF SA FORWARD WHICH I PRESENTED TO THIS BODY BEFORE AND YOU ARE FAMILIAR WITH SA FORWARD, BUT JUST SO YOU UNDERSTAND THE COMPLIMENT, THIS PLANS HELPS TO CODIFY THESE AREAS AROUND DATA AND INFORMATION TECHNOLOGY, OUR ONGOING WORK AROUND HEALTH EQUITY AND SOCIAL JUSTICE AND EVOLUTION OF OUR WORK AROUND MENTAL HEALTH AND COMMUNITY RESILIENCE AS WELL AS VIOLENCE PREVENTION EFFORTS. THERE'S NEARLY $2 MILLION OF SUPPORT FOR THE SA FORWARD INITIATIVE AND IT HELPS TO RETAIN 22 POSITIONS TO BUILD THE CAPACITY OF THAT PLAN.
WHY ARE WE TALKING ABOUT THIS? ACCORDING TO RECENT ANALYSIS FROM TUB HEALTH NEEDS SURVEY, THERE HAVE BEEN THREE OF THESE SURVEYS OVER THE LAST SIX OR SEVEN YEARS. NATIONALLY NEARLY HALF OF STATE AND LOCAL PUBLIC HEALTH EMPLOYEES LEFT THEIR JOBS BETWEEN 2017 AND 2021, EXACERBATING AN EXISTING WORKFORCE SHORTAGE. 46% OF LOCAL EMPLOYEES LEFT ORGANIZATIONS DURING THAT
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TIME. A NUMBER THAT ROSE TO 74% AMONG EMPLOYEES UNDER 35 AND 77% AMONG EMPLOYEES WITH LESS THAN FIVE YEARS OF EXPERIENCE.SO AGAIN, IN ADDITION TO ERODING SERVICES THAT IMPROVE FOOD SAFETY, MATERNAL CHILD HEALTH, INJURY PREVENTION AND OTHER NEEDS, THIS LOSS OF PUBLIC HEALTH EXPERIENCE AND INSTITUTIONAL KNOWLEDGE PUTS COMMUNITIES AT RISK FOR NEW INFECTIONS AND DISEASE THREATS AND OTHER HEALTH CRISES.
THEIR POSITIONS BY 2025. THIS IS ON TOP OF AN EXISTING SHORTAGE OF 80,000 FULL-TIME STAFF NEEDED TO PROVIDE ADEQUATE INFRASTRUCTURE AND FOUNDATIONAL PUBLIC SERVICES. SO WE PIVOT.
AND AGAIN, WE HAVE BEEN APPLYING LESSONS LEARNED IN THE MIDST OF OUR ONGOING RESPONSE EFFORTS TIED TO THE COVID-19 PANDEMIC. WE MADE A CONCERTED EFFORT TO INVEST IN THIS PLANNING PROCESS TO PREPARE FOR FUTURE STATES.
THROUGHOUT THE STRATEGIC PLANNING PROCESS WE MADE AN EFFORT TO ENGAGE STAFF AT ALL LEVELS. AN INTERNAL STRENGTHS AND WEAKNESSES AND SWAT ANALYSIS WAS RELEASED IN APRIL OF 2022, BELIEVE IT OR NOT THE SAME MONTH THAT WE ROLLED OUT SA FORWARD, AND THIS WAS TO UNDERSTAND OUR DEPARTMENT'S AREAS OF IMPROVEMENT FROM A STAFF PERSPECTIVE. WE GLEAN THAT FEEDBACK TO INFORM GOALS AND OBJECTIVES AND EACH OF THE FOCUS AREAS IN THE PLAN.
WE'VE CODIFIED SMART OBJECTIVES TO SUPPORT ACHIEVEMENT OF OUR METRO HEALTH 2 .0 PLANS IN OUR HOUSE AND WORK PLANS. WE TRY TO HAVE SOME FUN AND THIS MIGHT BE DIFFICULT TO SEE, BUT PARTICIPATED IN A NUMBER OF ROAD SHOWS TO GO PHYSICALLY TO OTHER SITES TO SOCIALIZE THIS. WE HAD SOME FUN AND WE HAD SOME BINGO GAMES, WE HAD TRIVIA. WE REALLY TRIED TO ENGAGE STAFF AND GET THEIR INPUT. AT THE END OF THE DAY WE DID THIS OVER THE COURSE OF THIS PAST SPRING AND USED OTHER RESOURCES TO HELP INFORM THIS PLAN WHICH WE ARE PRESENTING HERE TODAY. THESE ARE BENDS IN THE ROAD. AS I'VE BEEN TALKING ABOUT OUR EXPERIENCE, OUR SHARED EXPERIENCE AS A COMMUNITY AROUND OUR COVID RESPONSE EFFORTS AND THE ONGOING IMPACTS, JUST KNOW THAT WE RECOGNIZED EARLY ON AS EARLY AS SPRING OF LAST YEAR THAT WE NEED TO DO START TO PREPARE FOR THIS PHASE OF OUR WORK. SO WHAT YOU SEE HERE, AGAIN, THE ILLUSTRATION OF ADJUSTING TO BENDS IN THE ROAD. SO WHILE WE KICKED OFF INTERNALLY BACK IN SPRING OF 2022, WE DID OUR INTERNAL SWAT ANALYSIS THAT SAME SPRING. WE SHARED AND LAUNCHED OUR SA FORWARD PLAN THAT SAME SPRING. BUT THEN THE CDC HAD THE ANNOUNCEMENT THAT OCCURRED BY THE SUMMER, SO BY JUNE OF LAST YEAR WE REALIZED THAT WE HAD JUST ABOUT SIX TO EIGHT WEEKS TO PREPARE TO SUBMIT A SUCCESSFUL GRANT APPLICATION.
LAST NOVEMBER WE ANNOUNCED THERE BEING A RECIPIENT OF ONE OF THE FEDERAL GRANTS.
THERE ARE 107 GRANTEES NATIONWIDE, OVER $3 BILLION NO THE POOL TO SUPPORT THE INFRASTRUCTURE OF HEALTH DEPARTMENTS FROM COAST TO COAST.
WE HAVE HISTORICALLY BEEN A UNDER RESOURCED, UNDERUTILIZED, UNDER RECOGNIZED, UNDER APPRECIATED DISCIPLINE AND OUR FRAGILITY HAS BEEN IMPACTED AND EXACERBATED BY THE PANDEMIC. SO WE HAD TO SORT OF JUGGLE A NUMBER OF COMMITMENTS, WALK AND CHEW GUM AND JUGGLE BOWLING BALLS AT THE SAME TIME. WHAT YOU SEE IS A TIME LINE AND JUST KNOW THE ARC IS TOWARD NATIONAL REACCREDITATION. WE SUBMIT PAPERWORK BY THE END OF THIS YEAR AND EXPECT TO BE PHAB CREDITED BY EARLY 2025.
THIS IS A QUIT NOTE, THE LEFT SIDE OF THE SLIDE YOU'VE HEARD A LOT ABOUT SA FORWARD AND OUR SIX PRIORITY AREAS. IT'S A COMMUNITY BLUEPRINT INFORMED BY COMMUNITY PRIORITIES. IT IS A FIVE-YEAR PLAN.
WE HAVE -- WE TRACK THIS ON OUR MY SIDEWALK WEBSITE, THE DASHBOARD.
IT ADDRESSES HEALTH DISPARITIES EXACERBATED BY THE COVID-19 PANDEMIC AND THIS WAS CAT TAKE LIED BY AUTOPSY CERTIFIED BY THE CDC HEALTH DISPARITIES GRANT.
THE METRO HEALTH 2.0 PLAN, IT'S MORE INWARD FACING, IT'S INFORMED BY NATIONAL FRAMEWORKS. IT IS ALSO A FIVE-YEAR PLAN. IT'S TRACKED BY OUR INTERNAL PERFORMANCE DASHBOARD. AGAIN, THIS IS ABOUT ADDRESSING THE CHALLENGES OF AN OUTDATED PUBLIC HEALTH INFRASTRUCTURE AND THIS WAS MADE POSSIBLE BY THE SUPPORT OF THE CDC'S PUBLIC HEALTH INFRASTRUCTURE GRANT. SO THE HIGHLIGHTS OF THE PLAN. SO THERE ARE KEY DOCUMENTS. THIS IS ALL ABOUT ALIGNMENT, ALIGNMENT, ALIGNMENT INTERNAL TO METRO HEALTH. THESE ARE DOCUMENTS THAT WE USE TO SHAPE A CULTURE OF IMPROVED QUALITY AT THE DEPARTMENT.
THE SA FORWARD PLAN YOU ARE FAMILIAR IN TERMS OF ESTABLISHING GREATER HEALTH.
YOU ARE HEARING ABOUT METRO HEALTH 2.0 WHICH IS REQUIRED AS A STRATEGIC PLAN, BUT
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ALSO DOVE DETAILS WITH OUR INTERNAL ACTION PLAN AND INVESTMENT IN OUR STAFF AND WORKFORCE, WHICH IS ANCHORED AND REFLECTED IN OUR WORKFORCE DEVELOPMENT PLAN.SO HOW THIS IS MODELED, AGAIN, IT'S SIX FOCUS AREAS. IT'S MODELED AFTER THE NATIONAL BLUEPRINT FROM PUBLIC HEALTH FORWARD. THAT NATIONAL PLAN HAS A DOZEN CALLS TO ACTION. IN OUR PLAN WE HAVE 17 DEFINED GOALS, SO TO TWO THREE GOALS PER AREA. IT ACCELERATES SA FORWARD. I'LL QUICKLY HIGHLIGHT EACH OF THESE AREAS AND PART OF THIS TODAY IS MAKE SURE YOU ARE AT LEAST ORIENTED TO THE BLUEPRINT, AND THEN WE'LL HAVE SOME CONVERSATION ABOUT WHAT WE'RE INVESTING IN AS WE PREPARE TO LAUNCH THIS PLAN. SO WHY OUR INVESTMENT AROUND COMMUNITY ENGAGEMENT. WE BELIEVE IN INVESTING IN LONG-TERM RELATIONSHIPS WITH COMMUNITY-BASED ORGANIZATIONS AND COMMITTED TO INVESTING IN THE CAPACITY OF OUR PARTNER ORGANIZATIONS ON THE GROUNDEN A PROVIDING RESOURCES TO SUPPORT COLLABORATION TO SUPPORT THE WORK OF HEALTH DEPARTMENTS. THE THREE GOALS YOU SEE ARE ABOUT EMPOWERING STAFF, DEVELOPING STRATEGIES AND BETTER PRACTICES TO ENGAGE MEMBERS IN DECISION-MAKING, AND AGAIN, THERE'S BEEN A LOT OF TALK ABOUT HOW DO YOU DEFINE AS STEVEN COVEY WOULD SAY A WIN-WIN AND MAKING SURE THERE'S A BETTER BALANCE BUT IN PARTNERSHIP WITH OUR STAKEHOLDERS ON THE GROUND.
DATA AND INFORMATION TECHNOLOGY. AGAIN, APPLYING LESSONS LEARNED. IT'S NO SECRET A LOT OF WHAT WE HAD AND WHAT WE'VE EXPERIENCED ON THE GROUND HAS BEEN OLD SCHOOL. WE'VE BEEN TRYING TO AUTOMATE A NUMBER OF FUNCTIONS. THE THREE GOALS WHICH ARE INTENDED TO STRENGTHEN THE COLLECTION MUCH TIMELY AND ACTIONABLE DATA TO GUIDE OUR PROGRAMS, RESPOND TO EMERGENCIES AND ADDRESS HEALTH INEQUITIES.
IT'S ALSO ABOUT INVESTING IN DATA SHARING BETWEEN HEALTH DEPARTMENTS AND HEALTH CARE ENTITIES. WHAT YOU SEE HERE ABOUT OUR INVESTMENT IN CONDUCTING COMPREHENSIVE ASSESSMENTS, MAKING SURE THAT WE HAVE A DEPARTMENTAL-WIDE PLAN TO ADDRESS THESE GAPS AND NEEDS. BUT AT THE END OF THE DAY, IMPLEMENTING THE DATA AND INFRASTRUCTURE PLAN IN ASSIGNMENT WITH THE CITY'S DATA GOVERNANCE ADMINISTRATIVE DIRECTIVE. WITH THAT, WE ARE, YOU KNOW, INVESTING IN THE TRAINING OF OUR STAFF AND JUST MAKING SURE THAT WE'RE APPLYING THESE TOOLS AND RESOURCES TO BE A BETTER RESOURCE TO OUR COMMUNITY PARTNERS AND WITHIN THE AGENCY. FINANCING. AGAIN, IT'S NO SECRET THAT THE CHALLENGES THAT WE'VE EXPERIENCED IN OUR VERY ANEMIC DISCIPLINE HISTORICALLY, SO THIS IS ABOUT MAKING SURE WE HAVE ESTABLISHED FLEXIBLE FUNDING AND MAXIMIZING THE ASSETS TO SUPPORT OUR PUBLIC HEALTH SERVICES AND CAPABILITIES.
AND TO DO A BETTER JOB IN EVALUATING THE SOCIAL AND ECONOMIC IMPACT OF PUBLIC HEALTH PROGRAMS AND STRATEGIES, AGAIN, HAVING BEEN HERE A COUPLE YEARS, I CAN SAY THAT WE'VE TAKEN ADVANTAGE OF EXTERNAL GRANT FUNDING TO ACCELERATE THE GROWTH OF OUR DEPARTMENT, BUT THAT COMPLIMENT HAS BEEN STABILIZED BY THE INVESTMENT AND SUPPORT OF THE GENERAL FUND. JUST KNOW THIS IS INTENDED TO LOOK AT THE ALLOCATION OF OUR FUNDING TO ADDRESS GAPS IN CORE PROGRAMS, RETAIN EXISTING STAFF. IN ADDITION TO ENHANCING THE STANDARD FOR OPERATING PROCEDURES AS WE AT LEAST WORK ON OUR INTERNAL PROCESSES AND ESPECIALLY ADOPTING ZERO BASED BUDGETING, BUT ALSO CREATING A DASHBOARD AND ENHANCES THE ACHIEVEMENT OF ESTABLISHED GOALS. SO JUST KNOW THAT WE HAVE INVESTED IN THIS WORK OVER TIME AND JUST KNOW THAT WE'RE MAKING STEADY PROGRESS IN THIS SPACE AND JUST KNOW THAT THIS IS ADDRESSING A NATIONAL CONUNDRUM IN THE FINANCING OF HEALTH DEPARTMENTS. PARTNERSHIPS, JUST LIKE COMMUNITY ENGAGEMENT, THIS IS MORE ABOUT US BECOMING MORE INTENTIONAL IN HOW WE ESTABLISH AND NURTURE PARTNERSHIPS ON THE GROUND. HEALTH DEPARTMENTS ARE NOT ISLANDS UNTO THEMSELVES. IF YOU LOOK AT THE TEN ESSENTIAL SERVICES, NUMBER 4 TALKS ABOUT MOBILIZING OR STRENGTHENING PARTNERSHIPS, AND IT'S REALLY IN ORDER TO PROTECT ALL THOSE WHO LIVE, LEARN, WORK, PRAY IN OUR JURISDICTIONS.
JUST KNOW THIS IS BY DESIGN AND OUR THREE GOALS ARE ABOUT CREATING NEW AND EXPANDING EXISTING PARTNERSHIPS, GENERATING FUNDING TO SUPPORT THE WORK IN CONCERT WITH COMMUNITY PARTNERS, BUT ALSO INCREASING STAFF KNOWLEDGE NOT JUST TO COLLABORATE WITH PARTNERS BUT ALSO IN TERMS OF OUR AMBASSADORSHIP.
JUST KNOW THAT ABOUT A YEAR AND A HALF AGO WE ESTABLISHED AN OFFICE OF POLICY AND CIVIC ENGAGEMENT AND WE'VE INVESTED IN A SERIES OF TRAINING FOR INTERNAL AND EXTERNAL STAFF TO BUILD COALITION BUILDING AND RESOURCE COORDINATION AND THAT'S BEEN BY DESIGN. THE LAST COUPLE OF AREAS. IN TERMS OF PUBLIC HEALTH LAWS AND GOVERNANCE, TWO GOALS. ADVANCING OUR PUBLIC HEALTH POLICY AGENDA IN CONCERT WITH THE CITY'S GOVERNMENT AFFAIRS DEPARTMENT, BUT ALSO
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SUPPORTING OUR DEPARTMENT BY CLEARLY COMMUNICATING OUR MISSION AND DEMONSTRATING VALUE TO THE PUBLIC. SO JUST KNOW THAT THIS IS ABOUT REVIEWING AND EVALUATING AND MODERNIZING OUR PUBLIC HEALTH GOVERNANCE STRUCTURES, BUT ALSO SUPPORTING THE ROLES LIKE HEALTH DEPARTMENTS CAN PLAY ON THE GROUND TO SUPPORT OUR WORK. AND AGAIN, IN THE EXPERIENCE OF COVID, JUST KNOW THAT NATIONALLY THE DIALOGUE AROUND THE CHALLENGES TO OUR PUBLIC HEALTH AUTHORITY, DR. WUH AUTHORITY, JUST KNOW THAT EACH AND EVERY DAY WE TALK ABOUT THE EXPERIENCES THAT WE HAD NOT JUST THROUGH COVID BUT THE IMPLICATIONS MOVING FORWARD.SO WORKFORCE. WORKFORCE, WORKFORCE. I MENTION THIS ONLY BECAUSE AT THE CORE OF THIS, YOU KNOW, WE HAVE MADE A CONCERTED EFFORT TO INVEST IN THE RECRUITMENT AND RETENTION OF STAFF TO OUR WORK.
WE ARE COMMITTED TO WORKING WITH OUR H.R. DEPARTMENT IN IMPROVING THE HIRING AND PROMOTION POLICIES AND PROCESSES. WE IN CONCERT HAVE ESTABLISHED A COLLABORATION WITH THE COLLABORATIVE SCHOOL OF PUBLIC HEALTH, SCHOOL OF PUBLIC HEALTH IN SAN ANTONIO. THIS IS ABOUT ESTABLISHING AND DEMONSTRATING OUR COMMITMENT AS AN ACADEMIC HEALTH DEPARTMENT AND JUST KNOW THAT WE ARE NOW IN YEAR 2 OF THAT COLLABORATION AND IT REALLY DOES MY HEART GOOD TO SEE HOW WE HAVE CODIFIED OUR SUPPORT FOR THE WORKFORCE AND IT'S REFLECTED THIS THESE THREE GOALS ABOUT OUR INVESTMENT AND OUR PROFESSIONAL DEVELOPMENT, BUT ALSO MAKING SURE THAT WE RECRUIT TALENT TO OUR WORK. SO WITH THAT, COMING TO A THEATER NEAR YOU, WE HAVE METRO HEALTH 2.0. THIS IS OUR STRATEGIC PLAN.
THIS IS REALLY ABOUT MODERNIZING OUR PUBLIC HEALTH INFRASTRUCTURE.
THIS IS PART AND PARCEL WITH WHAT'S HAPPENING FROM COAST TO COAST AND APPLYING LESSON LEARNED FROM COVID. THIS PLAN AS WE HAVE IS INTENDED TO ACCELERATE THE IMPLEMENTATION OF OUR SA FORWARD PLAN WHICH WE MADE A COMMITMENT TO THAT OVER A YEAR AND A HALF AGO. AND JUST WANTED TO SAY THIS HELPS US TO STRENGTHEN OUR CAPACITY FOR PARTNER AND COMMUNITY ENGAGEMENT. SO I SAY THIS HAVING LED A HEALTH DEPARTMENT IN OTHER JURISDICTION IN CAMBRIDGE WHEN WE WENT THROUGH THE NATIONAL ACCREDITATION PROCESS, AND LANDING HERE AND SEEING THE COMMITMENT AND RESOLVE NOT ONLY BY OUR STAFF BUT ALSO OUR COMMUNITY PARTNERS, IT DOES MY HEART GOOD TO PRESENT THIS PLAN TO YOU TODAY. I WOULD BE REMISS IF I DIDN'T AT LEAST ACKNOWLEDGE THE KEY FOLKS WHO HELPED TO MAKE THIS HAPPEN.
SO BEHIND ME WE HAVE ASSISTANT DIRECTOR MARIO MARTINEZ.
THIS WORK IS ANCHORED TO THE DIVISION OF HEALTH AND OPERATIONS.
THAT UNIT HAS BEEN TASKED WITH HELPING US TO ESTABLISH A CULTURE OF IMPROVED QUALITY AT OUR DEPARTMENT AND I CAN'T SAY THANKS ENOUGH TO MARIO AND HIS TEAM. CLARISSA CORTEZ SERVES AS THE PUBLIC HEALTH ADMINISTRATOR WHO OVERSEES BUT AGAIN, THE INCREDIBLE SUPPORT OF OUR EXECUTIVE LEADERSHIP TEAM AND THE DIFFERENT UNITS WHO ARE HELPING TO MAKE THIS HAPPEN. I'LL STOP THERE AND I'M NOT SURE IF YOU WANTED ME TO FIELD QUESTIONS NOW OR IF YOU WANTED ME TO QUEUE UP THE NEXT PRESENTATION. I'LL DEFER TO YOU. WE HAVE TWO TODAY.
FANTASTIC. >> CASTILLO: THANK YOU SO MUCH FOR THE PRESENTATION.
IF YOU ALL CAN SIGNAL AND I CAN GET YOU ON THE QUEUE. GREAT.
WE CAN HAND IT OVER TO COUNCILMEMBER GAVITO. >> GAVITO: THANK YOU, CHAIR. I JUST HAD A FEW QUICK QUESTIONS.
SO ON SLIDE 5, YOU KNOW, IT SHOWS ABOUT THE NUMBER OF PUBLIC HEALTH WORKERS WHO ARE LEAVING THE FIELDS. WHAT IS THE MAJORITY OF THOSE POSITIONS THAT ARE
NEEDED TO BE BACKFILLED? >> JACOB: THIS IS NATIONALLY.
>> GAVITO: OKAY. >> JACOB: THIS IS REALLY BASED ON NATIONAL STUDIES.
LOOKING AT THE ANEMIC STATE OF THE WORKFORCE. THE CONTEXT OF THIS IS THAT BETWEEN 200 ON -- 20008 AND '16 THE WORKFORCE SORT OF DISSOLVED.
THIS IS JUST SPEAKING TO FACT WE NEED TO SHORE UP OUR STAFFING CAPACITY FOR HEALTH
DEPARTMENTS FROM COAST TO COAST. >> GAVITO: GREAT.
WHAT IS THAT LOOKING LIKE LOCALLY? >> JACOB: OUR VACANCY RATE CURRENTLY HOVERS AROUND 8%. I HAVE TO SAY OVER THE LAST TWO FISCAL YEARS OUR AGENCY HAS GROWN IN SIZE THANKS TO THE FUNDING THAT WE RECEIVED, BUT ALSO LEVERAGING THE GENERAL FUND. SO I WOULD SAY THIS IS THE NATIONAL PERSPECTIVE.
WE'RE DOING MUCH BETTER COMPARED TO HEALTH DEPARTMENTS ACROSS CITIES,
TOWNS AND COUNTIES. >> GAVITO: OKAY. YES, SOUNDS GOOD.
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THAT'S WHAT I WAS TRYING TO GET AT, WHAT IT LOOKS LIKE LOCALLY.ON SLIDE 11, I LOVE THE COMMUNITY ENGAGEMENT ASPECT AND I WOULD JUST ASK THAT HOWEVER YOU NEED TO LEVERAGE THE DISTRICT 7 OFFICE AS WELL AS PROBABLY THE OTHER COUNCIL COLLEAGUES' OFFICE TO GET THE WORD OUT OR HELP WITH THAT, YOU KNOW,
AVAILABLE TO SUPPORT THAT. >> JACOB: THANK YOU TO EACH AND EVERY ONE OF YOU AND YOU ARE AMBASSADORS OF THIS WORK. WHATEVER WE CAN DO THROUGH THE SUPPORT OF YOUR DISTRICT OFFICES TO HELP PEOPLE UNDERSTAND THE NATURE OF PUBLIC HEALTH AND NOT JUST OUTREACH PROGRAMS, BUT WE'LL TAKE YOU UP ON THAT
INVITATION. >> GAVITO: GREAT. AND WE COULD TAKE THIS MORE OFF LINE, BUT ONE OF THE THINGS WE HAD DONE IS SEND OUT A PHYSICAL NEWS LATER AND OUR RESIDENTS WERE REALLY HAPPY ABOUT IT AND WE'RE GOING TO SEND ANOTHER ONE OUT IN DECEMBER. YOU KNOW, WE'RE REALLY JUST HAVING IN OVERARCHING FOCUS OF MAKING SURE RESIDENTS ARE OPPORTUNITIES TO IMPROVE NOT ONLY THEIR PHYSICAL HEALTH BUT THEIR MENTAL HEALTH. WE'RE REALLY TRYING TO PUSH PROGRAMS GOING ON IN THE CITY, TAKING ADVANTAGE OF GREEN SPACES, GOING ON WALKS AND THAT KIND OF STUFF.
AND I REALLY, YOU KNOW, JUST A GENTLE NUDGE TO TRY TO GET PEOPLE IN IN THAT FRAME OF
MIND. >> JACOB: WE HAVE STAFF ON THE GROUND.
WE WORK WITH OUR PARTNERS IN POCKETS OF THE COMMUNITY SO LET US KNOW AND WE'LL MAKE SURE WE HAVE THE MATERIALS AND CONNECT TO YOUR DISTRICT AS WELL.
>> CASTILLO: THANK YOU. -- >> GAVITO: THANK YOU.
>> GARCIA: THANK YOU FOR THE PRESENTATION, DR. JACOB. I FEEL LIKE I HAVE SOME QUESTIONS AND A LOT OF THEM I'LL ASK OFF LINE. BUT ONE OF MY FIRST QUESTIONS IS ON YOUR SWAT ANALYSES ACROSS DEPARTMENTS, WHAT DID YOU FIND OR WAS
THERE A COMMON WEAKNESS? >> JACOB: SO GREAT QUESTION.
SO I WOULD SAY THAT, AGAIN, IF YOU IMAGINE THE FATIGUE BEING REAL, IF YOU IMAGINE THE FUNDING STREAMS AND THE DISRUPTION OF OUR FUNDING CYCLES, WE FOUND THAT TO BE A STRESSOR FOR STAFF. BUT IN TERMS OF THE AGENCY, I WOULD SAY THAT THE BIGGEST CHALLENGE HAS BEEN JUST ABOUT MAKING SURE THAT WE MAINTAIN THE STABILITY OF OUR PROGRAMMING. SO I FIND THAT TO BE A REASON FOR US TO ALSO PIVOT.
WE SEE THAT AS A STRENGTH NOW THAT WE'VE BEEN ABLE TO LEVERAGE EXTERNAL GRANT FUNDS BUT ALSO THE GENERAL FUND TO AT LEAST SHORE UP SOME OF OUR PROGRAMS. IN THE END IT WAS LACK OF FUNDING, BUT WE STABILIZED THAT OVER THE COURSE OF THE
LAST COUPLE YEARS. >> GARCIA: I ALSO HAVE A QUESTION, I DON'T KNOW IF THIS WOULD FIT INTO THIS, BUT TODAY IS THE 25TH ANNIVERSARY OF THE METHODIST CHILDREN'S HOSPITAL. AND THE -- SO AS I WAS THINKING ABOUT THAT, I WAS WONDERING WHAT IS THE STATE OF OUR CHILDREN'S HEALTH IN OUR CITY? AND WHERE ARE WE QUESTIONING THAT, AND IF WE'RE NOT QUESTIONING THAT IN THIS 2.0
STRATEGIC PLAN, WHERE WOULD WE BRING THAT UP? >> JACOB: THE STATE OF CHILDREN'S HEALTH, A COUPLE YEARS AGO YOU MAY HAVE SEEN THE DECLARATION DURING COVID-19 FROM THE AMERICAN ACADEMY OF PEDIATRICS ABOUT THE ONGOING STRESSORS FOR CHILDREN AND THE NATIONAL DECLARATION ABOUT MENTAL HEALTH IN THESE CREE SEASES.
AT THE END OF THE DAY IT'S NOT ONE ISSUE. IF YOU LOOK AT OBESITY RATES, IF YOU LOOK AT THE AVERAGE CHILDHOOD EXPERIENCES AND OUR INVESTMENTS IN THAT BEHAVIORAL HEALTH SPACE, WE'VE HAD TO TRIANGULATE.
KIDS ARE DEALING WITH A LOT THESE DAYS, BUT THIS PLAN IS INTERNAL TO THE WORK OF THE DEPARTMENT. SO WHAT YOU DON'T SEE HERE IS A SPECIFIC PROGRAM OR INITIATIVE. THIS IS REALLY ABOUT SHORING UP THE WORK OF THE DEPARTMENT, BUT IT'S A COMPLIMENT TO THE SA FORWARD PLAN WHERE WE HAVE OUR INVESTMENT IN ACCESS TO CARE, FOOD INSECURITY, VIOLENCE, MENTAL HEALTH, SO JUST KNOW THAT KIDS ARE PEOPLE TOO AND WE JUST WANT TO MAKE SURE THAT WE CONTINUE TO ADDRESS THE CONDITIONS THAT IMPACT THEIR QUALITY OF LIFE.
>> GARCIA: DO WE HAVE ENOUGH PUBLIC HEALTH EMPLOYEES IN SAN ANTONIO RIGHT NOW TO ADDRESS THE GROWING NEEDS OF OUR COMMUNITY?
>> JACOB: ENOUGH PUBLIC HEALTH EMPLOYEES TO ADDRESS THE GROWING NEEDS.
>> GARCIA: AND I'M TALKING ABOUT PREVENTIVE CARE, IN YOUR OPINION.
I WOULD HOPE THAT YOU WOULD SAY I ALWAYS NEED MORE MONEY, RIGHT? BUT I'M JUST TRYING TO SEE LIKE WHAT DO YOU NEED FROM US.
>> JACOB: THIS IS NOT A FISCAL ASK. WE ARE THANK PHYSICAL OF THE INCREDIBLE SUPPORT -- WE HAVE GROWN AS AN AGENCY. THE FACT THAT WE HAVE GONE FROM 450 OR SO AUTHORIZED POSITIONS TO OVER 650 AUTHORIZED POSITIONS JUST IN A VERY SHORT AMOUNT OF TIME, ACCELERATED BY OUR GRANTS. NEVER SAY NO TO ADDITIONAL RESOURCES, BUT I ALSO WANT TO THANK THE COUNCIL AND THE CITY MANAGER AND OUR INCREDIBLE PARTNERS FOR INVESTING THE WORK OF METRO HEALTH.
[00:30:01]
>> GARCIA: AND I THINK THAT'S WHY I WAS ASKING. TO ME THE FOCUS THAT WE DO AT METRO HEALTH IS MORE PREVENTIVE AND I FEEL LIKE THAT'S WHAT NEEDS MORE ATTENTION. THERE'S A LOT OF FOR-PROFITS OUT THERE, THERE'S BEEN SOME F WORK LIKE A FOR-PROFIT, BUT I FEEL IF WE FOCUS ON THE PREVENTIVE AND IF WE COULD INVEST MORE CRITICAL, EVEN INSURANCE AND THOSE WITH INSURANCE OR THOSE THAT LACK INSURANCE AND SO I WAS AT THE DOCTOR'S EARLIER AND I -- I HAVE A SIGN NEWS INFECTION. AND THEY SAID OH, WE -- I MENTIONED THAT I HAD LIKE AN EAR ACHE AND SOMETHING. SHE SAID WE CAN ONLY ADDRESS ONE ISSUE. AND SO IT'S LIKE SHE SAYS PER CONSULTATION.
I SAID SO DO YOU JUST WANT ME TO GO BACK OUT AND SIGN IN A SECOND TIME? AND SO -- AND SHE KIND OF GIGGLED AND SHE'S LIKE ACTUALLY IT'S PER DAY.
SO YOU WOULD HAVE TO COME BACK TOMORROW. I WAS LIKE, FIRST OF ALL, I DIDN'T TELL HER I'M ON MY LUNCH BREAK, LADY. BUT WHATEVER, RIGHT? SO THEN I WAS LIKE -- AND I HAVE INSURANCE. SO I'M THINKING HERE'S A PARENT THAT MIGHT M HAVE A SICK CHILD AND HAS MULTIPLE SYMPTOMS OF DIFFERENT THINGS, ASTHMA OR SINUS OR WHATEVER IT IS, BUT WE CAN ONLY ADDRESS ONE SO YOU NOW AS A PARENT HAVE TO CHOOSE. I FEEL LIKE A LOT OF THAT IS THE PREVENTIVE.
I LOVE YOUR ASTHMA PROGRAM, BY THE WAY. I JUST FEEL LIKE WE NEED TO CONTINUE INVESTING IN THAT BECAUSE I DON'T FEEL LIKE OUR INSURANCE SYSTEM IS
DOING A WHOLE LOT TO MAKE ME FEEL MORE CONFIDENT. >> JACOB: THAT'S THE BREAD AND BUTTER OF OUR WORK IS INVEST IN PROMOTING HEALTHIER LIFESTYLES, PREVENTING THE SPREAD OF DISEASE OR INJURIES. YOU ARE DESCRIBING OTHER CHALLENGES TO THE FINANCING OF HEALTH CARE SERVICES. JUST SAYING WHATEVER IT IS WE CAN DO OUT IN COMMUNITY TO PROMOTE HEALTHIER BEHAVIORS, WE'RE COMMITTED
TO THAT. >> GARCIA: WE'RE HERE TO HELP.
THANK YOU. >> CASTILLO: I'M ALWAYS IMPRESSED BY DR. ROCHA
GARCIA ASKING THE QUESTIONS, GETTING THE WORK DONE. >> I APPRECIATE THE UPDATES.
YOU GUYS ARE IN MY DISTRICT QUITE A BIT. I JUST WANTED TO COMMEND YOU FOR TAKING A NATIONAL FANNIE MAE WORK AND MAKING IT WORK ON A LOCAL LEVEL.
THE ONE EXAMPLE I WANT TO TOUT IS THE TRAILS WE JUST DID, THAT FIRST CAME TO MY MIND. ACTUALLY I HAVE TWO EXAMPLES.
IT WAS PARKS, IT WAS METRO HEALTH AND IT WAS REALLY SPEAKING TO WHAT THE COMMUNITY LOVES WHICH IS BEING OUTDOORS AND THE TRAILS.
AND THE SECOND IS, OF COURSE, VIA CORONADO AND TAKING THAT BUILDING AND REALLY REPURPOSING IT WITH ALL THE DIFFERENT DEPARTMENTS FROM METRO HEALTH AND GETTING THEM OUT THERE ON WHAT WAS A VERY HOT DAY TO KIND OF PASS OUT THINGS TO A COMMUNITY THAT, YOU KNOW, IS -- IS IN NEED OF HEALTH AND THEN THE MINUTE WE OPEN THAT BUILDING, THE [INAUDIBLE] CENTER WE HAVE PROBLEMS WITH THE OTHER BUILDING. I THINK IT'S THAT FLEXIBILITY AND THE FACT THE NUTRITION IS OUT THERE TRYING TO TELL MY TEAM NO, DON'T BRING DONUTS TO THE MEETING, BRING A HEALTHY OPTION. IT'S THOSE THINGS THAT I APPRECIATE IS THAT IT IS A NATIONAL FRAMEWORK, BUT YOU'RE UNDERSTANDING LOCALLY WHO WE ARE DEALING WITH BECAUSE YOU HAVE SO MANY QUALITY BOOTS ON THE GROUND PEOPLE THERE. MY CONCERN IS THE LACK OF WORKERS AND REALLY WORKING FORWARD WITH THE COMMUNITY COLLEGES AND EVEN GOING YOUNGER.
I THINK WE NEED TO START GOING INTO MAYBE THAT FIFTH GRADE, MIDDLE SCHOOL TO SAY, HEY, WHAT DO YOU WANT TO DO AND THESE ARE THE OPTIONS WE HAVE IN HEALTH CAREERS HERE WITHIN THE CITY OF SAN ANTONIO AND WITHIN OUR MEDICAL INDUSTRY.
I THINK WE MAY NEED TO KIND OF LOOK AT THAT AND MAYBE WORK WITH THE SCHOOL DISTRICTS OR DIFFERENT PROGRAMS BECAUSE I DO LOVE -- I LOVE GIRLS INC.
AND GIRLS ON THE RUN AND THEY ARE DOING A LOT OF THINGS, BUT WE NEED TO HAVE TO START THEM THINKING ABOUT CAREERS ALSO AND WHAT DECISIONS THEY MAKE.
THANK YOU. >> JACOB: THANK YOU. >> CASTILLO: THANK YOU.
COUNCILMEMBER KAUR. >> KAUR: WAS THIS BUILT PRE-DOBBS OR POST-DOBBS?
>> JACOB: PRE-DOBBS. >> KAUR: WAS THERE A THOUGHT HOW IT MIGHT NEED TO
EVOLVE OR CHANGE GIVEN OUR CIRCUMSTANCES? >> JACOB: GREAT QUESTION.
SO THE VALUE OF HAVING THIS IS OUR ABILITY TO AT LEAST TWEAK AND MODIFY AND ADJUST AS NEEDED. IT IS A FIVE-YEAR PLAN SO YOU HAVE TO HAVE A STARTING
[00:35:04]
POINT. AND WE HAVE THESE DEFINED GOALS AND WITHIN THAT EACH YEAR, EACH QUARTER WE'RE GOING THROUGH JUST TO SEE WHAT'S THE EFFECTIVENESS OF APPLYING THE PLAN. WE'RE GOING THROUGH THAT ADJUSTMENT RIGHT NOW WITH THE SA FORWARD PLAN, BUT OUR AGILITY THROUGH NOT JUST COVID BUT JUST IN GENERALHAS BEEN OUR LESS ASSET TO ADJUSTING TO OUR STRATEGIES. >> KAUR: WOULD IT BE SAFE TO SAY YOU ALL EVALUATE ON AN ANNUAL BASIS WHERE YOU ARE SEEING THE MOST NEED AND
CAN PIVOT? >> JACOB: INTERNALLY WE HAVE OUR OWN DASHBOARD.
JUST LIKE WITH SA FORWARD, YOU WILL HEAR ABOUT THE PROGRESS AS WE IMPLEMENT THE PLAN. YOU WILL GET THE FIRST REPORT IN THE COMING YEAR.
>> KAUR: YOU CAN ALLOCATE IF YOU NEED MORE FUNDING IN PUBLIC HEALTH OR ADVOCACY
YOU CAN MOVE DOLLARS AND RESOURCES NIMBLEY. >> JACOB: MOST OF THIS IS TIED TO STAFF FUNCTIONS, BUT IN TERMS OF REALLOCATION OF RESOURCES, WE MAY RECOMMEND JUST BASED ON OUR LENS AND THE WORK WE'RE SEEING ON THE GROUND OR THE FEEDBACK THAT
WE'RE GETTING FROM PARTNERS. >> KAUR: MY ALWAYS BIGGEST WITH STRATEGIC PLANS THERE'S THIS PRETTY DOCUMENT AND WE BLINDLY GO AT THEM WITHOUT ANNUALLY REFLECTED.
WHAT I'M HEARING FROM YOU THIS IS MORE SO THE FRAMEWORK FOR THE PRIORITIES YOU GUYS ARE GOING TO BE FOCUSING ON AND BASED ON THE DATA AND CASES YOU ARE GOING
TO CHANGE AS NECESSARY. >> JACOB: WE TALK ABOUT CYCLES, PLAN, DO, CHECK, ACT. THIS IS A WAY TO APPLY THESE PRINCIPLES TO MAKE SURE WE'RE SYSTEMATICALLY JAY JUST ADJUSTING AND LEARNING.
THIS IS A WAY WEEK TWEAK AND IMPROVE AND IT'S BAKED INTO THE PLAN AND WE'LL SEE HOW THAT MAN TESTS IF WE NEED TO ADJUST FURTHER DOWN THE ROAD.
>> CASTILLO: THANK YOU FOR THE PRESENTATION AND FOR YOUR PEOPLE TORE THE WORK YOU CONTINUE TO ACCOMPLISH. ONE THING I VALUE IS HOW YOU ALL INCORPORATED THE INPUT FROM STAFF AT ALL LEVELS. IT WASN'T JUST LEADERSHIP MAKING DECISIONS FOR EVERYONE INCLUDING ALL TEAM MEMBERS TO GIVE INPUT, PROVIDE DIRECTION AND INSIGHT I THINK IS HOW WE CREATE CULTURES THAT ARE REFLECTED IN THE 8% VACANCY.
IN COMPARISON TO NATIONAL NUMBERS, THAT'S VERY, VERY LOW.
THANK YOU TO YOU AND YOUR TEAM. I DID HAVE A COUPLE OF QUESTIONS, FOR EXAMPLE, ON SLIDE 12, I'M LOOKING AT GOALS 2 AND 3.
AND I'M WONDERING, DOES METRO HEALTH CURRENTLY OR PLAN ON COORDINATING WITH OTHER CITY DEPARTMENTS? AND I'M THINKING OF THE GOOD NEIGHBOR PROGRAM.
IS THAT SOMETHING THAT YOU ALL ARE ALREADY DOING AND INTENDING, OF COURSE, TO
CONTINUE TO DO? >> JACOB: YES. AGAIN, THIS IS INTERNAL TO THE WORK OF THE DEPARTMENT BUT WE WORK WITH OTHER DEPARTMENTS.
I REFERENCE THE ALIGNMENT WITH THE ADMINISTRATIVE DIRECTIVE.
JUST KNOW THIS IS BY DESIGN. WE HAVE DEDICATED STAFF, EPIDEMIOLOGISTS OR DETECTIVES. WE HAVE STAFF WHO COMMIT TO WORKING IN CONCERT WITH DIFFERENT INITIATIVES ACROSS THE CITY. SO JUST KNOW THAT YES, THIS
IS ANCHORED TO THE WORK OF THE DEPARTMENT. >> CASTILLO: GREAT.
ON SLIDE 13, WITH SOME OF THE ADDRESSING THE GAPS IN CORE PROGRAMS, WHAT ARE SOME
OF THE CURRENT CORE PROGRAMS THAT HAVE SOME GAPS? >> JACOB: THIS IS THE CONUNDRUM WITH PUBLIC HEALTH. AGAIN AT TIMES, WE WERE TALKING ABOUT THIS EARLIER WITH OUR LEADERSHIP TEAM. THE EBB AND FLOW FOR INFECTIOUS DISEASES. WE'RE TO HEELS OF AND STILL THE ENDEMIC STATE OF COVID.
WE'RE TALKING ABOUT SEXUALLY TRANSMITTED INFECTIONS OR TUBERCULOSIS.
WE MUST CONTINUE TO MAINTAIN AND SHORE UP. IN THE LAST BUDGET WORK SESSION WE TALKED ABOUT THE NEED TO SHORE UP STAFFING TIED TO OUR TB STAFF.
I WOULD SAY THIS DOESN'T GO AWAY, BUT A QUARTER OF THE WORK IS MAKING SURE WE PROTECT THE HEALTH AND WELL-BEING OF THOSE IN OUR JURISDICTION.
A COUPLE EXAMPLES SPECIFIC TO COMMUNICABLE DISEASE, BUT JUST KNOW THAT'S SOMETHING WE'VE ADDRESSED IN THE CURRENT BUDGET BUT THAT DOESN'T GO AWAY.
>> CASTILLO: GREAT. MY LAST QUESTION IS, I KNOW YOU PARTNER WITH INSTITUTIONS AND DIFFERENT UNIVERSITIES TO RECRUIT STUDENTS.
DOES PART OF THE RECRUITMENT PROCESS INCLUDE VISITING CLASSES AND GIVING LIKE A MINI LECTURE TO STUDENTS ABOUT THE WORK YOU DO AT METRO HEALTH?
>> JACOB: I'M CHUCKLING AND LOOKING OVER MY SHOULDER, WE DIDN'T REHEARSE THIS, BUT RIGHT BEFORE THIS DR. BENJAMIN DID A CAMPUS ON ENVIRONMENTAL HEALTH BUT I TALKED ABOUT CLIMATE CHANGE AND PUBLIC HEALTH. YES, WE DO THAT.
HOW THAT CONVERTS TO RECRUITING TO OUR DEPARTMENT WE'LL SEE, BUT CLEARLY HE WOWED THE STUDENTS THERE FOR THAT CLASS. DID A BROADER LECTURE AND WE
[00:40:02]
CAN SHARE THE LECTURE WITH YOU IF YOU ARE INTERESTED. >> CASTILLO: I WOULD LOVE TO SHARE THE LECTURE. YESTERDAY I WAS AT U.T. HEALTH PRESENTING TO HOUSING ON A RN CLASS AND I ASKED HOW MANY KNOW WHO YOUR CITY COUNCILMEMBER IS.
THREE RAISED THEIR HANDS. WE NEED TO WORK FOR THE CITY OR RUN FOR OFFICE, I'M LIKE YES, BOTH. I THINK IT WAS A GREAT EXPERIENCE AND I THINK IN THE CLASSROOMS WITH THE STUDENTS IS A GREAT WAY TO RECRUIT FOLKS.
LOOKING FORWARD TO REVIEWING THE LECTURE THAT YOU ALL PRESENTED.
ANY OTHER QUESTIONS ON THIS ITEM? GREAT.
WELCOME NOW MOVE ON TO NUMBER 3, A BRIEFING ON REPORT OF ACCESS TO HEALTH
CARE IN BEXAR COUNTY DURING COVID-19. >> THANK YOU.
SO THIS YOU JUST SAW EARLIER FROM DR. JACOB, METRO HEALTH IS A NATIONALLY ACCREDITED HEALTH DEPARTMENT AND PART OF THAT IS THE ASSESSMENT PART OF THINGS.
SPECIFICALLY WE'RE TALKING ABOUT ASSESSMENT OF ACCESS TO HEALTH CARE SERVICES AND HOW THAT CHANGED DURING COVID-19. IT'S ALSO OUR ROLE TO SHARE THE INFORMATION WITH THE PUBLIC LIKE WE'RE DOING HERE WITH YOU TODAY AND IN OTHER FORMATS. AND IT WILL BE OUR ROLE TO HELP FACILITATE CONVERSATIONS ABOUT HOW TO FILL THE GAPS. SO -- BECAUSE I'M SO SHORT.
SO WE CAME TO COUNCIL IN APRIL OF 2022 ASKING FOR YOUR PERMISSION TO CONDUCT THIS RESEARCH, AND AT THAT TIME WE SAID WE KNEW NATIONALLY THAT PEOPLE WERE DELAYING CARE, WERE JUST NOT --N SEEKING CARE. THAT THE HEALTH CARE WORKFORCE WAS TRAUMATIZED. THAT TELEHEALTH WAS A GROWING PHENOMENON, BUT THAT IT WASN'T ACCESSIBLE TO EVERYBODY. SO THE IDEA HERE WAS TO GET OUR LOCAL LENS ON THOSE NATIONAL PROBLEMS SO THAT WE COULD ADDRESS THEM COLLECTIVELY. AND OUR PARTNERS IN THIS ENDEAVOR WERE THE HEALTH COLLABORATIVE WHICH WAS THE LEAD AND DID A FANTASTIC JOB.
SEE OUR COMMUNITY INFORMATION NOW WHICH IS A LOCAL SOURCE OF GRANULAR DATA, IF YOU ARE NOT FAMILIAR WITH THEM. UTSA, C-3 HIE, WHICH IS OUR LOCAL HEALTH INFORMATION EXCHANGE, THAT'S, FOR INSTANCE, HOSPITAL ADMISSIONS AND DISCHARGE DATA, AND, OF COURSE, THE U.T. SCHOOL OF PUBLIC HEALTH. THIS WAS FUNDED BY THE COVID GRANT THAT THE HEALTH DISPARITIES GRANT THAT DR. JACOB MENTIONED, AND THIS WAS -- ALL TOGETHER THEY WERE PAID 200,000 COLLECTIVELY FOR THIS RESEARCH.
YOU CAN ALSO SEE A TIME LINE ON THE LEFT AND JUST REAL BRIEFLY, WHEN I SAY EXTENT DATA, THAT'S ABOUT 25 DIFFERENT SOURCES. IT COULD BE EXISTING LARGE NATIONAL SURVEYS FROM THE CDC, IT COULD BE SURVEYS THAT ORGANIZATIONS WERE ALREADY DOING ON THEIR OWN. THE FOCUS GROUPS AND KEY INFORMANT INTERVIEWS INCLUDED ABOUT 75 PEOPLE INCLUDING SOME COUNCIL OR COUNCIL STAFF.
BUT ALSO HEALTH CARE LEADERS, NON-PROFIT LEADERS, COMMUNITY HEALTH WORKERS, NURSES, OLDER ADULTS, FAMILIES, DOMESTIC WORKERS. AND THEN FINALLY WE HAD AN SA SPEAK UP SURVEY WHICH HAD 1821 RESPONSES DONE BETWEEN JANUARY AND MARCH OF THIS YEAR. THE HEALTH COLLABORATIVE DID A REALLY GREAT JOB BECAUSE A SA SPEAK UP SURVEY IS ONLINE. THEY HAVE COMMUNITY HEALTH WORKERS WITH TABLETS AND YOU CAN SEE 51% OF THE RESPONSES WERE IN SPANISH.
WE ALSO HAD RESPONSES IN PASHTO, CHINESE, VIETNAMESE AND ARABIC.
AND I THINK THAT'S ALL I HAVE TO SAY ABOUT THIS. OH, WELL -- SO THE RESPONDENTS WERE MORE LIKELY THAN AFTERNOON TO LIVE IN LOW AND MODERATE HOUSEHOLDS, MORE LIKELY TO BE FEMALE AND UNINSURED. ALMOST EVERY ZIP CODE WAS RENTED IN THE RESPONSES. YOU CAN SEE THAT IN THE MAP. MAYBE NOT SURPRISINGLY, ROUTINE CHECKUPS, ADULT CARE CHECKUPS AND DENTAL CARE WHAT WERE DROPPED THE MOST.
USE OF MENTAL HEALTH CARE DID INCREASE WITH TELEHEALTH PLAYING A ROLE THERE SO THERE WERE BRIGHT SPOTS AND TELEHEALTH WAS ONE OF THEM. SO THIS SLIDE SHOWS THE BARRIERS TO CARE BEFORE COVID WITH THE TOP THREE HIGHLIGHTED, LANGUAGE TRANSPORTATION AND DISCRIMINATION OR RUDE TREATMENT AT MEDICAL OFFICES. AND THEN ALL THE OTHER WERE ALSO LISTED IN DESCENDING
[00:45:02]
ORDER. THE ARROWS SHOW THE BIGGEST CHANGES DURING COVID.SO NOT SURPRISINGLY FEAR OF CATCHING AN ILLNESS AT THE DOCTOR'S OFFICE LESS OF A CONCERN BEFORE COVID, A BIGGER CONCERN DURING. ALSO GETTING AN APPOINTMENT AND THE COST OF PRESCRIPTIONS. THE -- THE IMAGES ON THIS PAGE COME FROM THE HANDOUT I JUST PASSED AROUND AND THAT ALSO HAS BEEN TRANSLATED INTO ALL THE LANGUAGES WE MENTIONED. IT'S ALSO AVAILABLE ON OUR WEBSITE. BUT THESE ARE SOME OF THE SURVEYS FROM PARTNERS.
DISABILITY SA, FOR EXAMPLE, FOUND AFFECTED THEIR ABILITY TO GET MEDICAL SUPPLIES AND ACCESS HEALTH CARE.
U.S. AUSTIN HAD A SURVEYY OF LGBTQ+ PEOPLE ACROSS TEXAS AND YOU CAN SEE FOR ACCESS ING MENTAL HEALTH, THE BLACK AND AFRICAN AMERICAN COMMUNITY AND NON-ENGLISH COMMUNITY WAS ESPECIALLY AFFECTED. THE CENTER FOR REFUGEE SERVICES SURVEYED THEIR AFGHAN REFUGEES AND YOU CAN SEE FOR THAT GROUP DENTAL PROBLEMS WERE A BIGGER CONCERN THAN EVEN LACK OF HEALTH INSURANCE OR LANGUAGE BARRIERS. FROM THE DATA BASES, BASED ON THE STATEWIDE IMMUNE NATION REGISTRY, VACCINATION AMONG KINDERGARTENERS DECLINED.
IT MAY NOT SEEM LIKE A LOT TO GO FROM -- TO -- THE HERD COMMUNITY THRESHOLD TO PREVENT MEASLES YOUTH BREAK IS ESTIMATED TO BE AT 95%. THIS WAS IN 2021 SO WE CAN HOPE IT'S BETTER NOW. FOR CHILDREN MEASLES IS FAIRLY BENIGN FOR MOST OF THEM, BUT ONE IN 1,000 IT CAN RESULT IN ENCEPHALITIS, HOSPITALIZATION OR WORSE.
AND DRUG RELATED DEATHS ALREADY WERE RISING BEFORE THE PANDEMIC AND WERE EXACERBATED. SUICIDE DEATHS ROSE PARTICULARLY IN MEN.
EARLY PRE-NATAL CARE HAS BEEN A PROBLEM FOR A LONG TIME IN OUR COMMUNITY AND HERE YOU CAN SEE A FEW DIFFERENT WAYS OF LOOKING AT IT.
ON THE LEFT THAT WE'VE GOT A GEOGRAPHICAL DISTRIBUTION OF OB-GYNS AND MIDWIVES, SO LARGE SWATH OF OUR COMMUNITY DON'T HAVE EASY ACCESS. ON THE RIGHT-HAND SIDE THE LINE THAT'S GOING UP SHARPLY SHOWS MEDICAID ENROLLMENT. BECAUSE THERE WAS CONTINUOUS MEDICAID COVERAGE, RIGHT, UNTIL THE END OF THE PUBLIC HEALTH EMERGENCY.
SO PEOPLE DID NOT NEED TO ENROLL THEMSELVES AND SO MEDICAID ENROLLMENTS SKYROCKETED. BUT THE PERCENTAGE OF BIRTHS TO MOTHERS WHO RECEIVED EARLY PRENATAL CARE, WHICH IS THAT FLATTISH LINE ON THE BOTTOM, THAT REMAINED ABOUT THE SAME. SO THERE ARE SO MANY OTHER FACTORS OTHER THAN JUST MEDICAID COVERAGE THAT GO INTO WHETHER WE CAN GET THAT EARLY PRENATAL CARE THAT MAKES SUCH A DIFFERENCE IN WHETHER WE HAVE A HEALTHY PREGNANCY.
FROM THE INTERVIEWS AND FOCUS GROUPS, WE SAW THAT -- WELL, OH, THIS WAS SOME OF THE GOOD. WE'LL START WITH THE GOOD STUFF.
THE CHANGES IN MEDICAID ENROLLMENT, THE TELEHOLT REIMBURSEMENT, THE AFFORDABLE CARE ACT ALL INCREASED ACCESS TO CARE AND I'LL REMIND MARKETPLACE SUBSIDIES ARE CONTINUING. OPEN ENROLLMENT STARTS NOVEMBER 1ST AND MOST PEOPLE CAN GET A PLAN FOR -- MOST PEOPLE GET A PLAN WITH A SUBSIDY.
A LOT OF PEOPLE GET A PLAN FOR, YOU KNOW, AS LITTLE AS $10 A MONTH.
WE SAW NEW PARTNERSHIPS THAT I HOPE WILL BE ENDURING PARTNERSHIPS AMONG OUR ORGANIZATION BUT THROUGHOUT THE COMMUNITY AMONG DIFFERENT NEW PARTNERS.
AND THAT INCLUDED TAKING HEALTH CARE INTO PEOPLE'S NEIGHBORHOODS.
LIKE THE WELL MED AND -- WELL MED COLLABORATION ON THE SOUTH SIDE FOR THOSE MODERNA VACCINES. AND OUR SOCIETY RECOGNIZED THE IMPORTANCE OF COMMUNITY HEALTH WORKERS AND SOCIAL DETERMINANTS OF HEALTH. PEOPLE DID ALSO SAY THAT LANGUAGE CONTINUES TO BE A BARRIER. LANGUAGE AND TRANSPORTATION, YOU KNOW, HAS BEEN BIG BARRIERS FOR A LONG TIME. PARTICULARLY FOR NON-ENGLISH, NON-SPANISH SPEAKERS. TRANSPORTATION -- I GUESS I WOULD JUST BE SAYING THE SAME THING. TRANSPORTATION REMAINS A KEY BARRIER AND THE MASS EXODUS OF HEALTH CARE STAFF AND PROVIDER FEAR AT THE BEGINNING OF THE PANDEMIC AFFECTED QUALITY OF CARE. WE SEE THAT ANY TIME THERE'S EMERGING INFECTIOUS DISEASE AND HOPEFULLY OVER TIME WE GET A LITTLE BETTER AT ADDRESSING THAT IN A SENSITIVE WAY. I THINK I SKIPPED A SLIDE.
[00:50:01]
THE COST OF CARE AND PRESCRIPTIONS CONTINUE TO RISE TO THIS DAY.TELEHEALTH DID WORK GREAT FOR SOME PEOPLE. OTHER PEOPLE, ESSENTIALLY OLDER ADULTS OR PEOPLE WHO DON'T HAVE BROADBAND ACCESS NEED EXTRA HELP.
PROVIDERS WHO PRE-LOADED THE INFORMATION ON TO A TABLET AND DELETED EVERYTHING ELSE THAT WAS EXTRANEOUS, MADE IT EASY FOR OLDER ADULTS OR PEOPLE WITH LOW HEALTH LITERACY, THAT WORKED REALLY WELL FOR THEM. MARKETING, THERE ARE A LOT OF -- AS ALL KNOW, A LOT OF RESOURCES IN SAN ANTONIO THAT PEOPLE JUST DON'T KNOW ABOUT. SO INCREASING AWARENESS AND MARKETING IS AUDIO] RESOURCES ALSO CAME UP ACROSS MULTIPLE FOCUS GROUPS.
SO SOME OF THE THINGS THAT WE CAN DO. WE WILL BE TAKING THIS INFORMATION OUT EVEN MORE BROADLY. RIGHT NOW WE'RE PRESENTING IT AS SOME OUTREACH EVENTS. THERE IS A FOLLOW-UP SURVEY BUT MORE TO COME IN SPRING OF 2024. THE REPRODUCTIVE JUSTICE FUND PREVIEW OF COMING ATTRACTIONS, I WOULD SUGGEST THAT WE APPROACH THE REPRODUCTIVE JUSTICE FUND BROADLY WITH CONSIDERATION OF SOME OF THESE GAPS IN PRENATAL CARE AND MATERNAL MENTAL HEALTH CARE. ACCESS TO CLINICS, YOU'VE GOT THE ABILITY AS POLICYMAKERS TO HELP PRIORITIZE TRANSPORTATION AND ACCESS TO CLINICS IN DESIGN AND PLANNING. CIVIL RIGHTS ACT OF 1964 ACTUALLY REQUIRES THAT TRANSLATION BE AVAILABLE FOR PEOPLE IN ALMOST ALL HEALTH CARE SETTINGS.
PEOPLE MAY NOT KNOW IT, BUT THAT IS A RIGHT THEY HAVE SO HELP SHARE THAT.
AS WELL AS THE OTHER EXISTING RESOURCES. I LISTED JUST A FEW THERE MIKE SACRED, LIKE OATS, BUT THERE ARE A LOT MORE. THE ACCESS TO CARE OFFICE AT METRO HEALTH HELPS EDUCATE CLINICIANS ON THAT RESPECTFUL CARE AND DOWN THE ROAD WE HAVE A -- WE'VE GOT SOMETHING IN MIND THAT WILL SHOWCASE PROVIDERS OF RESPECTFUL BLACK MATERNAL HEALTH CARE. THAT'S IT.
HAPPY TO TAKE QUESTIONS. >> CASTILLO: THANK YOU. COUNCILWOMAN ALDERETE
GAVITO. >> GAVITO: THANK YOU, CHAIR, AND THANK YOU SO MUCH FOR THIS PRESENTATION. I HAD A QUICK QUESTION -- TWO ACTUALLY.
ON SLIDE 11, SO WE SAW ALL OF THESE WOMEN SIGN UP FOR MEDICAID, BUT STILL NOT TAKE ACCESS -- STILL NOT ACCESS PRENATAL CARE. I MEAN ONE, THAT'S A HUGE SPIKE. SO I WONDER WHY THAT HAPPENED, WHY ALL OF THEM --
WHY SO MANY SIGNED UP. >> BECAUSE THEY DIDN'T HAVE TO SIGN UP.
THEY STAYED ON MEDICAID. BECAUSE OF THE PANDEMIC THERE WAS CONTINUOUS ENROLLMENT. IF YOU WERE ALREADY IN MEDICAID, YOU DIDN'T HAVE TO SIGN UP AGAIN EVERY YEAR. THIS MEDICAID UNCONFINING THAT STARTED AT THE END OF THE PUBLIC HEALTH EMERGENCY, YOU MAY HAVE HEARD TEXAS HAS BEEN LETTING A LOT OF PEOPLE GO, OFTEN FOR PROFESSIONAL REASONS. SO A LOT OF CHILDREN, GOING BACK TO DR. ROCHA GARCIA'S QUESTION, A LOT OF CHILDREN ARE LOSING THEIR MEDICAID EVEN THOUGH THEY ARE ELIGIBLE. THAT WAS THE REASON FOR THE INCREASE. I HEARD YOU KIND OF ASKING WHAT THE REASON FOR THE -- WHAT'S THE STORY BEHIND WHY PEOPLE AREN'T GOING OR WEREN'T GOING, AND YOU KNOW, MAYBE THEY DIDN'T REALIZE THAT THEY STILL HAD THE MEDICAID.
MAYBE THEY DIDN'T KNOW THEY WERE PREGNANT. MAYBE THEY -- SO MANY DIFFERENT REASONS. SOMETIMES PEOPLE HAD NEGATIVE EXPERIENCES AT MEDICAL PROVIDERS' OFFICES IN PRIOR PREGNANCIES. SO THAT IS ONE OF THE THINGS THAT WE CAN FOCUS ON AS WE HAVE THOSE COMMUNITY CONVERSATIONS IN THE SPRING.
>> GAVITO: AND ALSO TOO, I MEAN I WAS FORTUNATE ENOUGH TO BE WORKING IN CORPORATE AMERICA WHEN I HAD BOTH MY BABIES. AND I MEAN THERE'S NO BETTER PLACE TO BE THAN IN CORPORATE AMERICA BECAUSE OF THE BENEFITS THEY PROVIDE.
AT USAA I HAD FIVE MONTHS MA ATTORNEY ACTIVE LEAVE. GOING INTO PREGNANCY FULLY INSURED IS SCARY. I DON'T KNOW WHAT'S COVERED, WHAT'S NOT.
IT'S NERVE WRACKING. I WONDER IF THERE'S SOMETHING TO BE SAID FOR JUST AN INFORMATION CAMPAIGN OF, YOU KNOW, WHAT'S COVERED, WHAT'S NOT BECAUSE IT'S A CLUSTER. EVEN FOR EDUCATED PEOPLE IT'S LIKE I DON'T KNOW.
YOU KNOW, AND YOU GET A LOT OF VERY HIGH BILLS AND YOU ARE LIKE I'M NOT SURE WHAT
I'M SUPPOSED TO PAY AND IT'S TRICKY TO NAVIGATE. >> IT IS VERY TRICKY.
[00:55:03]
YOU CAN ONLY HAVE ONE HEALTH CONDITION A DAY BECAUSE OF THE BILLING.THAT'S BAKED INTO THE BILLING. >> GAVITO: RIGHT.
AND THEN MY SECOND -- THANK YOU FOR THAT INFORMATION. THEN MY SECOND QUESTION, YOU KIND OF ANSWERED IT ON SLIDE 13, I SAW THAT TRANSPORTATION REMAINS A KEY BARRIER AND THAT YOU ALL ARE GOING TO BE LOOKING ON SLIDE 15 ABOUT MAKING ACCESS TO CLINICS A PRIORITY IN TRANSPORTATION. DO WE HAVE THESE RESPONDENTS FOR THIS SURVEY? THE PEOPLE WHO RESPONDED TO THE SURVEY?
>> IT'S ANONYMOUS. >>. >> GAVITO: IF YOU ALL CAN MEET WITH VIA TO SAY HEY, THESE ARE THE PEOPLE WHO HAVE RESPONDED AND THEY ARE LETTING US KNOW THAT THEY ARE HAVING ISSUES ACCESSING TRANSPORTATION TO THEIR MEDICAL APPOINTMENTS. YOU KNOW, I -- I'M JUST LOOKING FOR ACTION AROUND THAT. I THINK IF WE PARTNER WITH VIA TO SAY WE KNOW THAT OUR SURVEY RESPONDENTS CAME FROM X AREA, THEY NEED TO GET ACCESS TO Y HOSPITAL OR, YOU KNOW, THAT MAYBE WE CAN FIGURE OUT FROM THEIR OPERATIONAL ROUTES TO FIGURE
HOW TO BEST DO THAT. >> IT'S WIDESPREAD. I CAN'T THINK OF A SINGLE HEALTH CONDITION WHERE ONCE YOU START TALKING TO PATIENTS THEY DON'T SAY
TRANSPORTATION IS AN ISSUE. >> GAVITO: UH-HUH. INTERESTING.
THANK YOU. THANK YOU, CHAIR. >> CASTILLO: THANK YOU.
COUNCILMEMBER DR. KAUR. >> KAUR: CAN WE GO TO SLIDE 6 REAL QUICK? HOW DID YOU ADVERTISE THIS SURVEY? WE'RE ALWAYS LOOKING FOR WAYS TO ENGAGE AND SEEING 51% SPANISH AND THE DIVERSITY AND RESULTS YOU GOT WAS PRETTY REMARKABLE. WE DON'T ALWAYS SEE THAT. WHAT DO YOU THINK WAS
DIFFERENT ABOUT THIS SURVEY? >> FULL CREDIT TO OUR PARTNERS AND PARTICULARLY THE BEXAR COUNTY HEALTH COLLABORATIVE AND THEIR USE OF COMMUNITY HEALTH WORKERS WHICH ARE LIKE THE SUPER HEROES, THE SECRET POWER OF PUBLIC HEALTH.
SO IT WAS COMMUNITY HEALTH WORKERS TALKING TO THE PEOPLE IN THEIR -- WHO THEY
USUALLY HAVE CONTACT WITH IN THEIR COMMUNITIES. >> KAUR: WE'VE GOT TO FIGURE HOW TO REPLICATE THAT BECAUSE THIS IS POWERFUL DATA AND YOU SEE A LOT THE HEAVY SURVEY COUNTS FROM SOME OF OUR MORE UNDER SERVED COMMUNITIES, WHICH IS REALLY AWESOME TO REALLY SEE THAT. BECAUSE SOMETIMES YOU ALWAYS QUESTION THE DATA DEPENDING UPON WHERE YOU GET IT FROM. THAT'S AWESOME.
THE OTHER QUESTION THAT I KIND OF JUST HAD WAS ONE OF THE THINGS THAT WE'VE NOTICED A LOT IN SCHOOLS IS A DROP IN -- FUNDED BY ADA SO WE'VE SEEN A DROP IN ATTENDANCE BECAUSE OF HEALTH ISSUES WITH FAMILIES. WAS THERE ANY OF THAT THAT CAME OUT AS A POTENTIAL FOCUS MOVING FORWARD OF HOW WE CAN PROVIDE SUPPORTS TO FAMILIES THAT POTENTIALLY AREN'T SENDING KIDS TO SCHOOL BECAUSE OF THIS FEAR
THAT YOU SHARED? >> THAT WAS NOT SOMETHING THAT WAS SPECIFICALLY ASKED ON THE SURVEY SO I DON'T HAVE A WAY TO ANSWER THAT WITH ANY LEVEL OF -- I JUST
DON'T KNOW. SORRY. >> KAUR: THAT'S OKAY.
IT WOULD BE COOL TO SEE AS YOU WORK TOWARDS SOLUTION IN THE SPRING COMMUNITY CONVERSATIONS, IF WE COULD ASK ABOUT THAT BECAUSE OUR SCHOOLS ARE BEING HIT HARD AND A LOT OF IT IS BECAUSE A KID HAS A COUGH AND THEY ARE NOT COMING TO SCHOOL.
I KNOW THAT'S TRICKY NOW, BUT IT'S REALLY TRYING TO FIGURE OUT A WAY TO GET FAMILY THE SUPPORT THEY NEED. SOME OF THEM ALREADY WEREN'T GOING TO GET MEDICAL HEALTH CARE AND NOW THEY ARE EVEN MORE CONCERNED AND HAVE FEAR ABOUT IT SO THEY ARE NOT SENDING KIDS TO SCHOOL. FROM A SCHOOL PERSPECTIVE, IT WOULD BE REALLY GREAT IF WE COULD GET INFORMATION ABOUT THAT AND SEE IF
THERE'S ANYTHING WE CAN DO TO MOVE FORWARD. >> THANK YOU FOR THAT AND I'LL REMIND THE GROUP A LOT OF CHILDREN ELIGIBLE FOR MEDICAID AREN'T COVERED.
THAT'S PART OF THE REASON PEOPLE MIGHT NOT BE GETTING THOSE HEALTH CONCERNS TAKEN
CARE OF. >> CASTILLO: COUNCILMEMBER ROCHA GARCIA.
>> GARCIA: THANK YOU. EVERY TIME DR. WU PRESENTS, I HAVE NO MONTH QUESTIONS AFTER. I WAS LOOKING THROUGH THE DOCUMENT, BUT IT'S 132-PAGER SO IT'S GOING TO TAKE ME A LITTLE LONGER. BUT I DID WANT TO SAY THANK YOU IN YOUR PRESENTATION. ACCESS TO CLINICS, THAT'S ONE OF THE THINGS WE'VE TALKED ABOUT FOR A WHILE IN THE SOUTH SIDE WITH THE HOSPITAL CLOSING ON THE SOUTH SIDE. VIA, I ASKED THEM TO WORK ON A MAP TO SEE THE CLOSEST
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ROUTES AND IT WOULD STILL TAKE THEM A COUPLE OF TRANSFERS TO GET TO THEIR HOSPITALS. AND THAT'S DURING THE OPERATING HOURS.SO IF IT WAS AN EMERGENCY AND UNFORTUNATELY A LOT OF RESIDENTS IN MY DISTRICT WILL SAY, NO, I DON'T WANT TO TAKE THE AMBULANCE, I'LL WAIT UNTIL THE MORNING BECAUSE THEY ARE GOING TO CHARGE ME $500. AND IT'S A SAD REALITY.
AND SO THE WAY -- UNFORTUNATELY IF THEY WAIT, IT MIGHT BE TOO LATE.
AND SO WHATEVER IT IS THAT WE CAN DO EVEN TO LIKE TRY TO FIGURE OUT ALTERNATIVES, LIKE IF VIA ISN'T ABLE TO DO DURING EMERGENCY HOURS, I KNOW WE HAVE VOUCHERS IN SOME REGARDS I THINK WITH THE EMS THAT ARE USED FOR TRANSPORTATION.
I DON'T KNOW HOW MANY OF THOSE WE HAVE OR HOW MANY ARE USED, BUT I'M WONDERING IF YOU HAVE EVER ASKED ABOUT THAT, THAT SORT OF INFORMATION, LIKE WHO ACTUALLY USES THEM. DO YOU WORK WITH EMS, BY CHANCE?
>> REMEMBER, WE DON'T HAVE A LOT OF OUR OWN CLINICS AT THIS POINT, BUT OUR CLINICS, LIKE THE TUBERCULOSIS AND STI CLINIC DO MAKE USE OF VOUCHERS AS WELL.
>> GARCIA: GOOD. I WAS HOPING. I WAS HOPING ON THE PREVENTIVE END SO THANK YOU. AS A MARKETING PROFESSOR, I'M EXCITED YOU SAID WE NEED AN INCREASE IN MARKETING. THAT'S ALWAYS MUSIC TO MY YEARS AND I AGREE COMPLETELY. COUNCILWOMAN ALDERETE GAVITO MENTIONED EARLIER, NEWSLETTERS OR WHATEVER IT IS WE CAN DO, WE WOULD BE HAPPY TO DO THIS.
AND COUNCILMAN DR. KAUR, I'M MAKING SURE I USEFUL TITLES, AND I LOVE IT.
SO -- AND ACTUALLY, COUNCILMEMBER CASTILLO DOES IT TOO SO THANK YOU.
BUT I'M EXCITED THAT SHE ALSO MENTIONED OR ASKED ABOUT THE CHILDREN'S ISSUE.
IN MY DISTRICT WE HAVE THE LARGEST NUMBER OF RENTERS WITH CHILDREN.
SO IT'S VERY UNSTEADY BECAUSE THEY MOVE A LOT, RIGHT? AND SO THEY MIGHT NOT BE EXPOSED TO THE BEST -- I'LL SAY IT, PUBLIC HOUSING, UNFORTUNATELY. SOMETIMES WE NEED A LITTLE WORK.
WE'RE WORKING ON IT SLOWLY BUT SURELY, BUT THEY ARE EX SUPPOSED TO A LOT MORE THINGS. IN THE MOVES I THINK IT'S DIFFICULT, SO I THINK MAYBE WE PARTNER ON SOMETHING THAT, YOU KNOW, IS JUST LIKE A SIGN-UP.
THEY REALLY DON'T KNOW. SO ANYTHING WE CAN DO TO HELP SIGN THEM UP, I THINK THAT WOULD BE AN INCREASE IN ACCESS TO OR CLINICS, OBVIOUSLY, AND OBVIOUSLY TO WHAT THEY ARE ELIGIBLE FOR. ON THE 51%, AND I'M GLAD THAT YOU MENTIONED THIS, AT 51% SPANISH SPEAKING, I FEEL BETTER BECAUSE LIKE I ALWAYS FEEL LIKE I ALWAYS ASK LIKE ABOUT THE SPANISH SPEAKERS. I THINK THIS IS THE VERY FIRST SURVEY THAT SAYS 51% OF THESE WERE IN SPANISH. SO I HOPE YOU ALL GET SOME SORT OF AWARD FOR THIS, DR. WU, BECAUSE THIS IS ROLE INCREDIBLE. TO ECHO MY COLLEAGUES.
WITH THAT SAID, BILINGUAL SERVICES, HOW DO WE ENSURE THAT AT EVERY OFFICE THAT WE HAVE AT EVERY CLINIC, AT EVERY STI CLINIC, AT EVERY DIABETES WORKSHOP, DO WE
ENSURE THAT THERE'S SOMEONE THAT SPEAKS SPANISH? >> SO ALL OF OUR PUBLIC-FACING DOCUMENTS, IT IS OUR POLICY TO HAVE IT IN ENGLISH AND SPANISH.
AS FAR AS OUTREACH EVENTS, YOU KNOW, IT'S GOING TO VARY, BUT THAT IS OUR -- THAT IS OUR GOAL. AND IT VARIES DEPENDING ON YOUR STAFFING.
LIKE RIGHT NOW WE -- THERE WAS THIS PERIOD WHERE I WOULD GUARANTEE YOU WALK INTO A STI CLINIC AND SOMEBODY THERE SPEAKS SPANISH.
I WOULD SAY FOR MOST OF OUR CLINICS, I'M GOING TO OFF THE TOP OF MY HEAD SAY LIKE AT LEAST 90% OF THE TIME YOU ARE GOING TO HAVE SOMEBODY THERE WHO SPEAKS SPANISH.
AND FOR DIABETES, I BELIEVE THERE'S A SCHEDULE, LIKE A SPANISH EVENT VERSUS AN ENGLISH-SPEAKING EVENT SO THEY WILL SCHEDULE OUT IN ADVANCE THAT WAY.
>> GARCIA: WONDERFUL. I'M GLAD YOU HAVE IT AS A GOAL OR PRESENCE.
I KNOW A LOT OF -- PREFERENCE. AND THE RESOURCES ARE IN SPANISH, SO I APPRECIATE THAT, BUT THERE'S THE OTHER LANGUAGES AS WELL.
I APPRECIATE THE FACT THAT YOU ALL HAVE THE AFGHAN REFUGEES ON HERE AS WELL.
DENTAL PROBLEMS, OF COURSE, WILL RELATE TO THE HEART. AND SO ANYWAY, SO IT'S ALL RELATED. SO I'M GLAD THAT WE'RE PAYING SPECIAL ATTENTION TO THESE AREAS. AND THEN MY FINAL QUESTION KIND OF GOES BACK TO THE CHILDREN. I'M ON THIS CHILDREN'S HIGH TODAY.
BUT SO I HEARD RECENTLY FROM SOME OF THE SCHOOL DISTRICTS.
I WAS IN A GROUP OF SOCIAL WORKERS AND THEY SAID THAT THEY WERE GETTING AN
[01:05:04]
INCREASED NUMBER OF CHILDREN WHO WERE COMING FROM LATIN AMERICAN COUNTRIES AND THEY WERE GOING TO SCHOOL. AND THAT THEY WERE HEARING THAT THEY NEEDED A LITTLE BIT MORE OF ATTENTION IN REGARDS TO HEALTH, RIGHT? AND SO I'M WONDERING IF YOU HAVE HEARD THAT ALSO AND WHAT WE'RE DOING TO MAYBE ADDRESS THAT.BECAUSE OUR SCHOOL DISTRICTS ARE ENTIRELY SEPARATE, BUT HOW DO WE WORK WITH THE
SCHOOL DISTRICTS I GUESS IS THE REAL QUESTION. >> BY THE WAY, AS YOU WERE TALKING, I WAS THINKING WHAT I MEAN TO SAY NO, MORE THAN 90% OF THE TIME THE CLINICIAN THEMSELVES WILL SPEAK SPANISH. BUT WE'VE ALWAYS GOT SOMEBODY WHO CAN TRANSLATE AT ALL OF OUR CLINICS. OUR NEXUS WITH THE SCHOOL DISTRICTS RIGHT NOW IS PROBABLY GREATEST THROUGH THE ASTHMA PROGRAM.
BUT I DON'T KNOW -- WE CAN GET YOU THE ANSWER TO THAT QUESTION.
>> GARCIA: OKAY. WONDERFUL. THANK YOU.
THOSE ARE ALL MY QUESTIONS. THANK YOU, CHAIR. >> CASTILLO: COUNCILMEMBER
VIAGRAN. >> VIAGRAN: THANK YOU, THANK YOU FOR THE PRESENTATION AND THANK YOU FOR WORKING AND I THINK -- I WAS GOING TO MENTION SOME OF THE THINGS THEY'VE ALREADY COVERED, BUT I DO WANT TO TALK ABOUT TELEHEALTH BECAUSE I REALLY THINK THAT THAT IS KEY AS WE MOVE FORWARD. BUT I THINK IT'S IMPORTANT THAT IF YOUR FINDINGS SHOW THAT THERE'S JUST MAYBE TOO MANY APPS ON THE DEVICE WHEN THEY GET IT, IF THERE NEEDS TO BE MORE WORK WITH THE SENIORS IN TERMS OF WORKING THEM THROUGH OR DEMOING, I THINK WE NEED TO LOOK AT THE OPPORTUNITY OF DOING THAT.
AND I THINK IT'S AN OPPORTUNITY TO GAP THAT DIGITAL DIVIDE.
IN DISTRICT 3 WE HAVE A LOT OF MULTI-GENERATIONAL HOUSEHOLDS AND WE HAVE A SCHOOL DISTRICT THAT -- HARLANDALE SCHOOL DISTRICT, ALL AVAILABLE FOR AFFORDABLE CONNECTIVITY PROGRA. THEN WE PASSED OUT DEVICES TO SENIORS, BUT IF THEY ARE JUST SITTING THERE, IT JUST BECOMES FRUSTRATING BECAUSE THEY CAN'T GET ACCESS.
ANYTHING WE CAN DO TO HELP WITH THAT. WHEN WE TALK ABOUT THE DIGITAL DIVIDE, I THINK WE NEED TO STRESS MORE THAT THAT TELEHEALTH ASPECT IS KEY. WHEN I GOT COVID, MY APPOINTMENT TO GET THE TREATMENT WAS THROUGH TELEHEALTH. AND THAT WAS FOR ME AND I HAD THAT ACCESS, BUT I THINK ABOUT ALL THE PEOPLE THAT DON'T HAVE THAT ACCESS AND HAVE TO WAIT SOMEWHERE TO GET THAT APPOINTMENT. NO, I JUST THINK THAT THE SURVEY IS EXCELLENT. I ALSO THINK IN EMS THE OF MARKETING, THIS IS -- IN TERMS OF MARKETING, DR. ROCHA GARCIA IS GOING TO BE LIKE NO, DON'T DO THIS.
WE NEED TO PICK A WEEK OR MONTH WHERE WE LIKE MARKET SOMETHING BECAUSE THAT SEEMS TO WORK WHEN WE DO THAT. WE DID IT FOR DOMESTIC VIOLENCE AWARENESS.
WE DO THAT FOR HEART DISEASE. WE DO THAT FOR CANCER.
MAYBE WE NEED TO PICK A WEEK RIGHT BEFORE FIESTA TO FOCUS ON SOMETHING.
I'M NOT SURE, JUST TAKE THAT -- >> LIKE NATIONAL PUBLIC
HEALTH WEEK, LIKE NOW? >> VIAGRAN: WELL, WE DO THAT, BUT LIKE FOR -- I'M LIKE WHAT'S THE WEEK WHERE ALL WE'RE TALKING ABOUT IS DENTAL HEALTH, YOU KNOW? LET'S PROMOTE THAT WEEK. IF THERE'S A DAY THAT SAN ANTONIO NEEDS TO DESIGNATE THE NATIONAL BRUSH YOUR TEETH DAY, WE'LL DO THAT.
SO BASED ON WHAT YOU FIND. THANK YOU. >> CASTILLO: THANK YOU, DR. WU. A COUPLE OF THINGS LISTENING TO THE DISCUSSION.
I WAS THINKING HOW METRO HEALTH WHERE COULD GET THE VACCINATIONS, AS A KID WE WOULD TAKE THE 68 BUS AND IT WOULD LEAVE YOU RIGHT IN FRONT OF IT.
NOW THERE'S CLINICS THROUGHOUT THE CITY SPRINKLED ALL ACROSS.
LIKE THERE'S ONE NEAR NORMOYLE PARK WHERE YOU CAN GET VACCINES.
NOW WITH THE CENTRAL HUB, IT'S INACCESSIBLE TO DOWNTOWN, YOU HAVE TO WALK FIVE CITY BLOCKS TO GET ANYWHERE, BEFORE YOU COULD JUST GET OFF THE BUS AND NEED WHERE YOU NEED TO BE. TRANSPORTATION IS A BARRIER. BUT ONE THING THAT I DO HAVE A QUESTION ON IS ON THE DATA WITH THE DRUG-RELATED DEATHS AND DEATHS BY SUICIDE THAT HAVE INCREASED SIGNIFICANTLY, DO WE KNOW WHAT THE DRUG-RELATED DEATHS
ARE RELATED TO, WHICH DRUG IN PARTICULAR? >> YEAH, A MAJORITY OF DRUG-RELATED DEATHS IN BEXAR COUNTY ARE STILL GOING TO BE FROM METHAMPHETAMINE.
BUT FENTANYL IS INCREASING. >> CASTILLO: OKAY. AND THAT -- I ASK THAT BECAUSE A COUPLE THINGS I'VE BEEN HEARING RECENTLY. FOR EXAMPLE, JUST OVERALL DENTAL HEALTH, RIGHT, AND HOW FOLKS WHO ARE RECOVERING WHO MAY HAVE USED A SUBSTANCE, HOW THEIR TEETH IMPACT CONFIDENCE TO APPLY FOR WORK AND GET CONNECTED
[01:10:06]
TO OPPORTUNITY. AND I KNOW THE CITY OF SAN ANTONIO METRO HEALTH IN PARTICULAR ALWAYS PARTNERS WITH U.T. HEALTH. AND I WAS THINKING I HAVE THE [INAUDIBLE] ON MY DISTRICT AND HEAR THE STORIES OF FOLKS WHO ARE WAITING FOR A RIDE OR LOOKING FOR THE BUS STOP BECAUSE IT'S CHANGED SO MUCH PEOPLE DON'T KNOW WHERE THE BUS STOPS ARE NOW. AND JUST CONNECTING -- IN MY PERFECT WORLD THERE WOULD BE WHERE WE COULD CONNECT ALL THESE PEOPLE TO DENTAL RESOURCES TO GET THE DENTAL CARE THEN DESERVE AND NEED BECAUSE IT CONNECTS THEM TO OPPORTUNITY AND GIVES THEM THE CONFIDENCE TO HAVE A JOB AND MAINTAIN IT.BECAUSE I HEAR THAT TOO OFTEN. AND THEN I HAD A BRIEFING A WHILE BACK FROM MIKE RAMSEY ON READY TO WORK AND HE CITED DENTAL HYGIENE AS -- NOT HYGIENE, BUT DENTAL CARE AS A BARRIER TO OPPORTUNITY. SO JUST SEEING THE CONNECTION THERE AND JUST THE OPPORTUNITY AND THE NEED FOR MORE DENTAL CLINICS THAT ARE ACCESSIBLE AND IN MY WORLD FREE, RIGHT? BUT I'M LOOKING AT SLIDE 11 AND THAT MAP. AND WHEN WE LOOK AT MAPS WHETHER IT'S WITH DEMOLITION, HOUSING AFFORDABILITY, IT IS THE SAME PATTERN THAT WE SEE OVER AND OVER AND OVER AGAIN. AND I APPRECIATE YOU ALL HIGHLIGHTING THE REPRODUCTIVE JUSTICE FUND BECAUSE I THINK THIS MAP DEMONSTRATES WHY WE NEED TO CONTINUE TO INVEST IN REPRODUCTIVE HEALTH CARE BECAUSE THERE'S NO ACCESS TO MIDWIVES OR DOCTORS WITHIN THE WEST SIDE AND IT LOOKS LIKE THE SOUTH SIDE AS WELL AND PIECES OF THE EAST SIDE. SO JUST WANTED TO THANK YOU ALL FOR THE WORK. THIS IS VERY IMPACTFUL AND JUST LOOKING FORWARD FOR THINGS AS THEY EVOLVE. ANY ADDITIONAL QUESTIONS FROM COMMITTEE MEMBERS? GREAT, THANK YOU, DR. WU. AND I BELIEVE THAT BRINGS US TO THE END OF OUR MEETING.
ALL RIGHT. GREAT. THE TIME IS NOW 3:11 AND THE MEETING IS ADJOURNED. THANK YOU.
* This transcript was compiled from uncorrected Closed Captioning.