Commission questions what Central Health is doing to address persistent disparities in health access

The Austin/Travis County Public Health Commission heard key findings of Central Health’s 2022 Demographic Report at its regular meeting on Jan. 3.

Central Health updated the report in February 2023, finding that Austin’s high cost of living and affordability crisis has morphed into a regional one that is impacting Travis and surrounding counties.

Austin is a key access point for health care, affordable housing, public transportation and social services, while families in poverty are becoming more concentrated along the Interstate 35 corridor. But access to care continues to be a major barrier for Central Health’s patient population, regardless of that person’s proximity to care.

The report found that unhoused people, which make up 8 percent of Central Health’s patient population, are twice as likely to experience chronic conditions as the population at large. The report found that health equity issues occur most significantly in East Central Austin and among Black patients. Race and ethnicity are more likely than location to factor into access to care inequities.

As of 2022, more than 23,000 families in poverty reside in Travis County. Central Health projects an increase of 1,799 families by 2027. About three-quarters of families living in poverty live along the I-35 corridor. The data shows 4,335 families living in poverty reside in Eastern Travis County, another 17,081 families living in poverty reside along the I-35 corridor, and just 2,239 families in poverty reside in Western Travis County.

“It is not going away,” said JP Eichmiller, director of Strategy and Information Design at Central Health. “Poverty will remain and continue to grow at rate.”

For the presentation, Central Health highlighted three focus areas: North Central Austin, Oak Hill and East Central Austin. In North Central Austin, also known as the Rundberg area, Central Health found the highest total number of families in poverty, enrollees and patients. The area also features the lowest median income and more than 5,200 unserved enrollees. For Oak Hill, which is the only new focus area in the 2022 report, Central Health found a 21 percent increase in poverty.

In East Central Austin, Central Health found the highest percentage of families in poverty and lower than expected enrollment. Additionally, 1 in 20 patients received all care in an emergency setting.

“The number of families in poverty within these nine focus areas that we identify is growing four times what it is overall in Travis County,” Eichmiller said. “Poverty and enrollment do not always align. There’s areas where we have high counts or high rates, but we’re seeing less enrollment than other areas. Spanish is the predominant language spoken in these focus areas – about double what the overall county rate is. It is also majority Latino in these areas.”

He continued, “The median income is about $34,000 less in these areas than it is overall, almost half the adults have a high school degree or less and people living in these areas are much less likely to have access to a vehicle.”

In terms of chronic conditions and disease prevalence, Austin Public Health data shows that chronic conditions account for 3 in 5 deaths of Travis County residents. The analysis found that 40 percent of Central Health’s patient population had a diagnosis of at least one chronic condition in the past three years and enrollees had an average of at least two and a half chronic conditions to manage. The top four conditions are cardiovascular disease, hypertension, behavioral health and diabetes.

In response to questions from the commission on what is being done to address the disparities outlined in the report, Central Health Vice President Monica Crowley said the district has looked at identification of moderate to significant gaps across the continuum of care. That resulted in new clinics in Hornsby Bend and Del Valle, as well as the continued design of a community health center in Colony Park.

“We also identified that there were areas of significant gap where we were meeting less than 50 percent of the need for particular services,” Crowley said. Central Health will continue “focusing on specialty care services, which are very significantly gapped in a number of different areas in the county. Some areas that are almost 100 percent gapped, like respite care services for people who don’t have a safe place to heal or prepare for health services.”

Central Health is currently remodeling a 50-bed respite center that is expected to open in 2026. It is also collaborating with the city to create additional respite beds in some of the shelter locations that the city recently opened in north, central and eastern parts of the county.

“And then also really focusing on diversion, diversion pilot services and working with the Sobering Center on expanding safe places for people who have decided that they’re ready to take that next step and enter into a treatment to have a place where they can receive some medication-assisted holdover therapy while they’re waiting for a treatment bed,” Crowley said.

Additionally, Central Health is working with Integral Care to provide psychiatric emergency services, including prescribing, 24 hours a day, seven days a week. “So if people are in a mental health crisis, including needing access to a substance use medication, there’s a place where they can receive those emergency services on a walk-in basis instead of, unfortunately, receiving them through the criminal justice system.”

Photo by Larry D. Moore, CC BY-SA 4.0, Link.

The Austin Monitor’s work is made possible by donations from the community. Though our reporting covers donors from time to time, we are careful to keep business and editorial efforts separate while maintaining transparency. A complete list of donors is available here, and our code of ethics is explained here.

This story was produced as part of the Austin Monitor’s reporting partnership with KUT.