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Key Findings and Planning Recommendations
No one would contest that in 1998, Austin is a dynamic, growing and thriving community. The economy is strong, the environment relatively healthy, and there are a variety of stimuli for all senses and preferences. Resources, creativity and the will to sustain it abound. Accompanying the drive for economic prosperity are signs of a renewed commitment to social equity, of each person having the chance to participate in that prosperity. One of three Greater Austin Chamber of Commerce Next Century strategies is to:
Explicitly link social and environmental goals to economic development goals
to protect the environment and quality of life and ensure social opportunity.
This CAN Community Assessment and an array of community initiatives suggest that many of the Austin/Travis County areas assets are being invested successfully in this kind of vision. Creative collaborations, new policy, and realigned incentives are being sought and implemented. But while individual and community health¾ broadly defined¾ is a widely held value, the assessment describes social equity issues that challenge our individual and combined assets. It recognizes that prosperity and a high quality of life are difficult to achieve for many of our citizens, especially those who are vulnerable or in crisis. The inevitable continued growth of the region, economic fluctuations, competition for resources and the likely continued shrinking social service dollar add to the challenge.
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ASSESSMENT STRUCTURE AND SCOPE
Much like the CAN Community Guide, this assessment of community conditions is organized by major outcome categories and the basic building blocks of a prosperous community. Outcomes addressed in the assessment include physical health, mental health, and public safety. Homelessness and substance abuse are negative outcomes that are also separately discussed. The building blocks include basic physical needs¾ housing, food, and clothing. Education, employment, transportation, and childcare are other essential building blocks that support basic needs and enhance quality of life and prosperity.
The assessment describes these aspects of community health, with a particular emphasis on populations who may not have the resources to participate as fully as possible. Not evaluated comprehensively are modifiable influences such as the environment, personal choice and behavior, and service quality and access. Spiritual and values elements are not specifically addressed. Community conditions are expressed in terms of measurable indicators where they exist. In many instances, conditions can be measured only in terms of what we know about populations as documented by social service agencies with which they come in contact.
Key findings are summarized below and discussed more fully in specific assessment chapters.
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SIGNALS -- OUTCOMES
Compared with Texas and the United States, Travis County people as a whole compare favorably in several measures of physical health and perceived safety, with some significant exceptions. In few instances did Travis County health outcomes meet Healthy People 2000 goals, which are targets for national health promotion and disease prevention indicators that were selected collaboratively by thousands of health professionals, advocates and consumers across the country. Proposed Healthy People 2010 objectives are even more challenging than the year 2000 goals. And they purposely eliminate differentiation in outcomes by population groups. The effort is seen as an effective strategy that has successfully focused investment and decision-making.
Chronic Disease
- From 1980 to 1996, deaths from cardiovascular diseases (heart disease and stroke) fell in Travis County by over a third, mirroring national and Texas trends. Even with this progress, Travis County misses the Healthy People 2000 heart disease mortality target by 8.8 percentage points and the stroke mortality target by 28.6 points. Hispanic females heart disease mortality actually increased by 16.6 percent during that time. The stroke death rate for African Americans was almost twice as high as the overall Travis County rate in 1996.
- In the same 17-year time period, Travis County deaths due to diabetes increased, especially in African Americans.
- Deaths due to lung cancer dropped in Travis County by 8.1 percent from 1980 to 1996. But the rate for females increased during that time by two-thirds, and by almost 90 percent for White females.
- The 17-year local breast cancer mortality trend dropped by 15.3 percent and met the year 2000 target. African American females had the highest death rate from breast cancer and Hispanic women the lowest.
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Communicable Disease
- The incidence of AIDS in Travis County dropped between 1993 and 1997. While the rate remained higher than the Texas rate through that time period, the infection rate is similar to other Texas urban areas where care and services are concentrated. AIDS incidence is significantly higher for African Americans and somewhat higher for Hispanics.
- Transmission of HIV has changed significantly in the past two decades. In the early 1980s, it originated from contact between White gay men and then to persons who injected illicit drugs, recipients of blood transfusions, and hemophiliacs. Through the 1990s, the proportion of AIDS cases in White gay men fell but increased among men and women of color, injecting drug users and their partners.
- No deaths from measles or whooping cough occurred in Travis County in the last several years due to diligence of the health care system in immunizing the preschool population. From 1990 to 1996, there were a total of 47 deaths from pneumonia, hepatitis B, and influenza in Travis County, well below the Healthy People 2000 objectives.
- The 1996 immunization rate for children under age two was 71 percent compared with a Healthy People 2000 target of 90 percent.
- Tuberculosis rates dropped for both Texas and Travis County since 1993, but the County rate in 1997 (10.9 per 100,000) was still three times the Healthy People 2000 target rate.
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Maternal and Infant Health
- The Travis County infant mortality rate was 5.9 per 1,000 live births in 1996 compared with the 6.3 Texas rate. The rate has not varied significantly in the past several years. The rate for African Americans was almost twice as high.
- More than 80 percent of all mothers giving birth in 1996 received prenatal care in the first trimester. Teen (ages 13-17) pregnancy, race/ethnicity and area of residence are factors related to use of prenatal care and infant mortality. Hispanic mothers get prenatal care in the first trimester far less frequently than other groups.
- The rate of teen pregnancy in Travis County was stable from 1992 to 1995, falling slightly in 1996. The Travis County rate has been consistently higher than the Texas rate through those years, and is much higher for Hispanic and African American teens.
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Safety and Injury
- In 1997, nine out of ten Austin residents reported feeling safe walking alone during the day in their own neighborhoods and in downtown Austin. At night, six in ten felt safe in their own neighborhoods, but only about one in four felt safe walking downtown.
- In 1993 and 1995, crime and violence was reported by two-thirds of survey respondents as the issue of greatest concern to their community. By 1998, just under half of respondents mentioned crime and violence as the issue of growth management surged to the forefront.
- Between 1992 and 1997, the total reported Travis County adult property crime rate fell by about 30 percent. The adult violent crime rate peaked in 1995.
- The rate of confirmed child abuse and neglect cases and victims dropped steadily by 42 percent between 1993 and 1996. The rate of reported domestic violence incidents fell by 23 percent between 1993 and 1995. A portion of the trends could be due to reporting changes.
- Between 1993 and 1995, about 14 percent of juveniles ages 10-16 were referred formally to the Travis County Juvenile Court. This rate fell by about a third in 1996 and 1997. Court records of gang affiliations dropped steadily between 1994 and 1997, by 12 percent.
- Proportionately, there is more violence in the middle schools than in the elementary or high schools in Travis County, as in the state of Texas.
- Unintentional injuries are the leading cause of death for Texans under age 45 and the fourth leading cause of death for all age groups combined. The Travis County death rate in 1996 was 26.7, close to the Healthy People 2000 objective of 25.9.
- Motor vehicle accidents led all unintentional injury causes, followed by falls (most impacting the elderly) and poisoning (highest among young adults). The age group 15-24 experienced the highest number of deaths due to motor vehicle accidents in 1996.
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Mental Health, Mental Retardation, Developmental Disabilities and Substance Abuse
- The Travis County suicide rate for the years 1986 to 1996 exceeded deaths from breast cancer and doubled the rate of homicides. This means that each week, on average, at least one person took his or her own life. It is likely that at least ten times that number attempted suicide.
- Male adults and the elderly are the groups most likely to commit suicide. The suicide rate for youth was zero in the last two years of available data (1995-96).
- An estimated one in five people in Travis County experience at least one diagnosable mental disorder in their life, and one in ten are severely handicapped by mental disorders.
- Compared with national survey results, an additional fifty percent of people surveyed in the Austin metropolitan statistical area reported that they experienced depression.
- A 1996 Texas Commission on Alcohol and Drug Abuse survey suggests that Austinites had higher rates of alcohol and illicit drug use than all other large Texas metropolitan areas. The 1998 Health Partnership 2000 survey showed that almost one in ten Travis County residents were problem drinkers, who were more likely than average to be White males under age 45. Only a small fraction sought treatment for these problems.
- Thirty percent of arrests by Austin police in 1995 were the direct result of alcohol or drug use. Many more arrests were due to alcohol- or drug-related activities.
- Substance use and abuse is usually much broader in its negative impact than most other behaviors. In 1995, more than one in three fatal injuries resulting from motor vehicle accidents in Travis County were related to alcohol or other drug use. In over 40 percent of confirmed Texas cases of child abuse in 1995, parental substance abuse was a contributing factor.
- About 19,000 people in Travis County have been diagnosed with mild to severe mental retardation.
Service barriers for populations with health issues continue to challenge community resources:
- About one in five households report that not all adults in the household have health insurance. In 12.6 percent of households, not all children are covered by a health plan.
- Psychiatric interventions, such as newer, more effective medications and case management are becoming more out-of-reach for many, as reimbursement drives an outpatient model.
- An estimated one in five youth in Travis County could benefit from community-based mental health services, whereas service resources exist for only a third of these youth.
- About two in five mentally retarded individuals with relatively mild conditions can live and work independently with appropriate support, which local agencies can provide only in part. In Travis County from 1995 to 1997, between 55 and 65 percent of applicants for supported employment initiatives were eligible for services. Of those, less than one in five were employed for at least 60 days.
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SIGNALS: BUILDING BLOCKS
Basic Needs, Including Employment
There are about 700,000 people who live in Travis County, the geographic boundary of this assessment. As the population grows, a greater proportion will be Hispanic and African American. The proportion of poor and elderly may not change significantly in the near future, although the total number will grow. Any economic downturn would affect individuals and families who are living marginally now, without health insurance and with minimal employability.
- Over the past several years, the estimated Travis County poverty rate was stable at between 15 and 16 percent, compared with a Texas rate of 18 percent in 1996. This translates into almost 100,000 local people who are challenged every day to meet their basic needs.
- Travis County unemployment is low at about 3 percent. In a strong economy, the concentration of people who are unemployed are more likely to be unemployable (in nursing homes or severely disabled, for example).
- For low income people there are major barriers to long-term employment and self-sufficiency, including lack of education and experience, especially in skills most required by local employers. The relatively high rate of teen (ages 13 to 17) pregnancy significantly impacts self-sufficiency.
- Illiteracy is relatively high in Travis County at 16 percent. The City of Austin illiteracy rate is 17 percent. The rates represent the proportion of the adult population at Level I Literacy (the lowest level).
Existing services can help only some people meet basic needs and move toward self-sufficiency. No comprehensive measures exist to describe demand/resource gaps precisely, or to gauge how much other support networks (families, employers, co-workers, churches, neighbors) contribute. The numbers served provide a very conservative estimate of minimum need. In 1997:
- Nine thousand or more people in Travis County received food supplies each day from reporting agencies.
- It is estimated that clothing was distributed to over a hundred people a day on average.
- In 1997, 13,850 people received Temporary Assistance for Needy Families (TANF) and almost 48,000 received food stamps.
- Over 40,000 students in Travis County schools were eligible for free lunches, which equates to approximately two out of five public school students.
- About 14,000 residents are Medicaid eligible for aged and disabled benefits, up from 12,760 in 1993. Total TANF eligibles dropped by about a fourth in that time period.
Meeting basic need for housing also presents challenges, and not just for low-income individuals and families.
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Housing and Homelessness
- While the stock of high-cost housing has expanded rapidly with the areas prosperity, the availability of affordable housing has not. There are major disincentives to build and integrate low cost housing, including low return on investment, regulation and red tape, and some "not in my backyard" sentiment. Federal funding for low-income housing has dropped significantly in recent years.
- Income has not kept pace with fast-rising rental prices. A third of all Travis County households pay over 30 percent of their income in rent. Three-fourths of poor renters pay over 30 percent of their income in rent.
- In recent years, about 1,000 requests for transitional housing were denied per year.
- There are about 1,100 families on the waiting list at the Austin Housing Authority.
- It is estimated that about 6,000 people are homeless in Travis County over the course of a year. On a given day, there are approximately 3,800 homeless in the area. A growing proportion of Travis Countys homeless population is in families. Possibly a third of homeless persons are dually diagnosed with mental illness and substance abuse issues.
- At the same time, there are 700 emergency shelter beds available and planned. Transitional housing filled about ten percent of requests in 1995 and 1996. There are currently seven substance abuse inpatient treatment slots allocated for homeless persons.
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Education and Child Care
- Purchased childcare is too expensive for low-income families, who spend over a third of their income on it.
- There is only one accredited slot available for every four children who need child care, and demand is on the rise, especially for infant care and care for children with special needs.
- The industry has major challenges in staff recruitment, training, and retention¾ factors that impact the availability and quality of services.
Indicators are mixed with regard to how well Travis County school systems are helping students prepare themselves for self-sufficiency and prosperity in adulthood:
- The 1990 census reported that 17 percent of Travis County residents over age 25 had not completed high school; among African Americans and Hispanics, the percentage was twice as high.
- Overall, the dropout rate has decreased in recent years and academic performance has improved.
- Students in wealthier communities have better outcomes on all indicators of school performance. Teachers in wealthier communities are more experienced and have more advanced education.
- The Austin Independent School District in the core of Travis County represents about three-fourths of all county students. Approximately half of AISD students are economically disadvantaged. AISD students fall below standard on attendance, dropout rate, and TAAS skills.
- In the Del Valle School District, representing five percent of County students, almost two-thirds of students are economically disadvantaged. Attendance, basic skills, and SAT scores are under the standard, and teacher turnover is high.
- The Manor School Districts two percent of County students are more likely to be economically disadvantaged than not (52 percent are). Performance issues include a relatively high dropout rate, lower than average SAT scores, low but recently improving TAAS scores, a teacher turnover rate twice the state average in school year 96-97, and the lowest percentage of teachers with advanced degrees in the County.
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Findings and recommendations on Assessment Process
The assessment effort uncovered numerous gaps in the availability and accessibility of data on community indicators. They include the following:
- This community assessment cannot be considered a one-time effort. Some of the goals and planned work can only be achieved over time. Most of the assessment goals needs to be tracked on a periodic basis.
Recommendation: The Community Action Network should have a continuous assessment, with an annual effort to consolidate all information from the assessment in the form of a widely disseminated publication. Over time, the original goals of specific gap analysis of needs, demand for services, supply of services, and resource availability can be achieved.
- Many gaps between specific needs and the capacity to meet those needs cannot be quantified at this time. Service capacity data are minimal and cannot be established with current resources.
Recommendation: Explore the use of private/public partnerships for monitoring and reporting the overall capacity to provide services in each of the twelve issue areas.
- Indicator data were available for only one-third of the communitys desired outcomes or aspirations and a significant portion of these data have weaknesses of reliability. The available data were found to be extremely scattered, somewhat inconsistent or contradictory, and relying on non-uniform definitions.
Recommendation: A centralized repository of data, with continuous updating, standardization of concepts and definitions should be established and adequately supported. This repository should make data available to decision makers, agencies, community organizations, advocates, researchers and others. A catalog of repository data should be published at regular intervals, minimally annually. Accessibility should be a high priority and should utilize internet media as well as more conventional methods.
- Indicator data are not available for over two-thirds of the outcomes in the Community Guide. Further, many of the published outcomes are either too vague, too complex or impossible to measure by any valid indicator.
Recommendation: Adopt a process to revise outcomes; establish criteria for measurable outcomes; and republish new, prioritized outcomes.
Recommendation: Invest in a comprehensive, annual community survey that can provide community indicator measures. This can be done by expanding current surveys or by launching new community survey efforts.
- Mental health, MR/DD, and the substance abuse issue areas can be more fully and adequately assessed with appropriate data on the broader community. At present, much of the available data is limited to the indigent population served by public organizations.
Recommendation: Adopt a limited number of key indicators for which private and public providers are willing and able to provide data and set up a system for compiling data from all sectors of the community.
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PLANNING AND RESEARCH OPPORTUNITIES
The assessment suggests several planning and research avenues that warrant consideration. Some are already being explored or implemented in limited ways. In terms of efficiency and effectiveness, they promise considerable value.
- Plan based on a consensus of assumptions about our community. Include population projections and likely economic fluctuations.
- Consider focusing future planning and decision-making towards achievement of specific community health objectives measured by outcome indicators that represent a special Austin vision. What is an acceptable level of outcome?
- Establish a vision of equity for all segments of the community. Implement standards that do not differentiate service or desired outcomes by population segment.
- Expand understanding of links between economic and work force development and the environment to social well-being outcomes.
- Center planning and investment in neighborhoods, the workplace, schools, and churches. Identify and build on assets.
- Explore further how life perspectives, values, and choices impact community health and how to incorporate that awareness in strategy development. This includes spirituality, social activity, culture, the arts, and other positive outlook- building.
- Understand local barriers to self-sufficiency, including environmental, systemic, cultural, and choice factors, and consider implementing services to address them.
- Create better systems to identify and link at-risk individuals and people in crisis with solutions.
- Expand the notion of linking or consolidating funding and services for at-risk individuals, using as models several local and national initiatives in effect today.
- Expand efforts to define and sustain continuums of care and service, and coordinate services using case management processes.
- Involve the leadership, creativity, and technology that propel the economic prosperity of the region in creative strategic planning, advisory, and implementation opportunities in community health.
- Measure and address challenges in recruiting and retaining high quality personnel in all issue areas.
ASSESSMENT USE
As stated above, this Community Assessment Report is the first step in an ongoing, complex process to describe community conditions. It contains substantial and detailed information but is not comprehensive or exhaustive. It should be used only as one reference among several for any decisions made about health and human services. It should not be used as a stand-alone source.
The authors acknowledge that there may be issues, subjects, elements, topics and concepts that are not included in a particular section of this report that are of special concern to certain users. Please advise us as soon as possible about these concerns so that they may be considered for inclusion in the follow-up work.
Plans are under way to put in place the next steps in this process to continuously research, collect, and analyze data on community needs, gaps in service, and trends relating to health and human services. The process and the data will be made available to the community as soon as possible.
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