Healthy Life Requires More Than Just Good Health Care, Survey Says
By Sean Price


People need good health care, but 57% of Texans know that isn’t everything when it comes to being healthy.

Instead, factors like where people live, work, and relax have a bigger impact, most Texans told a recent survey conducted by the Episcopal Health Foundation (EHF), a Houston nonprofit that focuses on community health. Those factors, often called social determinants of health, can include family income, the availability of clean water, or regional pollution levels, the survey says.

“We know that 80% of what determines a person’s health doesn’t involve access to medical care, and these survey results show that Texans live with that reality every day,” said Elena Marks, EHF’s president and CEO and a co-author of the survey.

For instance, the survey found that:

  • 67% reported living in an area with environmental pollutants, and 66% say that harmed their health;
  • 65% believe their health has been affected by not having a place to exercise;
  • 55% have had a job that pays insufficiently or have been unemployed as an adult;
  • 54% have had their health affected by living in a low-income area with few resources;
  • 41% have had to live in areas with poor-quality schools;
  • 37% have been unable to find affordable housing at some point; and
  • 36% have lived in a high-crime area during their lives.

“So many Texans face a range of social and economic conditions that almost conspire against their health,” Ms. Marks said. “We have to change the conversation to improving health, not just health care.”

It is official Texas Medical Association policy, adopted by the House of Delegates in 2019, that TMA “collaborate with innovative public and private partnerships to address social determinants of health and advocate for their adoption by state policymakers.”

Texans also reported high barriers to health care in the survey. For instance, 67% have faced health problems because of lack of access to a physician or a hospital. Meanwhile, about 58% believe health care costs are a big problem, and 53% point to lack of insurance as a major worry.

Concerns about health care costs already have prompted the Texas House of Representatives to form a select committee on statewide health care costs to study the issue ahead of the 2021 legislative session.

The problem of affordability is tied in part to the large number of Texans without health insurance. Texas is one of 14 states that has not expanded Medicaid. And in 2018, Texas’ rate of uninsured people rose for the second year in a row – to 17.7% from 17.3% in 2017 – the highest rate among the 50 states, according U.S. Census Bureau data.

Last Updated On

February 26, 2020

Sean Price


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Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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