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 area’s 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 area’s
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 County’s 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 District’s 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 community’s
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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