Making Austin the Healthiest Community in America

At Austin Public Health (APH), we are striving to make our city the Healthiest Community in America for all residents. To do that means not only taking stock of where we’re strong – like reducing chronic and communicable diseases such as Diabetes, Cancer, Heart Disease, HIV and other Sexually Transmitted Infections, and Tuberculosis; or applying an equity lens to service delivery to improve quality of life, health, and well-being for all – but also identifying the challenges our department and city face and turning them into opportunities for growth. Data is key to this.

Austin’s geographic border spans three separate counties – Hays, Travis, and Williamson – presenting us with unique data challenges. In the past, besides our own local data collection, we’ve had to rely on data that was organized at the county level which did not always reflect the stories or health issues we were seeing. Because of the city and neighborhood-level data that the City Health Dashboard provides, my team is better able to address what is going on within the borders of our city, and paint a clearer picture of the health of our constituents.

In 2017, in collaboration with our many partners across Austin, we completed our Community Health Assessment (CHA). The CHA provided us with an opportunity to hear directly from our community members, who shared their experiences and concerns with us. The issue of health disparities in sexual health, specifically around HIV/AIDS prevalence and access to care, was voiced repeatedly and has since become a Priority Area in our Community Health Improvement Plan.  

Setting Bold Goals to Reduce HIV

Between 2014 and 2018, 1,202 new HIV cases were reported in Austin, with the annual number of new reported cases ranging from 205 to 294.  Across the country, HIV infection disproportionately impacts black and Hispanic men who experience higher risk compared with white men and white women.  We saw similar trends in Austin. While black residents make up only about 7% of Austin’s population, they account for 18% of new HIV cases. We also saw the highest percent of new cases - 42% - among Hispanic residents, though they make up about 34% of the population.

Though the long-term trend is yet to be determined, the City of Austin is experiencing a decrease in new cases of HIV.  With 205 new HIV cases reported, 2018 has the lowest number of the past seven years.

Austin is committed to seeing the number of reported HIV cases continue to fall. We signed the Paris Declaration on Fast-Track Cities in June 2018, an initiative that helps local communities share ideas and practices to leverage new and existing resources to create community progress against HIV and to end the global AIDS epidemic by 2030.  This initiative focuses on three targets: 1) ensuring 90% of people living with HIV know their status; 2) providing antiretroviral treatment for 90% of those diagnosed; and 3) achieving viral suppression for 90% of those treated.  Austin was the second city in Texas to sign the declaration and commit to achieving the Fast Track Cities’ 90-90-90 targets.

Digging into Uninsurance to Better Understand HIV Burden

Addressing health care access is equally important to successfully address the AIDS epidemic. People without health insurance may have limited access to health services, delay pursuing treatment, and experience poorer overall health. People living with HIV who lack health insurance are less likely to receive antiretroviral treatment compared with people with health insurance. In 2017, 16.5% of Austin’s residents under age 65 lacked health insurance, compared with an average of 12.9% across the 500 largest U.S. cities. Looking at uninsured rates by race and ethnicity, similar patterns as was seen for new HIV cases emerge. 16.6% of Austin’s black residents are uninsured, and the uninsured rates for Hispanics are even higher, reaching 28%.

Looking at these numbers by neighborhood, there are some areas in Eastern Austin where over 30% of people are uninsured.

The Dashboard is a valuable tool to help our department understand geographic relationships between health conditions and risk factors.  For example, the two maps below show the patterns of uninsured residents (left) and new cases of HIV (right) in Austin at the zip code level. In general, neighborhoods in Eastern Austin that experience high uninsured rates also experience a high number of new HIV diagnoses.

Reducing the percent of people who lack health insurance will likely play a key role in Austin achieving the Fast Track Cities’ 90-90-90 targets.  Using these maps and other Dashboard visuals, community leaders can clearly see specific geographic areas for focusing efforts to improve health insurance coverage and ultimately reduce the burden of HIV in Austin. Integrating Dashboard data with what we are able to collect expands our capacity as a department, allowing us to better serve our constituents, and meet our goal of becoming the Healthiest Community in America.

Stephanie Hayden is the Director of Austin Public Health and has worked for the City of Austin since 2001. She is a Licensed Master Level Social Worker who has spent more than twenty years providing services and managing programs in the field of social services.