Harris County, Texas

Harris County, Texas is the third largest, fastest-growing, and most diverse metropolitan area in the United States.

Despite boom-and-bust cycles, Harris County’s oil-based economy has driven tremendous growth and in-migration of people from other states and nations. Racial and ethnic groups have tended to cluster in certain areas, where they face different risks and challenges. For example, Hispanic residents in the southeastern part of the county are particularly vulnerable to childhood obesity and environmental exposures.

The county faces rapid growth and a number of political and structural constraints, including a state governing structure that prohibits counties from enacting local ordinances and zoning laws. These challenges make it difficult to establish and enforce local health policies. Nevertheless, multiple sectors are collaborating to implement initiatives that address well-being like access to healthy foods and civic engagement. However, given the profound social, economic, and health inequities experienced by Hispanic and Black residents, lasting solutions will require ongoing collaboration, stakeholder commitment, and long-term investment.

Overview

Population and Demographics

Population: 4.3 million

SOURCES:
U.S. Census Bureau; photography courtesy Flickr user RockinRita, CC BY-NC-ND-2.0.

Context and Actions

Community Context and Challenges

Black residents face the highest unemployment rate in the county (10%), while Hispanic residents experience lower educational attainment and health care coverage.
Among Hispanics, 39% are uninsured, compared to 11% of white and 21% of Black residents; this may be because many non-U.S. citizens cannot receive public insurance or subsidized coverage through the Affordable Care Act’s insurance marketplace.
In 2010, cost prohibited 32% of Hispanic residents and 30% of Black residents from seeing a doctor, compared with only 11% of white residents.
Approximately 18% of residents don’t have consistent access to healthy food; 22% of children eat fast food at least three times a week, 77% lack sufficient physical activity, and one in three are overweight or obese.

SOURCES:
U.S. Census Bureau. (2014). 2010–2014 American Community Survey 5-year estimates; Texas Behavioral Risk Factor Surveillance System (BRFSS) (2010).

Taking Action

Through progressive collaboration across sectors, organizations have addressed some systematic factors that bear on health and well-being.

Several major initiatives are in place to nurture partnerships across sectors, provide opportunities for civic engagement, and share information and resources for improving the health of all Harris County residents.

NOTE:
These baseline reports, created in 2016, track community programs and initiatives in their early stages and measure initial progress only. Future reports will provide more in-depth insights and analysis into this community's efforts to build a Culture of Health.

Engaging Local Youth

Through a partnership with the Alliance for a Healthier Generation, a Clinton Foundation initiative, Healthy Living Matters (HLM) engaged more than 90 youth in the County through a series of social media activities, workshops and a youth summit to inform them of the challenges they face and to help them realize their critical role in policy change.

Healthy Living Matters

In 2011 the Houston Endowment provided $2.5 million to create the Healthy Living Matters (HLM) collaborative, a public-private partnership aimed at addressing the county’s extremely high rates of childhood obesity. Managed by Harris County Public Health and Environmental Services (HCPHES) and comprising organizations representing health care, education, policy making, business and recreation, HLM seeks to increase children’s access to healthy food, improve the built environment and encourage advocacy for decisions related to these issues.

BUILD Health Challenge

The BUILD Health Challenge, which stands for Bold, Upstream, Integrated, Local, and Data-driven, aims to improve the social, physical and economic environments to support healthy behaviors for all residents. To cultivate equitable access to healthy food and reduce food insecurity in northern Pasadena, the BUILD Health Challenge is working with businesses, schools, the local government and additional sectors to address the three arms of the food system: production, distribution and consumption.

Barriers to Health Care and Coverage

Despite being home to the Texas Medical Center, the largest medical center in the world, many Harris County residents face challenges in getting the health care they need. The state’s decision to opt out of the ACA’s Medicaid expansion also limited the ability of low-income adults to qualify for coverage and get assistance in paying for care.

Going Forward

Questions for Consideration

Despite significant political and structural challenges, Harris County is making progress in “turning the ship” toward health equity through innovative initiatives led by multi-sector partnerships. Additional surveillance, data and information gathering, analysis, and reporting will examine the progress and impact of these initiatives on the health and well-being of Harris County residents, especially at-risk Hispanic and Black residents.

The following questions could provide insights into the degree to which meaningful change is taking place and can be extended and sustained:

How are the various initiatives aligning their missions and collaborating with each other, and how are underserved groups involved in decision making?
How are local initiatives, particularly Healthy Living Matters, mobilizing support for their policy priorities among influential sectors, such as health care and education?
Who is benefiting from the initiatives, and who is not? How are the initiatives addressing inequities among Hispanic and Black residents?
How is Harris County measuring and evaluating the impact of completed and ongoing initiatives to address systematic drivers of obesity and related chronic illnesses?
In what ways have grassroots accomplishments, such as the BUILD Challenge, improved the social and economic environment?
What evidence is there that the initiatives are improving the health and well-being of Harris County residents? For instance, what are the trends in access to healthy foods, physical inactivity, and obesity prevalence?