Feature: 2018 RWJF Culture of Health Prize Community

In San Antonio, city leaders created a plan to boost equity and help households, businesses, and nonprofits weather the COVID-19 crisis and prepare for the future.

A Q&A with Colleen M. Bridger, Assistant City Manager and Interim Health Director

As communities across the nation struggled to contain the coronavirus through the spring and summer, federal relief funding provided much-needed aid to local governments. Many cities and counties used their share to pay for frontline pandemic responses such as testing and contact tracing and financial support for workers and businesses. Other local governments used relief funding for essential services like police and fire departments.

In San Antonio, city leaders decided to look to the future as well. They combined Coronavirus Aid, Relief, and Economic Security Act funding with $100 million in city general funds to create a COVID-19 recovery and resiliency plan, which the city council approved in June. The plan, which aims to boost equity and help households, businesses and nonprofits weather the crisis and prepare for the future, focuses on four pillar areas: workforce development, housing security, small business support and digital inclusion by expanding access to technology. The city, businesses and nonprofits are working together to implement the plan.

We talked with Colleen M. Bridger, San Antonio’s assistant city manager and interim health director.

Component Title

It goes back to why we won the Culture of Health Prize (in 2018). As a community, we are incredibly focused on upstream root causes of health disparities and on what we can do to intervene early enough to really make a difference. This plan resonated with city council and the mayor because it continued that culture of getting in front of problems before they get so bad.

To me, moving forward with this plan was incredibly far-sighted. It recognized that we have a once-in-a-lifetime opportunity to invest a significant amount of money into the community’s recovery, and focusing on social determinants of health was a smart way to do that.

When we put the four pillar areas together, and if the work we’re doing is done well and gets the results we expect, we will have come out of this pandemic-related recession stronger than we were before we went in.

One of the things I’m proud of is the Family Independence Initiative UpTogether program, under the housing security pillar. As part of the city’s housing assistance program, instead of giving families living in poverty financial support and telling them what to do with the money, we’re letting them decide how to use it. With the right support and fewer strings, people do better pulling themselves out of poverty than when we say, “We know better than you do.” We’re going to help 1,000 families using that model. Each participant will receive direct, unrestricted payments totaling about $6,000 over two years. Participants have proven that they will use these funds exactly the way they need to use them to keep a roof over their heads, food on the table, and their kids in a stable and safe environment.

Another focus of the housing security pillar is domestic violence prevention. We have a strong focus on Adverse Childhood Experiences (ACEs) in San Antonio. Reducing domestic violence is an essential way to reduce trauma in children’s lives. It’s that upstream focus. The plan will put an additional $3.3 million into an already improved domestic violence prevention strategy that we had funded with $16 million over the past fiscal year.

As part of our workforce development pillar, we’re going to pay for people to go back to school for job training, and we created a $400 a week stipend so they don’t have to maintain a job during their intense training course. In the end, they’ll have better chances of getting a well-paying job and being able to pay for groceries, rent and so on.

Our small business pillar includes grants of $10,000 to $75,000. Grant recipients will also receive support to increase their knowledge of financial practices that promote business resiliency. One goal is for half of grant recipients to rehire some or all employees they furloughed by the end of the year. The application process gives priority points to businesses in areas of the city that are struggling; generally, census tracts with a high percentage of poverty, high percentage of persons of color and formerly red-lined areas.

And finally, we’re addressing the digital divide, in part because of all the focus on virtual learning during the pandemic. We wanted to make sure that students had not just the laptops or tablets to be able to do the work but also that they had access to the internet. In the spring, our school systems were giving out thousands of hotspots. But it wasn’t a long-term solution. So we’ve committed to building the tech infrastructure to allow students to access internet at no cost in 50 neighborhoods in city.

We chose to invest in the future of the community. We’ve known for a long time that San Antonio has health disparities. That’s not news. We have some of the worst stats in the nation when it comes to diabetes, for example. That’s why we focused on ACEs even before the pandemic. We need to get as far upstream as we possibly can to start to address chronic conditions at an early enough age to make a difference.

What the pandemic did was reinforce the fact that we have people who are medically fragile at a much higher percentage than other places—people who are much more likely to die from COVID-19. So we said, “What can we do to make sure that the next time we’re dealing with a pandemic, we’re more resilient as a community? Let’s get out in front of this now because we know there will be a next time.”

A bicyclists riding through a park.

San Antonio, Texas

The residents of San Antonio, Texas, are focused on health inequities and the connections between education, health, and wealth. 

The Culture of Health Prize

The Prize honors and elevates U.S. communities working at the forefront of advancing health, opportunity, and equity for all.