People who have health insurance – regardless of income, education, age and ethnic background – are significantly more likely to report being in better health, according to a new report from Rice University's Kinder Institute for Urban Research that examined health disparities among Houstonians.
Other key findings: household income, age and educational attainment beyond high school are each independently associated with better health; Hispanics and African-Americans have significantly higher odds of being in poor health; and the nature and location of neighborhoods play a critical role in the health of area residents.
Sociologist Stephen Klineberg, co-director of Rice University's Kinder Institute for Urban Research, announced these findings in conjunction with the March 31 release of the report, "What Accounts for Health Disparities? Findings from the Houston Surveys (2001-2013)." The report is part of the Kinder Institute's Surveys of Health, Education and the Arts studies, funded by Houston Endowment Inc. It builds on findings from the 2012 Houston Area Health Survey, buttressed by rich data from the past 13 years of health-related questions included in the Kinder Institute Houston Area Survey.
The study's key finding is that at all levels of education, income and age and among all ethnicities, people who have health insurance are more likely to report that they are in good health and that they have ready access to high-quality health care. Fifty percent of people with health insurance said their health was excellent or very good; only 35 percent of people without health insurance reported the same.
"Houston is home to the largest medical complex in the world and boasts some of the highest standards for patient care and medical research," Klineberg said. "That's why it's especially troubling that this city has one of the highest percentages – 19 percent – of children without health insurance. And Texas has the highest rate – 24 percent – of uninsured individuals in the entire country.
"People without adequate insurance are severely limited in the types of health services they can access, and the research suggests that this is to the great detriment of their health," he said.
Twelve percent of the survey respondents said that there was a time during the previous year when they were unable to get the medical care they needed, mainly because of cost and inadequate insurance. "Providing greater access to affordable health insurance would contribute to improving the health and well-being of the Harris County population as a whole," Klineberg said.
"Unfortunately, the state of Texas so far has chosen not to expand Medicaid to the working poor, leaving a large gap in insurance coverage," he said.
The study also revealed that at all levels of income, education and age, African-Americans and Hispanics are significantly more likely than Anglos and Asians to report that their current state of health is only fair or poor. Only 17 percent of U.S.-born Anglos and 15 percent of Asians reported their health as fair or poor, while 21 percent of U.S.-born Hispanics, 28 percent of U.S.-born African-Americans and 30 percent of Hispanic immigrants reported their health as fair or poor.
Factors beyond the ethnic differences in education and income (for example, the vast discrepancies in family assets, the experience of discrimination and the added stress of minority status) may well be contributing to the more frequent health issues reported by the African-American and Latino residents of Harris County, Klineberg said.
Moreover, the study found that living in certain neighborhoods can independently foster or impede health-promoting behaviors, and exposure to environmental toxins has obvious health implications. The Texas Commission on Environmental Quality placed 10 local ZIP codes on its Air Pollutant Watch List (APWL), and this signals "particularly high levels of toxic pollutants along the Houston Ship Channel," according to the report.
Only 38 percent of respondents who lived in or adjacent to these locations reported their health as excellent or very good, compared with 57 percent of individuals living inside the 610 Loop and 50 percent living outside the 610 Loop. In addition, 54 percent of those living in the APWL areas said they were "very concerned" about the effects of air pollution on their family's health, compared to 43 percent of those living elsewhere in Harris County.
The study also found that "feeling comfortable in one's neighborhood" can contribute to health.
"The surveys show that people who live in places with high levels of social capital, interpersonal trust and a strong sense of belonging report better physical and mental health," Klineberg said. "Conversely, living in neighborhoods with low levels of social cohesion and high degrees of alienation and social disorder is related to higher levels of anxiety and depression and to lower levels of self-rated health."
The report noted that "despite Houston's growing economy and low unemployment rates, the inequalities have only deepened in recent years." More than one-fourth of all the survey participants said they had difficulty during the past year paying for groceries to feed their families. "Inadequate access to healthy, affordable food is clearly part of the reason why poverty and poor health are so strongly interconnected," Klineberg said.
In addition, the survey suggested that many residents are failing to take advantage of the available opportunities for health-enhancing activities. For example, 58 percent of Houstonians reported that there was a hike or bike trail within a mile of their home, but 57 percent said that they had not visited any of Houston's hike or bike trails during the past year.
The Survey Research Institute at the University of Houston's Hobby Center for Public Policy conducted the telephone interviews for the Houston Area Health Survey between June 6 and July 17, 2012. The survey reached a representative sample of 1,200 Harris County residents, measuring their self-reported health status, their experience with Houston's health care delivery systems and the health-related characteristics of their neighborhoods.
For more information or to download a copy of the report, visit kinder.rice.edu/.