Social Determinants of Health in the Context of Changing Demographics: Emerging Hispanic Communities

Background: Social determinants of health are defined by Healthy People 2020 as the conditions in the environments in which people live that affect their health and quality-of-life outcomes and risks. How are these environments impacted in the context of changing community conditions? Based on a mixed methods community needs assessment, we investigated how changing demographic trends have impacted social determinants of health in an outlying city located within a metropolitan area in Central Texas that is among the fifteen in the country with the fastest growing Hispanic populations.

Methods: A multi-stage, mixed methods analyses was used to conduct the needs assessment. We began by interviewing 14 key informants who work directly with the community in public and social services, followed by conducting 13 focus groups with 94 community members. Using the data from the focus groups, we developed an on-line and paper-based survey which was completed by a convenience sample of 157 respondents. The final stage involved interviews with five additional key informants who worked in an administrative capacity in the community. Graphic Information System (GIS) mapping based on census data was used to decipher geographic patterns.

Findings: From 2000 to 2014 the Hispanic community in this city more than doubled and grew from 18% to 24% of the total population of 56,500 residents. Findings from our data collection and GIS analyses indicated that the community’s infrastructure was struggling to keep pace with this rapid growth, affecting the quality of life of its residents. Dimensions of residents’ social environments most affected were in health and social services, healthy food availability, and employment opportunities. While the community includes a small hospital and a subsidized health care clinic, participants often travel 40-plus miles to the major city nearby, and as far as the distant Mexican border, for care due to health services not being able to accommodate their needs. Language and cultural barriers in health services were also major themes in our interviews with residents. Many participants described the difficulty of accessing the single grocery store located over 10 miles from the Hispanic community, which according to GIS mapping can be classified as a food desert. Residents regularly had to seek employment outside the city. Exacerbating their hardship, GIS mapping indicated that the majority of households in this area had either no car or one car. In addition, undocumented residents shared how the lack of access to a driver’s license, due to state law, resulted in accumulation of unpaid fines. Interactions with law officers resulted in fear of deportation and decreased their integration in the community. Although working to address all these issues, job generation and the lack of a bus transportation system were not yet part of the city’s agenda.

Implications: This study showed how emerging ethnic communities can potentially be at risk for greater health disparities. Analysis of community changes can serve as a foundation for building social environments conducive to optimal health and quality of life and can facilitate initiatives by local community leaders to prepare for growth.