Well.

I'm Randy Beamer, and this is Fall into Hell.

The State of health in San Antonio.

And there are so many issues around having a healthy community, issues that concern all of us.

There are issues that affect our families and our neighbors and our city, our community as a whole.

And that is why in so many cases, individual health issues are also public health issues.

And today we're going to talk about some of the most pressing, pressing issues with a host of experts here from University Health, UT Health and the Center for Health Care Services.

And we want to start with meeting our panel of experts First, Doctor Brian Alsip, who was chief medical officer at University Health.

Jennifer Northway is director of adult and pediatric injury Prevention at University Health.

Dr. Calvina Gonzalez Schlanger, who is assistant professor at UT Health and Jalyn LeBlanc Jamieson who is president and CEO of the Center for Health Care Services.

I want to thank you all for being here today.

And first of all, we want to talk about an issue that was top of mind for so much of the past year, and that is gun violence.

After you filed in the mass shooting with 19 children and two teachers shattered much of the community here.

So gun violence is maybe a top of mind top of the news already every day.

So there's way how do you deal with injury prevention no matter where it came from?

Where do we start with preventing gun violence?

Well, it really is a very complex issue as we look at it.

What we know is that those adults and children who are exposed to what we call adverse childhood experiences are are more likely to engage in violence.

It is one of those things where it's going to take a community solution, addressing the various risk factors.

What we know across lots of other social ills are their shared risk and protective factors.

And if we can collaboratively work to invest our resources to increase the protective factors around the family units and reduce those risk factors around family units, that we may see those violence numbers go down.

And how do we get around the political weight of all of this?

We saw very quickly that politics, in a way, came into this, but it also maybe deflected some from what we're going to talk about in terms of behavioral health and mental health and the other issues around gun violence and some people didn't want to hear about it.

If they heard that topic, they thought political.

How do we get around that?

It is going to take some strong representatives to really come to the table and have these difficult conversations so that we can come to some consensus.

One of our colleagues, Dr. Ronald Stewart, worked with the American College of Surgeons, was able to look at this issue with two very opposite groups, his what he called his gun lovers and those who felt like it was a it was a freedom and rights issue versus those who felt like guns were not the issue.

And he was able to show that.

Those two groups, though, they had very different opinions about the role of guns in our lives.

They were able to come to some consensus around key things related to access related to shoring up some of the loopholes that allow folks to purchase weapons at gun shows where there may not be some of the same regulations that have been agreed upon and put on put in place in communities.

And so that is a model that shows us there is the ability to make some of those things happen.

But it does take both sides coming to the table, having some fruitful, honest conversation about where there are loopholes and where we can put things in place to preserve freedom.

And access to weapons according to the Second Amendment, but also ensure that there are not loopholes and we keep our community members safe.

I think another way to sort of keep it from becoming political is just to frame the issue as a public health one.

Absolutely.

And you're really speaking not about gun control per se, but firearm injury prevention And if you look at something from a similar lens in terms of the success we've had around public health, look at the auto industry.

We've significantly reduced deaths from motor vehicle accidents through enhancements in safety around not just the automobiles themselves, but also the roads and highways on which we drive and that they're set up in a way that lampposts will break away.

And we've got sand barriers to take the impact of those those crashes.

And so looking at firearm injury prevention from a public health lens is also another way to help improve safety, because we didn't take cars away from people, just made them safer in the road, safer and you don't have to necessarily take all guns away from people, but you need to make them safer.

So that's another way to frame the perspective.

So if we take it one step further, what we're doing at the Center for Health Care Services is training the community in mental health first aid.

And so we're helping people understand the difference between trauma and the behaviors that are associated, the actions taken as a result of having adverse childhood or childhood conditions or trauma versus having a mental health disorder.

And many times you'll hear our leaders describe an event and say the individual had mental health condition, and that's not the case at all.

It's the individual was probably introduced to trauma as a child or introduced to trauma as an adult and is acting out from a behavioral standpoint.

It's not necessarily.

Behavioral health as opposed to or at least different from.

Mental health, correct behavior, health as a result of an action.

It is an action taken as a result of trauma that is behavioral health.

A mental health disorder is associated with having a many times a brain disease or a disease that a disorder that has been diagnosed.

And you receive treatment that has more to do with your feelings and thoughts versus an action taken.

I think that's where there's that confusion around the conversation about access.

What we know is when weapons are safely stored, then we can put time and distance in place.

If somebody is making a an action in the moment of anger, whether to hurt themselves or hurt somebody else, or again, putting time and space in between a child who might be playing at someone's home and not their own and find a weapon and, you know, pick it up out of curiosity.

I mean, we encourage our children to have curiosity.

And this is just unfortunately one of those areas where that leads to to death.

And so we need to have these honest conversations about what the word access really means.

Gun safety.

Yes.

And we talk about firearm injury prevention.

It really is about keeping our children safe.

Unfortunately, across Bear County, we've seen increases in youth suicide by all means.

And so when we can reduce that access to lethal means for adults, for children, it helps us keep people alive.

Because unfortunately, to John's point, when in the moment that behavior and that anger can take over and cause that irrational thought, we can see that violence towards one another.

Or picking up a weapon again out of curiosity and unintentionally shooting a friend, shooting a family member.

And of course, there's just devastation across.

And then that also brings up domestic violence, whether it's unintentionally or in the spur of the moment.

And I know you deal with this as well.

And Doctor, when that comes up and when people say domestic violence how do you deal with that in San Antonio?

Obviously, a huge issue here.

Yes.

What are your thoughts?

And basically, you know, all these trends and all these seem to be symptoms of something deeper.

You know, and we feel that there's some myths in our culture that we need to challenge.

And and basically what our Promotoras program or I think there's two institutions that we must be able to trust.

And those are the schools because we send their children, our children to them and health care because we come broken to it and it and that's when we are the most vulnerable and and we need to trust them.

But our social design is not is not to promote trust.

You know, we have the we need to transcend the economic value because we cannot buy trust.

Right.

So what is trust?

And we learn trust at home, we entrust is based on caring.

And what happens when someone is ready to grab a gun and shoot someone?

Where do we learn those, you know, those emotional regulations, those habits of caring and respect is in homes and financial and insecurity and poverty are destroying our homes.

So what we get to be green.

We have a program, Promotoras, which is basically focus on on maintaining the mission of health care, you know, and and they serve as trust links between the clinic and our patients.

So they bring me and their supervisor stories to all those patients that have mental illness, trauma all piled up with physical ailments to they have a story.

And it is on those stories where we are seeing that we need to think deeper in prevention.

And we I guess we need to think of health care in a larger and broader way than treating a wound.

And that's what you do.

Absolutely.

That kind of gets to the multifactorial and multi-layered approach to really trying to reduce this incident in our community.

And that's in helping parents understand child development and how your child develops and what we can do to nurture and grow them.

And in the right way, it comes with looking at how we're letting our own anger impact us and providing anger management courses and supports to those who maybe grew up in a home where they did not have someone to really show them how to handle frustration or how to deal with discipline in a productive and healthy way.

What about recidivism for someone who's involved in violence?

We have a reflective cord here specifically for those first time offenders, not with guns, but first time offenders for domestic violence.

But the second time or the stigma how much is there in terms of recidivism in this community?

Well, we've been working very closely with our county courts and many of the judges are referring them to receive outpatient services as a condition of the courts for behavioral health or mental health or substance abuse treatment.

And so we're seeing very good success with recidivism numbers based on those programs.

I'd have to also say that university health system has been a leader in the community to create the Trauma Informed Care Consortium.

And so many organizations that are providing care in San Antonio are now learning to basically start with the question, what happened to you?

And so it's a more empathetic and understanding the stories of these individuals and how they got where they are.

And so we can better treat all of the issues that they're facing and.

Underlying all this, and we'll get to it more later.

But Koven, are we seeing do you think that really multiplying these kinds of problems, the effects, the financial effects of COVID, the stress of being at home?

I think there are several things that we saw COVID exacerbate.

What we spoke about in a couple of instances is what we call the social determinants of health or the social drivers of health.

For a new moniker is these non-medical contributors to health.

It's the recognition that as an outcome of my my health, my mortality, my morbidity, how well I'm feeling is a result of many contributing factors.

And, you know, that is certainly health care, access to health care as a percentage, but a larger part of that percentage is other things that contribute to, you know, where you live, where you work, where you play, what what is your economic financial situation, how your educational situation, your transportation situation, what do you have concerns around food insecurity and so many other things.

And so health care, as I think is an institution in this country, is becoming more, I think, not just aware of those, but I think doing a better job of acknowledging screening for those and trying to connect patients for resources.

That's one of the huge benefits of the from authorities program is that, you know, you can actually see what exists in a patient's home outside of the health care setting and see what those challenges are in the barriers that they have and help connect them with the right resources.

I think public health nurses maybe 50 years ago did that in large urban centers, but they don't have that connection with the patients, that they live in their own neighborhoods and they actually know those challenges.

And so really what COVID did was create this incredible stress on the community health and exacerbated all of those things that were already underlying to begin with.

And now we're seeing that even as COVID is sort of transcending into a different new normal or endemic state, we now have significant financial pressures at the inflation that everyone is dealing with and disproportionately affects those that really have lower means.

And so they are also feeling that pressure even more so that also factors into their ability to even access health care and address their own needs.

And this is also everything has been a spotlight on these kinds of problems.

Because of COVID, the media has realized, oh, there's mental health issues, oh, there's some other issues.

Are we seeing more of that, you think, or is it just because we're hearing more of it as Jamison.

I appreciate the fact that we're talking about it.

The spotlight has helped people sort of get over the stigma to talk about the anxiety and the depression that was a result of the isolation and the change of conditions that COVID brought everyone.

The loss of jobs, loss of family, feeling very isolated.

So the spotlight has really caused those individuals who had coping mechanisms and could really cope with life's issues before finding themselves in a very different situation as a result of COVID.

And so they're more willing to talk about it another thing I would add is post COVID, we're trying to learn from the systems that we've created around trauma or crisis situations.

We have a very efficient and effective system of care.

We can navigate someone when they are in a crisis, whether it is a stroke a heart attack or even a mental health crisis, we can navigate them very quickly to receive the right care at the right time.

And we're looking at that system and trying to recreate that for pre crisis situations.

And so bringing nonprofits and the university health system to the table and understanding all of our capacity all of the services we're offering and creating a network so that individuals who are not in crisis but have identified a need for help can contact and be navigated in real time to either deal with social determinants of health or mental health or behavioral health or physical needs.

And so we're really looking to create a pre crisis system of care.

And also that pre-crisis brings up, OK, somebody else notices this.

What's the best advice for someone who notices something?

Is amiss with someone?

What do you tell those loved ones?

Create a safe place for them to share, be empathetic, listen to, understand and know that there are there's treatment out there that can help you, the individual and families.

Be resilient and learn how to live with that.

Just treat it as a physical health and maybe frame it that way for that person.

That's correct.

Yes.

And basically what you're what you're describing is caring, you know, care, authentic, caring does for the promotoras actually give the patient?

They're not under the clock.

They're there and they're really want to know, you know, if you when you care, you really want to know because you want to lift that person from this offering there.

And so you just don't go with an agenda.

Do you go there vulnerable, willing to listen and understand and in in where do we get those skills from?

Right.

Where do we have the time and where do we have those sensitivities and in habits of caring and respect, when do you care and get engaged?

When do you respect and step back?

That is what we call the ethics of the heart.

And that's what the Promotoras practices.

We have this in their heart.

We feel when somebody really cares about us.

And that is for us.

You know, when you think of the social determinants of health, you think of all the social activities of disease, really lack of transportation, food insecurity, lack of jobs, you know, so those are what we call the short term itself disease.

But when you flip it to positive, what is the social determinants of health?

And it is and that's when we we came up with trust and trust building and we have a culture that that doesn't promote trust because, you know, is, you know, he said win, lose gain.

And, you know, I, I sell expensive, you buy cheap and, and we grow the economy.

And when are we going to learn how to deal with each other's vulnerability?

And, and, you know, develop those skill sets.

So community a community can contain a market.

Right.

But a market cannot contain it.

Community we need to grow those skills.

And those are learned at home, right?

That's when you feel somebody actually listen to you.

When you create those safe spaces.

How do we learn to create those safe spaces?

I'm sorry.

When you talked about trust there, it brought to mind COVID and COVID vaccines.

And recently I saw a public service announcement reminding us that Kobane was the third leading cause of death in the US.

For a time now that's obviously dropped, but the COVID vaccine and the trust that it brings up where we are DR also where are we in terms of the community and the COVID vaccines now into the bi valent phase?

Well, I think it's important to acknowledge that we're probably in a much better space now than we've ever been as it relates to vaccines.

As for COVID19, you know, we have four vaccines that are either approved or authorized for use in the United States.

They cover an age group that goes as low as six months of age through adulthood.

The availability of those vaccines is more than it's ever been.

And as you mentioned, the baby vaccine, it's probably the most recent up to date version, you know, that we've had that really accounts for the type of variants that are circulating most frequently in the community.

So in a lot of respects, I think, you know, we're in a better place.

I think the is that with that complexity can also cause confusion.

You know, some of the primary series are a little bit different for each vaccine.

There's a lot to choose from.

So a lot of choice doesn't always make it easier for people.

I think there's still some misperceptions that they don't work.

You know, we certainly saw a breakthrough infections even in patients who are fully vaccinated or even up to date.

But we know they're not 100%.

But where they are very effective is in doing is preventing severe illness hospitalizations and death and have been consistently I mean say.

And how are you seeing some of those misconceptions and how do you deal with those when people come into you with other problems and they talk about the vaccine?

I'm not going to do that.

That is very I mean a lot of stories so helps a lot so you know well, you know they don't give me my insulin because I have money to pay for now.

They want to give me a free vaccine.

Like how come?

Right.

But also just listening, there's a lot of misinformation out there and you know, also theories about people are out to get you.

And it's really an environment of distrust.

And how do you build trust in an environment of distrust?

Well, it's difficult.

It's not easy, but it is possible.

It's not impossible.

And mostly it has to begin with caring to listen where people are coming from.

Honestly challenge them whether these sources of information are trustworthy or not, so that they come to grounds and to where am I getting this information?

Right.

And and then if they still, you know, stay with their belief, then you show them, you know, I'm concerned because I am concerned that you're not going to get vaccinated and and and you really believe this.

But and trust in vaccines also brings up the flu vaccine and where we are, you know, we're coming into flu season.

Are you seeing more distrust or are people saying, oh, I don't want to have the flu vaccine either?

And how do you deal with that?

Yeah, I mean, I think there's so much yet to be determined.

That's a secondary result of COVID fatigue.

You know, we've all been living this for over two and a half years, and so much of that dialog is around vaccines.

And sometimes that affects the uptake and we know that not everybody gets a flu shot every year to begin with.

And we've been fortunate actually the last two seasons, the incidence has been relatively low compared to prior years, a lot of it probably due to not just immunization availability, but also the fact that we were doing a lot of things that prevented transmission like wearing our masks and being socially distant and we're washing our hands more frequently.

And so those behaviors are not as frequent now as they were the past two years.

We've seen also as an indicator for influenza.

It happens during the winter months, and those are, you know, what we're accustomed to here in the northern hemisphere.

In the southern hemisphere, it it precedes these.

And so we've seen a higher level of activity in places like South America and Australia to indicate that it could be a more damaging flu season.

This year.

Well, we're about out of time, but as we've talked about all these different issues and people come into you for one of them, some final thoughts on how you pivot toward those other issues that you see at the same time.

That's the toughest part of all of this because there are so many different issues going on right now.

Well, I think you said the magical word pivot.

You have to, you know, keep your or your workforce safe.

And so we've been emphasizing hygiene and in keeping up all of the safe measures so that we can continue to serve our patients.

And while at the same time staying close and listening to our patients and understanding what they're facing so that we can continue to make treatment available to them as well.

So and that comes up when people come to you as well and they somehow find their way to you.

Well, I think so many of the things that have been mentioned today, the Institute for Trauma Informed Care, the work that they're doing through the operator is what we've done.

A better job in health care is seeing that we really need to think of the whole person.

They're not just presenting as a diabetic.

We're addressing the diabetes.

They're not just presenting with COVID, and we're addressing COVID there are so many things that continue to be threats to folks when they leave our hospital or doctor's office doors.

And we need to prepare them and provide the best support to them so they can continue to make healthy life choices, whether that's about the food that they're eating or the practices that they're engaging in or the coping mechanisms that they use, we really are starting to do a better job about whole person thinking and providing support to them.

And I would go further to make the home.

Absolutely.

Their home is the health unit.

Yes.

And nothing can replace that.

I mean, we can put all money or resources that are on, but the whole what has to happen in the home, these the shaping of each other in and having to share future people that share home to share a future.

How do we build these share futures in those tender years?

And that has to be our focus of attention.

And it's on all of us.

I wish we had more time, but it's clear that I think what we're talking about here is expand the idea of health, physical health to public health to it's all a responsibility of all of us because it affects all of us.

There's some great resources out there.

I encourage you to go to all those resources, find out more from these people and the great work they're doing.

I want to thank all of our guests today.

Doctor Alsipt Miss.

Northway, Doctor Schleicher and Miss Jamison, thank you very much for being here.

We also want to thank University Health for presenting this program.

And we thank you for being here and share some of these thoughts with others around the community.

Stay healthy, help our community stay healthy and take care.