Understanding Houston

Census 2020: What’s at Stake for the Houston Region

Why those who need the census most may also be those it threatens.

As a Latina whose family comes from the western border of Texas with Mexico, I have always felt the tug of two identities.

The calling to civic duty runs generations deep in my family, so when the 2010 census questionnaire landed in my mailbox, I was determined to be counted. However, the answers to my questionnaire were complicated by my present and historical position as a queer woman of color living in Texas.

With relative certainty, I was able to check the box next to “Yes. Mexican, Mexican Am., Chicano”, but when it came to the subsequent (required) question of “race”, I didn’t feel like I matched any of the options presented to me.

Had I had the right to legally marry, I probably would have designated my long-term, live-in partner as my “wife”, but since we were also required to include our “sex”, checking that box felt like outing ourselves to the same government that declined to legally acknowledge our partnership. So instead, we talked around our truth and settled on “roommate”.

Socially, a lot can change in ten years; and it has.

Changing dynamics and growing threats on the path to the 2020 Census

In 2011, Don’t Ask, Don’t Tell was repealed. In 2015, it became legal for me to marry.

Since 2017, however, even more has changed. While life for vulnerable communities has always come with its challenges, we’ve see new threats in laws, repeals of protections, bans, and acts of violence that have emboldened discrimination and incidents of hostility toward immigrants, people of color, the Muslim community and other religious minorities, as well as trans and gender non-binary folks. This has, and will continue to have, a chilling effect as communities look to protect themselves and their families.

And this is just the beginning when it comes to the challenges our region faces in our efforts to count everyone in the 2020 Census. For many people, talking about your country of origin, race and/or ethnicity can be complicated.

“The way you identify may seem excluded from the census questionnaire or may feel too risky to disclose on a government form.”

And while we’ve made great strides in the LGBTQ community, characterizing or implying one’s sexuality or gender for government documents might not be possible or feel safe for everyone in our community.

Beyond this, the census faces other challenges like under-resourcing; some estimate that regional field offices have been reduced by half and that there will be 200,000 fewer census workers to knock on doors. The census can reconfigure political power, congressional districts and representation of states in the Electoral College. And with this, the risks associated with putting the questionnaire online for the first time are significant. Between online security issues and malicious campaigns designed to confuse or profit from vulnerable users, moving the census online comes with its challenges.

The growing risk of underrepresentation

The impact of these challenges for the census itself is increased risk of undercount in our communities. In our region, the groups who have historically been undercounted are not too dissimilar from other regions. According to early research from January Advisors, these are renters, communities of color, households with children zero to five years old, those in crowded housing units, people living in poverty, as well as at-risk groups like the LGBTQ community, people experiencing homelessness, religious and ethnic minorities, and residents impacted by Hurricane Harvey. However, for the Houston region, the difference is that, as the near-third largest metropolitan area in the country, these groups and risk-factors are highly represented in our community, and are in some cases, the same groups who stand to lose the most.

“The census affects how billions of our tax dollars will come back into our communities through federal budgeting allocations over the next decade.”

If people are undercounted in the census, we see smaller budgets for services and programs like: public transit, highway planning and construction grants; billions of dollars in community development block grants; billions in housing related dollars, including Section 8 Housing Choice Vouchers and other housing assistance programs; teachers, textbooks, and other educational expenses; Title I grants that help local educational agencies serve low-income families and communities; special education grants; funds for the national school lunch program; Head Start; grants for improving teacher quality; and Community Health Centers serving low-income community members.

An important opportunity for the Houston region

Demographically, a lot can change in ten years; and it has.

Since 2010, Houston has rapidly grown and shifted at a well-documented rate. The 2020 Census is our chance to recalibrate and keep up with the demands associated with our growing population.

It is no accident that Houston in Action, with its mission to increase access and breakdown systemic barriers to civic participation, began planning for the 2020 Census during its formation in mid-2018. The members of Houston in Action reflect the multiplicity and abundance of our region’s populace and understand first-hand what’s at stake for their communities and the region at-large if we don’t all put in the hard work of counting each and every one of our friends, families and neighbors.

Houston in Action facilitates a first of its kind, regional Complete Count Committee, in partnership with the City of Houston and Harris County, engaging dozens of community groups and leaders to educate and energize our city toward a complete count.

Houston in Action members are front and center in our collective effort to reach a complete count for the 2020 Census: members like BakerRipley and the hundreds they serve at their Head Start centers; community members in the care of Hope Clinic, young people of color organizing their communities with the support of organizations like United We Dream, Mi Familia Vota, and Jolt; the Houstonians affected by Harvey and served through the housing work of groups like Avenue CDC and Texas Housers, those whose communities are represented in the work of coalitions like Empowering Communities Initiative, TFN-Texas Rising, and the Houston Area Urban League; and Houston area residents who rely on our public libraries, community centers, and public schools for education and access to the internet, to name only a few of those involved in the Houston in Action 50+ member network.

It is this on-the-ground experience that has shaped our coordination around the 2020 Census. Our work is grounded in the fundamental belief that when we create a culture of organizing ourselves for the empowerment of marginalized communities, we are better prepared to identify opportunities to engage civically, influence the systems and structures that affect our lives, and improve quality of life throughout our region.

“When we create a culture of organized empowerment, we are better prepared to influence and engage with the systems that affect our quality of life.”

The 2020 Census presents a great opportunity in this effort. For over a year, we’ve been able to build important connections, have conversations and coordinate in ways that did not previously exist. Together, we have shaped common strategies, shared resources, and built foundational systems for sharing critical impact data. We’ve developed infrastructure to grow our collective capacity and unite our efforts like never before — all necessary elements in our work to shift systems and culture, and create equitable access to civic participation for residents of the Houston region.

However, we know that we can’t do this without great partners and support, and that we can’t do this overnight. While our sights are set in the near-term on the decennial census and work just ahead, we are working for true equity and systems change for generations to come. It’s the kind of change that will be incremental — but long-lasting.

Because we know a lot can change in ten years; and it will. Together we can make it happen.

Frances Valdez is the Executive Director of Houston in Action after practicing immigration law for 13 years. Houston in Action is an initiative made up of people and organizations who have come together to advance our community forward through our respective and collective work to build a stronger Houston through a culture of civic engagement.

Using science and evidence to drive investments in early childhood

How research reinforces the importance of high-quality early childhood education.

The vitality of Houston depends, in part, on the aptitude of the next generation to achieve success. Houston needs a capable workforce that can handle the challenges of an ever-changing global economy, and the factors that shape the capacity of our future workforce depend on the decisions we make now as a region.

Decades of science demonstrate that the ability of an individual to achieve success is strongly influenced by how the brain develops during the first few years of life. From birth to age three, the brain makes over one million neuronal connections per second. These neuronal connections are vital to building a strong, healthy brain structure. The brain is responsible for every human function, from breathing to executive function, and how the brain develops during the first few years of life influences a person’s potential for learning, problem-solving, motor skills, emotional and behavioral function, and essentially every other aspect of human life. Yet, not all children have the same opportunities for the experiences and interactions necessary for healthy brain development.

An inequitable start for too many children

While the biological process of one neuron connecting to another is driven partly by genetics, environmental factors play a significant role in the quantity and quality of those connections. Whether connections are maintained, wither, or die depends on the input a child’s brain receives from his or her environment and relationships with caregivers. “Serve and return” is a phrase coined by the Center on the Developing Child at Harvard University that describes the types of interactions necessary for optimal brain development.

Serve and return interactions are those that occur between caretaker and child and involve responding to a child’s non-verbal and verbal cues with kindness, affection, physical touch, language and other forms of communication. While this seems fairly simple, the brain requires consistent, frequent serve and return interactions, which can be difficult for many working families, especially the working poor who often have multiple jobs. Moreover, many children spend the majority of their time in childcare centers where engagement with young children is limited to diaper changes and feeding.

Most caregivers want to give their children as many opportunities as possible, yet there are many social, economic, political and environmental factors that create barriers to caregivers’ ability to optimize brain development. For example, poverty, food insecurity, and neighborhood violence significantly increases the risk of parental stress and depression, which impedes caregiver-child interactions. Poor housing conditions, such as the presence of lead paint, can directly impact the brain development of a child, as lead deposits can cause neuronal cell death in the brain. Lastly, adverse childhood experiences and unrelenting, sustained stress have substantial and lasting impacts on both caregiver and child.

**Click here to explore funding recommendations that maximize impact.**

An investment gap that must be filled

The complex and large-scale nature of all the factors that can influence brain development during childhood has led to a gap in investment from birth to age three because the task can seem insurmountable. Also, access to families with children age three and younger can be difficult if they are not in a childcare system. Thus, philanthropy and advocacy organizations often steer their efforts to a more manageable goal of increasing access to pre-kindergarten. Increasing opportunities for early learning is very important and research has shown improved academic and economic gains from pre-K, especially for children from low-income families. However, these outcomes depend on how aligned the pre-K program is with developmental science.

The part of the brain primarily responsible for learning and memory is called the hippocampus, which unlike most of the other parts of the brain, continuously forms new neuronal connections throughout a lifetime. That is why adults can be life-long learners. However, the critical window of brain development during the first three years of life occurs in the cerebral cortex, which is responsible for intelligence, personality, “soft skills,” and many other vital human functions. Optimal cerebral function is required for individuals to be successful in the workplace and have healthy relationships. Yet, the cerebral cortex is not adequately stimulated by all pre-K programs. Moreover, most pre-K programs begin at age four, which is after the majority of brain architecture has already been developed.

Two-generational, whole family approaches hold tremendous promise

Early Head Start (EHS) is an excellent example of how policymakers developed a two-generation intervention based on science. EHS provides parental support to improve caregiver brain-building skills, and services start during pregnancy and continue through age three. EHS intentionally goes beyond a traditional “educational” framework to include components that stimulate the intellectual, social, and emotional aspects of a child’s development. This creates neuronal connections in other parts of a child’s brain, not just the hippocampus. EHS also addresses the social and economic needs of the parents, which, as described above, can be barriers to optimal caregiver-child interactions. This “two-generation” approach is an important aspect of the EHS program and is worthy of emulation.

National efforts are well underway to catalyze a resurgence of this approach. Simply put, two-generational approaches acknowledge an obvious truth: different children’s outcomes are largely dependent on the vitality of the families and neighborhoods in which they live. Hence, two-generation approaches intentionally focus on addressing the needs of the whole family and the factors that keep them from prospering, with the goal of optimizing conditions for both parents and their children.

In Houston, we have several opportunities to support or create holistic, two-generation interventions that facilitate early childhood development. The Mayor’s Complete Communities initiative provides an opportunity to leverage current neighborhood investments to reduce many adverse factors that affect families and create a caregiver educational program that increases caregiver brain-building skills. In partnership with the Children’s Museum of Houston, the City of Houston Health Department has launched Houston Basics, which is a public health campaign designed to increase caregiver serve and return with young children. Houston Basics can be leveraged to launch more intensive brain-building training for caregivers, as well as connect families to social support resources. Other cities, such as St. Paul, Minnesota, have increased the brain-building skills of childcare workers, and have standardized and improved childcare centers while also providing education and job training to help parents move out of poverty.

The opportunity for a focused, data-driven investment strategy

If we want improved outcomes for Houston’s children, we have to align our priorities, policies, and investments with science. Rather than divide our funding priorities and advocacy efforts in early childhood into education, childcare, and parenting program silos, we need to have a comprehensive and integrated approach that provides support for children and their families from pregnancy through Kindergarten. We should follow the child, rather than the sector. We also need to develop multi-sector interventions that can address some of the economic and social challenges many families experience, while also building their capacity to be brain builders despite these challenges. Lastly, we need to understand there are significant opportunity costs when we do not prioritize solutions that focus on the first few years of life. As we wait longer to intervene, the cost of intervention increases and the return on investment decreases.

Understanding Houston is a great step towards using data and science to inform decision-making. It also provides a platform for a variety of stakeholders to receive information, which hopefully will spur dialogue and challenge beliefs amongst a variety of interested parties. Houston is a strong, resilient region. The task of ensuring every child has the same opportunity for optimal brain development is large, but if we allow developmental science to shape our policies, practices and investments, we can ensure a bright, prosperous future for Houston’s children and prospective workforce.

Quianta Moore, M.D., J.D., is the Fellow in Child Health Policy at the Baker Institute for Public Policy. Her research focuses on developing empirically informed policies to advance the health and equitable future of children and their communities. Read more.

Parents Must Shape Public Education in Houston

As the keeper of Houston’s citywide education vision, Good Reason Houston is committed to making sure that happens.

Good Reason Houston exists for a very simple purpose — to ensure that every child, in every Houston neighborhood, excels in a world-class public school and thrives in the Houston of tomorrow. That means that we must transform our schools today. This is a citywide challenge and we need a citywide solution. Good Reason Houston will partner with those districts that are ready and willing to take bold and courageous action to transform their schools now, not five years from now. We began this work two years ago, and as we built the foundation for our strategy it became clear that the families most directly served and impacted by public education did not play an active role in critical education decisions impacting their children. As a community, we haven’t spent enough time trying to understand what families need and want for their children. In order to create the kind of citywide changes Houston needs, Good Reason Houston immediately began thinking about opportunities to bridge the gap between families and the schools and districts that serve them.

The first step required more and better information about parent attitudes toward the schools they have access to today, and what they hope for in the schools of tomorrow. Collecting that kind of information — across districts, across systems, across geography and demography — is no small task, so we engaged a best-in-class research partner to lead the work — Wakefield Research Partners.

Research objectives

Good Reason Houston partnered with Wakefield Research Partners to interview more than 1,500 families across Houston to understand how those families feel about the schools their children currently have access to and what they’d like to see for their children in the future. We then asked parents about the kind of information they wanted and needed to make decisions about their child’s education, and finally, we talked to them about their willingness to become advocates at the school and district level for education transformation.

Our methodology

Wakefield Research completed phase two quantitative research through a survey conducted between February 20, 2019, and March 28, 2019. 1,540 Houston parents across nine independent school districts and local charter schools completed the survey. Districts represented in the survey include Aldine, Alief, Channelview, Galena Park, Houston, Pasadena, Sheldon, Spring and Spring Branch. 216 of the total respondents have children who attend a charter school. The margin of error for this study among all Houston parents is +/- 2.5 percentage points at the 95% confidence level.

These findings are illuminating and we hope that others will learn as much from them as we have. To that end, we are releasing this research on our website: goodreasonhouston.org/parentresearch.

For Good Reason Houston, this data tells us parents are ready and willing to be a part of this discussion. We believe the TEA A-F ratings are a critical first step. We will work closely with parents and districts to make sure that parents not only have information, but have the ability to do something about it — whether that means improving their existing school, choosing to attend a different school, or joining with the district to create entirely new school options.

We’ve included some highlights below, and we hope this is just the beginning of a new citywide conversation about what parents want and expect for their children and how we — city and district leaders, educators, policymakers, education stakeholders, and the public — can ensure that our schools provide that for every family.

Key findings

Parents overwhelmingly support a common accountability system for schools and find that information valuable. The Texas Education Agency’s new A-F system was very popular with the vast majority of parents. They found it to be a credible source of objective information that allowed them to make more informed decisions.
Percent Who Feel the A-F Rating System is Very or Extremely Valuable
Parents think there is more to be done to improve the quality of schools. Parents are not satisfied with the quality of their own child’s school or the system as a whole. Parents in this city want and need more schools rated A and B.
Acceptable Ratings for Child’s School
Parents clearly want more diverse public school options for their students. Parents across districts and systems felt very positively about a variety of school types and want both better access to different kinds of schools, and more information about what is available for their students.
How Interested Are You in Enrolling Your Child(ren) in Each of the Following School Types?
Parents desire easier access to quality school options. Parents need better access to information, transportation and enrollment opportunities to feel like they have access to quality choices. For many parents, it’s not enough to make sure good schools exist; we must also make sure they are realistic options for more students.
Top Reasons Why Parents Don’t Feel They Have Access to Multiple Public Neighborhood Schools Options
Parents will take action and advocate for their children’s education. Parents want changes and they’re willing to work for them if we as a city can give them the resources and support to become advocates for not only their own child, but for all children.
Parents’ Level of Confidence in Reaching Out to Each Person or Group to Address School Quality
Parents are not concerned with the political infighting in education, they just want good schools. Despite the political debates about testing and accountability and divisive rhetoric about charter schools, parent opinion has not been impacted. This is clear in the discussion of the A-F system. Similarly, fewer than 1-in-10 parents feel negatively about charter schools, the majority feel positive and want to learn more, and more than 70% of parents believe quality is far more important than how a school is governed.
% Who Agree Academic Achievement is More Important Than School

Good Reason Houston is on a mission to increase the number of students succeeding in high-quality schools today and thriving in the workforce tomorrow.

Alexandra “Alex” Hales Elizondo is the founding CEO of Good Reason Houston. Prior to launching Good Reason Houston, Alex served as the Executive Director of Teach For America Dallas-Fort Worth, leading a team of 50 staff members and a network of 1,200 educators.

It’s “Okay to Say™” that you or a loved one have a mental illness

How evolving perspectives on mental health lead to more effective treatment and prevention.

I wasn’t born in Texas, but I got here as fast as I could! As a new Houstonian and the new Executive Director of The Hackett Center for Mental Health, I am honored to join the Understanding Houston initiative to address important quality of life issues impacting the Houston region. It’s time we all acknowledge that mental health is a critically important part of our overall health.

Most know that the mind and body are interconnected and intertwined and that our mental health impacts other parts of our physical health. A person with depression is more likely to experience cardiovascular disease, diabetes or stroke. A person with cancer, chronic pain or coronary artery disease is more likely to experience a major depressive episode, as are people with asthma and other respiratory conditions.¹ And, when these disorders occur together, the risk of death is significantly increased.² That is why when we talk about “health” we must include the “mental” as well as the “physical.”

It’s never too soon to start paying attention

We know that mental illness is, by definition, a pediatric illness. We say that because the majority of mental illness begins in childhood and adolescence. Half of all mental health conditions manifest by the time a child turns 14, and 75% of all lifetime cases have presented by age 24.³ And like many physical health conditions, early detection and treatment of mental health issues can improve long-term outcomes, allowing those diagnosed to lead full and productive lives.

“Neuro-biological factors, along with adverse environmental conditions, are all factors underlying mental disorders.⁴”

Our mental health is impacted by many factors during our lifetime. In addition to the biological and brain chemistry factors affecting conditions like depression, bipolar disorder, anxiety and schizophrenia, the natural and mental conditions in which we are raised also play an important role in our long-term mental health. Being bullied or abused, living through natural disasters, experiencing a divorce, going through or witnessing violence, economic hardships, or losing a loved one, all increase the chance that we develop a mental illness, and even more so for people in poverty and people of color given the extra challenges they face.⁵

Mental health issues are all around us

All of us have circumstances and experiences that may give rise to mental, emotional or behavioral conditions. In fact, as is the case for me and my family, it is likely that either you or someone you know, has either had or will have a mental health challenge.

“We are never more than “2 degrees of separation” away from a mental health concern. Our own family. Our co-worker’s child. We all know someone.”

Mental disorders affect people of all ages, backgrounds, races, ethnicities, geography and socioeconomic status. In a recent study, 3 out of 4 Texans stated that they have a friend or family member that has experienced a mental health issue.⁶

Fighting the stigma

Mental illness may not discriminate, but people do, which has led to the “stigma” associated with mental disorders. To eliminate the stigma and the prejudice and discrimination that can arise from mental, emotional and behavioral conditions, the Meadows Mental Health Policy Institute created the “Okay to Say™” campaign.

88% of Texans agree that the “stigma” surrounding mental illness needs to be removed.⁷ When people “Stand Up and Speak Out” it becomes “Okay to Say” that you or a loved one has a mental illness. This is so important because talking openly about our mental health, and our mental health needs can bring about the support, hope and treatment that people need to recover so that all Texans and Houstonians can lead full and productive lives.

“It is okay to say I have dealt with depression for years. Thanks to some wonderful medical professionals, I was diagnosed at an early stage and have been treated continuously. As a result I have functioned at a high level for 40 plus years. More people will get help if it is okay to say.”
– Tom L.

Building a more supportive community right here in Houston

In the Greater Houston area, I am already learning how fortunate we are to have many talented and caring individuals and organizations that are seeking to prevent mental illness and treat people with mental health conditions. We are also fortunate that the City of Houston, and its partners at the Baylor College of Medicine Menninger Department of Psychiatry, and their affiliate partner Texas Children’s Hospital, just received a system of care grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). This four-year grant will build on the collaborative spirit already present in Houston to create a more coordinated network of effective services and support systems that have been proven to advance partnerships and improve lives.

The focus of this grant will be the 150 youth in Harris County who first experience signs and symptoms of psychosis each year, along with youth who experience bipolar disorder, and this is an amazing opportunity for schools, professionals, youth and families — the entire community — to come together to improve capacity and access to critical services and supports!⁸

“The evidence shows that treatment is effective and that people can and do recover from mental illness.⁹”

More good news is that we are increasingly better at preventing mental illness, identifying mental health conditions sooner and intervening so that all of us can have emotional well-being.

Our mission isn’t over

One of the challenges our region still faces is that the majority of children, adolescents, young adults, adults and older adults who have mental health challenges do not receive treatment of any kind. One reason is because of stigma. Another is because people don’t know how to navigate the system.

31% of Texans said that if they or a family member needed help, they wouldn’t know where to go or who to contact for treatment. That is why The Meadows Mental Health Policy Institute continues to educate Texas legislators to strengthen access to mental healthcare. With Governor Abbott declaring mental health an emergency item for the 86th Texas Legislature, the session was one of the most significant in recent memory. Not only did legislators maintain and build upon previous advancements, but the creation of the Texas Child Mental Health Care Consortium will also impact the treatment of children with mental health issues and cultivate Texas’ need to grow as a research hub for mental health and substance abuse issues for years to come.

It’s “Okay to Say™” that you need help

In addition to policy change and investments in mental health, we need to talk about mental health, identify and implement strategies to improve mental health and make sure that it is “Okay to Say” so we can speak openly about mental illness. So, if you or someone you know can benefit from services and supports, please let them know that it is “okay” to talk their doctor, clergy, school counselor, family member, friend or someone they can trust, and let them know that you care and it’s okay to get help.

To improve the mental well-being of Houstonians and all Texans, The Hackett Center for Mental Health, and the Meadows Mental Health Policy Institute stand ready to assist with system improvement efforts. If you have questions or comments or want more information please visit www.texasstateofmind.org and www.okaytosay.org/, or contact Dr. Gary Blau at garyblau@texasstateofmind.org.

Together, we can and will make a difference to improve the lives of our fellow Houstonians and Texans, and I am grateful and eager for the opportunity to help.

Gary M. Blau, Ph.D is the Executive Director of The Hackett Center for Mental Health, a Regional Center of the Meadows Mental Health Policy Institute. Prior to this he was Chief of the Child, Adolescent and Family Branch at the federal Substance Abuse and Mental Health Services Administration. Follow him on Twitter @GaryBlauPhD

Through the generosity of the Maureen and Jim Hackett Family, The Hackett Center for Mental Health was established in January 2018 as the inaugural regional center of the Meadows Mental Health Policy Institute. Leveraging the participation of exceptionally skilled researchers, community leaders, and health care providers, The Hackett Center’s purpose is to transform systems and influence policy through unprecedented collaboration.

The Meadows Mental Health Policy Institute (MMHPI) is a leading policy and research organization that identifies effective mental health care solutions and partners with policy makers and communities to improve access to high quality, mental health services. MMHPI’s vision is for Texas to become a national leader in providing mental health services. Follow MMHPI on Twitter @TxMind

References:

National Institute of Mental Health, Chronic Illness and Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml, October 6, 2019.
Lichtman, J.H., et al. (2008). Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the American Heart Association prevention committee of the council on cardiovascular nursing, council on clinical cardiology, council on epidemiology and prevention, and interdisciplinary council on quality of care and outcomes research: Endorsed by the American Psychiatric Association. Circulation, 118(17), 1768-1775 Tanuseputro, P., Wodchis, W. P., Fowler, R., et al. (2015). The health care cost of dying: A population-based retrospective cohort study of the last year of life in Ontario, Canada. PLoS One, 10(3): e0121759. doi:10.1371/journal.pone.0121759. Pinquart, M. & Duberstein, P.R. (2010). Depression and cancer mortality: A meta-analysis. Psychological Medicine, 40(11)
Kessler, R., Amminger, G, Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustun, T. (2007). Age of onset of mental disorders: A recent literature review. Current Opinion in Psychiatry, 20(4): 359-364.
Uher, R. (2014). Gene-environment interactions in severe mental illness. Frontiers in Psychiatry, 5:48, doi.org/10.3389/fpsyt.2014.00048.
November 2018, Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States, Melissa T. Merrick, PhD; Derek C. Ford, PhD; Katie A. Ports, PhD; et al, https://jamanetwork.com/journals/jamapediatrics/article-abstract/2702204
Meadows Mental Health Policy Institute, Talk Openly about Mental Illness, Retrieved from https://www.okaytosay.org/files/downloadable_materials/ots_Infographic_11x17.pdf, October 6, 2019
November 2018, Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States, Melissa T. Merrick, PhD; Derek C. Ford, PhD; Katie A. Ports, PhD; et al, https://jamanetwork.com/journals/jamapediatrics/article-abstract/2702204
Kirkbride, J. B., Jackson, D., Perez, J., Fowler, D., Winton, F., Coid, J. W., Murray, R. M., & Jones, P. B. (2013). A population-level prediction tool for the incidence of first-episode psychosis: Translational epidemiology based on cross-sectional data. BMJ Open, 3(2), 1–12. Estimates of the incidence of first-episode psychosis are extrapolated from studies by Kirkbride and colleagues that used a range of ages (14–35 years) during which the first episode of psychosis is likely to occur.

The 21-Year Gap

Exploring how life expectancies vary across Houston-area neighborhoods.

Houston is home to the world’s biggest medical center, which includes the largest children’s hospital, the nation’s top-ranked cancer hospital, and internationally recognized pioneers in research and medicine. Yet, if you drive less than five miles southeast of the Texas Medical Center, you will find clusters of neighborhoods in the Sunnyside community where the expected life expectancy is as low as 66 years — on par with countries such as Rwanda and Pakistan. Drive five miles west of the Texas Medical Center and you’ll reach a neighborhood in Bellaire where the average life expectancy is 87 years. So, in a simple 15-minute drive through Houston, you’ll find two communities with two vastly different health prospects defined by a staggering 21-year gap in life expectancy. This was a major finding from a recent analysis conducted by the Episcopal Health Foundation (EHF) on life expectancy in Texas. The EHF research team used census-tract level estimates of life expectancy at birth in Texas produced by the USALEEP Neighborhood Life Expectancy Project and demographic data from the U.S. Census Bureau to understand why we see such large gaps in life expectancy from one neighborhood to the next.

Mapping Houston-area life expectancies

Click here to explore life expectancy across neighborhoods.

For Harris, Fort Bend and Montgomery counties, the USALEEP published life expectancy data for 830 neighborhoods (or “census tracts”). When these neighborhoods are ranked by life expectancy, data reveals that half of the neighborhoods had life expectancies above 78 years while the other half had life expectancies below 78 years. If we divide these Houston-area communities into five equal groups based on their life expectancies, the “healthiest” neighborhoods (those in the top 20%) had life expectancies between 81 years to 89 years. Meanwhile, the neighborhoods in the bottom 20% had life expectancies that ranged from 65 years to 75 years.

When the data from the USALEEP project is matched with demographic data from the U.S. Census Bureau, it reveals stark differences between communities with the longest life expectancies compared to communities with the shortest life expectancies.

Poverty was significantly correlated with life expectancy in the Houston area. Among Houston-area neighborhoods with the shortest life expectancies, over a quarter of residents (26%) lived in poverty. Yet only 8% of people living in the neighborhoods with the longest life expectancy had poverty-level incomes.

In Houston-area neighborhoods that have the longest life expectancies, a slight majority of people (51%) are White, 23% are Hispanic or Latino, 15% are Asian, and 11% are Black. In contrast, Houston-area neighborhoods that have the shortest life expectancy had significantly higher percentages of Black (33%) and Hispanic (45%) populations and significantly smaller proportions of White (18.7%) and Asian populations (2.5%).

Communities in the Houston area with the longest life expectancies had incredibly high levels of educational attainment. 53% of adults living in neighborhoods with the longest life expectancy had a bachelor’s degree or higher. Meanwhile, in neighborhoods with the shortest life expectancy, only 13% of adults had a bachelor’s degree or higher.

A tale of two Houstons

This data underscores recent concerns about how rising income inequality and high levels of racial residential segregation is leading to a “tale of two Houstons” where one set of neighborhoods enjoys increasing levels of wealth and another experiences concentrated levels of intergenerational poverty. Our analysis is a critical reminder that these inequities impact health and well-being in real and tangible ways.

“While this data may feel dispiriting, one thing we are learning in the research is that these differences are not inevitable.”

Recently a major study conducted by economists from Stanford and Harvard found that while there are significant differences in life expectancy between low-income and wealthy Americans, low-income Americans fare better in certain local communities compared to others. The researchers found that the gap in life expectancy between the rich and poor is much narrower in cities located mostly in the East and West coasts compared to cities in the Midwest and the Southern USA. This demonstrates the power of local conditions on community health and should encourage us to understand how we can replicate the successes happening in some local communities to continue to create healthy and vibrant communities for all Houston area residents.

One critical way forward is to ensure that we consider the root causes of poor health when developing strategies to improve health in low-income communities.

Building a broader perspective on health in our communities

In addition to improved access to medical care, a growing body of research is identifying how the biggest influences on population health include factors such as access to healthy foods, housing, transportation, and environmental conditions.

Source: Kaiser Family Foundation, Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity

From producing research that illuminates the connection between socioeconomic factors and health to funding community-based clinics to go outside the walls of their exam room and into communities to address underlying causes of poor health, The Episcopal Health Foundation is committed to helping shift the focus on improving health, not just healthcare. Our hope is that this data serves as a catalyst for non-profit leaders, healthcare providers, and policymakers to develop creative strategies to ensuring ALL Houston area — and particularly the most disadvantaged — live the longest and healthiest lives possible.

Robiel Abraha is a research associate at the Episcopal Health Foundation. By providing millions of dollars in grants, working with congregations and community partners, and providing important research, EHF supports solutions that address the underlying causes of poor health. With more than $1.2 billion in estimated assets, the Foundation operates as a supporting organization of the Episcopal Diocese of Texas and works across 57 Texas counties.

Houston native and community activist for the temporarily homeless

Sharon Johnson: Aspiring — temporarily homeless — graphic designer

There are 3,938 homeless men, women and children in the Harris, Montgomery and Fort Bend counties, combined, according to the 2019 homeless count by the Coalition for the Homeless. And as of now, Houston-native Sharon Johnson is one of them.

Johnson, 57, was born and raised in Houston and grew up in the Westbury area. As an adult, she continued to live in Houston, but moved often in order to find affordable, safe housing. As a graphic and website designer, Johnson was able to “make it work for her and her family.”

Though, in the fall of 2018, Johnson wasn’t paid for three months by her primary client. After depleting her savings, she was served eviction papers in December. By January 1, 2019, Johnson was homeless.

“I used to be one of the people that went to the food kitchens to help out,” Johnson said. “And all of the sudden, now I find myself on the flip side of that, where, you know, it’s like I can’t survive.”

For more than two weeks, Johnson crashed at whoever’s house she was welcomed and slept in her car when she had nowhere to go. But on January 14, Johnson fell in a “friend of a friend’s home,” which resulted in a broken wrist and a concussion.

She felt she had finally hit rock bottom, and she reached out to the Mission of Yahweh, a homeless shelter for women and children operating in Houston since 1961, for help.

Because Johnson had been in contact with the shelter since December, the mission gave Johnson a bed, despite not admitting walk-ins. So on January 14, Johnson joined the more than 130 individuals — 62 of which are children — at the shelter.

“Most of the people that I’m around are people who got knocked around by some catastrophe and now all of a sudden are scrambling to try to survive,” Johnson said. “And this is an avenue where there’s some place to live, there’s a roof over your head and they feed you. In exchange [at the Mission of Yahweh], you do chores. You don’t live there for free.”

Since being admitted, Johnson has been able to get the medical help she needed, has gone through a professional development boot camp with nonprofit WorkFaith Connection, and has gotten grants to go back to school to get her associate’s degree from Houston Community College.

“Right now, I’m living the dream,” Johnson said. “You know, there are so many ‘isms’ that are attached to homelessness, and somebody being homeless and their situation and where they live and how they live. But I have gotten the most amazing support — I found so much non-judgmental spiritual support here. I haven’t been able to breathe for a lot of years, I haven’t really been able to just breathe and feel safe and feel cared for and feel like everything was going to be okay,” Johnson said.

All across the Houston area, thousands of people just like Johnson are searching for the chance to break free from the cycle of homelessness. Visit the links below to learn more about homelessness and unemployment in our communities.

Additional Resources:

College student, voting rights activist

Cristina Camarillo: Dreamer — Aspiring Voter

Every American citizen remembers their first time voting and the sense of pride that comes with making your voice heard. But for Cristina Camarillo, her first trip to the polls meant speaking for her entire family. As the daughter of two immigrants from Mexico and the younger sister of two DACA recipients, she feels the responsibility for being the sole representative for the Camarillo family in the voting process.

“Growing up, a lot of people within my own family would be like, ‘Hey we can’t vote, but you’re going to be able to vote when you turn 18, so you better go out and vote,’” Camarillo said.

But when it came to her time to vote, she realized that the importance of voting wasn’t always instilled in her peers like it was for her.

In 2017, during her junior year of high school at Houston’s Heights High School, she volunteered with Mi Familia Vota and Student Voter Initiative to register seniors during their government classes.

“So here we are as 17-year-olds — 16-year-olds, some of us — telling 18-year-old seniors, ‘Hey, we can’t vote, but you can,’” Camarillo said. In the class presentations, Camarillo and the other student volunteers were trying to explain the importance of voting to the seniors, specifically during local-level elections.

By the end of the presentations, Camarillo registered about 40 students to vote all by herself

But with the November 2018 primaries fast approaching, Camarillo wanted to do more to make sure her own senior class would take advantage of their right to vote in the upcoming election. In addition to speaking to more than 500 students at her school’s voter registration drive, Camarillo worked through election day, helping first-time voters find their nearest polling stations.

Using the power of social media, Camarillo even gave her peers shout-outs on Snapchat once she discovered they voted. “I was asking everyone in all of my classes, ‘Have you voted today?’ And when they said, ‘Yeah.’ I’d be like, ‘Okay, hold up. Let me Snapchat this so everyone knows that you voted, ‘cause this is a big deal.’”

In the fall of 2019, the 18-year-old plans to attend Carleton College in Northfield, Minnesota on a full-ride scholarship through The Posse Foundation. While there, she plans to register to vote in Minnesota, get involved with school organizations involved with student registration and civil work and to continue to advocate for her peers to register. Her ultimate goal is to return to Houston after college and work within her community in the Near Northside.

“Even within my own community, I know a lot of people who could vote, but don’t, because they don’t see the major importance in it,” Camarillo said. “I hope people actually keep going out to vote and not just saying that they will or putting in their opinions on something politically, but not doing anything about it or going about change. That really irks me.”

Improving voter turnout means reaching out and continuing the conversations started by people like Camarillo. To learn more, check out The Local Elections in America Project (LEAP) to learn more about upcoming local elections throughout our region.

Additional Resources:

Archiving the Asian-American experience

Anne Chao: Manager, Houston Asian American Archive — Adjunct Lecturer in the Humanities — Rice University

Since 2010, Rice University’s Houston Asian American Archive (HAAA) has chronicled the oral history of Houston’s Asian American community.

“Houston has the eighth largest Asian American population in the country but does not have an oral history archive to record the contribution of Asian Americans to the city. That’s why we are documenting all this,” said Anne Chao. “My goal is that whoever the next historian of Texas will be — that scholar would have to consult our archive to put in Asian American activities. Because if you look at the textbooks of Texas now, they don’t mention Asian American activities and we’ve been here since the early 20th Century.”

To ensure these valuable voices are preserved, the stories of local Asian-Americans are available on the HAAA website, whereby interviewees such as Nathalie Ho Roff demonstrate the importance of Houston’s vibrant Asian American communities, highlighting how their remarkable experiences reflect the larger spirit of the Bayou City.

Roff fled Vietnam with her family in 1978 as a child. Their boat sank, tragically killing much of Roff’s family, including her parents. She and her remaining family members were sponsored by a Baptist church in Virginia with help from an aunt who had come to the United States in 1975. Roff and her brother weren’t happy in Virginia. After a visit, their older sister, seeing the conditions they were living in, took them away to Houston, where they stayed with friends of the family.

Roff went through middle and high school in Houston and eventually made her way to the University of Texas at Austin for college. Roff did everything she could to pay for her education and graduated with only a small amount of loans.

In 1990 Roff finally attended Baylor College of Medicine, where she earned her M.D. specializing in internal and geriatric medicine. After a childhood filled with strife and tragedy, Roff fought her way to an excellent education and currently serves as a respected wound care physician in the heart of Houston.

Roff is just one of more than 200 Asian-American Houstonians whose stories you can explore on the HAAA website. Visit the website here to explore how these experiences shape and inform our region, and visit the links below to learn more about diversity and immigration in the Houston area.

Additional resources on diversity:

Additional resources on immigration:

NAMI executive director, advocate for a broader perspective on mental illness

Neal Sarahan: Doctor — Ally — Advocate for mental illness

Annual physicals are a natural rhythm in a modern adult’s life, but nearly 15% of Americans haven’t had contact with a health care professional in the past year. Mental-health check-ups are even less common. Approximately, 1 in 5 adult Americans experiences mental illness in a given year. But even with the prevalence of mental illness, stigma keeps many from therapy, treatment, and recovery.

“Mental health instability is frightening. It’s also incredibly frustrating,” said Dr. Neal Sarahan, executive director of the National Alliance on Mental Illness of Greater Houston. “It’s something that we are not attuned to adapting to as parents and employers. This idea that there is a ‘norm,’ which is almost always stable, is not realistic and it’s not true. Too often, when we encounter instability, as individuals, parents, and employers, we are unprepared, and we remain silent, ashamed, and embarrassed.”

Sarahan, who has worked in the mental health industry for more than 40 years, says there has been an increased acceptance and pursuit of understanding mental health, but more work needs to be done for the general population to understand mental health instability.

“People are trying their best to adapt,” Sarahan said. “But people in the world want to be competent and successful. If I’m a teacher, and this child is making me feel very incompetent, then I might want to exclude them because they don’t make me feel very successful. Similarly, employers are telling us, ‘We have people who have depression and anxiety. We don’t want to lose them, because we need their talents, but we don’t know how to support them.’”

There are several programs at NAMI of Greater Houston to help employers, parents, teachers, and the general public educate themselves on mental health and how to best help their employees, loved ones, and students live with their mental illness to the best of their abilities. The classes target a wide variety of topics, including the basics of mental health, peer-to-peer and family-to-family support groups, veterans, local jail inmates and active-duty military education classes, and more.

“Helping everybody learn what pours gasoline on the mental instability fire and then what is the flame retardant,” Sarahan said. “Some of the punishment-and-demand systems simply accelerate mental instability. For some, external rewards do not work in an expected manner, because that’s not how that person’s brain works.”

Sarahan’s desire is for the general public to be aware that mental illness, unlike physical illnesses, aren’t easy fixes, but instead require day-by-day, hour-by-hour attention, patience, and understanding.

“A lot of parents want to go to a provider and say, ‘Fix my kid,’ like it would be this sort of surgical fix,” Sarahan said. “Well, mental illness doesn’t work that way. Sometimes you need to help peers, parents, and teachers understand the expectations of what this journey is going to be like.”

Sarahan suggests people work to understand mental health at the foundational level. This way, everyone will develop strategies that enhance mental stability, and face the necessary times when depression, trauma, mood, and emotions are out of balance.

“About 80% of our health is directly attributable to our food, diet, and exposure to chaos and injury,” he said. “We have to pay more attention to wellness and building conditions for wellness than seeking easy fixes.”

Sarahan’s mission to change how we think about mental health requires interest and understanding from everyday Houstonians. Visit the links below to learn more about NAMI and how mental health shapes our society.

Additional Resources:

Business manager, multi-county commuter

Ryan Stough: Manager — Parent — Commuter

As a six-year Houston resident, Ryan Stough has become all too familiar with one of Houston’s biggest headaches: long commutes.

As a Pearland resident, Ryan’s job as a general manager at a Houston-area Mister Car Wash Lube Center requires him to commute across two counties each day. And without access to any METRO public transportation from his community, he’s forced to rely solely on his car to complete his daily commute.

“When we bought the house, we didn’t really think about the commute,” Stough said. “I told my wife to pick an area she liked that was close to her teaching job because my job location is never secure. One day they might have me at one location for six months and the next day I will be at another.”

In the past three years, Stough’s work location has moved from Humble to Kirby and US-59/I-69 to the Sugar Land area. Currently, he’s commuting from Pearland, which is in Brazoria County, to the Sugar Land location, which is in Fort Bend County. Before moving to the Sugar Land location, he was traveling into Harris County to work off of US-59/I-69 and Kirby.

“I leave at 5:45 a.m. and it takes about 30 to 35 minutes. If I leave a minute after 6 — and I mean a minute after 6 — then there’s a lot of traffic,” Stough said of his more than 25-mile commute to Sugar Land. “It’s a little better when teachers are on their summer break. But coming back from the Kirby location, it would take me 45 to 50 minutes.”

Stough currently drives his Toyota Tacoma and spends about $120 per month just on gas, but he’s working on repairing his Honda Civic, which would cut his gas bill in half. His wife, Tabitha, also has a vehicle of her own.

Overall, Stough has come to accept his commute across two Houston-area counties as a part of his life now. “I’m pretty comfortable with the commute,” Stough said. In fact, Stough doesn’t mind his commute so much so that he’s willing to drive further for a higher paying position at the Mister Car Wash location in Humble. “I would make that sacrifice to drive further for much more money,” Stough said.

But he does keep in mind the cost of his time due to his commute. “I would say the only negative to my commute is the time away from my family because I already work long days and my commute is 30 minutes each way so that adds an extra hour to my workday,” he said.

Lack of access to public transportation in many Houston-area suburbs contributes to longer commutes for many Houstonians. Visit the links below to learn more about public transportation accessibility in the region.

Additional Resources: