BEXAR COUNTY, Texas – A new report examining Bexar County’s health landscape suggests instabilities and active work to address inequities spurred, partly, by the effects of the COVID-19 pandemic.
Released last week, the 252-page Community Health Needs Assessment (CHNA) — compiled every three years — encapsulates work from local hospitals, community partners, and residents.
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The CHNA report details five “urgent” health priorities that could be addressed.
- Mental and behavioral health
- Maternal and infant health
- Chronic disease
- Housing instability
- Food insecurity
“This data is not just numbers, it’s the lived reality of our community,” said Palmira Arellano, board chair of The Health Collaborative and vice president of community engagement for Methodist Healthcare System.
A significant growth trend in Bexar County is described in the demographics portion of the report. In 2023, San Antonio reached nearly 1.5 million residents, the highest population growth of any city in the United States at the time, according to the report
In the CHNA, a community survey was one of four research methods used to gauge health needs in Bexar County. The survey was conducted as a convenience sample, which meant participants were not randomly selected. The survey’s results gleaned insight, but “should not be seen as representing the county as a whole.”
A total of 162 Bexar County residents participated in the survey; however, many ZIP codes were underrepresented, the report stated.
“The findings show clear links between social conditions like housing and food access and the clinical outcomes we see every day,” wrote Dr. Camerino Salazar, chair of the CHNA Data Committee.
Poor air quality, high temperatures pose ‘serious’ health risks
Nearly 100 pages into the report, it begins to detail the “serious” health risks posed by prolonged exposure to poor air quality and extreme heat.
Both issues often disproportionately affect vulnerable populations such as children, older adults, those with chronic illnesses and people experiencing homelessness.
In San Antonio, for example, concerns about extreme heat affecting vulnerable populations are palpable issues. Last month, Mayor Gina Ortiz Jones and San Antonio’s Governance Committee flipped on a no-action recommendation from city staff to track heat-related deaths in the city.
Bexar County experienced 42 days of temperatures at or above 103 degrees in 2023. The figure is considered “dangerous heat,” and prolonged exposure could lead to heat disorders, according to the report.
The San Antonio Metropolitan Health District, the city’s public health agency, reported 781 cases of heat illness, primarily heat exhaustion, from March 2023 to October 2023.
Metro Health tracks heat illnesses on a dashboard that it updates weekly from March to October. The dashboard displays data from emergency room visits related to heat-related illnesses, complaints or discharge diagnoses starting in 2022.
According to the dashboard, June and August 2025 reported the highest number of heat-related illnesses in San Antonio, at 105 and 121, respectively. The heat index in August was 100 degrees, per the dashboard’s data.
The report states that nearly two weeks of 2024 presented unhealthy air quality for sensitive groups.
In 2024, the Texas Commission of Environmental Quality issued 11 Ozone Action Day alerts for San Antonio; however, only four of those days produced unhealthy levels for those with respiratory illnesses, according to a count by KSAT 12 meteorologists.
TCEQ issues the alerts accounting for ozone and fine particulate matter particles, such as PM2.5 and PM10, which are often composed of soot, dust, chemicals and other microscopic particles.
Eleven alerts were issued in 2023, again with four presenting unhealthy levels. Ten alerts were issued in 2022.
In 2025, San Antonio has received 11 Ozone Action Day alerts, according to a count by KSAT 12 meteorologists. Those issue dates were:
- April 9
- May 11, 12
- Sept. 9, 10, 28, 29, 30
- Oct. 1, 2, 14
Takeaways going forward
The report identifies mental and emotional health as persistent issues in Bexar County. The problems are widespread across demographic groups and neighborhoods, with appropriate care either “not easy” to access for those with insurance, or out-of-pocket expenses are too exorbitant.
The effects of the COVID-19 pandemic persist in Bexar County, primarily due to imbalances in the housing and job markets, according to the report. Other public health problems identified in the report center on vaccine hesitancy and “pervasive distrust of science and government.”
The report also puts basic needs and root causes of health inequities front and center.
“Issues like food security, decent housing, jobs with a livable wage, and literacy/education are all non-negotiable foundations of health and well-being – not sufficient, but certainly necessary,” the report states in its early pages.
San Antonio, like many U.S. cities, is experiencing the effects of a lapse in benefits for the Supplemental Nutrition Assistance Program, also known as SNAP.
Just this week, the city finalized plans to distribute a $1.6 million fund to help local SNAP recipients. The plan would prioritize low-income seniors and households with young children who are experiencing economic hardship, a Tuesday news release from the city said.
Despite the bleak outlook, the report notes work is being done to address mental illness and food insecurity in Bexar County. Moreover, workgroups will meet this year to address issues outlined in the 2024 Healthy Bexar Plan.
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