Next Tuesday, Jan. 14, Lubbock City Council will be voting to approve recommendations from the Board of Health on a Community Health Improvement Plan, or CHIP.
The initial presentation was given by the director of Lubbock Public Health (LPH) Katherine Wells in a December city council meeting. The vote to accept the recommendations was postponed as councilors felt they did not have enough time to review the improvement plan and the Community Health Needs Assessment, or CHNA.
The project ran from September 2023 to June 2024, in collaboration with Initium Health of Denver, Colorado. The health department conducted interviews, surveys, listening sessions, and a workshop – which collectively garnered responses from more than 2,100 residents across Lubbock.
“We really did a lot of advertising at the beginning to really bring everybody together. When we did a kickoff, we did that in this room,” Wells said in the council chambers of Citizens Tower. “This room was packed with all of the hospital administrators, school superintendents, just everybody that's been interested in: how do we improve the health of our Lubbock community?”
The goal of the report was to gather data and identify the broad health needs of Lubbock.
The Community Health Needs Assessment identified five critical health priorities: access to health care; mental health, substance use and homelessness; addressing chronic conditions; STIs and teen pregnancy; and improved coordination of information services and resources.
Access to Healthcare
20% of respondents to the Community Status Assessment Survey reported that they had not experienced barriers to receiving healthcare. 44% said that cost was the greatest barrier to care.
Lubbock families with income and benefits adding up to less than $35,000 per year was 22.1%, almost four percent more than both the state and national estimate, according to the U.S Census Bureau’s 2022 5-Year Estimates Data Profile. The median household income for Lubbock – according to the same profile – was almost $62,000, compared to the state’s more than $73,000 and the nation’s more than $75,000.
When discussing priorities, survey participants highlighted the need for healthy environments, non-jail crisis intervention, non-emergency services, and health insurance access.
“17% of our community is uninsured,” Wells said. “That means they don't have access to the services that are available at our hospitals. I mean, they can go to the ER and get care, but they don't have access to the specialists – all the extra care that's available here. We can do more to support those people.”
While Lubbock County’s uninsured rate is lower than that of the state – 20% of Texans lack insurance – the national population has an uninsured rate of 10%.
According to the CHNA report, a driver for the state’s high rates is that Texas is one of ten states that did not expand Medicaid eligibility under the Affordable Care Act. Something that also impacts many Lubbock residents.
The CHNA report indicated that better health literacy and alternate care options can improve the efficiency of healthcare.
Health access goes beyond the financial burden and number of physicians in a county; it includes food access and security, environment and walkability, and the care available at the neighborhood level.
“Compared to the booming economy of west Lubbock, east Lubbock has only one grocery store, no emergency department, and no pharmacies,” the CHNA report explained. “Industrial zoning to the area means that many areas on the East side are subject to industrial pollution, noise, and low walkability, with limited bus routes and limited hours of service.”
The CHNA report presented data specifically gathered from university students in the county, from Texas Tech University and Lubbock Christian University. The report stated that university students are more vulnerable to poor health outcomes. The students themselves said mental health, a healthy environment, STIs and unplanned pregnancy, and food access are their top concerns.
Students at both universities identified cost as the top barrier. Many LCU students listed stigma as another primary barrier, and many TTU students indicated not knowing where to go to seek care.
CHNA noted that while there are resources available to students, the survey suggests that students are not well informed or that the current resources are insufficient. It recommended that Lubbock Public Health provide resources to students on accessing affordable services.
The CHIP report listed goals to increase access in the community, including establishing a health literacy program, connecting residents to insurance, increasing access to medication, and expanding low-barrier clinics and services.
Mental Health, Substance Use, & Homelessness
Through its community engagement, CHNA found that the community views mental health, substance use, and homelessness as connected issues.
The January 2024 homeless census, Point-in-Time Count, found 325 people experiencing homelessness in Lubbock. Of these, 74 were children, and 23 were 18-24 years old.
Lubbock has a lower fatal overdose rate – 13 per 100,000 people – than both the national and state average, according to County Health Rankings & Roadmaps.
Compared to the rest of the United States, alcohol-related motor vehicle deaths were identified as one of Lubbock’s poorest health indicators, along with diabetes and sexually transmitted infections.
35% of Lubbock’s motor vehicle crash deaths involved alcohol, according to County Health Rankings & Roadmaps, ten percent more than the state and eight percent more than nationwide. The same report says 20% of Lubbock adults report heavy or binge drinking, two percent more than the state and nation.
Lubbock’s suicide rate of 18 per 100,000 people is higher than the United States and Texas rate of 14 per 100,000, according to County Health Rankings & Roadmaps.
However, the report says that with a rate of 490:1, Lubbock County has more mental health providers available per capita than is usual in Texas, with an average of 640:1. The county is still lower than the national average of 320:1.
The CHNA report recognized some root issues, such as a lack of access to detox services, the stigma of addiction and mental health, and a lack of education. It encouraged peer coaching programs, further integrating behavioral health into primary care, and diversion to connect those in crisis with medical professionals rather than jail.
The CHIP report outlined goals to improve these areas, including supporting and spreading the word about the West Texas Mental Health Collaborative, improving data collection about substance use disorders – currently not being “uniformly collected in Lubbock” – and creating a detox center.
The closest inpatient detox center is about 100 miles away, in Amarillo.
In March of 2024, the City of Lubbock broke ground on an ARPA-funded joint project with Lubbock County, the Hope Center, a mental health facility designed to provide resources for patients looking for mental health and substance abuse treatments that would typically weigh on resources for less effective responses from local jails and hospitals.
The 10,000-square-foot facility is expected to open this year.
Chronic Conditions
Treatment and prevention of chronic conditions are not exclusive to healthcare. They also deal heavily with environmental factors, such as infrastructure, weather, diet, and socioeconomic status.
Heart disease is the country’s leading cause of death, with a rate of 319.5 per 100,000 people. According to the U.S. Centers for Disease Control and Prevention, Lubbock’s rate of death from heart disease is 411.9. Also higher than Texas’ rate of 327.6.
Obesity can contribute to heart disease, diabetes, and cancer. County Health Rankings & Roadmaps reported 40% of adults in Lubbock County are obese, compared to 34% of adults in the U.S. and 36% of Texan adults. The rankings also showed that despite a higher percent of residents having access to exercise opportunities, 28% of residents report not engaging in physical activity outside of work, higher than the state and national numbers.
Unreliable access to nutritious food, due to a lack of fresh groceries and/or financial limitations, also present challenges to preventing and managing chronic conditions.
With fewer services and schools, less walkability and healthy food options, and increased exposure to pollution, CHNA said that residents of East Lubbock are at higher risk for diabetes, heart disease, obesity, cancer, and more. Disparities that are “compounded by lower access to insurance and limited access to healthcare.”
CHIP proposed the possibility of developing a chronic disease division within LPH to address risk factors – like tobacco use, violence, poor nutrition, and lack of physical activity – and provide management and education programs – particularly for diabetes.
It also stated that improving sidewalks and walkability, establishing social groups and events, and encouraging safe road-sharing with pedestrians and bicycles, could promote physical activity and decrease risk factors in the community.
STIs and Teen Pregnancy
Lubbock has a significantly higher rate of STIs than the national or statewide average, the CHNA report said.
The county’s STI rate is 722 per 100,000, whereas the state and national averages are 466 and 481, reported the Texas Department of State Health Services.
Lubbock is the 7th highest ranking county in Texas for gonorrhea – with 1,010 cases in 2022 – and the 6th for chlamydia – with 2,643 cases – according to State Health Services.
The department ranked Lubbock 2nd for primary and secondary syphilis and 9th for total syphilis in the state.
Syphilis rates in Lubbock increased 648% between 2018 and 2022, according to the National Association of County and City Health Officials.
The CDC has recommended that all sexually active adults in Lubbock be screened for syphilis. But Katherine Wells explained the disease impacts more than just those engaging in sexual activity.
“We had 12 babies born with congenital syphilis this last year,” Wells told the city council, her voice shaking. “How do we make sure that our providers are appropriately screening and treating those women so that these babies aren't dying?”
The rate of teen pregnancy in Lubbock is 1.5 times higher than the national average, according to County Health Rankings & Roadmaps.
Community respondents in the CHNA report said abstinence-only curriculum “perpetuates misinformation” and limits their access to information about safe sex practices. They proposed encouraging the community to prioritize inclusive sex education and accessible healthcare across age groups to combat the prevalence of STIs.
CHIP highlighted the need for community education on STIs through schools, universities, community centers, social media, and healthcare providers. It also stressed the goal of training providers on STI exams and identifying and communicating risk to patients.
Lubbock has a lower rate of HIV than the state and country. However, the significant number of patients visiting the new HIV clinic suggested the burden of the disease weighs heavy on the community. CHNA suggested expanding HIV outreach, testing, education, destigmatization, and clinic capacity.
CHIP aims to improve follow-up care for those diagnosed with STIs and HIV.
For university students, CHNA proposed that Lubbock Public Health provide free, confidential STI testing once a semester on campus.
Coordination of Information, Services, and Resources
Lubbock’s university students expressed a lack of awareness about available services, frustration with long wait times, privacy concerns, and cost barriers to both healthcare and food access. LPH can help remedy this by communicating with students about the resources available in their universities and the broader Lubbock community.
The students in CHNA’s student survey cited a disconnect between the universities and the rest of the community: “Throughout the focus groups, students expressed a lack of connection to the Lubbock community and how insulated the university is from the county. Increased efforts to engage the students in the community by providing access to healthcare services, nutritious food, and places to exercise, or simply spreading awareness of services and inviting students to utilize them, according to focus group participants, would help incentivize students to stay in Lubbock after they graduate.”
CHNA participants agreed that residents need resources, wraparound services, and support in navigating various healthcare systems.
CHIP’s collaboration goals were designed with community partnerships in mind. It aims to further develop “the Lubbock Community Collaborative,” to work together toward a common agenda with shared data. The report said this coordination would be facilitated by Lubbock Area United Way.
Next Phase
In addition to not feeling they had enough time to review the report before the December city council meeting, District 3 Councilman David Glasheen and District 5 Representative Dr. Jennifer Wilson had another concern. They feared Lubbock Public Health was aiming for too much expansion and extending beyond what a public health department should be providing.
“Once we come back and study this report, I'm ultimately going to recommend that we reject it,” Glasheen said after Wells’ presentation. “And partially you could say that's semantics. Accepting this report is not creating a budget obligation, but it is a policy decision. And approval of this report would indicate that these are policies that the city health department should pursue. And in fact, we need to discourage this sort of expansion of government spending and involvement in health care.”
“My concerns just in trying to get through part of the executive summary quickly was words such as increasing expanding comprehensive care, addressing chronic health conditions,” Dr. Wilson explained. “So to me as a physician, those are not things that should be done by the Health Department. Those are things that should be done by primary physicians out in the community.”
Wells explained that the report is not necessarily reflective of what actions the city government should take, but priorities for the community as a whole and identifying areas of collaboration within Lubbock.
“I'm not saying that the city council should be putting grocery stores in communities,” she said. “But what can we do to increase access for the community to food? Is that working with a church that wants to create a food pantry? Is that partnering with United that might want to put a small store somewhere? It's really about community health, overall health, and one of the roles I see for public health is helping to be a part of that leadership team and how to help our community move forward. These aren't things that I'm asking for us to fund. These are things that I'm saying we need to look at: how do we solve this as the community of Lubbock.”
Wells and both community health reports stressed the mission of Lubbock Public Health to bridge the gap in providing assistance to the underserved and being a leader in facilitating community collaboration for the health of the citizens.
Neither CHIP nor the CHNA are budgetary decisions or calls for funding, but Wells said that if approved, the studies can help LPH receive the grant funding on which the department relies.
Lubbock's city council is expected to vote on the reports on Tuesday, Jan. 14.
You can find both full community health reports on the City Of Lubbock website here.
Update: City council approved the Community Health Needs Assessment and Community Health Improvement Plan at the Jan. 14 meeting. It passed 6-1, with Councilman Glasheen voting against.