Social inputs on health care: Community effort is the foundation for achieving better health for all

When it comes to quality of health, Boulder County often ranks higher than the national average. When Boulder County residents were asked in a 2014 survey by the Colorado Department of Public Health and Environment if they think they are healthy, the answer was largely ‘yes.’ 91 percent of Anglo respondents reported they were in good to excellent health; 69 percent of Latinos reported the same. That perception is mostly backed up by fact, said Chris Barge, vice president of strategic initiatives at The Community Foundation Serving Boulder County.  Boulder County has lower death rates than the national average from heart disease, diabetes and pneumonia. And notably, the teen birth rate in Boulder County continues its downward trend, mirroring the national trend.

Regarding health insurance, the number of people insured is at a record high in the state.

“Things certainly look better in Boulder County as well,” Barge said.

Coverage for Latinos in general has improved significantly since 2010, growing from 71 percent to 86 percent. That being said, coverage for Latinos is still lower than that of Anglos, which grew from 93 percent during 2011-13 to 97 percent in 2015. People with an income of less than $25,000 went from 79 percent insured to 93 percent. Medicaid recipients increased from 22,500 in 2011 to 49,500 in 2015.

A real struggle

There are certain populations in the community that face significant inhibitors to good health, though.

“Everything rolls downhill from the lack of affordable housing in Boulder County,” Barge said. “Especially in Boulder. People of low income have a harder and harder time subsisting. You can’t just go to the eastern part of the county to get to a more comfortable place. You have to keep going into Weld County.”

To put things into perspective, the federal poverty level for a family of two adults and two children is $24,600. To get by in Boulder County without needing public assistance, the same family would need a household income of $75,000.

“Being poor is a full-time job, trying to navigate the system, to get everything they need in order to stay afloat.” Barge said. “What we used to think of as a middle-class income is really the minimum threshold needed to be self-sufficient.”

Because there is a higher income level in Boulder Country, there tends to be a separation between the majority population’s everyday experience — not greatly threatened by financial pressures — and the population that is struggling every day, Barge said.

“The greater distance we have between those who are comfortable and those who are not, means there’s less awareness among the majority about what the needs are,” he said. “All the more reason why those who want to be a part of changing the odds need to be led by those who are trying to beat the odds.”

In Boulder County, 9 percent of households live below the poverty level. 39 percent of Latino children compared with 13 percent overall are growing up in poverty in Boulder County.

Living in poverty affects many layers of life and health quality — housing, transportation, food and nutrition, education and access to health care. When basic needs and other necessary faculties are compromised or go unmet, physical and mental health take a hit. Add language and cultural barriers to poverty, and one’s social equity — having the same shot at success regardless of family income or race — drastically diminishes.

“Latinos are way over-represented when it comes to the number of kids who are in families experiencing poverty, who are also struggling in school,” Barge said.

Latinos make up 14 percent of Boulder County’s population, which amounts to about 43,260 people. The nearly 40 percent of Latino children living in poverty amounts to about 16,870 kids who are experiencing a shortage of basic needs and likely going without regarding anything beyond that. Considering that 80 percent of the Latino population in Boulder County has family who claim Mexico as their country of birth, language barriers are an issue, as well as fear about their immigrations status.

Strength in leadership

The Community Foundation recognized a need in the Latino community and developed a program to help families beat the odds.

“We stand with the vulnerable and the marginalized,” Barge said. “We also recognize resident leadership is of huge importance.”

He went on to explain that the strategy for tackling and changing the odds, is to be led by the people experiencing these long odds the most.

“What do people who know this issue because they live this issue say about how they personally can get to a place where they are beating these odds,” Barge said. “And then upon reaching that level of self-sufficiency for themselves and their family, how can they step into the civic space and then lead the community into a conversation, including the voices from more people with backgrounds like them?”

The program, called ELPASO — Engaged Latino Parents Advancing Student Outcomes — connects families to available resources to help overcome language, cultural and fear barriers and the trappings of poverty. Program coordinators also identify individuals with natural leadership abilities to teach others in their neighborhoods and community how to access resources and skills to better ready their young children for kindergarten and overall success. 3,000 families have benefitted from ELPASO since 2014.

Barge sees the program’s effects within the community, and he sees promise for the future — alumni of this program who feel passionately about wanting Latino children, not just their own, but all in their neighborhood, to succeed.

“Then they move from the work of beating the odds themselves to changing the odds in the community. Then superintendents, mayors, people in power and people working to help this population are led by the population,” he said. “This model can work for anything, not just education. Put the people struggling in the community at the center of the solution.”

Crime is complicated

One population that may not come to mind at first, but whose health — especially mental — is greatly affected, is the offender group. According to the city of Boulder, there were nearly 8,000 reported crimes in 2016. 602 adults were arrested, as well as 113 juveniles. Once individuals find themselves in the system, it’s very difficult to get out.

In 2016, there were 486 DUI arrests. While that number has decreased in recent years, that’s still 486 people that have lost their driver’s licenses. Some have lost their jobs. The weight of the $10,000 to $20,000 in fees and fines can be crushing to someone that may have already been marginalized by low income. Couple that with a transportation issues, and the offender runs the risk of violating probation by missing meetings or other court-appointed actions, which results in arrest and more fines.

“Jails are becoming a warehouse for the indigent male,” Barge said. “That’s not what jails is set up to do, but people get tangled in the system. When they don’t have all of their resources or abilities to figure their way out if it, they just get ensnared.”

In Longmont, The Reentry Initiative addresses the issues of female offenders released from incarceration, offering programs and services to restore lives, reconcile families, and renew communities through preeminent pre-and post-release programming, servicing, and housing opportunities.

The Initiative’s research reveals that approximately 35 percent of offenders are diagnosed with serious mental disorders that need immediate attention, such as a major depressive episode or schizophrenia. Up to one-third of people released from incarceration will be released homeless. In the Boulder County jail, it is estimated that up to 75 percent of offenders are homeless before coming into the jail.

It has been reported (Denver Post, 2013) that Colorado is one of the worst states in the nation for parolees, with roadblocks to employment, public assistance, housing and obtaining a driver’s license. Many offenders often don’t receive treatment for substance abuse or mental illness or participate in programs focusing on life skills. The state budget fund to transition inmates from prison to parole is a mere $15 per offender. Only 824 offenders completed the re-entry classes in 2015 through the Colorado Department of Corrections due to limited access.

The Reentry Initiative reports a lack of coordinated, reentry-focused strategic management of efforts between the cities, Boulder County and relevant nonprofits. Because no one organization is charged with re-entry, it makes coordination difficult. To the returning offender with no re-entry plan or means of support, the process of re-entry — navigating alone the complicated system of service providers one must see for basic survival and mental stability, housing, employment and family unification — is overwhelming emotionally, cognitively, socially, materially and physically.

Females offenders commonly wind up in criminal situations based on survival of abuse, poverty and the combination of substance abuse and mental illness. Most women who enter prison are in poor health as a result of lifestyles that damage their bodies, and poverty and histories of abuse prevent them from seeking and receiving the help they need.

How much harder is it for females to recover from incarceration than males?

“It’s pathetic,” said Deborah Simmons co-founder of The Reentry Initiative. “There’s really nothing good to say about re-entry for women anywhere, certainly in this state.”

There are no transitional housing options available to female offenders in Boulder County. Simmons also sees that traditional providers of housing won’t take people with felonies and, those who take vouchers will chose a non-felon over a felon.

Citing a study commissioned by the Boulder County Commissioners in 2016 — “Jail Overcrowding in Boulder County” — of the 77 programs offered in the Boulder County jail, only three were evidence-based.

“They were pretty much providing stuff for inmates to do to keep them busy,” Simmons said. “Not integrated, outcomes-based programming. Additionally, women in Boulder County jail typically stay in jail less than 45 days, so they don’t have access to any kind of programming that would be rehabilitative, so the recidivism rate is greater than males.”

Simmons said a new approach to incarceration is in the works, and she’s been invited to hear an overview about it later this month.

“We’ll see,” she said.

There are ways the community at large can be helpful to offenders reentering the community after incarceration. First, learn about the difficulties of reentry.

“People are released and have no one to pick them up at the gate, with no identification and just the clothes on their back. They have no place to live and have felonies on their record and no money in the bank and are expected to somehow succeed,” Simmons said. “The deck is so stacked against them, it’s not even funny.”

With so much room for improvement, this offender re-entry crisis provides an opportunity for organizational collaboration in Boulder County to better serve and support offenders in rebuilding their lives instead of becoming a casualty of broken incarceration systems.

Children of incarcerated parents are at a greater risk overall. The Colorado Trust reports their lives become harder, poverty deepens and school problems multiply. A report by the Annie E. Casey Foundation states that 60,000 kids in Colorado, about 5 percent of all children, have a parent in jail or prison, which is a stressful, traumatic experience of the same magnitude as abuse, domestic violence and divorce, with a potentially lasting negative impact on a child’s well-being.

Looking ahead

Encouraging and facilitating community support and engagement is a common goal among organizations dealing with quality-of-health issues in the region, directly or indirectly. As more emphasis is placed on individual and environmental health across the county, and Colorado continues to rank high in quality of life and health ratings, there’s hope that those who experience poor physical and mental health in Northern Colorado and the Boulder Valley as a result of complex social challenges will see improvement and solutions — more people beating the odds.

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