BY NICHOLE MANNA SEPTEMBER 22, 2020 06:00 AM ,
Life and death in Fort Worth’s 76104
People in Fort Worth’s 76104 ZIP code on average won’t see
their 67th birthday. What is causing the lowest life expectancy rate in Texas?
What can be done to help? Read the Star-Telegram’s investigation:
FORT WORTH
Marcus
Graves was barely a teenager when a school nurse told him he had high blood
pressure. At 39, a stroke nearly killed him and left him paralyzed on the right
side of his body.
By
that point, he had already buried both of his parents. His dad was killed in a
shooting when Graves was 2. His mom died at 55, likely related to a problem
with seizures.
Graves’
family illustrates what UT Southwestern researchers found when
they released a study on the life expectancy of Texans:
Residents in a cluster of neighborhoods south of downtown Fort Worth, on
average, don’t live to see their 67th birthday.
Specifically,
the study released in 2019 found that residents of the 76104 ZIP code have the
lowest life expectancy in the state at 66.7 years, almost 12 years younger than
the national average.
In
an investigation into the area’s low life
expectancy that began in August 2019, the Fort Worth
Star-Telegram spoke with more than 50 residents, interviewed doctors and
experts in public health and analyzed the records of 396 deaths in the ZIP code
that were reviewed by the Tarrant County Medical Examiner’s
office between 2005 and 2014 — the time frame of the UT
Southwestern study.
Residents
told stories of family members who died young of heart
disease — the No. 1 killer in deaths reviewed by the medical
examiner. They shared details of their personal struggles with health care.
Almost everyone knew someone who died in their 40s or 50s. They spoke about how
the neighborhoods east of Interstate 35W have changed over decades of neglect.
Some of those interviewed suffer from chronic illness themselves.
The
irony of the story of 76104 is that the ZIP code takes in the city’s medical
district, which includes five hospitals and hundreds of medical offices. Yet
residents described a lack of access to health care driven by a lack of
transportation, insurance and awareness of programs available to help.
Chief
among the barriers is I-35W, which runs north-south through the ZIP code. The
medical district is on the west side of the interstate. Neighborhoods on the
east side are less than two miles from the medical district, but the highway is
a wall that blocks people there from quality health care.
Among
the neighborhoods east of the interstate are Historic Southside, Morningside
and Hillside, referred to collectively by many as the south side. Of the
deaths examined by the medical examiner’s office, the majority occurred in
those three neighborhoods. There are no doctors’ offices or clinics there.
76104
The Historic Southside, Hillside and Morningside
neighborhoods in the 76104 ZIP code have the lowest life expectancy in Texas,
according to a study by UT Southwestern. 76104 also includes the Fort Worth's
Hospital District that is separated from the neighborhoods by South Freeway.
STEVE WILSON SWILSON@STAR-TELEGRAM.COM
The
UT Southwestern study and the Star-Telegram’s investigation show clear evidence
of the disparities in health care faced by people of color. About 38% of people
who live in 76104 are Black (43% are Hispanic, representing a demographic shift
in recent years). In Historic Southside, Morningside and Hillside, Black residents
make up 54% of the population.
Those
disparities have also played out during the COVID-19 pandemic. Excluding the
cases and deaths at nursing homes, the ZIP code is among the hardest hit in
Tarrant County in the number of coronavirus cases per capita, according to data
from the Tarrant County Public Health Department.
After
being presented with the Star-Telegram’s findings, Dr. David Capper, a member
of the John Peter Smith Hospital board,
acknowledged that improvements are needed.
The
area to the east of the interstate could benefit from a doctor’s office or
clinic, and the county, which owns JPS, should look into transportation
programs to help residents get to medical services, he said. He agreed that the
health disparities in the neighborhoods existed long before the arrival of
COVID-19.
“Primary
health access has not increased in these areas, and this is something that
needs to be addressed,” Capper said.
PROUD HISTORY
Don
Williams, 68, has put 12 years of work into the Juneteenth Museum on East Rosedale Street, a
block from the Southside Community Center.
Pictures
of Black greatness cover nearly every inch of all four walls in a room
dedicated to “Fort Worth Black Firsts”: The first Black doctor, the first Black council member,
the first Black Star-Telegram reporter.
“The
history of this neighborhood is rich,” Williams said.
The
neighborhoods were once occupied by middle-class Black residents who owned
thriving jazz clubs, restaurants, barber shops and grocery stores that lined Evans and Rosedale streets.
Children gathered at the community swimming pool until it was filled in and a
Church’s Chicken was built on the spot. The restaurant has since closed.
But
when the wealthier families moved out of the neighborhoods after integration in
the 1960s, poorer families were left behind and, slowly, businesses closed.
Then the crack and gang epidemics of the 1980s and 1990s drove even more people
away.
Derek Chapman, a family medicine and population
health professor at Virginia Commonwealth University, said
neighborhoods like these often were the result of the segregation of Black
people and redlining — a system backed by federal policies that
allowed banks to deny mortgages to (usually Black) people.
Bob
Ray Sanders, a lifelong resident of 76104 and member of the city’s Race and Culture Task Force,
said education, transportation and criminal justice reform — all of which
doctors say affect a person’s overall health — were lacking in the
neighborhoods. While large bond packages were passed, little trickled down to
those residents, he said.
Because
of those practices, the character and life of the neighborhoods has changed
drastically over the last several decades. Homes with wrap-around porches and
rocking chairs became dilapidated and were torn down, leaving dirt lots that
pepper many streets. At least 39 empty lots were listed for sale in Historic
Southside, Morningside and Hillside in early August.
Once-bustling
businesses are now empty eyesores. When longtime Black doctors retired, no one
was there to take over their practices.
What’s
left of the three neighborhoods? Forty-six churches and a dozen corner stores
that mostly sell canned foods, snacks, cigarettes and alcohol.
“Black
people there were obviously at the end of the food chain in terms of health
care,” Sanders said. “People living in that area were not supplied with
opportunities to have better health. There’s a lack of grocery stores, and you
couldn’t even walk down your street safely because of a lack of sidewalks. All
those things affect overall health.”
Still,
many longtime residents love their neighborhoods and are hopeful about the
future. They’re proud of their history.
LIFE WITHOUT HEALTH CARE
At
Graves’ house, health care came from the school nurse or the family’s medicine
cabinet, stocked with peroxide, epsom salt, Campho-Phenique and rubbing
alcohol.
Graves
was one of six children — four girls and two boys — who lived with their mom
and grandmother in the 1970s and ’80s on East White Street, just north of
Rosedale. The house was so tiny that when Graves was a baby, he slept inside a
dresser drawer because there wasn’t room for a crib. For that reason, when he
was in elementary school, the family moved to a marigold yellow house a half of
a mile south on East Magnolia.
The
house on White Street is now a church. Two other houses were knocked down
during the construction of the church. The yellow house still stands, but is
now pink.
It
was at that house where Helen Rhema Conner’s medicine cured her grandchildren’s
ailments. Graves remembers popping his knee as he wrestled with his brother
when he was 10. He wanted to go to a doctor, but his grandmother wrapped his
swollen leg in epsom salt and put him down for a nap.
“I
mean, thankfully, I didn’t have any lasting effects by not going to the
doctor,” he said, laughing at the memory. “We couldn’t afford a doctor. We
couldn’t afford to get hurt or sick.”
Marcus Graves, who grew up in Fort Worth’s 76104 ZIP code,
cleans the counters at the end of the day at Medical City in North Richland
Hills. Graves was a child when a school nurse told him he had high blood
pressure. At 40, a stroke nearly killed him and left him paralyzed on the right
side of his body. Yffy Yossifor YYOSSIFOR@STAR-TELEGRAM.COM
Graves,
53, moved to Watauga more than a decade ago to give his children a better life.
Graves’
upbringing was similar to those who grew up around him, and the circumstances
he faced are still a reality for many who live in the 76104 ZIP code today.
Children
don’t get yearly check-ups, single-parent homes are common (there are
about 1,500 single-mother homes and 400 single-father homes in the 76104 ZIP
code, according to the U.S. Census) and parents have to make food stamps
stretch.
“I
think if we had more money, my mother, my grandmother would have considered
buying healthier foods,” Graves said. “But we didn’t.”
The
adults lived on disability because they suffered from epileptic seizures.
His
bad diet (which included a lot of bologna, fried chicken, chitlins and hog maw
because that was all they could afford) caught up with him when he was 39. He
had two strokes within 24 hours, leaving him paralyzed on the right side of his
body. He now works in the cafeteria of Medical City North Hills, the hospital
that saved his life.
Dallas
cardiologist John Osborne said
Graves’ health likely began to decline when he was a teenager. Where you live affects heart health,
even if, like Graves, you move later, he said.
“Those
socioeconomic, geographic factors play a role,” Osborne said. “Those can be
access to medical care, access to healthy foods, the ability to exercise,
pollution — there are a lot of factors that drive it.”
It’s
likely why COVID-19 has hurt Black Americans more
than their white counterparts.
While
discussing the virus’ effect on Black Texans with other state Democrats in
April, state Rep. Eddie Bernice Johnson of
Dallas said no one should be surprised about
the data that was showing Black Texans were dying at a greater
rate. In Tarrant County, Black residents make up 16% of the population but 19%
of the COVID-19 deaths.
Texas’
refusal to participate in Obamacare’s Medicaid expansion has hurt Black
residents, Johnson said. (Texas has the most residents without health insurance in
the U.S.)
In
76104, more than 5,000 people are without health insurance, and plans through
the Affordable Care Act can cost $436 a
month with an $8,000 deductible for a 55-year-old single man who earns $10,000
a year, according to the federal government’s health care exchange.
In
total, 45% the households (or more
than 2,800) in the ZIP code bring in less than
$25,750 a year, the federal poverty level for a family of four.
About 1,200 of those households brought in less than $10,000 in 2018, according
to census data.
Poverty
affects health, doctors said, and a Harvard study found that residents in
rich neighborhoods live about 15 years longer than residents of poor
neighborhoods in the same cities. In those same areas, lower-income residents
of wealthy neighborhoods still lived longer than people in poorer ones because
of the resources close to them.
STEVE
WILSON SWILSON@STAR-TELEGRAM.COM
COVID-19
Andrew
Sims-Kirkland, 33, didn’t take the coronavirus seriously at first. But in late
March, he started to feel sick. Soon, he had trouble breathing.
“There
were points where I literally thought I was going to die,” he said.
Sims-Kirkland
is a director at the Tree of Life Funeral Directors funeral home. He
and his family live in Morningside. He’s not sure where he got the virus, but
COVID-19 quickly spread among his family.
Within
two weeks, four members of Sims-Kirkland’s family were sick. Two other
relatives who visited from out-of-state were also sick.
His
aunt, Janice Young, 74, who suffered from long-term health issues, died
at Baylor All Saints.
“She
was a light to everybody,” said her daughter, Rhonda Wade, 50. “She always
tried to help everybody. She was a mom and grandmother even to those who needed
one. She raised kids who weren’t hers.”
Wade
and Sims-Kirkland talked about how the virus affected their family while
wearing face masks and sitting on either side of a couch inside of the funeral
home. They recognize how lucky they are to have health insurance, but realize
many of their neighbors don’t.
Sims-Kirkland
believes the Black population was hit harder because many already faced
struggles with poverty and a lack of health care.
“A
lot of people don’t have access to doctors to even know if they have underlying
issues,” Wade said. “But we had everything we needed growing up. No extras. We
didn’t realize we were in a resource desert until we were adults and went into
the real world.”
And,
like Sims-Kirkland, Wade and Graves, many Black residents of 76104 work
essential jobs and didn’t have the option to stay home and quarantine early on,
which led to their increased chances of exposure. Residents of 76104 work in hospitality and construction jobs at higher rates than
the rest of Fort Worth, according to census data. About 14% of the workforce in
the ZIP code work jobs that were deemed essential during the pandemic, compared
to about 11% for the entire city of Fort Worth.
“African-Americans
and Hispanics are more likely to be working in jobs like grocery store clerks,
drug store clerks and bus drivers, where they’re exposed,” said Catherine
Troisi, an infectious disease epidemiologist with
the UNT Health Science Center at Houston. “If you are not a white collar worker
with internet access and a job you can do from home, you’re more likely to be
in a service position where you’re more likely to be exposed.”
NO CLINICS, PHARMACIES
Residents
on the east side of the interstate can see the tower of John Peter Smith
Hospital two miles away from the hills on which Historic Southside, Morningside
and Hillside were built. Yet the hospital and other services in the medical
district remain inaccessible to them.
There
are 3,205 working physicians in Tarrant County, yet the three neighborhoods
have no urgent care centers or clinics. The neighborhoods have no pharmacies,
either. A closed clinic on East Baker Street near Interstate 35W and the empty
Langley’s Pharmacy at Evans and Arlington avenues show the neighborhoods once
had better access to health care.
A sign for Langley’s Pharmacy is all that remains of the
business on Evans Avenue in the Hillside neighborhood in Fort Worth. Hillside,
Morningside and the Historic Southside neighborhoods don’t have any health
clinics or pharmacies. Yffy Yossifor YYOSSIFOR@STAR-TELEGRAM.COM
Because
many coronavirus testing sites were opened within clinics, none opened in any
of the three neighborhoods. But on Sept. 17, the University of North Texas
Health Science Center at Fort Worth announced that they received a potion of a
$12 million national award to help connect minority communities with public
health information regarding clinic research and vaccine trials, which will
include the neighborhoods in 76104.
Williams,
who has lived in Historic Southside for 20 years, said he’s angry about the
decline of the neighborhood and the lives cut short.
“People
are dying because they can’t afford doctors,” he said. “We don’t see any
outreach from the hospitals.”
Hospital
representatives said they don’t have clinics on the east side of the
interstate because of the area’s close proximity to the hospitals on the other
side of I-35W. But access is difficult because of a lack of transportation.
Doctors
who work in clinics within low-income neighborhoods elsewhere say they are in a
better position to serve their patients.
The Baylor Scott and White Citysquare clinic in
south Dallas caters to low-income patients without insurance. Its doctors live
in the neighborhood, and the clinic is within walking distance for many
residents, whose life expectancy, according to the UT Southwestern study, is,
on average, about a year and a half longer than those in Fort Worth’s 76104 ZIP
code. The clinic has been in the neighborhood for about six years. Before that,
volunteer doctors worked in the basement of a neighborhood church after they
discovered a need for accessible health care.
After
learning about the Star-Telegram’s findings, Benjamin McKinney, a doctor at the
Citysquare clinic, said he thinks the neighborhoods in 76104 could benefit from
a similar clinic.
“When
you look at transportation and access when people are walking to a clinic,
they’re much more likely to go to a clinic in their neighborhood,” he said.
“Access is huge for everything, but especially an area where there’s already so
many barriers.”
In
Fort Worth, a Baylor Scott & White clinic on the west side of the
interstate helps uninsured and low-income residents, most of whom
are directed there from the hospital’s emergency room. Doctors saw 6,172
patients in the 2019 fiscal year, a spokeswoman for the hospital said.
Mobile
units are another option. The Texas Health Harris mobile unit
visits the neighborhoods about 10 times a year, a spokesman
said.
Each
year, the hospital provides about $2.5 million in charity related to health
care costs to people living in the 76104 ZIP code, spokesman Stephen O’Brien
said.
“This
includes everything from the treatment of heart attacks and strokes, to trauma
cases and visits to our ERs,” he said.
But
there’s a disconnect between the available programs and residents.
Residents
told the Star-Telegram they didn’t know those programs existed. Williams, who
runs the Juneteenth museum, thinks having a clinic central to Historic
Southside, Hillside and Morningside would help, not only for access but to
build trust.
“People
can walk there, but they’d have to build something,” he said. “There’s no
facilities that’s conducive to a clinic in these neighborhoods, and if we had
one, I think people would be more likely to go.”
Capper,
the JPS board member, said transportation is the first issue the county should
tackle to close the health care gap. Living in these neighborhoods without a
vehicle (18% of households in the ZIP code don’t have one, according to census
data) could mean at least two transfers on a Trinity Metro bus, plus up to an
hour waiting and several blocks of walking to get to a doctor.
A
new Zipzone in the Near Southside will
help some residents of Hillside, but residents of Morningside will still have
to walk 30 minutes to take advantage of the $3 flat rate.
STEVE
WILSON SWILSON@STAR-TELEGRAM.COM
STRUGGLES AREN’T OPENLY DISCUSSED
Williams
moved to Texas with his family in 1961. He eventually settled on East Terrell
Avenue (in Historic Southside) in the early 2000s. He lives within walking
distance of at least nine churches, five fast food restaurants, a library and
the Juneteenth Gallery, which he operates.
“There’s
no food over here, there’s no clinics,” he said, his voice rising as he stood
up and pointed to the door of the museum. “This neighborhood used to be
something.”
Historic
Southside was prominent in Fort Worth’s Black community.
“We
were like the Black Wall Street, and then everything just went away,” Williams
said. “A lot of good people came from right here. Good doctors, lawyers and
teachers.”
Now,
Williams sees a lack of necessities, which makes UT Southwestern’s findings
about life expectancy unsurprising.
Williams,
who has health insurance because he’s a veteran, said a number of his neighbors
will call the fire department just to get a ride to the hospital.
“Really,
though, you just hope you don’t get sick,” he said. “And if you do get sick,
maybe your neighbor has a car and can help. You can’t rely on the bus system to
be on time or get you where you need, and some people can’t afford the fare.”
Asked
if he and his friends ever talk about the lack of health care, Williams said
no.
“That’s
just one of those unwritten rules,” he said. “You know people are struggling
but you don’t talk about it. It’s tough being poor in this neighborhood.”
Even
when COVID-19 crept in, residents mostly still stayed quiet, he said.
Don Williams inside the “Fort Worth Black Firsts” room at
the Juneteenth Museum on Rosedale Street. Yffy Yossifor YYOSSIFOR@STAR-TELEGRAM.COM
WHERE’S THE OUTREACH?
Capper
acknowledged that a homeless clinic, north of Southside, and
JPS have not done a good job of advertising their services.
“The
beauty is that JPS is committed to doing more,” he said. “The commitment is
there, unfortunately it’s dogged by bureaucracy, which is the nature of the
beast for any tax-funded entity.”
As
far as the homeless clinic, Capper said there are plans to strengthen its
outreach in the neighboring communities by knocking on doors and distributing
information about the clinic, but COVID-19 stalled the effort. Many people who
live just south of the clinic avoid using it because of the stigma that it is a
clinic for the homeless. Capper acknowledges that the clinic needs to help
people see past that.
Residents
said they don’t see the mobile medical units operated by JPS or other hospitals
in their neighborhoods, and they can’t afford the costs of routine screenings,
such as $100 to $300 annual mammograms or $75 calcium score tests that help
predict heart disease by measuring plaque buildup.
Asked how JPS advertises its services to the
community, Joy Parker, vice president of community health, said
information about the programs is posted online.
Asked
if she’s heard of any resources offered by JPS, resident Crystal Perry said,
“Right now, no.”
“They
usually have an informational health expo, and they do flu shots and things
like that, but I haven’t seen them or any fliers,” she said. “I usually do
because I work for a dentist’s office, and the hospital will tell us what they
have going on but I haven’t seen that lately.”
Perry,
44, worked west of Texas Wesleyan University — about five miles from the center
of Historic Southside, Morningside and Hillside. After the COVID-19 outbreak,
she began working as the office manager for her sister’s marketing company.
Perry’s
aunt, Cassandra Wren, 57, said she used to attend a JPS health expo for seniors
where blood pressure and diabetes checks were provided.
“But
as far as seeing JPS pass out fliers or coming out here to let us know what’s
going on in the area, we don’t hear anything from them about that,” Wren said.
A
team of JPS employees helps low-income residents find affordable health care
through the hospital’s eligibility and enrollment
centers, Parker said.
The
hospital’s JPS Connection helps people without health insurance who are not yet
Medicare eligible.
But
Capper said he believes 50% of the people who are eligible for the program
probably don’t know it exists.
BEHIND OUR
REPORTING
How we did this
story
In 2019, Fort Worth learned that
people living in the 76104 ZIP code have the lowest life expectancy in Texas:
66.7 — 70 years old for women and 63.7 for men, according to a UT Southwestern
study.
The Star-Telegram interviewed 50
people who live or used to live in the neighborhoods and 14 doctors and experts
in public health about how your neighborhood can affect your health. The
newspaper analyzed the records of 396 deaths in the ZIP code that were
investigated by the Tarrant County Medical Examiner’s Office between 2005 and
2014 — the time frame of the study. Most of those deaths happened to people who
lived on the east side of Interstate 35W, where there are no grocery stores,
doctors offices or clinics.
WHO IS RESPONSIBLE?
Sanders, the
lifelong 76104 resident who is also a former Star-Telegram columnist and
opinion editor, said one person or entity is not responsible for the health of
a particular area, but it’s a systemic issue that can be addressed by many. He
was part of the Fort Worth Task Force on Race and
Culture that created recommendations for the city, some of
which related to health in Black communities.
When
the task force began the study two years ago, Sanders said he could have
written it in a day.
“It
hasn’t changed in 30 years,” he said. “Part of that is education, part is
tradition, but it all goes back to a system that simply didn’t care about all
of its citizens. It’s interesting because when you want to improve things like
transportation, health care, criminal justice, Black people are normally the
ones who pass those bonds in elections. But they get very little of it back.
The City Council, with this study, finally approved some of those things we
recommended.”
The council approved 20 recommendations including
holding annual health forums for minorities, repairing and installing
sidewalks, improving street lights and negotiating shared use of public school
facilities through neighborhood associations.
In
the end, Sanders said, responsibility lies with those in power and those who
put them in power.
“Elected
officials are charged with making sure things are better for the people they
represent, but sometimes people in elected offices just stay there by figuring
out how to keep that power,” he said. “But, the truth of the matter is people
in those areas aren’t voting in strong enough numbers.”
Despite
the evidence around them, some residents don’t trust the validity of the UT
Southwestern study. Many say they know someone who has lived past 67. They want
to focus on the good of the neighborhood through its colorful past and the
potential of its future.
It’s
disheartening that an area so loved by its residents has been forgotten by
many, Williams said.
“People
are proud to be from the south side, that’s what they call it,” he said. “Most
people have been here many, many years and some leave and come back. It’s just
a good neighborhood.”
Nichole Manna is an award-winning investigative reporter
for the Star-Telegram focusing on criminal justice, civil rights and
healthcare. Before moving to Fort Worth in July 2018, she was a reporter at
newspapers in Tennessee, North Carolina, Nebraska and Kansas. She likes to
spend time with her two dogs, a dachshund named Opie and a three-legged terrier
named Oliver. Want something investigated? Send me news tips to
nmanna@star-telegram.com or 817-390-7684.
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