Arizona Social Vulnerability Index

Overcoming Obstacles to Improve Community Health

Esther Villa

 ^{Esther shares some of the many ways she has been able to help the Latino community of South Phoenix live healthier through her work with Unlimited Potential.} 

Esther Villa was born in Guadalajara, Mexico and has lived in South Phoenix for 20 years. For half of those years, she has worked with Unlimited Potential, an organization that has helped Esther obtain her GED, earn her community health worker license and eventually become the Director of Operations. Her primary focus is assisting the Latino and Hispanic community, connecting them with programs, classes, and other resources. 

Esther has witnessed many significant challenges in her area of South Phoenix and throughout the community. She shared that one of the biggest issues communities face is accessing healthcare. Esther approximates that around 70% of the community she serves lacks health insurance. She also notes that while there are nearby clinics, the low-cost options are often inaccessible due to long wait times for new patients and that other local clinics are too expensive. Additionally, Esther has noticed the absence of hospitals in her area. 

“We don’t have a hospital-hospital, only health clinics… We need a hospital where the community in this area can be helped.”

Preserving environmental conditions is another major challenge for Esther and her community. The increasing population density in South Phoenix has caused the development of housing units on natural land that, for years, was covered with fields. Esther believes these conditions have worsened the urban heat island effect, contributed to a decline in air quality, and increased asthma cases in her neighborhood. 

However, Esther has seen several initiatives that have effectively addressed some of these challenges. For health needs, she connects community members to programs about nutrition and chronic disease prevention or control, caregiver assistance, and mental support through a group of community therapists. To help improve the environment, Esther worked on the Cool Island Neighborhoods project in Tempe and helped mobilize the community to create cooler conditions for urban residents by receiving funding from the city to buy and plant trees. Similarly, Esther has helped clean up community parks to make them safer and more accessible for communities and their children.

“We were reaching out to communities about nearby parks that needed improvement in terms of safety and cleanliness, then began what was a challenge…We put up ‘children at play’ signs and threw away three trucks and a trailer full of garbage. That helped mobilize those communities.”

Despite the various challenges experienced by local communities, Esther and her organization continue their efforts to positively impact the lives of those they serve throughout the valley, empowering people to overcome obstacles and improve their well-being, little by little.

Improving Healthcare Accessibility in Colorado City

Hunter Adams

 ^{As the CEO of the only health clinic in Colorado City, Arizona, Hunter Adams describes how their clinic has provided programs and resources for this rural community to live healthier.}  

Hunter Adams is the CEO of Creek Valley Health Clinic in Colorado City, where he develops programs and partnerships to address community needs, aiming to improve healthcare accessibility, affordability, and overall well-being for Colorado City residents. He works with a local board of directors, composed primarily of patients of the clinic who represent many of the communities of Colorado City, including school principals, local elected government officials, representatives from the local health department, parents of children with special needs, low-income households, and persons with disabilities. 

In his work at the Clinic and with the board, Hunter has become acutely aware of many challenges that the community experiences. Some of the biggest barriers faced by residents of Colorado City are a limited housing supply, lack of specialist care, unreliable transportation, water shortages, poverty, unemployment, and an overall affordability crisis.

There is a disparity between wages earned and the average income needed to afford the cost of living in the community. The lack of affordable housing leads to cohabitation and an average household size of eight or nine individuals. There is a shortage of smaller homes and most houses in Colorado City tend to be very large, making it difficult for families to afford utilities. The smaller housing options, such as mobile homes and townhouses, rent for around $1,100 to $1,500 a month. Additionally, due to the isolated nature of Colorado City, the price of gas and groceries can be between 10-40% more expensive, and utilities can be 300-400% higher compared to more urban areas established nearby.

“Yet, we’re still developing quite rapidly” Hunter notes, mentioning his concern about drought and increasing water expenses. 

“For a rural community, we are still growing in the number of homes…and I do feel like water shortage is going to be a real factor in the community health of our future.”

Despite this growth, transportation is still a major barrier for accessing healthcare. Some miss appointments or go without specialist care due to the unavailability of reliable transportation. There are no ride-sharing apps, public transportation, taxi, or group transportation options available. Many people are also uninsured which adds another burden to accessing healthcare.

However, as the only primary care clinic in Colorado City, Creek Valley Health Clinic has been able to help many access healthcare services. They assisted people in getting health insurance and reduced the number of uninsured patients from 24% in 2019 to 12% by the end of June 2023. Additionally, they have partnered with regional hospitals and social service agencies to offer various health discount programs, nutrition and cooking classes, and gift cards for people with chronic conditions to purchase fruits and vegetables. They have also made significant progress in chronic disease management, resulting in improved health outcomes among patients with high blood pressure and diabetes, and offer programs and resources for children, such as free well-child visits and a local mountain biking team for adolescents.

“It's so incredible to see the innovation that's come out of our small clinic all in the last three years.” “Sometimes big ideas come from small communities”

Ability360’s Mission to Empower Independence

Ability360

 ^{A recreational therapist at Ability360 shares some of the challenges the disability community in Phoenix faces and how the organization supports individuals with disabilities to achieve and advocate for more equitable and independent lives.} 

Ability360 is a non-profit organization that provides resources and services to promote advocacy, independence, and equality for adolescents and adults with disabilities. We had the pleasure of speaking with a recreational therapist there who would like to remain anonymous; we have named her Mary for the purposes of sharing her story. Mary shared some of the biggest challenges that people with disabilities face and some of the ways Ability360 has provided support.

It can be difficult to find housing in Arizona, especially if you need additional accessibility features in the home. Many calls the organization receives are housing-related, but unfortunately, nothing is available solely for people with disabilities in the state. The assistance Mary and her organization can offer consists of community resources and shelter recommendations.

Moreover, funding cuts have made it difficult for individuals to receive the help they need to be independent. Homecare workers help individuals with daily non-medical activities, such as bathing, grocery shopping, laundry, and getting individuals ready to go to work or out in the community. However, due to funding cuts, they have had their hours slashed and Ability360 has had to tailor services back.

Employment discrimination is another prevalent issue for individuals with disabilities, especially those with visible disabilities. Mary shared her own experience with discrimination when applying for work. 

“I kept receiving emails to come into an agency for an interview…I use a power wheelchair, so they looked at me, went back into the back office for over 10 minutes, and then came out and said, ‘Well, nobody’s here. We’ll give you a call.’ And they never called back.”

Despite these challenges, there are ongoing efforts to help the community through various services and programs that promote independence and equality. Ability360 promotes self-advocacy and systems advocacy, which urges individuals to speak up for their needs and participate in disability legislation. They also help adolescents transition from high school to adulthood and anyone can receive resources from Ability360, such as developing independent living skills, peer support from staff or volunteers, home modifications, helping individuals transition from living in nursing homes into apartments, and a sports and fitness center with adaptive equipment. 

By raising awareness, building connections, and advocating for disability rights, individuals can work together to create a more inclusive community with equal opportunities and rights.

“What I would tell people is to speak up–to advocate. Speak up when you have the chance because if you want your voice to be heard, you want actions or changes to be made…the stories from people with disabilities are going to make those changes.”

Empowering and Advocating for Education

Herlinda Calderón

 ^{Herlinda expresses some of the health and safety challenges she and other residents face living near Downtown Phoenix and how she strives to improve conditions for Latino families.} 

Herlinda Calderón is a passionate and outspoken leader for the Latino community near Downtown Phoenix. She supports the families in her community, empowering parents and youth to embrace education. She is determined to improve her own skills by learning English, working towards obtaining her GED, and one day becoming a paralegal to support her community against injustices. 

"The community knows: I don't stop when I know there is injustice and we can raise our voices about it…Who will raise our voices if we don’t do it ourselves?"

Herlinda’s community faces many challenges. Most households are low-income and have little power to enforce air quality control or zoning laws to distance industrial operations from local schools and neighborhoods. Gas stations dominate street corners, and recycling and waste treatment plants worsen local air quality. Additionally, the community deals with drug dealing, homelessness, and stray dogs that may bite or attack. Such factors may contribute to higher rates of respiratory issues and obesity as residents avoid going outdoors.

Access to healthcare and housing can also be challenging for Herlinda’s community. There are few health clinics available and no nearby emergency centers. Not everyone qualifies for low-cost treatment and those who do face long wait times. Many avoid seeking care for fear of medical bills. Instead, community members sometimes help one another when injured or ill. Moreover, while Herlinda and her family dream of owning a home one day, the increasing housing, water, and electricity costs have stopped them from buying a home or renting elsewhere.

Herlinda recognizes the need for fair pay to match the cost of living. Many parents have to work multiple jobs, leaving little time to be involved in their children’s education. Sometimes, kids stay home alone because childcare is unaffordable. Herlinda feels that improving economic conditions would improve mental health and keep children safer and more engaged in school.

"There are amazing families living here, and they deserve a chance to have a beautiful life–a quality life–no matter if we are immigrants."

Herlinda continues to take steps to bring positive change to her community. She arranges workshops and works with the city of Phoenix, local colleges, and other organizations to give families information and resources, like English classes and college outreach programs. Her ultimate goal is to empower parents by making education attainable for them and their children. 

“I’ve realized that the real American dream is having a quality education and a life of dignity.”

Serving the Yuma Community with Compassion and Care

Regional Center for Border Health

 ^{An employee of the Regional Center for Border Health in San Luis tells of the needs of residents in rural Yuma County and the experiences of the refugees seeking care at his clinic.} 

The Regional Center for Border Health (RCFBH) is a non-profit healthcare organization that provides essential medical services to anyone regardless of their ability to pay. Their San Luis location serves over 3,500 people through many different public health programs such as chronic-care management and a summer outreach program for high school students. We spoke to one of the employees at RCFBH (they will be referred to here as Hugo to respect their wish to remain anonymous). 

Hugo shared some of the needs and challenges residents face in Yuma County with healthcare. One major issue highlighted was the shortage of doctors and physicians due to Yuma’s rural nature. Transportation is also a problem, especially for patients unable to drive. To address this, RCFBH has vehicles to bring patients to their appointments directly. Hugo believes there is a need for more investment in transportation in Yuma County to provide access to health services for all residents.

Food insecurity is another pressing concern in the area. Many patients struggle to access food but do not meet the requirements for SNAP. Additionally, Yuma needs more food banks and services like Meals on Wheels, especially for patients unable to travel or cook due to chronic conditions. Hugo believes there’s more that can be done to expand access and bolster funding for food services like SNAP to families. 

The Regional Center for Border Health in San Luis primarily services Hispanic patients and members of the Cocopah Indian Tribe but offers its services to anyone in the community. During the COVID-19 pandemic, the center played a crucial role in assisting refugees by providing free vaccines and tests. Being the only health center in the area available to refugees, Hugo sees a need for increased funding for programs that support refugees entering the U.S. The center also helps individuals with limited income access cellular and internet services through a federal program that provides free cell phones to those without one.

Hugo hopes to one day be a leader for refugees and asylees coming into the U.S. and emphasizes his and the clinic’s commitment to helping Yuma residents in need. 

“I can attest that the Regional Center is always going to be there for our patients, and everyone is welcome.”

How a Program Specialist at MatForce Utilizes Her Experiences to Transform Lives

Jessica Cox

 ^{Jessica Cox is a program specialist at Matforce in Prescott Valley; she explains why she aspires to spread the program to other locations in the state and country.} 

Jessica Cox is a program specialist at MatForce, a coalition in Yavapai County working to reduce substance abuse in the community. Jessica works in the Reentry Program, helping individuals who have been incarcerated within the past three years to reintegrate into the community. This includes helping people to get resources like shelter, clothing, and food as well as applying for employment, Medicaid, and food stamps. Jessica’s personal experiences with homelessness and the justice system help her to be a judgment-free advocate and a highly effective support for her clients.

Many people Jessica assists are below the poverty line and struggle with high costs of living. This can be especially challenging for those who have been in prison for several years and have never experienced paying bills. Affording transportation to get to work can also be a challenge, especially as rent, gas, and auto insurance costs rise. The winter season is particularly difficult for those who are unhoused, and the shelters that were already limited in space are further restricted when there is an outbreak of COVID. 

Food insecurity is also prevalent within the community. However, Jessica notes that it can be difficult for some to qualify for benefits like SNAP or Medicaid despite struggling to pay for food and healthcare. 

“Moms with two kids by themselves working don't qualify for health insurance or food stamps, you know? And I deal with that so much. I'll take my participants to go apply for food stamps and they get denied and I'm straight to the food bank.” 

Yet, since COVID-19, food banks haven’t been able to provide as much assistance as before.

However, Jessica believes MatForce has made many significant changes in the community and has a very effective model. From her own experience, she knows how important it is to create a sense of community, proactively contacting and connecting individuals to the resources they need. She credits Yavapai County for saving her life. 

“I didn’t have to be the one always reaching out…I made one phone call and I was hooked up with therapy, counseling, and drug services. And they were calling me and contacting me…That’s the kind of community we live in.”

MatForce collaborates with dozens of local organizations to provide a network of support to community members. Jessica’s dream job is to travel and implement effective MatForce models in other counties and states. 

“What's happening up here is working. And we're very boots on the ground. I just feel like if other organizations and other towns or cities had the opportunity to do what we're doing, that it would make a difference.”

How a Flagstaff Neighborhood Supports its Residents

Southside Community in Flagstaff

 ^{A Southside community member shares some of the challenges she has witnessed and  experienced as a Flagstaff resident and the pride she has for her community.} 

The Southside Community Association (SCA) serves the Southside Neighborhood and the greater Flagstaff community in Coconino County, Arizona. We spoke to a longtime resident of the Southside community, who we will refer to as Diana to preserve her anonymity. Diana identifies as a Black American woman and spoke with pride about her community, highlighting its diversity in age and culture among residents. Annual events organized by the SCA bring the community together, such as Miss Cleo’s Tea Party and the celebration of Juneteenth. The SCA regularly meets with community members to address issues such as accessibility to housing, childcare, healthcare, and health information.

In her community, Diana has seen several households share one roof with multiple family members to make ends meet due to increased housing costs. Housing units that used to be affordable, such as mobile homes, have become expensive. In addition, the high cost of childcare has forced some parents to stay home despite wanting to work. There is also a shortage of senior living facilities and shelters for veterans and the unhoused population.

Several services in the area help residents access the things they need, such as application assistance for public housing and rental assistance, diaper programs, utility assistance, cell phone and internet access, and even mobile food distribution services. However, Diana notes that these resources still fall short: 

“We do have a lot of good social services. I think they get exhausted really easily because you do have such a great need. If you literally aren't there right on the spot when it's accessible, you kind of miss out.”

Diana has noticed that families benefit from Medicaid and sliding-scale programs but she feels that more health education and promotion of programs would help build awareness:

“I think for the most part, a lot of families do have health care. Do I think they take advantage of some of the services they could get? Not as much. And I think it's just because they might not know what's available.” 

Diana has also observed a shift in the racial makeup of Southside. Many years ago she would describe Southside as a predominantly African-American community but recently Diana has noticed fewer Black families who are longtime residents. She shared that her children have experienced racial discrimination at work and she has felt a recent rise in the prevalence of prejudice. She’s also seen an influx of people moving to Flagstaff, contributing to more crowding and car flow. All things considered, Diana feels that Southside is a safe community surrounded by helpful people. By actively addressing issues and working together, the Southside Community strives towards creating a more equitable and inclusive environment for all residents.

Strength in Community Connectedness

Terrance Miguel, a community health representative for the Gila River Indian Community, shares how teamwork has enabled him to serve his patients.

Terrance Miguel

Terrance Miguel is a Community Health Representative (CHR) for the Gila River Indian Community. As a CHR, Terrance provides healthcare services to community members in their homes, where they may feel more comfortable. It is especially beneficial for those with mobility issues and difficulty traveling to healthcare facilities. He also assists in scheduling follow ups for patients who have missed any health appointments.

Terrance believes it is his responsibility as a CHR to set an example for the community and encourage people to get back to grassroots food instead of fast, processed foods from cities. Several members lack the means to buy healthy foods and food distribution centers don’t often offer fresh foods. Thus, he grows food from his garden and wants to find a way to engage the community to do the same.

In his experience, Terrance has observed instances where community members, grappling with health issues, take on the responsibility of raising their grandchildren due to factors such as alcohol and drug addiction or the incarceration of the children's parents.

Terrance and other CHRs at Gila River regularly work together and engage with the community to help their patients and improve the health of residents. For example, the CHR program put on an event called Movember to encourage the community to get active by offering incentives for participating in a mile or half-mile walk once a week throughout November.

Reflecting on his role, Terrance emphasizes the importance of teamwork in addressing patient needs and securing resources for their well-being: “We engage as much as we can to make the team work to better serve our patients and do the best we can to find resources for our patients… Having that camaraderie, or teamwork, to make things better for our patients–I think that’s one of the things I really enjoy about being employed with Gila River.”

The Challenges and Rewards of Being a Community Health Worker in Cochise County

Christopher Waters, a community health worker in Cochise County, describes the issues affecting the unhoused and underserved communities in his rural community.

Christopher Waters

Christopher Waters is a community health worker (CHW) serving the unhoused and underserved population in Cochise County. Christopher is from the area and describes it as a small rural and farming community. Based on his experience working directly with people in shelters and out in the community, he’s seen that some of the biggest challenges people face are severe environmental conditions and trouble accessing healthcare, housing, transportation, and telecommunications.

Unhoused individuals often lack documents, such as ID cards and birth certificates. Without these, a person may have trouble securing resources such as housing and healthcare. CHWs like Christopher help people obtain needed documents from the state to enroll in AHCCCS and other services. Yet, even with documentation, many struggle to qualify for housing aid. A long waiting list for housing exists and unless someone has been given priority status (e.g.veterans, people with disabilities, people with children), they are unlikely to receive immediate help.

Abnormal environmental conditions in the past couple of years have also impacted housing. Some have lost their homes from severe flooding during the monsoon season. Additionally, recent record-breaking heat adds another burden for those without shelter.

Telecommunications and transportation pose additional obstacles. While some unhoused individuals have phones, many do not and depend on free internet provisions or must borrow phones from others to make calls and send texts. Moreover, Christopher stressed how frustrating it is when he can’t connect people with resources due to a lack of transportation. He’s tried to reach out to agencies about providing help with transportation but so far this is still a gap for their rural county.

Food insecurity is also prevalent in the community. However, there are plenty of food resources available in Cochise County.

“I always try to let people know that here in Cochise County, they should never go hungry because there’s food out there.”

Christopher works to connect individuals with these resources and inform them of where they can find free food, although he notes that their programs are often lacking healthy and nutritious options.

Christopher is part of a CHW network that comes together regularly to discuss ways to streamline services to the community. The organizations in the network use a sliding scale or provide free services where possible. Christopher utilizes this network to raise awareness in the community about available resources and services.

“It was amazing to me how little people realize how much help was out there. And all they needed to do was ask, but they didn't know who to talk to.”

Christopher believes CHWs make a vital difference in their communities.

“It's so amazing for [people] to say, ‘Hey, I got that housing,’ or ‘Hey, I'm able to get eyeglasses' or ‘I was able to get enough food for the month.’ It's really rewarding whenever that sort of thing happens.”