While there are notable benefits of living in a smaller city or metropolitan region, there is a shortage of amenities needed to have a healthy community, most participants mentioned were limited access to direct health services, and the downfalls of unchecked population growth which continues to put pressure on existing resources. The cost of living and lack of affordable housing continue to be mentioned most often as barriers to being able to engage in a healthier lifestyle, coupled with stress and inability to have a healthy work-life-balance, both mental and physical health impacts are experienced.
Washoe County has the benefit of relatively great weather and climate, however in recent years smoke from wildfires has been cited as a reason for staying indoors, cancelling outdoor activities, including exercise options and outdoor event-based gatherings, and does have a direct impact on heart and lung health.
This section includes a summary of the analyses results for the four primary data collection methods utilized to solicit input directly from the community members of Washoe County. There were four types of primary data gathered for the purpose of this assessment, those include, 1) focus groups; 2) community survey; 3) key informant interviews; and 4) agency survey. Recruitment strategies were intended to solicit participation from a diverse representation of residents, not just limited to diversity of race and ethnicity, but sexual orientation, gender identity, occupational groups, and locations of residence within Washoe County. Primary data collection can be designed to obtain more information about the “why” and can be tailored around local trends. However, due to primary data not being entirely generalizable outside of the data collection cohort or weighted, these data are only indicative of the perceptions, thoughts, feelings, and opinions of those who participated, and are not intended to be representative of the greater community.
Some of the information presented in this section is available throughout the assessment, within areas closely related to the topics of discussion, for example when focus group participants discussed mental health-related issues, those are included in the mental health section to provide a deeper context for the reader.
FOCUS GROUPS
Nine focus groups were conducted from March through May of 2022 across Washoe County. The purpose of these focus groups was to elicit insights into existing and emerging factors, both societal and economic, affecting quality of life and health in the community. The questions asked of participants were designed to generate discussion about what it meant to live a healthy lifestyle, perceptions of qualities of a healthy community, and the top health needs of the community.
A total of 46 participants attended the focus groups. Attendance at the focus groups ranged from two to seven people. More than half of participants identified as female and as heterosexual. Majority of participants were between the ages of 25-44 years. Among all participants, 50% of individuals identified as White/Caucasian, 39% identified as Hispanic or Latino, 9% identified as Asian, and 2% identified as Black or African American.
Through analyses the following areas emerged as major categories which influence community health in Washoe County:
· Barriers to achieving a healthier community and living a healthy lifestyle
· Individual behaviors that help to lead a quality life
· Examples and qualities of a healthy community
BARRIERS TO ACHIEVING A HEALTHIER COMMUNITY AND LIVING A HEALTHY LIFESTYLE
Participants discussed a range of experiences they felt prevented them from being able to receive effective care and address their needs to live a healthy lifestyle. The top three examples of such experiences were: (1) Lack of access to healthcare; (2) Unaffordable cost of living, including unaffordable housing; and (3) Lack of road safety including limited bike access and poor walkability, and an insufficient public transportation system.
Lack of Access to Health Services
Participants in focus groups often cited barriers to accessing health services, including mental health services, primary practice providers, and specialists. Lack of providers was a predominant theme that emerged in the focus group data across nearly all participant groups. Even when a person has health insurance, they continue to experience barriers to timely, adequate, and affordable healthcare including issues with insurance acceptance. Persons on Medicaid predominantly cited they are unable to find providers who accept Medicaid through their private practice and experience challenges finding providers who treat them with respect. The majority of focus groups included discussions of experiences of having to wait weeks, and even months, to see a provider or the challenge of not being able to find providers who are accepting new patients and not being able to establish care.
Unaffordable Cost of Living
The second most frequently identified barrier to a healthy community was the increasing cost of living coupled with unaffordable housing.
The cost of goods and services and increased gas prices were on the minds of many focus group participants, as these issues had been a focus of national news media and impacts have been experienced across the region. Even among fully employed participants, the cost of living was mentioned as a barrier to being able to focus on individual health behavior. Examples included the need to work longer hours, having to compromise down time with friends or family support systems to work and having limits on being able to afford necessities and other competing financial pressures to pay for housing costs. Several participants expressed they are having difficulties in maintaining personal health because they are working more to afford basic amenities or are experiencing higher rates of stress due to financial burdens. The rising cost of goods and services; and the steady and steep increase in rent and gas were primary reasons people are seeking more work through overtime or additional jobs. The responsibility of having to increase the amount of time at work to ensure basic needs are covered financially were cited as a factor in compromising physical and mental health because they have less time for leisure activities.
Parents indicated they struggle with being able to provide a stable environment for their families when each month they must navigate difficult financial decisions. Ultimately, conflicting with the desire to take an active role in their child’s developmental years or paying for day-to-day costs of raising a family. Additionally, adults who are retired and on a fixed income expressed concerns with increasing cost of goods and services in addition to rent or property taxes and lack of being able to go the things they need to maintain a healthy lifestyle with limited or no additional income.
Lack of affordable housing was mentioned among many participants. Even fully employed young adults who mentioned the desire to call Reno and Sparks home, do not know if they will be able to enter the housing market in this area with the median cost of a house at above half a million dollars. Many participants shared the perception that affordable housing units are in terrible condition, located in unsafe and undesirable areas of town, are poorly kept, and are barely affordable to those who need them. Participants expressed fears of displacement as property owners continue to increase the cost of rent which limits the ability to live in safe and stable housing. Further, participants cited the need for more affordable housing units because wages have not kept pace with the cost of living in the area. Often mentioned was how the lack of attention and funding to improve low socio-economic neighborhoods has contributed to poor living standards.
Homelessness and unhoused populations were a frequently mentioned barrier, often coupled with the perception that persons who are unhoused contribute to litter and trash in the community and shared spaces, and several participants cited they feel unsafe when in areas of town where there is a lot of homeless persons, which makes them feel like they cannot go to those places and actively avoid those parts of town simply due to the presence of persons living on the streets.
Road Safety & Transportation
Participants mentioned road safety as a concern, including traffic congestion and too many vehicles on the roads as these issues impact being able to engage in biking or walking as means of transport or even physical activity. Participants provided several examples of how the public transportation system is ineffective as service hours and routes in Reno and Sparks have not expanded into areas where many individuals reside, especially in some lower income areas, and bus stops are uncovered leaving them vulnerable to the elements. Participants indicated they would like to rely on public transportation to reduce pollution and traffic congestion, however they choose not to use the public bus systems since the routes are not accessible, buses are not timely, nor do they run frequently enough.
INDIVIDUAL BEHAVIORS THAT HELP TO LEAD A QUALITY LIFE
Social Support Systems are Key
The pandemic shifted a multitude of daily patterns including how people work, play, and engage with one another and while not all were negative changes, recreating the lifestyle people were accustomed to prior to the pandemic is proving for some to be challenging. Many mentioned social support circles, such as family and friends, were essential for distressing, connecting, and when they were unable to engage in social connectedness in person, they noted the toll on mental health. With stay-at-home orders were lifted and social distancing was no longer widely practiced, focus group participants indicated they are having to make decisions between downtime with social support systems and taking on more work – either to earn more money or because of lack of staff to conduct the daily tasks of work, leading to ongoing stressors with an imbalance between work and life.
Outdoor Recreation for Physical & Mental Health
Many residents voiced their preference to engage in physical activity to increase physical health and mental health, as exercise serves as a stress reduction mechanism. The majority of participants also preferred to walk or bike in nature or at least outside. Several people expressed desire to reduce traffic congestion and no have to drive a personal vehicle if they could reliably utilize human-powered means of transportation, but lack of bike trails and walking paths connecting neighborhoods to areas where shops, food, and services are located, prohibit them from doing so. Additionally, the lack of safe roads due to lack of bike lanes, dangerous and distracted drivers, and long distances from neighborhood to services were all challenges mentioned by participants.
Self-Care & Self Fulfillment
Many participants were cognizant of their personal need to take care of themselves before they can provide support or care for others, including extended family. Examples included maintaining a work-life balance to the best of their ability, focusing on mental health and engaging in an activity to reduce stress, participating in hobbies such as gardening or volunteering to help others, maintaining good sleep habits and routines, being grateful for little moments of reprieve from outside stressors, or having a moment of alone time in nature, including parks or backyards. Participants openly described examples of having to take a step back from work or caring for an elder family member as it took a toll on their personal health, in order to re-establish a routine to achieve a healthier lifestyle.
EXAMPLES AND QUALITIES OF A HEALTHY COMMUNITY
The third major theme identified from focus group analyses was how participants envisioned a healthy community might look and feel. The examples provided included other locations participants had lived or visited, however some were inclusive of elements which contribute to Washoe County’s healthy lifestyles.
Outdoor Amenities
An often-recurring theme of accessing the outdoors, having outside recreational facilities and places to socialize was a dominant subcategory within this topic. Participants indicated a strong desire for more and improved parks with diversity in options to engage in physical activity, fields, trails, courts, and safe places for children to play. Having more bike paths for people to bike, run, and walk on, connecting residential areas to shopping was also expressed as a desire for the area as was the desire for additional public pools. Participants also recognized and were grateful for the number of parks in the community, acknowledging this is a beneficial public location that others can access to improve their health.
Close Proximity to Outdoor Recreation
Participants appreciated and acknowledged the benefit of living in the Reno/Sparks community is the proximity to the outdoors, including Lake Tahoe, the Sierra Nevada mountain range, and all the outdoor recreation opportunities being relatively close and accessible. Many recognized the weather in this region is generally great for spending time outdoors and while weather here can be extreme, the only barrier often mentioned was smoke in the summer and late fall contributing to unsafe air quality.
Community Resources & Community Events
The importance of having free and accessible community resources such as libraries, food banks, after school programs, and senior centers were mentioned by participants – both that Washoe County has these resources, and these resources are valuable for persons to live a healthy lifestyle. Community events and festivals were discussed in a positive manner, as focus group participants mentioned how these provide informal and formal opportunities for social gathering and meeting likeminded people, who might share interests.
Community Contribution
Volunteering and community contributions were frequently mentioned as being important for the collective to “own” the community and actively participate in making it a better place to live. The most common examples were community clean up events, outside of a formally organized event several persons indicated they contribute by keeping the environment clean both in personal spaces as well as public spaces. Volunteering examples also overlapped with community clean up events, but were inclusive of helping others in need such as food bank events, senior services events, handing out goods and food to persons living on the streets, and gift wrapping or bag stuffing for persons in need, especially around the holiday season.
Need to Feel Safe
The need to feel safe in the home, while walking on streets, while being in downtown regions, safe areas for kids to play – all were mentioned as examples for the importance of safety for community health. Often participants who resided in apartment complexes indicated they did not perceive their homes to be safe places, they indicated they rely on security or apartment building management to handle persons who should not be present or the physical location of the apartment complex was not in a “good neighborhood”.
Again, homelessness was mentioned as a perceived barrier to safety, often coupled with the connotation that homelessness contributes to trash and mental health issues, substance use issues and a general feeling of not being able to be around persons who are unhoused, as they pose a threat to others safety. Some participants mentioned they carry weapons such as firearms or knives, just to feel safer while out in the community.
Another example of safety and the need to feel safe was related to street and traffic safety, previously mentioned as barriers to having a healthy community under the road safety and transportation sub header.
FOCUS GROUP SUMMARY
Overall participants appreciate the small city lifestyle and generally good weather, however these positive attributes have contributed to rapid, and ongoing population and business growth that has left many residents concerned with the lack of adequate investment in infrastructure such as schools, roads, public transportation, and the lack of interconnectedness to shopping and food. Many of these factors were identified as barriers preventing people from engaging in healthy behaviors. Additionally, participants frequently expressed concerns with the conditions related to the cost of living as this is adding to financial strain and an increase in stress, resulting in poor mental health, lack of affordable housing/loss of housing, and the implications an imbalanced lifestyle can have on an individual, a growing family, parenting, and mental health and these cumulative factors were limiting their ability to improve personal health.