Homeless or mentally ill people and the working poor weigh heaviest on the minds of Gregg County residents when it comes to challenges in community and public health, a new survey shows.

Northeast Texas is among the least healthiest parts of the country, but Gregg County residents have a different perspective on the biggest challenges to improving the region's health, according to a 2016 community needs assessment released this past week by UT Health Northeast in Tyler and the Episcopal Health Foundation.

The assessment was among results from a survey of more than 2,300 residents from 28 counties, including 149 people in Gregg County gathered in dozens of health forums as well as clinics across the region.

Gregg County mirrored Northeast Texas in what survey respondents said were the top five priority health issues in the region — diabetes, obesity, substance abuse, high blood pressure and cancer — said Dr. Paul McGaha, associate professor of community health and preventive medicine with UT Health Northeast.

If Northeast Texas was a 51st U.S. state, it would rank among the five worst states for heart disease, stroke and other causes of death, he said.

In Gregg County, surveys showed the homeless population was identified as the population with the greatest needs (57 percent), followed by low-income groups (31.5 percent), people with mental illness (30 percent), the working poor (26 percent) and veterans (22 percent).

Collectively in the survey, Northeast Texans identified low-income groups (35.8 percent), the working poor (32.4 percent), the underinsured (30.7 percent), persons with mental illness (30.5 percent), and the homeless (28.9 percent) as presenting the greatest need.

"I don't want to say that it is all doom and gloom," McGaha said of the report.

"We know you guys are doing great work here already," he said, "but there are many issues that we still face in community health in the East Texas area, and I think that it's important to have a discussion about some of them."

McGaha and Episcopal Health senior community engagement officer Maryland Grier led a discussion of the results with about 30 paramedics and Gregg County area public health and social service leaders Tuesday at Pinecrest Country Club in Longview.

Northeast Texas has rates of high blood pressure, hypertension, motor vehicle wrecks and smoking that generally exceed other parts of the state, analysts said. Meanwhile, the rate of exercise is lower in the region.

"We are the least-healthy part of the state," he said. "A lot of people think it would be the lower Rio Grande Valley, but really it's not, and that's something that we're trying to share information about because we need to know."

Inman White, executive director for Community Healthcore, said many solutions that will be found still won't address the vast majority of mental illness that "walks our streets or that is within our population."

Services to help mentally ill people are private services and narrow, White said, but there also is great concern for people with severe, persistent mental illness, and the primary health services — or lack thereof — that are available to them.

"Until we find a way to better utilize the technology that is either available to us, or hasn't even been created yet, to find ways to develop health services in people's homes so that the nurse is mobile and the physician is through tele-video, we're still going to have difficulty in doing that because that regular health waiting room experience for people who have to come, sit, wait to be taken back and forth, with the mental illness on top of that, it's not an experience that gets you a good outcome," White said.

"We've tried different ways, but we don't have anyone with a battery pack and an antennae on their back yet to go into people's home," he added. "It has to be mobile. It has to be where people live."

Gregg County is in many ways a hub for health services such as sexually transmitted disease testing or mental health assistance, said county Health Department Administrative Assistant Fred Killingsworth.

"These folks (from other counties) that come in, they just want to access our facilities, and that tends to put a burden on everybody," he said. "It's nice to see that we're kind of working outside the box."

Analysts said the survey and its results provide a platform for UT Health Northeast and Episcopal Health Foundation to join alongside local social workers, groups and health professionals to frame community discussions in the future that are focused on improving health in Gregg County and Northeast Texas.

"We want to help our communities," McGaha said, "and we want to educate others that aren't necessarily in the middle of public health."

Results from the 2016 community needs assessment by UT Health Northeast in Tyler and the Episcopal Health Foundation:

Priority health issues

CategoryGregg CountyNortheast Texas
Diabetes36.8%36.1%
Adult obesity34.2%38.1%
High blood pressure31.5%35.5%
Substance abuse30.8%32.8%
Cancer30.8%36.2%

Individuals in greatest need

CategoryGregg CountyNortheast Texas
Homeless57.0%28.9%
Low-income groups31.5%35.8%
Persons with mental illness30.1%30.5%
Working poor26.1%32.4%
Veterans22.1%NA

Services most difficult to access

CategoryGregg CountyNortheast Texas
Health insurance24.1%15.7%
Mental health care19.5%15.7%
Housing assistance19.5%NA
Medication cost assistance16.8%14.3%
Healthy food and beverages14.1%NA

Top 5 causes of death TX rank NETX rank*

Heart disease 33rd 49th

Cancer 13th 25th

Chronic lower respiratory disease 21st 47th

Stroke 38th 51st

Unintentional injuries 9th 34th

All causes 31st 45th

*35 counties including Gregg, Smith, Harrison, Rusk, Upshur, Panola, Camp, Cass, Morris, Titus, Wood, Marion and Franklin, 1.5 million inhabitants

Source: UT Health Northeast