laredo/webb needs assessment project

P r e p a r e d b y J o s e F R e y e s

Healthcare Needs Assessment Secondary Data Collection & Analysis Prepared for: Mid Rio Grande Border Area Health Education Center

Laredo / Webb County 2011

08 Fall

Table of Contents EXECUTIVE SUMMARY ................................................................................................................................. 3

INTRODUCTION ........................................................................................................................................... 4

PROCESS DESCRIPTION ................................................................................................................................ 4 Models Identified .................................................................................................................................................................................................. 5 Exhibit 1. High Level System ................................................................................................................................................................................ 6

Specific Requests ................................................................................................................................................................................................... 6 Web Repository ...................................................................................................................................................................................................... 6 Exhibit 2. Collaboration and Resource Sharing Mechanism .................................................................................................................. 8

SELECTED DATA ........................................................................................................................................... 9 Community Profile ............................................................................................................................................................................................... 9 Exhibit 3. Indicators City of Laredo and Webb County ............................................................................................................................. 9 Exhibit 4. Age Group Distribution .................................................................................................................................................................... 10 Exhibit 5. Percent of Persons Aged 65 Years and Older in Texas Counties. ................................................................................... 10

County Health Rankings ................................................................................................................................................................................. 11 Health Outcomes ...................................................................................................................................................................................................... 11 Exhibit 6. Webb County Health Outcomes ..................................................................................................................................................... 11 Exhibit 7. Diabetes .................................................................................................................................................................................................. 12 Health Factors ........................................................................................................................................................................................................... 12 Exhibit 8. Webb County Health Factors ......................................................................................................................................................... 12 › Health Behaviors ........................................................................................................................................................................................... 13 › Clinical care ..................................................................................................................................................................................................... 13 Exhibit 9: Health Insurance Coverage-‐Webb County (Uninsured) Number of Uninsured Residents .................................. 14 Exhibit 10. Primary Care Admissions by County of Origin 2010. ....................................................................................................... 14 › Social & Economic Factors ........................................................................................................................................................................ 15 Exhibit 11. Higher Education, Fall 2010 Enrollment by Origin .......................................................................................................... 15 › Workforce ........................................................................................................................................................................................................ 16 Exhibit 12. Job Growth by occupations 2008-‐2018 .................................................................................................................................. 16 › Physical environment ................................................................................................................................................................................. 17 Exhibit 13. Webb County -‐ Texas Health Ranking .................................................................................................................................... 18

CONCLUSION ............................................................................................................................................. 19

Laredo/Webb Healthcare Needs Assessment 2011

EXECUTIVE SUMMARY

The following report is the result of an exhaustive curation process and analysis of a wide array of data and information relevant to the Healthcare Needs Assessment lead by the Mid Rio Grande Area Health Education Center for the Laredo / Webb County region.

The curation process consisted in the research and identification of reliable sources of data, the organization of that data and, in some cases, its transformation to formats that will make it useful for a planning and decision making process. The analysis filtered curated data to determine how adequate it was for the purpose of this project. The end result has been stored in a web repository where it can be updated, enhanced and disseminated throughout the community and all healthcare stakeholders. Several healthcare needs assessment models were reviewed for benchmarking purposes and selected sets of data have been incorporated into the report. The County Health Rankings under the auspices of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute were also key components to establishing a secondary data model for this project. The community profile for Webb County shows that it has reached the quarter of a million population mark according to the US Census 2010. A high concentration of population under 19 years bracket suggests a tremendous opportunity but also a significant burden for the educational and the healthcare systems. While mortality levels (length of life) are above the state levels, Webb still trails at the national level. More concerning is the county’s position in terms of health factors that contribute to healthcare instability. Among these factors, it is access to clinical care the one that represents a significant threat due to the following obstacles: • High rate of uninsured population (48%), • Primary care physician shortage (ratio of 1,843 population per 1 physician compared

1,050:1 in Texas and 631:1 in the nation) It is worth noting that while social and economic factors are not affecting as much in the short run relative to the impact caused by access to clinical care, it is evident that current high school graduation levels, percentage of population with a college level education, 35% of children in poverty along with a violent crime rate above the state’s average are factors that need adequate planning and effective implementation of programs that can deter their risk.


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INTRODUCTION This document constitutes the final report for the work commissioned by the Mid Rio Grande Area Health Education Center (AHEC) for the collection, organization and analysis of secondary data as part of the Laredo/Webb County Healthcare and Community Needs Assessment 2010-‐2011. The goal of this report is to document the work performed and elaborate on the different sources of data that were explored, the process and rationale under which information was captured and curated. In addition, it is the intent of the consultant to outline the current state of affairs and establish a baseline through selected metrics/indicators that can assist the research team to put the results of the primary research conducted into context. Considering how universal healthcare is for the well-‐being of a community, the enormous amount of data and its various uses, a web repository where all data could be kept, organized, shared and updated was created and its utilization can become an asset for the community beyond the report itself. Recommendations are also provided in an effort to enhance the visibility of health related information in the Laredo-‐Webb region and thus the improvement/development of healthcare policies and programs. For the purposes of this work, secondary data is defined as data previously collected or general information already available to the public at large.

PROCESS DESCRIPTION The curation process (collection and organization) and the analysis of secondary data was approached in accordance to the following tasks: 1. Identification of stakeholders and potential sources of data at the local, state and federal

level. 2. Research and review of previous studies and assessments that could serve as a models.

Analyze structure and scope. 3. Establishment of a baseline and determination of a set of key indicators that directly and

indirectly affect community healthcare and which can be subject to improvement. 4. Request of all available data and operational information that could assist in the

development of a community profiles. 5. Assess reliability and relevance. 6. Modification, enhancement and compilation.

In addition, the process required active participation and involvement in initial meetings with stakeholders and periodical meetings with the project core group and principal investigators.


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Models Identified Several community-‐based assessment programs were reviewed in search for components in their design that could assist in the assembly of the secondary data required in this Healthcare Needs Assessment. Despite the fact that each of the models was tailored to very specific objectives such as Title V 5-‐year Needs Assessment, Regional Primary Care Needs Assessment, etc., they all shared similar concepts and principles. Based on that review, the County Health Rankings model, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute was partially used in order to establish the baseline and current state of affairs of the Laredo / Webb County healthcare. The County Health Rankings model is described by its creators, as a ranking mechanism that measures two types of health outcomes to represent how healthy each county is: how long people live (mortality) and how healthy people feel (morbidity). These outcomes are the result of a collection of health factors classified in health behaviors, clinical care, social and economic, and the physical environment. These factors can be influenced by programs and policies at the local, state, and federal levels. (Exhibit 1) Some of the considerations to rely on the County Health Rankings model for the purpose of this report are: Holistic Approach/Comprehensive. Allows us to conceive and understand healthcare as a whole system through the indexing of different variables and metrics. Tested model. University of Wisconsin Population Health Institute has been using the ranking model since 2003. Availability. 223 Counties in Texas have already been ranked, including Webb. Benchmarking. It provides the means to establish comparisons and/with other counties/communities. Some of the models mentioned can be found in the Web Repository (www.symbaloo.com/mix/needs)


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Exhibit 1. High Level System

COUNTY HEALTH RANKINGS Health Outcomes Mortality Morbidity

Health Factors Health Behaviors Clinical Care Social & Economic Factors Physical Environment

Specific Requests Other tasks performed during the project aside from the secondary data analysis included the exploration, coordination and facilitation of exchanges between the UT School of Public Health and both Webb Appraisal District and City of Laredo Building Department GIS division in order to obtain critical geospatial data and local maps that could be used in the development of GIS mapping for the project. Tax rolls for 2011 were picked up from the Webb Appraisal District and delivered to Dr. John Kilburn on June 03, 2011.

Web Repository While conducting the work to compile all data selected it became apparent that the uses of the data varies significantly and that its availability across stakeholders provides an added incentive for collaboration and joint coordination of efforts. Based on that premise, a web bookmarking service (www.symbaloo.com) was selected and configured to serve as the single cloud-‐based

TASKS 1 2 3 4 5 6 7

Healthcare

Business

Local Government

State Government

Federal Government

Education

Non GovernmentOrganization

(NGO)


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repository of electronic data that is either available online or stakeholder (refer to Figure 1) or that can be uploaded as a single document. By using Symbaloo, one is able to create collections (webmixes) of website addresses that are embedded into a tile. Tiles can use of different colors and positioned within a matrix in the webmix. Thus, color and position become alternatives for data organization. (See screenshots below) Some of the advantages of using such a service are: • Dynamic source of compiled data (data available 24/7, 365) • Location of the data and accessibility (one web address) • Easy to use (visual and intuitive) • Share enabled (ability to share and disseminate) • Limitless possibilities to crowdsource (ability to empower stakeholders and staff members

to contribute and build a much more diverse and topic robust database) • Customizable & target oriented (ex. Veterans, minorities, women, domestic violence, etc.) In the case of this project, colors have been adopted to classify federal, state, local and non-‐government organizations in green, blue, orange and brown respectively. Red and white have not been fully adopted as of yet, but can be used for think-‐thanks and regional consortiums. For more specific Symbaloo features and usage instructions please review the following links from their developers: Video tutorials: http://www.youtube.com/user/SymbalooTutorials Blog: www.blog.symbaloo.com


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As noted, earlier in this report, the Web repository tool can become a catalyst for crowdsourcing. This concept can be translated into the act of an organization taking a function once performed by staff members and outsourcing it to an undefined (and generally large) network of people in the form of an open call. This can take the form of peer-‐production (when the job is performed collaboratively), but is also often undertaken by sole individuals. The crucial prerequisite is the use of the open call format and the large network of potential volunteers, in this case, community stakeholders. Each one with their own self interest. In exchange for belonging to the network they receive added value for sharing data that is open public records or refer valuable data that otherwise members of the network were not aware of. See Exhibit 2 for a visual diagram of the process recommended.

Exhibit 2. Collaboration and Resource Sharing Mechanism

WEB REPOSITORY


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SELECTED DATA

The data selected and presented herein was compiled based upon the requests of the principal investigators during the various meetings attended and the relevance it could bring to understand the linkages to an overall improvement of the quality of life and community healthcare. The selected indicators from the secondary data are presented in the following categories:

• Community Profile • County Health Rankings

› Health Outcomes › Health Factors

Additional data and information gathered can be consulted at all time in the Web Repository (Symbaloo.com/mix/needs)

Community Profile The community profile consists of demographic data collected through the U.S. Census Bureau, its recently released Census 2010, the American Fact Finder, the Small Area Income and Poverty Survey search tools. Other important sources are the City of Laredo’s Comprehensive Annual Financial Report (CAFR) 2010, the US Department of Agriculture, Economic and Research Service.

Exhibit 3. Indicators City of Laredo and Webb County

City of Laredo Webb County

1980 1990 2000 2010 2010 Total Population 91,444 129,273 176,576 236,091 250,304 Median Age 23.6 24.7 26.9 26.5 27.8 Age Group:

Youth (under 18) 36,080 47,490 53,190 82,723 88,158 Adults (18-64) 47,480 71,560 109,604 134,764 142,639 Seniors (65 +) 7,884 10,223 13,782 18,604 19,507

Percent Hispanic or Latino 93.03% 93.86% 94.10% 95.62% 95.74%

Poverty Level (%)*

Entire population 30.9%

Under 18 38.2% Source: City of Laredo 2010 CAFR (http://www.txcip.org/tac/census/profile.php?FIPS=48479) *Source: US Dept of Agriculture, Economic Research Service


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The median age in Webb County (27.8 years) is considerably lower than that in Texas (33.6) and the US (37.2) the high concentration of younger population is clearly visualized through a pyramid shaped age distribution by gender chart (see Exhibit 4). For planning purposes, this large number of young population presents itself with definite opportunities as well as substantial challenges for the region.

Exhibit 4. Age Group Distribution

Source: U.S. Census, 2010 Furthermore, this is also substantiated in Exhibit 5. As former US Census Administrator and University of Rice Professor Dr. Steven Murdock has pointed out in numerous forums, Texas current demographic dynamics suggest that by 2040 only two counties in the entire State will have a percentage below 12% in the 65+ age bracket. One of them being Webb County.

Exhibit 5. Percent of Persons Aged 65 Years and Older in Texas Counties.

Source: Texas State Data Center,

-15,000 -10,000 -5,000 0 5,000 10,000 15,000

Under 5 years 5 to 9 years

10 to 14 years 15 to 19 years 20 to 24 years 25 to 29 years 30 to 34 years 35 to 39 years 40 to 44 years 45 to 49 years 50 to 54 years 55 to 59 years 60 to 64 years 65 to 69 years 70 to 74 years 75 to 79 years 80 to 84 years

85 years and over

12,307 13,060

12,255 11,887

9,079 8,584 8,506 8,583

7,706 6,836

6,059 4,678

3,918 2,777

2,009 1,441

1,032 771

-12117.00 -12184.00

-11774.00 -11499.00

-9271.00 -9053.00 -9013.00

-9480.00 -8563.00

-7580.00 -6760.00

-5480.00 -4565.00

-3474.00 -2709.00

-2044.00 -1725.00 -1525.00

Age Pyramid Webb County

Female population Male population

2000 2040


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County Health Rankings Based on the county health rankings model, Webb County is ranked 30 among 223 counties in Texas that are part of the study. See Exhibit 13 for the full ranking details. By breaking down the rankings, these are some of the details that stand out:

Health Outcomes While Webb ranks 21 in terms of mortality, considering premature deaths (under 75 years), it is number 93 in morbidity, an indicator that measures how healthy people are while alive (Refer to Exhibit 6). The latter is primarily a result a 28% of adults reporting fair or poor health in comparison to a 19% and 10% in Texas and the US respectively. The Texas State Data Center has released projections for diabetes incidence and Webb County is expected to experience a 243% increase over the 2000-‐2040 period creating a greater demand for care services and potentially increasing both morbidity and mortality levels. (See Exhibit 7)

Exhibit 6. Webb County Health Outcomes

Webb

County Error

Margin National

Benchmark* Texas

Rank (of 223)

Health Outcomes 30 Mortality 21

Premature death 6,468 6,105-6,831 5,564 7,289 Morbidity 93

Poor or fair health 28% 22-34% 10% 19% Poor physical health days 3.7 2.5-4.8 2.6 3.6 Poor mental health days 2.9 2.0-3.7 2.3 3.3 Low birthweight 7.3% 7.0-7.5% 6.0% 8.1%


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Exhibit 7. Diabetes

http://txsdc.utsa.edu/download/pdf/diabetes/Summary_Report_Diabetes.pdf

Health Factors Health factors are made out of those variables that impact the health of a county (Exhibit 8). In this case, Webb County ranks 217of 223 counties, well below its ranking (21st place) in health outcomes. As we look in depth, the poor ranking is resulting from the following individual rankings: › Health Behaviors 189; › Clinical Care 216; › Social & Economic factors 200; and › Physical Environment 59.

Exhibit 8. Webb County Health Factors

Webb County Error Margin National

Benchmark* Texas RANK(of 223)

Health Factors 217 Health Behaviors 189

Adult smoking 21% 15-29% 15% 19% Adult obesity 28% 23-35% 25% 27% Excessive drinking 24% 17-33% 8% 16% Motor vehicle crash death rate 11 9-13 12 17 Sexually transmitted infections 383 83 422 Teen birth rate 107 104-110 22 64

Clinical Care 216 Uninsured adults 48% 44-53% 13% 30% Primary care physicians 1,843:1 631:1 1,050:1 Preventable hospital stays 98 95-102 52 80

0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000

Diabetes 2010

Diabetes 2020

Diabetes 2030

Diabetes 2040

Diabetes Incidence Projections

Webb County


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Diabetic screening 79% 74-85% 89% 80% Mammography screening 48% 42-54% 74% 59%

Social & Economic Factors 200 High school graduation 70% 92% 72% Some college 47% 68% 55% Unemployment 8.7% 8.5-8.8% 5.3% 7.6% Children in poverty 35% 31-40% 11% 23% Inadequate social support 22% 16-30% 14% 23% Children in single-parent households

36% 20% 32%

Violent crime rate 580 100 512 Physical Environment 59

Air pollution-particulate matter days 0 0 1 Air pollution-ozone days 0 0 18 Access to healthy foods 71% 92% 62% Access to recreational facilities 4 17 7

Source: The County Health Rankings, http://www.countyhealthrankings.org/texas/webb *90th percentile, i.e., only 10% are better Note: Blank values reflect unreliable or missing data

› Health Behaviors Factors such as smoking and obesity are marginally above state levels, however, drinking is significantly higher with a 24% in comparison with a 16% statewide and 8 % nationwide. Both sexually transmitted infections and motor crash deaths rate are inferior to that of the state.

› Clinical care Alarmingly, clinical care is below the 5th percentile, thus affecting Webb’s overall ranking. Reviewing the components that make up this item, the study shows that uninsured adults —represented by the percent of population under age 65 without health insurance reaches 48% (not including underinsured) compared to 30% statewide and 16.7%1 nationwide. Exhibit 9 shows the percentage of uninsured population is distributed across age groups. This is corroborated by the Texas Comptroller’s In Focus report: South Texas back in 2008, “…limited access to health care facilities and providers, high rates of the uninsured and a higher-‐than-‐average prevalence of chronic diseases such as diabetes pose difficult and expensive challenges for South Texas businesses, their employees and state and local governments…”

1 http://www.usatoday.com/news/nation/2010-‐09-‐17-‐uninsured17_ST_N.htm


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Exhibit 9: Health Insurance Coverage-‐Webb County (Uninsured) Number of Uninsured Residents

Source: SAHIE//State and County by Demographic and Income Characteristics/2007 Another vital statistic that cripples clinical care is the ratio of population to primary care physicians (PCPs), data shows a ratio of 1,843:1 when the State of Texas ratio is 1,050:1 and the national benchmark is 631:1. Added to the scarcity of PCPs, the ratio of mental health providers is at 12,418:1 versus 3,609:1 in the State. Primary care was also approached from a different angle. In response to the request of the principal investigators, the three major hospitals and clinics were asked to provide with data to assess the volume of patients that were served in 2010 from surrounding counties in addition to Webb county population. The numbers in each case do not represent a significant proportion to the total number of patients served. Refer to Exhibit 10.

Exhibit 10. Primary Care Admissions by County of Origin 2010. COUNTY

Laredo Medical Center

COUNTY

Doctor's Hospital COUNTY

Gateway Community Health Center*

WEBB 89.86% WEBB 95.00% WEBB 89.78% ZAPATA 5.84% ZAPATA 2.00% ZAPATA 5.70% JIM HOGG 1.24% JIM HOGG 1.00% JIM HOGG 4.52% OTHER 3.06% LA SALLE 2.00% Total 100.00% 100.00% 100.00% Source: Laredo Medical Center, Doctor’s Hospital, Gateway Community Health Center. *Includes patients from its four sites, therefore it is not representative of patients receiving services in Webb County alone.

25.41%

27.34% 44.62%

38.73%

0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000

under 19 years 18-64 years 40-64 years under 65 years

% Uninsured by Age Group Webb County 2007


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› Social & Economic Factors Even though current high school graduation levels and percentage of population with a college level education are only slightly below state average. Webb, as well as, its border peers is also challenged with a 49% of its population that is not proficient in English, thus adding another barrier to increase education levels. The urgency to turn education into a catalyst that improves quality of life and the community healthcare has never been more present. With 35.20% of the county’s population under 19 years and 35% of children living under poverty conditions plus violent crime rate that is 13.28% above state average and 5.8 times the national average, the converge of these factors provide enough evidence to suggest the need for action. Focusing exclusively in higher education, the 2-‐year and 4-‐year college and university were approached in order to determine the amount of students that were served from surrounding counties. The data received from the institutions also confirmed that while both the Laredo Community College and Texas A&M International University are magnets to residents from surrounding counties, the number of students is negligible relative to the total number of students enrolled. See Exhibit 11.

Exhibit 11. Higher Education, Fall 2010 Enrollment by Origin

• Source: Laredo Community College, Institutional Effectiveness Division; Texas A&M Int’l, Office of the Registrar’s.

96%

3% 1%

Laredo Community College!WEBB ZAPATA OTHER

89%

2% 2% 2% 1% 4%

Texas A&M International!

WEBB ZAPATA MAVERICK

STARR HIDALGO OTHER


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› Workforce

In reviewing the projections from South Texas Workforce Solutions (Exhibit 12), the designated workforce development board that covers Webb and surrounding Zapata and Jim Hogg counties, out of the 25 occupations with greater prospects to add more jobs into the workforce, we identify 4 occupations in the healthcare sector. These occupations stand out from others in the list given the fact that they require post-‐secondary education and thus, are more likely to offer better wage conditions and a greater chance of career advancement.

Exhibit 12. Job Growth by occupations 2008-‐2018

SOUTH TEXAS WORKFORCE DEVELOPMENT AREA

Occupations Adding the Most Jobs

Annual Average

Annual Average

SOC Occupation Employment

Number

Growth Job Openings

Code Title 2008 2018 Change Rate Growt

h Replacem

ent Total

Total, All Occupations 104,200 126,140 21,940 21.1% 2,230 2,385 4,615

39-9021 Personal & Home Care Aides 2,430 3,630 1,200 49.4% 120 30 150 31-1011 Home Health Aides 2,010 3,180 1,170 58.2% 115 20 135

35-3021 Combined Food Preparation & Serving Wkrs, Inc. Fast Food 2,580 3,590 1,010 39.1% 100 55 155

25-2021 Elementary School Teachers, Ex. Special Education 2,480 3,350 870 35.1% 85 55 140 53-3032 Truck Drivers, Heavy & Tractor-Trailer 3,740 4,480 740 19.8% 75 65 140 41-2031 Retail Salespersons 4,240 4,900 660 15.6% 65 120 185 33-3021 Detectives & Criminal Investigators 1,430 1,990 560 39.2% 55 30 85 41-2011 Cashiers 3,260 3,790 530 16.3% 55 145 200 43-5011 Cargo & Freight Agents 1,060 1,580 520 49.1% 50 25 75 29-1111 Registered Nurses 1,380 1,860 480 34.8% 50 25 75 43-4051 Customer Service Representatives 1,770 2,220 450 25.4% 45 55 100

25-2031 Secondary School Teachers, Ex. Special & Vocational Education 1,610 2,040 430 26.7% 45 45 90

25-2022 Middle School Teachers, Ex. Special & Vocational Education 1,240 1,660 420 33.9% 45 30 75

35-3031 Waiters & Waitresses 1,640 2,050 410 25.0% 40 90 130

13-1041 Compliance Officers, Ex. Agriculture, Construction, Health & Safety, & Transportation 1,010 1,420 410 40.6% 40 10 50

43-9061 Office Clerks, Genera l 2,000 2,360 360 18.0% 35 25 60 25-9041 Teacher Assistants 1,310 1,650 340 26.0% 35 30 65 31-1012 Nursing Aides, Orderlies, & Attendants 910 1,240 330 36.3% 30 10 40 39-9011 Child Care Wkrs 1,150 1,420 270 23.5% 25 35 60 43-5081 Stock Clerks & Order Fillers 1,400 1,650 250 17.9% 25 30 55

43-1011 First-Line Supervisors/Managers of Office & Administrative Support Wkrs 1,320 1,560 240 18.2% 25 30 55

41-1011 First-Line Supervisors/Managers of Retail Sales Wkrs 1,620 1,840 220 13.6% 25 35 60 29-2061 Licensed Practical & Licensed Vocational Nurses 680 890 210 30.9% 20 20 40 43-3031 Bookkeeping, Accounting, & Auditing Clerks 1,220 1,420 200 16.4% 20 15 35

35-1012 First-Line Supervisors/Managers of Food Preparation & Serving Wkrs 710 910 200 28.2% 20 5 25

Source: South Texas Workforce Solutions. Labor Market Information. http://www.tracer2.com/?PAGEID=94&SUBID=114


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› Physical environment Webb ranks 59 in this category where air pollution is an indicator but does not constitute a major factor. This can be attributable to a local economy that is concentrated in agricultural, mining and service sectors. Another factor is access to healthy foods where Webb stands above the State (62%) with a 71% of its zip codes with a healthy food outlet (i.e. grocery store or produce stands/farmers’ market). One final factor in this category is access to recreational facilities. While the State of Texas has 7 facilities per 100,000-‐population Webb County has only 4 facilities. This is definitely the weakest factor in the category.


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Exhibit 13. Webb County -‐ Texas Health Ranking

Webb

County Error

Margin National

Benchmark* Texas

Rank (of 223)

Health Outcomes 30 Mortality 21

Premature death 6,468 6,105-6,831 5,564 7,289 Morbidity 93

Poor or fair health 28% 22-34% 10% 19% Poor physical health days 3.7 2.5-4.8 2.6 3.6 Poor mental health days 2.9 2.0-3.7 2.3 3.3 Low birthweight 7.3% 7.0-7.5% 6.0% 8.1%

Health Factors 217 Health Behaviors 189

Adult smoking 21% 15-29% 15% 19% Adult obesity 28% 23-35% 25% 27% Excessive drinking 24% 17-33% 8% 16% Motor vehicle crash death rate 11 9-13 12 17 Sexually transmitted infections 383 83 422 Teen birth rate 107 104-110 22 64

Clinical Care 216 Uninsured adults 48% 44-53% 13% 30% Primary care physicians 1,843:1 631:1 1,050:1 Preventable hospital stays 98 95-102 52 80 Diabetic screening 79% 74-85% 89% 80% Mammography screening 48% 42-54% 74% 59%

Social & Economic Factors 200 High school graduation 70% 92% 72% Some college 47% 68% 55% Unemployment 8.7% 8.5-8.8% 5.3% 7.6% Children in poverty 35% 31-40% 11% 23% Inadequate social support 22% 16-30% 14% 23% Children in single-parent households

36% 20% 32%

Violent crime rate 580 100 512 Physical Environment 59

Air pollution-particulate matter days 0 0 1 Air pollution-ozone days 0 0 18 Access to healthy foods 71% 92% 62% Access to recreational facilities 4 17 7

Source: The County Health Rankings, http://www.countyhealthrankings.org/texas/webb *90th percentile, i.e., only 10% are better Note: Blank values reflect unreliable or missing data


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CONCLUSION The data gathering efforts and involvement in the various stakeholder meetings revealed that: • The network of NGOs (i.e. non-‐governmental organizations, non profits, stakeholders) has

good collaborative rapport. It also surfaced that such rapport could be translated into good practices such as quantitative documentation of each member’s contributions to the community as well as the creation of formats to aggregate such information and make it more reliable and meaningful.

• Out 29 organizations that were approached with requests for information only 7 responded. From those, 2 lacked any statistical and operational information while the remaining 5 partially provided it.

• While organizations compete for the same sources of funding, it is the search for new ones and those requiring partnerships where the network can result in win-‐win situations.

Data analyzed revealed the following conditions: • The Laredo / Webb County faces unique opportunities and challenges given its demographic

composition and growth. • It has grown at a faster pace than its infrastructure. Population exceeds the available supply

of primary care services. • Uninsured population under 65 years at almost 50% limits the ability for the healthcare

system to be more efficient. • Socio-‐economic factors such as education and jobs are particularly dormant and are limiting

the chances for growth and development, allowing for high percentage in both factors, children in poverty and violent crime rate.

The consultant recommends that: • Given the level of collaboration and participation from NGOs as well as the leadership of

AHEC/UTHSC and the expertise from the City of Laredo Health Department plus a very responsive and engaged University (TAMIU), there are grounds to strengthen synergies and nurture better data systems that can track and assist healthcare initiatives and programs across the region.

• AHEC, as the node of the healthcare network, maintains and improves the web repository as

a single go-‐to mechanism to keep all stakeholders abreast of new and updated data that is generated externally (secondary) as well as any information, which could be shared among the community.


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• Migration and cross-‐border healthcare be considered a potential topics for future research

or study.

laredo/webb needs assessment project

Documents

webb county health outcomes

p r e p

county health rankings

selected data

indicators city of laredo

resource sharing mechanism

texas counties

percent of persons