#1Pending#2Pending#3Pending#4Pending#5Pending#6DSHS - Roles in Border Public Health TEXAS Health and Human Services Texas Department of State Health Services#7DSHS Border Public Health Coverage DSHS and Local Health Department Coverage 9/10 Public health services provided by Local Health Department (LHD) Public health services provided by DSHS (no county LHD) Non-border county not included in data Counties served by DSHS or LHD 8 32 Texas border counties • 29 have no county local health department, public health services are provided by DSHS • 3 counties have local health departments TEXAS Health and Human Services Texas Department of State Health Services # of counties 10 0 0 3 29 LHD DSHS 11 Created by: DSHS - RLHO, Sept 2021 Data sources: DSHS 7#8Border Public Health Providers Rural and Frontier Counties Public Health Service Providers Frontier Rural Metro County with LHD Non-border county not included in data O County with DSHS office (2) County with FQHC(s) (12) County with DSHS office and FQHC(s) (12) TEXAS Health and Human Services # of Counties Texas Department of State Health Services 62 9/10 DSHS and FQHC Services 0 Both DSHS FQHC None Frontier Metro Non-Metro Note: Variations in hours of service and services provided by DSHS offices and FQHCS was not considered for this analysis. All locations were considered equally. 11 • 4 metro counties • 9 rural counties • 19 frontier counties 12 counties with DSHS office and Federally Qualified Health Center (FQHC) • 12 counties with only FQHC • 2 counties with only DSHS office 6 counties with no public health provider Created by: DSHS RLHO, Sept 2021 Data sources: DSHS 00#9Pending#10U.S.-Mexico Binational Coordination • Origin: In 1991, the 72nd Texas Legislature enacted Health and Safety Code, Section 12.071: ● "The department shall establish and maintain an office in the department to coordinate and promote health and environmental issues between this state and Mexico." Scope: All four U.S. southern border states have border health offices Texas, California, Arizona, and New Mexico 10#11Pending#12Pending#13Binational Health Councils Eight COBINAS currently: ● • ● • • Paso del Norte Binational Health Council (El Paso/Juarez/Las Cruces) Presidio/Ojinaga Binational Health Council Del Rio/Ciudad Acuña Binational Health Council HOPE-K Trinational Health Council (Eagle Pass/Kickapoo Traditional Tribe of Texas/Piedras Negras) Los Dos Laredos Binational Health Council (Laredo/Nuevo Laredo/Nuevo León) • SMAC Binational Health Council (Starr County/Miguel Aleman/Camargo) . • HIDA REY Binational Health Council (Hidalgo County/Reynosa) Brownsville/Matamoros Binational Health Council 13#14Pending#15Binational Infectious Disease Surveillance Program goals: ● ● Improve surveillance for infectious diseases of binational importance Develop strategies to control infectious diseases in the border region Improve binational communication and coordination related to disease case and outbreak notifications, to enhance bilateral infectious disease preparedness and response • Border Epidemiology Surveillance Teams (BEST) contribute to binational information exchange Current projects in Texas (PHR 11, 8, and 9/10): ● ● Integrate binational variables into disease surveillance Conduct surveys at border sites including US-Mexico land ports of entry and border clinics to understand border crossers' mobility patterns, as well as knowledge, attitudes, and practices related to COVID-19 and other diseases 15#16Task Force of Border Public Health Officials Origin: Created by Senate Bill 1680, 85th Legislature, Regular Session, 2017, codified in Health and Safety Code, Chapter 120. • Vision: A Healthy and Equitable Border Community Mission: To identify and raise awareness of health issues impacting border communities and establish policy priorities to enhance border public health, creating a healthy bi-national community. General Duties of the Task Force: The task force shall make recommendations to the [DSHS] commissioner for short-term and long- term border health improvement plans. Work Products: 2018 Report submitted; Updated recommendations for 2020-21 pending final vote 16#17Task Force of Border Public Health Officials - Topics . Primary topics of interest: • Access to preventative and specialized healthcare services • Lack of transit systems and transportation, especially in rural areas • High population of elderly living alone . High population of uninsured or underinsured resident • 2018 Biennial Report Topics Covered: • Border Public Health Infrastructure: · • Establish border-centric multi-disciplinary response teams Environmental Health: Improve process for recruitment and retention of registered sanitarians ⚫ Chronic Diseases: • Establish education-based components for: Child obesity prevention. • Advanced age pulmonary complications Maternal and Child Health: • Improve border surveillance • Extend year-round lab capacity (southmost counties without breaks in mosquito season) Communicable Diseases: • Expand community health worker training curricula . • Establish outreach program for high-risk pregnant mothers Improve knowledge-sharing/training of border health professionals Collaboration with Texas Medical Association and Texas Border Health Caucus 17#18Disease Burden TEXAS Health and Human Services Texas Department of State Health Services#19Disease Burden: Key Points • Border Health Indicators Noticeably Higher Compared to All of Texas:* ● Diabetes prevalence Poor physical health days (14 or more days total) Food insecurity ● Could not see a doctor/healthcare provider due to cost Most common inpatient admissions in Border Counties during 2020: ● Deliveries, sepsis, COVID-19, heart attacks, kidney disease, pneumonia - *Data from Texas Behavioral Risk Factor Surveillance System – annual data derived from telephonic surveys of adult Texans 19#20Chronic Health Conditions 50% 40% 30% Border 4.7% COPD All of Texas 5.1% 6.6% Asthma 7.4% 8.1% Cardiovascular Disease 7.3% 12.0% Prediabetes + 10.3% 18.4% 17.3% 20% 10% 0% Diabetes* Depressive Disorders 12.6% 17.7% 0% 10% 20% 30% 40% 50% + Prevalence estimate for prediabetes is for 2019 * Significant difference between Border and Texas Center for Health Statistics (CHS). Texas Behavioral Risk Factor Surveillance System. Austin, Texas: Texas Department of State Health Services, 2019 & 2020. 20#21Pending#22Health Status Indicators 26.1% 29.8% Border All of Texas 9.3% Poor Health Affected Usual Activities, 14+ days 7.9% 12.7% Physical Health Not Good, 14+ Days* 9.4% 14.0% Mental Health Not Good, 14+ Days 13.2% Health Rated as Fair or Poor* 15.9% 50% 40% 30% 20% 10% 0% * Significant difference between Border and Texas Food Insecurity* 21.0% 0% 10% 20% 30% 40% 50% Center for Health Statistics (CHS). Texas Behavioral Risk Factor Surveillance System. Austin, Texas: Texas Department of State Health Services, 2020. "22#23Pending#24Pending#25Underlying Causes of Death Top 10 Leading Causes of Death Border Counties Texas for 2020^ Cause of Death Total Death Rate Rank Total Death Rate Rank COVID-191 6,765 238.3 1 31,273 105.4 3 Diseases of heart 4,745 167.1 2 49,797 167.8 1 Malignant neoplasms 3,285 115.7 3 41,880 141.1 2 Alzheimer's disease 1,204 42.4 4 11,838 39.9 5 Diabetes mellitus 1,166 41.1 5 7,903 26.6 8 Accidents 870 30.6 6 12,600 42.5 Cerebrovascular diseases 837 29.5 7 11,570 39 6 Chronic liver disease and cirrhosis 673 23.7 8 4,898 16.5 9 Chronic lower respiratory disease 626 22 9 10,338 34.8 Nephritis, nephrotic syndrome and nephrosis 531 18.7 10 10 4,372 14.7 10 1 Count of COVID-19 Related Deaths as determined by visual inspection of Texas death certificates conducted by the Department of State Health Services Laboratory and Infectious Disease Services Division as of September 24, 2021. All other death totals in this report are calculated based on underlying cause ICD-10 codes assigned to the death record by the National Center for Health Statistics. CDR: Crude Death Rate per 100,000 populations. Population projections for 2020 provided by the Texas Demographics Center. ^Death data for 2020 are provisional. Provisional statistics are based on data that has not yet been finalized and may be incomplete and subject to change. 25#26Pending#27Healthcare Providers Population to Provider Ratio Higher Ratios = Higher Unmet Need Number of Persons per Provider 4000 3500 3000 2500 2000 1500 1000 500 0 Direct Patient Care Physicians* Border Primary Care Physicians* Non-Border Registered Nursest Dentists+ All of Texas Data Sources: * Texas Medical Board, 2020 + Texas Board of Nursing, 2019 + Texas State Board of Dental Examiners, 2020 27#28Pending#29Physician Shortages Select a physician specialty All Unmet Physician Demand Select a year 2022 % Unmet Demand 2.4% Select a physician specialty 36.6% All Unmet demand for All Physician FTEs in Texas, 2022 (as unmet demand increases, the color darkens) ©2021 Mapbox OpenStreetMap Panhandle Shortage of 336 FTEs 17.6% Unmet Demand West Texas Shortage of 681 FTEs 22.1% Unmet Demand North Texas Shortage of 1,534 FTEs 7.8% Unmet Demand East Texas Shortage of 1,074 FTES 29.1% Unmet Demand Central Texas Shortage of 192 FTĘS 2.4% Unmet Demand Gulf Coast South TexasShortage of 708 FTES Shortage of 505 FTE9% Unmet Demand 7.5% Unmet Demand Rio Grande Valley Shortage of 1,657 FTES 36.6% Unmet Demand Unmet Physician Demand Select a year 2030 % Unmet Demand 5.0% 39.1% Unmet demand for All Physician FTEs in Texas, 2030 (as unmet demand increases, the color darkens) © 2021 Mapbox OpenStreetMap Source: Workforce Supply & Demand Projections - Physician Supply and Demand Map https://healthdata.dshs.texas.gov/dashboard/healthcare-workforce/workforce-supply-and-demand-projections Panhandle Shortage of 230 FTEs 11 1% Unmet Demand West Texas Shortage of 580 FTEs 16.7% Unmet Demand North Texas Shortage of 3,120 FTES 13.1% Unmet Demand East Texas Shortage of 1,013 FTES 26.4% Unmet Demand Central Texas Shortage of 497 FTES 5l0% Unmet Demand Gulf Coast South Texashortage of 1,222 FTEs Shortage of 745 FT 6% Unmet Demand 9.4% Unmet Demand Rio Grande Valley Shortage of 1,936 FTES 39.1% Unmet Demand 29 29#30CDC Public Health Workforce Grant (PHWG) DSHS and Local Health Department Coverage 9/10 Public health services provided by Local Health Department (LHD) Public health services provided by DSHS (no county LHD) Non-border county not included in data Counties served by DSHS or LHD TEXAS Health and Human Services Texas Department of State Health Services # of counties 10 0 0 3 29 LHD DSHS 8 . Current DSHS Border Public Health Program is 24 FTES • 7 FTEs central office • • 6 FTES PHR 08 • 4 FTES PHR 09/10 • 7 FTES PHR 11 Created by: DSHS - RLHO, Sept 2021 Data sources: DSHS ⚫ PHWG will add 18 new FTEs • • • 6 FTES central office • 2 FTES PHR 08 . 6 FTES PHR 09/10 • 4 FTES PHR 11 PHWG adds $1,118,723 per year personnel investment to the DSHS Border Public Health Program • DSHS PHWG also provides grants to 6 local health entities in the border region, adding 60.5 FTEs • Grant will end in 2023 11 30#31Pending#32Pending#33- Top 10 Principal Diagnoses – Emergency Department Visits Border (Total Visits = 792,486) All of Texas (Total Visits = 9,984,936) Rank Top 10 Discharge Diagnoses (ICD-10 code) for 2020 Percent Count of Total Rank Top 10 Discharge Diagnoses (ICD-10 code) for 2020 Percent Count of Total 1 COVID-19 (U071) 33,693 4.3% 1 COVID-19 (U071) 377,193 3.8% 2 Urinary tract infection, site not specified (N390) 17,283 2.2% 2 Contact with and exposure to other viral communicable diseases (Z20828) 232,163 2.3% 3 Acute upper respiratory infection, unspecified (J069) 16,798 2.1% 3 Other chest pain (R0789) 185,071 1.9% 4 Sepsis, unspecified organism (A419) 14,631 1.8% Contact with and exposure to other viral communicable 4 Acute upper respiratory infection, unspecified (J069) 182,113 1.8% 5 diseases (Z20828) 12,478 1.6% 6 Other chest pain (R0789) 12,010 1.5% 5 Urinary tract infection, site not specified (N390) 172,074 1.7% 7 Viral infection, unspecified (B349) 10,757 1.4% 6 Chest pain, unspecified (R079) 145,566 1.5% Flu due to other identified influenza virus with other 7 Sepsis, unspecified organism (A419) 122,750 1.2% 8 respiratory manifestation (J101) 9,622 1.2% 8 Viral infection, unspecified (B349) 106,580 1.1% 9 Chest pain, unspecified (R079) 8,473 1.1% Encounter for observation for suspected exposure to other biological agents ruled out 9 Acute pharyngitis, unspecified (J029) 93,551 0.9% 10 (Z03818) 7,637 1.0% 10 Cough (R05) 89,615 0.9% Data Source: Inpatient Public Use Data Files and Outpatient Public Use Data Files (First through Fourth Quarters, 2020). Texas Department of State Health Services, Center for Health Statistics, Austin, Texas. September 2021. 33#34Nursing Shortages by Type Registered Nurses Supply and Demand Projection Estimates in 2022 Amarillo Non-Border Shortage of 24,954 FTEs 9.90% Unmet Demand Registered Nurses Supply and Demand Projection Estimates in 2030 Wichita Falls Lubbock Fort Worth Dallas Tyler Abilene El Paso Midland San Angelo Killeen Border Shortage of 6,632 FTEs 27.10% Unmet Demand Waco College Station Austin San Antonio Corpus Christi Laredo Data source: Texas Center for Nursing Workforce Studies. Map source: Center for Health Statistics. Agency Analytics Unit - GIS September 2021 McAllen Brownsville 0 Texarkana Beaumont Houston N 100 Miles 1 200 Amarillo Lubbock Abilene Non-Border Shortage of 43,923 FTEs 14.30% Unmet Demand Wichita Falls Fort Worth Dallas Tyler El Paso Midland Waco San Angelo Killeen College Station Austin Border Shortage of 6,023 FTEs 22.20% Unmet Demand San Antonio Corpus Christi Laredo TEXAS Health and Human Texas Department of State Services Health Services Data source: Texas Center for Nursing Workforce Studies. Map source: Center for Health Statistics. Agency Analytics Unit - GIS September 2021 McAllen Brownsville 0 Texarkana Beaumont Houston N 100 Miles TEXAS Health and Human Services Texas Department of State Health Services 34 200#35Pending#36Pending#37Pending#38Pending#39Physician Shortages Projected Unmet Physician Demand Percent of Demand for Services Not Met by Providers 40% 35% 30% 25% 20% 15% 10% 5% 0% 2023 2024 2025 2026 2027 2028 2029 2030 Calendar Year -Border -All of Texas Data Source: IHS Markit Health Workforce Model 39#40Primary Care Projected Shortages Projected Unmet Primary Care Physician Demand Percent of Demand for Services Not Met by Providers 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 2023 2024 2025 2026 2027 2028 2029 2030 Calendar Year -Border -All of Texas Data Source: IHS Markit Health Workforce Model 40 40#41Psychiatrist Projected Shortages Projected Unmet Psychiatrist Demand Percent of Demand for Services Not Met by Providers 70% 60% 50% 40% 30% 20% 10% 0% 2023 2024 2025 2026 2027 2028 2029 2030 Calendar Year -Border -All of Texas Data Source: IHS Markit Health Workforce Model 41#42Pending#43Thank you Texas Border Health Issues Presentation to the House Committee on Public Health [email protected]