Healthcare in Texas

Last updated

This article summarizes healthcare in Texas . In 2022, the United Healthcare Foundation ranked Texas as the 38th healthiest state in the United States. [1] Obesity, excessive drinking, maternal mortality, infant mortality, vaccinations, mental health, and limited access to healthcare are among the major public health issues facing Texas. [1]

Contents

Issues

Obesity

Obesity has quickly become a major health issue in Texas. [2] In 2017, 33.6% of Texas adults were obese as compared to 29.9% of U.S. adults. [3] [4] In 2000 21.7% of adults were obese and in 1990 only 10.7% of adults were obese. [5] In 2016, 33% of 10-17 year olds in Texas were obese. [5] When separated out by gender, 34.6% of Texas females and 32.8% of Texas males were obese. [4] When separated out by race, 31% of White adults, 41.7% of Black adults, and 37.8% of Hispanic adults were obese in Texas in 2016. [3] Research shows that an increase in household income is correlated with a decrease in obesity rates. [4] In 2014, Comptroller Susan Combs found that there are educational achievement patterns as well - 39% of the Texas population with less than a high school education was obese while only 23% of college graduates were obese. [6] Living in a rural area in Texas is also correlated with higher obesity rates. [4]

Consequences of obesity

Obesity causes several chronic diseases including heart disease and diabetes. [2] The three leading causes of death in Texas - heart disease, stroke, and cancer - are all linked to obesity. [2] Additionally, obesity can cause type 2 diabetes, arteriosclerosis, and hypertension. [2] In 2010, Texas saw 1,261,654 cases of heart disease and is predicted to see 5,688,482 cases in 2030. [5] In 2010, Texas saw 1,962,059 cases of diabetes and is predicted to see 2,851,697 cases in 2030. [5] In 2010, Texas saw 4,300,252 cases of hypertension and is predicted to see 5,689,509 cases in 2030. [5] In 2010, Texas saw 328,379 cases of obesity-related cancer and is predicted to see 810,806 cases in 2030.

Obesity also has substantial impacts on the economy in Texas. Obesity costs Texas businesses $9.5 billion annually. [6] 41% of this is due to obesity-related healthcare costs, 17% is due to absenteeism, and 37% is due to presenteeism. [6]

Obesity treatment

Effective treatment for obesity is known to be expensive and difficult. For childhood obesity, programs tend to focus on creating lifestyle changes including a healthier diet and more exercise. [2] Studies show that obesity treatment for children should aim more at changing the behavior of the family as a whole, especially the parents. [7] Comprehensive weight loss programs for children in Texas have had limited success in reducing weight. For example, only 20% of children finish the Weigh of Life Program and many of them are likely to gain the weight back later on. [2] For adults, surgery is an effective long-term treatment but it comes with several risks and complications. [8]

Obesity prevention

Environmental factors play a large role in obesity rates. [9] Studies have shown that people who live in the same socioeconomic contexts in Texas, regardless of race, tend to have similar rates of obesity. [10] Generally speaking, encouraging healthy habits, raising awareness, and educating people about portion sizes and nutritious requirements can help prevent obesity. [2] Childhood prevention is key - a child who was overweight at 12 years of age has a 75% chance of being overweight as an adult. [2]

Obesity policy

Public School Lunch School Lunch.jpg
Public School Lunch

In 2003, the Texas School Nutrition Policy Launch set nutrition standards with the intentions of discouraging obesity. [5] This policy lowered the availability of foods of minimal nutritional value in schools, limited portion sizes, limited trans fats, and limited fried foods. [5] Texas has also required early childhood education programs to encourage breastfeeding, provide drinking water access, and provide daily physical activity. [5] The state also has a fund specifically for financing healthy food. [5] In 2013, the Obesity Prevention Program was created after merging the Nutrition, Physical Activity, and Obesity Prevention (NPAOP) and Worksite Wellness Programs. [11] This program supports healthy eating, physical activity, and policies that promote healthier lifestyles. In 2021, during the 87th Texas Legislative Session, four House bills and two Senate bills were created in an attempt to improve obesity treatment, prevention, or both. [12] None of these bills were passed during the 87th Texas Legislative Session leaving obesity policy and healthcare in Texas relatively unchanged from the previous session. [13]

Alcohol use

The most commonly abused substance in Texas is alcohol. [14] The rate of binge drinking in males in Texas is comparable to that of males in the United States. In 2017, 22.4% of adult males in Texas reported binge drinking, as compared to 22.1% of males in the United States. [15] Less than 12% of females adults in Texas reported binge drinking. [15] Alcohol abuse and alcoholism can lead to a variety of health issues including liver damage, heart problems, cancer, and depression. [16] Further, 61% of high school students in Texas have tried alcohol and 17% of Texas high school students had their first drink before the age of 13. [17] Based on 2016-2017 surveys, it was estimated that in Texas on average each year over a million individuals 12 years old or older had an alcohol use disorder in the last year.

Alcohol policy

The Texas Ignition Interlock Law went into effect during September 2015. This law requires judges to order ignition interlocks for all drunk-drivers with a Blood Alcohol Level of 0.15% or greater. [18] Since the passing of this law, the drunk driving related death rate in Texas has decreased by 8.5%. [18]

Maternal health

Texas has the highest maternal mortality rate in the developed world, and the rate by which Texas women died from pregnancy related complications doubled from 2010 to 2014, to 23.8 per 100,000. A rate unmatched in any other U.S. state or economically developed country. [19]

Infant health

Texas has the seventh highest birth rate in the United States, with nearly 400,000 babies born each year. [20] [21] Over half of all Texas births are paid by Medicaid, totaling over $2.2 billion per year in birth and delivery-related services for mothers and infants. [22] Studies have found that infant mortality is usually caused by birth defects, pre-term birth, low birth weight, Sudden Infant Death Syndrome, and pregnancy complications. [23] The average amount spent in the first year of life for a preterm birth with major complications (excluding extreme prematurity) is $19,059, and $4,019 for a preterm birth without major complications compared to $410 for an uncomplicated, term birth. [22]

Rates of infant mortality

For decades the infant mortality rate in Texas was higher than the nationwide rate but that gap has slowly closed. In 2017, the infant mortality rate in Texas was identical to the nationwide rate: 5.9 deaths per 1,000 live births. [24] This rate is not identical across the state of Texas and studies have found significant disparities between zip codes. [25] For example, the 76164 zip code has an infant mortality rate of 12.3 deaths per 1,000 live births while the neighboring 76107 zip code has a rate of 1.8 deaths per 1,000 live births. [25] Additionally, Black families in Texas are disproportionately burdened by these rates. In 2015, the infant mortality rate for Black babies in Texas was 10.9 deaths per 1,000 births. [26] These disparities can be explained by factors such as socioeconomic status, air pollution, and access to health care. [25]

Preterm birth

A birth is considered preterm when it takes place more than 3 weeks before the estimated due date. [27] Preterm birth rates in Texas are consistently higher than the nationwide rate. In 2016, 10.4% of live births in Texas were preterm. [28] The rate for Black mothers specifically was elevated - 13.6%. [29] Numerous factors have been associated with premature birth, including lack of prenatal care,  race, obesity, smoking, and even air pollution. [30]

Low birth weight
Preterm Baby in Incubator Incubator-tahrir.jpg
Preterm Baby in Incubator

A low birth weight is less than 2500 grams. [31] The rate of low birth weight in Texas has always been higher than the nationwide rate. In 2016, 8.4% of live births in Texas had a low birth weight. [31] The rate for Black mothers specifically was 13.5%. [31] Babies of mothers who do not get prenatal care are 3 times more likely to have a low birth weight and 5 times more likely to die than those born to mothers who do get care. [32] As for long-term complications, low birth weight babies are at a higher risk for cerebral palsy, blindness, deafness, and developmental delay. [33]

Prenatal care

Prenatal care is the best way to prevent preterm births and low birth weight babies. [34]   Unfortunately, in 2016 only 65% of pregnant women in Texas had access to prenatal care in their first trimester. [35] Women being unaware of their pregnancies, economic hardship due to inability to work during pregnancy, lack of knowledge or access to health services, and difficulty finding transportation are contributing factors to this alarmingly low rate. [36] Texas has also seen significant disparities in who receives prenatal care - 75% of White women and only 55% of Black women received prenatal care during their first trimester. [35] Although women covered by Medicaid are supposed to automatically transition into the Healthy Texas Women program for postpartum coverage, this transition does not always take place. [37]

Abortion services

In 2017 the Guttmacher Institute reported that 96% of Texas counties had no clinics that provided abortions. Private insurance policies and the Affordable Care Act only cover abortion in cases of life endangerment or severely compromised physical health. Most women must receive counseling including information that is designed to discourage them from having an abortion, they must then wait 24 hours meaning they must make two trips to the facility which may entail missing two days of work, paying for the trip to the facility and the cost of an over night stay at the site of the abortion clinic. The working poor may not be able to cover the costs of abortion; the Guttmacher Institute called these requirements "unnecessary and burdensome." [38] In May 2021, Texas passed an abortion bill that will ban abortion from as early as six weeks, before many women realize that they are pregnant. The ban includes women or girls who become pregnant by incest or rape. The bill came into effect in September 2021. [39] On August 25, 2022, a full ban on abortion without exception for rape or incest went into effect in Texas. [40] Healthcare providers who violate the law face life in prison and a $100,000 fine. [41] This ban was an attack on abortion healthcare and made it impossible to receive an abortion in Texas unless it is to save the pregnant person's life or to prevent serious risk to the pregnant person's physical health. [42] This ban has resulted in new socioeconomic barriers to healthcare for pregnant people seeking an abortion in Texas as not all pregnant people can afford to travel out of state for this vital healthcare. [43] This further exacerbates the socioeconomic disparities already present in healthcare in Texas.

Vaccinations

In 2017, 67.8% of children aged 35 months in Texas completed the recommended vaccination schedule. [44] The highest individual vaccine rate was for the polio virus: 93.1% of children age 35 months in Texas received this vaccine. [44] The lowest individual vaccine rate was for hepatitis A: 62.6% of children age 35 months in Texas received this vaccine. [44] Some children are under-vaccinated due to issues with accessing preventative care, vaccine delivery, or parental choice. [45] The state has started to implement ImmTrac, a free vaccination record system. [46] As of early 2023 vaccination rates are as follows: 77% of Texans have received one dose of the vaccine making them partially vaccinated, 64% of Texans have received two doses making them fully vaccinated, and roughly 24 have received three or more doses making them fully vaccinated and boosted. [47]

Vaccination policy

In 2013, Texas passed legislation that requires employees of child-care facilities to have certain vaccinations, unless the employee objects for reasons of conscience. [48] Texas has allowed for parents to exempt their children from vaccines by citing medical reasons since 1972. Further, Texas has allowed for parents to exempt their children from vaccines on the basis of religious belief since 2003. [49] In October 2021 Governor Greg Abbott issued Executive Order GA-40 banning any entity in Texas from requiring a covid-19 vaccine or compelling the receipt of a covid-19 vaccine. [50] The Governor dealt a heavy blow to healthcare in Texas with this mandate. The maximum fine for violating this executive order is $1,000 with no jail time. [51]

Mental Health

Texas ranks 4th lowest in mental health issue prevalence and 51st in access to healthcare. [52] Texas spends $40.65 per capita on mental health placing it 48th in the U.S. and far from the top spot which belongs to Maine at $345.36. [53]

Mental Health Policy

In 2016 the Select Committee on Mental Health during the 85th Texas Legislature identified problems with, “Access to services, early intervention, assessment and treatment for both children and adults, adequate bed capacity,... and workforce challenges”. [54] Since 2016 little has been done to significantly improve these challenges, however, a recommendation made by the committee in 2016 was enacted into law in 2021 requiring a Mental health crisis hotline phone number be printed on the back of every student id issued by a public school, grades seven through college. [55] This was a minor step forward to address mental health concerns in Texas, that endures, despite multiple setbacks to mental health policy in Texas. This can be seen In June 2021 when Senate Bill 1109 was vetoed by Texas Governor Greg Abbott. [56] This bill would have required middle and high school students to receive instruction regarding the prevention of child abuse, family violence, and dating violence all of which contribute to poor mental health for their victims. [56]

Limited Access to Healthcare

Texas ranks 49th in mental health providers per 100,000 citizens and 47th in primary care providers per 100,000 citizens. [1] Texas also has the highest percentage of uninsured population coming in last place. [1] There are negative effects and increased risk when uninsured and uninsured adults are less likely to receive preventive services for chronic conditions such as diabetes, cancer, and cardiovascular disease. [57] Similarly, children without health insurance who lack access to healthcare are less likely to receive critical preventative services, immunizations, and treatment for conditions such as asthma. [58] On top of individual problems with healthcare in Texas there is a shortage of healthcare providers as a whole in the state. Of the 254 counties in Texas, 230 counties are experiencing a whole-county shortage of primary care physicians, 20 counties are experiencing a partial area-specific shortage of PCPs, and only 4 counties are experiencing no shortage of Primary Care Physicians. [59] Healthcare can be difficult to access in Texas for a multitude of different reasons that are less common or do not exist in other states.

Medical research

Texas has many research medical centers. The state has nine medical schools, [60] three dental schools, [61] and two optometry schools. [62] Texas has two Biosafety Level 4 (BSL-4) laboratories: one at The University of Texas Medical Branch (UTMB) in Galveston, [63] and the other at the Southwest Foundation for Biomedical Research in San Antonio—the first privately owned BSL-4 lab in the United States. [64]

The Texas Medical Center in Houston, holds the world's largest concentration of research and healthcare institutions, with 47 member institutions. [65] Texas Medical Center performs the most heart transplants in the world. [66] The University of Texas M. D. Anderson Cancer Center in Houston is a highly regarded academic institution that centers around cancer patient care, research, education and prevention. [67]

San Antonio's South Texas Medical Center facilities rank sixth in clinical medicine research impact in the United States. [68] The University of Texas Health Science Center is another highly ranked research and educational institution in San Antonio. [69] [70]

Both the American Heart Association and the University of Texas Southwestern Medical Center call Dallas home. The Southwestern Medical Center ranks "among the top academic medical centers in the world". [71] The institution's medical school employs the most medical school Nobel laureates in the world. [71] [72]

Legislative responses

The Trust for America's Health ranked Texas 15th highest in adult obesity, with 27.2 percent of the state's population measured as obese. [29] The 2008 Men's Health obesity survey ranked four Texas cities among the top 25 fattest cities in America; Houston ranked 6th, Dallas 7th, El Paso 8th, and Arlington 14th. [73] Texas had only one city, Austin, ranked 21st, in the top 25 among the "fittest cities" in America. [73] The same survey has evaluated the state's obesity initiatives favorably with a "B+". [73] The state is ranked forty-second in the percentage of residents who engage in regular exercise. [74]

Notwithstanding the concentration of elite medical centers in the state, The Commonwealth Fund ranks the Texas healthcare system the third worst in the nation. [75] Texas ranks close to last in access to healthcare, quality of care, avoidable hospital spending, and equity among various groups. [75] Causes of the state's poor rankings include politics, a high poverty rate, and the highest rate of illegal immigration in the nation. [76] In May 2006, Texas initiated the program "code red" in response to the report the state had 25.1 percent of the population without health insurance, the largest proportion in the nation. [77]

Texas Department of State Health Services

The Texas Department of State Health Services manages state government projects in Texas.

The health insurance marketplace for Texas is HealthCare.gov, which is also the federal marketplace usable by anyone.

Hospitals in Texas

Texas has hospitals serving every part of the state.

Healthcare by region

Dallas, Texas

Dallas, Texas offers healthcare services.

Galveston, Texas

Galveston, Texas offers healthcare services.

Houston, Texas

Houston, Texas offers healthcare services.

Lubbock, Texas

Lubbock, Texas offers healthcare services.

San Antonio, Texas

San Antonio, Texas offers healthcare services.

Related Research Articles

<span class="mw-page-title-main">Infant mortality</span> Death of children under the age of 1

Infant mortality is the death of an infant before the infant's first birthday. The occurrence of infant mortality in a population can be described by the infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births. Similarly, the child mortality rate, also known as the under-five mortality rate, compares the death rate of children up to the age of five.

<span class="mw-page-title-main">Maternal death</span> Aspect of human reproduction and medicine

Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

<span class="mw-page-title-main">Preterm birth</span> Birth at less than a specified gestational age

Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 34 weeks, late preterm birth is between 34 and 36 weeks' gestation. These babies are also known as premature babies or colloquially preemies or premmies. Symptoms of preterm labor include uterine contractions which occur more often than every ten minutes and/or the leaking of fluid from the vagina before 37 weeks. Premature infants are at greater risk for cerebral palsy, delays in development, hearing problems and problems with their vision. The earlier a baby is born, the greater these risks will be.

<span class="mw-page-title-main">March of Dimes</span> American nonprofit organization

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<span class="mw-page-title-main">Birth weight</span> Weight of a human baby at birth

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<span class="mw-page-title-main">Health in Finland</span> Overview of health in Finland

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Research shows many health disparities among different racial and ethnic groups in the United States. Different outcomes in mental and physical health exist between all U.S. Census-recognized racial groups, but these differences stem from different historical and current factors, including genetics, socioeconomic factors, and racism. Research has demonstrated that numerous health care professionals show implicit bias in the way that they treat patients. Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.

Prenatal care in the United States is a health care preventive care protocol recommended to women with the goal to provide regular check-ups that allow obstetricians-gynecologists, family medicine physicians, or midwives to detect, treat and prevent potential health problems throughout the course of pregnancy while promoting healthy lifestyles that benefit both mother and child. Patients are encouraged to attend monthly checkups during the first two trimesters and in the third trimester gradually increasing to weekly visits. Women who suspect they are pregnant can schedule pregnancy tests prior to 9 weeks gestation. Once pregnancy is confirmed an initial appointment is scheduled after 8 weeks gestation. Subsequent appointments consist of various tests ranging from blood pressure to glucose levels to check on the health of the mother and fetus. If not, appropriate treatment will then be provided to hinder any further complications.

<span class="mw-page-title-main">Health in Latvia</span>

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Montenegro is a country with an area of 13,812 square kilometres and a population of 620,029, according to the 2011 census. The country is bordered by Croatia, the Adriatic Sea, Bosnia, Herzegovina, Serbia, Kosovo and Albania. The most common health issues faced are non-communicable diseases accounting for 95% of all deaths. This is followed by 4% of mortality due to injury, and 1% due to communicable, maternal, perinatal and nutritional conditions. Other health areas of interest are alcohol consumption, which is the most prevalent disease of addiction within Montenegro and smoking. Montenegro has one of the highest tobacco usage rates across Europe. Life expectancy for men is 74 years, and life expectancy for women is 79.

<span class="mw-page-title-main">Maternal healthcare in Texas</span>

Maternal healthcare in Texas refers to the provision of family planning services, abortion options, pregnancy-related services, and physical and mental well-being care for women during the prenatal and postpartum periods. The provision of maternal health services in each state can prevent and reduce the incidence of maternal morbidity and mortality and fetal death.

<span class="mw-page-title-main">Maternal mortality in the United States</span> Overview of maternal mortality in the United States

Maternal mortality refers to the death of a woman during her pregnancy or up to a year after her pregnancy has terminated; this metric only includes causes related to the pregnancy, and does not include accidental causes. Some sources will define maternal mortality as the death of a woman up to 42 days after the pregnancy has ended, instead of one year. In 1986, the CDC began tracking pregnancy-related deaths to gather information and determine what was causing these deaths by creating the Pregnancy-Related Mortality Surveillance System. According to a 2010-2011 report although the United States was spending more on healthcare than any other country in the world, more than two women died during childbirth every day, making maternal mortality in the United States the highest when compared to 49 other countries in the developed world.

Black maternal mortality in the United States refers to the death of women, specifically those who identify as Black or African American, during or after child delivery. In general, maternal death can be due to a myriad of factors, such as the nature of the pregnancy or the delivery itself, but is not associated with unintentional or secondary causes. In the United States, around 700 women die from pregnancy-related illnesses or complications per year. This number does not include the approximately 50,000 women who experience life-threatening complications during childbirth, resulting in lifelong disabilities and complications. However, there are stark differences in maternal mortality rates for Black American women versus Indigenous American, Alaska Native, and White American women.

<span class="mw-page-title-main">Maternity care deserts in the United States</span> Counties that lack maternity care resources

Maternity care deserts in the United States, also known as maternal care deserts, are counties that lack maternity care resources. The March of Dimes defines a maternity care desert as a county that has no hospitals or birth centers offering obstetric care and no obstetric providers. As of 2020 March of Dimes classified 1095 of 3139 of U.S. counties (34.9%) as maternity care deserts. Its 2022 report indicated an increase of nearly 2%, with 1119 of 3142 US counties (35.6%) considered maternity care deserts, affecting a population of over 5.6 million women. People living in maternity care deserts may have to travel longer distances to receive care, which is associated with higher costs and a greater risk of pregnancy complications.

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