1. Action Planning Summit The Big Picture Billy U. Philips, Jr. Ph.D., M.P.H., Vice President and Director F. Marie Hall Institute Marie Hall Chair and Professor, Family and Community Medicine Big Spring, Texas October 28, 2011

2. Considerations The Landscape of West Texas The Health Issues The Changing Demography The Economy The Collaborative Opportunities The Challenges

4. Geography of the Health Infrastructure

6. PCPs (MDs and (MDs andDOs)PAsNPsRNsLVNs U.S., 2005 7927.733.7825132.6 Texas, 2008 68.4 (56) 17.322.1671.3277.5 Number of Providers per 100,000 population. Comparison between U.S. and Texas

7. Projected Increase of Obesity in Texas by Ethnicity, 2006-2040 7 Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011 Source: Texas State Data Center. Population Projections, 2000-2004 Migration Scenario.

8. Projected Number of Adults with Diabetes by Race and Ethnicity for Texas, 2010-2040 8 Projected Persons with Diabetes Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011 Source: Office of the State Demographer. 2006 Population Projections, 2000-2004 Migration Scenario.

9. Growing States, 2000-2010 2000 Population* 2010 Population* Numerical Change 2000-2010 Percent Change 2000-2010 United States 281,421,906308,745,53827,323,6329.7% Texas 20,851,82025,145,5614,293,74120.6% California 33,871,64837,253,9563,382,30810.0% Florida 15,982,37818,801,3102,818,93217.6% Georgia 8,186,4539,687,6531,501,20018.3% North Carolina 8,049,313 9,535,483 1,486,17018.5% Arizona 5,130,632 6,392,017 1,261,38524.6% Population values are decennial census counts for April 1, 2000 and April 1, 2010. 9 15.7% of numerical change in U.S. Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011 Source: U.S. Census Bureau. 2000 and 2010 Census Counts.

10. Percent Change Due to Year*Population Numerical Change Natural Increase Net Migration Percent Change Natural Increase Net Migration 19507,711,194-- 19609,579,6771,868,4831,754,652113,83124.293.916.09 197011,196,7301,617,0531,402,683214,37016.986.7413.26 198014,229,1913,032,4611,260,7941,771,66727.141.5858.42 199016,986,5102,757,3191,815,670941,64919.965.8534.15 200020,851,8203,865,3101,919,2811,946,02922.849.6550.35 200924,782,3023,930,4842,124,1241,781,78518.854.0445.33 *All values for the decennial dates are for the indicated census year. Values for 2009 are for July 1 as estimated by the U.S. Census Bureau. Source: Derived from U.S. Census Bureau Estimates for dates indicated by the Texas State Data Center. Note: Residual values are not presented in this table. Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011 Total Population and Components of Population Change in Texas, 1950-2009 10

11. Source: U.S. Census Bureau. 2009 Population Estimates. Estimated Annual Net Migration to Texas, 2000-2009 11

12. Percent of Migrants to Texas by Race and Ethnicity, 2000-2009 12 Sources: Percentages of domestic and international migrants by race and ethnicity derived from the 2006-2008 American Community Survey. Total numbers of domestic and international migrants between 2000-2009 are from Table 4. Cumulative Estimates of the Components of Resident Population Change for the United States, Regions, States, and Puerto Rico: April 1, 2000 to July 1, 2009, U.S. Census Bureau. (848,702 migrants ) (933,083 migrants) 52% of all migrants were international

13. Percent of Population Less Than 18 Years of Age Living Under Poverty During Past 12 Months by County, 2005-2009 Source: U.S. Census Bureau. American Community Survey, 5-Year Sample 2005-2009. Map by the Texas State Data Center. Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011

14. Estimated Domestic Migration (2000-2008) as a Percentage of 2000 Population by County Source: Population Division, U.S. Census Bureau, March 19, 2009. Map produced by the Texas State Data Center. Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011 14

15. Estimated International Migration (2000-2008) as a Percentage of 2000 Population by County Source: Population Division, U.S. Census Bureau, March 19, 2009. Map produced by the Texas State Data Center. Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011 15

16. Numeric Change of Total Population by County, 2000-2010 16 Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011. Source: U.S. Census Bureau. 2000 and 2010 Census Counts. Map produced by the Texas State Data Center.

17. Projected Population by Texas Counties, 2040 Source: Texas State Data Center and US Census Bureau. Vintage 2008 Population Projections, 2000-2007 Migration Scenario. Dr. Lloyd Potter, Slide taken from State Demographer presentation at 2011 Texas Rural Health Forum, 9/24/2011. Map produced by the Texas State Data Center.

18. Personal Services Assistant (PSA) Nursing CAN/LVN AND/RN Advance Practice Nurse/DPN Nutrition Commercial Nutrition Assistant Dietician/Nutritionist Certified Diabetes Educator Rehabilitation Promatora/CHE Social Worker OT/PT/OT&PT Assistants Speech Language Pathology Career Trajectory from Stem PSA in Four Major Fields Diagnostic/ Therapuetics Transportation/Infection Control Aide Phlebotomist Sonographer/Rad Tech/ Resp. Tech Physician Assistant Professional Conduct Work Habits Ethics Medical Terminology Anatomy/Physiology Pathobiology Information Technology Documentation Quality Improvement History Physical Exam Procedures Track Specific Skills

22. AHEC workforce strategies Distribution of health professionals, particularly in primary care fields, is crucial to addressing disparities Health professions schools are in need of increased capacity to develop more health care professionals for the future. High-need communities need ways to engage future professionals to recruit workforce Students from underserved or rural backgrounds are more likely to practice in underserved settings, but often are not aware of opportunities and are not adequately prepared to pursue opportunities Promote health careers to young people and foster preparation for entry into health professions education Expand community-based clinical training to meet need for increased academic capacity and engage students in high need communities F. Marie Hall Institute for Rural and Community Health

23. Exist in 49 states and DC Texas has three AHECs: West Texas AHEC East Texas AHEC South Texas AHEC

25. Career Information Provided by the F. Marie Hall Institute for Rural and Community Health Texas Tech University Health Sciences Center

26. Community Need Community Assets Translation Community Solutions Stronger Community