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The Changing Face of Houston and Texas: Healthcare ChallengesTracking the Economic and Demographic Transfor-mations through 33 Years of Houston Surveys.
Dr. Stephen Klineberg
Conference on “Designing Healthcare in Texas,” One Voice Texas, 4 June 2014.
The Kinder Institute Houston Area Survey (1982-2014)
More than three decades of systematic interviews with representative samples of Harris County residents, focused on three central issues:
2
Supported by a grant from Houston Endowment Inc., three focused surveys were developed during 2011 through a series of meetings with local leaders and national experts in the arts, education, and community health.
From November 2011 through July 2012, separate samples of 1,200 scien-tifically selected Harris County residents were interviewed in three successive surveys, with approximately 65% reached by landline and 35% by cell phone.
Weights were assigned to the data to ensure that the final distributions are in close agreement with the actual Harris County distributions with respect to ethnicity, age, gender, education levels, and home ownership.
The three printed reports on the most important findings from these separate surveys have now been released to the public and are available from the Kinder Institute web site (at: kinder.rice.edu/reports).
The SHEA Surveys on Health, Education
and the Arts (2012)
Two contrasting economic eras
Percent increase in before-tax income
The 30 years after World War II (1949-1979) The past 30 years (1980-2011)
Bottom 20%
Second 20%
Middle 20%
Fourth 20%
Top 20%
Top 5%
-10%
50%
110% 116%
100%
111% 114%
99%
86%
-3%
2% 5% 15%
43%
63%
4Source: U.S. Census Bureau, Current Population Survey, Annual Social And Economic Supplements.
Mean Household Income Received By Each Fifth And The Top 5 Percent, Inflation Adjusted.© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
The 30 years after World War II were a period ofbroad-based prosperity.
The past 30 years have been marked by growing income inequalities.
The New Economy
Percent rating job opportunities as “excellent” or “good”
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 140
10
20
30
40
50
60
70
80
90
100
Positive evaluations of job opportunities in the Houston area (1982-2014)
5Source: Kinder Houston Area Survey (1982-2014)© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
71%
36%
11%
42%
68%
43%
35%
66%
25%
41%
58% 60% 58%
48%
The New Economy
The official unemployment rates in Harris County (1982-2014)
6Source: U.S. Department of Labor, Bureau of Labor Statistics. Unemployment rates are not seasonally adjusted.© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 143.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
8.5
9.0
9.5
10.0
10.5
11.0
7.3
9.8 10.1
6.8
8.6
4.0 4.3
6.8
7.8
6.5
5.7
The New Economy
The prevalence of food insecurity (2014)
7Source: Kinder Institute Houston Area Survey (2014)© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
“At any time in the past year, did you have a problem paying for the groceries to feed your household? Has that been a very serious problem for you, somewhat serious, not much of a problem, or not a problem during the past year?”
67
16
126
"Not a problem"
"Not much of a problem"
"Somewhat serious problem"
"A very serious problem"
The New Economy
The importance of post-secondary education, in the total sample and by ethnicity (2013)
8Source: Kinder Institute Houston Area Survey (2013)© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
Total sample Anglos (N=331) Blacks (N=220) Hispanics (N=360) Asians (N=36)0
10
20
30
40
50
60
70
80
90
100
73
63
78 81
71
25
36
20 17
27
An education beyond high school is necessaryThere are many ways to succeed with no more than high school
PE
RC
EN
T O
F R
ES
PO
ND
EN
TS
"For a person to be successful in today's world, is it necessary to get an education beyond high school, or are there many ways to succeed with no more than a high school diploma?"
The New Economy
The New Economy10
The number of documented U.S. immigrants, by decade (1820-2010)
From 1492 to 1965, 82% of all immigrants coming to America came from Europe.
After reform in 1965, 88% of all the new immigrants have been non-Europeans.
Source: U.S. Department of Homeland Security. Office of Immigration Statistics.© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
1820s 1830s 1840s 1850s 1860s 1870s 1880s 1890s 1900s 1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s0
2000000
4000000
6000000
8000000
10000000
12000000
143,439.0
8,795,386.0
528,431.0
10,501,053.0
1924“National Origins Quota Act”
1965“Hart-Celler Act”
Millions of immigrants
The New Economy11
San DiegoLos Angeles
New York CitySan Francisco
Miami
Chicago
Houston
Major U.S. immigrant cities (2010)
Washington D.C.
Atlanta
Dallas
Boston
The New Economy12
Anglos
Blacks
Latinos
Asians
Anglos
Blacks
LatinosAsians
Asians
Anglos
BlacksLatinos
Anglos
BlacksLatinosAsians
Anglos
BlacksLatinosAsians
0
1,000,000
2,000,000
3,000,000
4,000,000
Pop
ula
tio
n in
Mill
ion
s
15.5%
9.9%
20.1%
69.2%
0.8%
1,741,912
1960
1970
1980
1990
2000
2010
The demographic transformations of Harris County
Anglos
Blacks
Latinos
Asians
2,818,199
22.7%
19.1%
54.0%
4.1%
6.7%
32.9%
18.2%
42.1%
3,400,578
7.7%
18.4%
40.8%
33.0% 4,092,459
19.7%
62.7%
2.1%
15.5%
2,409,5471,243,258
6.0%
19.8%
73.9%
0.3%
Source: U.S. Census. Classifications based on Texas State Data Center Conventions. © Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
The New Economy13
Anglos
BlacksLatinosAsians
Anglos
BlacksLatinosAsians
Anglos
Blacks
LatinosAsians
Anglos
BlacksLatinosAsians
0
300,000
600,000
15.5%
The demographic changes in Fort Bend County and Montgomery County
53.8%
20.3%
19.5%
6.5%
1990
46.2%
19.6%
21.1%
13.1%
36.2%
21.1%
23.7%
19.0%
Anglos
Blacks
Latinos
Asians
2000
2010
1990
2000
2010
87.5%
4.2%7.3%
1.0%
225,421 354,452 585,375 182,201 293,768 455,746
Fort Bend County Montgomery County
71.2%
4.1%20.8%
4.0%
81.4%
3.4%12.6%
2.5%
Source: U.S. Census. Classifications based on Texas State Data Center Conventions. © Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
The New Economy14
Harris County total population
Anglo
majority
Black majority
Latino
majority
No majority14Color represents demographic group being a majority in that census tract.Source: Outreach Strategists, LLC© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
1980
The New Economy15
Harris County total population
15Color represents demographic group being a majority in that census tract.Source: Outreach Strategists, LLC© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
Anglo
majority
Black majority
Latino
majority
No majority
1990
The New Economy16
Harris County total population
16Color represents demographic group being a majority in that census tract.Source: Outreach Strategists, LLC© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
Anglo
majority
Black majority
Latino
majority
No majority
2000
The New Economy17
Harris County total population
17Color represents demographic group being a majority in that census tract.Source: Outreach Strategists, LLC© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
Anglo
majority
Black majority
Latino
majority
No majority
2010
The New Economy18
Percent of the population by age group and ethnicity in Harris County in 2012
Source: U.S. Census Bureau. 2008-2012 ACS 5-year estimates© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research18
< 5 years5 to
9
10 to 14
15 to 19
20 to 24
25 to 29
30 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 + years
21 22 24 25 2529 28
31
41
5054
61
79 78 76 75 7571 72
69
59
5046
39
Non-Hispanic Whites All others
The New Economy19
Percent of the population by age group and ethnicity in Texas in 2012
Source: U.S. Census Bureau. 2008-2012 ACS 5-year estimates© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research19
< 5 years5 to
9
10 to 14
15 to 19
20 to 24
25 to 29
30 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 + years
32 33 35 3739 40 40
43
53
6065
7068 67 65 63 61 60 6057
47
4035
30
Non-Hispanic Whites All others
The New Economy20
Percent of the population by age group and ethnicity in the United States in 2012
Source: U.S. Census Bureau. 2008-2012 ACS 5-year estimates© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research20
< 5 years5 to
9
10 to 14
15 to 19
20 to 24
25 to 29
30 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 + years
5153 55 56 57 58 58
61
69
7578
82
4947 45 44 43 42 42
39
3125
2218
Non-Hispanic Whites All others
The New Economy21
Percent of the population by age group and ethnicity in the United States in 2050
Source: U.S. Census Bureau. 2012 National Population Projections, Alternative Net International Migration Series (Constant Series).© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
< 5 years5 to
9
10 to 14
15 to 19
20 to 24
25 to 29
30 to 34
35 to 44
45 to 54
55 to 64
64 to 74
75 + years
36 38 39 41 42 43 44 4650
5356
6464 62 61 59 58 57 56 5450
4744
36
Non-Hispanic Whites All others
The New Economy
Self-rated health status in Harris County
Excellent Very good Good Fair Poor0
5
10
15
20
25
30
35
40
19
25
38
13
6
20
26
32
16
5 The 2012 HAHS
2001-2013 KIHAS, combined
PERC
ENT
OF
RESP
ON
DEN
TS
“In general, would you say that your overall state of physical health these days is excellent, very good, good, fair, or poor?”
The New Economy
The structural correlates of self-rated health: The additional importance of health insurance
Independent Variable
Respondents who said that their “overall state of health these days” was only “fair” or “poor.”
Model 1(KHAS 2001-2013)
Model 2(KHAS 2001-2012)
B SE OR B SE ORSociodemographics Age +.022**** .002 1.022 +.025**** .002 1.025 Female -.043 .064 .958 -.060 .072 .942Ethnicitya
Non-Hispanic Whites (Anglos) -.406**** .072 .666 -.363**** .080 .695Measures of Socioeconomic Status Incomeb $35,501 – 50,000 -.459**** .096 .632 -.381**** .108 .683 $50,001 – 75,000 -.631**** .095 .532 -.529**** .107 .589 More than $75,000 -.951**** .093 .387 -.771**** .104 .463 Educationc High School Diploma -.165 .104 .848 -.053 .122 .948 Some College -.337*** .103 .714 -.214* .121 .807 College Degree -.838**** .113 .432 -.743**** .132 .476Health Insurance ----- ----- ----- -.463**** .093 .630N 6,972 5,435 aThere were no meaningful differences in self-rated health status between blacks, U.S.-born Latinos, and Latino immigrants . Blacks and Latinos make up the reference group. The few Asians and “others” were removed from this analysis.bReference group: Less than $35,501.cReference group: Less than high school.*p < .10, **p < .05, ***p < .01. ****p < .001 (two-tailed tests).
Source: KHAS (2001-2013)
The New Economy
Respondents’ ratings of the quality of health care available to them, by insurance coverage (HAHS)
Yes, Insured No, Not insured0
5
10
15
20
25
30
35
40
45
31
10
40
28
18
21
12
41
"Excellent"
"Good"
"Fair"
"Poor"
"Are you currently covered by any type of health insurance or health care plan?"
PERC
ENT
OF
RESP
ON
DEN
TS
The New Economy
Self-reported health status by proximity to the ten Harris County ZIP codes on the APWL (KIHAS)
APWL ZIP codes and surrounding areas
Inside the 610 Loop Outside the 610 Loop0
10
20
30
40
50
60
70
38
57
50
37
25
31
25
19 19
"Excellent" or "Very Good"
"Good"
"Fair" or "Poor"
PERC
ENT
OF
RESP
ON
DEN
TS
The New Economy
The effects of living in or near the APWL ZIP codes on self-reported health, controlling for the structural variables and for insurance coverage (KIHAS)
Independent Variable
Self-Reported “Fair” or “Poor” Health
Coefficient Standard Error Odds Ratio (OR)
1-OR(A) Socioeconomic Status (1) Educationa High School Diploma -.110 .126 .896 -.104 Some College -.261* .126 .770 -.230 College Degree -.781*** .139 .458 -.542 (2) Incomeb $35,501 to $50,000 -.449*** .112 .638 -.362 $50,001 to $75,000 -.522*** .109 .593 -.407 More than $75,000 -.776*** .106 .460 -.540(B) Demographic Characteristics (3) Ethnicityc Black +.423*** .095 1.526 +.526 Latino +.195* .100 1.216 +.216 Asian +.038 .281 1.039 +.039 (4) Age +.023*** .002 1.023 +.023 (5) Female -.101 .073 .904 -.096(C) Having Health Insuranced -.460*** .096 .631 -.369 (D) Living in or near APWL ZIP Codese +.248** .090 1.281 +.281----------------------- Constant -.457*** .144 .633 -.367N 5,275 a Reference group: Less than high school.b Reference group: Less than $35,000.c Reference group: Anglos.d The question about health insurance coverage was included in the 2001, 2003-2012 surveys. Reference group: Living in areas other than APWL ZIP codes or its surrounding ZIP codes.*p < .05, **p < .01. ***p < .001 (two-tailed tests).
The New Economy
The perceived determinants of a person’s health, average ratings (HAHS)
Diet and Physical Ac-
tivity
Amount of Stress
Amount of Social
Support
Air and Water Pollution
Level of Income
Genetic Makeup
Racial Dis-crimination
0
1
2
3
4
5
6
7
8
9
10
11
8.6 8.37.35 7.26 7.23 6.93
6.16
EFFE
CT O
N H
EALT
H (S
CALE
FRO
M 1
TO
10)
“How much do you think a person's health is determined by each of these factors? Using a scale from 1 to 10, where 1 means it has 'very little effect' and 10 means it has a 'very strong effect,' how important is each of the following?”
The New Economy
The availability of health-promoting resources compared to their usage by the general public
Source: SHEA Health Survey (2012)
0
10
20
30
40
50
60
70
80
90
56
14
83
44
58
30
44
24
PERC
ENT
OF
RESP
ON
DEN
TS
Hiking, boating,birding
Arts, culture, sports
Air and water qualityGreen spaces, trees
Urban centers
BayousTransportation
Quality of Place
Houston’s urban sprawl
2.1 million600 sq. mi.
Chicago2.7 million228 sq. mi.
Baltimore0.6 million81 sq. mi.
30Source: U.S. Census Bureau© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
Detroit0.7 million139 sq. mi. Philadelphia
1.5 million134 sq. mi.
Quality of Place
The nine-county Houston metropolitan area
5.8 million9,434 sq. mi.
New Jersey8.8 million8,729 sq. mi.
31Source: U.S. Census Bureau© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
Massachusetts6.6 million10,550 sq. mi.
Quality of Place
The divided preference for car-centered vs. transit-oriented developments (2009-2014)
32 Source: Kinder Institute Houston Area Survey (2009-2014)© Dr. Stephen L. Klineberg and the Kinder Institute for Urban Research
A s
ing
le-f
am
ily
resid
en
tial are
a
An
are
a w
ith
a m
ix
of
develo
pm
en
ts
A s
ing
le-f
am
ily
ho
me w
ith
need
to
d
rive e
very
wh
ere
A s
maller,
mo
re
urb
an
ized
ho
me
wit
hin
walk
ing
d
ista
nce
Sp
en
din
g m
ore
to
exp
an
d e
xis
tin
g
hig
hw
ays
Sp
en
din
g m
ore
to
im
pro
ve r
ail a
nd
b
uses
2009, 2011, 2013 2010, 2012, 2014 2010, 2012, 2014
0
10
20
30
40
50
60
70
52
47
58
39
475050 50
4751
44
51
4751 51
47 4649
Quality of Place
1978
© Alex MacLean
Quality of Place
2011
© Alex MacLean
Houston needs to develop
into a truly successful
multiethnic society, one
with equality of
opportunity for all
communities, where all are
encouraged to participate
as full partners in shaping
the region’s future.
Today’s pro-growth agenda
The Houston region needs
to nurture a far more
educated workforce and
develop the research
centers that will fuel the
new economy.
The Houston region needs
to grow into a much more
appealing urban
destination, while
accommodating an
expected 3.5 million
additional residents in the
next 20 years.
kinder.rice.edukinder@rice.edu
713-348-4132 @RiceKinderInst
/InstituteForUrbanResearch