The State of Health in New Mexico 2018
2. Healthy Children
Child Health Depends on Access to Preventive Care and Early Detection of Risk Factors
The Challenge of PovertyPoverty in New Mexico is a significant factor that presents challenges to health and wellness programs and affects the overall health and well-being of New Mexico families. Nearly one-third (30.1%) of New Mexico children grow up in poor households, that is, households whose annual income was below the federal poverty level (Figure 1). About two in five New Mexico children (38.4%) live in households that receive Supplemental Security Income (SSI), cash public assistance income, or Food Stamp/SNAP benefits. Despite, or perhaps because of the challenges, state, county and community programs continue to work aggressively to improve the life course trajectory for children in New Mexico.
Children with Special Health Care NeedsChildren with special health care needs are those who, "have or are at increased risk for chronic physical, developmental, behavioral or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally." Nine out of ten New Mexico parents (89.9%) rated their child's overall health excellent or very good in 2016 according to the National Survey of Children's Health, just slightly higher than the national percentage of (89.7%) (Figure 2). Close to ninety percent (86.2%) of parents with public insurance for their child rated their child's health as excellent or very good compared to 95.1% of parents of children who have private health insurance. Children with special health care needs account for one in five New Mexico children. 75.5% of parents of children with special health care needs rated their child's health as excellent or very good compared to 93.4% who did not have a child with special health care needs.
Childhood Obesity and Impact of EnvironmentKeeping children physically fit and at a healthy weight helps ensure the health of children. About 67.4% of New Mexico kindergarteners and 61.6% of third graders had a healthy weight in 2016 according to the New Mexico Statewide Childhood Obesity Surveillance System. About 31.8% of New Mexico children aged 6-11 years and 21.9% of children aged 12-17 years meet the CDC recommendation of at least one hour of physical activity every day. According to the CDC, creating or modifying environments to make it easier for people to walk or bike is a strategy that not only helps increase physical activity, but can make our communities better places to live. Children growing up in rural communities in New Mexico with scarce resources are at a disadvantage in their ability to access safe walking trails and playgrounds and need communities to come together to address these needs.
Eating healthy is another important way to keep children at a healthy weight. In 2015, the U.S. Department of Agriculture (USDA) Food Access Atlas reported that 135 of 499 New Mexican census tracts are food deserts with low access to healthy foods and 25% of children were considered food insecure at some time during the year. In 2014, it was estimated three out of four families (75%) with low food security in New Mexico made the financial trade-off of purchasing inexpensive, unhealthy food in order to have some food at home.
Child MortalityBetween 2014 and 2016, there were an average 82 deaths per year for children aged 1-14 years in New Mexico, a rate of 21.0 deaths per 100,000 children. The leading causes of death for this group were unintentional injury, 31 deaths per year on average, 8.0 per 100,000 children, homicide, 9 deaths per year on average, 2.2 per 100,000 children, and congenital malformations, 8 deaths per year on average, 2.0 per 100,000 children.
Leading causes of unintentional injury death in this age group were motor vehicle traffic injuries, motor vehicle non-traffic injuries, drowning, falls, and suffocation.
Boys aged 1-14 years had a higher death rate over the period than girls (23.2 vs. 18.6 per 100,000 population). Deaths from suicide were more common among boys than girls. American Indian children died at more than twice the rate (41.7 per 100,000) of the other racial/ethnic groups combined (18.6 per 100,000). Unintentional injuries accounted for nearly a third of all child deaths in the American Indian group. Hispanic children had the lowest child death rate at 18.0 per 100,000.
Mortality rates from 2014 through 2016 for children aged 1-14 years were highest in Rio Arriba, San Juan, McKinley, and Chaves counties, and lowest in Catron, Harding, Hidalgo, Lincoln, Los Alamos, Mora, Sierra, and Union counties.
Medical Home and Dental Health HomeThe Medical Home includes coordinated, accessible care delivered in a compassionate, culturally sensitive manner, with a family-centered approach. It is an evidence-based model for providing care for all children that has been shown to reduce costs and health-related complications. A child with a medical home has a primary care provider for both wellness and sickness care. A care coordinator for children with special health care needs addresses social determinants of health and links families to multiple service providers and supports. A medical home also promotes screening for early identification and treatment of conditions. In 2016, 32.8% of New Mexican children aged 10 months through 5 years of age received a developmental screening tool completed by the parent compared to 27.1% of children nationally. Fewer than half of New Mexico children (45.2%) in 2016 had a medical home compared to 50%, nationally. Children in poverty were half as likely to have a medical home as those in households that earned more than 400% of the Federal Poverty Level (Figure 3). About half of children (52.8%) received needed treatment or counseling for their mental/behavioral health condition.
The Dental Health Home model coordinates the oral health needs of children by providing comprehensive oral health care including acute care and preventive services. About 85% of New Mexico children had at least one preventive dental visit in the past year, which is higher than the national percentage of 78.7% of children. Close to ninety percent of New Mexico children (88.4%) with special health care needs received a preventive dental visit. However, a higher percentage of New Mexico children had tooth decay (14.0%) than the national percentage of (11.7%).
Risk and Resiliency FactorsMany factors limit access to health care in New Mexico, including provider shortages, lack of affordable insurance, and lack of awareness of insurance availability. Expansive geographies create long travel distances to primary health clinics and hospitals. Cultural barriers to care are comprised of cultural relevance and lack of trust in health care providers and systems, which cause healthcare utilization disparities in some areas of the state. Thirty-two of New Mexico's 33 counties are designated "health professional shortage areas." New Mexico Medicaid provides many health care services for children under a federal Medicaid policy which requires that children received Early Periodic Screening, Diagnostic, and Treatment (EPSDT) services. This policy includes preventive health services, maintenance health services and treatment of medical conditions. It also includes dental and behavioral health services.
Health DisparitiesThe social determinants of health such as poverty, single parent households, education level of parents, race and ethnicity, access to health care and safe communities affect overall child well-being. In New Mexico, the high rates of child poverty, the rural nature of the state, and poorly-resourced communities call for health policy that addresses health equity.
Assets and ResourcesThe Office of Oral Health provides dental sealants at school based health centers. Children's Medical Services assures children with special needs have a medical and a dental health home and provides care coordination linking families to services and community resources.
The Developmental Screening Initiative at Envision New Mexico works to increase the rate of developmental screening using a standardized tool and promote earlier referral for children from birth to five years of age.
Healthy Kids New Mexico creates healthy environments and programs to give kids what they need to play well, eat well, learn well, and live healthy and full lives. The Women, Infants and Children (WIC) program provides supplemental food for woman, infants and children up to age 5 and educates families on healthy food choices.
SummaryNew Mexico has seen some promising trends in the overall health of children; specifically, childhood obesity rates and the numbers of children without health insurance have both been declining, and the percentages of children with a primary source of medical and dental care are slightly above the national percentage. However, there are challenges that still need to be overcome, including high rates of childhood poverty and abuse and difficulty accessing pediatric specialty care. Efforts are needed to continue to address social determinants of health in childhood, including expanded use of care coordination in primary care practices to link families to community services and address risk factors.
Sources: U.S. Census Bureau, American Community Survey
Source: 2016 National Survey of Children's Health (NSCH)
What is Being Done?
- Safer New Mexico holds car seat inspection clinics monthly in different cities across the State and reinforces seat belt use for all ages.
- Medicaid access has increased with Medicaid expansion and emphasizes the Medical Home and care coordination as standards of care.
- Communities around the State are partnering with local farmers and schools to offer fresh fruit and vegetable choices in school lunches and identifying walking trails and playgrounds to increase physical activity.
- The John Paul Taylor task force, a legislatively authorized group of public and private partners, is tasked with creating a public health driven early childhood mental health action plan for infants and children to age eight and their families; developing a system to identify unserved and underserved at-risk children and families; promoting evidence based local community programs in New Mexico; and identifying current systems that can be used for the prevention of child abuse and neglect.
What Needs to be Done?
- Continue initiatives to address provider shortage areas.
- Increase the number of medical providers that use a standardized developmental screening tool for early identification of children requiring intervention.
- Expand use of care coordination in primary care practices to link families to community services to address socio-economic concerns.
- Understand the knowledge, attitudes and perceptions surrounding healthful eating and physical activity among New Mexicans and engage more communities in creating healthy environments for kids to grow up in.
- Ensure that all New Mexicans have access to affordable healthy foods.