POPULATION
With 121,365 square miles between its borders, the Land of Enchantment enjoys breathtaking scenery and endless opportunities for recreation to residents and visitors alike. NM is divided into 33 counties and contains 4 metropolitan cities with populations of 50,000 or more.
Seventy percent of the population lives in the seven more urban counties; 50% of the state’s population is concentrated into three counties (Bernalillo (home to a third of the state’s population), Doña Ana, and Santa Fe), which together comprise only 6% of the state’s land area. In 2020, New Mexico’s population density was only 17.5 persons per square mile, an increase from 17.0 in 2010. Seven percent of the population resides in frontier or sub-frontier areas. In fact, most counties (24) have population densities of less than 15 persons per square mile. From 2020 to 2021, nearly half of the state’s counties experienced a decline in population.
More than 2.1 million residents call New Mexico home. 50.2% identify as Hispanic or Latino; 35.7% as White Non-Hispanic or Latino; 11.2% as Native American or Alaskan
Native; 2.7% as Black or African American; 2.8% as two or more races; 2.0% as Asian; and 0.2% as Native Hawaiian or Pacific Islander. From 2016-2022, NM’s total population was 50% female. Of the total population, 19.1% is over the age of 65, 21.7% is under the age of 18 and 5.2% is under 5. Of the total population under the age of 65, 11.3% are living with a disability and 12.0% are without health insurance. In 2021, 7.0% of all New Mexican children were not insured.
CULTURE, LANGUAGE & IMMIGRATION
New Mexico has deep rooted history with an array of vibrant cultural traditions. It is the ancestral home of the Pueblo, Navajo and Apache people and to this day spans 23 sovereign nations (19 Pueblos, 3 Apache tribes, and the Navajo Nation), each with their own unique heritage and way of life. In New Mexico, there are:
Pueblos (19)
Acoma, Cochiti, Isleta, Jemez, Laguna, Nambe, Ohkay Owingeh, Picuris, Pojoaque, Sandia, San Felipe, San Ildefonso, Santa Ana, Santa Clara, Santo Domingo, Taos, Tesuque, Zia and Zuni.
Apache Tribes
Fort Sill Apache Tribe, the Jicarilla Apache Nation and the Mescalero Apache Tribe.
Navajo
Navajo Nation, Alamo, Ramah, Tohajiilee.
In the 1500s, Spanish explorers arrived in New Mexico, later founding Santa Fe, the states capital, around 1607. Modern day New Mexico was a part of Mexico until its seizure by the U.S. in 1850. Communities of color, mostly indigenous or having over five generations of family history make NM one of the most diverse and culturally grounded states. From 2017-2021, 33.0% of New Mexicans over the age of 5 spoke a language other than English at home. Spanish is the most prevalent non-English language, and it is an official language of the state. Native languages are spoken in all of New Mexico’s tribes and pueblos.
Foreign-born persons make up an estimated 9.2% of the population; 21.4% of children under age 18 are foreign-born or reside with at least one foreign-born parent (2022). In 2021, New Mexico was home to 192,634 immigrants: 99,977 females and 92,657 males, including 8,272 children. In 2016, the Pew Research Center estimated that 60,000 undocumented immigrants lived in New Mexico, which comprised 29% of the state’s immigrant population (3% of the total state population). One in eight New Mexico workers is an immigrant, a significant contribution to the workforce. As of March 2020, ~5,690 active Deferred Action for Childhood Arrivals (DACA) recipients lived in New Mexico.
EDUCATION, EMPLOYMENT & INCOME
In education, employment and income, New Mexico remains below the national rates, and continues to rank the third poorest state in the nation. Of New Mexicans 25 years and older, 86.8% have a high school graduate or higher, and 28.5% have a bachelor’s degree or higher.
From 2017-2021, 56.6% of New Mexicans aged 16 years or older were employed in the civilian labor force. Prior to the pandemic, unemployment was around 5%, but in 2021, 7.6% of New Mexicans were unemployed. From 2021 to 2022, New Mexico had a decrease in jobless rate and has been holding constant since mid-2022. In March 2023, the NM unemployment rate was 3.5, the same as the national unemployment rate (3.5%). In 2021, 19% of NM households with children had lost employment, compared to 20% nationally and 12.2% of NM children live in a household where no parent was employed or in the labor force. For those who are over the age of 16 and employed, the mean travel time to get to work was 22.9 minutes (2017-2021). There are 139,347 veterans in New Mexico (2017-2021).
The median household income in NM (in 2021 dollars) is $54,020 (2017-2021), nearly 22% lower than the national rate. Per capita income in the last 12 months (in 2021 dollars) was $29,624. Nearly all of the tribal communities have lower median incomes than the state. An estimated 18.4% of New Mexicans live in poverty which compares to 11.6% nationally. One in four children in NM live in poverty. An estimated 89.7% of households have a computer, and 80.0% of households have a broadband Internet subscription (2017-2021). Additionally, 43.0% of NM children are part of families receiving public assistance, putting our rank for that indicator at 50th in the U.S.(2021).
The American Rescue Plan Act of 2020 provided safety nets for birthing and parenting people receiving Medicaid benefits during pregnancy or for their children. In 2022, NM extended Medicaid for 12 months in the postpartum period, and the upcoming needs assessment will focus on the impact of the prolonged services on outcomes for postpartum people/mothers, infants and families in variety of areas. More detail follows about Medicaid in the perinatal period and opportunities for health status improvement.
HOUSING & FOOD SECURITY
There are 797,596 households with 2.59 persons per household, and 87.4% of persons aged 1 year or older lived in the same house 1 year prior (2017-2021). In mid-2022, 53.0% of NM households with children reported having difficulty paying for usual household expenses, higher than the national (48.0%). In the same year, 18.0% of NM and US households with children reported having little or no confidence that they would be able to pay their next rent or mortgage payment on time.
In 2021, 32% of children in NM households did not eat regular meals due to unaffordable food prices, comparing to 28% of US households. Fifteen percent of NM and US households experienced food security during the year (2019-2021). Child hunger persists, and solutions to this range from universal income to child tax credits. Paid family leave is another avenue for addressing pay gaps and to help families make ends meet without jeopardizing bonding and attention needed with their new children or caring for a loved one.
HEALTHCARE & HEALTH SYSTEMS
New Mexico expanded Medicaid to include low-income adults under the Affordable Care Act (ACA). Expansion has improved access to care, although having insurance does not guarantee access to a healthcare provider. Immediately after ACA implementation, the state’s uninsured rate was down to 12.8% in 2015, compared to 20.2% in 2013, and current estimates remain approximately 12%. At end of 2022, 884, 416 NM children and adults were enrolled in Medicaid or CHIP, which was 93% higher than reported for the end of 2013.
Medicaid finances approximately 62.3% of prenatal care benefits for resident births in NM (NM PRAMS). New Mexico consistently ranks in the top three states for the nation’s highest percentage of births covered by Medicaid, and well over half of NM resident births are financed by Medicaid each year. During pregnancy, individuals are covered if their household income is at or below 255% of the federal poverty level- FPL. Children aged 0-6 are eligible for CHIP coverage if the household income is at or below 305% of the FPL; all children are eligible for CHIP coverage if the household income is at or below 245% of the FPL. In 2020, the American Rescue Plan Act established the option for states to extend Medicaid and CHIP coverage, up to 12 months postpartum. Beginning in April of 2022, New Mexico extended postpartum Medicaid benefits to 12 months for all people with pregnancy Medicaid.
The Commonwealth Fund Scorecard on State Health System Performance compared 2016-2019 and 2018-2021 and found that 17.0% of women ages 18-44 went without a routine checkup in the last two years and that 31.0% women did not have a usual source of care. While the share of women who did not begin prenatal care in the first trimester improved from baseline measurements, 28.0% down from 32.0%, the proportion of women who did not attend a postpartum checkup increased to 14.0% from 13.0%. Almost half (47.0%) of children did not have age-appropriate medical and dental preventive care visits in the past year. New Mexico did see significant improvement in lowering high out-of-pocket medical spending relative to their annual household income and a reduction in the number of adults who went without care due to cost.
Loss of employment and healthcare coverage was a significant concern during and as NM emerged from the coronavirus pandemic. Federal restriction of Medicaid disenrollment was enacted to protect Americans throughout the pandemic. Additional protections, such as expanded assistance options for those who are not typically eligible for unemployment benefits, a new Healthcare Affordability fund, elimination of copays on behavioral health services for insured people, financial assistance for low-income New Mexicans, and the no or low-cost private insurance plan (beWellNM) and the High-Risk Medical Insurance Pool, ensure a minimum level of coverage and assistance for New Mexicans.
Pandemic-related and recovery challenges have included reduced healthcare accessibility, such as worsening provider shortages, decreased hospital and capacity, and equipment shortages which affected levels of care available and proximity to care, especially in rural areas. At baseline, thirty- two of NM’s thirty-three counties were designated full or partial “health professional shortage areas”. During the pandemic, some specialty populations, such as pregnant persons and CYSHCN in these rural areas, experienced additional barriers to receiving care when clinics and providers closed, reduced hours, or limited visitors. For example, some pregnant people reported challenges in making prenatal appointments because their provider limited the number of visitors at appointments, and they were unable to find care for their other children. Pregnant people who were also COVID positive faced barriers to prenatal care due to provider and clinic staff misinformation, and they were at times disrespected or mistreated during delivery care.
To improve utilization of care for the CYSHCN population, a limited amount of specialty clinics were coordinated throughout the state to reduce travel times for families, but most were changed to telehealth and many CYSHCN went without care., prenatal care and support groups were offered via telehealth. Other access challenges included access to food and other essential resources which protect health, such as propane and wood to heat homes through the winter.
Many post-pandemic challenges remain, and Medicaid disenrollment is one of those. With concerted collaboration between state agencies and local advocacy NGOs, there are continuous efforts to help families retain their benefits and to access care in a timely manner. Even with continuous coverage, many people struggle to be seen for primary and specialty care across every MCH population domain. Health provider shortages, rural hospitals and long distances to care result in OB/maternity care deserts and gaps in services for every age group.
These social determinants of health and healthcare challenges are not deficits of the population. They are deficits in health systems delivery and in administration of benefits for many different and historical reasons. They should not be construed as failures of the consumer population, and evidence persists that despite the mountain of difficulties our people face, resilience and problem solving prevail.
CHILD HEALTH RANKINGS
It is problematic to continue to frame New Mexico’s child health and education outcomes based on national comparisons. Although some indicators are good measures of progress, lack of progress or areas of concern, the Kids Count rankings do not measure assets, cultural resilience or traditional survival mechanisms most influential in our state. Some indicators are simply not analyzed correctly or in an actionable way, and this creates distractions for our state leadership. For example, low birthweight (LBW), which is associated but not always causally related to infant morbidity and mortality is misleading. LBW estimates should be presented among singleton births rather than the growing population of twins and triplets, and some health tracking systems also disaggregate birthweight from gestational age to make the information more understandable. Altitude is a factor in LBW, and appropriate measurement would adjust for an average or regional distribution of altitude to avoid confusion with significant remediable interactions, such as tobacco use.
An adjustment of core measures by poverty levels would render national indicators more useful, and as poverty constitutes its own aspect of the current rankings, it would be useful to acknowledge that in the interpretation of findings. Furthermore, implicit bias in measures such as teen birth rates and single-headed households (predominantly women) perpetuate antiquated assumptions about optimal outcomes, and in many perinatal outcomes, there is no evidence to support these indicators for state well-being. Even as teen birth rates decline in NM, the hypothesis that poverty would directly improve with decreasing teen births, is strikingly false (Personal note: fight me). Robust economic impact analysis shows instead that compared to peers of their own age, parenting teens in NM are more economically engaged and productive in the work force (Ganderton, 2005) over time. Appropriate analysis would consider social support, accessibility of doula, birth worker and home visiting influences on mode of delivery, prenatal care utilization and breastfeeding outcomes for birthing people of all ages.
Some health indicators of great value seem to be missing in Kids Count rankings and only included in a handful of state reporting. Breastfeeding is a protective investment both in health outcomes and in societal return on investment, however, it is missing in the indicators reported. The American Academy of Pediatrics has called for more promotion of exclusive and uninterrupted breastfeeding in the first six months of life as one of the most important influences of health over the lifetime, and this is missing altogether. They write in their 2022 policy recommendations: ‘ AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding’. Ironically, NM both excels in breastfeeding initiation rates and improved duration rates shaped by years of concerted and BIPOC-led strategies across the state. Workplace improvements are still needed, but sustained community-level breastfeeding promotion has helped to overcome some of those challenges with direct peer and traditional health expertise in communities of color.
Child health rankings seem to dehumanize and render theoretically helpless populations with the greatest potential for improvement of family health in New Mexico. Adolescent suicide is a grave concern in NM, and it deserves way more attention and resources than currently available, but that is not easily identified or called out in the aggregate of child and teen deaths. State and tribal partnerships continue to center this area for investment, but it might be lost in the distractions of less impactful measures and prioritization.
Although national comparable data have great value, they are not serving our public health and community-lead health efforts, especially among those most vulnerable. More important measurements would account for stronger evidence in birth outcomes and early childhood health. State Title V Maternal Child Health programs have the opportunity and great responsibility of reframing perinatal and childhood indicators to institute change, and there is a significant amount of work ahead of us.
References
2023 New Mexico Kids Count Data Book. New Mexico Voices for Children. (2023, June). Retrieved July 19, 2023, from
New Mexico 2023 KIDS COUNT Profile – New Mexico Voices for Children (nmvoices.org)
2023 Scorecard on State Health System Performance. COVID-19 | Commonwealth Fund. (2023, June 22). Retrieved July 24, 2023 from https://www.commonwealthfund.org/publications/scorecard/2023/jun/2023- scorecard-state-health-system-performance
American Immigration Council. (2020). Immigrants in New Mexico. Retrieved July 18, 2023, from https://www.americanimmigrationcouncil.org/sites/default/files/research/immigrants
Annie E. Casey Foundation. (n.d.). Selected Kids Count Indicators for State in New Mexico. KIDS COUNT Data Center. Retrieved July 19, 2023, from https://datacenter.aecf.org/data/customreports/33/any
Barnes, Z. April 2023. State Unemployment Rates. Retrieved July 17, 2023, from https://www.ncsl.org/labor-and-employment/state-unemployment-rates
Data.Medicaid.gov. State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data. Retrieved July 21, 2023, from. https://data.medicaid.gov/dataset/6165f45b-ca93-5bb5-9d06-db29c692a360/data
Healthinsurance.org. Medicaid eligibility and enrollment in New Mexico. Retrieved July 21, 2023, from https://www.healthinsurance.org/medicaid/new-mexico/
Migration Policy Institute. State Immigration Data Profiles. New Mexico. Retrieved July 18, 2023, from
https://www.migrationpolicy.org/data/state-profiles/state/demographics/NM
New Mexico Breastfeeding Task Force. Is your Hospital Baby-Friendly?. Retrieved July 18, 2023, fromhttps://breastfeedingnm.org/programs-services/hospitals-clinics/
New Mexico Health Care Workforce Committee. (2022, October 1). 2022 Annual Report. Retrieved July 18, 2023, from https://digitalrepository.unm.edu/cgi/viewcontent.cgi?article=1009&context=nmhc_ workforce
New Mexico’s Health Indicator Data & Statistics, American Community Survey Query Measure Selection. Retrieved July 19, 2023, from https://ibis.doh.nm.gov/query/selection/acs/_ACSSelection.html
Pew Research Center. (2019, February 5). U.S. unauthorized immigrant population estimates by state, 2016. Retrieved July 18, 2023, from https://www.pewresearch.org/hispanic/interactives/u-s-unauthorized-immigrants- by-state/
United States Census Bureau. QuickFacts: New Mexico. Retrieved July 17, 2023, from https://www.census.gov/quickfacts/NM
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