III.B. Overview of the State

 

POPULATION

As the fifth largest state with 121,365 square miles, New Mexico’s (NM) wide-open plains, dense forested mountains and broad deserts provide breathtaking scenery and endless opportunities for recreation. Despite its span, New Mexico’s population is only 2 million. It 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. New Mexico’s population density sits at only 17.3 persons per square mile. Seven percent of the population resides in frontier or sub-frontier areas. In fact, the majority of counties (24) have population densities of less than 15 persons per square mile. From 2010 to 2019, two-thirds of the state’s counties experienced a decline in population.

 

In 2019, NM's total population was 49.3% Hispanic, 37.6% non-Hispanic White, 9.1% American Indian or Alaskan Native, 2.3% Black or African American, and 1.8% Asian and Pacific Islander, with 5.8% of persons under the age of 5, 23% under the age of 18, and 50.5% female. In 2019, 10.5% of New Mexicans under age 65 years lived with a disability and 12.0% under age 65 years were without health insurance.

 

These figures solidify New Mexico as one of the most diverse and rural states, which makes it a challenge to provide timely access to many services, including health care. In more sparsely populated areas of the state, providing health care and public health services pose challenges, such as the ability to hire and maintain full-time clinicians and specialists, and the great distances that many people must travel to get care. These challenges became even more apparent during the novel Coronavirus pandemic, which exacerbated the hardships experienced by low income and rural New Mexicans.

 

 

LANGUAGE, CULTURE & IMMIGRATION

New Mexico is home to resilient and culturally rooted populations, including 23 Federally Recognized Tribes. Communities of color, mostly indigenous or having over five generations of family history make NM one of the most diverse states. New Mexico has a rich cultural heritage with a blend of many peoples and cultures. 

 

Most NM residents (over 60%) identify as a person of color or American Indian/Alaska Native. The Hispanic populations of NM include deeply rooted families and more recent immigrants.  Although small, the Black population has a significant voice in improving health through organizations such as the Office of African American Affairs, the NM Birth Equity Collaborative, Black Health New Mexico, and the Governor’s Task Force on Racism and Equity.

 

Thirty-three percent of NM’s population speaks a language other than English at home. Native languages are spoken in all of New Mexico’s tribes and pueblos. A high proportion of Native American children ages 5 to 17 living in their communities speak their native language, and a higher proportion of Native American children (31 percent) speak English and another language than do New Mexico children as a whole (26 percent). Tribes with more than half of their children speaking two languages include Acoma, Cochiti, Jemez, San Felipe, Santo Domingo, Zia, and Zuni.

 

Many families are of mixed status, documented and undocumented, and several NM cities have passed policies supportive of immigrant safety. Foreign born persons makeup 5.6% of the population. In 2018, New Mexico was home to 198,522 immigrants: 92,604 women, 95,014 men, and 10,904 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.

 

The coronavirus pandemic impacted culture and bilingualism in less measurable, however no less significant ways. With the suspension of operations at Navajo Nation and other tribes and pueblos due to the pandemic, events and gatherings which promote cultural connection and provide a platform for native communication were halted. Additionally, the loss of life, especially elders, whose wisdom, cultural knowledge and native fluency are considered sacred, has affected the opportunities for native youth’s learning of culture, history and language.

 

EDUCATION, EMPLOYMENT & INCOME

When assessing education, employment and income, New Mexico remains below the national rates, and ranks the third poorest state in the nation.

 

Of those aged 25 years or older, 85.6% were a high school graduate or higher, and 27.3% had earned a bachelor’s degree or higher.

 

As far as employment, 57.3% of New Mexicans aged 16 years or older were employed in the civilian labor force from 2015-2019. In October 2020, New Mexico’s unemployment was 8.1%, higher than the national average of 6.9%. The New Mexico annual unemployment rate decreased from 7% in 2015 to 2.5% in 2019, dropping below pre-recession (2009) rates of 4%; 10.6% of NM children live in a household where no parent was employed or in the labor force. Since March 13, 2020, 46% of households with children lost employment income in New Mexico, which is less than the national average of 49%. In 2019, the mean travel time for employment was 22 minutes.

 

From 2015-2019, the median household income (in 2019 dollars) was $49,754, and per capita income in the past 12 months was $27,230. In contrast to 12.3% nationally, 18.2% of the population lives in poverty.

 

In 2019, 18.2% of New Mexicans are now living in poverty, compared to 10.5%, nationwide.  Between 2019-2019, almost one-third of NM children, aged 0-17, lived in poverty. Additionally, 35% of NM children are part of families receiving public assistance, putting our rank for that indicator at 50th in the U.S.

 

During the coronavirus pandemic, financial burden experienced by families was widespread. A host of federal, state and local programs and services were developed in order to address the health and well-being of families and individuals throughout the state. Most notably, the American Rescue Plan Act (ARP) of 2020 provides funding, program support and tax policies to reduce the burdens felt by Americans throughout the U.S.

 

 

HOUSING & HOMELESSNESS

New Mexico falls short of the US median household income of ($49,754 and $62,843, respectively).

 

Low-income households throughout New Mexico faced unprecedented financial strains during the pandemic. Challenges experienced were synonymous with national trends- loss of employment or healthcare, limited access to care, as well as other financial stressors and burdens.

 

The unhoused population in New Mexico was not spared from the burdensome effects of the pandemic. During the height of the pandemic in 2020, unhoused individuals experienced social isolation, increased risk of covid-19 disease and lack of access to resources. Shelters throughout the state experienced covid-19 outbreaks and faced numerous challenges in protecting the health and wellbeing of not only their patrons but their staff as well. One mitigation effort which yielded some success in prevention of covid-19 transmission as well as adherence to isolation/quarantine guidelines was the temporary lodging of unhoused people with medically high-risk conditions, covid-19 positive cases or exposed individuals and some families with young children in hotels.

 

 

HEALTHCARE & HEALTH SYSTEMS 

New Mexico was one of the states that expanded Medicaid to include low-income adults under the Affordable Care Act (ACA).  This has helped improve access to some extent, 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 the end of 2020, 818,279 New Mexico children and adults were enrolled in Medicaid. Currently, 42.3% of Medicaid enrollees are children under age 21 years, 9.5% are non-expansion parents and caretakers, 32% are adults under Medicaid expansion, and .7% are pregnant (HSD, 2020). Sixty-three percent of NM children under the age of 21 were enrolled in Medicaid in 2018. 

 

Medicaid finances over 65% of prenatal care for resident births in NM. During pregnancy, individuals are traditionally covered if their household income is at or below 250% 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, this option will be available for 5 years. 

 

Loss of employment and healthcare coverage was a significant concern amidst 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.

 

Further challenges included healthcare accessibility, such as continued provider shortages, hospital and capacity, equipment shortages which affected level of care availability, and a person’s proximity to care, especially in rural areas. At baseline, thirty-two of NM’s thirty-three counties are 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 also faced barriers to prenatal care due to provider and clinic staff misinformation and lack of proper personal protective equipment.  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.

 

The Commonwealth Fund Health Care Coverage and COVID-19 Survey, conducted from March through June 2021, found that almost half of respondents had been directly affected by the pandemic in one of the following ways: they experienced a COVID-19 infection, lost income or lost their employer sponsored healthcare coverage. Furthermore, a third of adults reported they had lost income. In terms of challenges faced in paying medical bills or medical debt, one third of insured adults and half of uninsured adults had this experience in the previous year. For those who did have problems with paying medical bills and/or medical debt, 35% used all or most of their savings, 35% assumed new credit card debt, 27% were unable to pay for basic needs like food or rent, and 23% delayed education or career plans.

 

 

SUMMARY

 

Persistent challenges in advancing Maternal Child Health are still experienced in New Mexico, and the novel coronavirus pandemic exacerbated many of these for its residents.  Communities of color, and especially Native American communities, have been hit hard by COVID. In its pandemic response, NMDOH quickly mobilized to protect the health of New Mexicans. Public health offices closed, and staff pivoted to remote work arrangements from home, which affected day to day operations in every aspect from client communications to policies and reporting.

 

As the virus spread in New Mexico, staff leaned into the pandemic response in areas of contact tracing and case investigations, covid-19 testing site work and coordination, and other pandemic related duties; for example, helping families get connected to resources such as food, housing, and financial assistance. State agencies came together, and new non-traditional partnership were created. Because of these efforts, New Mexico maintained lower cases (daily average of 6 per 100,000) and hospitalizations (daily average of 4 per 100,000), than the national average (US case daily average of 8 per 100,000; US hospitalization daily average of 6 per 100,000). However, the New Mexico death rate (0.10 per 100,000) was slightly higher than the national (0.09 per 100,000).

 

As the covid-19 vaccinations became available in the U.S. via Food & Drug Administration Emergency Use Authorization, many staff were redistributed once again to focus on vaccine promotion and distribution efforts. New Mexico’s vaccination rollout has had great success; in fact, at the time of this writing, NM is leading the country with the highest percentage of constituents with vaccination series completed at 54.9% of New Mexicans.

 

Unfortunately, these changes due to the pandemic did impact progress on Title V objectives, which we will discuss later in greater detail.

 

References

 

American Immigration Council. (2020). Immigrants in New Mexico. Retrieved from https://www.americanimmigrationcouncil.org/sites/default/files/research/immigrants_in_new_mexico.pdf.

Annie E. Casey Foundation, Kids Count Data Center, 2019.

Collins, S. R., Aboulafia, G. N., & Gunja, M. Z. (2021, July 16). As the Pandemic Eases, What Is the State of Health Care Coverage and Affordability in the U.S.? As Pandemic Eases What's State of Coverage Affordability in U.S.? | Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2021/jul/as-pandemic-eases-what-is-state-coverage-affordability-survey.

Estimated Population Counts, 2019. Retrieved on July 13, 2021, from New Mexico Department of Health, Indicator-Based Information System for Public Health website: http://ibis.health.state.nm.us/

New Mexico Department of Health COVID-19 Vaccine Dashboard. cvvaccine.nmhealth.org. (n.d.). https://cvvaccine.nmhealth.org/public-dashboard.html.

NM-IBIS: University of New Mexico, Geospatial and Population Studies (GPS) Program, 2019

Population, 2017. Retrieved on July 13, 2021, from New Mexico Department of Health, Indicator-Based Information System for Public Health website: http://ibis.health.state.nm.us/

NM PRAMS, 2018. Retrieved on July 14, 2021, from New Mexico Department of Health, Indicator-Based Information System for Public Health website: http://ibis.health.state.nm.us/

 

 

U.S. Bureau of Labor Statistics. (2020). Employment situation summary. Retrieved July 7, 2021.

U.S. Census Bureau. 2014-2018 American Community Survey Public Use Microdata Samples.

U.S. Census Bureau. 2015-2019 American Community Survey Public Use Microdata Samples.

U.S. Census Bureau. Selected housing characteristics, 2015-2019.