The City of El Paso Department of Public Health (CEPDPH) serves the West Texas counties of El Paso and Hudspeth. The City of El Paso is the principal city in the area and is the sixth largest city in Texas and the 20th largest city in the US with a 2015 census population estimate of 681,124, a 4.9% increase from the 2010 census and a 20.84% increase from the 2000 census (https://www.census.gov). El Paso is located in the Southwest Region of the country and in the Far West corner of Texas abutting the US/Mexico border. El Paso is one of the poorer areas in the nation, with a per capita income of $18,705 that is only 65.50% of the national average of $28,555, thus meeting the criterion of an Economically Distressed Area as defined by the Government Accountability Office. El Paso County's 2014 estimated poverty rate of 23.4% far exceeds the 17.7% state rate and the 15.6% national rate. The leading health disparities in the El Paso area are diabetes, hypertension, obesity, and heart disease. In 2017-2018, El Paso experienced a major influx of influenza, with 12,405 reported cases compared to 4,619 reported cases in 2016-2017, and 6,144 in 2015-2016. The community also lags behind national rate in having proper preventive dental care. With extremely high rates of uninsured persons with limited or no access to preventive health, local providers face multiple challenges in serving El Paso, a community with a disproportionate physician/patient ratio, a high teen pregnancy rate, and a usage of the emergency room for treating basic and preventable health issues.
Issue: The CEPDPH faces multiple challenges in providing the HPV vaccine, as well as other vaccines for preventable diseases. Having a large service area with both urban and rural areas, the CEPDPH needs to work closely with community partners in reaching families with education about the HPV vaccine. It is crucial to have a basic understanding of the challenges that the CEPDPH faces in serving a demographic where many families face very poor prospects to adequate health care, making public health services extremely more important than in other communities where poverty and the lack of adequate health insurance are not as pronounced. The CEPDPH works in a resource-poor backdrop where socio-economic barriers are experienced by the majority of its clients. To illustrate a snapshot of these challenges, when compared to other states, Texas has the largest number of uninsured people in the nation, with more than 4.3 million Texans, including 623,000 children lacking health insurance (Texas Medical Association, 2016). Texas is one of 19 states that has not expanded Medicaid. In such states, 3.1 million poor uninsured adults fall into a coverage gap” and will likely remain uninsured (Kaiser Foundation, 2016). These individuals would have been eligible for insurance coverage under the Medicaid expansion; however, they do not earn enough for premium tax credits to purchase Marketplace coverage, which begin at 100% FPL. Disconcertedly, there are over three million uninsured poor non-elderly adults in the coverage gap. In this pool, there are approximately 700,000 uninsured Hispanic non-elderly adults, of which a staggering 52% reside in Texas (Kaiser Family Foundation, 2016). Comparatively, of the uninsured nonelderly adults in the US, 19% of the 1.4 million of the whites and 16% of the 0.9 million blacks live in Texas. Together all subgroups comprise over five million Texans lacking health insurance in 2014, nearly one of every five individuals. Texas makes Medicaid available to persons with disabilities who have incomes below 75 percent of the FPL (under $9,000 a year for an individual); pregnant women with incomes less than 200 percent of the FPL (about $23,500 a year); and parents with incomes less than 19 percent of the FPL (just under $5,000 a year for a family of four) (Heberlein et al, 2012). In a study funded by The Commonwealth Fund, 1,000 Texans low-income Texans were surveyed in late 2013, 2014 and 2015, comparing to 1,000 low-income individuals surveyed in Kentucky and Arkansas, both of which expanded Medicaid under the ACA.
To address the problem, The CEPDPH's Immunizations Program is one of the most engaged prevention programs in Texas with 109 Texas Vaccines for Children (TVC) participating providers and over 60 community partners, including public and private schools, the Housing Authority of the City of El Paso, homeless shelters, community-based organizations, and higher education institutions. The staff works diligently using a multi-pronged strategy comprised of a technical assistance component, a dissemination of information component, and a direct service component. A standout feature of program is the emphasis placed on illness prevention, and in the case of HPV, the prevention of cancer. The strategy allows the staff to focus on the possible negative health outcomes that can comes from not vaccinating, instead of focusing on the modes of transmission, which often is the deciding factor for partners in having their children vaccinated for HPV. Through its technical assistance capacities, the CEPDPH oversees and provides technical assistance to the various participating providers. Technical assistance consists of onsite compliance visits, approving vaccines for ordering, and providing guidance to the providers on strategies to maximize the disbursement of vaccines to the targeted clientele. To disseminate important information about vaccinations, including cancer prevention, statistical information, and best and promising practices, the CEPDPH publishes a bi-monthly electronic newsletter for its TVC and community partners and the staff communicates through an email distribution list for more pressing information. The department also issues frequent news releases to educate the community at-large through feature articles in the El Paso Times and the El Paso Diario, a regional Spanish language newspaper. The CEPDPH also provides vaccines through its own clinics throughout the El Paso area. The department's website provides information in Spanish, as well at EPSalud.com and EPHealth.com.
Goals and objectives: A nurtured healthy and sustainable community; improved communication among a network of partners; and increased HPV vaccinations. The CEPDPH partnered with local TVC providers to develop and implement a community-wide plan to ensure that parents are educated about the benefits of having their children vaccinated for HPV. Moreover, through education on cancer prevention, the CEPDPH increased the number of HPV vaccines over the last five (5) years.
Results:
- 48,254 children, youth and adults vaccinated in 2017;
- 3,611 HPV vaccines HPV vaccines administered to children and young adults ages 9 to 18 in 2016;
- 2,258 HPV vaccines administered in 2017; and,
- 46 outreach events, 40 community presentations, and 47 health fairs in 2017.
The CEPDPH website is: https://www.elpasotexas.gov/public-health