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