Midland, Texas

A growing city in west Texas, Midland’s future changed dramatically in 1923 with the discovery of oil, attracting thousands of investors and workers eager to find their fortune.

Midland’s history and plans for the future are closely linked to the oil industry. By 1950, more than 200 oil companies had set up offices in Midland, increasing the population and supporting the construction of new schools, a full-service hospital, and cultural attractions. Competition from foreign oil producers during the 1960s forced some companies to leave, but the boom period returned in the 1970s and Midland continued to prosper through the early 1980s. Growth came to an abrupt halt when oil prices collapsed by nearly 70% in early 1986. As oil prices recovered through the 2000s, Midland’s population and economic growth have resumed, although the long-term effects of the current decline in oil prices may temper that prosperity.

Although the oil industry remains the city’s dominant source of employment, civic leaders have worked to diversify the economy and develop a comprehensive framework for the future, including investments in housing, transportation, and green spaces.

Overview

Population and Demographics

Population: 128,000

SOURCES:
U.S. Census Bureau; photography courtesy Flickr user imagematters1, CC BY-NC-ND 2.0.

Context and Actions

Community Context and Challenges

Local economic growth has outpaced that of most of the nation—Midland residents have a significantly higher median household income than Texas residents, however stark income disparities exist across sub-populations in the city.
One in five adults (21%) in Midland lack health insurance, with 32% of Hispanic residents uninsured, compared to 23% of Black residents and 19% of white residents.
Factors influencing the high rate of uninsurance in Texas include the state’s refusal to expand Medicaid under the Affordable Care Act and historically low thresholds for Medicaid eligibility; insufficient access to primary and preventative care is also a concern—30% of residents have no doctor or health care provider.
The growing population and increased traffic volume has strained decades-old resources and infrastructure, while creating congestion that affects public safety and quality of life.
Infrastructure concerns are reflected in health outcomes such as high rates of obesity and physical inactivity; 31% of adults in Midland County are obese, compared with 28% for Texas and 26% of adults report no leisure-time physical activity, compared with 24% for the state.

SOURCES:
U.S. Census Bureau. (2014). 2010–2014 American Community Survey 5-Year Estimates

Taking Action

Longstanding initiatives supported by local institutions, businesses, and organizations have offered a range of health and social services to address unmet community needs.

However, evidence of collaboration and coordination among partners, reach of the initiatives to populations especially in need, and the impact on population health are not well-documented and thus difficult to assess.

NOTE:
These baseline reports, created in 2016, track community programs and initiatives in their early stages and measure initial progress only. Future reports will provide more in-depth insights and analysis into this community's efforts to build a Culture of Health.

Comprehensive Plan for the Future

Community leaders have engaged residents in developing a comprehensive plan for its long-term future that provides a framework for investments in housing, transportation and quality of life issues, such as availability of parks and green spaces. However, a lack of understanding about the value of primary and preventive care among uninsured, low-income and non-English-speaking populations is an ongoing concern.

Long-Standing Initiatives

Long-standing initiatives supported by Midland Memorial Hospital, the United Way, local businesses, and community organizations have offered a range of health and social services to address unmet needs.

Tall City Tomorrow

Tall City Tomorrow serves as a blueprint for decision-making that reflects input from Midland residents, businesses, city government agencies, planning and transportation experts and others. This planning process identified broad priority areas that will inform land use development and public investment decisions over the next 10 to 20 years.

High Uninsurance, Limited Access to Care

Midland’s high levels of uninsurance and resulting lack of access to primary and preventive care contribute to elevated rates of chronic lower respiratory disease, chronic liver disease and cirrhosis, and sexually transmitted diseases, compared with state levels, according to a 2015 community health needs assessment.

Going Forward

Midland’s strong business climate and emphasis on economic growth have contributed to prosperity benefiting large sectors of the population. However, the state’s refusal to expand Medicaid under the Affordable Care Act and the modest efforts of Midland’s community stakeholders in addressing significant inequities in access to health care threaten to solidify the already sharp differences in health outcomes among Midland’s uninsured and low-income residents.

Additional surveillance, data and information gathering, analysis, and reporting will examine the extent to which ongoing initiatives are coordinated across sectors, help to meet the demand for services, and bridge cultural differences through education and outreach.

The following questions could provide insights into the degree to which meaningful change is taking place:

What strategies are being used to identify and assist low-income and minority populations, especially those without health insurance, to access health care services?
To what extent does collaboration and coordination exist among Midland’s key organizations, including Midland Memorial Hospital, the United Way, and local business groups, to address gaps in services for the community’s low-income and uninsured population?
To what extent is the health department involved in education and outreach to Midland’s Hispanic community? Do other organizations partner in this effort?
To what extent are Midland residents limited in obtaining health insurance coverage by their status as legal immigrants or as undocumented immigrants?
What impact has the closure of the Planned Parenthood clinic in Midland had on access to reproductive health services? Has the local Federally Qualified Health Clinic been able to fill the gaps in services formerly provided by Planned Parenthood?
Given the lack of physicians to treat patients covered by Medicare and Medicaid, what specific strategies has Midland considered to recruit and retain mid-level health physicians, such as physician assistants and nurse practitioners?
To what extent are health providers who work in area clinics able to provide education and follow-up to children and adult patients?