Hispanic-Serving Institutions Contributing to the Training and Diversity of the Public Health and Health Care Workforce

Abstract

The University of Texas at El Paso (UTEP), a Hispanic Serving and Carnegie R1 institution, serves as a pathway for socioeconomically diverse Hispanic/Latino (H/L) health profession students via equal-access strategies. The Center for Institutional Evaluation, Research, and Planning data illustrates UTEP’s success in graduating H/L health professionals (i.e., allied health, nursing, pharmacy, and psychology) students between 2014 and 2023. Nearly 90% of these graduates are employed in Texas one year after graduation, and 85% remain employed after 10 years. (Am J Public Health. 2024;114(S6):S472–S477. https://doi.org/10.2105/AJPH.2024.307655)

The Hispanic/Latino (H/L) population is the largest US ethnic minority group, projected to increase by 60% in 2050.¹ It is also projected that the H/L population will become more diversified both in ethnic/racial identity and socioeconomic status.¹ Despite this growth and diversity, recent reports indicate that the H/L population is underrepresented in the public health/health care workforce.^2–4 Hispanic Serving Institutions (HSIs), classified by Title V of the Higher Education Act, have a role in expanding educational pathways to educate the next generation of the health care workforce.

INTERVENTION AND IMPLEMENTATION

The University of Texas at El Paso (UTEP) serves as a case study of an HSI/Carnegie R1 institution that leverages its research capacity with its focus on student success. It has historically and intentionally served its US-Mexico Border region in West Texas. UTEP is a community-engaged institution that is responsive to the needs of its community.⁵ In the past four decades, UTEP has driven significant growth in its academic programs, research expenditures, and the diversification of its student population (Figure 1). It intentionally shifted from an institution that primarily enrolled students from more affluent areas in the region to one that better reflects its community demographics. UTEP has also driven significant growth in research expenditures and academic programs, strengthening its position and ability to meaningfully affect its educational outcomes which have led to the diversification of the health care regional workforce. UTEP has achieved this through multiple strategies; in this article, we focus on three:

• 1.Enhance K-16 pathways to ensure representative enrollment
• 2.Adopt institutional policies to increase college enrollment and student success
• 3.Enhance academic and research programs to address emergent health needs of the US-Mexico border region

FIGURE 1—

The University of Texas at El Paso (UTEP) Timeline of Strategic Events and Impact

Note. Included in the timeline are examples of the three strategies UTEP uses to increase the diversification of students in health care professions. Strategy 1) Enhance K-16 pathways to ensure representative enrollment; Strategy 2) Adopt institutional policies to increase college enrollment and student success; Strategy 3) Enhance academic/research programs to address emergent health needs of the US–Mexico border region.

K-16 Pathways

In the 1980s, the El Paso K-12 education system was considered among the most underperforming in the nation. In 1991, UTEP President Diana Natalicio established the El Paso Collaborative for Academic Excellence in collaboration with local school districts, the El Paso Community College, and other regional stakeholders to raise the aspirations and preparation of K-12 students, and to improve access to higher education. During the first 25 years, high school enrollment in the region increased by 24%, high school degree completion increased by 74%, and high school graduates enrolling in higher education increased by 102%.^6,7 UTEP’s College of Nursing exemplifies how this collaboration has enhanced recruitment from magnet high schools with health professional tracks to the program. In this case, high school students tour and access UTEP’s College of Nursing clinical simulation center for immersion into nursing practice. Additionally, the community college works closely with College of Nursing to ease the transfer from introductory science courses to required UTEP nursing courses in preparation for the student selection process.

Institutional Policies/ Practices

Enrollment

Many institutions hinder access to higher education by adopting policies correlated with socioeconomic characteristics (e.g., requiring high standardized test scores and high school ranks). These selective policies are ostensibly implemented to identify students most likely to succeed in college. However, longitudinal analysis of UTEP students revealed that pre-entry characteristics have limited statistical power in explaining success and, more importantly, that the institution can create conditions that increase the likelihood of success for all students, including those considered to be at high risk for attrition.

Financial

Affordability is a key to accessibility and success. Sixty-eight percent of the UTEP student body receives financial support through financial aid and scholarships, and the average out-of-pocket expense for students is $800 a year. Moreover, UTEP offers free tuition to students from households with incomes of $75 000 or less.

Retention and quality education

To increase retention and persistence, UTEP adopted an asset-based framework that acknowledges the strengths of its students’ demographic, cultural, and experiential characteristics. Additionally, UTEP leverages its faculty’s community-engaged research and service education to increase faculty-student interactions, which are integral in enhancing student educational experience, mentoring, and career development. Another critical factor to UTEP’s student success is its large proportion of H/L faculty (32%), some of whom were first-generation college students, significant in comparison to the national H/L faculty rate (4%).

Academic and Research Programs

Three decades ago, the El Paso region was among the poorest metropolitan areas in the nation, with poverty rates at nearly 30% and a manufacturing-focused workforce. Through UTEP’s community, regional agency, and industrial partnerships, it has had a critical role in transforming the region’s workforce. UTEP had five health-related academic programs before 1990 and has added 18 health-related undergraduate and graduate programs in following years. Between 1993 and 2021, multiple health-related advanced degrees, including Nurse Practitioner/Doctor of Nursing Practice, Doctor of Interdisciplinary Health Sciences, Doctor of Physical Therapy, and Doctor of Pharmacy, were created in response to regional health care needs. UTEP’s School of Pharmacy exemplifies its mission to diversify the pharmacy workforce by enhancing students’ cultural competency to prepare them to care for diverse patient populations. Required Spanish-language courses are incorporated into the PharmD curriculum to develop bilingual skills. Additionally, students complete StudyAway experiences in the United States and other nations, allowing for exposure to different cultures and communities, many of which benefit from bilingual pharmacy students’ skills in areas with few, if any, Spanish-speaking pharmacists. The creation of these advanced health care degrees contributes to the local workforce needs, facilitates the social mobility of students from low socioeconomic status, and positively impacts the health of the community that UTEP serves.

PLACE, TIME, AND PERSONS

UTEP is situated in El Paso, along the US–Mexico border with Cuidad Juárez, Mexico, and southeastern New Mexico. The region has an estimated 2.3 million people and a predominantly H/L population (83%). In 2021, the median income in El Paso County was lower ($50 919) than that of both Texas and the US ($67 321 and $69 021, respectively), and had a poverty rate of 18.8%, almost twice the national rate (10.5%).⁸ In 2022, UTEP enrolled 23 880 students: 83% from El Paso County, 47% from the lowest income quartile, and 84% of students reporting H/L ethnicity. UTEP educates underserved student populations, including low-income students, full-time employed students, and students from nontraditional ages and backgrounds. Nearly half of the students at UTEP are first-generation students.

PURPOSE

In light of national calls for health care workforce diversity and representation of underserved populations, this article demonstrates how UTEP has contributed to the H/L workforce by strategically responding to the region’s needs.^9–11 A descriptive and retrospective analysis of degree completion among H/L undergraduate and graduate health profession students was conducted.

EVALUATION AND ADVERSE EFFECTS

Between 2014 and 2023, 11 976 health profession degrees were awarded, 79% of which were earned by H/L students. This includes 8731 undergraduate and 3245 graduate degrees awarded (84% and 64% by H/L students, respectively). Figure 2 illustrates the increasing number of health-related degrees awarded to H/L undergraduate and graduate students from 2014 to 2023. Through community partnerships and relationships in the health care industry, this educational pathway extended to workforce entry and other graduate programs (UTEP is one of the top institutions for H/L doctoral graduates). At the time of analysis, nearly 90% of health science graduates were employed in Texas one year after graduation, and 85% remained employed in Texas after 10 years. The US Department of Labor data show that 89% of these graduates were employed full-time in Texas and 89% in the El Paso region in 2021. These outcomes have (1) transformed the regional health care workforce, which has grown by over 90%; (2) enhanced regional workforce productivity; (3) impacted student social mobility, enabling movement from the bottom income quintile to the top income quintile, and (4) reduced the regional poverty rate from nearly 30% to less than 20%.^12,13

FIGURE 2—

Health-Related Degrees Awarded Undergraduate Graduate Students in the College of Health Sciences, College of Nursing, School of Pharmacy, and Department of Psychology: University of Texas El Paso, 2014–2023

Note. The College of Health Science includes degrees in clinical laboratory sciences, kinesiology, health promotion, occupational therapy, public health, rehabilitation sciences, social work, speech-language pathology, a doctorate in Interdisciplinary Health Sciences, and a special professional degree in physical therapy. See also supplemental Table A (available as a supplement to this article at https://www.ajph.org). Data for the School of Pharmacy is only for the first three cohorts of students awarded graduate degrees in 2021, 2022, and 2023.

SUSTAINABILITY

UTEP’s multilevel strategy can be traced to historical actions led by a president who provided leadership for 30 years. Despite leadership changes, the university has demonstrated its continued commitment to institutionalized strategies. In 2017, UTEP ranked first nationally in student social mobility, and in 2023, ranked first in Texas for student social mobility.^12,13

Fostering student success for lower-income students is strategic in ensuring a health care workforce representative of individuals experiencing disparities in health outcomes and quality of care.

PUBLIC HEALTH SIGNIFICANCE

UTEP’s contribution to the health profession workforce diversity is critical for addressing the persistent health disparities in the H/L population it serves. In 2022, the US Latina/o/x public health collective stated, “We cannot reduce the burden of disease or effectively address pandemics as they affect people of color when we exclude those same people from the work of developing solutions.”¹⁴ UTEP’s equal-access approach can be modeled and adapted by institutions looking to expand educational pathways toward a more diverse and locally representative health care/public health workforce to solve regional public health issues. UTEP’s success can be attributed to its self-study and data-led approach, which informs its strategy for yielding the outcomes it identified as necessary for the region and its students. UTEP continues using the metrics it identified as effective in predicting UTEP student success. Higher education institutional shifts are needed nationwide to respond similarly and effectively to national and international trends impacting health.