F. Marie Hall Institute of Rural Health
HomeF. Marie Hall Institute for Rural Health


The F. Marie Hall Institute for Rural and Community Health has devoted extensive resources to understanding the demographic, economic, and health care infrastructure issues of rural Texas, and rural West Texas in particular.

It is important for community leaders, educators, policy developers, economic development professionals, and rural advocates to be aware of the needs facing rural communities as well as the opportunities that abound.

West Texas and much of rural America demonstrate four prevalent population trends:

  • The rural population as a whole is growing slowly, but its relative share of the overall total population has dropped markedly.
  • The rural population is declining in West Texas counties not adjacent to metropolitan areas.
  • The demographic profile of West Texas is changing dramatically.
  • Declines in population are associated with factors of economic hardship that are worsening.
Per Capita Income and Poverty Comparisons for Texas
Per Capita Income % Poverty, All Ages % Poverty, with Related Children % Poverty, over Age 65
U.S. $30,906 12.4% 16.1% 9.9%
Texas $29,039 15.4% 20.2% 12.8%
West Texas $23,156 18.5% 23.9% 16.3%
West Texas Border $18,823 25.7% 30.7% 26.2%

Source: Most recent data available. Income information from the Bureau of Economic Analysis, 2002 data. Poverty data from the U.S. Bureau of the Census, 2000 Census.

Texas Map - Hispanic percentage

Texas Map - Change in senior population

Source: The Texas Challenge in the Twenty–First Century: Implications of Population Change for the Future of Texas prepared by the Center for Demographic and Socioeconomic Research and Education. http://www.txsdc.tamu.edu/

Limited Access to Health Care

Limited access to care is exhibited by the fact that, in West Texas, there are 27 counties that have one or no physician. Nine counties have no primary care physician, no nurse practitioner and no physician assistant. An additional 37 counties have no hospital, and 19 have no pharmacist. Fifty–four counties are designated as primary care health professional shortage areas, and 80 are classified as medically underserved and have limited access to public health services. As in much of the nation, public health infrastructure has declined in recent years. The Texas State Office of Rural Community Affairs has determined that 75% of rural Texas hospitals reported financial losses for the past year.

Texas Map - Number of Doctors by County
Comparison of health professionals per 100,000 population.
Ratio of primary care doctors Ratio of physician assistants Ratio of nurse practitioners Ratio of pharmacists Ratio of RNs Ratio of LVNs
U.S., 2000 69 14.4 33.7 71.2 780.2 240.8
Texas, 2005 (2000) 68.5 (56) 14.7 (11.9) 17.7 (24.4) 73.7 (74.1) 628.6 (603.4) 269 (280.9)
West Texas, 2005 41.7 16 13.4 50.9 364.5 424
West Texas Border, 2005 25.7 15.2 18.4 64.1 230.7 161

Source: U.S and Texas data from HRSA Bureau of Health Professions (most recently reported, 2000), West Texas and West Texas Border data from Texas Department of State Health Services, 2005.

Health Care and Economic Development

Health care is a major economic driver in rural areas. In communities that still have a local hospital or nursing home, health–related businesses are often the larger employers. One rural physician can generate more than five full–time jobs and $233,000 in local economic activity. For every health care dollar generated locally, an estimated 1.5 dollars are brought into the community economy. Therefore, out–migration from rural counties is a major contributor to loss of revenues, and 70 to 80% of out–migration is due to availability of care issues (Texas Department of Health, 2001; Texas State Office of Rural Community Affairs, 2001).

Throughout West Texas, low population density is a challenge; it is difficult to maintain health care services if there is not enough population to support a physician's practice. While the general population is affected by limitations in access to care, those most impacted are people with special health care needs: the elderly; the poor; the homeless; mothers, children and adolescents; those living with chronic diseases and disabilities; and agricultural workers (Lishner, 1996: Rickets, 1999; US AHRQ 2002).

The TWITR Project

The Telemedicine Wellness Intervention Triage and Referral Project (TWITR Project) is a Telemental health model demonstration project focused on middle to high school students in three West Texas independent school districts. The three-part project includes:

  • Identification by Telehealth assisted screening of high risk teens that demonstrate risk behaviors likely to end in an encounter with the juvenile justice system. The primary purpose is to find teens who could potentially benefit from community mental health services, academic and mentoring resources, and to identify and refer to care, those teens who may be a danger to themselves or others. Teens will be informed and engaged with the TWITR Project using peer-developed social media messaging and programming in three school districts (Plainview, Lubbock and Abilene). These three schools reflect small, medium and large rural and urban schools in Texas. The schools have been selected because they have significant numbers of teen referrals from the school system into the Texas criminal justice system.
  • Ongoing training for School Resource Officers (aka School Police) will be provided via the Bexar County Probation Department’s nationally recognized Children’s Crisis Intervention Training (CCIT). CCIT is Texas Commission on Law Enforcement Officer Standards and Education (TCLEOSE) sanctioned and comes with a year’s worth of police CEUs and a TCLEOSE Mental Health Officer Certification. Our long term goal is to work with staff from the Bexar County Judges’ Children’s Diversion Initiative to develop a train-the-trainer model that could be replicated, by CCIT alumni police and SROs, and our mental health professionals via telemedicine.
  • Formulation and dissemination of model policies that decriminalize student non-violent behavioral health issues and impart a graduated sanctions model to avert relatively minor infractions from the juvenile justice system. These will be based on model policies developed from a previous Governor’s initiative in Waco and incorporate community engagement principles and practices developed by the Wellness Engagement and Development Center of Angelo State University (San Angelo). These two components together have been shown to dramatically reduce engagements with the juvenile justice system in Texas.

Study on Arsenic in Ground water

Exposure to arsenic is linked to many diseases. Most Americans in rural areas use groundwater for drinking, which may contain arsenic above the currently allowable level, 10 µg/L. Geographic Information System (GIS) has been used to interpolate an arsenic level surface based on existing data from wells with known arsenic concentrations. Inverse Distance Weighted (IDW), Kriging Gaussian and Kriging Spherical interpolations are among the most commonly used interpolation techniques. However, their accuracy is unknown. We used the leave-one-out-cross-validation technique to compare their accuracy in estimating groundwater arsenic concentrations in >8,000 wells in Texas provided by Texas Water Development Board. We found that the degree of correlation between GIS-estimated and measured groundwater arsenic concentrations was marginally (p=0.054) higher with Kriging Gaussian (r=0.7784) than IDW (r=0.7460) interpolation for wells in the southwest part of Texas Panhandle, a hot-spot for arsenic. However, the correlation was significantly (p=0.004) better with IDW (r=0.6950) than Kriging Gaussian or Kriging Spherical interpolations (r=0.6682) for wells in whole Texas.