What’s wrong with community health in Texas—especially rural Texas—and how can we fix it?

So, how healthy is life in the Lone Star State these days?

According to a recent report that compared 150 life quality indicators in all 50 states, Texas really does stand alone—near the bottom of the heap, health-wise. Despite the braggadocio of native and adopted sons alike, asserting to anyone who will listen that Texas is not only big, brawny, brainy and beautiful, but also the best place in America to live, the facts seem to say otherwise.

Texas is first (meaning worst) of all 50 states in: manufacturing use of toxic chemicals, toxic manufacturing emissions, total hazardous waste, environmental civil rights complaints, total air pollutant emissions, cancerous air emissions, number of clean water permit violators, animal manure affecting water quality, number of people without health insurance and total alcohol-related traffic fatalities.

Texas also ranks among the ten worst states in hazardous chemical spills, lack of prenatal care, lack of child immunizations, children lacking insurance, high teen birth rate, occupational deaths, number of overweight adults who also smoke, women remaining unscreened for breast cancer, state mental health spending and percent of poor receiving Medicaid.

In some ways, Texas’ 196 rural counties are not that different from rural areas in other states. Depending on the definition of rural used (and there are, at last count, over 45 of those), rural dwellers represent the “graying of America,” i.e., a significant population of so-called Baby Boomers and their parents, that is shifting the demographics of the state towards a ‘bulge’ of those aged 50 and over.

Seniors are the largest consumers of healthcare in rural communities, and the average senior spends 12 years of his or her life living alone. Seniors must balance income levels and caretaking issues with a desire to remain independent. Lack of access to assistance for basic needs--food buying, bill-paying, home repair and legal assistance—loom large. Seniors on fixed incomes struggle to pay for the average six prescription drugs he or she takes monthly. While retirees from urban areas, who represent a rapid growth sector among rural populations, tend to enjoy better health and higher incomes than some of their senior peers, they also exhibit higher expectations of the health care system, demanding easy access to specialists and choices in health plans.

At the other end of the spectrum, children in rural Texas are the most likely members of the community to be underinsured or uninsured. In spite of efforts to enroll youngsters in the state Children’s Health Insurance Plan (CHIP), conservative estimates point out that over 2 million remain uninsured. Without insurance, these families are more likely to misuse hospital emergency rooms for primary health care needs, forego needed dental checkups, or neglect to buy needed medications, leading to longer-term and more acute health problems, which may then tax public assistance plans. Factors cited as complications in this bleak picture are a general lack of affordable insurance plans for low-income workers, Texas’ complex Medicaid enrollment and verification forms and procedures, language and/or education barriers and a paucity of low-cost dental care options.