Community Vulnerability Compass (CVC)
CVC Rural Vulnerability in Texas: A Structurally Different Crisis
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CVC Rural Texas Vulnerability
Rural Vulnerability in Texas: A Structurally Different Crisis Urban solutions don’t solve rural health problems. Analyses through PCCI’s Community Vulnerability Compass (CVC) indicate that rural Texas faces a distinct chronic disease crisis characterized by entrenched clinical conditions and significant barriers to healthcare access, including connectivity, provider shortages, and infrastructure erosion. Despite stable family structures and low unemployment, over 80% of rural populations live in areas highly vulnerable to life-threatening chronic diseases, compounded by unmet mental health needs and limited care options. More than half of Texans living in rural census tracts, approximately 670,000 individuals, reside in areas classified as high or very high vulnerability. Rural vulnerability, however, is not simply a higher-intensity version of urban vulnerability. It is structurally distinct. It reflects the convergence of entrenched chronic disease burden, limited healthcare infrastructure, geographic isolation, workforce shortages, and fragile economic and service ecosystems. These conditions shape how, and whether, care can be accessed, sustained, and trusted. CVC analysis shows that vulnerability in rural Texas is more tightly coupled to clinical disease prevalence, mortality, and access constraints, while urban vulnerability is more often driven by environmental exposures, behavioral risk factors, and neighborhood conditions. This distinction has profound implications for how interventions must be designed, deployed, and evaluated.
Figure 1: PCCI’s state-wide Community Vulnerability Compass dashboard. More than 23,000 unique geographies mapped across
Texas with more than 700,000 unique vulnerability scores.
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CVC Rural Texas Vulnerability
“Rural vulnerability is not a data problem. It is a systems and access problem. In rural communities, distance, digital deserts, and provider shortages create barriers that traditional urban-led healthcare models simply weren’t built to overcome. We see the impact most clearly in chronic disease management, maternal health, and behavioral health, where long travel distances delay care and increase risk, and where workforce shortages force families into crisis care instead of prevention. That’s why proactive, data- driven program designs must be tailored to rural communities and not just parachuted in from leading practices from urban institutions. Urban solutions don’t solve rural health problems . When we use tools like the Community Vulnerability Compass to identify the root causes of needs at a hyper-localized level, we can design population health solutions that are tailored to the rural community and generate the scale required to drive systemic change,” said Dr. Steve Miff, President and CEO of the Parkland Center for Clinical Innovation (PCCI) .
Clinical Burden and Mortality: The Foundation of Rural Vulnerability Rural Texans experienced is proportionate mortality from heart disease, cancer, chronic respiratory disease, and stroke. Life expectancy in the most vulnerable rural tracts is meaningfully lower, reflecting delayed diagnosis, limited access to specialty care, and poor continuity of treatment. These outcomes are driven less by lack of awareness and more by structural barriers to timely, sustained care delivery. According to CVC analyses, high and very high vulnerability in rural census tracts is overwhelmingly driven by entrenched clinical conditions, not short-term social instability. The most common clinical root causes include: • Coronary Heart Disease: 88 percent of rural Texas census tracts are high or very high vulnerability for chronic heart disease (362 rural census tracts) • Cancer : Nearly 85 percent of rural Texas census tracts are high or very high vulnerability for cancer (350 rural census tracts) • High Blood Pressure : 87 percent of rural Texas census tracts are high or very high vulnerability for high blood pressure (353 rural census tracts) • Mental Health : more than 40 percent of rural Texans live in areas with high or very high mental health vulnerability (154 rural census tracts)
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PHONE: 214.385.4876
3000 Pegasus Park Drive Suite 1050, Dallas Texas, 75247
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CVC Rural Texas Vulnerability
These conditions are not only more prevalent in rural communities, they also produce significantly higher age-adjusted mortality rates than in urban areas.
“ On average, Texans in rural communities are older, more likely to be low income, and more likely to have at least one disability… Their mortality rate is higher, as are incidence rates of heart disease, cancer, stroke, and unintentional injuries .”- Texas Health and Human Services: Rural Texas Strong: Supporting Health and Wellness, October 7, 2025. By contrast, the CVC shows that high-vulnerability urban tracts are more often driven by alcohol misuse, environmental exposures such as poor air quality, limited walkability and availability of green space, and clustered behavioral risk factors. This divergence underscores a critical insight: rural vulnerability is more clinically entrenched and therefore more resistant to change without fundamental improvements in access and delivery infrastructure. Access to Care: Distance as a Vulnerability Multiplier CVC findings identify access to healthcare infrastructure as one of the most powerful amplifiers of rural vulnerability. Distances in rural communities are not only inconvenient, they are most often impossible. • Seventy-four Texas counties have no hospital 1 ; • As of 2024, nearly one in five rural Texas counties did not have a licensed primary care physician; • Rural residents travel an average of 59 miles to reach referral centers; • In parts of West Texas, travel distances exceed 100 miles ; • Large regions function as obstetric deserts, requiring 70+ miles of travel for delivery care. Rural Texas’s very high vulnerability to chronic diseases, hospital closures, and departure of providers is highlighted by CVC’s analysis of a cluster of four counties in rural East Texas with nearly 150,000 residents that have only 182 inpatient hospital beds available to them within 100 miles. Although the region is populated with urgent, specialty, and day clinics, few offer inpatient care settings. The cluster includes Trinity, Angelina, Huston, and Leon counties. The city of Lufkin is roughly the center of this area, with a population of 35,000 residents. As the main provider of health care in the area, the Woodland Heights Medical Center in Lufkin around 180 inpatient beds. HCA Houston in Conroe, 101 miles from Lufkin, provides 332 inpatient rooms as a Level II trauma center. The nearest Level I trauma center is the Red Duke Trauma Institute (Texas Medical Center) located in Houston, 124 miles from Lufkin.
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PHONE: 214.385.4876
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CVC Rural Texas Vulnerability
For census tracts the CVC identifies as high or very high for overall vulnerability, access challenges extend well beyond hospitals. Preliminary CVC analysis of Access to Vital Services indicates that many vulnerable rural census tracts are removed from primary care clinics, pharmacies, behavioral health providers, and emergency services. This “distance to care” effect compounds disease severity, medication non- adherence, delayed diagnosis, and preventable mortality. A deeper issue related to access is the lack of providers and prospective providers who have grown up or lived in rural communities. According to the CVC, nearly 16 percent of rural residents do not graduate from high school. Additionally, more than 33 percent of rural residents graduate from high school (or equivalent) but do not continue their education or pursue professional or trade training. Access to Care Constraints: Lack of Internet Connectivity and its Impact on Modern Care Compounding the disease and eroding infrastructure burden, the lack of internet connectivity in rural Texas significantly constrains modern care delivery. CVC data shows that: • Nearly 74 percent of rural census tracts are high or very high vulnerability for connectivity • 73 percent of the population in those rural census tracts are experiencing high or very high vulnerability for connectivity Without reliable broadband access, telehealth, remote monitoring, and digital navigation tools remain inaccessible, further widening disparities in chronic disease management. The State of Texas’s Rural Texas Strong 2 project, a comprehensive, statewide strategy designed to reach residents in 100% of Texas’s rural counties, has laid out a plan to invest $150 million to expand technology, AI, and broadband in rural Texas. This would allow rural counties for the first time to participate in connectivity- and data-driven programs that are critical for improving health outcomes through enabling remote care, enhancing patient engagement, preventing and managing chronic diseases, and reducing mortality rates.
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PHONE: 214.385.4876
3000 Pegasus Park Drive Suite 1050, Dallas Texas, 75247
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CVC Rural Texas Vulnerability
Deep Dive: Maternal Health - Access Gaps with Intergenerational Consequences
Maternal health offers a significant, equally urgent example of how rural vulnerability manifests through access constraints. According to the CVC, there are more than 107,000 women aged 18-34 residing in rural Texas census tracts. This makes up more than 8 percent of the entire rural population. Large portions of rural Texas function as obstetric deserts, requiring pregnant individuals to travel 70 miles or more for prenatal care and delivery services. These distances delay care, disrupt continuity, and increase the risk of adverse maternal and infant outcomes and mortality. Maternal vulnerability is rarely driven by a single factor. It reflects the intersection of chronic disease, transportation barriers, provider shortages, behavioral health needs, and social stressors, many of which are magnified in rural settings. Without intentional intervention, these risks compound across pregnancies and generations. Nearly all rural counties in Texas are designated Mental Health Professional Shortage Areas 3 . Many high- vulnerability rural tracts have no mental or behavioral
health provider within a reasonable travel distance, forcing emergency departments and primary care clinics to function as default mental health access points. This results in crisis-driven care rather than prevention or longitudinal management. The recently launched North Texas Maternal Health Accelerator (NTX-MHA) is testing how these challenges can be addressed through an innovative, scalable new model. By using CVC and clinical data to identify high- risk populations early and pairing those insights with proactive outreach, iron distribution, care navigation, digital engagement, and dissemination of proven care delivery through clinical simulations, the Accelerator aligns clinical care, behavioral health support, and community-based resources around the needs of pregnant individuals. While launched in North Texas, this model is intentionally designed to scale, particularly to rural regions where access barriers are greatest and the return on early intervention can be even higher.
Figure 2: Regional NTX- MHA map highlighting vulnerability via the CVC (green background), the prevalence and density of pregnant women experiencing Serious Obstetric Complications
(red heat map) and phase 1 of the iron distribution sites.
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PHONE: 214.385.4876
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CVC Rural Texas Vulnerability
“The North Texas Maternal Health Accelerator is a unique collaboration of health systems and community partners aligned to improve maternal health outcomes through preventative measures, preparedness training, and enhanced access to care. Successful elements of this program have the opportunity to be scaled to rural communities in Texas and beyond.” David B. Nelson, MD, FACOG F. Gary Cunningham, M.D. Chair in Obstetrics and Gynecology, University of Texas Southwestern Medical Center Rural Strengths: A Foundation for Scalable, Trust-Based Solutions Despite the many outlined challenges, rural communities possess strengths that are often underutilized or unavailable in traditional healthcare models. Along with the CVC data showing strong families and low unemployment, there are identified protective factors in many rural communities that are less common in high-vulnerability urban tracts, including: • Stronger social cohesion, resilience, and informal caregiving networks • Higher trust in local providers and institutions • Lower rates of violent crime and housing instability • Deep community identity and willingness to engage in locally driven solutions • Lower cost of living • Environmental benefits, such as lower pollution rates and more green space These strengths create a powerful foundation for place-based, hub-and- spoke, and technology-enabled care models, when paired with intentional, data-guided outreach. “The strengths inherent in our rural communities combined with data- guided outreach strategies can serve as a force multiplier in moving from crisis care to proactive, preventive care. When we use tools like the Community Vulnerability Compass to identify needs early and connect people to care through telehealth and trusted local partners, we can deliver care that is timely, relevant, and accessible and significantly move the needle in improving the health and well-being of rural Texans.” said Ted Shaw, Former CEO of the Texas Hospital Association.
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@PCCInnovation
PHONE: 214.385.4876
3000 Pegasus Park Drive Suite 1050, Dallas Texas, 75247
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CVC Rural Texas Vulnerability
About PCCI PCCI is a mission-driven research organization with industry- leading expertise in the practical applications of artificial intelligence and Non-Medical Drivers of Health (NMDoH). We strive to leapfrog the status quo by harnessing the transformative potential of data. Our unique capabilities allow us to provide innovative, actionable solutions that more effectively identify needs, prioritize services, empower providers and engage patients. Community Vulnerability Compass PCCI’s Community Vulnerability Compass (CVC) is an innovative NMDoH methodology and database with a web- based tool enabling its users to visualize and more fully understand the context and complexities of a community’s most vulnerable populations across all urban and rural geographies. Through its alignment with the Healthy People 2030 framework, it focuses on the wide range of specific, actionable neighborhood risk factors known to influence the health of vulnerable populations at both the community and individual level. In a paper titled “The Community Vulnerability Compass: a novel, scalable approach for measuring and visualizing social determinants of health insights,” PCCI authors give a deep look at how the CVC is developed and deployed to create an accurate and scalable social determinants digital measurement tool that shows the true vulnerabilities residents face across our communities. https://pccinnovation.org/jamia-open-publishes-a-paper-on- pccis-community-vulnerability-compass-cvc/ Citations 1 Texas Organization of Rural & Community Hospitals: Twenty-five things to know about Texas rural hospitals. https://capitol.texas.gov/tlodocs/87R/handouts/C2102021031110301/131e50a7-5c5d-4136- afa6-639d830a5405.PDF. 2 Texas Health and Human Services: Rural Texas Strong: Supporting Health and Wellness, October 7, 2025. https://pfd.hhs.texas.gov/sites/default/files/documents/hospital-svcs/rural- txstrong-prjct-narr.pdf. 3 Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services, Designated Health Professional Shortage Areas Statistics: Designated HPSA Quarterly Summary, as of December 31, 2025 available at https://data.hrsa.gov/topics/health-workforce/shortage-areas.
Contact us
@PCCInnovation
PHONE: 214.385.4876
3000 Pegasus Park Drive Suite 1050, Dallas Texas, 75247
PCCI
www.pccinnovation.org
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