Access to mental health services and to prenatal care are top health challenges for Fort Bend County despite overall good health ratings

Despite Fort Bend County’s reputation as one of Texas’ most prosperous regions, a comprehensive new health assessment reveals significant gaps in access to mental health services and to prenatal care, affecting thousands of residents across this rapidly growing, diverse community.

The assessment by Rice University’s Kinder Institute for Urban Research and the Institute for Health Policy at UTHealth Houston School of Public Health, conducted for Fort Bend County Health and Human Services, surveyed 3,440 residents and uncovered concerning disparities hidden beneath the county’s overall prosperity.

Fort Bend County has experienced explosive growth, expanding from 50,000 residents in 1970 to nearly 1 million in 2024. While median household income increased from about $76,000 to $105,000 from 2010 to 2023, with population growth, the number of residents living in poverty also increased from about 53,000 to more than 80,000 in the same period.

“Since Fort Bend is a relatively prosperous county, statewide, it is easy to overlook pockets of unmet health needs that can remain invisible,” said Stephen Linder, PhD, professor and director of the Institute for Health Policy at UTHealth Houston School of Public Health. “This survey helps identify health care needs and shows which groups in the population need the most help from local health care providers.”

The report identified a serious gap in access to mental health services. Half of the county’s residents said they had needed mental health care in the past 12 months, but less than half (49%) said they could always access it. About 1 in 8 residents (13%) reported poor/fair mental health status overall.

Differences in the number of average days of “not good” mental health in the past 30 days varied along demographic lines. Young adults, ages 18 to 29, experienced nearly 6 “not good” days; for those ages 30 to 54, it was 4.1 days; and for those age 55 and over, it was 2.6 days. Asian and white respondents reported 3.3 days of “not good” mental health, Black residents reported 4.5 days, and Hispanic residents 5 days. College graduates had significantly better outcomes, with only 2.8 days of “not good” mental health compared to those with a high school degree at 5.3 days.

When it came to prenatal care, 3 in 10 residents said they needed it in the past year, but less than half (46%) said they were “always” able to access it, and more than one-third (36%) said they were “never” able to access it. This gap threatens maternal and infant health outcomes.

Cost emerged as the overwhelming barrier to health care access, with 41% responding that the care was too expensive or they could not afford the out-of-pocket costs. The next largest barrier was that their medical insurance provider would not cover it (31%), and the third most common issue was that they were not able to get an appointment (27%). Another 22% said they were too busy or could not take time off work.

Most Fort Bend County residents, about 88%, reported currently having health insurance or some other plan that helps pay for medical expenses. Most insurance coverage, 53%, was provided by an employer. Medicare coverage was reported by 16% of insured residents, and 12% had marketplace insurance. The overall percentage of those with no health insurance was 12%, or 1 in 8. Of those, most (1 in 5) were younger (18 to 29 years old), or Hispanic. Around 7% of white, 8% of Asian, 10% of Black, and 23% of Hispanic residents reported not having any health insurance. 

Overall, residents ranked their physical health, in order, as very good (37%), good (31%), excellent (21%), or poor/fair (11%), but 56% also reported having at least one chronic condition. Of those with chronic conditions, the majority reported hypertension (high blood pressure) at 25% and high cholesterol at 24%. Residents also reported diabetes (12%) and obesity (12%).  When asked how many days of “not good” physical health they experienced in the last 30 days, residents reported 3.5 days. Those with college degrees had fewer “not good” health days, with 2.4 days compared to residents with some college or a high school diploma at 4.7 days.

A low level of physical fitness can accompany and complicate these chronic conditions. Almost one-third of residents (31%) rated their fitness as poor/fair, and 17% reported no physical activity in a typical week.

The study found that housing instability and food insecurity were key stressors that can lead to ill health and increase the risk of disease.

Housing stability, a key social determinant of health, was a source of concern. While 26% of residents said they never worried or stressed about being able to pay for housing and 18% responded “rarely,” 26% responded “sometimes,” 16% responded “very often,” and 13% responded “often.” About 11% of residents responded that they had to move in the past 12 months at least once because of cost, and 1 in 6 reported they had fallen behind with their rent or mortgage in the past 12 months.

Most residents reported being food secure (high or marginal food security at 73%), with 13% reporting they had low food security, and 14% reporting very low food security. Young adults were more likely to report being food insecure. There were differences across race/ethnicity, with 23% of Black respondents and 19% of Hispanic residents reporting very low food security compared to Asian (7%) and white (9%) residents.

On a more positive side, more than 75% of respondents said they would be interested in health education or information about at least one health-related topic from the county, particularly around nutrition, physical activity, and wellness. Other education interest was expressed for stress management and mental health. For community features, most residents rated their access to social/recreational activities and healthy food as “excellent,” “very good,” or “good,” but access to public transportation was mostly rated “poor.”

The report concludes that targeted efforts to expand access to mental health services and prenatal and primary care, combined with programs addressing food insecurity and housing instability, could substantially improve health outcomes for Fort Bend’s nearly 1 million residents.

“This data validates what we see as boots on the ground and supports our current strategic priorities. It provides a clear roadmap for action, allowing us to collaborate with community partners to build a healthier and more equitable Fort Bend County,” said Letosha Gale-Lowe, MD, director of Fort Bend County Health and Human Services. “It pinpoints where we must focus our collective efforts to ensure that our county’s prosperity translates into lasting health and well-being for all residents.”

The Fort Bend Community Health Assessment was conducted through a partnership between the Kinder Institute at Rice University and the Institute for Health Policy at UTHealth Houston School of Public Health. Nearly 85,000 invitations were mailed to randomly selected Fort Bend County residents during a three-month recruitment period that ended in January 2025, resulting in 3,440 respondents. These Fort Bend respondents are now included in the Greater Houston Community Panel, a large cohort of respondents developed through this UTHealth Houston/Rice partnership.

“This is the largest survey sample we’ve ever had representing Fort Bend County,” said Dan Potter, co-director of the Houston Population Research Center at the Kinder Institute for Urban Research. “This allows Fort Bend leaders to hear from a wide range of communities all across the county, from the urban to the suburban to the rural.”

The panel will be re-surveyed over time to collect information about needs, values, preferences, experiences, and circumstances throughout the region. External support for this assessment was provided by the Fort Bend County Department of Health and Human Services and the Texas Epidemic Public Health Institute.

About the Houston Population Research Center

The Houston Population Research Center at the Kinder Institute for Urban Research collects and disseminates data to understand social and demographic change in Houston and Harris County — the nation’s fourth-largest city and third-largest county and home to one of its most diverse populations. 

About the Institute for Health Policy

The Institute for Health Policy at UTHealth Houston School of Public Health provides technical expertise and analytical support for county and city health authorities and other health providers, specializing in community health assessments. It serves as the home of publicly accessible health data files available online and free of charge. 

About the Greater Houston Community Panel

The Greater Houston Community Panel is a collaboration between Rice University’s Kinder Institute for Urban Research and UTHealth Houston School of Public Health. The panel is composed of thousands of scientifically selected adults in Harris County, Fort Bend County, and Montgomery County, Texas, who are regularly surveyed about their families and communities, including their health, well-being, expectations, opinions, priorities, and aspirations. Surveys are designed in direct collaboration with city leaders and community groups so that the resulting data provided can inform actionable, targeted approaches to addressing the dynamic needs of the city’s diverse population.