A windmill-driven water pump standing on the horizon during sunsets.

North Central Nebraska


North Central Nebraska is a vast, sparsely populated region composed of nine counties; though it spans more than 14,000 square miles, it is home to less than 3% of the state’s population.

In the mid to late 1800s, homesteaders seeking to develop farms and ranches settled in North Central Nebraska. The region remains a predominantly agricultural area, with eastern counties focused on farming and western counties focused on ranching. North Central Nebraska sits atop the Ogallala aquifer, one of the world’s largest underground reservoirs. The aquifer stretches from South Dakota to Texas and serves as a major water supply for more than 2 million people across the Great Plains.

As the agriculture industry becomes more efficient and mechanized, the region’s population is shrinking and aging as many young people move to larger cities. Major concerns for the region include meeting the health needs of an aging population in an area with limited resources; protecting the unique environment; and ensuring water supply necessary to maintain the region’s agriculture industry. North Central Nebraska’s physician shortages and limited health care and public health funding create significant challenges to meeting residents’ needs. In response to these challenges, the North Central District Health Department (NCDHD)—established in 2001 as part of a grant to improve public health—provides services at schools and worksites. With respect to environmental health, multiple stakeholders are working together to preserve the region’s environment and wildlife.

  • Overview

    Population and Demographics

    Population: 45,800

    U.S. Census Bureau

  • Context and Actions

    Community Context and Challenges

    • Approximately 20% of the region’s population has a four-year college degree or higher, which is lower than the state (29%) and national rates (29%).
    • North Central Nebraskans experience skin cancer at a statistically higher rate than residents in the rest of the state, although it remains unclear why.
    • In 2014, 20% of North Central Nebraskans were ages 65 or older, compared with 13% of Nebraskans overall.
    • The region faces a shortage of health care providers and funding for new health care initiatives; given the vastness of the region and sparse population density, it is not uncommon for residents to live many miles from the nearest health care provider.
    • Five of the nine counties in North Central Nebraska are state-designated shortage areas for general dentistry.

    Centers for Disease Control and Prevention. (2011–2014). Behavioral Risk Factor Surveillance Survey.

    Taking Action

    As a “Turning Point” grant recipient, the state of Nebraska, along with the North Central region, is working to strengthen the public health system through community-based, collaborative efforts.

    In conjunction with the proposals developed through the Turning Point grant, the nine counties formed the North Central Community Care Partnership (NCCCP), a private, nonprofit organization that supports regional health efforts. In 1999, NCCCP signed an agreement to create a single public health coalition and produced the region’s first Community Health Improvement Plan, which highlighted public health concerns and laid out steps for improvement.

    These baseline reports, created in 2016, reflect our initial observations on select community programs and initiatives to gauge ongoing, as well as newer, efforts to improve community health. Future reports will provide more in-depth insights and analysis into this community's activities.

    Preserving the Environment

    North Central Nebraska residents, recognizing the environment’s vital role in the region’s agriculture-based economy, have worked to preserve the environment by opposing the Keystone Pipeline and participating in the Sandhills Task Force.

    Sandhills Task Force

    The Sandhills Task Force is a nonprofit Land Trust that works with public private partnerships, including ranchers, conservation organizations and natural resource agencies, to safeguard the ecosystem while sustaining ranching and biodiversity. The organization has provided hundreds of thousands of dollars to dozens of projects across the Sandhills, including partnering with landowners to remove invasive species, working with ranchers to create grazing plans that help maintain diversity of plants and offering education to new ranchers.

    Future Efforts

    Efforts to create a healthier, more equitable community in North Central Nebraska will be detailed further in future reports.

    Miles to Smiles

    The NCDHD’s Miles to Smiles program is working to improve oral health across the region. Started in 2013, Miles to Smiles now exists in 38 of 39 district elementary and middle schools. The program provides students with oral health screenings and fluoride varnish treatments. 

  • Going Forward

    Questions for Consideration

    North Central Nebraska is a vast, biodiverse region that economically relies on agriculture. The region is characterized by an aging population with numerous health challenges and a lack of resources to tackle them adequately. NCDHD, formed in 2001, is working to address the region’s health concerns and has made small steps toward that end.

    Additional surveillance; data and information gathering; analysis; and reporting will examine how initiatives are coordinating their efforts and the extent of their impact. Future reports will also convey how stakeholders are working to create a healthier, more equitable community; the impact of new and ongoing initiatives to address priority health concerns; and whether gaps are emerging in priority areas.

    Answers to the following questions could provide insights into the degree to which meaningful change is taking place and can be sustained:

    • To what extent will NCDHD be able to achieve its goals given its limited funding? Where will it find new or additional funding sources? Is the region adopting any innovative approaches to work within funding constraints?
    • How will the region’s physician shortages affect its aging population? What is the region doing to expand access to care? How and when will the region implement telemedicine to address physician shortages?
    • As the region’s population shrinks and hospitals close, what steps is the region taking to ensure that residents have access to health care services, including emergency care needs?
    • How is the region following up on goals outlined in its Community Health Improvement Plans, and how is it working to overcome any barriers to successful implementation?
    • How will the region continue to work to protect the environment, and what impact would any environmental changes, such as the potential Keystone Pipeline, have on the population and its health?
  • Downloads

    Community Snapshot Report

    Community Portrait Report

    Community Landscape Report