Community Context 

Midland is a small city located within the Permian Basin, a region in West Texas and New Mexico rich with petroleum, natural gas, and potassium deposits. 

The city’s economy is almost entirely dependent on the industry, although aerospace, ranching and agriculture, healthcare, and transportation are growing. Despite a median income of about $79,000, Midland has a significant wealth gap. Due to Midland’s heavy reliance on the oil and gas industry, the city is vulnerable to intense fluctuations in its economy depending on the strength of the market—often referred to as a “boom and bust” lifestyle. In 2020, the price of oil dropped with the pandemic and Midland again faced a struggling economy; although by fall 2021, the oil industry—and the city—were beginning to thrive again.  

In line with the general composition of the state, Midland’s local government tends to be more conservative than other parts of the country. 

Texas has not expanded Medicaid, and nearly one in five Midland residents are uninsured. Although Midland has its own hospital, the surrounding areas are rural and access to preventive and emergency services—as well as transportation to these services—remains a challenge for individuals living outside of the city. Midland also faces a shortage of healthcare providers, but there have been recent efforts to address this ongoing issue. The community continues to address chronic health conditions such as obesity, diabetes, and sexually transmitted infections.  More recently, Midland has sought to address rising mental health concerns.  

Midland’s Journey to Promote Health, Well-Being, and Equity

Five years into the Sentinel Communities Surveillance Project, Midland’s capacity to address the health needs of its community members is led by Midland Memorial Hospital and bolstered by a range of strategic partnerships.

Midland continues to take steps toward better health, well-being, and equity with an increase in addressing basic needs around food insecurity and homelessness; a strategic plan that focuses on topics including stronger neighborhoods and improved quality of life for residents; and a renewed focus on education and early literacy. Though there is a growing emphasis on mental health issues and improving quality of place, barriers remain in terms of developing a shared value of health and sharing health data. In 2017, there was little discussion of health equity and while that has changed somewhat in Midland over the past five years, discussions tend to be narrowly focused on access to healthcare.

Lessons Learned: Where is Midland Five Years Later?

Midland’s journey to promote health and well-being illustrates the importance of anchor institutions and collaboration. Progress on health and health equity has happened slowly, but measurably. 

There may be an opportunity to further advance how people think about health and also investments in health. To do this, Midland could continue to expand linkages between health and well-being with other community priorities, specifically as they relate to strengthening the economy and the education system. 

Other communities can learn from Midland’s approaches, as well as the challenges they encountered, to inform their own journeys. 

Future research could consider the ways in which the community can become more resilient to strong fluctuations in the oil industry, and how that type of resilience translates to improved health, equity, and well-being. It can also influence community health narratives and decisions moving forward.

The strength of Midland’s philanthropic foundations has long been a crucial facilitator in the community’s ability to work toward overall well-being, and more recently, health and quality of life. However, Midland is still grappling with how best to maintain a strong economy and workforce within the “boom and bust cycle” and the stark wealth gap keeps the community from achieving widespread health and prosperity. 


  • Strong support from philanthropic foundations

  • Private sector involvement in improving “quality of life” for residents

  • Partnership with sister city, Odessa, allows for increased capacity for initiatives


  • Challenges of maintaining economic stability

  • Concerns around the economy and the struggling education system take precedent over health concerns 

  • Strongly held health beliefs, guided by individualism and conservatism, pose barriers for collective action for health and well-being