December 2, 2023

Health Insurance

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Worrying signs for the health of North Texas kids emerge, but some bright spots too

The physical and mental health of North Texas children over the last two years is a mixed bag with encouraging advancements in areas such as asthma rates and births by adolescent mothers, but worrying increases in obesity and diabetes and fewer vaccinations.

The bottom line from the latest Children’s Health Beyond ABC Report is that access to the programs and support systems meant to help the D-FW’s most vulnerable children and families is waning, which threatens to undo any progress made for children’s well-being.

The report, released in partnership with the University of Texas at Dallas, comes out every two years and looks at data across seven counties, including Dallas, Tarrant, Collin and Denton.

The findings in the year’s report tell a story all-too-familiar to many North Texas families. Nearly one in six children in Dallas County had no health insurance in 2021. The number of children experiencing housing instability increased in Dallas and Tarrant counties. The number of children enrolled in the Supplemental Nutrition Assistance Program sits below 2018 levels.

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Brent Christopher, left, and Dr. Nadine Burke Harris speak during the Beyond ABC Symposium...
Brent Christopher, left, and Dr. Nadine Burke Harris speak during the Beyond ABC Symposium at the Capital One Conference Center in Plano, TX, on Nov 14, 2023. (Jason Janik/Special Contributor)(Jason Janik / Special Contributor)

“The data is very, very clear that experiencing adversity increases the risk for children’s physical, mental and behavioral health. And, unfortunately, that is what we’re seeing manifest right now,” said Dr. Nadine Burke Harris, former California Surgeon General and expert on the connection between adverse childhood experiences and lifelong health.

Repercussions from the COVID-19 pandemic continue to reverberate across home life, education and health care for kids. Even before the pandemic, mental health diagnosis rates were increasing across North Texas, spurring investments in pediatric mental health care at the state and local level. But progress is slow.

“We need to be putting into place the infrastructure that responds to the scale of the problem,” Burke Harris said at the symposium introducing the new Beyond ABC report.

Here’s a look at how pediatric health has or has not improved across North Texas:


Texas has more people without health insurance than any other state. From 2016 to 2021, the percentage of Dallas County children without health insurance jumped from around 13% to around 15%. Nearly 12% of children in Tarrant County were without insurance in 2021, while Collin and Denton sat at 7.7% and 7.5%. The national average in 2021 was 5%, according to the U.S. Census Bureau.

Health coverage improved with the COVID-era continuous enrollment policy that allowed people to stay on Medicaid without having to reapply. That program ended in March, and since then about 812,000 Texas children have lost Medicaid coverage, according to KFF data.

“Pediatric health is a prime indicator of a healthy adult life,” said Christopher Durovich, president and CEO of Children’s Health. “Too many children are starting at a disadvantage.”

Non-emergency visits to the emergency room in North Texas’ major counties did not immediately return to pre-COVID numbers in 2021. Births to adolescent mothers decreased across North Texas between 2017 and 2021, while the percentage of babies born at a low weight increased. Premature deliveries increased in Collin, Denton and Tarrant counties.

Asthma rates across North Texas improved, while the number of children experiencing obesity and diabetes worsened. The number of childhood vaccinations given in the region declined from 2017 to 2023.

Economic Security

Childhood poverty is linked to a number of negative health outcomes that can stretch into adulthood. The percentage of children in North Texas living in poverty decreased from 2017 to 2021, with Dallas County experiencing the largest drop from 27% to just over 21%.

The percentage of children who don’t have access to enough food declined from 2017 to 2021 in the Dallas-Fort Worth area. And while enrollment in the Supplemental Nutrition Assistance Program for children decreased over the last few years, program participation increased from 2021 to 2022.

But other economic security markers show that the issue isn’t going away anytime soon.

The number of youth without a permanent residence increased in Dallas and Tarrant counties between 2018 and 2023. The average monthly number of children receiving benefits under the Temporary Assistance for Needy Families program fell across all of North Texas, while the number of subsidized housing vouchers allotted in Dallas County dropped from more than 26,700 in 2017 to 24,100 in 2022.

“For us to truly live up to our mission to make life better for children, we must treat the whole child. To do that, we must first better understand what non-medical factors are impacting children’s health today,” Durovich said. “Many of these also impact their ability to receive and continue treatment, and they may be the cause of long-term medical and mental health challenges in the future.”


Adverse childhood experiences, including physical, emotional and sexual abuse, neglect and family substance abuse, can, like poverty, have significant negative impacts on lifelong health. Safety and poverty are also linked: Children living in low socioeconomic circumstances are five times more likely to experience abuse and neglect because of the strain placed on families dealing with poverty, according to the Beyond ABC report.

The number of children who are confirmed victims of child abuse declined in North Texas between 2018 and 2022, as did the number of gunfire-related emergency room visits between 2017 and 2022. Alcohol and substance abuse emergency room visits fell in Dallas, Denton and Tarrant counties between 2017 and 2021.

Dallas and Tarrant counties have experienced increased child homicides since 2018, while adolescent suicide rates fluctuated slightly in the years between 2018 and 2022. Child mortality rose across North Texas, with Dallas County having the highest rate in the region of 67.6 deaths per 100,000 people.

Commitments to the Texas Juvenile Justice Department, which takes youth with felony-level offenses, fell in Dallas County from 53 in 2018 to 42 in 2022. Commitments in Denton County more than doubled in that period, from 15 to 32. In 2019 and 2021, Tarrant County sentenced more youth to juvenile prisons than any other county in the state.


Interrupted learning because of the COVID-19 pandemic, both in the classroom and in social settings, has undone some of the progress made in educational milestones over the last few years.

The percentage of students in North Texas’ four major counties passing all STAAR tests has yet to return to pre-pandemic rates. Less than half of third graders in Dallas County were reading at grade level in 2022, although that percentage has increased since 2017.

Enrollment in the Head Start and public kindergarten programs fell in 2020 and 2021, but has since largely returned to rates seen before COVID-19. High school graduation rates in North Texas remained stable through the pandemic.