Thriving Rural Communities

Our work with rural communities emerged from the Foundation’s recognition that rural health improvement is strongly influenced and tied to social determinants of health (SDOH). Social determinants of health are described as critical social and economic drivers that significantly impact health outcomes that are ultimately influenced by the community context which people live, learn, work, and play. Consequently, it was important for the Foundation to build on existing local assets to partner with the community in new ways to address over time, the complex social problems contributing to the negative health outcomes as shown in the County Health Rankings.

The negative health outcomes consistently illustrated that rural communities experience a disproportionate burden of disease morbidity and mortality on several health indicators. And while rural communities in Central Texas experience significant health disparities, they are also home to adaptive and resilient residents and possess several key assets including a strong sense of community, a culture of caring, and a commitment to strengthening local capacity which often translates into a shared responsibility to address issues, and an innovative spirit to do more with less.

It is from this place of strength that St David’s Foundation endeavors to do this work to build a culture of health that explicitly focuses on improving population health and shifting power dynamics using the health equity lens to address the social determinants of health.


In defining rural communities as those that are non-metro, our work prioritizes Bastrop, Caldwell, Hays and the eastern part of Williamson County. These communities were thoughtfully identified using multiple criteria including but not limited to the following: Community readiness to engage in a community change effort; existing momentum to build on community capacity; Community Health Needs Assessment; County Health Rankings & Roadmaps; community guidance gathered from field trips and listening sessions.

As a Foundation, we are eager to learn alongside communities to ideate and co-create community-designed solutions that over time, tackle complex social issues while building community capacity and amplifying voices not often heard. We are humbled to do this work with the community by leveraging the expertise, wisdom and lived experiences of multiple partners including residents, community groups, nonprofits, government, ISDs, business, philanthropy and others.

Our Approach

Our work with Central Texas rural communities is grounded in the core principles of place-based efforts that acknowledges that this work is complex and long-term success is contingent on efforts that honor the rich cultural, human, and community asset of each place; requires intentional partnering with those most impacted, takes an ecosystem approach that builds strong alignment between institutions, communities, and resources, and requires incremental and interactive strategies that embrace an emergent approach of test, do, learn. Work together toward a shared vision of:

  • A strong culture of health;
  • Reduced economic and social barriers that impede health, particularly for economically vulnerable populations, communities of color, immigrants, young children and elderly;
  • Increased engagement, alignment of networks working across/among sectors, communities, and institutions;
  • Increased community capacity and infrastructure to build a robust ecosystem for change to address SDOH;
  • Increased leadership capacity that is diverse, aligned and working collectively to shift power dynamics, policies, practices, behaviors, and resources to align with an agenda focused on building and sustaining a culture of health.

Our work with rural communities requires a more comprehensive community approach that includes a diverse mix of investments, cultivation of new relationships with non-traditional partners and adoption of an emergent posture that is grounded in testing, doing, and collaborative learning. This approach builds community capacity, empowers local residents to work collaboratively to address their own community problems, invests in improving the conditions for residents to live healthy and thrive, and brings together all segments of the rural infrastructure to identify multi-sector solutions that support the health and well-being of residents. This includes:

  • Engaging and empowering rural communities to strengthen networks and transform policies, practices, and alignment of resources to address prioritized social determinants of health.
  • Building the capacity of people and places including formal and informal leaders within communities and organizations to lead community-centered change.
  • Strategically investing in solutions that harness community assets to support innovation, ecosystem building, and other promising rural-relevant approaches that can be scaled.

Strategic Investments through grantmaking are focused on seeding, deepening, and scaling initiatives/approaches, that have the potential to have a significant “return on investment” towards addressing the economic and social drivers that impact health disparities over time. This particular focus will include an investment in general operating support, project/initiative, programming, and data/research in three distinct investment areas:

  • Innovation: Supports innovative projects/initiatives that target specific populations impacted health disparities in multiple SDOH Domains;
  • Infrastructure Building: Seed, build, and strengthen infrastructure from grassroots to institutions necessary to support SDOH through supporting alignment, coordination, research/data, technical assistance and training towards addressing systems change within SDOH; and
  • Promising Approaches: Tied to specific outcomes within one or more SDOH that is informed by lived experience, data, best practices or research


Co-create solutions with the community and invest in place-based initiatives that are community designed and community-led to address prioritized social determinants of health and support thriving communities that:

  • Develop a culture of health that transcends beyond healthcare access;
  • Nurtures strong social connection among rural residents;
  • Ensures residents are engaged in thriving cross-sector and community-based networks that promote health and well-being;
  • Encourages rural systems change including policies, practices, behaviors, and resources to better promote health and well-being;
  • Fosters a strong infrastructure with adequate capacity among rural organizations;
  • Engages and empowers a diverse, civic leadership to activate and improve community well-being.

We believe in working with the community to amplify voices least engaged and by elevating community driven solutions we could collectively, over time, make positive progress on rural health and well-being through targeted investments with local residents and other internal and external public and private partners to support rural communities to not only survive, but thrive. Our approach is explicitly grounded in the belief that good health begins in places where we live, work, learn, and play and when we create a good culture of health, everyone has the opportunity to live a healthier life, no matter who we are, where we live or how much money we make; and system-change approaches that address systemic issues and grounded in health equity are critical to addressing health disparities long-term. The Foundation has adopted a collaborative learning agenda as we know that we don’t have all of the answers and intend to be informed by those most impacted by rural and systemic inequities.

Senior Program Officer

Abena Asante, MHA
Learn more about Abena here.

By The Numbers

County Health Rankings (2019):

While urban counties have remained consistent or improved in ranking (Travis), rural counties continue to drop in 2019.

According to the Cantril Scale used by Wellbeing in the Nation 55% of those in
Bastrop, 61% in Caldwell and 66% in Hays counties are thriving. The national
and state averages are 57% and 60%, respectively.