America’s Forgotten Cities: Public Health Crises in the Texas Colonias


Texas is the second most populous state in the US. An economic powerhouse of the United States, if Texas were a sovereign nation it would rank as the fourteenth largest economy in the world.1 With a gross state product of over 1.6 trillion dollars in 2014, Texas has the second largest state economy in the US. Large agricultural and oil-related industries support the state economy. Home to gleaming cities, expansive ranches, and picturesque deserts, Texas’ economic and cultural importance remains unquestionable today. However, unimaginable landscapes exist just to the south of its largest cities. The state of Texas is home to nearly three thousand colonias, informal settlements strung along the US-Mexico border.2 Colonias exist throughout the Southwest, but the most populous settlements are found in Texas. Here, over five hundred thousand people call the colonias home.2

A maquiladora factory in Mexico. Source: Wikimedia Commons.
A maquiladora factory in Mexico. Source: Wikimedia Commons.

Nearly all colonias sit on undeveloped land that sold at far-below market prices to low-income Mexican immigrants looking for affordable housing in the 1950s and 60s. During this period, the rise of the maquiladora industry in border counties attracted immigrants, and Mexican textile factories that sat directly on the border employed low-wage workers living in border communities. The small supply of worker housing in Texas could not accommodate the state’s swelling population. Land developers viewed the demand for cheap housing as an opportunity to divide relatively isolated and worthless areas of land into properties comprised of small lots. Quickly, people began to settle into these plots, which they purchased at below-market rates. They built their homes from whatever materials they could find; colonia housing materials today typically include plywood, cardboard and tarps.3 Most communities lack access to basic services such as electricity and running water. A majority of colonia residents are low-income, impoverished Hispanics, nearly 65 percent of whom are US citizens.4 Nearly half of all residents live below the US poverty line—$23,850 for a family of four.4

Due to Texas’ tax and regulation systems, the state did not control or manage the growth of most colonia settlements as they grew in popularity; in unincorporated counties of Texas, local governments have very little regulatory power. Since the colonias sit on unincorporated land, workers may legally construct unregulated structures that do not comply with state building or health codes. Due to these exemptions for colonia buildings, nontraditional homes populate the colonias—a combination of two RV vehicles may form one house, another may add on rooms only supported by cinderblocks, and homes may have extension cords that run outside, increasing the danger of fire and electrical shocks.5 New colonia construction continues to this day. A Texas realtor currently sells half-acre plots for $25,000 with a twenty-year financing scheme that only requires a $500 down payment.7 Because the median price of a home in Houston is over $220,000, and housing costs in many other cities are prohibitive, many low-wage Hispanic workers in Texas have been forced to buy land in these undeveloped areas. As many residents have neither the credit history nor the resources to qualify for traditional home financing methods, majority of colonia land plots are purchased via “contracts for deed,” a financing arrangement in which land ownership remains with the seller until the total purchase price is paid.6

Colonia communities lack basic services such as clean water and sewage systems, electricity, and paved roads. While many households are equipped with septic tanks, the tanks frequently overflow, creating rivers of stinking sewage on the unpaved streets and roadsides. Residents often collect rainwater for drinking and bathing with buckets that sit outside or from stagnant wells. The improper and nonexistent sanitation infrastructure has enabled hepatitis A, a virus usually spread by consuming food or water contaminated with fecal matters, to become ubiquitous in the colonias. Most hepatitis A infections travel by way of improper drinking sources and toilet facilities.3 In addition, due to the lack of municipal garbage collection, colonia residents often must burn their waste. This practice, combined with mold and cockroaches inside homes, leads to high rates of asthma, rashes and lice infestations.5 Residents of colonia communities also suffer from tuberculosis at three times the national rate due to poor sanitary conditions.3

Ruperto Peña receives a blood pressure test from a local Rio Grande Firefighter during Operation Lone Star at Ringgold Middle School in Rio Grande City, Texas, July 30, 2013. Operation Lone Star serves as the only access many residents in the South Texas Border Region have to medical care or doctors.  Available services included immunizations, diabetic and blood pressure screenings, hearing and vision exams, sports physicals and dental services. (U.S. Army National Guard photo by Army Spc. Aaron Moreno) 130730-Z-QF937-369
Ruperto Peña receives a blood pressure test from a local Rio Grande Firefighter during Operation Lone Star at Ringgold Middle School in Rio Grande City, Texas, July 30, 2013. Operation Lone Star serves as the only access many residents in the South Texas Border Region have to medical care or doctors. Source: U.S. Army National Guard, photo by Army Spc. Aaron Moreno.

Given the high incidence of disease, access to healthcare remains the most dire health issue facing the colonias today. Across the Texas colonias, anywhere from fifty to eighty percent of residents do not have health insurance.7 While most residents qualify for Medicaid, many do not use the service for myriad reasons, such as distrust of the program, confusion over how to register for the services, and fear that any contact with government officials or agencies will lead to deportation.5 Insurance rates are so low that community activists have reported instances of residents pulling out their own teeth because they could not afford to visit a dentist. While colonia population has increased dramatically in recent years, the quality and availability of healthcare has not risen to meet the demand.

Despite the severity of health issues that plague the colonias, a glimmer of hope for healthcare in these communities exists in volunteer organizations, which strive to fill the gap left by government healthcare systems. One of the most successful healthcare interventions are promotoras, Spanish-speaking volunteer nurses who walk door-to-door in the colonias and distribute free healthcare advice. They advise residents on a variety of topics, ranging from teaching new mothers about breastfeeding to notifying community members about public health screenings.3 In addition, the large-scale Operation Lone Star, a medical training exercise jointly run by state agencies, the Texas State Guard and the National Guard, operates once a year for two weeks. Residents wait in line for hours for their chance to receive free basic medical and dental care.5

Colonia communities rarely receive media attention outside Texas, despite the fact that hundreds of thousands of people live and work in these areas. While there have been some state interventions in the form of electricity cabling and paved roads for some colonias, ensuring that quality of life in the colonias rises to match living standards in the broader US requires much more work. The main barrier to infrastructural and sanitary improvements lies in the high state costs of reform—Texas and other states with large colonia populations will need to spend billions of dollars in order to improve wellbeing in these communities. While the future of colonias remains uncertain, grassroots efforts from local residents have made strides toward giving their communities the standard of living that they deserve.

Eli Rami is a sophomore in Ezra Stiles College majoring in History. He can be contacted at



  1. Riva, A. (2012, November 14). What if Texas really were its own country? International Business Times. Retrieved from
  2. Cisneros, A. (2001, June). Texas Colonias housing and infrastructure issues. Federal Reserve Bank of Dallas. Retrieved from
  3. Etter, L. (2015, October 15). Texas towns push back on instant slums. Bloomberg News. Retrieved from
  4. Leach, C. T., Koo, F. C., Hilsenbeck, S. G., & Jenson, H. B. (1999). The epidemiology of viral hepatitis in children in south Texas: Increased prevalence of hepatitis A along the Texas-Mexico border. The Journal of Infectious Diseases180(2), 509–513.
  5. Mauleon, V. & Ting, C. (n.d.). El Paso: Texas colonias. Retrieved from
  6. Colonias FAQs. (n.d.). Texas Secretary of State. Retrieved from
  7. Ramshaw, E. (2011, July 10). Conditions, health risks sicken colonias residents. The Texas Tribune. Retrieved from

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